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Santos‐Ferreira D, Diaz SO, Ferreira JP, Girerd N, Pellicori P, Mariottoni B, Cosmi F, Hazebroek M, Verdonschot JA, Cuthbert J, Petutschnigg J, Heymans S, Staessen JA, Pieske B, Edelmann F, Clark AL, Rossignol P, Fontes‐Carvalho R, Cleland JG, Zannad F. Phenotyping patients with ischaemic heart disease at risk of developing heart failure: an analysis of the HOMAGE trial. ESC Heart Fail 2024; 11:209-218. [PMID: 37939716 PMCID: PMC10804163 DOI: 10.1002/ehf2.14465] [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: 02/16/2023] [Revised: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS We aim to characterize the clinical and proteomic profiles of patients at risk of developing heart failure (HF), with and without coronary artery disease (CAD) or prior myocardial infarction (MI). METHODS AND RESULTS HOMAGE evaluated the effect of spironolactone on plasma and serum markers of fibrosis over 9 months of follow-up in participants with (or at risk of having) CAD, and raised natriuretic peptides. In this post hoc analysis, patients were classified as (i) neither CAD nor MI; (ii) CAD; or (iii) MI. Proteomic between-group differences were evaluated through logistic regression and narrowed using backward stepwise selection and bootstrapping. Among the 527 participants, 28% had neither CAD or MI, 31% had CAD, and 41% had prior MI. Compared with people with neither CAD nor MI, those with CAD had higher baseline plasma concentrations of matrix metalloproteinase-7 (MMP-7), galectin-4 (GAL4), plasminogen activator inhibitor 1 (PAI-1), and lower plasma peptidoglycan recognition protein 1 (PGLYRP1), whilst those with a history of MI had higher plasma MMP-7, neurotrophin-3 (NT3), pulmonary surfactant-associated protein D (PSPD), and lower plasma tumour necrosis factor-related activation-induced cytokine (TRANCE). Proteomic signatures were similar for patients with CAD or prior MI. Treatment with spironolactone was associated with an increase of MMP7, NT3, and PGLYRP1 at 9 months. CONCLUSIONS In patients at risk of developing HF, those with CAD or MI had a different proteomic profile regarding inflammatory, immunological, and collagen catabolic processes.
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Affiliation(s)
- Diogo Santos‐Ferreira
- Department of CardiologyCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
- Department of Surgery and Physiology, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
| | - Sílvia O. Diaz
- Department of Surgery and Physiology, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
| | - João Pedro Ferreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineNancyFrance
| | - Nicolas Girerd
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineNancyFrance
| | | | | | - Franco Cosmi
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineNancyFrance
| | - Mark Hazebroek
- Department of CardiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Job A.J. Verdonschot
- Department of CardiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Joe Cuthbert
- Department of CardiologyUniversity of Hull, Castle Hill HospitalCottinghamUK
| | - Johannes Petutschnigg
- Department of Internal Medicine and CardiologyCharité University Medicine, Berlin Institute of Health (BIH), and German Centre for Cardiovascular Research (DZHK), Partner Site BerlinBerlinGermany
| | - Stephane Heymans
- Department of CardiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Jan A. Staessen
- Non‐Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED)MechelenBelgium
| | - Burkert Pieske
- Department of Internal Medicine and CardiologyCharité University Medicine, Berlin Institute of Health (BIH), and German Centre for Cardiovascular Research (DZHK), Partner Site BerlinBerlinGermany
- German Heart Center BerlinBerlinGermany
| | - Frank Edelmann
- Department of Internal Medicine and CardiologyCharité University Medicine, Berlin Institute of Health (BIH), and German Centre for Cardiovascular Research (DZHK), Partner Site BerlinBerlinGermany
| | - Andrew L. Clark
- Department of CardiologyUniversity of Hull, Castle Hill HospitalCottinghamUK
| | - Patrick Rossignol
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineNancyFrance
| | - Ricardo Fontes‐Carvalho
- Department of CardiologyCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
- Department of Surgery and Physiology, Cardiovascular R&D Centre ‐ UnIC@RISEFaculty of Medicine of the University of PortoPortoPortugal
| | - John G.F. Cleland
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Faiez Zannad
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineNancyFrance
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Han BG, Pak D, Kim JS, Sohn Y. The moderating effect of fluid overload on the relationship between the augmentation index and left ventricular diastolic function in patients with CKD. Sci Rep 2024; 14:480. [PMID: 38177252 PMCID: PMC10767097 DOI: 10.1038/s41598-023-50746-5] [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: 09/03/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024] Open
Abstract
Increased vascular stiffness, fluid overload, and left ventricular diastolic dysfunction (LVDD) are common in patients with chronic kidney disease (CKD). We investigated the potential moderating effect of volume status in the relationship between arterial stiffness and left ventricular (LV) diastolic function in non-dialysis patients with stage 5 CKD. The radial augmentation index at a heart rate of 75 beats/min (rAIx75), overhydration/extracellular water (OH/ECW), and E/e´ ratio were concurrently measured in 152 consecutive patients. Each of these parameters reflects the status of vascular stiffness, fluid balance, and LV diastolic function, respectively. Hierarchical regression analysis demonstrated a significant interaction effect of OH/ECW for all patients (P = 0.015), even after controlling for confounders. In separate analyses, this interaction effect was particularly significant in women (P = 0.010), whereas its significance in patients with diabetes was marginally significant (P = 0.062). Our study suggested that fluid overload could be one of the more aggravating factors of LVDD in patients with CKD who have increased arterial stiffness. Therefore, it is advisable to conduct simultaneous assessments of vascular stiffness, fluid balance, and LV function, particularly in the specific groups mentioned earlier. Our results may serve as evidence applicable to patients with chronic heart failure.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Kang-Won, Wonju, Korea
| | - Daewoo Pak
- Division of Data Science, Yonsei University, Kang-Won, Wonju, Korea
| | - Jae-Seok Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Kang-Won, Wonju, Korea
| | - Yujin Sohn
- Department of Infectious Disease, Yonsei University Wonju College of Medicine, Kang-Won, Wonju, Korea.
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Han BG, Seol JH, Choi S, Shin D, Kim JS, Kim YH. Comparing Left Ventricular Diastolic Function between Peritoneal Dialysis and Non-Dialysis Patients with Stage 5 Chronic Kidney Disease: A Propensity Score-Matched Analysis. J Clin Med 2023; 12:5092. [PMID: 37568494 PMCID: PMC10420270 DOI: 10.3390/jcm12155092] [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: 07/04/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have a high incidence of left ventricular diastolic dysfunction (LVDD), which increases the risk of heart failure and mortality. We assessed fluid overload as an independent risk factor for LVDD in patients with decreased kidney function and compared its impact on the E/e' ratio as a parameter for assessing left ventricular diastolic functions between patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and those with non-dialysis CKD stage 5 (CKD5) using propensity score matching (PSM). After PSM, 222 patients (CAPD, n = 111; CKD5, n = 111) were included. Fluid balance was assessed using bio-impedance spectroscopy and LVDD was determined by echocardiography based on an E/e' ratio of >15. The CKD5 group had a significantly higher E/e' ratio (p = 0.002), while fluid overload (OH/ECW) did not differ significantly between the groups. In the CAPD group, there were no significant differences in OH/ECW between patients with and without LVDD (p = 0.517). However, in the CKD5 group, patients with LVDD showed a significantly higher OH/ECW (p = 0.001). In a regression analysis investigating factors associated with the E/e' ratio, OH/ECW was not significantly associated with the E/e' ratio in the CAPD group (p = 0.087), but in the CKD5 group, it was independently correlated (p = 0.047). The factors closely associated with LVDD varied depending on dialysis dependence. While fluid overload independently influenced LVDD in non-dialysis patients, it was not statistically significant in patients with CAPD. Early assessment and management of volume status are crucial in addressing LVDD in patients with advanced-stage CKD.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (B.-G.H.)
| | - Jae Hee Seol
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sooyeon Choi
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (B.-G.H.)
| | - Donghui Shin
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (B.-G.H.)
| | - Jae-Seok Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (B.-G.H.)
| | - Yong Hyuk Kim
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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Su H, Cantrell AC, Chen JX, Gu W, Zeng H. SIRT3 Deficiency Enhances Ferroptosis and Promotes Cardiac Fibrosis via p53 Acetylation. Cells 2023; 12:1428. [PMID: 37408261 PMCID: PMC10217433 DOI: 10.3390/cells12101428] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
Cardiac fibrosis plays an essential role in the development of diastolic dysfunction and contributes to heart failure with preserved ejection fraction (HFpEF). Our previous studies suggested Sirtuin 3 (SIRT3) as a potential target for cardiac fibrosis and heart failure. In the present study, we explored the role of SIRT3 in cardiac ferroptosis and its contribution to cardiac fibrosis. Our data showed that knockout of SIRT3 resulted in a significant increase in ferroptosis, with increased levels of 4-hydroxynonenal (4-HNE) and downregulation of glutathione peroxidase 4 (GPX-4) in the mouse hearts. Overexpression of SIRT3 significantly blunted ferroptosis in response to erastin, a known ferroptosis inducer, in H9c2 myofibroblasts. Knockout of SIRT3 resulted in a significant increase in p53 acetylation. Inhibition of p53 acetylation by C646 significantly alleviated ferroptosis in H9c2 myofibroblasts. To further explore the involvement of p53 acetylation in SIRT3-mediated ferroptosis, we crossed acetylated p53 mutant (p534KR) mice, which cannot activate ferroptosis, with SIRT3KO mice. SIRT3KO/p534KR mice exhibited a significant reduction in ferroptosis and less cardiac fibrosis compared to SIRT3KO mice. Furthermore, cardiomyocyte-specific knockout of SIRT3 (SIRT3-cKO) in mice resulted in a significant increase in ferroptosis and cardiac fibrosis. Treatment of SIRT3-cKO mice with the ferroptosis inhibitor ferrostatin-1 (Fer-1) led to a significant reduction in ferroptosis and cardiac fibrosis. We concluded that SIRT3-mediated cardiac fibrosis was partly through a mechanism involving p53 acetylation-induced ferroptosis in myofibroblasts.
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Affiliation(s)
- Han Su
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA (J.-X.C.)
| | - Aubrey C. Cantrell
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA (J.-X.C.)
| | - Jian-Xiong Chen
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA (J.-X.C.)
| | - Wei Gu
- Institute for Cancer Genetics, Columbia University, 1130 Nicholas Avenue, New York, NY 10032, USA;
| | - Heng Zeng
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA (J.-X.C.)
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Huang S, Lan Y, Zhang C, Zhang J, Zhou Z. The Early Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review and Meta-Analysis. Obes Surg 2023; 33:453-468. [PMID: 36508155 DOI: 10.1007/s11695-022-06366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND This meta-analysis was performed to investigate how cardiac structures and functions change in the very early stage after bariatric surgery. MATERIALS AND METHODS We thoroughly searched the PubMed, Embase, Cochrane Library, and Web of Science databases for articles including patients who underwent bariatric surgery and examined the changes of their cardiac indices. Results were pooled by using Review Manager 5.1 and Stata 12.0. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were obtained. The I-squared (I2) test was used to determine the heterogeneity between studies. To identify publication bias, funnel plots and Egger's test were utilized. The leave-one-out method was used to conduct sensitivity analysis. RESULTS In this meta-analysis, 24 research including 942 patients were considered. According to our findings, most cardiac indices changed 3-6 months following bariatric surgery. An improvement in cardiac geometry was reflected by a reduction in left ventricular mass (LVM) (WMD = - 22.06, 95% CI = (- 27.97, - 16.16)). The left ventricular diastolic function improved, as reflected by the decrease in the E/e' ratio (WMD = - 0.90, 95% CI = (- 1.83, - 0.16)). Left ventricular ejection fraction (LVEF) did not show an obvious change (WMD = 0.94, 95% CI = (- 0.19, 2.07)), while a more sensitive indicator of left ventricular systolic function, left ventricular longitudinal strain (LV LS), increased (WMD = - 2.43, 95% CI = (- 3.96, - 0.89)). CONCLUSION This meta-analysis includes the newest and most comprehensive cardiac indices to prove that cardiac structures and functions are improved early after bariatric surgery, which has not been reported by any other studies.
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Affiliation(s)
- Shanya Huang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yi Lan
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.,Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Song H, Li Y, Yu R, Meng X, Bi Y. Change in left ventricular diastolic function after pioglitazone treatment in patients with type 2 diabetes mellitus: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32613. [PMID: 36607862 PMCID: PMC9829294 DOI: 10.1097/md.0000000000032613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pioglitazone is currently used as an anti-diabetic agent and can reduce cardiovascular events in in patients with type 2 diabetes mellitus (T2DM). Left ventricular diastolic dysfunction has been recognized as an early manifestation of myocardial dysfunction in T2DM patients. This systematic review and meta-analysis aimed to investigate changes in the left ventricular diastolic function after the treatment of pioglitazone. METHODS A systematic literature search of PubMed, Embase, and the Cochrane Library until May 2021 with keywords pioglitazone and left ventricular diastolic function was performed in accordance with the meta-analysis of observational studies in epidemiology guidelines and preferred reporting items for systematic reviews and meta-analyses statement. Three reviewers independently selected the studies and extracted data. Quality assessment of the included studies was undergone. A fixed effects model was used to calculate overall effect sizes. Subgroup analyses were subsequently performed. A fixed effects model was used to calculate the overall effect size. Subgroup analyses were then performed. RESULTS Seven studies with 233 patients were investigated. We found pioglitazone significantly improved hemoglobin A1c (%) in patients with T2DM and left ventricular diastolic function had an improvement tendency (weighted mean difference [WMD], 0.03; 95% confidence interval [CI], 0.01-0.05, P < .01) despite moderate heterogeneity (I2 = 66%). Subsequent subgroup analysis indicated that left ventricular diastolic function were significantly improved (WMD, 0.20; 95% CI, 0.12-0.29, P < .001) in T2DM patients whose average age < 55 after receiving pioglitazone treatment. However, in T2DM patients with mean age ≥ 55 years, there was no significant improvement of left ventricular diastolic function (WMD, 0.02; 95% CI, 0-0.04, P = .04). CONCLUSION Pioglitazone treatment significantly improved left ventricular diastolic function in type 2 diabetic patients with a mean age of < 55 years, but did not improve left ventricular diastolic function in patients with a mean age of ≥ 55 years.
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Affiliation(s)
- Han Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yunye Li
- Department of Pharmacy, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
| | - Ruiming Yu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiangbin Meng
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanwen Bi
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
- * Correspondence: Yanwen Bi, Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong 250012, China (e-mail: )
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Akbar AY, Cui ZY, Hsu CJ, Li YZ, Rahman FF, Xia C, Yang AL, Lee SD. Anti-apoptotic and anti-fibrotic efficacy of exercise training in hypertensive hearts: A systematic review. Front Cardiovasc Med 2023; 10:1138705. [PMID: 37187789 PMCID: PMC10176093 DOI: 10.3389/fcvm.2023.1138705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
Background This review aims to summarize the antiapoptotic, pro-survival, and antifibrotic effects of exercise training in hypertensive hearts. Methods Keyword searches were conducted in PubMed, Web of Science, and Scopus in May 2021. Research published in English on the effects of exercise training on the apoptosis, survival, and fibrosis pathways in hypertension was included. The CAMARADES checklist was used to determine the quality of the studies. Two reviewers independently implemented predesigned protocols for the search and selection of studies, the assessment of study quality, and the evaluation of the strength of evidence. Results Eleven studies were included after selection. The duration of the exercise training ranged from 5 to 27 weeks. Nine studies showed that exercise training improved cardiac survival rates by increasing IGF-1, IGF-1 receptor, p-PI3K, Bcl-2, HSP 72, and p-Akt. Furthermore, 10 studies showed that exercise training reduced apoptotic pathways by downregulating Bid, t-Bid, Bad, Bak, Bax, TNF, and FADD. Finally, two studies reported the modification and subsequent improvement of physiological characteristics of fibrosis and decreased MAPK p38 and PTEN levels by exercise training in the left ventricle of the heart. Conclusions The findings of the review showed that exercise training could improve cardiac survival rates and attenuate cardiac apoptotic and fibrotic pathways in hypertension, suggesting that exercise training could act as a therapeutic approach to prevent hypertension-induced cardiac apoptosis and fibrosis. Systematic Review Registration https://www.crd.york.ac.uk, identifier: CRD42021254118.
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Affiliation(s)
- Adjar Yusrandi Akbar
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Department of Biology Education, University of Muhammadiyah Malang, Malang, Indonesia
| | - Zhen-Yang Cui
- School of Rehabilitation Medicine, Weifang Medical University, Shandong, China
| | - Che-Jui Hsu
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yan-Zhang Li
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Ferry Fadzlul Rahman
- Department of Public Health, Universitas Muhammadiyah Kalimantan Timur, Kalimantan Timur, Indonesia
| | - Chunqiu Xia
- College of Physical Education, Chengdu University, Chengdu, China
| | - Ai-Lun Yang
- Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
- Correspondence: Ai-Lun Yang Shin-Da Lee
| | - Shin-Da Lee
- School of Rehabilitation Medicine, Weifang Medical University, Shandong, China
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Correspondence: Ai-Lun Yang Shin-Da Lee
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Ou SM, Chao CJ, Tsai MT, Lee KH, Tseng WC, Bin PJ, Lin YP, Hsu CY, Tarng DC. Echocardiographic features of left ventricular dysfunction and outcomes in chronic kidney disease. Heart 2023; 109:134-142. [PMID: 36371660 PMCID: PMC9811083 DOI: 10.1136/heartjnl-2022-321404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/11/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Heart failure (HF) imposes a substantial burden and the prevalence of HF is high in patients with chronic kidney disease (CKD). HF results in multiple hospital admissions, but whether HF subtypes worsen long-term outcomes and renal function in patients with CKD remains inconclusive. METHODS The study comprised 10 904 patients with CKD aged ≥20 years who underwent echocardiography between 1 January 2011 and 31 December 2018. The patients were stratified into four groups: non-HF, HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). The primary end points were all-cause mortality, major adverse cardiovascular events (MACEs) and adverse renal outcomes. RESULTS In inverse probability of treatment weighting-adjusted method, the risk of all-cause mortality and MACEs relative to the non-HF group was greatest in the HFrEF group (HR 3.18 (95% CI 2.57 to 3.93) and HR 3.83 (95% CI 3.20 to 4.59)), followed by the HFmrEF (HR 2.75 (95% CI 2.22 to 3.42) and HR 3.08 (95% CI 2.57 to 3.69)) and HFpEF (HR 1.85 (95% CI 1.59 to 2.15) and HR 2.43 (95% CI 2.16 to 2.73) groups. In addition, the HFrEF group had the greatest risks of end-stage renal disease (HR 2.58 (95% CI 1.94 to 3.44)) compared with other groups. CONCLUSIONS HF is associated with subsequent worse clinical outcomes, which may be more pronounced in patients with HFrEF, followed by those with HFmrEF and those with HFpEF relative to non-HF group.
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Affiliation(s)
- Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pin-Jie Bin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
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Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
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Sonaglioni A, Nicolosi GL, Trevisan R, Granato A, Zompatori M, Lombardo M. Modified Haller index validation and correlation with left ventricular strain in a cohort of subjects with obesity and without overt heart disease. Intern Emerg Med 2022; 17:1907-1919. [PMID: 35753022 DOI: 10.1007/s11739-022-03026-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/04/2022] [Indexed: 12/29/2022]
Abstract
The present study was primarily designed to validate the modified Haller index (MHI), the ratio of chest transverse diameter over the distance between sternum and spine, measured by a ruler and transthoracic echocardiography (TTE), respectively, in a cohort of subjects with obesity, but otherwise healthy, by comparing the results to the conventional Haller index (HI) measured on chest X-ray (CXR). 100 consecutive subjects with body mass index (BMI) ≥ 30 kg/m2 and 60 matched controls with BMI < 30 kg/m2, who underwent a two-plane CXR for any clinical indication, were prospectively examined over a 6-month period. All participants underwent MHI assessment, TTE and speckle-tracking analysis of left ventricular (LV) global longitudinal strain (GLS). Bland-Altman analysis was used to compare the radiological and nonradiological techniques. Second, independent predictors of subclinical myocardial dysfunction, defined as LV-GLS less negative than - 20%, were evaluated. Bland-Altman analysis revealed a bias of - 4.91 cm for latero-lateral thoracic diameter, of - 0.74 cm for antero-posterior (A-P) thoracic diameter and of - 0.22 for HI assessment, suggesting a systematic overestimation of the nonradiological methodology in comparison to that radiological. Despite normal LV systolic function on TTE, LV-GLS resulted impaired in 76% of subjects with obesity. Waist circumference (OR 1.13, 95%CI 1.04-1.22) and nonradiological A-P thoracic diameter (OR 0.51, 95%CI 0.28-0.93) were the main independent predictors of subclinical myocardial dysfunction in subjects with obesity. The impairment in LV myocardial strain detected in subjects with obesity appears to be primarily related to extrinsic abdominal and thoracic compressive phenomena, rather than intrinsic myocardial dysfunction.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | | | - Roberta Trevisan
- Division of Radiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Alberto Granato
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2, Grugliasco, 10095, Turin, Italy
| | - Maurizio Zompatori
- Division of Radiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
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Lumori BAE, Nuwagira E, Abeya FC, Araye AA, Masette G, Mondo CK, Okello S, Muzoora C, Muyingo A. Association of body mass index with left ventricular diastolic dysfunction among ambulatory individuals with diabetes mellitus in rural Uganda: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:279. [PMID: 35725371 PMCID: PMC9210682 DOI: 10.1186/s12872-022-02718-2] [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] [Received: 12/04/2021] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Left ventricular diastolic dysfunction (LVDD) is a recognized complication of diabetes mellitus that precedes and is a risk factor for heart failure. We aimed to determine the prevalence of LVDD and its association with body mass index in ambulatory adults with diabetes mellitus in rural Uganda.
Methods We conducted a cross-sectional study, over 5 months, to enroll 195 ambulatory Ugandan adults living with diabetes mellitus for at least five years at Mbarara Regional Referral Hospital. We collected demographic, and clinical data and measured body mass index (BMI). Echocardiography was performed to determine LVDD by assessing the mitral inflow ventricular filling velocities (E/A and E/è ratios), tricuspid regurgitant jet peak velocity, and left atrium maximum volume index. We used logistic regression to estimate the odds ratio for the association of LVDD with BMI and evaluated the variation of associations by age and hypertension status.
Results Of the 195 participants, 141 (72.31%) were female, the mean age was 62 [standard deviation, 11.50] years, and the median duration of diabetes diagnosis was 10 [interquartile range, 7, 15] years. Eighty-six percent (n = 168) had LVDD with the majority (n = 127, 65.1%) of participants in the grade 1 category of LVDD. In the adjusted model, the odds of LVDD for each 1 kg/m2 increase in BMI was 1.11 [95% confidence interval 1.00, 1.25, p = 0.04]. The adjusted odds of LVDD among individuals aged ≥ 50 years with BMI ≥ 25 kg/m2 was 13.82 times the odds of LVDD in individuals aged < 50 years with BMI < 25 kg/m2. Conclusion LVDD is prevalent and positively associated with BMI among ambulatory Ugandan adults living with diabetes mellitus for at least five years. The association was higher for older overweight/obese than younger individuals with normal weight. Future studies should focus on the effect of weight loss on LVDD as a possible target for the prevention of heart failure.
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Affiliation(s)
| | - Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Fardous Charles Abeya
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Abdirahman Ali Araye
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Godfrey Masette
- Department of Microbiology and Immunology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles K Mondo
- Uganda Heart Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Anthony Muyingo
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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12
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Zhang G, Shi K, Yan WF, Li XM, Li Y, Guo YK, Yang ZG. Effects of diabetes mellitus on left ventricular function and remodeling in hypertensive patients with heart failure with reduced ejection fraction: assessment with 3.0 T MRI feature tracking. Cardiovasc Diabetol 2022; 21:69. [PMID: 35524215 PMCID: PMC9077817 DOI: 10.1186/s12933-022-01504-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) is a major health burden worldwide with high morbidity and mortality. Comorbidities of HFrEF complicate treatment and lead to poor prognosis, among which hypertension (HTN) and diabetes mellitus (DM) are common and frequently cooccur. DM was found to have additive effects on cardiac function and structure in hypertensive patients, while its effects on the HFrEF cohort in the context of HTN remain unclear. METHODS A total of 171 patients with HFrEF were enrolled in our study, consisting of 51 HFrEF controls, 72 hypertensive HFrEF patients (HTN-HFrEF [DM-]) and 48 hypertensive HFrEF patients with comorbid DM (HTN-HFrEF [DM+]). Cardiac MRI-derived left ventricular (LV) strains, including global radial (GRPS), circumferential (GCPS) and longitudinal (GLPS) peak strain, and remodeling parameters were measured and compared among groups. The determinants of impaired LV function and LV remodeling in HFrEF patients were investigated by multivariable linear regression analyses. RESULTS Despite a similar LV ejection fraction, patients in the HTN-HFrEF (DM+) and HTN-HFrEF (DM-) groups showed a higher LV mass index and LV remodeling index than those in the HFrEF control group (all p < 0.05). Compared with the HTN-HFrEF (DM-) and HFrEF control groups, the HTN-HFrEF (DM+) group exhibited the most severe GLPS impairment (p < 0.001). After adjustment for covariates in HFrEF patients, DM was found to be an independent determinant of impaired LV strains in all three directions (GRPS [β = - 0.189; p = 0.011], GCPS [β = 0.217; p = 0.005], GLPS [β = 0.237; p = 0.002]). HTN was associated with impaired GLPS (β = 0.185; p = 0.016) only. However, HTN rather than DM was associated with LV remodeling in HFrEF patients in the multivariable regression analysis (p < 0.05). CONCLUSIONS DM aggravated LV longitudinal dysfunction in hypertensive HFrEF patients without further changes in LV remodeling, indicating that HFrEF patients with comorbid HTN and DM may have a hidden high-risk phenotype of heart failure that requires more advanced and personalized management.
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Affiliation(s)
- Ge Zhang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ke Shi
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Sahebjam M, Toofaninejad N, Ajam A, Hosseini K, Jalali A, Zoroufian A. Assessment of Left Ventricular Function and Mitral Regurgitation Severity Early After Percutaneous Device Closure of the Atrial Septal Defect. Crit Pathw Cardiol 2022; 21:30-35. [PMID: 34907937 DOI: 10.1097/hpc.0000000000000274] [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: 11/26/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is one the most prevalent forms of congenital heart disease in adults. Closure of ASDs eliminates left-to-right shunt and reduces right heart volumes, but the effects of ASD closure, on the left ventricle (LV) and mitral valve competence are somewhat inconsistent. Therefore, we designed this study to evaluate the early effect of percutaneous closure of ASD on LV function and mitral regurgitation (MR) severity. METHODS In this prospective study, we enrolled 32 patients with ASD secundum who underwent percutaneous device closure in Tehran Heart Center. We used transthoracic and transesophageal echocardiography (TEE) before the procedure and TTE 24 hours after the procedure, then compared obtained LV parameters before and after the procedure. RESULTS LV end-diastolic diameter (LVEDD) increased significantly from 44.8 ± 2.4 to 45.8 ± 2.8 (P < 0.001). LV end-systolic diameter (LVESD) also increased but was statistically insignificant (P = 0.063) and LV ejection fraction (LVEF) remained nearly unchanged. Highest alteration was in right ventricular systolic pressure (12.4% decrease; P < 0.001) and mitral early Doppler/tissue Doppler velocity ratio (E/E') (9.7% increase; P = 0.010). The change in MR severity was insignificant using Wilcoxon signed-rank test (P = 0.157). CONCLUSIONS We concluded that systolic functions do not change immediately. However, LVEDD and E/E' will increase immediately, resulting from the passage of all blood from the LA into the LV in the early diastole just after closure. We also observed the positive effect of device closure on reducing right ventricular systolic pressure, and at least it does not worsen MR early after the procedure.
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Affiliation(s)
- Mohammad Sahebjam
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Toofaninejad
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Qin Z, Liu D, You X, Duan Q, Zhao Y. Evaluating Impact of Pulse Pressure on Indexes of Myocardial Work by Speckle-Tracking Echocardiography in Normotensive, Prehypertensive and Newly Diagnosed Hypertensive Patients. Int J Gen Med 2022; 15:1933-1943. [PMID: 35228817 PMCID: PMC8882027 DOI: 10.2147/ijgm.s351628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background The impact of pulse pressure (PP) on indexes of myocardial work (MWIs). This study aims to explore the potential association of high PP with myocardial work (MW). Hypothesis PP had an association with four indexes of MW in a mixed population of normotensive, prehypertensive and newly diagnosed hypertensive individuals. Methods The study was a single-center, cross-sectional, observational study. A total of 204 participants (66 normotensive, 35 prehypertensive and 103 newly diagnosed hypertensive individuals) were evaluated by speckle-tracking echocardiography (STE) and blood pressure measurement. According to the PP tertiles, the participants were divided into three groups: Group I (<44 mmHg, n=67), Group II (44–52 mmHg, n=68) and Group III (≥52 mmHg, n=69). Results In Group II and Group III, the proportion of males was higher than that in Group I (median 46 vs 30 (P=0.002)). With increasing PP, the three indexes of MW, namely, GWI, GCW and GWW, increased, and the differences among the three groups were statistically significant (P<0.001). PP was positively related to GWI, GCW and GWW and negatively correlated with GWE. After adjusting for E/e’, LVMI, LAVI and GLS, PP was still significantly correlated with the four MW indexes (both P<0.001). Conclusion PP had a strong association with four indexes of MW in a mixed population of normotensive, prehypertensive and newly diagnosed hypertensive individuals. The evaluation of PP and MWIs might be valuable for identifying very early diastolic impairment of the heart.
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Affiliation(s)
- Zheng Qin
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Dawei Liu
- Department of Cardiovascular Medicine, The Bishan Hospital of Chongqing Medical University, Chongqing, 402760, People’s Republic of China
| | - Xiaojun You
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Qin Duan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Correspondence: Qin Duan, Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China, Email
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Yu Zhao, Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China, Email
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15
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Yılmaz AS, Şatıroğlu Ö, Çetin M. Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up. KARDIOLOGIIA 2022; 62:72-79. [PMID: 35168536 DOI: 10.18087/cardio.2022.1.n1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
Aim Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10‑yrs period.Material and methods Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared.Results Of 1261 patients included in the study, MACE developed in 374 (29.6 %). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE.Conclusion The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention.
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Affiliation(s)
- Ahmet Seyda Yılmaz
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Cardiology, Rize, Turkey
| | - Ömer Şatıroğlu
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Cardiology, Rize, Turkey
| | - Mustafa Çetin
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Cardiology, Rize, Turkey
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Sukumaran V, Gurusamy N, Yalcin HC, Venkatesh S. Understanding diabetes-induced cardiomyopathy from the perspective of renin angiotensin aldosterone system. Pflugers Arch 2021; 474:63-81. [PMID: 34967935 DOI: 10.1007/s00424-021-02651-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/31/2022]
Abstract
Experimental and clinical evidence suggests that diabetic subjects are predisposed to a distinct cardiovascular dysfunction, known as diabetic cardiomyopathy (DCM), which could be an autonomous disease independent of concomitant micro and macrovascular disorders. DCM is one of the prominent causes of global morbidity and mortality and is on a rising trend with the increase in the prevalence of diabetes mellitus (DM). DCM is characterized by an early left ventricle diastolic dysfunction associated with the slow progression of cardiomyocyte hypertrophy leading to heart failure, which still has no effective therapy. Although the well-known "Renin Angiotensin Aldosterone System (RAAS)" inhibition is considered a gold-standard treatment in heart failure, its role in DCM is still unclear. At the cellular level of DCM, RAAS induces various secondary mechanisms, adding complications to poor prognosis and treatment of DCM. This review highlights the importance of RAAS signaling and its major secondary mechanisms involving inflammation, oxidative stress, mitochondrial dysfunction, and autophagy, their role in establishing DCM. In addition, studies lacking in the specific area of DCM are also highlighted. Therefore, understanding the complex role of RAAS in DCM may lead to the identification of better prognosis and therapeutic strategies in treating DCM.
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Affiliation(s)
| | - Narasimman Gurusamy
- Department of Bioscience Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Al-Tarfa, 2371, Doha, Qatar
| | - Sundararajan Venkatesh
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, Newark, NJ, USA
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17
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Chen X, Ashraf S, Ashraf N, Harmancey R. UCP3 (Uncoupling Protein 3) Insufficiency Exacerbates Left Ventricular Diastolic Dysfunction During Angiotensin II-Induced Hypertension. J Am Heart Assoc 2021; 10:e022556. [PMID: 34533037 PMCID: PMC8649532 DOI: 10.1161/jaha.121.022556] [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: 11/16/2022]
Abstract
Background Left ventricular diastolic dysfunction, an early stage in the pathogenesis of heart failure with preserved ejection fraction, is exacerbated by joint exposure to hypertension and obesity; however, the molecular mechanisms involved remain uncertain. The mitochondrial UCP3 (uncoupling protein 3) is downregulated in the heart with obesity. Here, we used a rat model of UCP3 haploinsufficiency (ucp3+/‐) to test the hypothesis that decreased UCP3 promotes left ventricular diastolic dysfunction during hypertension. Methods and Results Ucp3+/‐ rats and ucp3+/+ littermates fed a high‐salt diet (HS; 2% NaCl) and treated with angiotensin II (190 ng/kg per min for 28 days) experienced a similar rise in blood pressure (158±4 versus 155±7 mm Hg). However, UCP3 insufficiency worsened diastolic dysfunction according to echocardiographic assessment of left ventricular filling pressures (E/e’; 18.8±1.0 versus 14.9±0.6; P<0.05) and the isovolumic relaxation time (24.7±0.6 versus 21.3±0.5 ms; P<0.05), as well as invasive monitoring of the diastolic time constant (Tau; 15.5±0.8 versus 12.7±0.2 ms; P<0.05). Exercise tolerance on a treadmill also decreased for HS/angiotensin II‐treated ucp3+/‐ rats. Histological and molecular analyses further revealed that UCP3 insufficiency accelerated left ventricular concentric remodeling, detrimental interstitial matrix remodeling, and fetal gene reprogramming during hypertension. Moreover, UCP3 insufficiency increased oxidative stress and led to greater impairment of protein kinase G signaling. Conclusions Our findings identified UCP3 insufficiency as a cause for increased incidence of left ventricular diastolic dysfunction during hypertension. The results add further support to the use of antioxidants targeting mitochondrial reactive oxygen species as an adjuvant therapy for preventing heart failure with preserved ejection fraction in individuals with obesity.
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Affiliation(s)
- Xu Chen
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Sadia Ashraf
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | | | - Romain Harmancey
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
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Chade AR, Engel JE, Hall ME, Eirin A, Bidwell GL. Intrarenal modulation of NF-κB activity attenuates cardiac injury in a swine model of CKD: a renal-cardio axis. Am J Physiol Renal Physiol 2021; 321:F411-F423. [PMID: 34396789 DOI: 10.1152/ajprenal.00158.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have a high cardiovascular mortality. CKD and heart failure (HF) coexist in up to 50% of patients, and both associate with inflammation. We aimed to define the cardiac phenotype of a novel swine model of CKD and test the hypothesis that inflammation of renal origin propels the development of precursors of HF in CKD. CKD was induced in 14 pigs, which were followed for 14 wk. Renal (multidetector computed tomography) and cardiac (echocardiography) hemodynamics were quantified before and 8 wk after single intrarenal administration of placebo or a biopolymer-fused peptide inhibitor of NF-κB that blocks NF-κB activity and decreases inflammatory activity (SynB1-ELP-p50i). Blood was collected to quantify cytokines (TNF-α, monocyte chemoattractant protein-1, and interleukins), markers of inflammation (C-reactive protein), and biomarkers of HF (atrial and brain natriuretic peptides). Pigs were then euthanized, and kidneys and hearts were studied ex vivo. Normal pigs were used as time-matched controls. Renal dysfunction in CKD was accompanied by cardiac hypertrophy and fibrosis, diastolic dysfunction, increased renal and cardiac expression of TNF-α, monocyte chemoattractant protein-1, and interleukins, canonical and noncanonical mediators of NF-κB signaling, circulating inflammatory factors, and biomarkers of HF. Notably, most of these changes were improved after intrarenal SynB1-SynB1-ELP-p50i, although cardiac inflammatory signaling remained unaltered. The translational traits of this model support its use as a platform to test novel technologies to protect the kidney and heart in CKD. A targeted inhibition of renal NF-κB signaling improves renal and cardiac function, suggesting an inflammatory renal-cardio axis underlying early HF pathophysiology in CKD.NEW & NOTEWORTHY Chronic kidney disease (CKD) is a progressive disorder with high cardiovascular morbidity and mortality. This work supports the role of inflammatory cytokines of renal origin in renal-cardio pathophysiology in CKD and that the heart may be a target. Furthermore, it supports the feasibility of a new strategy in a translational fashion, using targeted inhibition of renal NF-κB signaling to offset the development of cardiac injury in CKD.
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Affiliation(s)
- Alejandro R Chade
- Department of Physiology and Biophysics, grid.410721.1University of Mississippi Medical Center, Jackson, Mississippi.,Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jason E Engel
- Department of Physiology and Biophysics, grid.410721.1University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael E Hall
- Department of Physiology and Biophysics, grid.410721.1University of Mississippi Medical Center, Jackson, Mississippi.,Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Alfonso Eirin
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Gene L Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Pharmacology and Experimental Therapeutics, University of Mississippi Medical Center, Jackson, Mississippi
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19
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Wang Z, Yang T, Fu H. Prevalence of diabetes and hypertension and their interaction effects on cardio-cerebrovascular diseases: a cross-sectional study. BMC Public Health 2021; 21:1224. [PMID: 34172039 PMCID: PMC8229421 DOI: 10.1186/s12889-021-11122-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertension and diabetes mellitus are two of the major risk factors for cardio-cerebrovascular diseases (CVDs). Although prior studies have confirmed that the coexistence of the two can markedly increase the risk of CVDs, few studies investigated whether potential interaction effects of hypertension and diabetes can result in greater cardio-cerebrovascular damage. We aimed to investigate the prevalence of hypertension and diabetes and whether they both affect synergistically the risk of CVDs. METHODS A cross-sectional study was conducted by using a multistage stratified random sampling among communities in Changsha City, Hunan Province. Study participants aged > = 18 years were asked to complete questionnaires and physical examinations. Multivariate logistic regression models were performed to evaluate the association of diabetes, hypertension, and their multiplicative interaction with CVDs with adjustment for potential confounders. We also evaluated additive interaction with the relative excess risk ratio (RERI), attribution percentage (AP), synergy index (SI). RESULTS A total of 14,422 participants aged 18-98 years were collected (men = 5827, 40.7%). The prevalence was 22.7% for hypertension, 7.0% for diabetes, and 3.8% for diabetes with hypertension complication, respectively. Older age, women, higher educational level, unmarried status, obesity (central obesity) were associated with increased risk of hypertension and diabetes. We did not find significant multiplicative interaction of diabetes and hypertension on CVDs, but observed a synergistic additive interaction on coronary heart disease (SI, 1.43; 95% CI, 1.03-1.97; RERI, 1.94; 95% CI, 0.05-3.83; AP, 0.26; 95% CI, 0.06-0.46). CONCLUSIONS Diabetes and hypertension were found to be associated with a significantly increased risk of CVDs and a significant synergistic additive interaction of diabetes and hypertension on coronary heart disease was observed. Participants who were old, women, highly educated, unmarried, obese (central obese) had increased risk of diabetes and hypertension.
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Affiliation(s)
- Zhehui Wang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province, China. .,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China.
| | - Hanlin Fu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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20
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Shimamoto K, Kanzaki H, Tanaka T, Hirayama A, Koga M, Kusano KF, Toyoda K, Yasuda S, Ihara M. Echocardiographic predictors of cardioembolic stroke due to underlying atrial fibrillation: Reliable left atrial remodeling signs in acute stroke. J Neurol Sci 2021; 427:117514. [PMID: 34130062 DOI: 10.1016/j.jns.2021.117514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atrial remodeling due to high-burden atrial fibrillation (AF) is associated with cardioembolic stroke (CES). As not all CESs is caused by AF, we analyzed the diagnostic values of each echocardiographic parameter to distinguish likely AF-related CES in acute stroke patients while in non-AF rhythm. METHODS The data of consecutive patients with acute ischemic stroke in sinus rhythm between 2012 and 2015 were obtained. The echocardiographic parameters of patients with CES due to underlying AF (n = 61) and control patients (n = 319) with either large artery atherosclerosis or small-vessel occlusion were compared using receiver operating characteristic curves and logistic regression analyses. Each parameter was reassessed in acute stroke patients through a validation study using the same database with different periods of generalization. RESULTS CES patients with underlying AF showed a significantly larger left atrial volume index (LAVi), higher mitral inflow E wave (E), and lower A wave (A) than the controls. The area under the curve (AUC) (95% confidence interval) for diagnosing CES due to underlying AF was significantly higher for LAVi/A than for LAVi (0.785 versus 0.696, P < 0.01). Among patients aged >60 years, the E/A ratio had the highest AUC (0.857) of the parameters. The cut-off values were ≥ 0.70 (sensitivity, 55.7%; specificity, 90.9%) and ≥ 0.82 (sensitivity, 71.4%; specificity, 84.1%) for LAVi/A and the E/A ratio, respectively, in patients >60 years. The cut-off values of all parameters showed similar trends in a validation study. CONCLUSION LAVi/A is a useful indicator for distinguishing CES patients with underlying AF regardless of age, and the E/A ratio is reliable among patients aged >60 years in evaluation during acute stroke admission.
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Affiliation(s)
- Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan; Department of Molecular Imaging in Cardiovascular Medicine, Osaka University, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Atsushi Hirayama
- Department of Public Health and Social Medicine, Osaka University, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kengo F Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan; Department of Cardiovascular Medicine, Tohoku University, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
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21
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Cardiovascular Risk Factor Profiles and Disease in Black Compared to Other Africans with Chronic Kidney Disease. Int J Nephrol 2021; 2021:8876363. [PMID: 33680512 PMCID: PMC7929676 DOI: 10.1155/2021/8876363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Methods Cardiovascular risk factors, aortic and cardiac function, atherosclerosis extent, and cardiovascular event rates were assessed in 115 consecutive predialysis (n = 67) and dialysis patients (n = 48) including 46 black and 69 other (32 Asian, 28 white, and 9 mixed race) participants. Data were analysed in multivariable regression models. Results Overall, black compared to other African CKD patients had less frequent carotid artery plaque (OR (95% CI) = 0.38 (0.16–0.91)) despite an increased cardiovascular risk factor burden. In receiver operator characteristic curve analysis, the Framingham score performed well in identifying non-black but not black CKD patients with carotid plaque (area under the curve (AUC) (95% CI) = 0.818 (0.714–0.921) and AUC (95% CI) = 0.556 (0.375–0.921), respectively). Black compared to other African predialysis patients experienced larger Framingham scores and more adverse nontraditional cardiovascular risk factors, impaired arterial and diastolic function but similar cardiovascular event rates (OR (95% CI) = 0.93 (0.22 to 3.87)). Among dialysis patients, black compared to other Africans had an overall similar traditional and nontraditional cardiovascular risk factor burden, similar arterial and diastolic function but increased systolic function (partial R = 0.356, p = 0.01 and partial R = 0.315, p = 0.03 for ejection fraction and stroke volume, respectively) and reduced cardiovascular event rates (OR (95% CI) = 0.22 (0.05 to 0.88)). Conclusion Black compared to other African CKD patients have less frequent very high risk atherosclerosis and experience weaker cardiovascular risk factor-atherosclerotic CVD relationships. These disparities may be due to differences in epidemiological health transition stages. Among dialysis patients, black compared to other Africans have less cardiovascular events, which may represent a selection bias as previously documented in black Americans.
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22
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Pareek A, Ram CVS, Joshi S, Mehta RT. 2020 International Society of Hypertension Guidelines: preference of calcium channel blocker over thiazide-like diuretics lacks evidence. J Hypertens 2020; 38:2335-2336. [DOI: 10.1097/hjh.0000000000002601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Additive effect of hypertension on left ventricular structure and function in patients with asymptomatic type 2 diabetes mellitus. J Hypertens 2020; 39:538-547. [PMID: 33031176 DOI: 10.1097/hjh.0000000000002643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to comprehensively determine the effects of hypertension on left ventricular (LV) structure, microcirculation, tissue characteristics, and deformation in type 2 diabetes mellitus (T2DM) using multiparametric cardiac magnetic resonance (CMR) imaging. METHODS We prospectively enrolled 138 asymptomatic patients with T2DM (80 normotensive and 58 hypertensive individuals) and 42 normal glucose-tolerant and normotensive controls and performed multiparametric CMR examination to assess cardiac geometry, microvascular perfusion, extracellular volume (ECV), and strain. Univariable and multivariable linear analysis was performed to analyze the effect of hypertension on LV deformation in patients with T2DM. RESULTS Compared with controls, patients with T2DM exhibited decreased strain, decreased microvascular perfusion, increased LV remodeling index, and increased ECV. Hypertension lead to greater deterioration of LV strain (peak strain-radial, P = 0.002; peak strain-longitudinal, P = 0.006) and LV remodeling index (P = 0.005) in patients with T2DM after adjustment for covariates; however, it did not affect microvascular perfusion (perfusion index, P = 0.469) and ECV (P = 0.375). In multivariable analysis, hypertension and diabetes were independent predictors of reduced LV strain, whereas hypertension is associated with greater impairment of diastolic function (P = 0.009) but not systolic function (P = 0.125) in the context of diabetes, independent of clinical factors and myocardial disorder. CONCLUSION Hypertension in the context of diabetes is significantly associated with LV diastolic function and concentric remodeling; however, it has little effect on systolic function, myocardial microcirculation, or fibrosis independent of covariates, which provide clinical evidence for understanding the pathogenesis of comorbidities and explaining the development of distinct heart failure phenotypes.
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24
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Nana M, Morgan H, Bondugulapati LNR. Sodium-glucose co-transporter 2 inhibitors and heart failure-the present and the future. Heart Fail Rev 2020; 26:953-960. [PMID: 32020487 DOI: 10.1007/s10741-020-09925-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 diabetes mellitus is associated with an increased risk of heart failure. The prevalence of type 2 diabetes mellitus is on an upward trend. Heart failure represents one of the major causes for hospitalisation and mortality despite advances in management. Recent cardiovascular outcome trials have demonstrated that sodium-glucose co-transporter 2 inhibitors, which were introduced to the market in 2013, can incur a clinically significant risk reduction in heart failure outcomes in such patients. In this review, we discuss the epidemiology and pathophysiology of heart failure in diabetes and explore the landmark trials, the potential mechanisms of benefit of SGLT-2 inhibitors in heart failure, how the trials have led to major changes in treatment guidelines, and future potential directions for use of these drugs, including in those without diabetes.
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Affiliation(s)
- Melanie Nana
- Diabetes and Endocrinology Department, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Wales, LL13 7TD, UK.
| | - Holly Morgan
- Cardiology Department, Royal Glamorgan Hospital, Llantrisant, Wales, CF72 8XR, UK
| | - L N Rao Bondugulapati
- Diabetes and Endocrinology Department, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, Wales, LL13 7TD, UK
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25
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Albu A, Para I. Left ventricular diastolic dysfunction in diabetes mellitus and the therapeutic role of exercise training. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Left ventricular diastolic dysfunction (LVDD) with normal ejection fraction is considered common among people with diabetes mellitus (DM). LVDD is a progressive condition and an independent predictor of mortality in diabetic patients. The etiopathogenesis of LVDD is multifactorial, including diabetes associated comorbidities, such as hypertension, coronary atherosclerosis and obesity, as well as myocardial vascular and metabolic disturbances which lead to diabetic cardiomyopathy. Early stages of LVDD may be detected using echocardiographic techniques. Treatment strategies evolve, based on a better understanding of pathogenic mechanisms, although it is still difficult to efficiently control LVDD evolution. This review synthesizes the main pathophysiological processes and clinical features that characterize DM associated LVDD. Among treatment options, the therapeutic relevance of exercise training programs is underlined.
Key words: diabetes mellitus, left ventricular diastolic dysfunction, physical training,
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Affiliation(s)
- Adriana Albu
- 2nd Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ioana Para
- 4th Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
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26
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Heiskanen JS, Ruohonen S, Rovio SP, Kytö V, Kähönen M, Lehtimäki T, Viikari JSA, Juonala M, Laitinen T, Tossavainen P, Jokinen E, Hutri-Kähönen N, Raitakari OT. Determinants of left ventricular diastolic function-The Cardiovascular Risk in Young Finns Study. Echocardiography 2019; 36:854-861. [PMID: 30905083 DOI: 10.1111/echo.14321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/29/2022] Open
Abstract
Decreased left ventricular (LV) diastolic function is associated with increased all-cause mortality and risk for a heart failure. The determinants of LV diastolic function have been mainly studied in elderly populations; however, the origin of LV heart failure may relate to the lifestyle factors acquired during the life course. Therefore, we examined biochemical, physiological, and lifestyle determinants of LV diastolic function in 34-49-year-old participants of the Cardiovascular Risk in Young Finns Study (Young Finns Study). In 2011, clinical examination and echocardiography were performed for 1928 participants (880 men and 1048 women; aged 34-49 years). LV diastolic function was primarily defined using E/é-ratio (population mean 4.8, range 2.1-9.0). In a multivariate model, systolic blood pressure (P < 0.005), female sex (P < 0.005), age (P < 0.005), waist circumference (P = 0.024), smoking (P = 0.028), serum alanine aminotransferase (P = 0.032) were directly associated with E/é-ratio, while an inverse association was found for height (P < 0.005). Additionally, a higher E/é-ratio was found in participants with concentric hypertrophy compared to normal cardiac geometry (P < 0.005). Other indicators of the LV diastolic function including E/A-ratio and left atrial volume index showed similarly strong associations with systolic blood pressure and age. In conclusion, we identified systolic blood pressure, waist circumference and smoking as modifiable determinants of the LV diastolic function in the 34-49-year-old participants of the Young Finns Study.
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Affiliation(s)
- Jarkko S Heiskanen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Saku Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Orion Pharma, Turku, Finland
| | - Suvi P Rovio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Ville Kytö
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital, Tyks T-Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Eero Jokinen
- Department of Paediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
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27
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Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr 2019; 32:216-232.e2. [DOI: 10.1016/j.echo.2018.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 12/30/2022]
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28
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Blomstrand P, Sjöblom P, Nilsson M, Wijkman M, Engvall M, Länne T, Nyström FH, Östgren CJ, Engvall J. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol 2018; 17:113. [PMID: 30107798 PMCID: PMC6090791 DOI: 10.1186/s12933-018-0756-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022] Open
Abstract
Aims Obesity is associated with type 2 diabetes mellitus, left ventricular diastolic dysfunction and heart failure but it is unclear to which extent it is related to left ventricular systolic dysfunction. The aim of the study was to explore the effects of overweight and obesity on left ventricular systolic function in patients with type 2 diabetes mellitus and a control group of non-diabetic persons. Methods We prospectively investigated 384 patients with type 2 diabetes mellitus, and 184 controls who participated in the CARDIPP and CAREFUL studies. The participants were grouped according to body mass index (normal weight < 25 kg/m2, overweight 25–29 kg/m2, and obesity ≥ 30 kg/m2). Echocardiography was performed at the beginning of the study and after 4-years in the patient group. Results Univariable and multivariable regression analysis revealed that variations in left ventricular ejection fraction, global longitudinal strain, left ventricular mass and diastolic function expressed as E/é (the ratio between early diastolic mitral flow and annular motion velocities) all are related to body mass index. The mean and standard deviation of left ventricular ejection fraction and global longitudinal strain values were 57% (8%) vs. − 18.6% (2.3%) for normal weight patients, 53% (8%) vs. − 17.5% (2.3%) for overweight, and 49% (9%) vs. − 16.2% (3.0%) for obese (p < 0.05 vs. p < 0.05). Corresponding results in the control group were 58% (6%) vs. − 22.3% (3.0%), 55% (7%) vs. − 20.8% (3.1%) and 54% (8%) − 19.6% (4.0%) (p < 0.05 vs. p < 0.05). Patients who gained weight from baseline to follow-up changed left ventricular ejection fraction (median and interquartile range) by − 1.0 (9.0) % (n = 187) and patients who lost weight changed left ventricular ejection fraction by 1.0 (10.0) % (n = 179) (p < 0.05). Conclusion Overweight and obesity impair left ventricular ejection fraction and global longitudinal strain in both patients with type 2 diabetes mellitus and non-diabetic persons. Trial registration ClinicalTrials.gov identifier NCT 01049737
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Affiliation(s)
- Peter Blomstrand
- Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden. .,Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Peter Sjöblom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Primary Health Care and Department of Medical and Health Sciences, Linköping University, Finspång, Sweden
| | - Mats Nilsson
- Futurum, Academy for Health and Care, Jönköping, Sweden
| | - Magnus Wijkman
- Department of Internal Medicine and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden
| | - Martin Engvall
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Toste Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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29
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Abstract
PURPOSE OF REVIEW The following is a review of the current concepts on the relationship between hypertension (HTN) and diabetes mellitus with a focus on the epidemiology and cardiovascular prognostic implications of coexistent HTN and diabetes mellitus, shared mechanisms underlying both conditions and pathophysiology of increased risk of cardiovascular disease, treatment of HTN in individuals with diabetes mellitus, and effects of anti-diabetic medications on blood pressure (BP). RECENT FINDINGS Diabetes mellitus and HTN often coexist in the same individual. They share numerous risk factors and underlying pathophysiologic mechanisms, most important of which are insulin resistance and inappropriate activation of the rennin-angiotensin-aldosterone system. Recently updated guidelines recommend a BP goal of 140/90 mmHg in most individuals with diabetes mellitus. A new class of anti-diabetic medications, sodium-glucose co-transporter 2 inhibitors, has shown favorable effects on BP. SUMMARY HTN affects the majority of individuals with diabetes mellitus. Coexistence of diabetes mellitus and HTN, especially if BP is not well controlled, dramatically increases the risk of morbidity and mortality from cardiovascular disease. BP control is an essential part of management of patients with diabetes mellitus, because it is one of the most effective ways to prevent vascular complications and death.
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30
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Lee SC, Daimon M, Di Tullio MR, Homma S, Hasegawa T, Chiou SH, Nakao T, Hirokawa M, Mizuno Y, Yatomi Y, Yamazaki T, Komuro I. Beneficial effect of body weight control on left ventricular diastolic function in the general population: an analysis of longitudinal data from a health check-up clinic. Eur Heart J Cardiovasc Imaging 2017; 19:136-142. [PMID: 29237001 DOI: 10.1093/ehjci/jex219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seitetz C Lee
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Takahiro Hasegawa
- Department of Biostatistics, Shionogi & Co., Ltd, 1-8-3, Doshomachi, Chuo, Osaka 541-0045, Japan
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Sy Han Chiou
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Epidemiology and Systems, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Tsutomu Yamazaki
- Clinical Research Support Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
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31
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Pareek AK, Mehta RT, Purkait I, Grover A. Diabetic Hypertensives and Diastolic Dysfunction: Use of Calcium Channel Blockers-A Clinical Concern. JACC. HEART FAILURE 2017; 5:850-851. [PMID: 29096795 DOI: 10.1016/j.jchf.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022]
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32
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Tugcu A, Russo C, Jin Z, Homma S, Nakanishi K, Elkind MSV, Rundek T, Sacco RL, Di Tullio MR. Association of body size metrics with left atrial phasic volumes and reservoir function in the elderly. Eur Heart J Cardiovasc Imaging 2017; 19:1157-1164. [DOI: 10.1093/ehjci/jex236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/13/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Aylin Tugcu
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Cesare Russo
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Koki Nakanishi
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology and Epidemiology, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA
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Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Tugcu A, Sacco RL, Di Tullio MR. Association of Blood Pressure Control Level With Left Ventricular Morphology and Function and With Subclinical Cerebrovascular Disease. J Am Heart Assoc 2017; 6:JAHA.117.006246. [PMID: 28757483 PMCID: PMC5586460 DOI: 10.1161/jaha.117.006246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Left ventricular (LV) hypertrophy and subclinical cerebrovascular disease are early manifestations of cardiac and brain target organ damage caused by hypertension. This study aimed to investigate whether intensive office systolic blood pressure (SBP) control has beneficial effects on LV morphology and function and subclinical cerebrovascular disease in elderly patients with hypertension. Methods and Results We examined 420 patients treated for hypertension without history of heart failure and stroke from the CABL (Cardiovascular Abnormalities and Brain Lesions) study. All patients underwent 2‐dimensional echocardiographic examination and brain magnetic resonance imaging. Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume. Patients were divided into 3 groups: SBP <120 mm Hg (intensive control); SBP 120 to 139 mm Hg (less intensive control); and SBP ≥140 mm Hg (uncontrolled). Prevalence of LV hypertrophy and diastolic dysfunction were lowest in the intensive control, intermediate in the less intensive control, and highest in the uncontrolled groups (12.8%, 31.8%, and 44.7%, respectively [P<0.001], for LV hypertrophy; 46.8%, 61.7%, and 72.6%, respectively [P=0.003], for diastolic dysfunction). Patients with less intensive SBP control had greater risk of LV hypertrophy than those with intensive control (adjusted odds ratio, 3.26; P=0.013). A similar trend was observed for LV diastolic dysfunction but did not reach statistical significance (adjusted odds ratio, 1.65; P=0.144). Conversely, intensive SBP control was not significantly associated with reduced risk of silent brain infarcts and white matter hyperintensity volume compared with less intensive control. Conclusions Compared with less intensive control, intensive SBP control may have a stronger beneficial effect on cardiac than cerebral subclinical disease.
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Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL.,Department of Human Genetics, Miller School of Medicine, University of Miami, FL
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Mitter SS, Shah SJ, Thomas JD. A Test in Context: E/A and E/e' to Assess Diastolic Dysfunction and LV Filling Pressure. J Am Coll Cardiol 2017; 69:1451-1464. [PMID: 28302294 DOI: 10.1016/j.jacc.2016.12.037] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 02/08/2023]
Abstract
Diastolic dysfunction represents a combination of impaired left ventricular (LV) relaxation, restoration forces, myocyte lengthening load, and atrial function, culminating in increased LV filling pressures. Current Doppler echocardiography guidelines recommend using early to late diastolic transmitral flow velocity (E/A) to assess diastolic function, and E to early diastolic mitral annular tissue velocity (E/e') to estimate LV filling pressures. Although both parameters have important diagnostic and prognostic implications, they should be interpreted in the context of a patient's age and the rest of the echocardiogram to describe diastolic function and guide patient management. This review discusses: 1) the physiological basis for the E/A and E/e' ratios; 2) their roles in diagnosing diastolic dysfunction; 3) prognostic implications of abnormalities in E/A and E/e'; 4) special scenarios of the E/A and E/e' ratios that are either useful or challenging when evaluating diastolic function clinically; and 5) their usefulness in guiding therapeutic decision making.
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Affiliation(s)
- Sumeet S Mitter
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Kain V, Halade GV. Metabolic and Biochemical Stressors in Diabetic Cardiomyopathy. Front Cardiovasc Med 2017; 4:31. [PMID: 28620607 PMCID: PMC5449449 DOI: 10.3389/fcvm.2017.00031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) or diabetes-induced cardiac dysfunction is a direct consequence of uncontrolled metabolic syndrome and is widespread in US population and worldwide. Despite of the heterogeneous and distinct features of DCM, the clinical relevance of DCM is now becoming established. DCM progresses to pathological cardiac remodeling with the higher risk of heart attack and subsequent heart failure in diabetic patients. In this review, we emphasize lipid substrate quality and the phenotypic, metabolic, and biochemical stressors of DCM in the rodent and human pathophysiology. We discuss lipoxygenase signaling in the inflammatory pathway with multiple contributing and confounding factors leading to DCM. Additionally, emerging biochemical pathways are emphasized to make progress toward therapeutic advancement to treat DCM.
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Affiliation(s)
- Vasundhara Kain
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ganesh V Halade
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Abstract
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals. Blood pressure lowering using antihypertensive medications can improve LVDD; however, it remains unclear whether this improvement in LV diastolic function can improve cardiovascular outcomes.
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Affiliation(s)
- Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Nakanishi K, Jin Z, Russo C, Homma S, Elkind MS, Rundek T, Tugcu A, Sacco RL, Di Tullio MR. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 2016; 24:392-398. [PMID: 27856809 DOI: 10.1177/2047487316679903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study investigated the relationship between CKD and left atrial (LA) volume and function in a sample of the general population without overt cardiac disease. Design and methods We examined 358 participants from the Cardiovascular Abnormalities and Brain Lesions study. The LA minimum volume index (LAVImin), LA maximum volume index (LAVImax), and LA emptying fraction (LAEF) were assessed by real-time three-dimensional echocardiography. Based on their estimated glomerular filtration rate (eGFR), the participants were divided into a CKD group (eGFR <60 ml/min/1.73 m2) and a non-CKD group (eGFR ≥60 ml/min/1.73 m2). Results Of the 358 participants, 69 (19%) were classified as having CKD and 289 (81%) as non-CKD. Participants with CKD were older, had a greater prevalence of hypertension and use of antihypertensive drugs, a larger left ventricular (LV) mass index, and a higher prevalence of diastolic dysfunction than those without CKD (all p < 0.05). There was no significant difference in LAVImax between the CKD and non-CKD groups (23.4 ± 7.1 vs. 22.8 ± 5.8 ml/m2, p = 0.47), whereas significant differences were observed for LAVImin (13.6 ± 5.5 vs. 12.0 ± 4.6 ml/m2, p = 0.01) and LAEF (42.7 ± 11.4 vs. 47.8 ± 11.5%, p = 0.001). Multivariate regression analysis revealed that the eGFR was significantly associated with LAEF independent of age, LV mass index, and diastolic dysfunction (all p < 0.05). Conclusions Participants with CKD in an unselected community-based cohort had significantly impaired LA reservoir function. Assessment of LA function may add important information in the prognostic assessment of patients with CKD even in the absence of overt cardiac disease.
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Affiliation(s)
| | - Zhezhen Jin
- 2 Department of Biostatistics, Columbia University, USA
| | - Cesare Russo
- 1 Department of Medicine, Columbia University, USA
| | | | - Mitchell Sv Elkind
- 3 Department of Neurology, Columbia University, USA.,4 Department of Epidemiology, Columbia University, USA
| | - Tatjana Rundek
- 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.,6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA
| | - Aylin Tugcu
- 1 Department of Medicine, Columbia University, USA
| | - Ralph L Sacco
- 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.,6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA.,7 Department of Human Genetics, Miller School of Medicine, University of Miami, USA
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38
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Lee SL, Daimon M, Nakao T, Singer DE, Shinozaki T, Kawata T, Kimura K, Hirokawa M, Kato TS, Mizuno Y, Watanabe M, Yatomi Y, Yamazaki T, Komuro I. Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors? J Cardiol 2016; 68:275-81. [DOI: 10.1016/j.jjcc.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
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Perceived Discrimination and Nocturnal Blood Pressure Dipping Among Hispanics: The Influence of Social Support and Race. Psychosom Med 2016; 78:841-50. [PMID: 27136505 PMCID: PMC5003673 DOI: 10.1097/psy.0000000000000341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Little is known about the relationship of perceived racism to ambulatory blood pressure (ABP) in Hispanics. We explored possible associations between ABP nocturnal dipping and perceived racism in a Hispanic cohort. METHODS Participants included 180 community-dwelling Hispanics from the Northern Manhattan Study. Measures included perceived racism, socioeconomic status, social support, and ABP monitoring. Nocturnal ABP nondipping was defined as a less than 10% decline in the average asleep systolic blood pressure relative to the awake systolic blood pressure. RESULTS Overall, 77.8% of participants reported some form of perceived racism (Perceived Ethnic Discrimination Questionnaire scores >1.0). Greater social support was associated with less perceived discrimination (Spearman r = -0.54, p < .001). Those with higher perceived discrimination scores reported more depressive symptoms (r = 0.25, p < .001). Those with higher Perceived Ethnic Discrimination Questionnaire scores were less likely to show nocturnal ABP nondipping in multivariate models (odds ratio = 0.40, confidence interval = 0.17-0.98, p = .045). Among those with low perceived racism, black Hispanic participants were more likely to have nocturnal ABP nondipping (82.6%) compared with white Hispanics (53.9%; p = .02). Among those with high perceived racism, no associations between race and the prevalence of ABP nondipping was found (black Hispanic = 61.5% versus white Hispanic = 51.4%, p = .39; p interaction = .89). CONCLUSIONS Perceived racism is relatively common among US Hispanics and is associated with ABP. Nondipping of ABP, a potential cardiovascular risk factor, was more common in black Hispanic participants with low perceived racism. This finding may reflect different coping mechanisms between black versus white Hispanics and related blood pressure levels during daytime exposures to discrimination.
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40
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Zhan Y, Hu D, Yu J. Current status of glucose test prescription for hypertensive outpatients. Clin Exp Hypertens 2016; 38:550-4. [PMID: 27392259 DOI: 10.3109/10641963.2016.1174250] [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: 11/13/2022]
Abstract
OBJECTIVES The prescription of glucose test for essential hypertensive patients is estimated to be very low in cardiology clinics, but it has not been well studied. The aim of the present study aimed to investigate glucose test prescription for the hypertensive outpatients. METHODS Five thousand two hundred and forty hypertensive outpatients without previous known diabetes were recruited consecutively by cardiologists from >90 hospitals. Blood glucose prescription records were collected by special investigators. RESULTS Of the 5240 hypertensive outpatients recruited, only 258 (4.92%) were prescribed glucose tests, and 12.17% and 42.61% of them were diagnosed with diabetes mellitus and impaired glucose tolerance, respectively. Patients' hypertension stage, cardiovascular disease history, diabetes family history, dyslipidemia, and hospital level were associated with higher odds of glucose tests prescription. CONCLUSION Glucose tests were poorly prescribed for hypertensive outpatients in China. It was highly recommended to raise cardiologists' awareness to prescribe glucose tests for hypertensive outpatients who were with high cardiovascular risk factors.
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Affiliation(s)
- Yiqiang Zhan
- a School of Public Health , Institute of Clinical Epidemiology, Fudan University , Shanghai , P. R. China
| | - Dayi Hu
- b Heart Center , Peking University People's Hospital , Beijing , P. R. China
| | - Jinming Yu
- a School of Public Health , Institute of Clinical Epidemiology, Fudan University , Shanghai , P. R. China
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41
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Smith C, Asrar Ul Haq M, Jerums G, Hanson E, Hayes A, Allen JD, Sbaraglia M, Selig S, Wong C, Hare DL, Levinger I. Assessing the Value of BMI and Aerobic Capacity as Surrogate Markers for the Severity of Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Who Are Obese. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:61-5. [PMID: 27199576 PMCID: PMC4869605 DOI: 10.4137/cmc.s38116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/05/2022]
Abstract
Left ventricular diastolic dysfunction (LVDD) is one of the earliest signs for abnormal cardiac function in patients with type 2 diabetes (T2DM). It is important to explore the risk factors that will assist in identifying the severity of the LVDD in this population. We examined the influences of fitness and fatness on the level of left ventricular (LV) impairment in patients with T2DM. Twenty-five patients (age: 64.0 ± 2.5 years, body mass index [BMI] = 36.0 ± 1.5 kg/m(2), mean ± standard error of measurement) with T2DM and preserved systolic function, but impaired diastolic function, mitral valve (MV) E/e', participated in the study. LV function was assessed using a stress echocardiograph, aerobic power was assessed with a sign- and symptom-limited graded exercise test, and the fatness level was assessed using Dual-energy X-ray absorptiometry and BMI. Patients in the higher 50% of BMI had higher lateral and septal MV E/e' (∼34% and ∼25%, respectively, both P < 0.001), compared to those in the lower 50% of BMI, with no difference in LV ejection fraction (LVEF) (P > 0.05). In addition, a higher BMI correlated with a higher lateral (r = 0.62, P < 0.001) and septal (r = 0.56, P < 0.01) E/e'. There was no such relationship for VO2peak. BMI and VO2peak were not correlated with LV systolic function (ejection fraction). In individuals with T2DM and diastolic dysfunction, a higher BMI was associated with worsening diastolic function independent of their aerobic capacity. The data provide a simple and practical approach for clinicians to assist in the early identification and diagnostics of functional changes in the heart diastolic function in this population.
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Affiliation(s)
- Cassandra Smith
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Muhammad Asrar Ul Haq
- University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
| | - George Jerums
- University of Melbourne and the Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Erik Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Alan Hayes
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.; Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Jason D Allen
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Melissa Sbaraglia
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Steve Selig
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - Chiew Wong
- University of Melbourne and Western Health, Melbourne, Australia
| | - David L Hare
- University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
| | - Itamar Levinger
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.; University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
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Russo C, Sera F, Jin Z, Palmieri V, Homma S, Rundek T, Elkind MSV, Sacco RL, Di Tullio MR. Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: A population-based cohort study. Eur J Heart Fail 2016; 18:537-44. [PMID: 27109744 DOI: 10.1002/ejhf.521] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/23/2016] [Accepted: 02/12/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS General obesity, measured by body mass index (BMI), and abdominal adiposity, measured as waist circumference (WC) and waist-to-hip ratio (WHR), are associated with heart failure and cardiovascular events. However, the relationship of general and abdominal obesity with subclinical left ventricular (LV) dysfunction is unknown. We assessed the association of general and abdominal obesity with subclinical LV systolic dysfunction in a population-based elderly cohort. METHODS AND RESULTS Participants from the Cardiovascular Abnormalities and Brain Lesions study underwent measurement of BMI, WC, and WHR. Left ventricular systolic function was assessed by two-dimensional echocardiographic LV ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS). The study population included 729 participants (mean age 71 ± 9 years, 60% women). In multivariate analysis, higher BMI (but not WC and WHR) was associated with higher LVEF (β = 0.11, P = 0.003). Higher WC (β = 0.08, P = 0.038) and higher WHR (β = 0.15, P < 0.001) were associated with lower GLS, whereas BMI was not (P = 0.720). Compared with normal WHR, high WHR was associated with lower GLS in all BMI categories (normal, overweight, and obese), and was associated with subclinical LV dysfunction by GLS both in participants without [adjusted odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.6, P = 0.020] and with general obesity (adjusted OR 5.4, 95% CI 1.1-25.9, P = 0.034). WHR was incremental to BMI and risk factors in predicting LV dysfunction. CONCLUSION Abdominal adiposity was independently associated with subclinical LV systolic dysfunction by GLS in all BMI categories. BMI was not associated with LV dysfunction. Increased abdominal adiposity may be a risk factor for LV dysfunction regardless of the presence of general obesity.
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Affiliation(s)
- Cesare Russo
- Department of Medicine, Columbia University, New York, NY, USA
| | - Fusako Sera
- Department of Medicine, Columbia University, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Vittorio Palmieri
- Cardiology Unit, Department of Heart and Vessels, S.G. Moscati National Hospital, Avellino, Italy
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, Department of Public Health Sciences, University of Miami, Miami, FL, USA.,Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
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Yang H, Wang Y, Negishi K, Nolan M, Marwick TH. Pathophysiological effects of different risk factors for heart failure. Open Heart 2016; 3:e000339. [PMID: 27042319 PMCID: PMC4800761 DOI: 10.1136/openhrt-2015-000339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/07/2015] [Accepted: 01/08/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hypertension and type 2 diabetes mellitus (T2DM) are important causes of non-ischaemic heart failure (HF). Understanding the pathophysiology of early HF may guide screening. We hypothesised that the underlying physiology differed according to aetiology. Methods In this cross-sectional study of 521 asymptomatic community-based subjects ≥65 years with ≥1 HF risk factors, 187 participants (36%) had T2DM and hypertension (T2DM+/HTN+), 109 (21%) had T2DM with no hypertension (T2DM+/HTN−) and 72 (14%) had neither T2DM nor hypertension (T2DM−/HTN−). In 153 patients (29%), clinic blood pressure was ≥140/90 mm Hg, defined as active hypertension (T2DM−/HTN+). All underwent a comprehensive echocardiogram, including conventional parameters for systolic and diastolic function as well as global longitudinal strain (GLS), diastolic strain (DS) and DS rate (DSR). A 6 min walk (6MW) test was used to assess functional capacity. Results GLS in T2DM−/HTN+ group (−18.9±2.7%) was similar to that in T2DM−/HTN− group (−19.4±2.4%) and greater than T2DM+/HTN− (−18.0±2.8%, p=0.005). DS in T2DM−/HTN− (0.47±0.15%) exceeded that in T2DM−/HTN+ (0.43±0.14%) and T2DM+/HTN− (0.43±0.13%). 6MW distance was preserved in T2DM−/HTN+ (482±85 m) and reduced in T2DM+/HTN− (469±93, p<0.001). Those with T2DM and active hypertension had worst GLS, DS, DSR and shortest 6MW distance (p<0.002). In multivariable analysis, GLS was associated with T2DM but neither active hypertension nor a history of hypertension. Diastolic markers and left ventricular (LV) mass were associated with hypertension and T2DM. Thus, patients with HF risk factors show different functional disturbances according to aetiology. Conclusions Patients with hypertension had relatively less impaired GLS and preserved 6MW distance but more impaired diastolic function.
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Affiliation(s)
- Hong Yang
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Ying Wang
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Mark Nolan
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
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Lee SL, Daimon M, Di Tullio MR, Homma S, Nakao T, Kawata T, Kimura K, Shinozaki T, Hirokawa M, Kato TS, Mizuno Y, Watanabe M, Yatomi Y, Yamazaki T, Komuro I. Relationship of Left Ventricular Diastolic Function to Obesity and Overweight in a Japanese Population With Preserved Left Ventricular Ejection Fraction. Circ J 2016; 80:1951-6. [DOI: 10.1253/circj.cj-16-0381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seitetsu L. Lee
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
| | - Masao Daimon
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
- Department of Clinical Laboratory, the University of Tokyo Hospital
| | | | | | - Tomoko Nakao
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
- Department of Clinical Laboratory, the University of Tokyo Hospital
| | - Takayuki Kawata
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
| | - Koichi Kimura
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
| | | | - Megumi Hirokawa
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
| | - Tomoko S. Kato
- Department of Clinical Laboratory, the University of Tokyo Hospital
- Heart Center, Juntendo University School of Medicine
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
- Department of Clinical Epidemiology and Systems, the University of Tokyo Hospital
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
| | - Yutaka Yatomi
- Department of Clinical Laboratory, the University of Tokyo Hospital
| | - Tsutomu Yamazaki
- Clinical Research Support Center, the University of Tokyo Hospital
| | - Issei Komuro
- Department of Cardiovascular Medicine, the University of Tokyo Hospital
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45
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Gu H, Liu Y, Mei S, Wang B, Sun G, Wang X, Xiao Y, Staup M, Gregoire FM, Chng K, Wang YJ. Left ventricular diastolic dysfunction in nonhuman primate model of dysmetabolism and diabetes. BMC Cardiovasc Disord 2015; 15:141. [PMID: 26518730 PMCID: PMC4628306 DOI: 10.1186/s12872-015-0133-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is one of the major risk factors for cardiomyopathy and heart failure with reduced ejection fraction (EF) and highly associated with left ventricular (LV) dysfunction in human. This study aimed 1) to noninvasively assess cardiac function using echocardiography; 2) to test the hypothesis that like diabetic human, cardiac function may also be compromised; in spontaneously developed obese, dysmetabolic and diabetic nonhuman primates (NHPs). METHODS Cardiovascular functions were measured by noninvasive echocardiography in 28 control, 20 dysmetabolic/pre-diabetic and 41 diabetic cynomolgus monkeys based on fasting blood glucose and other metabolic status. RESULTS The LV end-systolic volume (ESV) was higher while end-diastolic volume (EDV, 12 ± 5.7 mL) and EF (63 ± 12.8 %) significantly lower in the diabetic compared to control (14 ± 7 mL and 68 ± 9.8 %) group, respectively. The E/A ratio of LV trans-mitral peak flow rate during early (E) over late (A) diastole was significantly lower in the diabetic (1.19 ± 0.45) than control (1.44 ± 0.48) group. E-wave deceleration time (E DT) was prolonged in the diabetic (89 ± 41 ms) compared to control (78 ± 26 ms) group. Left atrial (LA) maximal dimension (LADmax) was significantly greater in the diabetic (1.3 ± 0.17 cm) than control (1.1 ± 0.16 cm) group. Biochemical tests showed that total cholesterol and LDL were significant higher in the diabetic (167 ± 63 and 69 ± 37 mg/dL) than both pre-diabetic (113 ± 37 and 41 ± 23 mg/dL) and control (120 ± 28 and 41 ± 17 mg/dL) groups, respectively. Multivariable logistic regression analysis demonstrated that LV systolic (reduced EF) and diastolic (abnormal E/A ratio) dysfunctions are significantly correlated with aging and hyperglycemia. Histopathology examination of the necropsy heart revealed inflammatory infiltration, cardiomyocyte hypertrophy and fragmentation, indicating the myocardial ischemia and remodeling which is consistent with the LV dysfunction phenotype. CONCLUSIONS Using noninvasive echocardiography, the present study demonstrated for the first time that dysmetabolic and diabetic NHPs are associated with LV systolic (increased ESV, decreased EF, etc.) and diastolic (decreased EDV and E/A ratio, prolonged E DT, etc.) dysfunctions, accompanied by LA hypertrophic remodeling (increased LADmax), the phenotypes similarly to those found in diabetic patients. Thus, spontaneously developed dysmetabolic and diabetic NHPs is a highly translatable model to human diseases not only in the pathogenic mechanisms but also can be used for testing novel therapies for cardiometabolic disorders.
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Affiliation(s)
- Haihua Gu
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Yongqiang Liu
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Shuang Mei
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Bingdi Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Guofeng Sun
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Xiaoli Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Yongfu Xiao
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Michael Staup
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Francine M Gregoire
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Keefe Chng
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Yixin Jim Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China. .,Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
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Minoo F, Mahdavi Mazdeh M, Abasi MR. Association of micro albuminuria with diastolic function in obese normotensive no diabetic individuals. Nephrourol Mon 2015; 6:e22386. [PMID: 25738115 PMCID: PMC4330686 DOI: 10.5812/numonthly.22386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/11/2014] [Accepted: 08/16/2014] [Indexed: 02/05/2023] Open
Abstract
Background: Recently, an association between impaired diastolic function and increased urinary albumin excretion has been hypothesized. Objectives: We tried to assess the association between diastolic function and micro albuminuria in normotensive no diabetic obese individuals. Patients and Methods: This cross-sectional study was conducted on 186 consecutive obese normotensive no diabetic individuals who were older than 18 years and attended the outpatient health clinic at the Tehran Municipality in 2011. Systolic and diastolic blood pressures were measured using a standard mercury sphygmomanometer. Micro albuminuria was defined as abnormal urinary albumin to creatinine ratio (UACR) between 30 and 300 mg/g/d. Results: An adverse significant linear correlations was found between the UACR measurement and diastolic function (r = -0.184 and P = 0.012); however, this correlation was insignificant for systolic function (r = 0.007 and P = 0.926). Multivariable linear regression analysis showed that UACR index had a significant reverse correlation with diastolic function (Standardized Beta = -0.218 and P = 0.006). Conclusions: Our study obtained some evidences on the association of micro albuminuria with diastolic dysfunction in obese normotensive no diabetic individuals. Nonetheless, more assessment is necessary for obtaining a causal relationship between micro albuminuria and diastolic dysfunction.
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Affiliation(s)
- Farzanehsadat Minoo
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Farzanehsadat Minoo, Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2166581568, Fax: +98-2166581568, E-mail:
| | - Mitra Mahdavi Mazdeh
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Reza Abasi
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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47
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Pareek M, Nielsen ML, Gerke O, Leósdóttir M, Møller JE, Hindersson P, Sehestedt TB, Wachtell K, Nilsson PM, Olsen MH. Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricular mass in a supra-additive fashion in an elderly, healthy, Swedish population. Int J Cardiol 2015; 184:466-472. [PMID: 25756566 DOI: 10.1016/j.ijcard.2015.03.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/02/2015] [Indexed: 01/07/2023]
Abstract
AIMS To examine whether increasing fasting plasma glucose (FPG) levels were associated with worsening left ventricular (LV) diastolic function, independently of LV mass index (LVMI) in elderly, otherwise healthy subjects. METHODS AND RESULTS We tested cross-sectional associations between echocardiographically determined averaged E/é ratio/diastolic function, LVMI, cardiovascular risk factors, and FPG categorized as normal (NFG), impaired (IFG), and new-onset diabetes mellitus (DM), in 483 men and 208 women aged 56-79 years without overt cardiovascular disease, who received no cardiovascular, anti-diabetic, or lipid-lowering drugs and had a preserved LV ejection fraction >50%. Median E/é was significantly higher among subjects with diabetes than those without (8 vs. 7; p = 0.03), as was the prevalence of grade 2 or 3 diastolic dysfunction (25% vs. 16%; p = 0.02). E/é and diastolic function were significantly associated with LVMI (p ≤ 0.002), but not FPG category, on multivariable analysis. However, interaction analyses revealed that increasing LVMI was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG > 6 mmol/L (β=0.005 for IFG and DM vs. 0.001 for NFG; p = 0.02), whereas increasing systolic blood pressure was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG ≤ 6.9 mmol/L (β = 0.005 for NFG and 0.003 for IFG vs. -0.001 for DM; p=0.001). CONCLUSION Diastolic dysfunction was significantly more prevalent among patients with DM than those without. The importance of LVMI increased, but the importance of systolic blood pressure decreased with higher FPG category.
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Affiliation(s)
- Manan Pareek
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark.
| | - Mette Lundgren Nielsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Peter Hindersson
- Department of Clinical Biochemistry, Holstebro Hospital, Holstebro, Denmark
| | | | - Kristian Wachtell
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Michael Hecht Olsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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Johnson EJ, Dieter BP, Marsh SA. Evidence for distinct effects of exercise in different cardiac hypertrophic disorders. Life Sci 2015; 123:100-6. [PMID: 25632833 PMCID: PMC4339313 DOI: 10.1016/j.lfs.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/05/2014] [Accepted: 01/02/2015] [Indexed: 02/08/2023]
Abstract
Aerobic exercise training (AET) attenuates or reverses pathological cardiac remodeling after insults such as chronic hypertension and myocardial infarction. The phenotype of the pathologically hypertrophied heart depends on the insult; therefore, it is likely that distinct types of pathological hypertrophy require different exercise regimens. However, the mechanisms by which AET improves the structure and function of the pathologically hypertrophied heart are not well understood, and exercise research uses highly inconsistent exercise regimens in diverse patient populations. There is a clear need for systematic research to identify precise exercise prescriptions for different conditions of pathological hypertrophy. Therefore, this review synthesizes existing evidence for the distinct mechanisms by which AET benefits the heart in different pathological hypertrophy conditions, suggests strategic exercise prescriptions for these conditions, and highlights areas for future research.
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Affiliation(s)
- Emily J Johnson
- Graduate Program in Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - Brad P Dieter
- Graduate Program in Movement Sciences, College of Education, University of Idaho, Moscow, ID, USA; Section of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - Susan A Marsh
- Section of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA.
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Relative impact of blood pressure as compared to an excess adiposity on left ventricular diastolic dysfunction in a community sample with a high prevalence of obesity. J Hypertens 2014; 32:2457-64; discussion 2464. [DOI: 10.1097/hjh.0000000000000330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Jin Q, Lou Y, Chen H, Li T, Bao X, Liu Q, He X. Lower free testosterone level is correlated with left ventricular diastolic dysfunction in asymptomatic middle-aged men with type 2 diabetes mellitus. Int J Clin Pract 2014; 68:1454-61. [PMID: 25040479 DOI: 10.1111/ijcp.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Low testosterone (T) level is associated with cardiovascular risk factors. However, the relationship between T level and heart function in asymptomatic men with type 2 diabetes mellitus (T2DM) is unknown. METHODS A total of 325 men were recruited who had no history, symptoms, or signs of heart disease. RESULTS T2DM had significantly lower free T (FT) levels than those with normal glucose metabolism (NGM) (428 ± 38 pmol/l vs. 444 ± 38 pmol/l, p = 0.0002), and had an increased risk of LVDD (66.1% vs. 31.8%). There was a significant difference in FT level between subjects with and without LVDD among those with T2DM (421 ± 37 pmol/l vs. 442 ± 40 pmol/l, p = 0.0007), but not among those with NGM (439 ± 37 pmol/l vs. 447 ± 39 pmol/l, p = 0.247) or in the group overall (426 ± 38 pmol/l vs. 445 ± 38 pmol/l, p = 0.156). Lower FT level was significantly associated with LVDD [univariate odds ratio (OR) = 0.63, p = 0.032; multivariate OR = 0.71, p = 0.039]. Receiver operating characteristic curve analysis of the usefulness of FT level for predicting LVDD showed an area under the curve (AUC) of 0.85 for T2DM (p < 0.001) and 0.66 for NGM (p < 0.05). FT level had a high predictive value for LVDD in T2DM (83% for FT < 414 pmol/l), but a low predictive value in NGM (61% for FT < 423 pmol/l). Comparison of the AUCs showed that FT level was more strongly correlated with LVDD in T2DM than in NGM. CONCLUSIONS Lower FT level is correlated with LVDD in asymptomatic middle-aged men with T2DM.
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Affiliation(s)
- Q Jin
- Department of Geriatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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