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Deng MX, Barodi B, Elbatarny M, Yau TM. Considerations & challenges of mitral valve repair in females: diagnosis, pathology, and intervention. Curr Opin Cardiol 2024; 39:86-91. [PMID: 38116820 DOI: 10.1097/hco.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Disparities in mitral valve (MV) repair outcomes exist between men and women. This review highlights sex-specific differences in MV disease aetiology, diagnosis, as well as timing and type of intervention. RECENT FINDINGS Females present with more complicated disease: anterior or bileaflet prolapse, leaflet dysplasia/thickening, mitral annular calcification, and mixed mitral lesions. The absence of indexed echocardiographic mitral regurgitation (MR) severity parameters contributes to delayed intervention in women, resulting in more severe symptom burden at time of surgery. The sequelae of chronic MR also necessitate concomitant procedures (e.g. tricuspid repair, arrhythmia surgery) at the time of mitral surgery. Complex MV pathology, greater patient acuity, and more complicated procedures collectively pose challenges to successful MV repair and postoperative recovery. As a consequence, women receive disproportionately more MV replacement than men. In-hospital mortality after MV repair is also greater in women than men. Long-term outcomes of MV repair are comparable after risk-adjustment for preoperative status; however, women experience a greater incidence of postoperative heart failure. SUMMARY To address the inequity in MV repair outcomes between sexes, indexed diagnostic measurements, diligent surveillance of asymptomatic MR, increased recruitment of women in large clinical trials, and mandatory reporting of sex-based subgroup analyses are recommended.
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Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
| | - Batol Barodi
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
| | - Malak Elbatarny
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
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2
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Rivas VN, Ueda Y, Stern JA. Sex-specific differences and predictors of echocardiographic measures of diastolic dysfunction in rhesus macaques (Macaca mulatta). J Med Primatol 2023; 52:374-383. [PMID: 37461241 PMCID: PMC10792101 DOI: 10.1111/jmp.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Diastolic dysfunction in humans is an age-related process with an overrepresentation in women. In rhesus macaques (Macaca mulatta), the incidence and predictors of diastolic dysfunction have yet to be reported. METHODS Data from routine echocardiographic evaluations on clinically healthy rhesus macaques was obtained and used for univariate, bivariate, hypothesis testing, and linear regression statistical analyses interrogating differences and predictors of diastolic function. RESULTS Rhesus macaques fully recapitulate previously reported human hemodynamic studies. Female monkeys display impaired diastology and are at an increased risk for developing diastolic dysfunction. Age, sex, and proxies of exercise activity are confirmed predictors for measures of diastolic dysfunction, regardless of specific pathogen-free status. CONCLUSIONS Rhesus macaques share common sex- and age-related echocardiographic findings as humans, therefore, serve as a valuable translational nonhuman primate model for future studies of diastolic dysfunction. These findings confirm the importance of sex- and age-matching within future rhesus macaque cardiovascular research.
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Affiliation(s)
- Victor N. Rivas
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Yu Ueda
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Joshua A. Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States of America
- California National Primate Research Center, University of California-Davis, Davis, CA, United States of America
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3
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Casado-Barragán F, Lazcano-Páez G, Larenas PE, Aguirre-Delgadillo M, Olivares-Aravena F, Witto-Oyarce D, Núñez-Allimant C, Silva K, Nguyen QM, Cárdenas P, Kassan M, Gonzalez AA. Increased Renal Medullary NOX-4 in Female but Not Male Mice during the Early Phase of Type 1 Diabetes: Potential Role of ROS in Upregulation of TGF-β1 and Fibronectin in Collecting Duct Cells. Antioxidants (Basel) 2023; 12:antiox12030729. [PMID: 36978977 PMCID: PMC10045926 DOI: 10.3390/antiox12030729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic diabetes mellitus (DM) can lead to kidney damage associated with increased reactive oxygen species (ROS), proteinuria, and tubular damage. Altered protein expression levels of transforming growth factor-beta 1 (TGF-β1), fibronectin, and renal NADPH oxidase (NOX-4) are associated with the profibrotic phenotype in renal tubular cells. NOX-4 is one of the primary sources of ROS in the diabetic kidney and responsible for the induction of profibrotic factors in collecting duct (CD) cells. The renal medulla is predominantly composed of CDs; in DM, these CD cells are exposed to high glucose (HG) load. Currently there is no published literature describing the expression of these markers in the renal medulla in male and female mice during the early phase of DM, or the role of NOX-4-induced ROS. Our aim was to evaluate changes in transcripts and protein abundances of TGF-β1, fibronectin, and NOX-4 along with ROS levels in renal medullary tissues from male and female mice during a short period of streptozotocin (STZ)-induced type 1 DM and the effect of HG in cultured CD cells. CF-1 mice were injected with or without a single dose of STZ (200 mg/kg) and euthanized at day 6. STZ females showed higher expression of fibronectin and TGF-β1 when compared to control mice of either gender. Interestingly, STZ female mice showed a >30-fold increase on mRNA levels and a 3-fold increase in protein levels of kidney medullary NOX-4. Both male and female STZ mice showed increased intrarenal ROS. In primary cultures of inner medullary CD cells exposed to HG over 48 h, the expression of TGF-β1, fibronectin, and NOX-4 were augmented. M-1 CD cells exposed to HG showed increased ROS, fibronectin, and TGF-β1; this effect was prevented by NOX-4 inhibition. Our data suggest that at as early as 6 days of STZ-induced DM, the expression of profibrotic markers TGF-β1 and fibronectin increases in renal medullary CD cells. Antioxidants mechanisms in male and female in renal medullary tissues seems to be differentially regulated by the actions of NOX-4.
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Affiliation(s)
- Felipe Casado-Barragán
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Geraldine Lazcano-Páez
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Paulina E. Larenas
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | | | | | - Daniela Witto-Oyarce
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Camila Núñez-Allimant
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Katherin Silva
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Quynh My Nguyen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Pilar Cárdenas
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Modar Kassan
- College of Dental Medicine, Lincoln Memorial University, Knoxville, TN 37917, USA
| | - Alexis A. Gonzalez
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
- Correspondence:
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4
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Karthikeya K. Electrocardiogram as a Tool to Predict Diastolic Dysfunction in the Early Hypertensive Patients and its Comparison in Males and Females. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives:
Heart failure with preserved ejection fraction continues to be a major healthcare challenge. Assessment of diastolic dysfunction (DD) is an integral part of the routine cardiologic examination, however little is known about ECG changes in diastolic dysfunction. several resting ECG parameters have been investigated to predict left ventricular diastolic dysfunction (LVDD). The study aims to assess diastolic dysfunction in recently diagnosed hypertensive patients by echocardiography and to find the value of ECG-derived parameters in predicting diastolic dysfunction.
Materials and Methods:
One hundred and fifty hypertensive patients of less than 1-year duration were divided into two groups based on the presence or absence of diastolic dysfunction. ECG parameters such as P wave dispersion, QT and QTc interval, ventricular activation time, Tend P, Tend Q were analyzed in all patients, and correlation was done with echo parameters to assess diastolic dysfunction in both males and females.
Results:
In both men and women a significant correlation was found between p wave dispersion, ventricular activation time, Corrected QT interval, TendP, and, Tend Q in ECG with diastolic dysfunction on bivariate regression analysis. Multivariate regression analysis showed that p wave dispersion had a greater correlation with diastolic dysfunction when compared with other ECG parameters (r=0.88, R2=0.78).
Conclusion:
Analysis of certain ECG parameters especially p wave dispersion is of great value in predicting diastolic dysfunction in both men and women.
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Affiliation(s)
- Kapil Karthikeya
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
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5
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Cao Y, Vergnes L, Wang YC, Pan C, Chella Krishnan K, Moore TM, Rosa-Garrido M, Kimball TH, Zhou Z, Charugundla S, Rau CD, Seldin MM, Wang J, Wang Y, Vondriska TM, Reue K, Lusis AJ. Sex differences in heart mitochondria regulate diastolic dysfunction. Nat Commun 2022; 13:3850. [PMID: 35787630 PMCID: PMC9253085 DOI: 10.1038/s41467-022-31544-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/15/2022] [Indexed: 01/10/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) exhibits a sex bias, being more common in women than men, and we hypothesize that mitochondrial sex differences might underlie this bias. As part of genetic studies of heart failure in mice, we observe that heart mitochondrial DNA levels and function tend to be reduced in females as compared to males. We also observe that expression of genes encoding mitochondrial proteins are higher in males than females in human cohorts. We test our hypothesis in a panel of genetically diverse inbred strains of mice, termed the Hybrid Mouse Diversity Panel (HMDP). Indeed, we find that mitochondrial gene expression is highly correlated with diastolic function, a key trait in HFpEF. Consistent with this, studies of a "two-hit" mouse model of HFpEF confirm that mitochondrial function differs between sexes and is strongly associated with a number of HFpEF traits. By integrating data from human heart failure and the mouse HMDP cohort, we identify the mitochondrial gene Acsl6 as a genetic determinant of diastolic function. We validate its role in HFpEF using adenoviral over-expression in the heart. We conclude that sex differences in mitochondrial function underlie, in part, the sex bias in diastolic function.
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Affiliation(s)
- Yang Cao
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Laurent Vergnes
- Metabolism Theme, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA
| | - Yu-Chen Wang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Calvin Pan
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Karthickeyan Chella Krishnan
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
- Department of Pharmacology and Physiology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Timothy M Moore
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Manuel Rosa-Garrido
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Todd H Kimball
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zhiqiang Zhou
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Sarada Charugundla
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Christoph D Rau
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marcus M Seldin
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Jessica Wang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Yibin Wang
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas M Vondriska
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Karen Reue
- Metabolism Theme, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA
- Molecular Biology Institute at UCLA, Los Angeles, CA, 90095, USA
| | - Aldons J Lusis
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA.
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA.
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, CA, USA.
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6
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Sex differences in the longitudinal relationship of low-grade inflammation and echocardiographic measures in the Hoorn and FLEMENGHO Study. PLoS One 2021; 16:e0251148. [PMID: 33945586 PMCID: PMC8096104 DOI: 10.1371/journal.pone.0251148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/21/2021] [Indexed: 01/09/2023] Open
Abstract
Background This study aimed to determine the within-person and between-persons associations of low-grade inflammation (LGI) and endothelial dysfunction (ED) with echocardiographic measures related to diastolic dysfunction (DD) in two general populations and whether these associations differed by sex. Methods Biomarkers and echocardiographic measures were measured at both baseline and follow-up in the Hoorn Study (n = 383) and FLEMENGHO (n = 491). Individual biomarker levels were combined into either a Z-score of LGI (CRP, SAA, IL-6, IL-8, TNF-α and sICAM-1) or ED (sICAM-1, sVCAM-1, sE-selectin and sTM). Mixed models were used to determine within-person and between-persons associations of biomarker Z-scores with left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) and left atrial volume index (LAVI). These associations were adjusted for a-priori selected confounders. Results Overall Z-scores for LGI or ED were not associated with echocardiographic measures. Effect modification by sex was apparent for ED with LVEF in both cohorts (P-for interaction = 0.08 and 0.06), but stratified results were not consistent. Effect modification by sex was apparent for TNF-α in the Hoorn Study and E-selectin in FLEMENGHO with LVEF (P-for interaction≤0.05). In the Hoorn Study, women whose TNF-α levels increased with 1-SD over time had a decrease in LVEF of 2.2 (-4.5;0.01) %. In FLEMENGHO, men whose E-selectin levels increased with 1-SD over time had a decrease in LVEF of 1.6 (-2.7;-0.5) %. Conclusion Our study did not show consistent associations of LGI and ED with echocardiographic measures. Some evidence of effect modification by sex was present for ED and specific biomarkers.
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Wang J, Tillin T, Hughes AD, Richards M, Sattar N, Park C, Chaturvedi N. Subclinical macro and microvascular disease is differently associated with depressive symptoms in men and women: Findings from the SABRE population-based study. Atherosclerosis 2020; 312:35-42. [PMID: 32971394 PMCID: PMC7594642 DOI: 10.1016/j.atherosclerosis.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/04/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS Mechanisms underlying the association between cardiovascular disease (CVD) and depression are unknown, and sex differences understudied. We investigated associations between a comprehensive set of measures of macro and microvascular disease and depressive symptoms in older men and women. METHODS We performed cross-sectional analyses of the SABRE (Southall And Brent REvisited) population-based study. Participants (1396) attended clinic between 2008 and 2011 for assessment of subclinical macrovascular (carotid ultrasound, echocardiography, cerebral magnetic resonance imaging) and microvascular (retinopathy, nephropathy) disease, and depression. RESULTS Mean age of 1396 participants was 69.5 years, and 76.2% were male. The median (interquartile range) of depression score was 1 [0, 2] for men and 1 [0, 3] for women. All measures of subclinical macro and microvascular disease were adversely associated with depressive symptoms, even when known CVD was excluded. Physical activity partly explained some of these relationships. The association between left atrial dimension index (LADI), a measure of chronic elevated left ventricular filling pressure, and depressive symptoms was stronger in women (regression coefficient 0.23 [95% CI 0.11, 0.35]) than men (0.07 [-0.01, 0.15]), p for interaction 0.06, on multivariable adjustment. CONCLUSIONS Subclinical macro and microvascular disease is associated with depressive symptoms, even in the absence of established CVD. These were in part accounted for by physical activity. We observed stronger association between LADI and depressive symptoms in women than in men. The beneficial role of physical activity in abrogating the association between subclinical CVD and depression warrants further investigation.
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Affiliation(s)
- Jingyi Wang
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
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8
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Riesenhuber M, Spannbauer A, Rauscha F, Schmidinger H, Boszotta A, Pezawas T, Schukro C, Gwechenberger M, Stix G, Anvari A, Wrba T, Khazen C, Andreas M, Laufer G, Hengstenberg C, Gyöngyösi M. Sex Differences and Long-Term Outcome in Patients With Pacemakers. Front Cardiovasc Med 2020; 7:569060. [PMID: 33195457 PMCID: PMC7536343 DOI: 10.3389/fcvm.2020.569060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Evidence of sex-related differences in patients with pacemakers regarding comorbidities is insufficiently investigated. The aim of this study was to determine the relationship of cardiovascular comorbidities and sex category with properties of pacemaker implantation, pacemaker follow-up, and long-term survival. Methods: This retrospective, single-center cohort study consisted of 6,362 pacemaker-patients (39.7% female) enrolled between May 2000 and April 2015. Functional pacemaker parameters were registered at regular pacemaker controls. Survival status and cause of death were analyzed in relation to comorbidities, implanted pacing devices, and echocardiography. Survival analyses were plotted for a 10-year follow-up. Results: Patients with hypertension or hyperlipidemia had higher rates of implantations due to sick sinus syndrome (28.6 vs. 25.5% without hypertension, P < 0.001; 30.7 vs. 25.7% without hyperlipidemia, P < 0.001), while endocarditis was associated with higher rates of implantations due to AV block (46.7 vs. 33.4%, P < 0.001). Patients with valvular heart disease had higher rates of pacemaker implantation due to bradycardic atrial fibrillation (24.9 vs. 21.0% without valvular heart disease, P < 0.001). Ventricular pacing threshold increased in both sexes during the follow-up and was higher in women in the final follow-up (0.94 vs. 0.91 V in men, P = 0.002). During the 10-years follow-up, 6.1% of women and 8.6% of men underwent lead replacement (P = 0.054). Device and lead replacement rates were increased if the comorbidities coronary artery disease, heart failure, hypertension, hyperlipidemia, valvular heart disease, previous stroke/TIA, atrial arrhythmias, chronic kidney disease, or endocarditis were present. Diabetes and previous CABG increase the rates of device replacement, but not the rate of lead replacement. Severe tricuspid regurgitation after implantation of pacemaker was present in more men than women (14.4 vs. 6.1%, P < 0.001). In a multivariate COX regression, the following variables were associated with independent decrease of 10-year survival: hypertension (HR 1.34, 95% CI 1.09-1.64), chronic kidney disease (HR 1.83, 95% CI 1.53-2.19), tricuspid regurgitation after pacemaker implantation (HR 1.48, 95% CI 1.26-1.74). Survival was independently increased in female sex (HR 0.83, 95% CI 0.70-0.99) and hyperlipidemia (HR 0.81, 95% CI 0.67-0.97). Conclusions: Cardiovascular comorbidities influenced significantly pacemaker implantations and long-term outcome. Trial Registration: ClinicalTrials.gov Unique identifier: NCT03388281.
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Affiliation(s)
- Martin Riesenhuber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Spannbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Friedrich Rauscha
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Herwig Schmidinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Adelinde Boszotta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph Schukro
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marianne Gwechenberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Günter Stix
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Anahit Anvari
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Wrba
- IT Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Cesar Khazen
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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9
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Incidence, predictors and prognostic implications of dyspnea at admission among acute coronary syndrome patients without heart failure. Int J Cardiol 2020; 301:29-33. [DOI: 10.1016/j.ijcard.2019.11.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/29/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
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10
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Kokhan EV, Ozova EM, Romanova VA, Kiyakbaev GK, Kobalava ZD. Left Atrial Phasic Function in Patients with Hypertension and Recurrent Atrial Fibrillation: Gender Differences of the Relationship with Diastolic Dysfunction and Central Aortic Pressure. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-622-633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To evaluate gender-related differences of left atrial (LA) phasic function and structural remodeling in conjunction with the parameters of left ventricular (LV) diastolic dysfunction and central aortic pressure in patients with hypertension and recurrent atrial fibrillation (AF).Material and methods. The comparative study included 30 men and 37 women with non-valvular AF, hypertension and LV hypertrophy. Conventional echocardiographic measures were extended with LA measures, including its volume in three phases, LAemptying fraction (LAEF), passive and active ejection fraction. The parameters of central aortic pressure were estimated by applanation tonometry method.Results. No difference was observed between LA and LV structural parameters in men and women. However, in women LAEF (39 [28;50] vs 50 [42;55]%; p=0.02) and E/E’(9.7 [7.8;12] vs 7.1 [5.6;8.6]; p=0.001) were worse than in men. Active LA ejection fraction was higher in women (31 [21;42] vs 24 [19;31]%; p=0.04), whereas passive one – in men (12 [10;14] vs 33 [23;38]%; p<0.001), respectively. Men and women had comparable heart rate (HR), central and peripheral systolic and diastolic pressure, pulse wave velocity (PWV), but women had higher augmentation index (AI) values [33 [28;39] vs 23 [21;28]%; p<0.001], even adjusted by HR (AI 75) (34 [27;39] vs 26 [20;29]%; p<0.001). Only in men PWV weakly correlated with AI 75 (r=0.44; p=0.02 versus r=-0.11; p=0.51, respectively for men and women; intergroup differences: z=2.26; p=0.012). In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and glomerular filtration rate (GFR), whereas in women – with E’ and AI 75.Conclusion. Patients of different genders with recurrent AF and hypertension have comparable LA structuralremodeling. However, women characterized by a more pronounced decrease in LAEF and impaired LV diastolic function than men. In women as distinct from men LV filling is predominantly due to LA systole. In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and GFR, whereas in women – with E’ and AI 75.
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Affiliation(s)
- E. V. Kokhan
- Peoples Friendship University of Russia (RUDN University)
| | - E. M. Ozova
- Peoples Friendship University of Russia (RUDN University)
| | - V. A. Romanova
- Peoples Friendship University of Russia (RUDN University)
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Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction. Int J Cardiol 2019; 299:31-36. [PMID: 31300172 DOI: 10.1016/j.ijcard.2019.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sex-specific outcome data following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse cardiac events (MACE). Since mechanistic principles remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation. METHODS In total, 795 ST-elevation MI patients underwent post-interventional CMR imaging. Feature-tracking (CMR-FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster-pump strains (εa). Tissue characterisation included infarct size, microvascular obstruction and area at risk. Primary endpoint was the occurrence of MACE within 1 year. RESULTS Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13-3.42, p = 0.017) but not independently of baseline confounders (p = 0.526) with women being older, more often diabetic and hypertensive (p < 0.001) and of higher Killip-class (p = 0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p = 0.011, εe p < 0.001) but increased systolic ventricular mechanics (GLS p = 0.001, LVEF p = 0.048). While atrial and ventricular function predicted MACE in men only LV GLS and GCS were associated with MACE in women irrespective of confounders (GLS p = 0.036, GCS p = 0.04). CONCLUSION In men ventricular systolic contractility is impaired and volume assessments precisely stratify elevated risks. In contrast, women experience reduced atrial but increased ventricular systolic strain. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE adding incremental value to sex-specific prognosis evaluation.
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12
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Blackman AO, Sobral Neto J, Lima ML, Rodrigues TMA, Gomes OM. Assessment and clinical relevance of the dynamic parameters of ventricular repolarization in patients with grade I left ventricular diastolic dysfunction 1. Can J Physiol Pharmacol 2019; 97:577-580. [PMID: 30676775 DOI: 10.1139/cjpp-2018-0507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imbalance in ventricular repolarization parameters are related to increased risk of severe arrhythmia and sudden cardiac death. There is limited research regarding markers to detect patients at risk in this early stage. We aimed to assess the influence of grade I left ventricular diastolic dysfunction on repolarization parameters in asymptomatic patients. Ambulatory patients with grade I left ventricular diastolic dysfunction were studied and compared with a control group. We assessed the QT dispersion circadian variation, heart rate variability in the time and frequency domains, and dynamics of QT using a 12-lead Holter. In the diastolic dysfunction group, 8 (30%) patients had QT dispersion > 80 ms. One (3.8%) patient presented premature ventricular complex > 10/h. The comparison between the 2 groups showed that the difference between the standard deviation of normal-to-normal intervals and low frequency power in both groups was statistically significant. We therefore conclude that increased parameters of ventricular repolarization and depressed heart rate variability reflect an imbalance in autonomic responses in patients with grade I left ventricular diastolic dysfunction without cardiovascular symptoms, enabling the identification of patients that are at a higher risk for cardiovascular events.
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Affiliation(s)
- Antoinette Oliveira Blackman
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil.,b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil.,c Faculdade de Medicina, Uniceub, Brasília, DF, Brazil
| | - José Sobral Neto
- b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil
| | - Melchior Luiz Lima
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
| | | | - Otoni Moreira Gomes
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
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13
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Left Ventricular Diastolic Function After Aortic Valve Replacement for Chronic Aortic Regurgitation. Ann Thorac Surg 2018; 106:24-29. [DOI: 10.1016/j.athoracsur.2018.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/23/2017] [Accepted: 03/11/2018] [Indexed: 11/19/2022]
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Platt MJ, Huber JS, Romanova N, Brunt KR, Simpson JA. Pathophysiological Mapping of Experimental Heart Failure: Left and Right Ventricular Remodeling in Transverse Aortic Constriction Is Temporally, Kinetically and Structurally Distinct. Front Physiol 2018; 9:472. [PMID: 29867532 PMCID: PMC5962732 DOI: 10.3389/fphys.2018.00472] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022] Open
Abstract
A growing proportion of heart failure (HF) patients present with impairments in both ventricles. Experimental pressure-overload (i.e., transverse aortic constriction, TAC) induces left ventricle (LV) hypertrophy and failure, as well as right ventricle (RV) dysfunction. However, little is known about the coordinated progression of biventricular dysfunction that occurs in TAC. Here we investigated the time course of systolic and diastolic function in both the LV and RV concurrently to improve our understanding of the chronology of events in TAC. Hemodynamic, histological, and morphometric assessments were obtained from the LV and RV at 2, 4, 9, and 18 weeks post-surgery. Results: Systolic pressures peaked in both ventricles at 4 weeks, thereafter steadily declining in the LV, while remaining elevated in the RV. The LV and RV followed different structural and functional timelines, suggesting the patterns in one ventricle are independent from the opposing ventricle. RV hypertrophy/fibrosis and pulmonary arterial remodeling confirmed a progressive right-sided pathology. We further identified both compensation and decompensation in the LV with persistent concentric hypertrophy in both phases. Finally, diastolic impairments in both ventricles manifested as an intricate progression of multiple parameters that were not in agreement until overt systolic failure was evident. Conclusion: We establish pulmonary hypertension was secondary to LV dysfunction, confirming TAC is a model of type II pulmonary hypertension. This study also challenges some common assumptions in experimental HF (e.g., the relationship between fibrosis and filling pressure) while addressing a knowledge gap with respect to temporality of RV remodeling in pressure-overload.
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Affiliation(s)
- Mathew J. Platt
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Jason S. Huber
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Nadya Romanova
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Keith R. Brunt
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Jeremy A. Simpson
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
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15
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Chandramouli C, Reichelt ME, Curl CL, Varma U, Bienvenu LA, Koutsifeli P, Raaijmakers AJA, De Blasio MJ, Qin CX, Jenkins AJ, Ritchie RH, Mellor KM, Delbridge LMD. Diastolic dysfunction is more apparent in STZ-induced diabetic female mice, despite less pronounced hyperglycemia. Sci Rep 2018; 8:2346. [PMID: 29402990 PMCID: PMC5799292 DOI: 10.1038/s41598-018-20703-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/23/2018] [Indexed: 12/17/2022] Open
Abstract
Diabetic cardiomyopathy is a distinct pathology characterized by early emergence of diastolic dysfunction. Increased cardiovascular risk associated with diabetes is more marked for women, but an understanding of the role of diastolic dysfunction in female susceptibility to diabetic cardiomyopathy is lacking. To investigate the sex-specific relationship between systemic diabetic status and in vivo occurrence of diastolic dysfunction, diabetes was induced in male and female mice by streptozotocin (5x daily i.p. 55 mg/kg). Echocardiography was performed at 7 weeks post-diabetes induction, cardiac collagen content assessed by picrosirius red staining, and gene expression measured using qPCR. The extent of diabetes-associated hyperglycemia was more marked in males than females (males: 25.8 ± 1.2 vs 9.1 ± 0.4 mM; females: 13.5 ± 1.5 vs 8.4 ± 0.4 mM, p < 0.05) yet in vivo diastolic dysfunction was evident in female (E/E' 54% increase, p < 0.05) but not male diabetic mice. Cardiac structural abnormalities (left ventricular wall thinning, collagen deposition) were similar in male and female diabetic mice. Female-specific gene expression changes in glucose metabolic and autophagy-related genes were evident. This study demonstrates that STZ-induced diabetic female mice exhibit a heightened susceptibility to diastolic dysfunction, despite exhibiting a lower extent of hyperglycemia than male mice. These findings highlight the importance of early echocardiographic screening of asymptomatic prediabetic at-risk patients.
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Affiliation(s)
- Chanchal Chandramouli
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- National Heart Centre, Singapore, Singapore
| | - Melissa E Reichelt
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Claire L Curl
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Upasna Varma
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura A Bienvenu
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Parisa Koutsifeli
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | | | - Miles J De Blasio
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- School of Biosciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Cheng Xue Qin
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca H Ritchie
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kimberley M Mellor
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Lea M D Delbridge
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia.
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16
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Regitz-Zagrosek V. Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women. Korean Circ J 2018; 48:792-812. [PMID: 30146804 DOI: 10.4070/kcj.2018.0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
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Affiliation(s)
- Vera Regitz-Zagrosek
- CHARITÉ Universitätsmedizin Berlin, Institute of Gender in Medicine and CCR, and DZHK (partner site Berlin), Berlin, Germany.
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17
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Butler CG, Ho Luxford JM, Huang CC, Ejiofor JI, Rawn JD, Wilusz K, Fox JA, Shernan SK, Muehlschlegel JD. Aortic Atheroma Increases the Risk of Long-Term Mortality in 20,000 Patients. Ann Thorac Surg 2017; 104:1325-1331. [PMID: 28577841 DOI: 10.1016/j.athoracsur.2017.02.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association between long-term survival and aortic atheroma in cardiac surgical patients has not been comprehensively investigated. In this study we determine the relation between grade of atheroma and the risk of long-term mortality in a retrospective cohort of more than 20,000 patients undergoing cardiac operation during a 20-year period. METHODS We included 22,304 consecutive intraoperative transesophageal and epiaortic ultrasound examinations performed at Brigham and Women's Hospital between 1995 and 2014, with long-term follow-up. The extent of atheromatous disease recorded in each examination was used for analysis. Mortality data were obtained from our institution's data registry. Mortality analyses were done using Cox proportional hazard regression models with follow-up as a time scale. We repeated the analysis in a subgroup of 14,728 patients with more detailed demographic characteristics, including postoperative stroke, queried from the institutional Society of Thoracic Surgeons database. RESULTS A total of 7,722 mortality events and 872 stroke events occurred. Patients with atheromatous disease demonstrated a significant increase in mortality across all grades of severity, both for the ascending and descending aorta. This relation remained unchanged after adjusting for additional covariates. Adjustments for postoperative stroke resulted in only minimal attenuation in the risk of postoperative mortality related to aortic atheroma. CONCLUSIONS Aortic atheromatous disease of any grade in the ascending and descending aorta is a significant long-term risk of long-term, all-cause mortality in cardiac operation patients. This association remains independent of other conventional risk factors and is not related to postoperative cerebrovascular accidents.
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Affiliation(s)
- Carolyn Goldberg Butler
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jamahal Maeng Ho Luxford
- Department of Anaesthesia and Pain Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Chuan-Chin Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Julius I Ejiofor
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - James D Rawn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kerry Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - John A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Jochen Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston.
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18
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19
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Wittnich C, Wallen J, Belanger M. The Role of 17β-Estradiol in Myocardial Hypertrophy in Females in the Presence and Absence of Hypertension. Cardiovasc Drugs Ther 2016; 29:347-53. [PMID: 26109517 DOI: 10.1007/s10557-015-6603-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE There are gender-differences in the development of cardiac hypertrophy, which appear to be related, in part, to sex hormones. This report gives an overview of this relationship and reports on original data assessing how varying levels of plasma 17β-estradiol determine relative heart size, in vivo function, in hypertensive versus normotensive rats. METHODS Female spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats were either surgically neutered or sham operated at 21 days of age. A subgroup of neutered females received 17β-estradiol replacement. At 6 months, in vivo heart function was measured, the heart/body weight ratio (mg/g) was assessed as a measure of hypertrophy and correlated with plasma 17β-estradiol. RESULTS There was a significant positive relationship between plasma 17β-estradiol and heart/body weight ratio in both WKY (R = 0.509, P = 0.011) and SHR females (R = 0.359, P = 0.032). Interestingly, the slope of this relationship was 2-fold steeper in the WKY females, suggesting a blunted effect in the SHR, whose hearts also had 35 % lower ERβ content. With increasing plasma estradiol levels, WKY females showed improved LV function while SHR females showed impaired LV relaxation. CONCLUSIONS Plasma estradiol modulates relative heart mass in both normotensive and hypertensive female rats. With any increase in plasma 17β-estradiol, hypertensive females show a blunted response compared with the normotensive females, which may be related to a reduced estrogen receptor expression in the presence of hypertension. In contrast to normotensive females, hypertensive females showed impaired function with increases in plasma 17β-estradiol.
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Affiliation(s)
- Carin Wittnich
- From the Departments of Physiology (J.W., C.W., M.B) and Surgery (C.W.) and The Cardiovascular Sciences Collaborative Program (W.J.W., C.W.), University of Toronto, 1 King's College Circle, Medical Sciences Bldg. Room 7256, Toronto, Ontario, Canada, M5S 1A8,
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20
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 422] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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den Ruijter HM, Haitjema S, van der Meer MG, van der Harst P, Rouleau JL, Asselbergs FW, van Gilst WH. Long-term outcome in men and women after CABG; results from the IMAGINE trial. Atherosclerosis 2015; 241:284-8. [PMID: 25731671 DOI: 10.1016/j.atherosclerosis.2015.02.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/05/2015] [Accepted: 02/18/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to determine sex differences in long-term outcome after coronary artery bypass grafting (CABG). METHODS The international randomized controlled IMAGINE study included 2553 consecutive patients with a left ventricular ejection fraction of >40% who underwent isolated CABG. Median follow-up was 32 months (IQR 17-42 months). The composite endpoint comprised of death, myocardial infarction (MI), cerebrovascular event, angina, revascularization and congestive heart failure. Cox regression analysis was used to examine sex differences in outcome post-CABG. RESULTS Of the 2553 patients, 2229 were men and 324 (13%) were women. Women were older and more often reported diabetes and hypertension. Smoking and impaired renal function were more prevalent in men. Women experienced a higher event rate during follow-up (composite endpoint 18% vs 12%; P = 0.007). Cox regression showed an increased risk of the composite endpoint in women after adjustment for age (HR 1.48 (95% CI: 1.11-1.97)) which was non-significant after additional adjustment for other confounders (HR 1.26 (95% CI: 0.92-1.72)). CONCLUSION Women have a worse long-term outcome after CABG than men in univariate analysis. However, after adjusting for potential confounders female sex became a non-significant predictor for prognosis, possibly due to the small sample size of women. Definite answers regarding sex-differences in long-term outcome after CABG should come from future pooling of studies comprising a larger number of women.
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Affiliation(s)
- Hester M den Ruijter
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Haitjema
- Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Manon G van der Meer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jean L Rouleau
- Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research, University of Montreal, Montreal, Canada
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Wiek H van Gilst
- Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands
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