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Crosier R, Lopez Laporte MA, Unni RR, Coutinho T. Female-Specific Considerations in Aortic Health and Disease. CJC Open 2024; 6:391-406. [PMID: 38487044 PMCID: PMC10935703 DOI: 10.1016/j.cjco.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
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Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Rudy R. Unni
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Thomas TS, Walpert AR, Srinivasa S. Large lessons learned from small vessels: coronary microvascular dysfunction in HIV. Curr Opin Infect Dis 2024; 37:26-34. [PMID: 37889554 DOI: 10.1097/qco.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Large cohort studies have consistently shown the presence of heart failure is approximately doubled among persons with HIV (PWH). Early studies of cardiovascular disease (CVD) in HIV were primarily focused on atherosclerotic burden, and we now have a greater understanding of large vessel disease in HIV. More recent studies have begun to inform us about small vessel disease, or coronary microvascular dysfunction (CMD), in HIV. CMD is recognized to be an important risk factor for adverse events related to heart failure, associated with cardiovascular mortality, and often presents without overt atherosclerotic disease. RECENT FINDINGS In this review, we highlight implications for CMD and relevant clinical studies in HIV. Inflammation and endothelial dysfunction, well known risk factors in HIV, may mediate the pathogenesis of CMD. Initial studies suggest that CMD worsens with ART initiation. Newer studies reveal CMD is present among well treated PWH without known CVD. In addition, myocardial flow reserve (MFR), a marker of CMD, is reduced in HIV similar to diabetes. There also appears to be sex differences, such that CMD is worse among women vs. men with HIV. SUMMARY Alterations in the coronary microvasculature may be an important mediator of subclinical myocardial dysfunction that deserves further clinical attention among PWH without known CVD.
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Affiliation(s)
- Teressa S Thomas
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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3
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Ma P, Liu J, Hu Y, Chen L, Liang H, Zhou X, Shang Y, Wang J. Stress CMR T1-mapping technique for assessment of coronary microvascular dysfunction in a rabbit model of type II diabetes mellitus: Validation against histopathologic changes. Front Cardiovasc Med 2023; 9:1066332. [PMID: 36741851 PMCID: PMC9895118 DOI: 10.3389/fcvm.2022.1066332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
Background Coronary microvascular dysfunction (CMD) is an early character of type 2 diabetes mellitus (T2DM), and is indicative of adverse events. The present study aimed to validate the performance of the stress T1 mapping technique on cardiac magnetic resonance (CMR) for identifying CMD from a histopathologic perspective and to establish the time course of CMD-related parameters in a rabbit model of T2DM. Methods New Zealand white rabbits (n = 30) were randomly divided into a control (n = 8), T2DM 5-week (n = 6), T2DM 10-week (n = 9), and T2DM 15-week (n = 7) groups. The CMR protocol included rest and adenosine triphosphate (ATP) stress T1-mapping imaging using the 5b(20b)3b-modified look-locker inversion-recovery (MOLLI) schema to quantify stress T1 response (stress ΔT1), and first-pass perfusion CMR to quantify myocardial perfusion reserve index (MPRI). After the CMR imaging, myocardial tissue was subjected to hematoxylin-eosin staining to evaluate pathological changes, Masson trichrome staining to measure collagen volume fraction (CVF), and CD31 staining to measure microvascular density (MVD). The associations between CMR parameters and pathological findings were determined using Pearson correlation analysis. Results The stress ΔT1 values were 6.21 ± 0.59%, 4.88 ± 0.49%, 3.80 ± 0.40%, and 3.06 ± 0.54% in the control, T2DM 5-week, 10-week, and 15-week groups, respectively (p < 0.001) and were progressively weakened with longer duration of T2DM. Furthermore, a significant correlation was demonstrated between the stress ΔT1 vs. CVF and MVD (r = -0.562 and 0.886, respectively; p < 0.001). Conclusion The stress T1 response correlated well with the histopathologic measures in T2DM rabbits, indicating that it may serve as a sensitive CMD-related indicator in early T2DM.
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Affiliation(s)
- Peisong Ma
- Department of Radiology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China,Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Liu
- Department of Ultrasound, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yurou Hu
- Department of Radiology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Lin Chen
- Department of Radiology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Hongqin Liang
- Department of Radiology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Yongning Shang
- Department of Ultrasound, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China,*Correspondence: Yongning Shang,
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China,Jian Wang,
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Zhan J, Zhong L, Wu J. Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound. Front Cardiovasc Med 2022; 9:899099. [PMID: 35795368 PMCID: PMC9251174 DOI: 10.3389/fcvm.2022.899099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.
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Plin5, a New Target in Diabetic Cardiomyopathy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2122856. [PMID: 35509833 PMCID: PMC9060988 DOI: 10.1155/2022/2122856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Abnormal lipid accumulation is commonly observed in diabetic cardiomyopathy (DC), which can create a lipotoxic microenvironment and damage cardiomyocytes. Lipid toxicity is an important pathogenic factor due to abnormal lipid accumulation in DC. As a lipid droplet (LD) decomposition barrier, Plin5 can protect LDs from lipase decomposition and regulate lipid metabolism, which is involved in the occurrence and development of cardiovascular diseases. In recent years, studies have shown that Plin5 expression is involved in the pathogenesis of DC lipid toxicity, such as oxidative stress, mitochondrial dysfunction, endoplasmic reticulum (ER) stress, and insulin resistance (IR) and has become a key target of DC research. Therefore, understanding the relationship between Plin5 and DC progression as well as the mechanism of this process is crucial for developing new therapeutic approaches and exploring new therapeutic targets. This review is aimed at exploring the latest findings and roles of Plin5 in lipid metabolism and DC-related pathogenesis, to explore possible clinical intervention approaches.
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
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Yin Z, Chen C. Biological Functions and Clinical Prospects of Extracellular Non-Coding RNAs in Diabetic Cardiomyopathy: an Updated Review. J Cardiovasc Transl Res 2022; 15:469-476. [PMID: 35175553 DOI: 10.1007/s12265-022-10217-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
Diabetic cardiomyopathy (DCM) is one of the major causes of heart failure in diabetic patients. However, the pathogenesis of diabetic cardiomyopathy has not been fully elucidated. Diagnosis and therapeutic strategy of DCM is still challenging. Various non-coding RNAs (ncRNA) are implicated in the onset and progression of DCM. Interestingly, ncRNAs not only are regulators intracellularly, but also can exist and function in extracellular space. Recent evidences have demonstrated that extracellular ncRNAs play emerging roles in both intracardiac and inter-organ communication during the pathogenesis of DCM; thus, extracellular ncRNAs are attractive diagnostic biomarkers and potential therapeutic targets for DCM. This article will review the current knowledge of the roles of extracellular ncRNAs in DCM, especially focusing on their physio-pathological properties and perspectives of potential clinical translation for biomarkers and therapies. Recent evidences have demonstrated that extracellular ncRNA play emerging roles in both intracardiac and inter-organ communication involved in the pathogenesis of diabetic cardiomyopathy (DCM), thus shown as attractive diagnostic biomarkers and potential therapeutics for DCM. In the current review, we first summarize the progress regarding the paracrine role of extracellular ncRNA in DCM. miRNAs and circRNAs have been shown to mediate the communication among cardiomyocytes, endothelial cells, and vascular smooth muscle cells in the diabetic heart. Subsequently, we systematically describe that extracellular ncRNAs contribute to the crosstalk between the heart and other organs in the context of diabetes. Researches have indicated that miRNAs acted as hepatokines and adipokines to mediates the injure effect of distal organs on hearts. As for clinical application, extracellular ncRNAs are promising biomarker and have therapeutic potential. (Created with BioRender.com).
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Affiliation(s)
- Zhongwei Yin
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Chen Chen
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China.
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8
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Prakoso D, Tate M, Blasio M, Ritchie R. Adeno-associated viral (AAV) vector-mediated therapeutics for diabetic cardiomyopathy - current and future perspectives. Clin Sci (Lond) 2021; 135:1369-1387. [PMID: 34076247 PMCID: PMC8187922 DOI: 10.1042/cs20210052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Diabetes increases the prevalence of heart failure by 6-8-fold, independent of other comorbidities such as hypertension and coronary artery disease, a phenomenon termed diabetic cardiomyopathy. Several key signalling pathways have been identified that drive the pathological changes associated with diabetes-induced heart failure. This has led to the development of multiple pharmacological agents that are currently available for clinical use. While fairly effective at delaying disease progression, these treatments do not reverse the cardiac damage associated with diabetes. One potential alternative avenue for targeting diabetes-induced heart failure is the use of adeno-associated viral vector (AAV) gene therapy, which has shown great versatility in a multitude of disease settings. AAV gene therapy has the potential to target specific cells or tissues, has a low host immune response and has the possibility to represent a lifelong cure, not possible with current conventional pharmacotherapies. In this review, we will assess the therapeutic potential of AAV gene therapy as a treatment for diabetic cardiomyopathy.
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Affiliation(s)
- Darnel Prakoso
- Departments of Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Australia
| | - Mitchel Tate
- Departments of Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Australia
- Diabetes, Monash University, Clayton, Victoria 3800, Australia
| | - Miles J. De Blasio
- Departments of Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Australia
- Pharmacology, Monash University, Clayton, Victoria 3800, Australia
| | - Rebecca H. Ritchie
- Departments of Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Australia
- Diabetes, Monash University, Clayton, Victoria 3800, Australia
- Pharmacology, Monash University, Clayton, Victoria 3800, Australia
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9
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Morris PD, Gosling R, Zwierzak I, Evans H, Aubiniere-Robb L, Czechowicz K, Evans PC, Hose DR, Lawford PV, Narracott AJ, Gunn JP. A novel method for measuring absolute coronary blood flow and microvascular resistance in patients with ischaemic heart disease. Cardiovasc Res 2021; 117:1567-1577. [PMID: 32666101 PMCID: PMC8152717 DOI: 10.1093/cvr/cvaa220] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 01/28/2023] Open
Abstract
AIMS Ischaemic heart disease is the reduction of myocardial blood flow, caused by epicardial and/or microvascular disease. Both are common and prognostically important conditions, with distinct guideline-indicated management. Fractional flow reserve (FFR) is the current gold-standard assessment of epicardial coronary disease but is only a surrogate of flow and only predicts percentage flow changes. It cannot assess absolute (volumetric) flow or microvascular disease. The aim of this study was to develop and validate a novel method that predicts absolute coronary blood flow and microvascular resistance (MVR) in the catheter laboratory. METHODS AND RESULTS A computational fluid dynamics (CFD) model was used to predict absolute coronary flow (QCFD) and coronary MVR using data from routine invasive angiography and pressure-wire assessment. QCFD was validated in an in vitro flow circuit which incorporated patient-specific, three-dimensional printed coronary arteries; and then in vivo, in patients with coronary disease. In vitro, QCFD agreed closely with the experimental flow over all flow rates [bias +2.08 mL/min; 95% confidence interval (error range) -4.7 to +8.8 mL/min; R2 = 0.999, P < 0.001; variability coefficient <1%]. In vivo, QCFD and MVR were successfully computed in all 40 patients under baseline and hyperaemic conditions, from which coronary flow reserve (CFR) was also calculated. QCFD-derived CFR correlated closely with pressure-derived CFR (R2 = 0.92, P < 0.001). This novel method was significantly more accurate than Doppler-wire-derived flow both in vitro (±6.7 vs. ±34 mL/min) and in vivo (±0.9 vs. ±24.4 mmHg). CONCLUSIONS Absolute coronary flow and MVR can be determined alongside FFR, in absolute units, during routine catheter laboratory assessment, without the need for additional catheters, wires or drug infusions. Using this novel method, epicardial and microvascular disease can be discriminated and quantified. This comprehensive coronary physiological assessment may enable a new level of patient stratification and management.
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Affiliation(s)
- Paul D Morris
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Rebecca Gosling
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Iwona Zwierzak
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Holli Evans
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
| | - Louise Aubiniere-Robb
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
| | - Krzysztof Czechowicz
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
| | - Paul C Evans
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- The Bateson Centre, University of Sheffield, Sheffield, UK
| | - D Rodney Hose
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Patricia V Lawford
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Andrew J Narracott
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield , UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
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Carbone A, D'Andrea A, Sperlongano S, Tagliamonte E, Mandoli GE, Santoro C, Evola V, Bandera F, Morrone D, Malagoli A, D'Ascenzi F, Bossone E, Cameli M. Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings. Echocardiography 2021; 38:993-1001. [PMID: 33948990 PMCID: PMC8252466 DOI: 10.1111/echo.15059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023] Open
Abstract
Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.
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Affiliation(s)
- Andreina Carbone
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Simona Sperlongano
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Evola
- Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy
| | - Francesco Bandera
- Heart Failure Unit, Chair of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Health Science, University of Milan, Milan, Italy
| | - Doralisa Morrone
- Cardiothoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Patient factors and outcomes associated with discordance between quantitative and qualitative cardiac PET ischemia information. PLoS One 2021; 16:e0246149. [PMID: 33657111 PMCID: PMC7928488 DOI: 10.1371/journal.pone.0246149] [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: 02/22/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac PET can provide quantitative myocardial blood flow (MBF) estimates. The frequency and clinical significance of discordant ischemia information between quantitative and qualitative parameters is unclear. METHODS This retrospective, cohort study analyzed 256 Rb-82 stress-rest PET/CT studies. Global MBF and myocardial flow reserve (MFR) were estimated in absolute units for quantitative results and sum-stress and difference scores were used for qualitative results. Four groups of patients were evaluated based on a specific definition of concordant and discordant quantitative and qualitative results. RESULTS 31% of cases demonstrated discordance. Factors associated with microvascular disease were more common in the groups with abnormal quantitative results, regardless of the qualitative findings. Patients with concordant abnormal results had a significantly increased risk of myocardial infarction, heart failure, percutaneous intervention, and all-cause-mortality at 1 year compared to patients with concordant normal results. In patients with discordant results of abnormal quantitative and normal qualitative findings, there was a higher prevalence of heart failure than in controls (12.5% vs 0%, p = 0.01). CONCLUSIONS Discordance in qualitative and quantitative ischemia measures from PET is common, and further study is needed to clarify its prognostic implications. Moreover, quantitative estimation of MBF and MFR appears to add value to qualitative visual interpretation by supporting qualitative findings when results are concordant. Abnormal quantitative findings, regardless of concordance or discordance with qualitative findings, occurred in patients with risk factors associated with diffuse disease and with increased risk of heart failure admission.
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12
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Garla V, Subauste A, Butler J, Lien LF. The role of sodium glucose co-transporter inhibitors in heart failure prevention. J Diabetes Complications 2021; 35:107811. [PMID: 33280983 DOI: 10.1016/j.jdiacomp.2020.107811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 01/11/2023]
Abstract
The worldwide prevalences of diabetes mellitus (DM) and of heart failure (HF) have collectively been on the rise. HF accounts for a large portion of the cardiovascular mortality and morbidity associated with DM. DM increases the risk of developing heart failure by promoting atherosclerosis and exerting direct deleterious effects on the myocardium. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are agents approved for the treatment of DM; they exert their anti-hyperglycemic effects by blocking renal reabsorption of glucose and inducing glycosuria. SGLT-2 inhibitors have consistently decreased the hospitalization rate of HF and cardiovascular mortality in several clinical trials. SGLT-2 inhibitors also possess anti-inflammatory, anti-fibrotic, and antihypertensive in addition to beneficial effects on the myocardial metabolism, which may account for their heart failure benefits. However, further research still needs to be done to evaluate the use of SGLT-2 inhibitors in non-diabetic patients and their efficacy in preventing or treating different heart failure phenotypes.
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Affiliation(s)
- Vishnu Garla
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA; Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Mississippi Medical Center, Jackson, USA; Mississippi Center for Clinical and Translational Research, University of Mississippi Medical Center, Jackson, USA.
| | - Angela Subauste
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA; Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Lillian F Lien
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA; Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Mississippi Medical Center, Jackson, USA
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Matos LCV, Carvalho LS, Modolo R, Santos S, Silva JCQE, de Almeida OLR, Sposito AC. Gensini Score and Thrombus Burden Add Predictive Value to the SYNTAX Score in Detecting No-Reflow after Myocardial Infarction. Arq Bras Cardiol 2021; 116:466-472. [PMID: 33656051 PMCID: PMC8159555 DOI: 10.36660/abc.20200045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND No-reflow after percutaneous coronary intervention is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). SYNTAX score is a good predictor of no-reflow. OBJECTIVE We aimed to evaluate whether atherosclerotic burden (Gensini score) and thrombus burden in the culprit coronary artery would improve the ability of the SYNTAX score to detect no-reflow. METHODS In this prospective cohort study, consecutive patients with STEMI who presented within 12 h of onset of symptoms were selected for this study. No-reflow was defined as TIMI flow < 3 o r TIMI flow = 3 but myocardial blush grade <2. Thrombus burden was quantified according to the TIMI thrombus grade scale (0 to 5). RESULTS A total of 481 patients were included (mean age 61±11 years). No-reflow occurred in 32.8%. SYNTAX score (OR=1.05, 95%CI 1.01-1.08, p<0.01), thrombus burden (OR=1.17, 95%CI 1.06-1.31, p<0.01), and Gensini score (OR=1.37, 95%CI 1.13-1.65, p<0.01) were independent predictors of no-reflow. Combined scores had a larger area under the curve than the SYNTAX score alone (0.78 [0.73-0.82] vs 0.73 [0.68-0.78], p=0.03). Analyses of both categorical (0.11 [0.01-0.22], p=0.02), and continuous net reclassification improvement (NRI>0) (0.54 [0.035-0.73], p<0.001) showed improvement in the predictive ability of no-reflow in the combined model, with integrated discrimination improvement (IDI) of 0.07 (0.04-0.09, p<0.001). CONCLUSIONS Our findings suggest that, in patients with STEMI undergoing percutaneous coronary intervention, atherosclerotic burden and thrombus burden in the culprit artery add predictive value to the SYNTAX score in detecting the no-reflow phenomenon. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).
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Affiliation(s)
- Luís Carlos V Matos
- Escola Superior de Ciências da SaúdeBrasíliaDFBrasilEscola Superior de Ciências da Saúde,Brasília, DF - Brasil,Hospital de Base do Distrito FederalIGESDFBrasíliaDFBrasilHospital de Base do Distrito Federal - IGESDF,Brasília, DF - Brasil
| | - Luiz Sergio Carvalho
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas,Campinas, SP - Brasil,Hospital de Base do Distrito FederalIGESDFBrasíliaDFBrasilHospital de Base do Distrito Federal - IGESDF,Brasília, DF - Brasil
| | - Rodrigo Modolo
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas,Campinas, SP - Brasil
| | - Simone Santos
- Hospital BrasíliaBrasíliaDFBrasilHospital Brasília – Ecocardiografia,Brasília, DF - Brasil,Eccos Diagnóstico Cardiovascular AvançadoBrasíliaDFBrasilEccos Diagnóstico Cardiovascular Avançado,Brasília, DF - Brasil
| | - José Carlos Quinaglia e Silva
- Escola Superior de Ciências da SaúdeBrasíliaDFBrasilEscola Superior de Ciências da Saúde,Brasília, DF - Brasil,Hospital de Base do Distrito FederalIGESDFBrasíliaDFBrasilHospital de Base do Distrito Federal - IGESDF,Brasília, DF - Brasil
| | - Osório Luis Rangel de Almeida
- Escola Superior de Ciências da SaúdeBrasíliaDFBrasilEscola Superior de Ciências da Saúde,Brasília, DF - Brasil,Hospital de Base do Distrito FederalIGESDFBrasíliaDFBrasilHospital de Base do Distrito Federal - IGESDF,Brasília, DF - Brasil
| | - Andrei C. Sposito
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas,Campinas, SP - Brasil
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Shabab S, Gholamnezhad Z, Mahmoudabady M. Protective effects of medicinal plant against diabetes induced cardiac disorder: A review. JOURNAL OF ETHNOPHARMACOLOGY 2021; 265:113328. [PMID: 32871233 DOI: 10.1016/j.jep.2020.113328] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Nowadays, there is an increase in global tendency to use medicinal plants as preventive and therapeutic agents to manage diabetes and its long-term complications such as cardiovascular disorders owing to their availability and valuable traditional background. AIM OF STUDY This review aims to introduce common medicinal plants, which have been demonstrated to have cardioprotective effects on diabetes and their mechanisms of action. MATERIALS AND METHODS Online literature databases, including Web of Sciences, PubMed, Science Direct, Scopus and Google Scholar were searched without date limitation by May 2020. The following keywords (natural products or medicinal plants or herbal medicine or herb or extract) and (diabetes or antidiabetic or hyperglycemic) and (cardiomyopathy or heart or cardioprotective or cardiac or cardio) were used, and after excluding non-relevant articles, 81 original English articles were selected. RESULTS The surveyed medicinal plants induced cardioprotective effects mostly through increasing antioxidant effects leading to attenuating ROS production as well as by inhibiting inflammatory signaling pathways and related cytokines. Moreover, they ameliorated the Na+/K + ATPase pump, the L-type Ca2+ channel current, and the intracellular ATP. They also reduced cardiac remodeling and myocardial cell apoptosis through degradation of caspase-3, Bax, P53 protein, enhancement of Bcl-2 protein expression as well as downregulation of TGFβ1 and TNFα expression. In addition, the extracts improved cardiac function through increasing EF% and FS% as well as restoring hemodynamic parameters. CONCLUSIONS The reviewed medicinal plants demonstrated cardioprotective manifestations in diabetes through intervention with mechanisms involved in the diabetic heart to restore cardiovascular complications.
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Affiliation(s)
- Sadegh Shabab
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Gholamnezhad
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mahmoudabady
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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15
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Li N, Zhou H. SGLT2 Inhibitors: A Novel Player in the Treatment and Prevention of Diabetic Cardiomyopathy. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:4775-4788. [PMID: 33192053 PMCID: PMC7654518 DOI: 10.2147/dddt.s269514] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022]
Abstract
Diabetic cardiomyopathy (DCM) characterized by diastolic and systolic dysfunction independently of hypertension and coronary heart disease, eventually develops into heart failure, which is strongly linked to a high prevalence of mortality in people with diabetes mellitus (DM). Sodium-glucose cotransporter type2 inhibitors (SGLT2Is) are a novel type of hypoglycemic agent in increasing urinary glucose and sodium excretion. Excitingly, the EMPA-REG clinical trial proved that empagliflozin significantly reduced the relative risk of cardiovascular (CV) death and hospitalization for heart failure (HHF) in patients with type 2 DM (T2DM) plus CV disease (CVD). The EMPRISE trial showed that empagliflozin decreased the risk of HHF in T2DM patients with and without a CVD history in routine care. These beneficial effects of SGLT2Is could not be entirely attributed to glucose-lowering or natriuretic action. There could be potential direct mechanisms of SGLT2Is in cardioprotection. Recent studies have shown the effects of SGLT2Is on cardiac iron homeostasis, mitochondrial function, anti-inflammation, anti-fibrosis, antioxidative stress, and renin-angiotensin-aldosterone system activity, as well as GlcNAcylation in the heart. This article reviews the current literature on the effects of SGLT2Is on DCM in preclinical studies. Possible molecular mechanisms regarding potential benefits of SGLT2Is for DCM are highlighted, with the purpose of providing a novel strategy for preventing DCM.
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Affiliation(s)
- Na Li
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Hong Zhou
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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16
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Coronary Microvascular Dysfunction and the Role of Noninvasive Cardiovascular Imaging. Diagnostics (Basel) 2020; 10:diagnostics10090679. [PMID: 32916881 PMCID: PMC7555249 DOI: 10.3390/diagnostics10090679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with coronary microvascular dysfunction (CMD) have significantly higher rates of cardiovascular events, including hospitalization for heart failure, sudden cardiac death, and myocardial infarction (MI). In CMD, several pathophysiological changes lead to functional and structural abnormalities in the coronary microvasculature, which disrupt the ability of the vessels to vasodilate and augment myocardial blood flow in response to increased myocardial oxygen demand, causing ischemia and angina. With the advent of more advanced non-invasive cardiac imaging techniques, the coronary microvasculature has been subjected to more intense study in the past two decades-this has led to further insights into the diagnosis, pathophysiology, treatment, prognosis and follow-up of CMD. This review will highlight and compare the salient features of the currently available non-invasive imaging modalities used in these patients, and discuss the clinical utility of these techniques in the workup and management of these patients.
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Leopoulou M, Mistakidi VC, Oikonomou E, Latsios G, Papaioannou S, Deftereos S, Siasos G, Antonopoulos A, Charalambous G, Tousoulis D. Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives. Curr Atheroscler Rep 2020; 22:21. [PMID: 32468244 DOI: 10.1007/s11883-020-00839-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW In this review article, we focus on the mechanisms and features of acute coronary syndromes (ACS) with no ruptured plaque (NONRUPLA) highlighting the uncertainties over diagnostic evaluation and treatment. RECENT FINDINGS The most common cause of ACS is obstruction due to atherosclerotic plaque ruptured or erosion. In 14% of patients who present in the Emergency Department as myocardial infarction, the final diagnosis is ACS with NONRUPLA. Although the clinical presentation of NONRUPLA may mimic myocardial infarction, the underlying pathogenesis is different, and it may guide therapeutic approaches and overall prognosis that vary according to etiology. The possible mechanisms of ACS with NONRUPLA are coronary embolism, acute dissection of the aorta or coronary artery, vasospasm, microvascular dysfunction, the imbalance between oxygen demand and supply, coronary trauma and stent complications, direct cellular toxicity and damage, Takotsubo syndrome, and myocardial infarction with non-obstructive coronary arteries (MINOCA).
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Affiliation(s)
- Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Vasiliki C Mistakidi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - George Latsios
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Spyridon Papaioannou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Spyridon Deftereos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Alexis Antonopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - George Charalambous
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
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Mauricio D, Alonso N, Gratacòs M. Chronic Diabetes Complications: The Need to Move beyond Classical Concepts. Trends Endocrinol Metab 2020; 31:287-295. [PMID: 32033865 DOI: 10.1016/j.tem.2020.01.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/22/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022]
Abstract
Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| | - Núria Alonso
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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19
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Mao Y, Hu Y, Feng W, Yu L, Li P, Cai B, Li C, Guan H. Effects and mechanisms of PSS-loaded nanoparticles on coronary microcirculation dysfunction in streptozotocin-induced diabetic cardiomyopathy rats. Biomed Pharmacother 2019; 121:109280. [PMID: 31715373 DOI: 10.1016/j.biopha.2019.109280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022] Open
Abstract
Coronary microvascular dysfunction (CMD) is the pathological basis and pathogenesis of diabetic cardiomyopathy (DCM). Propylene glycol alginate sodium sulfate (PSS) as heparinoid drug has many biological activities. Here, a novel PSS-loaded nanoparticle (PSS-NP) was prepared to study its effect on the CMD of DCM. We used diabetes mellitus rat induced by STZ to establish the CMD model of DCM, and the study was detected by echocardiography, histological analysis, transmission electron microscopy, immunofluorescence staining, enzyme-linked immunosorbent assay, real time-PCR analysis, liquid-chip analysis, western blot analysis and so on. The experimental results suggested that PSS-NP could improve the survival state of rats, cardiac function, myocardial morphology and coronary microcirculation structure disorders, and increase the number of microvessels. In addition, we demonstrated that PSS-NP could alleviate the CMD by improving endothelial function, anticoagulation and antioxidative stress. The outcomes of this study provided new treatment thoughts for the therapy of coronary microcirculation dysfunction in DCM.
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Affiliation(s)
- Yongjun Mao
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Department of Geriatric Medicine, The affiliated hospital of Qingdao University, Qingdao 266003, China
| | - Yi Hu
- Department of Geriatric Medicine, The affiliated hospital of Qingdao University, Qingdao 266003, China
| | - Wenjing Feng
- Department of Geriatric Medicine, The affiliated hospital of Qingdao University, Qingdao 266003, China
| | - Luyan Yu
- Department of Geriatric Medicine, The affiliated hospital of Qingdao University, Qingdao 266003, China
| | - Pengli Li
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Bing Cai
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Chunxia Li
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266003, China
| | - Huashi Guan
- Key Laboratory of Marine Drugs, Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266003, China.
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Abstract
Heart failure and related morbidity and mortality are increasing at an alarming rate, in large part, because of increases in aging, obesity, and diabetes mellitus. The clinical outcomes associated with heart failure are considerably worse for patients with diabetes mellitus than for those without diabetes mellitus. In people with diabetes mellitus, the presence of myocardial dysfunction in the absence of overt clinical coronary artery disease, valvular disease, and other conventional cardiovascular risk factors, such as hypertension and dyslipidemia, has led to the descriptive terminology, diabetic cardiomyopathy. The prevalence of diabetic cardiomyopathy is increasing in parallel with the increase in diabetes mellitus. Diabetic cardiomyopathy is initially characterized by myocardial fibrosis, dysfunctional remodeling, and associated diastolic dysfunction, later by systolic dysfunction, and eventually by clinical heart failure. Impaired cardiac insulin metabolic signaling, mitochondrial dysfunction, increases in oxidative stress, reduced nitric oxide bioavailability, elevations in advanced glycation end products and collagen-based cardiomyocyte and extracellular matrix stiffness, impaired mitochondrial and cardiomyocyte calcium handling, inflammation, renin-angiotensin-aldosterone system activation, cardiac autonomic neuropathy, endoplasmic reticulum stress, microvascular dysfunction, and a myriad of cardiac metabolic abnormalities have all been implicated in the development and progression of diabetic cardiomyopathy. Molecular mechanisms linked to the underlying pathophysiological changes include abnormalities in AMP-activated protein kinase, peroxisome proliferator-activated receptors, O-linked N-acetylglucosamine, protein kinase C, microRNA, and exosome pathways. The aim of this review is to provide a contemporary view of these instigators of diabetic cardiomyopathy, as well as mechanistically based strategies for the prevention and treatment of diabetic cardiomyopathy.
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Affiliation(s)
- Guanghong Jia
- From the Diabetes and Cardiovascular Research Center (G.J., J.R.S.) and Department of Medical Pharmacology and Physiology (M.A.H., J.R.S.), University of Missouri School of Medicine, Columbia; Dalton Cardiovascular Research Center, University of Missouri, Columbia (M.A.H., J.R.S.); and Research Service, Truman Memorial Veterans Hospital, Columbia, MO (G.J., J.R.S.)
| | - Michael A Hill
- From the Diabetes and Cardiovascular Research Center (G.J., J.R.S.) and Department of Medical Pharmacology and Physiology (M.A.H., J.R.S.), University of Missouri School of Medicine, Columbia; Dalton Cardiovascular Research Center, University of Missouri, Columbia (M.A.H., J.R.S.); and Research Service, Truman Memorial Veterans Hospital, Columbia, MO (G.J., J.R.S.)
| | - James R Sowers
- From the Diabetes and Cardiovascular Research Center (G.J., J.R.S.) and Department of Medical Pharmacology and Physiology (M.A.H., J.R.S.), University of Missouri School of Medicine, Columbia; Dalton Cardiovascular Research Center, University of Missouri, Columbia (M.A.H., J.R.S.); and Research Service, Truman Memorial Veterans Hospital, Columbia, MO (G.J., J.R.S.).
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Coutinho T, Mielniczuk LM, Srivaratharajah K, deKemp R, Wells GA, Beanlands RS. Coronary artery microvascular dysfunction: Role of sex and arterial load. Int J Cardiol 2018; 270:42-47. [DOI: 10.1016/j.ijcard.2018.06.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 05/27/2018] [Accepted: 06/18/2018] [Indexed: 01/09/2023]
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Sivasankar D, George M, Sriram DK. Novel approaches in the treatment of diabetic cardiomyopathy. Biomed Pharmacother 2018; 106:1039-1045. [PMID: 30119169 DOI: 10.1016/j.biopha.2018.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Durgalakshmi Sivasankar
- Department of Clinical Research, Hindu Mission Hospital, West Tambaram, Chennai, 600045, Tamil Nadu, India.
| | - Melvin George
- Department of Clinical Research, Hindu Mission Hospital, West Tambaram, Chennai, 600045, Tamil Nadu, India.
| | - Damal Kandadai Sriram
- Department of Endocrinology & Diabetology, Hindu Mission Hospital, West Tambaram, Chennai, 600045, Tamil Nadu, India.
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Bietenbeck M, Florian A, Shomanova Z, Meier C, Yilmaz A. Reduced global myocardial perfusion reserve in DCM and HCM patients assessed by CMR-based velocity-encoded coronary sinus flow measurements and first-pass perfusion imaging. Clin Res Cardiol 2018; 107:1062-1070. [PMID: 29774406 DOI: 10.1007/s00392-018-1279-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is an independent predictor of poor prognosis in patients suffering from dilative or hypertrophic cardiomyopathy (DCM/HCM). To assess CMD, quantitative myocardial first-pass perfusion (1P) cardiovascular magnetic resonance (CMR) can be performed. Coronary sinus flow (CSF) measurements at rest and during maximal vasodilatation are an alternative and well-validated approach for the quantification of global myocardial blood flow (MBF) in CMR. METHODS Global myocardial perfusion reserve (MPR) was used to compare both methods, 1P and CSF. This measure reflects the ratio of myocardial blood flow during maximal coronary vasodilatation over rest. 1P-MPR and CSF-MPR were calculated in 17 HCM patients, 14 DCM patients and 16 controls, who underwent a stress CMR study to rule out obstructive coronary artery disease. All patients were examined on a 1.5-T system and the study protocol comprised both, first-pass myocardial perfusion imaging (MPI) and velocity-encoded (VENC) phase-contrast imaging of CSF during rest and adenosine stress. RESULTS 1P-MPR was significantly decreased only in HCM patients compared to controls (1.14 vs. 1.43, p = 0.045) whereas CSF-MPR was significantly reduced in both patient groups, HCM and DCM, compared to controls (2.38 and 2.07 vs. 3.18, p = 0.041 and p = 0.032). CSF-MBF at maximal stress was significantly lower in HCM and DCM patients compared to the control group (0.11 and 1.23 vs. 1.58 ml/min/g, p = 0.008 and p = 0.040). A moderate but significant correlation between CSF-MPR and 1P-MPR was observed (r = 0.39, p = 0.011). A negative correlation between LV wall thickness and CSF-MBF at rest and stress was found in the DCM group using VENC-based CSF measurements (r = - 0.64, p = 0.013 and r = - 0.69, p = 0.006)-but not using 1P-MPI. Post-proceeding analysis regarding 1P-MPR and CSF-MPR measurements required 20.1 and 6.5 min, respectively (p < 0.001). CONCLUSION The presence of microvascular disease can be non-invasively and quickly detected by VENC-based CSF-MPR measurements during routine stress perfusion CMR in both HCM and DCM patients. Compared to conventional 1P-MPI, VENC-based CSF-MPR is particularly useful in DCM patients with thinned ventricular walls.
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Affiliation(s)
- Michael Bietenbeck
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anca Florian
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Zornitsa Shomanova
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Claudia Meier
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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Baeza Garzón F, Pan Álvarez-Ossorio M, Romero Moreno MÁ, Martín Palanco V, Herrera Arroyo C, Suárez de Lezo Cruz Conde J. Reserva coronaria y función ventricular izquierda tras la terapia regenerativa en pacientes con infarto anterior agudo revascularizado. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spyridopoulos I, Arthur HM. Microvessels of the heart: Formation, regeneration, and dysfunction. Microcirculation 2018; 24. [PMID: 27926994 DOI: 10.1111/micc.12338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 12/24/2022]
Abstract
This issue of microcirculation focusses on the special topic of "microvessels of the heart" and contains five state-of-the-art reviews and one expert article that reflect current efforts to address the major gaps in our understanding of these key microvessels. In the adult heart, most attention until recently (especially among the clinical cardiology community) has been given to the main coronary arteries, which are the culprit vessels in patients with coronary artery disease, including its most serious manifestation, acute MI. However, due to major advances in efficiently reopening the acutely blocked coronary arteries, MI is no longer the killer disease it once was. In contrast, there are few treatment options for patients who develop microvascular obstruction during acute MI. Indeed, we have a very poor understanding of this disease, or even how heart vessels are initially formed in development. This is surprising in light of the essential nature of the cardiac microvessels for efficient cardiac function throughout life. The articles in this issue are from six keynote speakers at the 66th annual meeting of the BMS at Newcastle University and review our understanding of these key vessels from initial development to their role in adult heart disease.
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Affiliation(s)
- Ioakim Spyridopoulos
- Institute of Genetic Medicine, Centre for Life, Newcastle University, Newcastle, UK
| | - Helen M Arthur
- Institute of Genetic Medicine, Centre for Life, Newcastle University, Newcastle, UK
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Diagnóstico y tratamiento de la cardiopatía isquémica en mujeres. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Baeza Garzón F, Pan Álvarez-Ossorio M, Romero Moreno MÁ, Martín Palanco V, Herrera Arroyo C, Suárez de Lezo Cruz Conde J. One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry. ACTA ACUST UNITED AC 2017; 71:344-350. [PMID: 29097079 DOI: 10.1016/j.rec.2017.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. METHODS Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. RESULTS Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. CONCLUSIONS Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.
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