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Abubakar M, Saleem A, Hajjaj M, Faiz H, Pragya A, Jamil R, Salim SS, Lateef IK, Singla D, Ramar R, Damara I, Shahid L. Sex-specific differences in risk factors, comorbidities, diagnostic challenges, optimal management, and prognostic outcomes of heart failure with preserved ejection fraction: A comprehensive literature review. Heart Fail Rev 2024; 29:235-256. [PMID: 37996694 DOI: 10.1007/s10741-023-10369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Due to hormonal variations, heart failure with preserved ejection fraction (HFpEF) remains prevalent in women and affects almost half of the heart failure (HF) patients. Given the yearly death rate of 10-30% and the unavailability of medications targeting HFpEF, the need arises for a better understanding of the fundamental mechanisms of this syndrome. This comprehensive review explores sex-specific differences in traditional risk factors; female-specific factors that may impact HFpEF development and response to therapy, including variations in hormone levels that may occur pre- and post-menopausal or during pregnancy; and disparities in comorbidities, clinical presentation, and diagnostic challenges. Lastly, the review addresses prognostic outcomes, noting that women with HFpEF have a poor quality of life but a higher survival rate. It also discusses novel biomarkers and precision medicine, emphasizing their potential to improve early detection and personalized treatment.
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Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Ameer-Ud-Din Medical College, Lahore General Hospital, 6 Birdwood Road, Jinnah Town, Lahore, Punjab, 54000, Pakistan.
| | - Ayesha Saleem
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Mohsin Hajjaj
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Haseeb Faiz
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Aastha Pragya
- Department of Internal Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Rosheen Jamil
- Department of Internal Medicine, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Siffat Saima Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
| | | | - Deepak Singla
- Department of Internal Medicine, Government Medical College, Patiala, Punjab, India
| | - Rajasekar Ramar
- Department of Internal Medicine, Rajah Muthiah Medical College, Chidambaram, Tamil Nadu, India
| | - Ivan Damara
- Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laraib Shahid
- Department of Dermatology, Lahore General Hospital, Lahore, Punjab, Pakistan
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2
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Chehab O, Abdollahi A, Whelton SP, Wu CO, Ambale-Venkatesh B, Post WS, Bluemke DA, Tsai MY, Lima JAC. Association of Lipoprotein(a) Levels With Myocardial Fibrosis in the Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol 2023; 82:2280-2291. [PMID: 38057070 DOI: 10.1016/j.jacc.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Lipoprotein(a) (Lp[a]) has been identified as an emerging risk factor for adverse cardiovascular (CV) outcomes, including heart failure. However, the connections among Lp(a), myocardial fibrosis (interstitial and replacement), and cardiac remodeling as pathways to CV diseases remains unclear. OBJECTIVES This study investigated the relationship between Lp(a) levels and myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping and late gadolinium enhancement, as well as cardiac remodeling by cine CMR, in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. METHODS The study included 2,040 participants with baseline Lp(a) measurements and T1 mapping for interstitial myocardial fibrosis (IMF) evaluation in 2010. Lp(a) was analyzed as a continuous variable (per log unit) and using clinical cutoff values of 30 and 50 mg/dL. Multivariate linear and logistic regression were used to assess the associations of Lp(a) with CMR measures of extracellular volume (ECV fraction [ECV%]), native T1 time, and myocardial scar, as well as parameters of cardiac remodeling, in 2,826 participants. RESULTS Higher Lp(a) levels were associated with increased ECV% (per log-unit Lp[a]; β = 0.2%; P = 0.007) and native T1 time (per log-unit Lp[a]; β = 4%; P < 0.001). Similar relationships were observed between elevated Lp(a) levels and a higher risk of clinically significant IMF defined by prognostic thresholds per log-unit Lp(a) of ECV% (OR: 1.20; 95% CI: 1.04-1.43) and native T1 (OR: 1.2; 95% CI: 1.1-1.4) equal to 30% and 955 ms, respectively. Clinically used Lp(a) cutoffs (30 and 50 mg/dL) were associated with greater prevalence of myocardial scar (OR: 1.85; 95% CI: 1.1-3.2 and OR: 1.9; 95% CI: 1.1-3.4, respectively). Finally, higher Lp(a) levels were associated with left atrial enlargement and dysfunction. CONCLUSIONS Elevated Lp(a) levels are linked to greater subclinical IMF, increased myocardial scar prevalence, and left atrial remodeling.
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Affiliation(s)
- Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ashkan Abdollahi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Heath, Madison, Wisconsin, USA
| | - Michael Y Tsai
- Department of Pathology, University of Minnesota, Saint Paul-Minneapolis, Minneapolis, Minnesota, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
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3
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Leibowitz D, Zwas D, Beeri R, Alcalai R, Gotsman I. The impact of aging on cardiac remodeling in chronic mitral regurgitation. J Geriatr Cardiol 2023; 20:748-755. [PMID: 37970225 PMCID: PMC10630172 DOI: 10.26599/1671-5411.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Chronic mitral regurgitation (MR) is a volume overload state that causes dilatation of the left sided cardiac chambers. The presence of significant dilatation is considered an indication for mitral valve intervention, however, aging may affect left ventricular (LV) remodeling independently of valvular disease. The objective of this study was to examine age-related changes in cardiac remodeling in a broad population of patients with chronic MR. METHODS Consecutive subjects that underwent echocardiography examinations recorded in the echocardiography database of a university-affiliated laboratory were retrieved. Subjects were categorized into none/mild, moderate or severe MR. For purposes of analysis of differences with aging, the population was divided into groups above and below 70 years of age and standard echocardiographic measurements were compared between the groups. RESULTS A total of 3492 subjects with at least moderate MR (mean age: 76 years, 52% female) were included in the study and compared to 18,250 subjects with none or mild MR. Older patients had significantly smaller LV end-diastolic diameters and volumes and significantly larger left atrial (LA) volumes when compared to the younger group. LA volume index increased in both age groups as MR severity increased, while LV end-diastolic volume increased with increasing MR only in the younger population. CONCLUSIONS Cardiac remodeling in chronic MR is significantly influenced by age. Guideline based recommendations of timing of mitral valve interventions in asymptomatic MR patients, based on assessment of LA and LV remodeling, may need to take age into account.
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Affiliation(s)
- David Leibowitz
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Donna Zwas
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronen Beeri
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronny Alcalai
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Israel Gotsman
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ilkhanoff L, Qian X, Lima JA, Tran H, Soliman EZ, Yeboah J, Seliger S, deFilippi CR. Electrocardiographic Associations of Cardiac Biomarkers and Cardiac Magnetic Resonance Measures of Fibrosis in the Multiethnic Study of Atherosclerosis (MESA). Am J Cardiol 2023; 204:287-294. [PMID: 37567020 DOI: 10.1016/j.amjcard.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023]
Abstract
Abnormalities in myocardial substrate, including diffuse and replacement fibrosis, increase the risk of cardiovascular disease (CVD). Data are sparse on whether electrocardiogram (ECG) measures, coupled with circulating biomarkers, may aid in identifying cardiac fibrosis. This study aimed to determine whether 12-lead ECG and biomarkers together augment the prediction of cardiac fibrosis in participants who are free of known CVD. This is a cross-sectional analysis in the MESA (Multiethnic Study of Atherosclerosis) study at visit 5 (2010 to 2012), with measurements of biomarkers (cardiac troponin T and growth differentiation factor-15), gadolinium-enhanced cardiac magnetic resonance imaging, and ECG. Logistic regression associations of ECG measures with cardiac magnetic resonance surrogates of fibrosis (highest quartile extracellular volume [interstitial fibrosis] and late gadolinium enhancement [replacement fibrosis]) were adjusted for demographics and risk factors. Using the C-statistic, we evaluated whether adding ECG measures and biomarkers to clinical characteristics improved the prediction of either type of fibrosis. There were 1,170 eligible participants (aged 67.1 ± 8.6 years). Among the ECG measures, QRS duration (odds ratio [OR] 1.41 per 10 ms, 95% confidence interval [CI] 1.10 to 1.81), major ST-T abnormalities (OR 3.03, 95%CI 1.20, 7.65), and abnormal QRS-T angle (OR 6.32, 95%CI 3.00, 13.33) were associated with replacement fibrosis, whereas only abnormal QRS-T angle (OR 3.05, 95%CI,1.69, 5.48) was associated with interstitial fibrosis. ECG markers, in addition to clinical characteristics, improved the prediction of replacement fibrosis (p = 0.002) but not interstitial fibrosis. The addition of cardiac troponin T and growth differentiation factor-15 to the ECG findings did not significantly improve the model discrimination for either type of cardiac fibrosis. In CVD free participants, simple ECG measures are associated with replacement fibrosis and interstitial fibrosis. The addition of these measures improves identification of replacement but not interstitial fibrosis. These findings may help refine the identification of myocardial scar in the general population.
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Affiliation(s)
| | - Xiaoxiao Qian
- Inova Heart and Vascular Institute, Fall Church, Virginia
| | - Joao A Lima
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Henry Tran
- Inova Heart and Vascular Institute, Fall Church, Virginia
| | | | - Joseph Yeboah
- Wake Forest University, Winston-Salem, North Carolina
| | - Stephen Seliger
- University of Maryland School of Medicine, Baltimore, Maryland
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5
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Varadarajan V, Marques MD, Venkatesh BA, Allison M, Ostovaneh MR, Yoneyama K, Donekal S, Shah RV, Murthy VL, Wu CO, Tracy RP, Ouyang P, Rochitte CE, Bluemke DA, Lima JAC. Cardiovascular Interactions of Renin-Angiotensin-Aldosterone System Assessed by Cardiac Magnetic Resonance: The Multi-Ethnic Study of Atherosclerosis. Am J Hypertens 2023; 36:517-523. [PMID: 37208017 PMCID: PMC10403971 DOI: 10.1093/ajh/hpad050] [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: 04/10/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The effects of the renin-angiotensin-aldosterone system in cardiovascular system have been described based on small studies. The aim of this study was to evaluate the relationship between aldosterone and plasma renin activity (PRA) and cardiovascular structure and function. METHODS We studied a random sample of Multi-Ethnic Study of Atherosclerosis participants who had aldosterone and PRA blood assays at 2003-2005 and underwent cardiac magnetic resonance at 2010. Participants taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were excluded. RESULTS The aldosterone group was composed by 615 participants, mean age 61.6 ± 8.9 years, while the renin group was 580 participants, mean age 61.5 ± 8.8 years and both groups had roughly 50% females. In multivariable analysis, 1 SD increment of log-transformed aldosterone level was associated with 0.07 g/m2 higher left ventricle (LV) mass index (P = 0.04) and 0.11 ml/m2 higher left atrium (LA) minimal volume index (P < 0.01). Additionally, higher log-transformed aldosterone was associated with lower LA maximum strain and LA emptying fraction (P < 0.01). Aldosterone levels were not significantly associated with aortic measures. Log-transformed PRA was associated with lower LV end diastolic volume index (β standardized = 0.08, P = 0.05). PRA levels were not significantly associated with LA and aortic structural or functional differences. CONCLUSIONS Higher levels of aldosterone and PRA are associated with concentric LV remodeling changes. Moreover, aldosterone was related to deleterious LA remodeling changes.
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Affiliation(s)
| | - Mateus D Marques
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Mohammad R Ostovaneh
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sirisha Donekal
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ravi V Shah
- Cardiovascular Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Venkatesh L Murthy
- Department of Internal Medicine, University of Michigan Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Colin O Wu
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, Maryland, USA
| | - Russell P Tracy
- Department of Pathology, University of Vermont, Colchester, Vermont, USA
| | - Pamela Ouyang
- Clinical Research Unit, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Carlos E Rochitte
- Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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6
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Lau ES, Kaur G, Sharma G. Sex and Age Differences in Myocardial Fibrosis: Do Sex Hormones Address the Knowledge Gap? JACC. ADVANCES 2023; 2:100332. [PMID: 38939576 PMCID: PMC11198065 DOI: 10.1016/j.jacadv.2023.100332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Doughan M, Chehab O, de Vasconcellos HD, Zeitoun R, Varadarajan V, Doughan B, Wu CO, Blaha MJ, Bluemke DA, Lima JAC. Periodontal Disease Associated With Interstitial Myocardial Fibrosis: The Multiethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e8146. [PMID: 36718872 PMCID: PMC9973639 DOI: 10.1161/jaha.122.027974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Periodontitis is a chronic inflammatory disease common among adults. It has been suggested that periodontal disease (PD) may be a contributing risk factor for cardiovascular disease; however, pathways underlying such a relationship require further investigation. Methods and Results A total of 665 men (mean age 68±9 years) and 611 women (mean age 67±9 years) enrolled in the MESA (Multiethnic Study of Atherosclerosis) underwent PD assessment using a 2-item questionnaire at baseline (2000-2002) and had cardiovascular magnetic resonance 10 years later. PD was defined when participants reported either a history of periodontitis or gum disease or lost teeth caused by periodontitis or gum disease. Multivariable linear regression models were constructed to assess the associations of baseline self-reported PD with cardiovascular magnetic resonance-obtained measures of interstitial myocardial fibrosis (IMF), including extracellular volume and native T1 time. Men with a self-reported history of PD had greater extracellular volume percent (ß=0.6%±0.2, P=0.01). This association was independent of age, left ventricular mass, traditional cardiovascular risk factors, and history of myocardial infarction. In a subsequent model, substituting myocardial infarction for coronary artery calcium score, the association of PD with IMF remained significant (ß=0.6%±0.3, P=0.03). In women, a self-reported history of PD was not linked to higher IMF. Importantly, a self-reported history of PD was not found to be associated with myocardial scar independent of sex (odds ratio, 1.01 [95% CI, 0.62-1.65]; P=0.9). Conclusions In a community-based setting, men but not women with a self-reported PD history at baseline were found to be associated with increased measures of IMF. These findings support a plausible link between PD, a proinflammatory condition, and subclinical IMF.
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Affiliation(s)
- Maria Doughan
- Division of Orthodontics, Department of DentistryUniversity of MarylandBaltimoreMD
| | - Omar Chehab
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | - Ralph Zeitoun
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Vinithra Varadarajan
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Bassel Doughan
- Faculty of Dental SurgeryCôte d’Azur UniversityNiceFrance
| | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of HealthBethesdaMD
| | - Michael J Blaha
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - David A. Bluemke
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HeathMadisonWI
| | - Joao A. C. Lima
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
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8
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Cai Y, Song W, Li J, Jing Y, Liang C, Zhang L, Zhang X, Zhang W, Liu B, An Y, Li J, Tang B, Pei S, Wu X, Liu Y, Zhuang CL, Ying Y, Dou X, Chen Y, Xiao FH, Li D, Yang R, Zhao Y, Wang Y, Wang L, Li Y, Ma S, Wang S, Song X, Ren J, Zhang L, Wang J, Zhang W, Xie Z, Qu J, Wang J, Xiao Y, Tian Y, Wang G, Hu P, Ye J, Sun Y, Mao Z, Kong QP, Liu Q, Zou W, Tian XL, Xiao ZX, Liu Y, Liu JP, Song M, Han JDJ, Liu GH. The landscape of aging. SCIENCE CHINA. LIFE SCIENCES 2022; 65:2354-2454. [PMID: 36066811 PMCID: PMC9446657 DOI: 10.1007/s11427-022-2161-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
Aging is characterized by a progressive deterioration of physiological integrity, leading to impaired functional ability and ultimately increased susceptibility to death. It is a major risk factor for chronic human diseases, including cardiovascular disease, diabetes, neurological degeneration, and cancer. Therefore, the growing emphasis on "healthy aging" raises a series of important questions in life and social sciences. In recent years, there has been unprecedented progress in aging research, particularly the discovery that the rate of aging is at least partly controlled by evolutionarily conserved genetic pathways and biological processes. In an attempt to bring full-fledged understanding to both the aging process and age-associated diseases, we review the descriptive, conceptual, and interventive aspects of the landscape of aging composed of a number of layers at the cellular, tissue, organ, organ system, and organismal levels.
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Affiliation(s)
- Yusheng Cai
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Wei Song
- Frontier Science Center for Immunology and Metabolism, Medical Research Institute, College of Life Sciences, Wuhan University, Wuhan, 430071, China
| | - Jiaming Li
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ying Jing
- University of Chinese Academy of Sciences, Beijing, 100049, China
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Chuqian Liang
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Liyuan Zhang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
| | - Xia Zhang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Wenhui Zhang
- University of Chinese Academy of Sciences, Beijing, 100049, China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Beibei Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China
| | - Yongpan An
- Peking University International Cancer Institute, Peking University Health Science Center, Peking University, Beijing, 100191, China
| | - Jingyi Li
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Baixue Tang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, 100084, China
| | - Siyu Pei
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Xueying Wu
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yuxuan Liu
- School of Pharmaceutical Sciences, Beijing Advanced Innovation Center for Structural Biology, Ministry of Education Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology, Tsinghua University, Beijing, 100084, China
| | - Cheng-Le Zhuang
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, 200072, China
| | - Yilin Ying
- Department of Geriatrics, Medical Center on Aging of Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- International Laboratory in Hematology and Cancer, Shanghai Jiaotong University School of Medicine/Ruijin Hospital, Shanghai, 200025, China
| | - Xuefeng Dou
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yu Chen
- Shanghai Key Laboratory of Maternal Fetal Medicine, Clinical and Translational Research Center of Shanghai First Maternity and Infant Hospital, Frontier Science Center for Stem Cell Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China
| | - Fu-Hui Xiao
- State Key Laboratory of Genetic Resources and Evolution/Key Laboratory of Healthy Aging Research of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, China
- CAS Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, 650223, China
| | - Dingfeng Li
- Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230027, China
| | - Ruici Yang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Ya Zhao
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, 330031, China
| | - Yang Wang
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, 610065, China
| | - Lihui Wang
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medical Sciences, Hangzhou, 311121, China
| | - Yujing Li
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Shuai Ma
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
| | - Si Wang
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- Aging Translational Medicine Center, International Center for Aging and Cancer, Beijing Municipal Geriatric Medical Research Center, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- The Fifth People's Hospital of Chongqing, Chongqing, 400062, China.
| | - Xiaoyuan Song
- MOE Key Laboratory of Cellular Dynamics, Hefei National Research Center for Physical Sciences at the Microscale, CAS Key Laboratory of Brain Function and Disease, Neurodegenerative Disorder Research Center, School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China.
| | - Jie Ren
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Liang Zhang
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Jun Wang
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Weiqi Zhang
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Aging Translational Medicine Center, International Center for Aging and Cancer, Beijing Municipal Geriatric Medical Research Center, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
| | - Zhengwei Xie
- Peking University International Cancer Institute, Peking University Health Science Center, Peking University, Beijing, 100191, China.
| | - Jing Qu
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Jianwei Wang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, 100084, China.
| | - Yichuan Xiao
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Ye Tian
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Gelin Wang
- School of Pharmaceutical Sciences, Beijing Advanced Innovation Center for Structural Biology, Ministry of Education Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology, Tsinghua University, Beijing, 100084, China.
| | - Ping Hu
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, 200072, China.
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, 510005, China.
| | - Jing Ye
- Department of Geriatrics, Medical Center on Aging of Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
- International Laboratory in Hematology and Cancer, Shanghai Jiaotong University School of Medicine/Ruijin Hospital, Shanghai, 200025, China.
| | - Yu Sun
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031, China.
- Department of Medicine and VAPSHCS, University of Washington, Seattle, 98195, USA.
| | - Zhiyong Mao
- Shanghai Key Laboratory of Maternal Fetal Medicine, Clinical and Translational Research Center of Shanghai First Maternity and Infant Hospital, Frontier Science Center for Stem Cell Research, School of Life Sciences and Technology, Tongji University, Shanghai, 200092, China.
| | - Qing-Peng Kong
- State Key Laboratory of Genetic Resources and Evolution/Key Laboratory of Healthy Aging Research of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, China.
- CAS Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, 650223, China.
| | - Qiang Liu
- CAS Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, 650223, China.
- Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230027, China.
| | - Weiguo Zou
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Xiao-Li Tian
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, 330031, China.
| | - Zhi-Xiong Xiao
- Center of Growth, Metabolism and Aging, Key Laboratory of Bio-Resource and Eco-Environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, 610065, China.
| | - Yong Liu
- Frontier Science Center for Immunology and Metabolism, Medical Research Institute, College of Life Sciences, Wuhan University, Wuhan, 430071, China.
| | - Jun-Ping Liu
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medical Sciences, Hangzhou, 311121, China.
- Department of Immunology and Pathology, Monash University Faculty of Medicine, Prahran, Victoria, 3181, Australia.
- Hudson Institute of Medical Research, and Monash University Department of Molecular and Translational Science, Clayton, Victoria, 3168, Australia.
| | - Moshi Song
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Jing-Dong J Han
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology, Peking University, Beijing, 100871, China.
| | - Guang-Hui Liu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- Aging Translational Medicine Center, International Center for Aging and Cancer, Beijing Municipal Geriatric Medical Research Center, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
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9
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Lyu Z, Han W, Zhao H, Jiao Y, Xu P, Wang Y, Shen Q, Yang S, Zhao C, Tian L, Fu P. A clinical study on relationship between visualization of cardiac fibroblast activation protein activity by Al18F-NOTA-FAPI-04 positron emission tomography and cardiovascular disease. Front Cardiovasc Med 2022; 9:921724. [PMID: 36072860 PMCID: PMC9441604 DOI: 10.3389/fcvm.2022.921724] [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: 04/16/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective FAP plays a vital role in myocardial injury and fibrosis. Although initially used to study imaging of primary and metastatic tumors, the use of FAPI tracers has recently been studied in cardiac remodeling after myocardial infarction. The study aimed to investigate the application of FAPI PET/CT imaging in human myocardial fibrosis and its relationship with clinical factors. Materials and methods Retrospective analysis of FAPI PET/CT scans of twenty-one oncological patients from 05/2021 to 03/2022 with visual uptake of FAPI in the myocardium were applying the American Heart Association 17-segment model of the left ventricle. The patients’ general data, echocardiography, and laboratory examination results were collected, and the correlation between PET imaging data and the above data was analyzed. Linear regression models, Kendall’s TaU-B test, the Spearman test, and the Mann–Whitney U test were used for the statistical analysis. Results 21 patients (60.1 ± 9.4 years; 17 men) were evaluated with an overall mean LVEF of 59.3 ± 5.4%. The calcific plaque burden of LAD, LCX, and RCA are 14 (66.7%), 12 (57.1%), and 9 (42.9%). High left ventricular SUVmax correlated with BMI (P < 0.05) and blood glucose level (P < 0.05), and TBR correlated with age (P < 0.05). A strong correlation was demonstrated between SUVmean and CTnImax (r = 0.711, P < 0.01). Negative correlation of SUVmean and LVEF (r = −0.61, P < 0.01), SUVmax and LVEF (r = −0.65, P < 0.01) were found. ROC curve for predicting calcified plaques by myocardial FAPI uptake (SUVmean) in LAD, LCX, and RCA territory showed AUCs were 0.786, 0.759, and 0.769. Conclusion FAPI PET/CT scans might be used as a new potential method to evaluate cardiac fibrosis to help patients’ management further. FAPI PET imaging can reflect the process of myocardial fibrosis. High FAPI uptakes correlate with cardiovascular risk factors and the distribution of coronary plaques.
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Affiliation(s)
- Zhehao Lyu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongyue Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuying Jiao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yangyang Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiuyi Shen
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuai Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Changjiu Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Tian
- Department of Pathology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Lin Tian,
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Peng Fu,
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10
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Ambrosini S, Gorica E, Mohammed SA, Costantino S, Ruschitzka F, Paneni F. Epigenetic remodeling in heart failure with preserved ejection fraction. Curr Opin Cardiol 2022; 37:219-226. [PMID: 35275888 PMCID: PMC9415220 DOI: 10.1097/hco.0000000000000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we critically address the role of epigenetic processing and its therapeutic modulation in heart failure with preserved ejection fraction (HFpEF). RECENT FINDINGS HFpEF associates with a poor prognosis and the identification of novel molecular targets and therapeutic approaches are in high demand. Emerging evidence indicates a key involvement of epigenetic signals in the regulation of transcriptional programs underpinning features of HFpEF. The growing understanding of chromatin dynamics has led to the development of selective epigenetic drugs able to reset transcriptional changes thus delaying or preventing the progression toward HFpEF. Epigenetic information in the setting of HFpEF can be employed to: (i) dissect novel epigenetic networks and chromatin marks contributing to HFpEF; (ii) unveil circulating and cell-specific epigenetic biomarkers; (iii) build predictive models by using computational epigenetics and deep machine learning; (iv) develop new chromatin modifying drugs for personalized management of HFpEF. SUMMARY Acquired epigenetic signatures during the lifetime can contribute to derail molecular pathways involved in HFpEF. A scrutiny investigation of the individual epigenetic landscape will offer opportunities to develop personalized epigenetic biomarkers and therapies to fight HFpEF in the decades to come.
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Affiliation(s)
- Samuele Ambrosini
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Era Gorica
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | | | - Sarah Costantino
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | | | - Francesco Paneni
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
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11
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Marques MD, Weinberg R, Kapoor S, Ostovaneh MR, Kato Y, Liu CY, Shea S, McClelland RL, Post WS, Bluemke DA, Lima JAC, Ambale-Venkatesh B. Myocardial fibrosis by T1 mapping magnetic resonance imaging predicts incident cardiovascular events and all-cause mortality: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J Cardiovasc Imaging 2022; 23:1407-1416. [PMID: 35147665 PMCID: PMC9463991 DOI: 10.1093/ehjci/jeac010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate whether myocardial fibrosis predicts cardiovascular events (CVEs) and mortality in the Multi-Ethnic Study of Atherosclerosis. METHODS AND RESULTS Cardiac magnetic resonance (CMR) T1 mapping with gadolinium administration for assessment of extracellular volume fraction (ECV) was performed in 1326 participants, in whom myocardial scar was assessed by late gadolinium enhancement (LGE). The clinical outcomes were defined as all-cause mortality, atherosclerotic CVEs, and incident heart failure (HF) during an average of 8 years of follow-up after the scan. Participants' mean native T1 time was 971 ms [standard deviation (SD) 45.5], ECV was 27 (SD 2.9), and 117 (8.8%) of them had LGE. At the time of the CMR exam, participant age was 68 years (SD 9) and 48% of them were women. Ideal cut-offs were identified using classification and regression trees accounting for time-to-event outcomes for ECV (30%) and native T1 time (954 ms). Over the follow-up period, 106 participants died, 78 developed CVE, and 23 developed HF. After adjustment for risk factors, ECV >30% was associated with death [hazard ratio (HR): 1.67, P < 0.05], incident CVE (HR: 2.02, P < 0.05), and incident HF (HR: 2.85, P < 0.05). After adjustments, native T1 >954 ms was associated with incident CVE (HR: 2.09, P < 0.05). Myocardial scar by LGE was not predictive of clinical outcomes after adjustments. CONCLUSION ECV is an independent prognostic marker of incident HF, atherosclerotic CVEs, and all-cause mortality. ECV, with its ability to characterize both diffuse and focal fibrosis processes, better predicted incident events than regional myocardial abnormalities as visualized by LGE imaging in a large multi-ethnic population.
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Affiliation(s)
- Mateus D Marques
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA,Cardiology, Federal University of Santa Maria, 1000 Cidade Universitária Bairro - Camobi, Santa Maria - RS, 97105-900, Brazil
| | - Raquel Weinberg
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Shrey Kapoor
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Mohammad R Ostovaneh
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA,Pennsylvania State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Yoko Kato
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Chia Ying Liu
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Steven Shea
- Division of General Medicine, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Robyn L McClelland
- Biostatistics, University of Washington, Bldg. 29, Suite 210 Seattle, WA 98115, USA
| | - Wendy S Post
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, 3252 Clinical Science Center 600 Highland Ave Madison, WI 53792
| | - João A C Lima
- Department of Cardiology, School of Medicine, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
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12
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Qi RX, Jiang JS, Shao J, Zhang Q, Zheng KL, Xiao J, Huang S, Gong SC. Measurement of myocardial extracellular volume fraction in patients with heart failure with preserved ejection fraction using dual-energy computed tomography. Eur Radiol 2022; 32:4253-4263. [DOI: 10.1007/s00330-021-08514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
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13
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Sinha A, Rivera AS, Doyle MF, Sitlani C, Fohner A, Huber SA, Olson NC, Lima JA, Delaney JA, Feinstein MJ, Shah SJ, Tracy RP, Psaty BM. Association of immune cell subsets with cardiac mechanics in the Multi-Ethnic Study of Atherosclerosis. JCI Insight 2021; 6:149193. [PMID: 34236048 PMCID: PMC8410049 DOI: 10.1172/jci.insight.149193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
BackgroundImmunomodulatory therapy may help prevent heart failure (HF). Data on immune cells and myocardial remodeling in older adults with cardiovascular risk factors are limited.MethodsIn the Multi-Ethnic Study of Atherosclerosis cohort, 869 adults had 19 peripheral immune cell subsets measured and underwent cardiac MRI during the baseline exam, of which 321 had assessment of left ventricular global circumferential strain (LV-GCS). We used linear regression with adjustment for demographics, cardiovascular risk factors, and cytomegalovirus serostatus to evaluate the cross-sectional association of immune cell subsets with left ventricular mass index (LVMI) and LV-GCS.ResultsThe average age of the cohort was 61.6 ± 10.0 years and 53% were women. Higher proportions of γ/δ T cells were associated with lower absolute (worse) LV-GCS (-0.105% [95% CI -0.164%, -0.046%] per 1 SD higher proportion of γ/δ T cells, P = 0.0006). This association remained significant after Bonferroni's correction. Higher proportions of classical monocytes were associated with worse absolute LV-GCS (-0.04% [95% CI -0.07%, 0.00%] per 1 SD higher proportion of classical monocytes, P = 0.04). This did not meet significance after Bonferroni's correction. There were no other significant associations with LV-GCS or LVMI.ConclusionPathways associated with γ/δ T cells may be potential targets for immunomodulatory therapy targeted at HF prevention in populations at risk.FundingContracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and grant R01 HL98077 from the National Heart, Lung, and Blood Institute/NIH and grants KL2TR001424, UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences/NIH.
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Affiliation(s)
- Arjun Sinha
- Department of Medicine and
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adovich S. Rivera
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Margaret F. Doyle
- Department of Pathology and Laboratory Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Colleen Sitlani
- Department of Medicine
- Cardiovascular Health Research Unit, and
| | - Alison Fohner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sally A. Huber
- Department of Pathology and Laboratory Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nels C. Olson
- Department of Pathology and Laboratory Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Joao A.C. Lima
- Divison of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph A. Delaney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew J. Feinstein
- Department of Medicine and
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Russel P. Tracy
- Department of Pathology and Laboratory Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Biochemistry, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce M. Psaty
- Department of Medicine
- Cardiovascular Health Research Unit, and
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
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14
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Hamdani N, Costantino S, Mügge A, Lebeche D, Tschöpe C, Thum T, Paneni F. Leveraging clinical epigenetics in heart failure with preserved ejection fraction: a call for individualized therapies. Eur Heart J 2021; 42:1940-1958. [PMID: 36282124 DOI: 10.1093/eurheartj/ehab197] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Described as the 'single largest unmet need in cardiovascular medicine', heart failure with preserved ejection fraction (HFpEF) remains an untreatable disease currently representing 65% of new heart failure diagnoses. HFpEF is more frequent among women and associates with a poor prognosis and unsustainable healthcare costs. Moreover, the variability in HFpEF phenotypes amplifies complexity and difficulties in the approach. In this perspective, unveiling novel molecular targets is imperative. Epigenetic modifications-defined as changes of DNA, histones, and non-coding RNAs (ncRNAs)-represent a molecular framework through which the environment modulates gene expression. Epigenetic signals acquired over the lifetime lead to chromatin remodelling and affect transcriptional programmes underlying oxidative stress, inflammation, dysmetabolism, and maladaptive left ventricular remodelling, all conditions predisposing to HFpEF. The strong involvement of epigenetic signalling in this setting makes the epigenetic information relevant for diagnostic and therapeutic purposes in patients with HFpEF. The recent advances in high-throughput sequencing, computational epigenetics, and machine learning have enabled the identification of reliable epigenetic biomarkers in cardiovascular patients. Contrary to genetic tools, epigenetic biomarkers mirror the contribution of environmental cues and lifestyle changes and their reversible nature offers a promising opportunity to monitor disease states. The growing understanding of chromatin and ncRNAs biology has led to the development of several Food and Drug Administration approved 'epidrugs' (chromatin modifiers, mimics, anti-miRs) able to prevent transcriptional alterations underpinning left ventricular remodelling and HFpEF. In the present review, we discuss the importance of clinical epigenetics as a new tool to be employed for a personalized management of HFpEF.
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Affiliation(s)
- Nazha Hamdani
- Institute of Physiology, Ruhr University, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany.,Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany.,Clinical Pharmacology, Ruhr University, Bochum, Germany
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland
| | - Andreas Mügge
- Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany.,Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany
| | - Djamel Lebeche
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY 10029, USA.,Department of Medicine, Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Medicine, Graduate School of Biological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,University Heart Center, Cardiology, University Hospital Zurich, Zürich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
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15
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Siebermair J, Köhler MI, Kupusovic J, Nekolla SG, Kessler L, Ferdinandus J, Guberina N, Stuschke M, Grafe H, Siveke JT, Kochhäuser S, Fendler WP, Totzeck M, Wakili R, Umutlu L, Schlosser T, Rassaf T, Rischpler C. Cardiac fibroblast activation detected by Ga-68 FAPI PET imaging as a potential novel biomarker of cardiac injury/remodeling. J Nucl Cardiol 2021; 28:812-821. [PMID: 32975729 PMCID: PMC8249249 DOI: 10.1007/s12350-020-02307-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/14/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fibroblast activation protein (FAP) as a specific marker of activated fibroblasts can be visualized by positron emission tomography (PET) using Ga-68-FAP inhibitors (FAPI). Gallium-68-labeled FAPI is increasingly used in the staging of various cancers. In addition, the first cases of theranostic approaches have been reported. In this work, we describe the phenomenon of myocardial FAPI uptake in patients who received a Ga-68 FAPI PET for tumor staging. METHOD AND RESULTS Ga-68 FAPI PET examinations for cancer staging were retrospectively analyzed with respect to cardiac tracer uptake. Standardized uptake values (SUV) were correlated to clinical covariates in a univariate regression model. From 09/2018 to 11/2019 N = 32 patients underwent FAPI PET at our institution. Six out of 32 patients (18.8%) demonstrated increased localized myocardial tracer accumulation, with remote FAPI uptake being significantly higher in patients with vs without localized focal myocardial uptake (SUVmax 2.2 ± .6 vs 1.5 ± .4, P < .05 and SUVmean 1.6 ± .4 vs 1.2 ± .3, P < .05, respectively). Univariate regression demonstrated a significant correlation of coronary artery disease (CAD), age and left ventricular ejection fraction (LVEF) with remote SUVmean uptake, the latter with a very strong correlation with remote uptake (R2 = .74, P < .01). CONCLUSION Our study indicates an association of CAD, age, and LVEF with FAPI uptake. Further studies are warranted to assess if fibroblast activation can be reliably measured and may be used for risk stratification regarding early detection or progression of CAD and left ventricular remodeling.
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Affiliation(s)
- J Siebermair
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - M I Köhler
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Kupusovic
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S G Nekolla
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - L Kessler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Ferdinandus
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - N Guberina
- Department of Radiotherapy, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - H Grafe
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J T Siveke
- Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Kochhäuser
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - W P Fendler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - L Umutlu
- University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Schlosser
- University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Rischpler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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16
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Qi RX, Shao J, Jiang JS, Ruan XW, Huang S, Zhang Q, Hu CH. Myocardial extracellular volume fraction quantitation using cardiac dual-energy CT with late iodine enhancement in patients with heart failure without coronary artery disease: A single-center prospective study. Eur J Radiol 2021; 140:109743. [PMID: 33971572 DOI: 10.1016/j.ejrad.2021.109743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the relationship between myocardial extracellular volume (ECV) fraction measured using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and risk of heart failure (HF) in patients without coronary artery disease (CAD), and to evaluate the relationship between ECV and left ventricular structure and function. MATERIALS AND METHODS Sixty consecutive HF patients without CAD and 60 consecutive participants without heart disease who underwent coronary CT angiography (CCTA) following LIE-DECT were included. ECV of the left ventricle was calculated from the iodine maps and hematocrit levels using the American Heart Association (AHA) 16-segment model. Cardiac structural and functional parameters were collected including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), interventricular septal thickness (IVST), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). RESULTS ECV in HF patients without CAD (31.3 ± 4.0 %) was significantly higher than that in healthy subjects (27.1 ± 3.7 %) (P < 0.001). Multivariate linear analysis revealed that ECV was associated with age (β = 0.098, P = 0.010) and hypertension (β = 2.093, P = 0.011) in all participants. Binary logistic regression analysis showed that after adjusting for age, sex, body mass index (BMI), smoking, and drinking, ECV was a risk factor affecting the occurrence of HF in those without CAD (OR = 1.356, 95 %CI:1.178-1.561, P < 0.001). A positive correlation was found between ECV and NT-pro-BNP, LVEDV, LVESV, and LAV (r = 0.629, 0.329, 0.346, and 0.338, respectively; all P < 0.001) in all participants. CONCLUSIONS ECV could be measured using LIE-DECT iodine maps. ECV elevation was a risk factor for HF without CAD and correlated with cardiac structure and function.
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Affiliation(s)
- Rong-Xing Qi
- Department of Radiology, First Affiliated Hospital of Soochow University, Shizi Street No.188, Suzhou, 215002, China; Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Jun Shao
- Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Jia-Shen Jiang
- Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Xi-Wu Ruan
- Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Sheng Huang
- Department of Radiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Qing Zhang
- Cardiology, Second Affiliated Hospital of Nantong University, Haierxiang (North) Road No.6, Nantong, 226001, China.
| | - Chun-Hong Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Shizi Street No.188, Suzhou, 215002, China; Institute of Medical Imaging, Soochow University, Shizi Street No.188, Suzhou, 215002, China.
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17
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Extracellular Volume in Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2020; 14:1146-1160. [PMID: 33341409 DOI: 10.1016/j.jcmg.2020.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/30/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study used cardiovascular magnetic resonance (CMR) to evaluate whether elevated extracellular volume (ECV) was associated with mitral valve prolapse (MVP) or if elevated ECV was a consequence of remodeling independent of primary mitral regurgitation (MR) etiology. BACKGROUND Replacement fibrosis in primary MR is more prevalent in MVP; however, data on ECV as a surrogate for diffuse interstitial fibrosis in primary MR are limited. METHODS Patients with chronic primary MR underwent comprehensive CMR phenotyping and were stratified into an MVP cohort (>2 mm leaflet displacement on a 3-chamber cine CMR) and a non-MVP cohort. Factors associated with ECV and replacement fibrosis were assessed. The association of ECV and symptoms related to MR and clinical events (mitral surgery and cardiovascular death) was ascertained. RESULTS A total of 424 patients with primary MR (229 with MVP and 195 non-MVP) were enrolled. Replacement fibrosis was more prevalent in the MVP cohort (34.1% vs. 6.7%; p < 0.001), with bi-leaflet MVP having the strongest association with replacement fibrosis (odds ratio: 10.5; p < 0.001). ECV increased with MR severity in a similar fashion for both MVP and non-MVP cohorts and was associated with MR severity but not MVP on multivariable analysis. Elevated ECV was independently associated with symptoms related to MR and clinical events. CONCLUSIONS Although replacement fibrosis was more prevalent in MVP, diffuse interstitial fibrosis as inferred by ECV was associated with MR severity, regardless of primary MR etiology. ECV was independently associated with symptoms related to MR and clinical events. (DeBakey Cardiovascular Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823).
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18
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Abstract
PURPOSE OF THE REVIEW This review summarizes sex-related changes in the heart and vasculature that occur with aging, both in the presence and absence of cardiovascular disease (CVD). RECENT FINDINGS In the presence of CVD risk factors and/or overt CVD, sex-specific changes in the number of cardiomyocytes, extent of the myocardial extracellular matrix, and myocellular hypertrophy promote unique patterns of LV remodeling in men and women. In addition, age- and sex-specific vascular stiffening is also well established, driven by changes in endothelial dysfunction, elastin-collagen content, microvascular dysfunction, and neurohormonal signaling. Together, these changes in LV chamber geometry and morphology, coupled with heightened vascular stiffness, appear to drive both age-related increases in systolic function and declines in diastolic function, particularly in postmenopausal women. Accordingly, estrogen has been implicated as a key mediator, given its direct vasodilating properties, association with nitric oxide excretion, and involvement in myocellular Ca2+ handling, mitochondrial energy production, and oxidative stress. The culmination of the abovementioned sex-specific cardiac and vascular changes across the lifespan provides important insight into heart failure development, particularly of the preserved ejection fraction variety, while offering promise for future preventive strategies and therapeutic approaches.
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Affiliation(s)
- Andrew Oneglia
- Applied Physiology and Advanced Imaging Lab, University of Texas at Arlington, 655 West Mitchell St, Arlington, TX, 76010, USA
| | - Michael D Nelson
- Applied Physiology and Advanced Imaging Lab, University of Texas at Arlington, 655 West Mitchell St, Arlington, TX, 76010, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP Suite A3206, Los Angeles, CA, 90048, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP Suite A3206, Los Angeles, CA, 90048, USA.
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19
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Pezel T, Viallon M, Croisille P, Sebbag L, Bochaton T, Garot J, Lima JAC, Mewton N. Imaging Interstitial Fibrosis, Left Ventricular Remodeling, and Function in Stage A and B Heart Failure. JACC Cardiovasc Imaging 2020; 14:1038-1052. [PMID: 32828781 DOI: 10.1016/j.jcmg.2020.05.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
Myocardial interstitial fibrosis is part of the advanced disease stage of most cardiovascular pathologies. It has been characterized histologically in various disease settings from hypertensive heart disease and diabetic cardiomyopathy to severe aortic stenosis. It is also involved in the process of aging. In cardiovascular medicine, myocardial interstitial fibrosis is associated with several adverse outcomes, especially heart failure (HF) and sudden cardiac death. Until recently, clinical measures of interstitial fibrosis could only be made by invasive myocardial biopsy. The availability of cardiac magnetic resonance (CMR) T1 mapping techniques allows for the indirect measurement of interstitial space characteristics and extracellular volume size, which is closely correlated with collagen content and interstitial infiltration by amyloid and other molecules. There has been significant improvement in the accuracy and reproducibility of T1 acquisition sequences in the last decade; however, the correct use of this technique requires a solid CMR expertise in daily imaging practice. CMR has become the gold standard to assess left ventricular (LV) remodeling and functional features associated with interstitial fibrosis. These features can be detected in the early stages of HF. The main objective of this paper is to review the relevant results of preclinical and clinical observational studies that demonstrate the prognostic impact of interstitial fibrosis assessed by T1 mapping, as well as adverse left ventricular remodeling, as determinants of HF. Therefore, this review focuses on the pathological mechanisms underlying LV remodeling and interstitial fibrosis, in addition to the technical considerations involved in the assessment of interstitial LV fibrosis by CMR. It provides a thorough review of clinical evidence that demonstrates the association of interstitial fibrosis and other-CMR derived LV phenotypes with Stages A and B HF.
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Affiliation(s)
- Theo Pezel
- Department of Cardiology, Paris University, Lariboisiere Hospital, AP-HP, INSERM, UMRS 942, Paris, France; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Magalie Viallon
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Laurent Sebbag
- Heart Failure and Transplant Department, Hospices Civils de Lyon, Hôpital Louis Pradel, Bron, France
| | - Thomas Bochaton
- Hospices Civils de Lyon, Hôpital Louis Pradel, Cardiac Intensive Care Unit, Bron, France
| | - Jerome Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay-Générale de Santé, Massy, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Nathan Mewton
- Cardiovascular Hospital Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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20
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Yan T, Chen Z, Chopp M, Venkat P, Zacharek A, Li W, Shen Y, Wu R, Li L, Landschoot-Ward J, Lu M, Hank KH, Zhang J, Chen J. Inflammatory responses mediate brain-heart interaction after ischemic stroke in adult mice. J Cereb Blood Flow Metab 2020; 40:1213-1229. [PMID: 30465612 PMCID: PMC7238382 DOI: 10.1177/0271678x18813317] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 02/03/2023]
Abstract
Stroke induces cardiac dysfunction which increases post stroke mortality and morbidity particularly in aging population. Here, we investigated the effects of inflammatory responses as underlying mediators of cardiac dysfunction after stroke in adult mice. Adult (eight-to-nine months) male C57BL/6 mice were subjected to photothrombotic stroke. To test whether immunoresponse to stroke leads to cardiac dysfunction, splenectomy was performed with stroke. Immunohistochemistry, flow cytometry, PCR, ELISA and echocardiography were performed. We found marginal cardiac dysfunction at acute phase and significant cardiac dysfunction at chronic phase of stroke as indicated by significant decrease of left ventricular ejection fraction (LVEF) and shortening fraction (LVSF). Stroke significantly increases macrophage infiltration into the heart and increases IL-1β, IL-6, MCP-1, TGF-β and macrophage-associated inflammatory cytokine levels in the heart as well as induces cardiac-fibrosis and hypertrophy. Splenectomy with stroke significantly reduces macrophage infiltration into heart, decreases inflammatory factor expression in the heart, decreases cardiac hypertrophy and fibrosis, as well as significantly improves cardiac function compared to non-splenectomized adult stroke mice. Therefore, cerebral ischemic stroke in adult mice induces chronic cardiac dysfunction and secondary immune response may contribute to post stroke cardiac dysfunction.
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Affiliation(s)
- Tao Yan
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
| | - Zhili Chen
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
- Neurology, Henry Ford Hospital, Detroit,
MI, USA
| | - Michael Chopp
- Neurology, Henry Ford Hospital, Detroit,
MI, USA
- Department of Physics, Oakland
University, Rochester, MI, USA
| | | | | | - Wei Li
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
- Neurology, Henry Ford Hospital, Detroit,
MI, USA
| | - Yi Shen
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
- Neurology, Henry Ford Hospital, Detroit,
MI, USA
| | - Ruixia Wu
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
| | - Linlin Li
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
| | | | - Mei Lu
- Public Health Sciences, Henry Ford
Hospital, Detroit, MI, USA
| | - Kuan-Han Hank
- Public Health Sciences, Henry Ford
Hospital, Detroit, MI, USA
| | - Jianning Zhang
- Department of Neurology, Tianjin Medical
University General Hospital, Tianjin Neurological Institute, Tianjin, China
- Department of Neurosurgery, Tianjin
Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key
Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous
System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jieli Chen
- Neurology, Henry Ford Hospital, Detroit,
MI, USA
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21
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Differential Gender-Dependent Patterns of Cardiac Fibrosis and Fibroblast Phenotypes in Aging Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8282157. [PMID: 32566103 PMCID: PMC7267867 DOI: 10.1155/2020/8282157] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
Aging is characterized by physiological changes within the heart leading to fibrosis and dysfunction even in individuals without underlying pathologies. Gender has been shown to influence the characteristics of cardiac aging; however, gender-dependent cardiac fibrosis occurring with age remains largely not elucidated. Thus, broadening our understanding of this phenomenon proves necessary in order to develop novel anti-fibrotic strategies in the elderly. In this study, we aim to characterize cardiac fibrosis and cardiac fibroblast (CF) populations in aged male and female mice. Echocardiography revealed eccentric hypertrophy with left ventricular dilatation in the aged male versus concentric hypertrophy with left posterior wall thickening in the female, with preserved cardiac function in both groups. Reactive fibrosis was evidenced in the myocardium and epicardium of the aged female mice hearts whereas perivascular and replacement ones where present in the male heart. Collagen I was predominant in the aged male heart whereas collagen III was the main component in the female heart. CFs in the aged male heart were mainly recruited from resident PDGFRα+ populations but not derived from epicardium as evidenced by the absence of epicardial progenitor transcription factors Tcf21, Tbx18 and Wt1. Our results present a paradigm for gender-dependent cardiac fibrosis and the origins of CFs with age. This sets forth to revisit cardiac anti-fibrotic management according to the gender in the elderly and to explore novel therapeutic targets.
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22
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Doria de Vasconcellos H, Betoko A, Ciuffo LA, Moreira HT, Nwabuo CC, Ambale-Venkatesh B, Reis JP, Allen N, Lloyd-Jones DM, Colangelo LA, Schreiner PJ, Lewis CE, Shikany JM, Sidney S, Cox C, Gidding SS, Lima JAC. Sex Differences in the Association of Cumulative Body Mass Index from Early Adulthood to Middle Age and Left Atrial Remodeling Evaluated by Three-Dimensional Echocardiography: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2020; 33:878-887.e3. [PMID: 32336609 PMCID: PMC7388576 DOI: 10.1016/j.echo.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
Background: The relationship between long-term obesity and left atrial (LA) structure and function is not entirely understood. We examined the association of cumulative body mass index (cBMI) with LA remodeling using three-dimensional (3D) speckle-tracking echocardiography (STE). Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a community-based cohort of black and white, men and women, ages 18–30 years at baseline in 1985–86 from four U.S. centers. This study included 2,144 participants who had satisfactory image quality and body mass index measurements during the entire follow-up period. The 3D STE-derived LA parameters were maximum, minimum, and pretrial contraction volumes; total, passive, and active emptying fraction; maximum systolic longitudinal strain; and early and late diastolic longitudinal strain rates. Multivariable linear regression analyses stratified by sex assessed the relationship between cBMI and 3D STE-derived LA parameters, adjusting for demographics and traditional cardiovascular. Results: The mean age of the cohort was 55 ± 3.6 years; 54.8% were women, and 46.5% were black. There were statistically significant additive sex interactions for the association between cBMI and LA minimum contraction value, maximum systolic longitudinal strain, and early and late diastolic longitudinal strain rates. In the fully adjusted model, greater cBMI was associated with lower magnitude LA longitudinal deformation (maximum systolic longitudinal strain and early and late diastolic longitudinal strain rates) in men and with higher LA emptying fraction in women. In addition, greater cBMI was associated with higher LA phasic volumes indices in both men and women. Conclusions: This study showed that while greater cBMI from early adulthood throughout middle age was associated with higher LA volumes in both genders, differences were found for LA function, with lower longitudinal deformation in men and higher reservoir and active LA function in women. (J Am Soc Echocardiogr 2020;33:878–87.)
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Affiliation(s)
- Henrique Doria de Vasconcellos
- Johns Hopkins University, Baltimore, Maryland; Universidade Federal do Vale do Sao Francisco/School of Medicine, Petrolina, Pernambuco
| | | | | | - Henrique T Moreira
- Johns Hopkins University, Baltimore, Maryland; University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
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23
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Venkat P, Cui C, Chen Z, Chopp M, Zacharek A, Landschoot-Ward J, Culmone L, Yang XP, Xu J, Chen J. CD133+Exosome Treatment Improves Cardiac Function after Stroke in Type 2 Diabetic Mice. Transl Stroke Res 2020; 12:112-124. [PMID: 32198711 DOI: 10.1007/s12975-020-00807-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022]
Abstract
Cardiac complications post-stroke are common, and diabetes exacerbates post-stroke cardiac injury. In this study, we tested whether treatment with exosomes harvested from human umbilical cord blood derived CD133+ cells (CD133+Exo) improves cardiac function in type 2 diabetes mellitus (T2DM) stroke mice. Adult (3-4 m), male, BKS.Cg-m+/+Leprdb/J (db/db, T2DM) and non-DM (db+) mice were randomized to sham or photothrombotic stroke groups. T2DM-stroke mice were treated with phosphate-buffered saline (PBS) or CD133+Exo (20 μg, i.v.) at 3 days after stroke. T2DM sham and T2DM+CD133+Exo treatment groups were included as controls. Echocardiography was performed, and mice were sacrificed at 28 days after stroke. Cardiomyocyte hypertrophy, myocardial capillary density, interstitial fibrosis, and inflammatory factor expression were measured in the heart. MicroRNA-126 expression and its target gene expression were measured in the heart. T2DM mice exhibit significant cardiac deficits such as decreased left ventricular ejection fraction (LVEF) and shortening fraction (LVSF), increased left ventricular diastolic dimension (LVDD), and reduced heart rate compared to non-DM mice. Stroke in non-DM and T2DM mice significantly decreases LVEF compared to non-DM and T2DM-sham, respectively. Cardiac dysfunction is worse in T2DM-stroke mice compared to non-DM-stroke mice. CD133+Exo treatment of T2DM-stroke mice significantly improves cardiac function identified by increased LVEF and decreased LVDD compared to PBS treated T2DM-stroke mice. In addition, CD133+Exo treatment significantly decreases body weight and blood glucose but does not decrease lesion volume in T2DM-stroke mice. CD133+Exo treatment of T2DM mice significantly decreases body weight and blood glucose but does not improve cardiac function. CD133+Exo treatment in T2DM-stroke mice significantly decreases myocardial cross-sectional area, interstitial fibrosis, transforming growth factor beta (TGF-β), numbers of M1 macrophages, and oxidative stress markers 4-HNE (4-hydroxynonenal) and NADPH oxidase 2 (NOX2) in heart tissue. CD133+Exo treatment increases myocardial capillary density in T2DM-stroke mice as well as upregulates endothelial cell capillary tube formation in vitro. MiR-126 is highly expressed in CD133+Exo compared to exosomes derived from endothelial cells. Compared to PBS treatment, CD133+Exo treatment significantly increases miR-126 expression in the heart and decreases its target gene expression such as Sprouty-related, EVH1 domain-containing protein 1 (Spred-1), vascular cell adhesion protein (VCAM), and monocyte chemoattractant protein 1 (MCP1) in the heart of T2DM-stroke mice. CD133+Exo treatment significantly improves cardiac function in T2DM-stroke mice. The cardio-protective effects of CD133+Exo in T2DM-stroke mice may be attributed at least in part to increasing miR-126 expression and decreasing its target protein expression in the heart, increased myocardial capillary density and decreased cardiac inflammatory factor expression.
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Affiliation(s)
- Poornima Venkat
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Chengcheng Cui
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Zhili Chen
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
- Department of Physics, Oakland University, Rochester, MI, 48309, USA
| | - Alex Zacharek
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | | | - Lauren Culmone
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Xiao-Ping Yang
- Hypertension Research, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Jiang Xu
- Hypertension Research, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Jieli Chen
- Department of Neurology, Henry Ford Hospital, Detroit, MI, 48202, USA.
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Kropidlowski C, Meier-Schroers M, Kuetting D, Sprinkart A, Schild H, Thomas D, Homsi R. CMR based measurement of aortic stiffness, epicardial fat, left ventricular myocardial strain and fibrosis in hypertensive patients. IJC HEART & VASCULATURE 2020; 27:100477. [PMID: 32099896 PMCID: PMC7026624 DOI: 10.1016/j.ijcha.2020.100477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/06/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
Introduction A combined assessment of different parameters of cardiovascular (CV) risk and prognosis can be supportive and performed with cardiac magnetic resonance (CMR). Aortic stiffness, epicardial fat volume (EFV), left ventricular (LV) strain and fibrosis were evaluated within a single CMR examination and results were related to the presence of hypertension (HTN) and diabetes mellitus (DM). Methods 20 healthy controls (57.2 ± 8.2 years(y); 26.2 ± 3.9 kg/m2), 31 hypertensive patients without DM (59.6 ± 6.7 y; 28.4 ± 4.7 kg/m2) and 12 hypertensive patients with DM (58.8 ± 9.9y; 30.7 ± 6.3 kg/m2) were examined at 1.5Tesla. Aortic stiffness was evaluated by calculation of aortic pulse wave velocity (PWV), EFV by a 3D-Dixon sequence. Longitudinal & circumferential systolic myocardial strain (LS; CS) were analyzed and T1-relaxation times (T1) were determined to detect myocardial fibrosis. Results EFV was highest in hypertensive patients with diabetes (78.4 ± 28.0 ml/m2) followed by only hypertensive patients (64.2 ± 27.3 ml/m2) and lowest in controls (50.3 ± 22.7 ml/m2; p < 0.05). PWV was higher in hypertensive patients with diabetes (9.8 ± 3.3 m/s) compared to only hypertensive patients (8.6 ± 1.7 m/s; p < 0.05) and to controls (8.1 ± 1.9 m/s; p < 0.05). LS&CS were worse in hypertensive patients with diabetes (LS:-20.9 ± 5.1% and CS: -24.4 ± 5.7%) compared to both only hypertensive patients (LS: -24.7 ± 4.6%; CS: -27.1 ± 5.0%; p < 0.05) and to controls (LS: -25.5 ± 3.8; CS: -28.3 ± 4.1%; p < 0.05). Both hypertensive groups with and without DM had higher T1́s (994.0 ± 43.2 ms; 991.6 ± 35.5 ms) than controls (964.6 ± 40.3 ms; p < 0.05). Conclusion CMR revealed increased aortic stiffness and EFV in hypertensive patients, which were even higher in the presence of DM. Also signs of LV myocardial fibrosis and a reduced strain were revealed. These parameters support the assessment of CV risk and prognosis. They can accurately be measured with CMR within a single examination when normally different techniques are needed.
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Affiliation(s)
| | | | - Daniel Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Alois Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Hans Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Rami Homsi
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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25
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Nwabuo CC, Vasan RS. Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy. Curr Hypertens Rep 2020; 22:11. [PMID: 32016791 DOI: 10.1007/s11906-020-1017-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Given that the life expectancy and the burden of hypertension are projected to increase over the next decade, hypertensive heart disease (HHD) may be expected to play an even more central role in the pathophysiology of cardiovascular disease (CVD). A broader understanding of the features and underlying mechanisms that constitute HHD therefore is of paramount importance. RECENT FINDINGS HHD is a condition that arises as a result of elevated blood pressure and constitutes a key underlying mechanism for cardiovascular morbidity and mortality. Historically, studies investigating HHD have primarily focused on left ventricular (LV) hypertrophy (LVH), but it is increasingly apparent that HHD encompasses a range of target-organ damage beyond LVH, including other cardiovascular structural and functional adaptations that may occur separately or concomitantly. HHD is characterized by micro- and macroscopic myocardial alterations, structural phenotypic adaptations, and functional changes that include cardiac fibrosis, and the remodeling of the atria and ventricles and the arterial system. In this review, we summarize the structural and functional alterations in the cardiac and vascular system that constitute HHD and underscore their underlying pathophysiology.
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Affiliation(s)
| | - Ramachandran S Vasan
- Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA, 01702, USA. .,Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA. .,Department of Medicine, Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Boston University Schools of Medicine, Boston, MA, USA.
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26
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Xie E, Lima JA. Global Nature of Incipient Chamber Remodeling and Dysfunction in Diabetic Individuals Living in the Community. Circ Cardiovasc Imaging 2019; 12:e009729. [DOI: 10.1161/circimaging.119.009729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric Xie
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - João A.C. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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27
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Cardiovascular Aging and Heart Failure. J Am Coll Cardiol 2019; 74:804-813. [DOI: 10.1016/j.jacc.2019.06.053] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
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Puntmann VO, Carr-White G, Jabbour A, Yu CY, Gebker R, Kelle S, Rolf A, Zitzmann S, Peker E, D'Angelo T, Pathan F, Elen, Valbuena S, Hinojar R, Arendt C, Narula J, Herrmann E, Zeiher AM, Nagel E. Native T1 and ECV of Noninfarcted Myocardium and Outcome in Patients With Coronary Artery Disease. J Am Coll Cardiol 2019; 71:766-778. [PMID: 29447739 DOI: 10.1016/j.jacc.2017.12.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the major cause of cardiac morbidity and mortality worldwide, despite the advances in treatment with coronary revascularization and modern antiremodeling therapy. Risk stratification in CAD patients is primarily based on left ventricular volumes, ejection fraction (LVEF), risk scores, and the presence and extent of late gadolinium enhancement (LGE). The prognostic role of T1 mapping in noninfarcted myocardium in CAD patients has not yet been determined. OBJECTIVES This study sought to examine prognostic significance of native T1 mapping of noninfarcted myocardium in patients with CAD. METHODS A prospective, observational, multicenter longitudinal study of consecutive patients undergoing routine cardiac magnetic resonance imaging with T1 mapping and LGE. The primary endpoint was all-cause mortality. Major adverse cardiocerebrovascular events (MACCE) (cardiac mortality, nonfatal acute coronary syndrome, stroke, and appropriate device discharge) are also reported. RESULTS A total of 34 deaths and 71 MACCE (n = 665, males n = 424, median age [interquartile range] 57 [22] years; 64%; median follow-up period of 17 [11] months) were observed. Native T1 and extracellular volume were univariate predictors of outcome. Native T1 and LGE were stronger predictors of survival and MACCE compared with extracellular volume, LVEF, cardiac volumes, and clinical scores (p < 0.001). Native T1 of noninfarcted myocardium was the sole independent predictor of all-cause mortality (chi-square = 21.7; p < 0.001), which was accentuated in the absence of LGE or LVEF ≤35%. For MACCE, native T1 and LGE extent were joint independent predictors (chi-square = 25.6; p < 0.001). CONCLUSIONS Characterization of noninfarcted myocardium by native T1 is an important predictor of outcome in CAD patients, over and above the traditional risk stratifiers. The current study's results provide a basis for a novel risk stratification model in CAD based on a complementary assessment of noninfarcted myocardium and post-infarction scar, by native T1 mapping and LGE, respectively.
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Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany.
| | - Gerry Carr-White
- Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; King's College Hospital NHS Trust, Denmark Hill, London, United Kingdom
| | - Andrew Jabbour
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Chung-Yao Yu
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Rolf Gebker
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Sabine Zitzmann
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Elif Peker
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University Hospital, Ankara, Turkey
| | - Tommaso D'Angelo
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
| | - Faraz Pathan
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Imaging, Menzies Institute for Medical Research, Hobart Tasmania, Australia
| | - Elen
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Jakarta, Jakarta, Indonesia
| | - Silvia Valbuena
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Rocio Hinojar
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Christophe Arendt
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Jagat Narula
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York
| | - Eva Herrmann
- DZHK Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
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Aaron CP, Hoffman EA, Kawut SM, Austin JHM, Budoff M, Michos ED, Hinckley Stukovsky K, Sack C, Szpiro AA, Watson KD, Kaufman JD, Barr RG. Ambient air pollution and pulmonary vascular volume on computed tomography: the MESA Air Pollution and Lung cohort studies. Eur Respir J 2019; 53:13993003.02116-2018. [PMID: 31167881 DOI: 10.1183/13993003.02116-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/14/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Air pollution alters small pulmonary vessels in animal models. We hypothesised that long-term ambient air pollution exposure would be associated with differences in pulmonary vascular volumes in a population-based study. METHODS The Multi-Ethnic Study of Atherosclerosis recruited adults in six US cities. Personalised long-term exposures to ambient black carbon, nitrogen dioxide (NO2), oxides of nitrogen (NO x ), particulate matter with a 50% cut-off aerodynamic diameter of <2.5 μm (PM2.5) and ozone were estimated using spatiotemporal models. In 2010-2012, total pulmonary vascular volume was measured as the volume of detectable pulmonary arteries and veins, including vessel walls and luminal blood volume, on noncontrast chest computed tomography (TPVVCT). Peripheral TPVVCT was limited to the peripheral 2 cm to isolate smaller vessels. Linear regression adjusted for demographics, anthropometrics, smoking, second-hand smoke, renal function and scanner manufacturer. RESULTS The mean±sd age of the 3023 participants was 69.3±9.3 years; 46% were never-smokers. Mean exposures were 0.80 μg·m-3 black carbon, 14.6 ppb NO2 and 11.0 μg·m-3 ambient PM2.5. Mean±sd peripheral TPVVCT was 79.2±18.2 cm3 and TPVVCT was 129.3±35.1 cm3. Greater black carbon exposure was associated with a larger peripheral TPVVCT, including after adjustment for city (mean difference 0.41 (95% CI 0.03-0.79) cm3 per interquartile range; p=0.036). Associations for peripheral TPVVCT with NO2 were similar but nonsignificant after city adjustment, while those for PM2.5 were of similar magnitude but nonsignificant after full adjustment. There were no associations for NO x or ozone, or between any pollutant and TPVVCT. CONCLUSIONS Long-term black carbon exposure was associated with a larger peripheral TPVVCT, suggesting diesel exhaust may contribute to remodelling of small pulmonary vessels in the general population.
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Affiliation(s)
- Carrie P Aaron
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric A Hoffman
- Dept of Radiology, University of Iowa, Iowa City, IA, USA
| | - Steven M Kawut
- Depts of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John H M Austin
- Dept of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Matthew Budoff
- Dept of Medicine, University of California, Los Angeles, CA, USA
| | - Erin D Michos
- Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Coralynn Sack
- Dept of Medicine, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - Karol D Watson
- Dept of Medicine, University of California, Los Angeles, CA, USA
| | - Joel D Kaufman
- Dept of Medicine, University of Washington, Seattle, WA, USA.,Dept of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.,Dept of Epidemiology, University of Washington, Seattle, WA, USA
| | - R Graham Barr
- Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Dept of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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30
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Ambale-Venkatesh B, Liu CY, Liu YC, Donekal S, Ohyama Y, Sharma RK, Wu CO, Post WS, Hundley GW, Bluemke DA, Lima JAC. Association of myocardial fibrosis and cardiovascular events: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imaging 2019; 20:168-176. [PMID: 30325426 DOI: 10.1093/ehjci/jey140] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022] Open
Abstract
Aims We used contrast-enhanced cardiac magnetic resonance (CMR) to evaluate differences in myocardial fibrosis measured at the year-10 examination between participants with and without cardiovascular (CV) events accrued in a large population based study over the preceding 10-year follow-up period in this retrospective study. Methods and results The MESA study enrolled 6814 participants free of CV disease at baseline (2000-2002). We included MESA participants who underwent contrast-enhanced CMR at the MESA year-10 exam (N = 1840). We defined a composite CV endpoint of coronary heart disease, heart failure, atrial fibrillation, stroke, and peripheral artery disease. Using CMR, we characterized myocardial fibrosis with late-gadolinium enhancement for scar and T1 mapping indices of diffuse fibrosis. Demographic and CV-risk adjusted logistic (presence of scar) and linear regression (pre-contrast T1, T1 at 12 and 25 min post-contrast, and extracellular volume fraction or ECV) models were used to assess the relationship between fibrosis and events. The mean values of T1 indices were-pre-contrast T1: 977 ± 45 ms; T1 at 12': 456 ± 40 ms; T1 at 25': 519 ± 41 ms; ECV: 27.1 ± 3.2%. One-hundred and forty-six (7.9%) participants had myocardial scar. The presence of scar was strongly associated with prior CV events (adjusted coeff: 1.36, P < 0.001). Lower post-contrast T1 times and higher ECV, indicative of greater diffuse fibrosis were strongly associated with CV events (T1 at 12': coeff = -10.0 ms, P = 0.004; T1 at 25': coeff =-9.2 ms, P = 0.008; ECV: coeff = 1.31%, P < 0.001). Conclusion Individuals who suffered prior CV events have greater likelihood of diffuse myocardial fibrosis when compared with event-free individuals living in the same community.
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Affiliation(s)
- Bharath Ambale-Venkatesh
- Johns Hopkins University, MR 110 Radiology, Nelson Basement, 600 N Wolfe Street, Baltimore, MD, USA
| | - Chia-Ying Liu
- Johns Hopkins University, MR 110 Radiology, Nelson Basement, 600 N Wolfe Street, Baltimore, MD, USA
| | - Yuan-Chang Liu
- Cardiology, Johns Hopkins Hospital, Blalock 524, 600 N Wolfe Street, Baltimore, MD, USA
| | - Sirisha Donekal
- Cardiology, Johns Hopkins Hospital, Blalock 524, 600 N Wolfe Street, Baltimore, MD, USA
| | - Yoshiaki Ohyama
- Cardiology, Johns Hopkins Hospital, Blalock 524, 600 N Wolfe Street, Baltimore, MD, USA
| | - Ravi K Sharma
- Cardiology, Johns Hopkins Hospital, Blalock 524, 600 N Wolfe Street, Baltimore, MD, USA
| | - Colin O Wu
- Office of Biostatistics Research, 2 Rockledge Center, Room 9212, 6701 Rockledge Drive, Bethesda, MD, USA
| | - Wendy S Post
- Cardiology, Johns Hopkins Hospital, Halsted 566, 600 N Wolfe St, Baltimore, MD, USA
| | - Gregory W Hundley
- Wake Forest University Health Sciences, Department of Internal Medicine/Cardiology, Medical Center Blvd., Winston-Salem, NC, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue, Madison, WI, USA
| | - João A C Lima
- Cardiology, Johns Hopkins Hospital, Blalock 524, 600 N Wolfe Street, Baltimore, MD, USA
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31
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Marques MD, Nauffal V, Ambale-Venkatesh B, Vasconcellos HD, Wu C, Bahrami H, Tracy RP, Cushman M, Bluemke DA, Lima JAC. Association Between Inflammatory Markers and Myocardial Fibrosis. Hypertension 2019; 72:902-908. [PMID: 30354713 DOI: 10.1161/hypertensionaha.118.11463] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inflammation promotes adverse ventricular remodeling. T1 mapping has been used to noninvasively assess interstitial myocardial fibrosis. We examined the association of baseline markers of systemic inflammation with interstitial myocardial fibrosis measured by extracellular volume fraction (ECV) and native T1 mapping at 10-year follow-up in the MESA (Multi-Ethnic Study of Atherosclerosis). Seven hundred seventy-two participants had complete baseline data and underwent cardiac magnetic resonance imaging. All analyses were stratified by sex. Multivariable linear regression models were constructed to assess the associations of baseline CRP (C-reactive protein), IL (interleukin)-6, and fibrinogen with native T1 time and ECV. Longer native T1 times and higher percentages of ECV represent increasing myocardial fibrosis. A 1-SD increment of log-transformed IL-6 levels was associated with 0.4% higher ECV in men (β=0.4; P=0.05). CRP and fibrinogen were not associated to ECV. A 1-SD increment in the log-transformed CRP levels was associated with 4.9 ms higher native T1 (β=4.9; P=0.03). In women, the inflammatory markers did not demonstrate association with native T1 nor ECV. Higher IL-6 and CRP levels are associated with increased interstitial myocardial fibrosis assessed by cardiac magnetic resonance in men. However, no inflammatory markers were associated to myocardial fibrosis in women.
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Affiliation(s)
- Mateus D Marques
- From the Department of Medicine (M.D.M., V.N., H.D.V., J.A.C.L.), Johns Hopkins University, Baltimore, MD.,Department of Internal Medicine, Federal University of Santa Maria, Rio Grande do Sul, Brazil (M.D.M.)
| | - Victor Nauffal
- From the Department of Medicine (M.D.M., V.N., H.D.V., J.A.C.L.), Johns Hopkins University, Baltimore, MD
| | | | - Henrique D Vasconcellos
- From the Department of Medicine (M.D.M., V.N., H.D.V., J.A.C.L.), Johns Hopkins University, Baltimore, MD.,Federal University of Vale do São Francisco, Pernambuco, Brazil (H.D.V.)
| | - Colin Wu
- Office of Biostatistics, National Institutes of Health, Bethesda, MD (C.W.)
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Los Angeles (H.B.)
| | - Russell P Tracy
- Department of Pathology, University of Vermont, Colchester (R.P.T., M.C.)
| | - Mary Cushman
- Department of Pathology, University of Vermont, Colchester (R.P.T., M.C.)
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.)
| | - João A C Lima
- From the Department of Medicine (M.D.M., V.N., H.D.V., J.A.C.L.), Johns Hopkins University, Baltimore, MD
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32
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Chu PY, Joshi MS, Horlock D, Kiriazis H, Kaye DM. CXCR4 Antagonism Reduces Cardiac Fibrosis and Improves Cardiac Performance in Dilated Cardiomyopathy. Front Pharmacol 2019; 10:117. [PMID: 30837882 PMCID: PMC6389782 DOI: 10.3389/fphar.2019.00117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/31/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Myocardial fibrosis is a key pathologic finding in the failing heart and is implicated as a cause of increased ventricular stiffness and susceptibility to ventricular arrhythmia. Neurohormonal mediators such as aldosterone and angiotensin II are known to cause fibrosis in experimental models, however, clinical evidence for the reversal of fibrosis with relevant antagonists is limited. Recent studies suggest that inflammatory mediators may contribute to fibrosis. In dilated cardiomyopathy the mechanism for myocardial fibrosis is unclear and its implications on systolic function are not known. Methods and Results: We studied the effect of a highly selective antagonist of SDF-1/CXCR4 signaling, AMD3100, on the development of cardiac fibrosis and cardiac function in mice with dilated cardiomyopathy due to cardiac-specific transgenic overexpression of the stress-kinase, Mst1. AMD3100 significantly attenuated the progression of myocardial fibrosis and this was accompanied by significant improvements in diastolic and systolic performance as evaluated in isolated Langendorff perfused hearts. AMD3100 reduced BNP mRNA expression but did not alter the expression of Ca2+ handling genes. CXCR4 antagonism also reduced the abundance of splenic CD4+ T cells. Conclusion: This study demonstrates that CXCR4 pathway contributes to pathogenesis of cardiac fibrosis in dilated cardiomyopathy, and it represents a new potential therapeutic target in heart failure. The data also demonstrate that anti-fibrotic strategies can improve systolic performance.
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Affiliation(s)
- Po-Yin Chu
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Mandar S Joshi
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Duncan Horlock
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Kiriazis
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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34
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Salvanic acid B inhibits myocardial fibrosis through regulating TGF-β1/Smad signaling pathway. Biomed Pharmacother 2019; 110:685-691. [DOI: 10.1016/j.biopha.2018.11.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/12/2018] [Accepted: 11/25/2018] [Indexed: 12/18/2022] Open
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35
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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36
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Tian G, Sun Y, Liu S, Li C, Chen S, Qiu R, Zhang X, Li Y, Li M, Shang H. Therapeutic Effects of Wenxin Keli in Cardiovascular Diseases: An Experimental and Mechanism Overview. Front Pharmacol 2018; 9:1005. [PMID: 30233380 PMCID: PMC6134428 DOI: 10.3389/fphar.2018.01005] [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: 06/06/2018] [Accepted: 08/16/2018] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the major public health problem and a leading cause of morbidity and mortality on a global basis. Wenxin Keli (WXKL), a formally classical Chinese patent medicine with obvious efficacy and favorable safety, plays a great role in the management of patients with CVDs. Accumulating evidence from various animal and cell studies has showed that WXKL could protect myocardium and anti-arrhythmia against CVDs. WXKL exhibited its cardioprotective roles by inhibiting inflammatory reaction, decreasing oxidative stress, regulating vasomotor disorders, lowering cell apoptosis, and protection against endothelial injure, myocardial ischemia, cardiac fibrosis, and cardiac hypertrophy. Besides, WXKL could effectively shorten the QRS and Q-T intervals, decrease the incidence of atrial/ventricular fibrillation and the number of ventricular tachycardia episodes, improve the severity of arrhythmias by regulating various ion channels with different potencies, mainly comprising peak sodium current (INa), late sodium current (INaL), transient outward potassium current (Ito), L-type calcium current (ICaL), and pacemaker current (If).
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Affiliation(s)
- Guihua Tian
- Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Sun
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuo Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chengyu Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shiqi Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Youping Li
- Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
| | - Min Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Integration of Traditional Chinese and Western Medicine, Guangzhou Medical University, Guangzhou, China
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37
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Muiesan ML, Paini A, Aggiusti C, Bertacchini F, Rosei CA, Salvetti M. Hypertension and Organ Damage in Women. High Blood Press Cardiovasc Prev 2018; 25:245-252. [DOI: 10.1007/s40292-018-0265-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022] Open
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38
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Liang ZG, Yao H, Xie RS, Gong CL, Tian Y. MicroRNA‑20b‑5p promotes ventricular remodeling by targeting the TGF‑β/Smad signaling pathway in a rat model of ischemia‑reperfusion injury. Int J Mol Med 2018; 42:975-987. [PMID: 29786750 PMCID: PMC6034914 DOI: 10.3892/ijmm.2018.3695] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 04/26/2018] [Indexed: 01/04/2023] Open
Abstract
Myocardial ischemic injury results from severe impairment of the coronary blood supply and may lead to metabolic and ultrastructural changes, thereby causing irreversible damage. MicroRNA (miR)-20b-5p has been demonstrated to be involved in malignancies of the breast, colorectum, stomach, blood and oropharynx. The present study aimed to investigate the effects of miR-20b-5p on ventricular remodeling following myocardial ischemia-reperfusion (IR) injury in rats by targeting small mothers against decapentaplegic homolog 7 (Smad7) via the transforming growth factor-β (TGF-β)/Smad signaling pathway. A total of 70 adult male Sprague-Dawley rats were divided into seven groups: Sham group, IR group, negative control group, miR-20b-5p mimics group, miR-20b-5p inhibitors group, small interfering RNA (siRNA)-Smad7 group, and miR-20b-5p inhibitors + siRNA-Smad7 group. Dual luciferase reporter gene assays were used to verify the association between miR-20b-5p and Smad7. Myocardial infarction size, myocardial collagen volume fraction and perivascular collagen area were detected separately using triphenyltetrazolium chloride and Masson's staining. The rate of positive expression of Smad7 was detected using immunohistochemistry, and the expression levels of miR-20b-5p, TGF-β1, Smad3 and Smad7 were detected using reverse transcription-quantitative polymerase chain reaction and western blot analyses. The findings revealed that miR-20b-5p inhibited Smad7. Compared with the sham group, the other six groups had increased myocardial infarction size, myocardial collagen, and expression of miR-20b-5p, TGF-β1 and Smad3, and decreased expression of Smad7. Compared with the IR group, the miR-20b-5p mimics group and the siRNA-Smad7 group had increased myocardial infarction size and myocardial collagen, increased expression of TGF-β1 and Smad3, and decreased expression of Smad7. The expression of miR-20b-5p was markedly increased in the miR-20b-5p mimics group, but did not differ significantly from that in the siRNA-Smad7 group. The results demonstrated that miR-20b-5p promoted ventricular remodeling following myocardial IR injury in rats by inhibiting the expression of Smad7 through activating the TGF-β/Smad signaling pathway.
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Affiliation(s)
- Zhao-Guang Liang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Hong Yao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Rong-Sheng Xie
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Chun-Lin Gong
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ye Tian
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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Wang R, Liu X, Schoepf UJ, van Assen M, Alimohamed I, Griffith LP, Luo T, Sun Z, Fan Z, Xu L. Extracellular volume quantitation using dual-energy CT in patients with heart failure: Comparison with 3T cardiac MR. Int J Cardiol 2018; 268:236-240. [PMID: 29804697 DOI: 10.1016/j.ijcard.2018.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUNDS Cardiac magnetic resonance (CMR) T1 mapping and the extracellular volume (ECV) have been developed to quantitative analysis of diffusely abnormal myocardial fibrosis (MF). However, dual-energy CT (DECT) has a potential for calculation of ECV. The aim of this study is to evaluate the feasibility and accuracy of DECT technique in determining the ECV in patients with heart failure, with 3T CMR as the reference. METHODS Thirty-five patients with various reasons of heart failure were enrolled in this study. Both DECT and CMR exams were completed within 24 h. ECVs were calculated, and the relationship between DECT-ECV, CMR-ECV, and other heart function parameters, including left ventricular end systolic and diastolic volume, cardiac output and ejection fraction (LVESV, LVEDV, CO, LVEF), Brain natriuretic peptide (BNP) was determined. All participants gave informed consent, and the study was approved by the institutional review board. RESULTS The median ECVs on DECT and CMR were 33% (95%CI: 32%-36%) and 30% (95%CI: 30% - 32%), respectively. A good correlation between myocardial ECV at DECT and that at CMR (r = 0.945, P < 0.001) was observed. Bland-Altman analysis between DECT and CMR showed a small bias (2.6%), with 95% limits of agreement of -0.4% and 5.6%. Interobserver agreement for ECV at DECT was excellent (ICC = 0.907). Both ECVs, for DECT and CMR, were inversely associated with LVEF and CO. CONCLUSION DECT-based ECV could be an alternative non-invasive imaging tool for myocardial tissue characterization. However, overestimation of the extent of diffuse MF is observed with use of DECT.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Xinmin Liu
- Wards 40 of Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University or South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Internal Medicine, Medical University or South Carolina, Charleston, SC, USA
| | - Marly van Assen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University or South Carolina, Charleston, SC, USA; Center for Medical Imaging North-East Netherlands (CMI-NEN), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Imtiaz Alimohamed
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University or South Carolina, Charleston, SC, USA
| | - L Parkwood Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University or South Carolina, Charleston, SC, USA
| | - Taiyang Luo
- Wards 40 of Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA 6845, Australia
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China.
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40
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Ladeiras-Lopes R, Moreira HT, Bettencourt N, Fontes-Carvalho R, Sampaio F, Ambale-Venkatesh B, Wu C, Liu K, Bertoni AG, Ouyang P, Bluemke DA, Lima JA. Metabolic Syndrome Is Associated With Impaired Diastolic Function Independently of MRI-Derived Myocardial Extracellular Volume: The MESA Study. Diabetes 2018; 67:1007-1012. [PMID: 29444891 PMCID: PMC5910005 DOI: 10.2337/db17-1496] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/07/2018] [Indexed: 01/09/2023]
Abstract
The relationship of metabolic syndrome (MetS) and insulin resistance (one of its key pathophysiological mediators) with diastolic dysfunction and myocardial fibrosis is not well understood. This study aimed to evaluate the association of MetS with diastolic function and myocardial extracellular matrix (ECM) using cardiac MRI (CMRI) in a large community-based population. This cross-sectional analysis included 1,582 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with left ventricular ejection fraction ≥50% and no history of cardiac events. Diastolic function was assessed using tagged CMRI parameters including end-diastolic strain rate (EDSR) and strain relaxation index (SRI). ECM was evaluated using extracellular volume (ECV) quantification. Participants' mean age was 67.4 ± 8.6 years, and 48.1% were males. MetS was present in 533 individuals (33.7%), and type 2 diabetes in 250 (15.8%). In the multivariable analyses, MetS (irrespective of the presence of type 2 diabetes) and higher insulin resistance were associated with impaired diastolic function (higher SRI and lower EDSR), independent of ECV. In conclusion, MetS, irrespective of the presence of type 2 diabetes, was independently associated with impaired diastole. These functional myocardial changes seem to result from intrinsic cardiomyocyte alterations, irrespective of the myocardial interstitium (including fibrosis).
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Affiliation(s)
- Ricardo Ladeiras-Lopes
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Henrique T Moreira
- The Johns Hopkins University, Baltimore, MD
- University of São Paulo, Ribeirão Preto, Brazil
| | - Nuno Bettencourt
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Colin Wu
- National Institutes of Health, Bethesda, MD
| | - Kiang Liu
- Northwestern University, Chicago, IL
| | - Alain G Bertoni
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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41
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Ostovaneh MR, Ambale-Venkatesh B, Fuji T, Bakhshi H, Shah R, Murthy VL, Tracy RP, Guallar E, Wu CO, Bluemke DA, Lima JAC. Association of Liver Fibrosis With Cardiovascular Diseases in the General Population: The Multi-Ethnic Study of Atherosclerosis (MESA). Circ Cardiovasc Imaging 2018; 11:e007241. [PMID: 29523555 PMCID: PMC5846116 DOI: 10.1161/circimaging.117.007241] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association of cardiovascular diseases (CVD) with liver fibrosis is poorly understood. We aim to assess the association of liver fibrosis by T1-mapping magnetic resonance imaging and CVD in MESA (Multi-Ethnic Study of Atherosclerosis). METHODS AND RESULTS MESA enrolled 6814 participants free of clinical CVD at baseline (2000-2002). A subsample of participants underwent T1-mapping magnetic resonance imaging 10 years after the baseline (Y10 MESA exam, 2010-2012). Liver T1 maps were generated avoiding vessels and biliary ducts from which native T1 (n=2087) and extracellular volume fraction (ECV, n=1234) were determined. Higher ECV and native T1 were indicators of liver fibrosis. Linear regression analysis evaluated the cross-sectional relationship between liver native T1 and ECV at Y10 MESA exam with a history of CVD events (atrial fibrillation, heart failure, and coronary heart disease [CHD]). Of the 2087 participants (68.7±9.1 years; 46% females), 153 had prior CVD events (78 atrial fibrillation, 25 heart failure, and 78 CHD). History of CVD events was associated with 18.5 ms higher liver native T1 (P<0.001) and 1.4% greater ECV (P=0.06). Prior atrial fibrillation was related to higher liver native T1 (β=21.1; P=0.001) and greater ECV (β=2.2; P=0.02), whereas previous heart failure was associated with greater liver ECV (β=4.1; P=0.02). There was also a relationship of prior CHD with liver native T1 (β=13; P=0.05) and ECV (β=1.9; P=0.05), which was attenuated by adjustment for coronary artery calcium score (β=7.1 and 1.6; P=0.37 and 0.13, respectively). CONCLUSIONS Liver fibrosis by T1-mapping magnetic resonance imaging is associated with history of heart failure, atrial fibrillation, and CHD in a multiethnic cohort. The association of liver fibrosis and CHD is at least in part mediated by atherosclerosis.
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Affiliation(s)
| | - Bharath Ambale-Venkatesh
- From the Depatrment of Cardiology (M.R.O., T.F., H.B., E.G., J.A.C.L.) and the Department of Radiology (B.A.V.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Harvard University, Boston, MA (R.S.); Department of Medicine, University of Michigan, Ann Arbor (V.L.M.); Department of Pathology and Laboratory Medicine, University of Vermont, Colchester (R.P.T.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (C.O.W.); and Department of Radiology, University of Wisconsin, Madison (D.A.B.).
| | | | | | | | | | | | | | - Colin O. Wu
- National Institutes of Health, Bethesda MD, USA
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42
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Lu HI, Lee FY, Wallace CG, Sung PH, Chen KH, Sheu JJ, Chua S, Tong MS, Huang TH, Chen YL, Shao PL, Yip HK. SS31 therapy effectively protects the heart against transverse aortic constriction-induced hypertrophic cardiomyopathy damage. Am J Transl Res 2017; 9:5220-5237. [PMID: 29312478 PMCID: PMC5752876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
This study tested the hypothesis that SS31 therapy could effectively protect the heart against transverse aortic constriction (TAC)-induced hypertrophic cardiomyopathy (HCM) damage. Adult-male B6 mice (n=36) were equally divided into sham-operated control (group 1), TAC only (group 2) and TAC+SS31 (group) (2.0 mg/kg/day by intra-peritoneal administration from day 28 after TAC induction) and euthanized by day 60. In vitro results showed that SS31 markedly suppressed angiotensin-II induced protein expressions of BNP/β-MHC, ATM, p-P38 and P53 and ATP damage in H9C2 cells, and protein expression of pro-collagen-I/CTGF in fibroblasts (all P<0.001). By day 60, left ventricular ejection fraction (LVEF) and sarcomere length were significantly lower in group 2 than groups 1 and 3, and significantly lower in group 3 than in group 1, whereas the LEVDd/LVESd and ratio of heart weight to tibial length showed an opposite pattern to LVEF (all P<0.0001). Microscopic findings of numbers of apoptotic nuclei, inflammatory (CD14+, F4/80+) and oxidative-stress (H2DCFDA+) biomarkers, disorganized score of endocardium, and fibrotic and collagen-deposition areas showed an opposite pattern to LVEF among the three groups (all P<0.0001). The protein expressions of inflammatory (PDGF/TNF-α/NF-κB/COX-2), oxidative-stress (NOX-1/NOX-2/oxidized protein), fibrotic (TGF-β/Smad3) apoptotic (cleaved-caspase-3/cleaved-PARP), pressure/volume overload (BNP/β-MHC), CTGF, mitochondrial-damaged (cytosolic cytochrome-C), p-ERK1/2, p-Akt and PI3K signaling showed an opposite pattern to LVEF among the three groups (all P<0.001). The protein expression of anti-oxidants (HO-1/Nrf2) were significantly progressively increased in groups 1 to 3 (all P<0.001). In conclusion, SS31 therapy effectively protected the heart against TAC-induced damage.
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Affiliation(s)
- Hung-I Lu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Fan-Yen Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | | | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Jiunn-Jye Sheu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Tien-Hung Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Pei-Lin Shao
- Department of Nursing, Asia UniversityTaichung 41354, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
- Department of Nursing, Asia UniversityTaichung 41354, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial HospitalKaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial HospitalKaohsiung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical UniversityTaichung 40402, Taiwan
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43
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Haggerty CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Wehner GJ, Jing L, Charnigo RJ, Fornwalt BK, Fogel MA. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19:100. [PMID: 29228952 PMCID: PMC5724335 DOI: 10.1186/s12968-017-0410-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
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Affiliation(s)
- Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Nguyen KL, Hu P, Ennis DB, Shao J, Pham KA, Chen JJ. Cardiac MRI: a Translational Imaging Tool for Characterizing Anthracycline-Induced Myocardial Remodeling. Curr Oncol Rep 2017; 18:48. [PMID: 27292153 DOI: 10.1007/s11912-016-0533-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular side effects of cancer therapeutics are the leading causes of morbidity and mortality in cancer survivors. Anthracyclines (AC) serve as the backbone of many anti-cancer treatment strategies, but dose-dependent myocardial injury limits their use. Cumulative AC exposure can disrupt the dynamic equilibrium of the myocardial microarchitecture while repeated injury and repair leads to myocyte loss, interstitial myocardial fibrosis, and impaired contractility. Although children are assumed to have greater myocardial plasticity, AC exposure at a younger age portends worse prognosis. In older patients, there is lower overall survival once they develop cardiovascular disease. Because aberrations in the myocardial architecture predispose the heart to a decline in function, early detection with sensitive imaging tools is crucial and the implications for resource utilization are substantial. As a comprehensive imaging modality, cardiac magnetic resonance (CMR) imaging is able to go beyond quantification of ejection fraction and myocardial deformation to characterize adaptive microstructural and microvascular changes that are important to myocardial tissue health. Herein, we describe CMR as an established translational imaging tool that can be used clinically to characterize AC-associated myocardial remodeling.
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Affiliation(s)
- Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA.
| | - Peng Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiaxin Shao
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kimberly A Pham
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
| | - Joseph J Chen
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
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45
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Yoneyama K, Venkatesh BA, Bluemke DA, McClelland RL, Lima JAC. Cardiovascular magnetic resonance in an adult human population: serial observations from the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson 2017; 19:52. [PMID: 28720123 PMCID: PMC5514469 DOI: 10.1186/s12968-017-0367-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
The Multi-Ethnic Study of Atherosclerosis (MESA) is the first large-scale multi-ethnic population study in the U.S. to use advanced cardiovascular magnetic resonance (CMR) imaging. MESA participants were free of cardiovascular disease at baseline between 2000 and 2002, and were followed up between 2009 and 2011 with repeated CMR examinations as part of MESA. CMR allows the clinician to visualize and accurately quantify volume and dimensions of all four cardiac chambers; measure systolic and diastolic ventricular function; assess myocardial fibrosis; assess vessel lumen size, vessel wall morphology, and vessel stiffness. CMR has a number of advantages over other imaging modalities such as echocardiography, computed tomography, and invasive angiography, and has been proposed as a diagnostic strategy for high-risk populations. MESA has been extensively evaluating CMR imaging biomarkers, as markers of subclinical disease, in the last 15 years for low-risk populations. On a more practical level, some of the imaging biomarkers developed and studied are translatable to at-risk populations. In this review, we discuss the progression of subclinical cardiovascular disease and the mechanisms responsible for the transition to symptomatic clinical outcomes based on our findings from MESA.
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Grants
- N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169, UL1-TR-000040 and UL1-TR-001079
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Affiliation(s)
- Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - João A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
- Professor of Medicine, Radiology and Epidemiology, Johns Hopkins Hospital, Johns Hopkins University, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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Ohyama Y, Ambale-Venkatesh B, Noda C, Chugh AR, Teixido-Tura G, Kim JY, Donekal S, Yoneyama K, Gjesdal O, Redheuil A, Liu CY, Nakamura T, Wu CO, Hundley WG, Bluemke DA, Lima JAC. Association of Aortic Stiffness With Left Ventricular Remodeling and Reduced Left Ventricular Function Measured by Magnetic Resonance Imaging: The Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004426. [PMID: 27353852 DOI: 10.1161/circimaging.115.004426] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/18/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AND RESULTS Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine magnetic resonance imaging. LV circumferential strain (Ecc), torsion, and early diastolic strain rate were determined by tagged magnetic resonance imaging. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, P<0.05) and LV mass to volume ratio (B=0.015, P<0.01), impaired LV ejection fraction (LVEF; B=-0.84; P<0.001), Ecc (B=0.55; P<0.001), torsion (B=-0.11; P<0.001), and early diastolic strain rate (B=-0.003; P<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02; P<0.05), impaired Ecc (B=0.60; P<0.001), and LVEF (B=-0.45; P<0.05), but with maintained torsion in women. Higher PWV was associated with impaired Ecc (B=0.49; P<0.001) and LVEF (B=-1.21; P<0.001), with lower torsion (B=-0.17; P<0.001) in men. CONCLUSIONS Higher arch PWV is associated with LV remodeling, and reduced LV systolic and diastolic function in a large multiethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling and relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion, and LVEF, with less concentric LV remodeling in men.
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Affiliation(s)
- Yoshiaki Ohyama
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Bharath Ambale-Venkatesh
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Chikara Noda
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Atul R Chugh
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Gisela Teixido-Tura
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Jang-Young Kim
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Sirisha Donekal
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Kihei Yoneyama
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Ola Gjesdal
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Alban Redheuil
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Chia-Ying Liu
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Tetsuya Nakamura
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Colin O Wu
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - W Gregory Hundley
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - David A Bluemke
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.)
| | - Joao A C Lima
- From the Department of Cardiology (Y.O., C.N., A.R.C., G.T.-T., J.-Y.K., S.D., K.Y., O.G., J.A.C.L.), Department of Radiology (B.A.-V.), Johns Hopkins University, Baltimore, MD; Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain (G.T.-T.); Department of Cardiology, Oslo University Hospital, Norway (O.G.); Imagerie Cardiovasculaire/Cardiovascular Imaging DICVRI, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France (A.R.); National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD (C.-Y.L., D.A.B.); Clinical Investigation and Research Unit, Gunma University, Maebashi, Japan (T.N.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (W.G.H.).
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Yang X, Chen Y, Li Y, Ren X, Xing Y, Shang H. Effects of Wenxin Keli on Cardiac Hypertrophy and Arrhythmia via Regulation of the Calcium/Calmodulin Dependent Kinase II Signaling Pathway. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1569235. [PMID: 28573136 PMCID: PMC5440795 DOI: 10.1155/2017/1569235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/05/2017] [Indexed: 12/19/2022]
Abstract
We investigated the effects of Wenxin Keli (WXKL) on the Calcium/Calmodulin dependent kinase II (CaMK II) signal transduction pathway with transverse aortic constriction (TAC) rats. Echocardiographic measurements were obtained 3 and 9 weeks after the surgery. Meanwhile, the action potentials (APDs) were recorded using the whole-cell patch clamp technique, and western blotting was used to assess components of the CaMK II signal transduction pathway. At both 3 and 9 weeks after treatment, the fractional shortening (FS%) increased in the WXKL group compared with the TAC group. The APD90 of the TAC group was longer than that of the Sham group and was markedly shortened by WXKL treatment. Western blotting results showed that the protein expressions of CaMK II, phospholamban (PLB), and ryanodine receptor 2 (RYR2) were not statistically significant among the different groups at both treatment time points. However, WXKL treatment decreased the protein level and phosphorylation of CaMK II (Thr-286) and increased the protein level and phosphorylation of PLB (Thr-17) and the phosphorylation of RYR2 (Ser-2814). WXKL also decreased the accumulation of type III collagen fibers. In conclusion, WXKL may improve cardiac function and inhibit the arrhythmia by regulating the CaMK II signal transduction pathway.
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Affiliation(s)
- Xinyu Yang
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yu Chen
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
- Fujian Health College, Fuzhou 350101, China
| | - Yanda Li
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaomeng Ren
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yanwei Xing
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Hongcai Shang
- The Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100053, China
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48
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Interrelations of Epicardial Fat Volume, Left Ventricular T1-Relaxation Times and Myocardial Strain in Hypertensive Patients. J Thorac Imaging 2017; 32:169-175. [DOI: 10.1097/rti.0000000000000264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Aaron CP, Hoffman EA, Lima JAC, Kawut SM, Bertoni AG, Vogel-Claussen J, Habibi M, Hueper K, Jacobs DR, Kalhan R, Michos ED, Post WS, Prince MR, Smith BM, Ambale-Venkatesh B, Liu CY, Zemrak F, Watson KE, Budoff M, Bluemke DA, Barr RG. Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study. PLoS One 2017; 12:e0176180. [PMID: 28426728 PMCID: PMC5398710 DOI: 10.1371/journal.pone.0176180] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 04/06/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evaluation of impaired left ventricular (LV) filling has focused on intrinsic causes of LV dysfunction; however, pulmonary vascular changes may contribute to reduced LV filling and dyspnea. We hypothesized that lower total pulmonary vascular volume (TPVV) on computed tomography (CT) would be associated with dyspnea and decrements in LV end-diastolic volume, particularly among ever-smokers. METHODS The Multi-Ethnic Study of Atherosclerosis recruited adults without clinical cardiovascular disease in 2000-02. In 2010-12, TPVV was ascertained as the volume of arteries and veins in the lungs detectable on non-contrast chest CT (vessels ≥1 mm diameter). Cardiac measures were assessed by magnetic resonance imaging (MRI). Dyspnea was self-reported. RESULTS Of 2303 participants, 53% had ever smoked cigarettes. Among ever-smokers, a lower TPVV was associated with a lower LV end-diastolic volume (6.9 mL per SD TPVV), stroke volume, and cardiac output and with dyspnea (all P-values <0.001). Findings were similar among those without lung disease and those with 0-10 pack-years but were mostly non-significant among never-smokers. TPVV was associated smaller left atrial volume but not with LV ejection fraction or MRI measures of impaired LV relaxation. In a second sample of ever-smokers, a lower pulmonary microvascular blood volume on contrast-enhanced MRI was also associated with a lower LV end-diastolic volume (P-value = 0.008). CONCLUSION Reductions in pulmonary vascular volume were associated with lower LV filling and dyspnea among ever-smokers, including those without lung disease, suggesting that smoking-related pulmonary vascular changes may contribute to symptoms and impair cardiac filling and function without evidence of impaired LV relaxation.
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Affiliation(s)
- Carrie P. Aaron
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States of America
| | - Joao A. C. Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Steven M. Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Alain G. Bertoni
- Departments of Medicine and Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Mohammadali Habibi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Katja Hueper
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Erin D. Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Wendy S. Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Martin R. Prince
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Bharath Ambale-Venkatesh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Chia-Ying Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Filip Zemrak
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Karol E. Watson
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - Matthew Budoff
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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50
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Kawel-Boehm N, McClelland RL, Zemrak F, Captur G, Hundley WG, Liu CY, Moon JC, Petersen SE, Ambale-Venkatesh B, Lima JAC, Bluemke DA. Hypertrabeculated Left Ventricular Myocardium in Relationship to Myocardial Function and Fibrosis: The Multi-Ethnic Study of Atherosclerosis. Radiology 2017; 284:667-675. [PMID: 28418811 DOI: 10.1148/radiol.2017161995] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if excess greater left ventricle (LV) trabeculation is associated with decreased average regional myocardial function, diffuse fibrosis, or both. Materials and Methods This was a HIPAA-compliant institutional board approved multicenter study, and all participants provided written informed consent. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a comprehensive cardiac magnetic resonance (MR) examination. LV trabeculation was measured with the maximal apical fractal dimension (FD), which is a marker of endocardial complexity. Demographic covariates, cardiovascular risk factors, and cardiac MR measurements were compared across quartiles of FD. Associations between FD and peak regional systolic circumferential strain (Ecc) and T1 time, a surrogate for diffuse myocardial fibrosis, were assessed with multivariable linear regression models. Results A total of 1123 subjects (593 [52.8%] female; mean age, 67.1 years ± 8.7 [standard deviation]) underwent FD and Ecc measurement, and 992 (521 [52.5%] female; mean age, 67.1 years ± 8.7) underwent FD and T1 measurement. Mean FD was 1.2 ± 0.07 in both groups, and mean Ecc was -18.3 ± 2.27 in the subjects who underwent FD and Ecc measurement. Global volumes and ejection fraction showed no differences between FD quartiles. However, with increasing FD quartile, Ecc was greater (indicating worse average regional function) (P < .001). After adjustment, greater trabeculation was associated with 21% worse myocardial strain (relative to the mean) per unit change in FD (regression coefficient = 4.0%; P < .001). There was no association between the degree of trabeculation and diffuse fibrosis measured with T1 mapping. Conclusion Average regional LV function was worse in individuals with greater LV trabeculation, supporting the concept of hypertrabeculation being an epiphenomenon of disease. © RSNA, 2017.
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Affiliation(s)
- Nadine Kawel-Boehm
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Robyn L McClelland
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Filip Zemrak
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Gabriella Captur
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - W Gregory Hundley
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Chia-Ying Liu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - James C Moon
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Steffen E Petersen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Bharath Ambale-Venkatesh
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - João A C Lima
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - David A Bluemke
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md
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