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Mandry D, Girerd N, Lamiral Z, Huttin O, Filippetti L, Micard E, Beaumont M, Ncho Mottoh MPB, Pace N, Zannad F, Rossignol P, Marie PY. Relationship Between Left Ventricular Ejection Fraction Variation and Systemic Vascular Resistance: A Prospective Cardiovascular Magnetic Resonance Study. Front Cardiovasc Med 2022; 8:803567. [PMID: 35004914 PMCID: PMC8739894 DOI: 10.3389/fcvm.2021.803567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: This cardiovascular magnetic resonance (CMR) study aims to determine whether changes in systemic vascular resistance (SVR), obtained from CMR flow sequences, might explain the significant long-term changes in left ventricular (LV) ejection fraction (EF) observed in subjects with no cardiac disease history. Methods: Cohort subjects without any known cardiac disease but with high rates of hypertension and obesity, underwent CMR with phase-contrast sequences both at baseline and at a median follow-up of 5.2 years. Longitudinal changes in EF were analyzed for any concomitant changes in blood pressure and vascular function, notably the indexed SVR given by the formula: mean brachial blood pressure / cardiac output x body surface area. Results: A total of 118 subjects (53 ± 12 years, 52% women) were included, 26% had hypertension, and 52% were obese. Eighteen (15%) had significant EF variations between baseline and follow-up (7 increased EF and 11 decreased EF). Longitudinal changes in EF were inversely related to concomitant changes in mean and diastolic blood pressures (p = 0.030 and p = 0.027, respectively) and much more significantly to SVR (p < 0.001). On average, these SVR changes were -8.08 ± 9.21 and +8.14 ± 8.28 mmHg.min.m2.L-1, respectively, in subjects with significant increases and decreases in EF, and 3.32 ± 7.53 mmHg.min.m2.L-1 in subjects with a stable EF (overall p < 0.001). Conclusions: Significant EF variations are not uncommon during the long-term CMR follow-up of populations with no evident health issues except for uncomplicated hypertension and obesity. However, most of these variations are linked to SVR changes and may therefore be unrelated to any intrinsic change in LV contractility. This underscores the benefits of specifically assessing LV afterload when EF is monitored in populations at risk of vascular dysfunction. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT01716819 and NCT02430805.
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Affiliation(s)
- Damien Mandry
- CHRU-Nancy, Université de Lorraine, Department of Radiology, Nancy, France.,Université de Lorraine, INSERM, UMR-1254, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Zohra Lamiral
- Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Laura Filippetti
- CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Emilien Micard
- Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Marine Beaumont
- Université de Lorraine, INSERM, UMR-1254, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | | | - Nathalie Pace
- CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France
| | - Faïez Zannad
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Cardiology, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, France.,FCRIN INI-CRCT, Nancy, France
| | - Pierre-Yves Marie
- Université de Lorraine, INSERM, UMR-1116, Nancy, France.,CHRU-Nancy, Université de Lorraine, Department of Nuclear Medicine and Nancyclotep, Nancy, France
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2
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Mandry D, Girerd N, Lamiral Z, Huttin O, Filippetti L, Micard E, Ncho Mottoh MPB, Böhme P, Chemla D, Zannad F, Rossignol P, Marie PY. Arterial and Cardiac Remodeling Associated With Extra Weight Gain in an Isolated Abdominal Obesity Cohort. Front Cardiovasc Med 2021; 8:771022. [PMID: 34805324 PMCID: PMC8602697 DOI: 10.3389/fcvm.2021.771022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: This study aims to assess the changes in cardiovascular remodeling attributable to bodyweight gain in a middle-aged abdominal obesity cohort. A remodeling worsening might explain the increase in cardiovascular risk associated with a dynamic of weight gain. Methods: Seventy-five middle-aged subjects (56 ± 5 years, 38 women) with abdominal obesity and no known cardiovascular disease underwent MRI-based examinations at baseline and at a 6.1 ± 1.2-year follow-up to monitor cardiovascular remodeling and hemodynamic variables, most notably the effective arterial elastance (Ea). Ea is a proxy of the arterial load that must be overcome during left ventricular (LV) ejection, with increased EA resulting in concentric LV remodeling. Results: Sixteen obese subjects had significant weight gain (>7%) during follow-up (WG+), whereas the 59 other individuals did not (WG-). WG+ and WG- exhibited significant differences in the baseline to follow-up evolutions of several hemodynamic parameters, notably diastolic and mean blood pressures (for mean blood pressure, WG+: +9.3 ± 10.9 mmHg vs. WG-: +1.7 ± 11.8 mmHg, p = 0.022), heart rate (WG+: +0.6 ± 9.4 min-1 vs. -8.9 ± 11.5 min-1, p = 0.003), LV concentric remodeling index (WG: +0.08 ± 0.16 g.mL-1 vs. WG-: -0.02 ± 0.13 g.mL-1, p = 0.018) and Ea (WG+: +0.20 ± 0.28 mL mmHg-1 vs. WG-: +0.01 ± 0.30 mL mmHg-1, p = 0.021). The evolution of the LV concentric remodeling index and Ea were also strongly correlated in the overall obese population (p < 0.001, R2 = 0.31). Conclusions: A weight gain dynamic is accompanied by increases in arterial load and load-related concentric LV remodeling in an isolated abdominal obesity cohort. This remodeling could have a significant impact on cardiovascular risk.
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Affiliation(s)
- Damien Mandry
- Department of Radiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,INSERM, UMR-1254, Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- INSERM, UMR-1116, Université de Lorraine, Nancy, France.,Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,CHRU-Nancy, INSERM, CIC 1433, Université de Lorraine, Nancy, France
| | - Zohra Lamiral
- CHRU-Nancy, INSERM, CIC 1433, Université de Lorraine, Nancy, France
| | - Olivier Huttin
- INSERM, UMR-1116, Université de Lorraine, Nancy, France.,Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Laura Filippetti
- Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Emilien Micard
- CHRU-Nancy, INSERM, CIC 1433, Université de Lorraine, Nancy, France
| | | | - Philip Böhme
- Department of Endocrinology, Diabetology, Nutrition, CHRU-Nancy, Nancy, France
| | - Denis Chemla
- Explorations Fonctionnelles, Hôpital Kremlin Bicêtre, APHP, Paris, France.,INSERM, UMR- 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Faïez Zannad
- INSERM, UMR-1116, Université de Lorraine, Nancy, France.,Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France.,CHRU-Nancy, INSERM, CIC 1433, Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- INSERM, UMR-1116, Université de Lorraine, Nancy, France.,CHRU-Nancy, INSERM, CIC 1433, Université de Lorraine, Nancy, France.,FCRIN INI-CRCT, Nancy, France
| | - Pierre-Yves Marie
- INSERM, UMR-1116, Université de Lorraine, Nancy, France.,CHRU-Nancy, Université de Lorraine, Nuclear Medicine & Nancyclotep Platform, Nancy, France
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3
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Brinkley TE, Leng I, Bailey MJ, Houston DK, Hugenschmidt CE, Nicklas BJ, Hundley WG. Effects of Exercise and Weight Loss on Proximal Aortic Stiffness in Older Adults With Obesity. Circulation 2021; 144:684-693. [PMID: 34333991 DOI: 10.1161/circulationaha.120.051943] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obesity may accelerate age-related increases in aortic stiffness. Although aerobic exercise training generally has favorable effects on aortic structure and function, exercise alone may not be sufficient to improve aortic stiffness in older adults with obesity. We determined the effects of aerobic exercise training with and without moderate- to high-caloric restriction (CR) on the structure and function of the proximal aorta in 160 older (65-79 years) men and women with obesity (body mass index=30-45 kg/m2). METHODS Participants were randomly assigned to 1 of 3 groups: aerobic exercise training only (treadmill 4 days/week for 30 minutes at 65% to 70% of heart rate reserve; n=56), aerobic exercise training plus moderate CR (n=55), or aerobic exercise training plus more intensive CR (n=49) for 20 weeks. Aortic pulse wave velocity, aortic distensibility, and other measures of aortic structure and function were assessed by cardiovascular magnetic resonance imaging. Pearson correlation coefficients were examined to assess associations between changes in proximal aortic stiffness and changes in fitness, fatness, and other potential confounders. RESULTS Weight loss in the aerobic exercise training plus moderate CR (-8.0 kg [95% CI, -9.17 to -6.87]) and aerobic exercise training plus more intensive CR (-8.98 kg [95% CI, -10.23 to -7.73) groups was significantly greater compared with the aerobic exercise training-only group (-1.66 kg [95% CI, -2.94 to -0.38]; P<0.017 for both). There were significant treatment effects for descending aorta distensibility (P=0.008) and strain (P=0.004) and aortic arch pulse wave velocity (P=0.01) with the aerobic exercise training plus moderate CR group having a 21% increase in distensibility (P=0.016) and an 8% decrease in pulse wave velocity (P=0.058). None of the aortic stiffness measures changed significantly in the aerobic exercise training-only or aerobic exercise training plus more intensive CR groups, and there were no significant changes in any other measure of aortic structure or function in these groups. Overall, increases in aortic distensibility were correlated with improvements in body weight and body fat distribution, but these associations were not statistically significant after adjustment for multiple comparisons. CONCLUSIONS In older adults with obesity, combining aerobic exercise with moderate CR leads to greater improvements in proximal aortic stiffness than exercise alone. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01048736.
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Affiliation(s)
- Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine (T.E.B., D.K.H., C.E.H., B.J.N.)
| | - Iris Leng
- Division of Public Health Sciences, Department of Biostatistics and Data Science (I.L.)
| | - Margie J Bailey
- Hypertension and Vascular Research Center (M.J.B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine (T.E.B., D.K.H., C.E.H., B.J.N.)
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine (T.E.B., D.K.H., C.E.H., B.J.N.)
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine (T.E.B., D.K.H., C.E.H., B.J.N.)
| | - W Gregory Hundley
- Department of Internal Medicine, Virginia Commonwealth University, Richmond (W.G.H.)
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Gao Y, Ren Y, Guo YK, Liu X, Xie LJ, Jiang L, Shen MT, Deng MY, Yang ZG. Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study. Cardiovasc Diabetol 2020; 19:70. [PMID: 32471503 PMCID: PMC7260782 DOI: 10.1186/s12933-020-01044-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that collectively cause an increased risk of type 2 diabetes mellitus (T2DM) and nonatherosclerotic cardiovascular disease. This study aimed to evaluate the role of myocardial steatosis in T2DM patients with or without MetS, as well as the relationship between subclinical left ventricular (LV) myocardial dysfunction and myocardial steatosis. METHODS AND MATERIALS We recruited 53 T2DM patients and 20 healthy controls underwent cardiac magnetic resonance examination. All T2DM patients were subdivide into two group: MetS group and non-MetS. LV deformation, perfusion parameters and myocardial triglyceride (TG) content were measured and compared among these three groups. Pearson's and Spearman analysis were performed to investigate the correlation between LV cardiac parameters and myocardial steatosis. The receiver operating characteristic curve (ROC) was performed to illustrate the relationship between myocardial steatosis and LV subclinical myocardial dysfunction. RESULTS An increase in myocardial TG content was found in the MetS group compared with that in the other groups (MetS vs. non-MetS: 1.54 ± 0.63% vs. 1.16 ± 0.45%; MetS vs. normal: 1.54 ± 0.63% vs. 0.61 ± 0.22%; all p < 0.001). Furthermore, reduced LV deformation [reduced longitudinal and radial peak strain (PS); all p < 0.017] and microvascular dysfunction [increased time to maximum signal intensity (TTM) and reduced Upslope; all p < 0.017)] was found in the MetS group. Myocardial TG content was positively associated with MetS (r = 0.314, p < 0.001), and it was independently associated with TTM (β = 0.441, p < 0.001) and LV longitudinal PS (β = 0.323, p = 0.021). ROC analysis exhibited that myocardial TG content might predict the risk of decreased LV longitudinal myocardial deformation (AUC = 0.74) and perfusion function (AUC = 0.71). CONCLUSION Myocardial TG content increased in T2DM patients with concurrent MetS. Myocardial steatosis was positively associated with decreased myocardial deformation and perfusion dysfunction, which may be an indicator for predicting diabetic cardiomyopathy.
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Affiliation(s)
- Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ming-Yan Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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5
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Plasma Galectin-3 predicts deleterious vascular dysfunction affecting post-myocardial infarction patients: An explanatory study. PLoS One 2020; 15:e0232572. [PMID: 32392260 PMCID: PMC7213735 DOI: 10.1371/journal.pone.0232572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES In a previous analysis of a post-myocardial infarction (MI) cohort, abnormally high systemic vascular resistances (SVR) were shown to be frequently revealed by MRI during the healing period, independently of MI severity, giving evidence of vascular dysfunction and limiting further recovery of cardiac function. The present ancillary and exploratory analysis of the same cohort was aimed at characterizing those patients suffering from high SVR remotely from MI with a large a panel of cardiovascular MRI parameters and blood biomarkers. METHODS MRI and blood sampling were performed 2-4 days after a reperfused MI and 6 months thereafter in 121 patients. SVR were monitored with a phase-contrast MRI sequence and patients with abnormally high SVR at 6-months were characterized through MRI parameters and blood biomarkers, including Galectin-3, an indicator of cardiovascular inflammation and fibrosis after MI. SVR were normal at 6-months in 90 patients (SVR-) and abnormally high in 31 among whom 21 already had high SVR at the acute phase (SVR++) while 10 did not (SVR+). RESULTS When compared with SVR-, both SVR+ and SVR++ exhibited lower recovery in cardiac function from baseline to 6-months, while baseline levels of Galectin-3 were significantly different in both SVR+ (median: 14.4 (interquartile range: 12.3-16.7) ng.mL-1) and SVR++ (13.0 (11.7-19.4) ng.mL-1) compared to SVR- (11.7 (9.8-13.5) ng.mL-1, both p < 0.05). Plasma Galectin-3 was an independent baseline predictor of high SVR at 6-months (p = 0.002), together with the baseline levels of SVR and left ventricular end-diastolic volume, whereas indices of MI severity and left ventricular function were not. In conclusion, plasma Galectin-3 predicts a deleterious vascular dysfunction affecting post-MI patients, an observation that could lead to consider new therapeutic targets if confirmed through dedicated prospective studies.
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Zhang Z, Ma Q, Cao L, Zhao Z, Zhao J, Lu Q, Zeng L, Zhang M, Pohost GM, Li K. Correlation between left ventricular myocardial strain and left ventricular geometry in healthy adults: a cardiovascular magnetic resonance-feature tracking study. Int J Cardiovasc Imaging 2019; 35:2057-2065. [PMID: 31402413 DOI: 10.1007/s10554-019-01644-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
This study was aimed to investigate the correlation between left ventricular (LV) myocardial strain and LV geometry in healthy adults using cardiovascular magnetic resonance-feature tracking (CMR-FT). 124 gender-matched healthy adults who underwent healthy checkup using CMR cine imaging were retrospectively analyzed. Peak global radial, circumferential, longitudinal strain (GRS, GCS and GLS) for left ventricle were measured. LV geometry was assessed by the ratio of LV mass (LVM) and end-diastolic volume (EDV). GRS, GCS and GLS were 34.18 ± 6.71%, - 22.17 ± 2.28%, - 14.76 ± 2.39% for men, and 33.40 ± 6.95%, - 22.49 ± 2.27%, - 15.72 ± 2.36% for women. Multiple linear regression showed that LVM/EDV was associated with decreased GLS (β = - 0.297, p = 0.005), but was not significantly associated with GRS and GCS (both p > 0.05). There was an increase in the magnitude of GRS, GCS and GLS with advancing age (β = 0.254, β = 0.466 and β = 0.313, all p < 0.05). Greater BMI was associated with decreased GRS, GCS and GLS (β = - 0.232, β = - 0. 249 and β = - 0.279, all p < 0.05). In conclusion, compared with GRS and GCS, GLS is more sensitive to assess LV concentric remodeling in healthy adults. GRS, GCS and GLS are all independently positively associated with age and negatively associated with BMI. Sex-based LV strain reference values for healthy Chinese adults are established.
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Affiliation(s)
- Zhen Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Qiaozhi Ma
- Department of Magnetic Resonance, the Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lizhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhiwei Zhao
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Jun Zhao
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Qing Lu
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Linan Zeng
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Mingzhu Zhang
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China
| | - Gerald M Pohost
- Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,Xiamen Zhouxin Medical Imaging Diagnostic Centre, Xiamen, China.
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Huttin O, Mandry D, Eschalier R, Zhang L, Micard E, Odille F, Beaumont M, Fay R, Felblinger J, Camenzind E, Zannad F, Girerd N, Marie PY. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:2. [PMID: 28063459 PMCID: PMC5219670 DOI: 10.1186/s12968-016-0314-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular (LV) remodeling following acute myocardial infarction (MI) is difficult to predict at an individual level although a possible interfering role of vascular function has yet to be considered to date. This study aimed to determine the extent to which this LV remodeling is influenced by the concomitant evolution of vascular function and LV loading conditions, as assessed by phase-contrast Cardiovascular Magnetic Resonance (CMR) of the ascending aorta. METHODS CMR was performed in 121 patients, 2-4 days after reperfusion of a first ST-segment elevation myocardial infarction and 6 months thereafter. LV remodeling was: (i) assessed by the 6-month increase in end-diastolic volume (EDV) and/or ejection fraction (EF) and (ii) correlated with the indexed aortic stroke volume (mL.m-2), determined by a CMR phase-contrast sequence, along with derived functional vascular parameters (total peripheral vascular resistance (TPVR), total arterial compliance index, effective arterial elastance). RESULTS At 6 months, most patients were under angiotensin enzyme converting inhibitors (86%) and beta-blockers (84%) and, on average, all functional vascular parameters were improved whereas blood pressure levels were not. An increase in EDV only (EDV+/EF-) was documented in 17% of patients at 6 months, in EF only (EDV-/EF+) in 31%, in both EDV and EF (EDV+/EF+) in 12% and neither EDV nor EF (EDV-/EF-) in 40%. The increase in EF was mainly and independently linked to a concomitant decline in TPVR (6-month change in mmHg.min.m2.L-1, EDV-/EF-: +1 ± 8, EDV+/EF-: +3 ± 9, EDV-/EF+: -7 ± 6, EDV+/EF+: -15 ± 20, p < 0.001) while the absence of any EF improvement was associated with high persisting rates of abnormally high TPVR at 6 months (EDV-/EF-: 31%, EDV+/EF-: 38%, EDV-/EF+: 5%, EDV+/EF+: 13%, p = 0.007). By contrast, the 6-month increase in EDV was mainly dependent on cardiac as opposed to vascular parameters and particularly on the presence of microvascular obstruction at baseline (EDV-/EF-: 37%, EDV+/EF-: 76%, EDV-/EF+: 38%, EDV+/EF+: 73%, p = 0.003). CONCLUSION LV remodeling following reperfused MI is strongly influenced by the variable decrease in systemic vascular resistance under standard care vasodilating medication. The CMR monitoring of vascular resistance may help to tailor these medications for improving vascular resistance and consequently, LV ejection fraction. TRIAL REGISTRATION NCT01109225 on ClinicalTrials.gov site (April, 2010).
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Affiliation(s)
- Olivier Huttin
- CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France
- INSERM, UMR-1116, Nancy, F-54000, France
| | - Damien Mandry
- INSERM, UMR-947, Nancy, F-54000, France
- CHRU-Nancy, Department of Radiology, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Romain Eschalier
- CHU-Clermont-Ferrand, Department of Cardiology, Clermont-Ferrand, F-63000, France
- Université d'Auvergne, UMR6284, Clermont-Ferrand, F-63000, France
| | - Lin Zhang
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Emilien Micard
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Freddy Odille
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Marine Beaumont
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | | | - Jacques Felblinger
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Edoardo Camenzind
- CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Faïez Zannad
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Nicolas Girerd
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Pierre Y Marie
- INSERM, UMR-1116, Nancy, F-54000, France.
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.
- CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Allée du Morvan, 54500, Vandœuvre, France.
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Dupont AC, Poussel M, Hossu G, Marie PY, Chenuel B, Felblinger J, Mandry D. Aortic compliance variation in long male distance triathletes: A new insight into the athlete's artery? J Sci Med Sport 2016; 20:539-542. [PMID: 27838232 DOI: 10.1016/j.jsams.2016.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/21/2016] [Accepted: 10/21/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess cardiac and vascular adaptations in long-distance male triathletes and the influence of an increased training volume on these parameters. DESIGN Case-control study using long-distance male triathletes (Tri) (n=12) and an age-matched cohort of sedentary volunteers (Ctrl). METHODS All participants gave an informed consent and underwent a Cardiovascular Magnetic Resonance imaging (CMR) exam to measure left and right ventricle functional parameters, and aortic parameters (surface, strain, compliance, pulse wave velocity). This exam was repeated in the triathletes' group after an increased training volume of at least 2h/week for six weeks. RESULTS Compared to control volunteers, triathletes presented at baseline a typical pattern of athlete's heart (higher end-diastolic, end-systolic and stroke volumes index, p≤0.009, and lower cardiac rate, p=0.015) but similar vascular characteristics except a trend towards an enlarged ascending aorta (surface 942±106 vs 812±127mm2, p=0.058). Between the two visits, the triathletes increased their weekly training time from 9.67±2.43 (Tri1) to 12.15±3.01h (Tri2): no modifications were found regarding cardiac parameters, but compliance and distensibility of the ascending aorta increased, from 2.60 to 3.34mm2/mmHg (p=0.028) and from 3.36 to 4.40×10-3mmHg-1 (p=0.048) respectively. CONCLUSIONS Using CMR, we showed that vascular characteristics of the ascending aorta may vary along the sport season in endurance athletes. This remodelling could be considered as a physiological adaptation, but could eventually lead to an adverse vascular remodelling.
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Affiliation(s)
| | - Mathias Poussel
- CHRU Nancy, Department of Pulmonary Function Testing and Exercise Physiology, France; Universite de Lorraine, EA 3450 DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, France
| | | | - Pierre-Yves Marie
- CHRU Nancy, Department of Medical Imaging, France; INSERM UMR-1116, France; Universite de Lorraine, France
| | - Bruno Chenuel
- CHRU Nancy, Department of Pulmonary Function Testing and Exercise Physiology, France; Universite de Lorraine, EA 3450 DevAH-Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, France
| | - Jacques Felblinger
- INSERM, IADI U 947, France; INSERM, CIC-IT 1433, France; CHRU Nancy, Department of Medical Imaging, France
| | - Damien Mandry
- INSERM, IADI U 947, France; CHRU Nancy, Department of Medical Imaging, France; Universite de Lorraine, France.
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Marie PY, Mandry D, Huttin O, Micard E, Bonnemains L, Girerd N, Beaumont M, Fay R, Joly L, Rossignol P, Benetos A, Felblinger J, Zannad F. Comprehensive monitoring of cardiac remodeling with aortic stroke volume values provided by a phase-contrast MRI sequence. J Hypertens 2016; 34:967-73. [DOI: 10.1097/hjh.0000000000000889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Joly L, Mandry D, Verger A, Labat C, Watfa G, Roux V, Karcher G, Marie PY, Benetos A. Influence of Thoracic Aortic Inflammation and Calcifications on Arterial Stiffness and Cardiac Function in Older Subjects. J Nutr Health Aging 2016; 20:347-54. [PMID: 26892585 DOI: 10.1007/s12603-015-0574-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Vascular aging is accompanied by gradual remodeling affecting both arterial and cardiac structure and mechanical properties. Hypertension is suggested to exert pro-inflammatory actions enhancing arterial stiffness. OBJECTIVE To determine the influence of thoracic aortic inflammation and calcifications on arterial stiffness and cardiac function in hypertensive and normotensive older subjects. DESIGN A prospective study. SETTING An acute geriatrics ward of the University Hospital of Nancy in France. SUBJECTS Thirty individuals ≥ 65 years were examined, including 15 hypertensive subjects and 15 controls well-matched for age and sex. MEASUREMENTS Applanation tonometry was used to measure aortic pulse wave velocity (AoPWV) and carotid/brachial pulse pressure amplification (PPA). Left ventricular parameters were measured with magnetic resonance imaging. Local thoracic aortic inflammation and calcification were measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Biomarkers of low-grade inflammation were also quantified. RESULTS AoPWV was higher in elderly hypertensive subjects comparatively to normotensive controls (15.5±5.3 vs. 11.9±2.5, p=0.046), and hypertensives had a higher calcification volume. In the overall population, calcifications of the thoracic descending aorta and inflammation of the ascending aorta accounted for respectively 18.1% (p=0.01) and 9.6% (p=0.07) of AoPWV variation. Individuals with high levels of calcifications and/or inflammation had higher AoPWV (p=0.003). Inflammation had a negative effect on PPA explaining 13.8% of its variation (p<0.05). CONCLUSION This study highlights the importance of local ascending aortic inflammation as a potential major actor in the determination of PPA while calcifications and hypertension are more linked to AoPWV. Assessment of PPA in the very elderly could provide complementary information to improve diagnostic and therapeutic strategies targeting ascending aortic inflammation.
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Affiliation(s)
- L Joly
- Laure Joly, MD, PhD; Department of Geriatrics; CHU-Nancy, 54511 Vandoeuvre les Nancy, France, Tel: +(33) 383 15 33 22; fax: +(33) 383 15 76 68; E-mail:
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11
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Central pulse pressure is a determinant of heart and brain remodeling in the elderly: a quantitative MRI and PET pilot study. J Hypertens 2015; 33:1378-85. [PMID: 25827431 DOI: 10.1097/hjh.0000000000000566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The sustained elevation of blood pressure (BP) and especially of central pulse pressure (cPP) leads to heart and brain damage. This pilot study was aimed to precise the relationships between peripheral and central BP levels, and the remodeling of heart and brain as objectively quantified by cardiac MRI and brain F-fluorodeoxyglucose (FDG)-PET imaging in the elderly. METHODS Twenty-eight apparently healthy elderly individuals (66-85 years old, 14 women) were prospectively recruited and allocated into two half groups, one with and one without hypertension, and all were referred for the quantitative determinations of peripheral and central BP using applanation tonometry, indexed left ventricular mass (per m of body surface area) using cardiac MRI, and brain metabolism with a voxel-based analysis of FDG-PET images adjusted for age and sex. RESULTS Indexed left ventricular mass, reflecting cardiac remodeling, was correlated with the overall pressure variables involving both peripheral and central levels of systolic and pulse pressure (all P ≤ 0.001). By contrast, brain metabolism was significantly correlated with only cPP (P < 0.02). A cPP of at least 50 mmHg was associated with both a lower metabolism in frontal areas (P = 0.005) and a higher indexed left ventricular mass (P = 0.03). CONCLUSION This pilot study suggests that, when quantified by MRI and PET imaging, left ventricular mass and brain metabolism of elderly individuals are related to the cPP and to the 50 mmHg threshold, corresponding to what has previously been documented for the risk of cardiovascular event.
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Imbert L, Galbrun E, Odille F, Poussier S, Noel A, Wolf D, Karcher G, Marie PY. Assessment of a Monte-Carlo simulation of SPECT recordings from a new-generation heart-centric semiconductor camera: from point sources to human images. Phys Med Biol 2015; 60:1007-18. [PMID: 25574814 DOI: 10.1088/0031-9155/60/3/1007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Geant4 application for tomographic emission (GATE), a Monte-Carlo simulation platform, has previously been used for optimizing tomoscintigraphic images recorded with scintillation Anger cameras but not with the new-generation heart-centric cadmium-zinc-telluride (CZT) cameras. Using the GATE platform, this study aimed at simulating the SPECT recordings from one of these new CZT cameras and to assess this simulation by direct comparison between simulated and actual recorded data, ranging from point sources to human images. Geometry and movement of detectors, as well as their respective energy responses, were modeled for the CZT 'D.SPECT' camera in the GATE platform. Both simulated and actual recorded data were obtained from: (1) point and linear sources of (99m)Tc for compared assessments of detection sensitivity and spatial resolution, (2) a cardiac insert filled with a (99m)Tc solution for compared assessments of contrast-to-noise ratio and sharpness of myocardial borders and (3) in a patient with myocardial infarction using segmented cardiac magnetic resonance imaging images. Most of the data from the simulated images exhibited high concordance with the results of actual images with relative differences of only: (1) 0.5% for detection sensitivity, (2) 6.7% for spatial resolution, (3) 2.6% for contrast-to-noise ratio and 5.0% for sharpness index on the cardiac insert placed in a diffusing environment. There was also good concordance between actual and simulated gated-SPECT patient images for the delineation of the myocardial infarction area, although the quality of the simulated images was clearly superior with increases around 50% for both contrast-to-noise ratio and sharpness index. SPECT recordings from a new heart-centric CZT camera can be simulated with the GATE software with high concordance relative to the actual physical properties of this camera. These simulations may be conducted up to the stage of human SPECT-images even if further refinement is needed in this setting.
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Affiliation(s)
- Laetitia Imbert
- CRAN, UMR 7039, Université de Lorraine-CNRS, Vandoeuvre, F-54500, France. Institut de Cancérologie de Lorraine, Department of Radiotherapy, Vandoeuvre, F-54500, France. Nancyclotep Experimental Imaging Platform, Nancy, F-54000, France. CHU Nancy, Department of Nuclear Medicine, Nancy, F-54000, France
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Maroules CD, Khera A, Ayers C, Goel A, Peshock RM, Abbara S, King KS. Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study. J Cardiovasc Magn Reson 2014; 16:33. [PMID: 24886531 PMCID: PMC4031496 DOI: 10.1186/1532-429x-16-33] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/02/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) has been validated for the noninvasive assessment of total arterial compliance and aortic stiffness, but their associations with cardiovascular outcomes is unknown. The purpose of this study was to evaluate associations of CMR measures of total arterial compliance and two CMR measures of aortic stiffness with respect to future cardiovascular events. METHODS The study consisted of 2122 Dallas Heart Study participants without cardiovascular disease who underwent CMR at 1.5 Tesla. Aortic stiffness was measured by CMR-derived ascending aortic distensibility and aortic arch pulse wave velocity. Total arterial compliance was calculated by dividing left ventricular stroke volume by pulse pressure. Participants were monitored for cardiovascular death, non-fatal cardiac events, and non-fatal extra-cardiac vascular events over 7.8 ± 1.5 years. Cox proportional hazards regression was used to assess for associations between CMR measures and cardiovascular events. RESULTS Age, systolic blood pressure, and resting heart rate were independently associated with changes in ascending aortic distensibility, arch pulse wave velocity, and total arterial compliance (all p < .0001). A total of 153 participants (6.9%) experienced a cardiovascular event. After adjusting for traditional risk factors, total arterial compliance was modestly associated with increased risk for composite events (HR 1.07 per 1SD, p = 0.03) while the association between ascending aortic distensibility and composite events trended towards significance (HR 1.18 per 1SD, p = 0.08). Total arterial compliance and aortic distensibility were independently associated with nonfatal cardiac events (HR 1.11 per 1SD, p = 0.001 and HR 1.45 per 1SD, p = 0.0005, respectively), but not with cardiovascular death or nonfatal extra-cardiac vascular events. Arch pulse wave velocity was independently associated with nonfatal extra-cardiac vascular events (HR 1.18 per 1SD, p = 0.04) but not with cardiovascular death or nonfatal cardiac events. CONCLUSIONS In a multiethnic population free of cardiovascular disease, CMR measures of arterial stiffness are associated with future cardiovascular events. Total arterial compliance and aortic distensibility may be stronger predictors of nonfatal cardiac events, while pulse wave velocity may be a stronger predictor of nonfatal extra-cardiac vascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Amit Khera
- Division of Cardiology, Internal Medicine, and Clinical Sciences, Dallas, TX, USA
| | - Colby Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Akshay Goel
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Ronald M Peshock
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
- Division of Cardiology, Internal Medicine, and Clinical Sciences, Dallas, TX, USA
| | - Suhny Abbara
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Kevin S King
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
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Leptin induces cardiac fibrosis through galectin-3, mTOR and oxidative stress. J Hypertens 2014; 32:1104-14; discussion 1114. [DOI: 10.1097/hjh.0000000000000149] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Eschalier R, Rossignol P, Kearney-Schwartz A, Adamopoulos C, Karatzidou K, Fay R, Mandry D, Marie PY, Zannad F. Features of cardiac remodeling, associated with blood pressure and fibrosis biomarkers, are frequent in subjects with abdominal obesity. Hypertension 2014; 63:740-6. [PMID: 24446063 DOI: 10.1161/hypertensionaha.113.02419] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Incidence and prevalence of abdominal obesity (AO) are growing exponentially. Subjects with AO are at higher risk of developing heart failure. The purpose of the study was to investigate early changes in cardiac and arterial structure and function and extracellular matrix biomarkers in normotensive healthy subjects with AO. Subjects with AO and age- and sex-matched controls underwent echocardiography, MRI (cardiac remodeling index), carotid intima-media thickness, pulse wave velocity, and blood fibrosis biomarkers measurements. We enrolled 87 subjects with AO and 53 controls. Although normotensive, subjects with AO had higher systolic blood pressure (BP; 122±11 versus 116±11 mm Hg; P=0.003), left ventricular mass (94±24 versus 84±21 g; P=0.034), and cardiac remodeling index (0.67±0.16 versus 0.60±0.10 g/mL; P=0.026) but unchanged carotid intima-media thickness and pulse wave velocity. Diastolic dysfunction (E' <10 cm/s) could be detected in 38% of subjects with AO (4% in controls). Left ventricular remodeling, as assessed by cardiac remodeling index, was positively and independently associated with higher BP (systolic BP and mean arterial pressure but not diastolic BP) and AO. Higher BP, AO, and procollagen-III-N-terminal peptide (≥2.4 ng/mL) concentrations (odds ratio, 4.15 [1.42-12.2]; P=0.01) were positively associated with diastolic dysfunction. Early cardiac structural remodeling, fibrosis, and diastolic dysfunction were detectable in healthy subjects with AO. Higher BP, procollagen-III-N-terminal peptide, and AO were independently associated with early cardiac structural and functional changes. It is to be investigated whether in subjects with AO, an early BP reduction, even if normotensive, combined with weight loss may avoid adverse cardiac remodeling and protect against progression to heart failure.
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Affiliation(s)
- Romain Eschalier
- CIC Plurithématique, Institut Lorrain du cœur et des vaisseaux, 4 rue du Morvan, 54500 Vandœuvre lès Nancy, France.
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Nyman K, Granér M, Pentikäinen MO, Lundbom J, Hakkarainen A, Sirén R, Nieminen MS, Taskinen MR, Lundbom N, Lauerma K. Cardiac steatosis and left ventricular function in men with metabolic syndrome. J Cardiovasc Magn Reson 2013; 15:103. [PMID: 24228979 PMCID: PMC3842676 DOI: 10.1186/1532-429x-15-103] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic accumulation of fat accompanies visceral obesity with detrimental effects. Lipid oversupply to cardiomyocytes leads to cardiac steatosis, and in animal studies lipotoxicity has been associated with impaired left ventricular (LV) function. In humans, studies have yielded inconclusive results. The aim of the study was to evaluate the role of epicardial, pericardial and myocardial fat depots on LV structure and function in male subjects with metabolic syndrome (MetS). METHODS A study population of 37 men with MetS and 38 men without MetS underwent cardiovascular magnetic resonance and proton magnetic spectroscopy at 1.5 T to assess LV function, epicardial and pericardial fat area and myocardial triglyceride (TG) content. RESULTS All three fat deposits were greater in the MetS than in the control group (p <0.001). LV diastolic dysfunction was associated with MetS as measured by absolute (471 mL/s vs. 667 mL/s, p = 0.002) and normalized (3.37 s⁻¹ vs. 3.75 s⁻¹, p = 0.02) LV early diastolic peak filling rate and the ratio of early diastole (68% vs. 78%, p = 0.001). The amount of epicardial and pericardial fat correlated inversely with LV diastolic function. However, myocardial TG content was not independently associated with LV diastolic dysfunction. CONCLUSIONS In MetS, accumulation of epicardial and pericardial fat is linked to the severity of structural and functional alterations of the heart. The role of increased intramyocardial TG in MetS is more complex and merits further study.
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Affiliation(s)
- Kristofer Nyman
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 4, BOX 340, FI-00029 HUS, Finland
| | - Marit Granér
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Markku O Pentikäinen
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Jesper Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 4, BOX 340, FI-00029 HUS, Finland
| | - Antti Hakkarainen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 4, BOX 340, FI-00029 HUS, Finland
| | - Reijo Sirén
- Department of General Practice and Primary Health Care, Health Care Centre of City of Helsinki and University of Helsinki, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Marja-Riitta Taskinen
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Nina Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Haartmaninkatu 4, BOX 340, FI-00029 HUS, Finland
| | - Kirsi Lauerma
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Stenbäckinkatu 11, BOX 281, Helsinki FI-00029 HUS, Finland
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Di Bello V, Fabiani I, Conte L, Barletta V, Delle Donne MG, Cuono C, Leo LA, Dini FL, Marzilli M, Pinchera A, Santini F. New echocardiographic techniques in the evaluation of left ventricular function in obesity. Obesity (Silver Spring) 2013; 21:881-92. [PMID: 23404860 DOI: 10.1002/oby.20071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity has reached global epidemic proportions and is associated with numerous comorbidities, including major cardiovascular (CV) diseases. DESIGN AND METHODS It has many adverse effects on hemodynamics and CV structure and function: it increases total blood volume and cardiac output, and the cardiac workload is greater. Typically, obese patients have a higher cardiac output but a lower level of total peripheral resistance at any given level of arterial pressure. Most of the increase in cardiac output in obesity is caused by stroke volume, although heart rate typically mildly increases also due to enhanced sympathetic activation. RESULTS Over the last few years, experimental investigations have unraveled some important pathogenetic mechanisms that may underlie a specific form of "obesity cardiomyopathy." Bariatric surgery represents an effective alternative to treat obesity when nonsurgical weight loss programs (diet + behavior modifications + regular exercise) have failed. A great numbers of questions are still open in the global comprehension of the pathophysiological interactions between obesity and heart. CONCLUSION Conventional two-dimensional Doppler echocardiography, integrated by relative new technological ultrasonic approaches, represents the reference technique to study and possibly clarify both the very complex hemodynamic changes induced by obesity and those relative to obesity treatment.
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