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Gopalasingam N, Moeslund N, Christensen KH, Berg‐Hansen K, Seefeldt J, Homilius C, Nielsen EN, Dollerup MR, Alstrup Olsen AK, Johannsen M, Boedtkjer E, Møller N, Eiskjær H, Gormsen LC, Nielsen R, Wiggers H. Enantiomer-Specific Cardiovascular Effects of the Ketone Body 3-Hydroxybutyrate. J Am Heart Assoc 2024; 13:e033628. [PMID: 38563382 PMCID: PMC11262493 DOI: 10.1161/jaha.123.033628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The ketone body 3-hydroxybutyrate (3-OHB) increases cardiac output (CO) by 35% to 40% in healthy people and people with heart failure. The mechanisms underlying the effects of 3-OHB on myocardial contractility and loading conditions as well as the cardiovascular effects of its enantiomeric forms, D-3-OHB and L-3-OHB, remain undetermined. METHODS AND RESULTS Three groups of 8 pigs each underwent a randomized, crossover study. The groups received 3-hour infusions of either D/L-3-OHB (racemic mixture), 100% L-3-OHB, 100% D-3-OHB, versus an isovolumic control. The animals were monitored with pulmonary artery catheter, left ventricle pressure-volume catheter, and arterial and coronary sinus blood samples. Myocardial biopsies were evaluated with high-resolution respirometry, coronary arteries with isometric myography, and myocardial kinetics with D-[11C]3-OHB and L-[11C]3-OHB positron emission tomography. All three 3-OHB infusions increased 3-OHB levels (P<0.001). D/L-3-OHB and L-3-OHB increased CO by 2.7 L/min (P<0.003). D-3-OHB increased CO nonsignificantly (P=0.2). Circulating 3-OHB levels correlated with CO for both enantiomers (P<0.001). The CO increase was mediated through arterial elastance (afterload) reduction, whereas contractility and preload were unchanged. Ex vivo, D- and L-3-OHB dilated coronary arteries equally. The mitochondrial respiratory capacity remained unaffected. The myocardial 3-OHB extraction increased only during the D- and D/L-3-OHB infusions. D-[11C]3-OHB showed rapid cardiac uptake and metabolism, whereas L-[11C]3-OHB demonstrated much slower pharmacokinetics. CONCLUSIONS 3-OHB increased CO by reducing afterload. L-3-OHB exerted a stronger hemodynamic response than D-3-OHB due to higher circulating 3-OHB levels. There was a dissocitation between the myocardial metabolism and hemodynamic effects of the enantiomers, highlighting L-3-OHB as a potent cardiovascular agent with strong hemodynamic effects.
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Affiliation(s)
- Nigopan Gopalasingam
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyGødstrup HospitalHerningDenmark
| | - Niels Moeslund
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Heart, Lung and Vascular SurgeryAarhus University HospitalAarhusDenmark
| | - Kristian Hylleberg Christensen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kristoffer Berg‐Hansen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Jacob Seefeldt
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | | | - Erik Nguyen Nielsen
- Department of Nuclear Medicine and PETAarhus University HospitalAarhusDenmark
| | | | - Aage K. Alstrup Olsen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Nuclear Medicine and PETAarhus University HospitalAarhusDenmark
| | | | | | - Niels Møller
- Department of Endocrinology and MetabolismAarhus UniversityAarhusDenmark
| | - Hans Eiskjær
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | | | - Roni Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Henrik Wiggers
- Department of CardiologyAarhus University HospitalAarhusDenmark
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Moriwaki K, Fujimoto N, Omori T, Miyahara S, Kameda I, Ishiyama M, Sugiura E, Nakamori S, Dohi K. Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction. ESC Heart Fail 2021; 8:4882-4892. [PMID: 34725954 PMCID: PMC8712776 DOI: 10.1002/ehf2.13682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
Aims Isometric handgrip (IHG) training reduces the blood pressure in patients with hypertension. It is unclear how IHG exercise affects the haemodynamics and cardiovascular function through the muscle reflex in patients with heart failure (HF) with reduced (HFrEF) and preserved ejection fraction (HFpEF). Methods and results Twenty patients (HFrEF: n = 10, HFpEF: n = 10) underwent left ventricular (LV) pressure–volume assessments using a conductance catheter and microtip manometer to evaluate haemodynamics, LV and arterial function, and LV‐arterial coupling during 3 min of IHG at 30% of maximal voluntary contraction (MVC), followed by 3 min of post‐exercise circulatory arrest (PECA). Three minutes of IHG exercise produced significant and modest increases in the heart rate (HR) and LV end‐systolic pressure (LVESP), respectively, in both HFpEF and HFrEF groups. In HFrEF, the increase in LVESP was caused by the variable increase in effective arterial elastance (Ea), which was counterbalanced by the increase in LV end‐systolic elastance (Ees), resulting in a maintained Ees/Ea. In HFpEF, the increase in LVESP was not accompanied by changes in Ea, Ees, Ees/Ea, or LV end‐diastolic pressure. LVESP during PECA was not maintained in HFpEF, suggesting smaller metabo‐reflex activity in HFpEF. Conclusions The IHG exercise used in this study may increase the LVESP and LVEDP without detrimental effects on cardiac function or ventricular‐arterial coupling, especially in HFpEF patients. The effects of IHG exercise on haemodynamics and ventricular‐arterial coupling may be affected by the patient background and the type and intensity of the exercise.
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Affiliation(s)
- Keishi Moriwaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - So Miyahara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Issei Kameda
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Masaki Ishiyama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Emiyo Sugiura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
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Takagi K, Ishihara S, Kenji N, Iha H, Kobayashi N, Ito Y, Nohara T, Ohkuma S, Mitsuishi T, Ishizuka A, Shigihara S, Sone M, Tokuyama H, Omote T, Kikuchi A, Nakamura S, Yamamoto E, Ishikawa M, Amitani K, Takahashi N, Maruyama Y, Imura H, Sato N, Shimizu W. Clinical significance of arterial stiffness as a factor for hospitalization of heart failure with preserved left ventricular ejection fraction: a retrospective matched case-control study. J Cardiol 2020; 76:171-176. [DOI: 10.1016/j.jjcc.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/18/2019] [Accepted: 02/12/2020] [Indexed: 12/28/2022]
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Williams RP, Asrress KN, Lumley M, Arri S, Patterson T, Ellis H, Manou‐Stathopoulou V, Macfarlane C, Chandran S, Moschonas K, Oakeshott P, Lockie T, Chiribiri A, Clapp B, Perera D, Plein S, Marber MS, Redwood SR. Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease. J Am Heart Assoc 2018; 7:e008837. [PMID: 30762468 PMCID: PMC6064824 DOI: 10.1161/jaha.118.008837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
Background Cold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual-sensor intracoronary wires measured coronary microvascular resistance ( MVR ) and blood flow velocity ( CBF ), and cardiac magnetic resonance measured subendocardial perfusion. Methods and Results Forty-two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5-minute supine-cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR , CBF , and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% ( P=0.41), increasing CBF by 20% ( P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% ( P<0.01), reducing CBF by 3% ( P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion ( P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% ( P<0.001) and increased CBF by 61% ( P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR ( P=0.12) and CBF ( P<0.05), an effect attributable to defective early diastolic CBF acceleration ( P<0.05) and associated with greater ST -segment depression ( P<0.05). Conclusions In patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF . These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand.
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Affiliation(s)
- Rupert P. Williams
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Kaleab N. Asrress
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Matthew Lumley
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Satpal Arri
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Tiffany Patterson
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Howard Ellis
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | | | - Catherine Macfarlane
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Shruthi Chandran
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Kostantinos Moschonas
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Pippa Oakeshott
- Population Health Research InstituteSt George's University of LondonUnited Kingdom
| | - Timothy Lockie
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Amedeo Chiribiri
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Brian Clapp
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Divaka Perera
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Sven Plein
- Leeds UniversityLeeds Teaching Hospitals NHS TrustLeedsUnited Kingdom
| | - Michael S. Marber
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Simon R. Redwood
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
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5
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Catino AB, Hubbard RA, Chirinos JA, Townsend R, Keefe S, Haas NB, Puzanov I, Fang JC, Agarwal N, Hyman D, Smith AM, Gordon M, Plappert T, Englefield V, Narayan V, Ewer S, ElAmm C, Lenihan D, Ky B. Longitudinal Assessment of Vascular Function With Sunitinib in Patients With Metastatic Renal Cell Carcinoma. Circ Heart Fail 2018; 11:e004408. [PMID: 29664405 PMCID: PMC6360089 DOI: 10.1161/circheartfailure.117.004408] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 02/08/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sunitinib, used widely in metastatic renal cell carcinoma, can result in hypertension, left ventricular dysfunction, and heart failure. However, the relationships between vascular function and cardiac dysfunction with sunitinib are poorly understood. METHODS AND RESULTS In a multicenter prospective study of 84 metastatic renal cell carcinoma patients, echocardiography, arterial tonometry, and BNP (B-type natriuretic peptide) measures were performed at baseline and at 3.5, 15, and 33 weeks after sunitinib initiation, correlating with sunitinib cycles 1, 3, and 6. Mean change in vascular function parameters and 95% confidence intervals were calculated. Linear regression models were used to estimate associations between vascular function and left ventricular ejection fraction, longitudinal strain, diastolic function (E/e'), and BNP. After 3.5 weeks of sunitinib, mean systolic blood pressure increased by 9.5 mm Hg (95% confidence interval, 2.0-17.1; P=0.02) and diastolic blood pressure by 7.2 mm Hg (95% confidence interval, 4.3-10.0; P<0.001) across all participants. Sunitinib resulted in increases in large artery stiffness (carotid-femoral pulse wave velocity) and resistive load (total peripheral resistance and arterial elastance; all P<0.05) and changes in pulsatile load (total arterial compliance and wave reflection). There were no statistically significant associations between vascular function and systolic dysfunction (left ventricular ejection fraction and longitudinal strain). However, baseline total peripheral resistance, arterial elastance, and aortic impedance were associated with worsening diastolic function and filling pressures over time. CONCLUSIONS In patients with metastatic renal cell carcinoma, sunitinib resulted in early, significant increases in blood pressure, arterial stiffness, and resistive and pulsatile load within 3.5 weeks of treatment. Baseline vascular function parameters were associated with worsening diastolic but not systolic function.
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Affiliation(s)
- Anna B Catino
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Rebecca A Hubbard
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Julio A Chirinos
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Ray Townsend
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Stephen Keefe
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Naomi B Haas
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Igor Puzanov
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - James C Fang
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Neeraj Agarwal
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - David Hyman
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Amanda M Smith
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Mary Gordon
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Theodore Plappert
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Virginia Englefield
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Vivek Narayan
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Steven Ewer
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Chantal ElAmm
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Daniel Lenihan
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.)
| | - Bonnie Ky
- From the Division of Cardiovascular Medicine (A.B.C., J.C.F.) and Division of Oncology (N.A.), Department of Medicine, University of Utah, Salt Lake City; Department of Biostatistics, Epidemiology and Informatics (R.A.H., B.K.), Division of Cardiology (J.A.C., D.H., A.M.S., T.P., V.E., B.K.), Division of Hematology and Oncology (S.K., N.B.H., V.N.), and Division of Nephrology (R.T.), Department of Medicine, and Abramson Cancer Center (S.K., N.B.H., V.N., B.K.), University of Pennsylvania, Philadelphia; Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (I.P.); Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison (S.E.); Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (C.E.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (M.G.); and Division of Cardiology, Department of Medicine, Washington University in St Louis, MO (D.L.).
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Chirinos JA, Phan TS, Syed AA, Hashmath Z, Oldland HG, Koppula MR, Tariq A, Javaid K, Miller R, Varakantam S, Dunde A, Neetha V, Akers SR. Late Systolic Myocardial Loading Is Associated With Left Atrial Dysfunction in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006023. [PMID: 28592592 DOI: 10.1161/circimaging.116.006023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late systolic load has been shown to cause diastolic dysfunction in animal models. Although the systolic loading sequence of the ventricular myocardium likely affects its coupling with the left atrium (LA), this issue has not been investigated in humans. We aimed to assess the relationship between the myocardial loading sequence and LA function in human hypertension. METHODS AND RESULTS We studied 260 subjects with hypertension and 19 normotensive age- and sex-matched controls. Time-resolved central pressure and left ventricular geometry were measured with carotid tonometry and cardiac magnetic resonance imaging, respectively, for computation of time-resolved ejection-phase myocardial wall stress (MWS). The ratio of late/early ejection-phase MWS time integrals was computed as an index of late systolic myocardial load. Atrial mechanics were measured with cine-steady-state free-precession magnetic resonance imaging using feature-tracking algorithms. Compared with normotensive controls, hypertensive participants demonstrated increased late/early ejection-phase MWS and reduced LA function. Greater levels of late/early ejection-phase MWS were associated with reduced LA conduit, reservoir, and booster pump LA function. In models that included early and late ejection-phase MWS as independent correlates of LA function, late systolic MWS was associated with lower, whereas early systolic MWS was associated with greater LA function, indicating an effect of the relative loading sequence (late versus early MWS) on LA function. These relationships persisted after adjustment for multiple potential confounders. CONCLUSIONS A myocardial loading sequence characterized by prominent late systolic MWS was independently associated with atrial dysfunction. In the context of available experimental data, our findings support the deleterious effects of late systolic loading on ventricular-atrial coupling.
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Affiliation(s)
- Julio A Chirinos
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA.
| | - Timothy S Phan
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Amer A Syed
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Zeba Hashmath
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Harry G Oldland
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Maheswara R Koppula
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Ali Tariq
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Khuzaima Javaid
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Rachana Miller
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Swapna Varakantam
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Anjaneyulu Dunde
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Vadde Neetha
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Scott R Akers
- From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (J.A.C., Z.H., S.V., A.D., V.N., M.R.K.); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., T.S.P., A.A.S., H.G.O., S.V.); and Department of Medicine (J.A.C., T.S.P., A.T., K.J., R.M., S.V.) and Department of Radiology (S.R.A.), Corporal Michael J. Crescenz VAMC, Philadelphia, PA
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Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations. J Cardiovasc Transl Res 2017; 10:261-274. [PMID: 28401511 DOI: 10.1007/s12265-017-9736-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 969] [Impact Index Per Article: 107.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chirinos JA, Segers P, Duprez DA, Brumback L, Bluemke DA, Zamani P, Kronmal R, Vaidya D, Ouyang P, Townsend RR, Jacobs DR. Late systolic central hypertension as a predictor of incident heart failure: the Multi-ethnic Study of Atherosclerosis. J Am Heart Assoc 2015; 4:e001335. [PMID: 25736440 PMCID: PMC4392425 DOI: 10.1161/jaha.114.001335] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. METHODS AND RESULTS We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/E(SPTI)) was assessed as a predictor of incident HF during median 8.5 years of follow-up. The L/E(SPTI) was predictive of incident HF (hazard ratio per 1% increase=1.22; 95% CI=1.15 to 1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95% CI=1.14 to 1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/E(SPTI) was the modifiable factor associated with the greatest improvements in model performance. A high L/E(SPTI) (>58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI=0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). CONCLUSIONS Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population.
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Affiliation(s)
- Julio A Chirinos
- Division of Cardiovascular, School of Medicine, University of Pennsylvania, Philadelphia, PA (J.A.C., P.Z.)
| | - Patrick Segers
- Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Future Health Department, Ghent University, Ghent, Belgium (P.S.)
| | - Daniel A Duprez
- Division of Cardiology, School of Medicine, University of Minnesota, Minneapolis, MN (D.A.D.)
| | - Lyndia Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA (L.B., R.K.)
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health (NIH) Clinical Center, Bethesda, MD (D.A.B.)
| | - Payman Zamani
- Division of Cardiovascular, School of Medicine, University of Pennsylvania, Philadelphia, PA (J.A.C., P.Z.)
| | - Richard Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA (L.B., R.K.)
| | | | - Pamela Ouyang
- Johns Hopkins School of Medicine, Baltimore, MD (D.V., P.O.)
| | - Raymond R Townsend
- Division of Nephrology/Hypertension, School of Medicine, University of Pennsylvania, Philadelphia, PA (R.R.T.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (D.R.J.) Department of Nutrition, University of Oslo, Norway (D.R.J.)
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Chirinos JA, Rietzschel ER, Shiva-Kumar P, De Buyzere ML, Zamani P, Claessens T, Geraci S, Konda P, De Bacquer D, Akers SR, Gillebert TC, Segers P. Effective arterial elastance is insensitive to pulsatile arterial load. Hypertension 2014; 64:1022-31. [PMID: 25069668 DOI: 10.1161/hypertensionaha.114.03696] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective arterial elastance (E(A)) was proposed as a lumped parameter that incorporates pulsatile and resistive afterload and is increasingly being used in clinical studies. Theoretical modeling studies suggest that E(A) is minimally affected by pulsatile load, but little human data are available. We assessed the relationship between E(A) and arterial load determined noninvasively from central pressure-flow analyses among middle-aged adults in the general population (n=2367) and a diverse clinical population of older adults (n=193). In a separate study, we investigated the sensitivity of E(A) to changes in pulsatile load induced by isometric exercise (n=73). The combination of systemic vascular resistance and heart rate predicted 95.6% and 97.8% of the variability in E(A) among middle-aged and older adults, respectively. E(A) demonstrated a quasi-perfect linear relationship with the ratio of systemic vascular resistance/heart period (middle-aged adults, R=0.972; older adults, R=0.99; P<0.0001). Aortic characteristic impedance, total arterial compliance, reflection magnitude, and timing accounted together for <1% of the variability in E(A) in either middle-aged or older adults. Despite pronounced changes in pulsatile load induced by isometric exercise, changes in E(A) were not independently associated with changes pulsatile load but were rather a nearly perfect linear function of the ratio of systemic vascular resistance/heart period (R=0.99; P<0.0001). Our findings demonstrate that E(A) is simply a function of systemic vascular resistance and heart rate and is negligibly influenced by (and insensitive to) changes in pulsatile afterload in humans. Its current interpretation as a lumped parameter of pulsatile and resistive afterload should thus be reassessed.
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Affiliation(s)
- Julio A Chirinos
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium.
| | - Ernst R Rietzschel
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Prithvi Shiva-Kumar
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Marc L De Buyzere
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Payman Zamani
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Tom Claessens
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Salvatore Geraci
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Prasad Konda
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Scott R Akers
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Thierry C Gillebert
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
| | - Patrick Segers
- From the Department of Medicine, Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C., P.Z.); Department of Medicine, Philadelphia VA Medical Center, PA (J.A.C., P.S.-K., S.R.A., S.G.); Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., D.D.B.); and Department of Public Health (E.R.R.), Department of Industrial Technology and Construction (T.C.), and Institute Biomedical Technology, iMinds Future Health Department (T.C., P.S.), Ghent University, Ghent, Belgium
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Chirinos JA, Segers P, Rietzschel ER, De Buyzere ML, Raja MW, Claessens T, De Bacquer D, St. John Sutton M, Gillebert TC. Early and Late Systolic Wall Stress Differentially Relate to Myocardial Contraction and Relaxation in Middle-Aged Adults. Hypertension 2013; 61:296-303. [DOI: 10.1161/hypertensionaha.111.00530] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Julio A. Chirinos
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Patrick Segers
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Ernst R. Rietzschel
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Marc L. De Buyzere
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Muhammad W. Raja
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Tom Claessens
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Dirk De Bacquer
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Martin St. John Sutton
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
| | - Thierry C. Gillebert
- From the Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA (J.A.C., M.W.R., M.S.J.S.); Institute Biomedical Technology (P.S., T.C.) and Department of Public Health (E.R.R., D.D.B.), Ghent University, Ghent, Belgium; Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium (E.R.R., M.L.D.B., T.C.G.); and Department of Mechanics, University College Ghent, Ghent, Belgium (T.C.)
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12
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Abstract
Interactions between the left ventricle (LV) and the arterial system, (ventricular-arterial coupling) are key determinants of cardiovascular function. Ventricularearterial coupling is most frequently assessed in the pressure-volume plane using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES). EA (usually interpreted as a lumped index of arterial load) can be computed as end-systolic pressure/stroke volume, whereas EES (a load-independent measure of LV chamber systolic stiffness and contractility) is ideally assessed invasively using data from a family of pressure-volume loops obtained during an acute preload alteration. Single-beat methods have also been proposed, allowing for non-invasive estimations of EES using simple echocardiographic measurements. The EA/EES ratio is useful because it provides information regarding the operating mechanical efficiency and performance of the ventricular-arterial system. However, it should be recognized that analyses in the pressure-volume plane have several limitations and that "ventricular-arterial coupling" encompasses multiple physiologic aspects, many of which are not captured in the pressure-volume plane. Therefore, additional assessments provide important incremental physiologic information about the cardiovascular system and should be more widely used. In particular, it should be recognized that: (1) comprehensive analyses of arterial load are important because EA poorly characterizes pulsatile LV load and does not depend exclusively on arterial properties; (2) The systolic loading sequence, an important aspect of ventricular-arterial coupling, is neglected by pressure-volume analyses, and can profoundly impact LV function, remodeling and progression to heart failure. This brief review summarizes methods for the assessment of ventricular-arterial interactions, as discussed at the Artery 12 meeting (October 2012).
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania, Philadelphia, PA, USA ; Philadelphia VA Medical Center, Philadelphia, PA, USA
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13
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Incremental Prognostic Values of Serum Tenascin-C Levels With Blood B-type Natriuretic Peptide Testing at Discharge in Patients With Dilated Cardiomyopathy and Decompensated Heart Failure. J Card Fail 2009; 15:898-905. [DOI: 10.1016/j.cardfail.2009.06.443] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 06/26/2009] [Accepted: 06/30/2009] [Indexed: 11/19/2022]
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Fujimoto N, Onishi K, Dohi K, Tanabe M, Kurita T, Takamura T, Yamada N, Nobori T, Ito M. Hemodynamic characteristics of patients with diastolic heart failure and hypertension. Hypertens Res 2009; 31:1727-35. [PMID: 18971551 DOI: 10.1291/hypres.31.1727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diastolic heart failure (DHF) has different underlying pathophysiologic mechanisms. We sought to compare hemodynamic characteristics in DHF patients with or without hypertension. A conductance catheter with microtip-manometer was used to measure left ventricular (LV) function and hemodynamics in 28 DHF patients. After baseline measurements, nitroglycerin was infused to alter the loading condition and the measurements were repeated. At baseline, end-systolic pressure was higher and the time constant of LV relaxation (tau) was longer in hypertensive DHF patients. Patients in hypertensive DHF had lower LV-arterial coupling ratio than those in non-hypertensive DHF. The peak of loading sequence was in early systole in non-hypertensive DHF patients and in late systole in hypertensive DHF patients. Nitroglycerin decreased LV end-systolic pressure and end-diastolic volume in both groups. In non-hypertensive DHF, nitroglycerin significantly reduced stroke volume and shortened tau (59+/-11 vs. 54+/-10 ms, p<0.05) without any changes in the time to peak LV force, effective arterial elastance (E(a)), or LV-arterial coupling ratio. In contrast, in hypertensive DHF patients, nitroglycerin significantly reduced E(a) and shortened the time to peak LV force, resulting in an improved LV-arterial coupling ratio, preserved stroke volume and shortened tau (75+/-14 vs. 62+/-13 ms, p<0.05). In conclusion, LV relaxation was more prolonged in hypertensive DHF patients than non-hypertensive DHF patients, partly because of the different loading sequence. Changing the loading condition by nitroglycerin improved LV systolic and diastolic function in hypertensive DHF patients.
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Affiliation(s)
- Naoki Fujimoto
- Department of Cardiology, Mie University Graduate School of Medicine, 2-175 Edobashi, Tsu, Japan
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Yamanaka T, Onishi K, Tanabe M, Dohi K, Funabiki-Yamanaka K, Fujimoto N, Kurita T, Tanigawa T, Kitamura T, Ito M, Nobori T, Nakano T. Force- and relaxation-frequency relations in patients with diastolic heart failure. Am Heart J 2006; 152:966.e1-7. [PMID: 17070168 DOI: 10.1016/j.ahj.2006.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 06/07/2006] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chronotropic effects on myocardial contractility (the positive force-frequency relation) and relaxation (the positive relaxation-frequency relation) are impaired in patients with congestive heart failure and depressed left ventricular (LV) ejection fraction (systolic heart failure [SHF]). However, the force- and relaxation-frequency relation and LV-arterial coupling in patients with diastolic heart failure (DHF) has not been fully investigated. METHODS AND RESULTS To examine inotropic and lusitropic responsiveness to atrial pacing, LV pressure-volume relations were measured using a conductance catheter and microtip manometer in patients with DHF (n = 18) and SHF (n = 11). In patients with SHF, an increase in heart rate by 40 beat/min did not affect LV end-systolic elastance (Ees), which reflects LV contractility, or the time constant of LV relaxation. By contrast, in patients with DHF, an increase in heart rate by 40 beat/min significantly enhanced Ees (2.1 vs 2.9 mm Hg/mL, P < .05) but not the time constant. Furthermore, LV-arterial coupling, quantified as Ees/arterial elastance, was impaired during pacing in patients with DHF (1.1 vs 0.8, P < .05) as well as SHF. CONCLUSIONS In patients with DHF, the force-frequency relation was preserved, but the relaxation-frequency relation was impaired. Furthermore, LV-arterial coupling was impaired as heart rate increased, which may be related to the impaired LV function. These results suggest that the impaired relaxation-frequency relation and exacerbated LV-arterial coupling during tachycardia may be an important therapeutic target in patients with DHF.
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Affiliation(s)
- Takashi Yamanaka
- The First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan
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