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Vrabie AM, Totolici S, Delcea C, Badila E. Biomarkers in Heart Failure with Preserved Ejection Fraction: A Perpetually Evolving Frontier. J Clin Med 2024; 13:4627. [PMID: 39200768 PMCID: PMC11355893 DOI: 10.3390/jcm13164627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/28/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents a complex clinical syndrome, often very difficult to diagnose using the available tools. As the global burden of this disease is constantly growing, surpassing the prevalence of heart failure with reduced ejection fraction, during the last few years, efforts have focused on optimizing the diagnostic and prognostic pathways using an immense panel of circulating biomarkers. After the paradigm of HFpEF development emerged more than 10 years ago, suggesting the impact of multiple comorbidities on myocardial structure and function, several phenotypes of HFpEF have been characterized, with an attempt to find an ideal biomarker for each distinct pathophysiological pathway. Acknowledging the limitations of natriuretic peptides, hundreds of potential biomarkers have been evaluated, some of them demonstrating encouraging results. Among these, soluble suppression of tumorigenesis-2 reflecting myocardial remodeling, growth differentiation factor 15 as a marker of inflammation and albuminuria as a result of kidney dysfunction or, more recently, several circulating microRNAs have proved their incremental value. As the number of emerging biomarkers in HFpEF is rapidly expanding, in this review, we aim to explore the most promising available biomarkers linked to key pathophysiological mechanisms in HFpEF, outlining their utility for diagnosis, risk stratification and population screening, as well as their limitations.
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Affiliation(s)
- Ana-Maria Vrabie
- Cardio-Thoracic Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.T.); (C.D.); (E.B.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Stefan Totolici
- Cardio-Thoracic Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.T.); (C.D.); (E.B.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Caterina Delcea
- Cardio-Thoracic Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.T.); (C.D.); (E.B.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Elisabeta Badila
- Cardio-Thoracic Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.T.); (C.D.); (E.B.)
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Elia E, Ministrini S, Carbone F, Montecucco F. Diabetic cardiomyopathy and inflammation: development of hostile microenvironment resulting in cardiac damage. Minerva Cardiol Angiol 2021; 70:357-369. [PMID: 33427423 DOI: 10.23736/s2724-5683.20.05454-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetes mellitus is emerging as a major risk factor for heart failure. Diabetic cardiomyopathy is defined as a myocardial dysfunction that is not caused by underlying hypertension or coronary artery disease. Studies about clinical features, natural history and outcomes of the disease are few and often conflicting, because a universally accepted operative definition of diabetic cardiomyopathy is still lacking. Hyperglycemia and related metabolic and endocrine disorders are the triggering factors of myocardial damage in diabetic cardiomyopathy through multiple mechanisms. Among these mechanisms, inflammation has a relevant role, similar to other chronic myocardial disease, such as hypertensive or ischemic heart disease. A balance between inflammatory damage and healing processes is fundamental for homeostasis of myocardial tissue, whereas diabetes mellitus produces an imbalance, promoting inflammation and delaying healing. Therefore, diabetes-related chronic inflammatory state can produce a progressive qualitative deterioration of myocardial tissue, which reflects on progressive left ventricular functional impairment, which can be either diastolic, with prevalent myocardial hypertrophy, or systolic, with prevalent myocardial fibrosis. The aim of this narrative review is to summarize the existing evidence about the role of inflammation in diabetic cardiomyopathy onset and development. Ultimately, potential pharmacological strategies targeting inflammatory response will be reviewed and discussed.
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Affiliation(s)
- Edoardo Elia
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Stefano Ministrini
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy - .,IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
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3
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Mado H, Szczurek W, Gąsior M, Szyguła-Jurkiewicz B. Adiponectin in heart failure. Future Cardiol 2020; 17:757-764. [PMID: 32915067 DOI: 10.2217/fca-2020-0095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The adipose tissue, apart from storing energy, plays a role of an endocrine organ. One of the most important adipokines secreted by adipose tissue is adiponectin, which is also produced by cardiomyocytes and connective tissue cells within the heart. Adiponectin is known for its beneficial effect on the metabolism and cardiovascular system and its low level is a factor of development of many cardiovascular diseases. Paradoxically, in the course of heart failure, adiponectin level gradually increases with the severity of the disease and higher adiponectin level is a factor of poor prognosis. As a result, there is a growing interest in adiponectin as a marker of heart failure progression and a predictor of prognosis in the course of this disease.
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Affiliation(s)
- Hubert Mado
- Student Scientific Society, 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GF, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Marinella Ruospo
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Patrizia Natale
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Robert R Quinn
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Paul E Ronksley
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical Center, Department of Medicine, 3459 Fifth Avenue, Pittsburgh, PA, USA, 15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of Otago, Department of Medicine, Nephrologist, Christchurch, New Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Giovanni Fm Strippoli
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
- The Children's Hospital at Westmead, Cochrane Kidney and Transplant, Centre for Kidney Research, Westmead, NSW, Australia, 2145
| | - Pietro Ravani
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
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Association between adiponectin rs17300539 and rs266729 gene polymorphisms with serum adiponectin level in an Iranian diabetic/pre-diabetic population. Endocr Regul 2019; 52:176-184. [PMID: 31517610 DOI: 10.2478/enr-2018-0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Adiponectin is an adipokine that is mostly secreted from adipose tissues and has a significant role in the improvement of insulin resistant and type 2 diabetes mellitus (T2DM). This study is conducted to examine the association of rs17300539 and rs266729 with T2DM and serum adiponectin level in Iranian population. METHOD A case-control study was conducted on 80 individuals with fasting plasma glucose (FPG) >100 (mg/dl) as diabetic-pre-diabetic group, and 80 individuals with fasting plasma glucose 70-100 (mg/dl) as control group. DNA extraction was done on samples and genotyping method was performed by PCR-RFLP. RESULT The frequency of GA genotype in rs17300539 (diabetic/pre-diabetic 35.5%, control 11.3%, (OR [95%CI]=4.18[1.8-9.6]; p=0.001) and allele A (diabetic/pre-diabetic 31%, control 9%, (OR [95% CI]=4.67[2-10.7]) was significantly more in diabetic/pre-diabetic group compared to control group. The difference in the genotype frequency for rs266729 in diabetic group compared to that in control was not significant. The levels of adiponectin in diabetic cases had no difference compared to the control group in both polymorphisms. The rs266729 was not associated with any metabolic parameter except waist circumference (p=0.03), however, rs17300539 shows association only with fasting plasma glucose, triglyceride, and total cholesterol (p=0.007, 0.039, 0.0032, respectively). CONCLUSION Our findings showed that there is an association between rs17300539 with the increase of T2DM but rs266729 showed no association with the risk of T2DM. Allele A of rs17300539 increased the risk of diabetes. There is no association between adiponectin level and both polymorphisms.
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Bai W, Huang J, Zhu M, Liu X, Tao J. Association between elevated adiponectin level and adverse outcomes in patients with heart failure: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 52:e8416. [PMID: 31314851 PMCID: PMC6644532 DOI: 10.1590/1414-431x20198416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022]
Abstract
Studies regarding the prognostic value of circulating adiponectin level in
patients with heart failure are conflicting. The aim of this meta-analysis was
to evaluate the association between elevated circulating adiponectin level and
adverse outcomes in patients with heart failure. We searched PubMed and Embase
databases from their inception to June 2018. Original observational studies that
investigated the prognostic value of adiponectin in heart failure patients and
reported all-cause mortality or combined endpoints of death/readmission as
outcome measure were included. Pooled risk ratio (RR) with 95% confidence
intervals (CI) were estimated by higher versus lower circulating adiponectin
level. A total of 7 studies involving 862 heart failure patients were
identified. Meta-analysis showed that heart failure patients with higher
adiponectin level had significantly increased risk of all-cause mortality (RR
2.05; 95%CI 1.22–3.43) after adjustment for potential confounders. In addition,
higher adiponectin level was associated with an increased risk of the combined
endpoints of death/readmission (RR 2.22; 95%CI 1.38–3.57). Elevated baseline
circulating adiponectin level is possibly associated with an increased risk of
all-cause mortality and the combined endpoints of death/readmission in patients
with heart failure. Determination of circulating adiponectin level has potential
to improve risk stratification in heart failure patients.
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Affiliation(s)
- Wenwei Bai
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jingjing Huang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Min Zhu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaoyong Liu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jianping Tao
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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The Role of Serum Adiponectin for Outcome Prediction in Patients with Dilated Cardiomyopathy and Advanced Heart Failure. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3818292. [PMID: 29318144 PMCID: PMC5727561 DOI: 10.1155/2017/3818292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 11/17/2022]
Abstract
Clinical interpretation of patients' plasma adiponectin (APN) remains challenging; its value as biomarker in dilated cardiomyopathy (DCM) is equivocal. We evaluated whether circulating APN level is an independent predictor of composite outcome: death, left ventricle assist device (LVAD) implantation, and heart transplantation (HT) in patients with nonischemic DCM. 57 patients with nonischemic DCM (average LV diastolic diameter 6.85 cm, LV ejection fraction 26.63%, and pulmonary capillary wedge pressure 22.06 mmHg) were enrolled. Patients underwent echocardiography, right heart catheterization, and endomyocardial biopsy. During a mean follow-up of 33.42 months, 15 (26%) patients died, 12 (21%) patients underwent HT, and 8 (14%) patients were implanted with LVAD. APN level was significantly higher in patients who experienced study endpoints (23.4 versus 10.9 ug/ml, p = 0.01). APN was associated with worse outcome in univariate Cox proportional hazards model (HR 1.04, CI 1.02-1.07, p = 0.001) but lost significance adjusting for other covariates. Average global strain (AGS) is an independent outcome predictor (HR 1.42, CI 1.081-1.866, p = 0.012). Increased circulating APN level was associated with higher mortality and may be an additive prognostic marker in DCM with advanced HF. Combination of serum (APN, BNP, TNF-α) and echocardiographic (AGS) markers may increase the HF predicting power for the nonischemic DCM patients.
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Pratesi A, Di Serio C, Orso F, Foschini A, Bartoli N, Marella A, Fumagalli S, Di Bari M, Marchionni N, Tarantini F, Baldasseroni S. Prognostic value of adiponectin in coronary artery disease: Role of diabetes and left ventricular systolic dysfunction. Diabetes Res Clin Pract 2016; 118:58-66. [PMID: 27344545 DOI: 10.1016/j.diabres.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 03/16/2016] [Accepted: 04/14/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Adiponectin (AD) promotes insulin sensitivity and has anti-atherogenic properties. However, the role of AD on clinical outcomes in coronary artery disease (CAD) is controversial. We analyzed whether AD was an independent predictor of all-cause mortality and hospitalization in patients with CAD. METHOD We prospectively enrolled 138 patients with stable CAD, with or without type 2 diabetes and with or without left ventricular dysfunction. A telephone follow-up was conducted to register long term outcomes. Sensitivity/specificity ratio for AD was investigated with ROC analysis and the independent role of AD on outcome was evaluated with Cox regression model of analysis. The survival rate was represented by Kaplan Meyer curves. RESULTS Of 138 patients, 61 had type 2 diabetes and 71 left ventricular systolic dysfunction (EF<40%). Median time of follow-up was 1384days; mortality rate was 18.8% (26 deaths) and hospitalization rate was 47.1% (65 events). Mean concentration of AD was 9.87±7.53ng/ml; the analysis of the ROC curve identified an AD cut-off level of 13.2ng/ml (AUC 0.779; p<0.0001). Patients with AD >13.2ng/ml had a significantly higher risk of death (HR=6.50; 95% CI: 2.40-17.70), but not of cardiovascular hospitalization (HR=0.87; 95% CI: 0.31-2.44). AD predictivity remained significant also in patients with type 2 diabetes and with left ventricular systolic dysfunction. CONCLUSION In stable CAD, an AD value of >13.2ng/ml independently predicts a 6-fold increased risk of all-cause mortality.
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Affiliation(s)
- Alessandra Pratesi
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Claudia Di Serio
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Orso
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alice Foschini
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Nadia Bartoli
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrea Marella
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Stefano Fumagalli
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Mauro Di Bari
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesca Tarantini
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Samuele Baldasseroni
- Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Intensive Care Unit, Division of Cardiology, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi (AOUC), Florence, Italy.
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Cosmi F, Di Giulio P, Masson S, Finzi A, Marfisi RM, Cosmi D, Scarano M, Tognoni G, Maggioni AP, Porcu M, Boni S, Cutrupi G, Tavazzi L, Latini R. Regular Wine Consumption in Chronic Heart Failure. Circ Heart Fail 2015; 8:428-37. [DOI: 10.1161/circheartfailure.114.002091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/17/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Franco Cosmi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Paola Di Giulio
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Serge Masson
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Andrea Finzi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Rosa Maria Marfisi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Deborah Cosmi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Marco Scarano
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Gianni Tognoni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Aldo P. Maggioni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Maurizio Porcu
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Silvana Boni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Giovanni Cutrupi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Luigi Tavazzi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Roberto Latini
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
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10
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Abstract
Cardiovascular disease, including heart failure, is a principal cause of death in individuals with obesity and diabetes. However, the mechanisms of obesity- and diabetes-induced heart disease are multifaceted and remain to be clearly defined. Of relevance to this review, there is currently great research and clinical interest in the endocrine effects of adipokines on the myocardium and their role in heart failure. We will discuss the potential significance of adipokines in the pathogenesis of heart failure via their ability to regulate remodeling events including metabolism, hypertrophy, fibrosis, and cell death. As an excellent example, we will first focus on adiponectin which is best known to confer numerous cardioprotective effects. However, we comprehensively discuss the existing literature that highlights it would be naive to assume that this was always the case. We also focus on lipocalin-2 which mediates pro-inflammatory and pro-apoptotic effects. It is important when studying actions of adipokines to integrate cellular and mechanistic analyses and translate these to physiologically relevant in vivo models and clinical studies. However, assimilating studies on numerous cardiac remodeling events which ultimately dictate cardiac dysfunction into a unifying conclusion is challenging. Nevertheless, there is undoubted potential for the use of adipokines as robust biomarkers and appropriate therapeutic targets in heart failure.
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Affiliation(s)
- Min Park
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
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11
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Youcef G, Olivier A, L'Huillier CPJ, Labat C, Fay R, Tabcheh L, Toupance S, Rodriguez-Guéant RM, Bergerot D, Jaisser F, Lacolley P, Zannad F, Laurent Vallar, Pizard A. Simultaneous characterization of metabolic, cardiac, vascular and renal phenotypes of lean and obese SHHF rats. PLoS One 2014; 9:e96452. [PMID: 24831821 PMCID: PMC4022510 DOI: 10.1371/journal.pone.0096452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 04/07/2014] [Indexed: 12/18/2022] Open
Abstract
Individuals with metabolic syndrome (MetS) are prone to develop heart failure (HF). However, the deleterious effects of MetS on the continuum of events leading to cardiac remodeling and subsequently to HF are not fully understood. This study characterized simultaneously MetS and cardiac, vascular and renal phenotypes in aging Spontaneously Hypertensive Heart Failure lean (SHHF(+/?) regrouping (+/+) and (+/cp) rats) and obese (SHHF(cp/cp), "cp" defective mutant allele of the leptin receptor gene) rats. We aimed to refine the milestones and their onset during the progression from MetS to HF in this experimental model. We found that SHHF(cp/cp )but not SHHF(+/?) rats developed dyslipidemia, as early as 1.5 months of age. This early alteration in the lipidic profile was detectable concomitantly to impaired renal function (polyuria, proteinuria but no glycosuria) and reduced carotid distensibility as compared to SHHF(+/?) rats. By 3 months of age SHHFcp/cp animals developed severe obesity associated with dislipidemia and hypertension defining the onset of MetS. From 6 months of age, SHHF(+/?) rats developed concentric left ventricular hypertrophy (LVH) while SHHF(cp/cp) rats developed eccentric LVH apparent from progressive dilation of the LV dimensions. By 14 months of age only SHHF(cp/cp) rats showed significantly higher central systolic blood pressure and a reduced ejection fraction resulting in systolic dysfunction as compared to SHHF(+/?). In summary, the metabolic and hemodynamic mechanisms participating in the faster decline of cardiac functions in SHHF(cp/cp) rats are established long before their physiological consequences are detectable. Our results suggest that the molecular mechanisms triggered within the first three months after birth of SHHF(cp/cp) rats should be targeted preferentially by therapeutic interventions in order to mitigate the later HF development.
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Affiliation(s)
- Gina Youcef
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; Genomics Research Unit, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Arnaud Olivier
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
| | - Clément P J L'Huillier
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France
| | - Carlos Labat
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France
| | - Renaud Fay
- CHU Nancy, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
| | - Lina Tabcheh
- Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; UMR 7365 CNRS, Vandoeuvre-lès-Nancy, France
| | - Simon Toupance
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
| | - Rosa-Maria Rodriguez-Guéant
- Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Nancy, France; U954 Inserm, Vandoeuvre-lès-Nancy, France
| | | | - Frédéric Jaisser
- CHU Nancy, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
| | - Patrick Lacolley
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Nancy, France
| | - Faiez Zannad
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
| | - Laurent Vallar
- Genomics Research Unit, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Anne Pizard
- UMRS U1116 Inserm, Vandoeuvre-lès-Nancy, France; Fédération de Recherche 3209, Nancy, France; Université de Lorraine, Nancy, France; CIC 1433, Pierre Drouin, Vandoeuvre-lès-Nancy, France
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12
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Pileggi S, Barlera S, Nicolis E, Crociati L, Pietri S, Specchia C, Franzosi MG. Association of ADIPOQ variants and heart failure in an Italian population. Ther Adv Cardiovasc Dis 2014; 8:89-96. [PMID: 24713294 DOI: 10.1177/1753944714531063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Adiponectin has insulin-sensitizing, anti-inflammatory and anti-atherogenic properties. There are few and controversial data on the role of ADIPOQ variants in heart failure (HF) pathogenesis. We planned this large association study to investigate the potential association of four selected ADIPOQ polymorphisms with HF in a population of Italian origin. METHODS We genotyped 1173 cases with symptomatic HF and 1136 controls for alleles rs17300539, rs266729, rs1501299 and rs2241766. Cases were patients enrolled in the GISSI-Heart Failure genetic sub-study, with a long-term follow up (median 3.9 years). Controls were blood donors with no history of diabetes or cardiovascular disease (CVD). Genotype and allele frequencies of the four single nucleotide polymorphisms (SNPs) were compared between the two groups. RESULTS Clinical characteristics were significantly different between HF patients and controls. No significant differences were reported in the allelic and genotypic distribution, with the exception of rs266729 G allele, which showed a significant association with an increased risk of HF [odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.07-1.48; p = 0.006). We divided the GISSI-HF population according to HF etiology (ischemic and nonischemic) and presence of diabetes. For rs266729 G allele, a significant association with HF was confirmed in both ischemic (OR = 1.29; 95% CI = 1.06-1.56; p = 0.009) and nonischemic patients (OR = 1.2; 95% CI = 1.02-1.42; p = 0.03) as well as in nondiabetic patients (OR = 1.25; 95% CI = 1.05-1.49; p = 0.012). rs2241766 G allele showed a significant reduction of risk of HF in nonischemic (OR = 0.77; 95% CI = 0.62-0.95; p = 0.02) and diabetic patients (OR = 0.62; 95% CI = 0.45-0.84; p = 0.0025). CONCLUSIONS We confirm the association between rs266729 G allele and an increased risk of HF and between rs2241766 G allele and decreased risk of HF. Our study extends the knowledge on the influence of ADIPOQ variants on CVD.
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Affiliation(s)
- Silvana Pileggi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Via Giuseppe La Masa 19, 20156 Milano, Italy
| | - Simona Barlera
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Enrico Nicolis
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Luisa Crociati
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Silvia Pietri
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
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13
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Christensen HM, Schou M, Goetze JP, Faber J, Frystyk J, Flyvbjerg A, Kistorp C. Body mass index in chronic heart failure: association with biomarkers of neurohormonal activation, inflammation and endothelial dysfunction. BMC Cardiovasc Disord 2013; 13:80. [PMID: 24083942 PMCID: PMC3850723 DOI: 10.1186/1471-2261-13-80] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers of neurohormonal activation, inflammation, and endothelial dysfunction are associated with BMI in CHF. METHODS In a cross-sectional study including 171 patients with CHF and a left ventricular ejection fraction (LVEF) ≤45% the impact of BMI on circulating plasma concentrations of adiponectin, α-defensins, high sensitivity C-reactive protein (hsCRP), copeptin, mid-regional pro-adrenomedullin (MR-proADM), NT-proBNP, and mid-regional pro-A-type natriuretic peptide (MR-proANP) were evaluated. RESULTS In multivariable linear regression analysis including age, sex, LVEF, New York Heart Association functional classification (NYHA), estimated glomerular filtration rate (eGFR), and diabetes, only NT-proBNP (β = -0.32) and adiponectin (β = -0.39) remained independently associated with BMI. MR-proANP was associated with BMI but adjusting for age attenuated the relation being no longer significant. CONCLUSIONS Among biomarkers typically increased in patients with CHF only adiponectin and NT-proBNP demonstrated independent inverse associations with BMI. This indicates a direct effect of these two biomarkers enhancing the wasting process seen in CHF.
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Affiliation(s)
- Heidi M Christensen
- Departments of Cardiology and Endocrinology, Herlev University Hospital, Ringvej 75, Herlev 2730, Denmark.
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14
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Turer AT, Hill JA, Elmquist JK, Scherer PE. Adipose tissue biology and cardiomyopathy: translational implications. Circ Res 2013; 111:1565-77. [PMID: 23223931 DOI: 10.1161/circresaha.111.262493] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is epidemiologically established that obesity is frequently associated with the metabolic syndrome and poses an increased risk for the development of type 2 diabetes mellitus and cardiovascular disease. The molecular links that connect the phenomenon of obesity, per se, with insulin resistance and cardiovascular disease are still not fully elucidated. It is increasingly apparent that fully functional adipose tissue can be cardioprotective by reducing lipotoxic effects in other peripheral tissues and by maintaining a healthy balance of critical adipokines, thereby allowing the heart to maintain its full metabolic flexibility. The present review highlights both basic and clinical findings that emphasize the complex interplay of adipose tissue physiology and adipokine-mediated effects on the heart exerted by either direct effects on cardiac myocytes or indirect actions via central mechanisms through sympathetic outflow to the heart.
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Affiliation(s)
- Aslan T Turer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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