1
|
Li XM, Shi R, Shen MT, Yan WF, Jiang L, Min CY, Liu XJ, Guo YK, Yang ZG. Impact of Type 2 Diabetes Mellitus on Left Atrioventricular Coupling and Left Atrial Deformation in Patients with Essential Hypertension: An MRI Feature Tracking Study. J Magn Reson Imaging 2024. [PMID: 38703135 DOI: 10.1002/jmri.29427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are both associated with left ventricular (LV) and left atrial (LA) structural and functional abnormalities; however, the relationship between the left atrium and ventricle in this population is unclear. PURPOSE To identify differences between hypertensive patients with and without T2DM as the basis for further investigation the atrioventricular coupling relationship. STUDY TYPE Cross-sectional, retrospective study. POPULATION 89 hypertensive patients without T2DM [HTN (T2DM-)] (age: 58.4 +/- 11.9 years, 48 male), 62 hypertensive patients with T2DM [HTN (T2DM+)] (age: 58.5 +/- 9.1 years, 32 male) and 70 matched controls (age: 55.0 +/- 9.6 years, 37 male). FIELD STRENGTH/SEQUENCE 2D balanced steady-state free precession cine sequence at 3.0 T. ASSESSMENT LA reservoir, conduit, and booster strain (εs, εe, and εa) and strain rate (SRs, SRe, and SRa), LV radial, circumferential and longitudinal peak strain (PS) and peak systolic strain rate and peak diastolic strain rate (PSSR and PDSR) were derived from LA and LV cine images and compared between groups. STATISTICAL TESTS Chi-square or Fisher's exact test, one-way analysis of variance, analysis of covariance, Pearson's correlation, multivariable linear regression analysis, and intraclass correlation coefficient. A P value <0.05 was considered significant. RESULTS Compared with controls, εs, εe, SRe and PS-longitudinal, PDSR-radial, and PDSR-longitudinal were significantly lower in HTN (T2DM-) group, and they were even lower in HTN (T2DM+) group than in both controls and HTN (T2DM-) group. SRs, εa, SRa, as well as PS-radial, PS-circumferential, PSSR-radial, and PSSR-circumferential were significantly lower in HTN (T2DM+) compared with controls. Multivariable regression analyses demonstrated that: T2DM and PS-circumferential and PS-longitudinal (β = -4.026, -0.486, and -0.670, respectively) were significantly associated with εs; T2DM and PDSR-radial and PDSR-circumferential were significantly associated with εe (β = -3.406, -3.352, and -6.290, respectively); T2DM and PDSR-radial were significantly associated with SRe (β = 0.371 and 0.270, respectively); T2DM and PDSR-longitudinal were significantly associated with εa (β = -1.831 and 5.215, respectively); and PDSR-longitudinal was significantly associated with SRa (β = 1.07). DATA CONCLUSION In hypertensive patients, there was severer LA dysfunction in those with coexisting T2DM, which may be associated with more severe LV dysfunction and suggests adverse atrioventricular coupling. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 3.
Collapse
Affiliation(s)
- Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Jing Liu
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Genovese D, De Michieli L, Prete G, De Lazzari M, Previtero M, Mele D, Cernetti C, Tarantini G, Iliceto S, Perazzolo Marra M. Left atrial expansion index measured with cardiovascular magnetic resonance estimates pulmonary capillary wedge pressure in dilated cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:71. [PMID: 38031092 PMCID: PMC10688459 DOI: 10.1186/s12968-023-00977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) assessment is fundamental for managing dilated cardiomyopathy (DCM) patients. Although cardiovascular magnetic resonance (CMR) has become the gold-standard imaging technique for evaluating cardiac chamber volume and function, PCWP is not routinely assessed with CMR. Therefore, this study aimed to validate the left atrial expansion index (LAEI), a LA reservoir function parameter able to estimate filling pressure with echocardiography, as a novel CMR-measured parameter for non-invasive PCWP estimation in DCM patients. METHODS We performed a retrospective, single-center, cross-sectional study. We included electively admitted DCM patients referred to our tertiary center for further diagnostic evaluation that underwent a clinically indicated right heart catheterization (RHC) and CMR within 24 h. PCWP invasively measured during RHC was used as the reference. LAEI was calculated from CMR-measured LA maximal and minimal volumes as LAEI = ( (LAVmax-LAVmin)/LAVmin) × 100. RESULTS We enrolled 126 patients (47 ± 14 years; 68% male; PCWP = 17 ± 9.3 mmHg) randomly divided into derivation (n = 92) and validation (n = 34) cohorts with comparable characteristics. In the derivation cohort, the log-transformed (ln) LAEI showed a strong linear correlation with PCWP (r = 0.81, p < 0.001) and remained a strong independent PCWP determinant over clinical and conventional CMR parameters. Moreover, lnLAEI accurately identified PCWP ≥ 15 mmHg (AUC = 0.939, p < 0.001), and the optimal cut-off identified (lnLAEI ≤ 3.85) in the derivation cohort discriminated PCWP ≥ 15 mmHg with 82.4% sensitivity, 88.2% specificity, and 85.3% accuracy in the validation cohort. Finally, the equation PCWP = 52.33- (9.17xlnLAEI) obtained from the derivation cohort predicted PCWP (-0.1 ± 5.7 mmHg) in the validation cohort. CONCLUSIONS In this cohort of DCM patients, CMR-measured LAEI resulted in a novel and useful parameter for non-invasive PCWP evaluation.
Collapse
Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.
| | - Laura De Michieli
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giacomo Prete
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Donato Mele
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Schulz A, Lange T, Evertz R, Kowallick JT, Hasenfuß G, Backhaus SJ, Schuster A. Sex-Specific Impairment of Cardiac Functional Reserve in HFpEF: Insights From the HFpEF Stress Trial. JACC. ADVANCES 2023; 2:100327. [PMID: 38938247 PMCID: PMC11198589 DOI: 10.1016/j.jacadv.2023.100327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 06/29/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men with similar predisposing risk factors between both sexes. Objectives This study aimed to identify sex-specific pathophysiological features in HFpEF using rest and exercise stress right heart catheterization (RHC), echocardiography and cardiovascular magnetic resonance imaging (CMR). Methods Seventy-five patients with exertional dyspnea, preserved ejection fraction (EF) (≥50%), and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF Stress Trial. Patients underwent RHC, echocardiography and CMR at rest and during exercise stress. Patients were diagnosed with HFpEF and noncardiac dyspnea according to RHC measurements. Results After exclusion, the final study cohort comprised 68 patients (females n = 44, males n = 24) with a mean age of 66.9 ± 9.7 years. Compared to men, women with HFpEF revealed lower right ventricular stroke volumes during exercise stress (females 38.1 vs males 50.4 mL/m2 BSA; P = 0.011). This was accompanied by a decreasing left atrial EF in women but not men comparing resting to exercise conditions (females -2.7% vs males 2.5%, P = 0.020) and impaired left ventricular filling (females 35.5 vs males 44.2 mL/m2 BSA, P = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in noncardiac dyspnea. Conclusions Women with HFpEF demonstrate sex-specific functional alterations of right ventricular, left atrial, and left ventricular function during exercise stress. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
Collapse
Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| |
Collapse
|
4
|
First-Phase Left Ventricular Ejection Fraction as an Early Sign of Left Ventricular Dysfunction in Patients with Stable Coronary Artery Disease. J Clin Med 2023; 12:jcm12030868. [PMID: 36769516 PMCID: PMC9918081 DOI: 10.3390/jcm12030868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Left ventricular (LV) systolic function is often measured with echocardiography using LV ejection fraction (LVEF) or global longitudinal peak systolic strain (GLPSS). Global wasted work (GWW), global work efficiency (GWE), and first-phase ejection fraction (LVEF-1) are newer LV systolic function indices. We examined these parameters in 45 healthy individuals and 50 patients with stable coronary artery disease (CAD), normal LV contractility, and LVEF > 50%. Compared to healthy individuals, CAD patients had similar LVEF but increased GLPSS and GWW and reduced GWE and LVEF-1. The highest area under the receiver operating characteristic for detecting CAD was found for LVEF-1 (0.84; 95% CI 0.75-0.91; p < 0.0001), and it was significantly larger than for GLPSS (+0.166, p = 0.0082) and LVEF (+0.283, p = 00001). For LVEF-1 < 30%, the odds ratio for the presence of CAD was 22.67 (95% CI 6.47-79.44, p < 0.0001) in the logistic regression adjusted for age, sex, and body mass index. Finding LVEF-1 < 30% in an individual with normal LV myocardial contraction and preserved LVEF strongly suggests the presence of CAD.
Collapse
|
5
|
Pietschner R, Bosch A, Kannenkeril D, Striepe K, Schiffer M, Achenbach S, Schmieder RE, Kolwelter J. Is vascular remodelling in patients with chronic heart failure exaggerated? ESC Heart Fail 2022; 10:245-254. [PMID: 36193013 PMCID: PMC9871653 DOI: 10.1002/ehf2.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Vascular remodelling of large arteries increases afterload of the left ventricle. The aim of this study was to analyse whether vascular remodelling and function under laboratory and 24-hour ambulatory conditions is impaired in patients with chronic heart failure (CHF) independently of cardiovascular risk factors. METHODS AND RESULTS In this monocentric cross-sectional observational study, 105 patients with CHF and an ejection fraction ≤49% (CHF+) were compared to 118 subjects without CHF (CHF-). After adjustment for age, gender, arterial hypertension, hyperlipidaemia, type 2 diabetes, obesity and smoking, vascular function and structure parameters, as assessed by pulse wave analysis (SphygmoCor) and the UNEX EF device, respectively, between the CHF+ and the CHF- group differed for resting pulse wave velocity (PWV) (P = 0.010), 24-h ambulatory PWV (P = 0.011), central systolic blood pressure (cSBP) (P = <0.001), 24-h ambulatory cSBP (P = <0.001), resting central augmentation index (P = 0.002), and brachial intima-media thickness (P = 0.022). In CHF+ patients, higher levels of NT-proBNP, taken as a marker for the severity of CHF, were related to a higher PWV (r = 0.340, P = <0.001), a higher cSBP (r = 0.292, P = 0.005), and a trend to higher central pulse pressure (cPP) (r = 0.198, P = 0.058), higher 24-h brachial PP (r = 0.322, P = 0.002), and 24-h total peripheral resistance (s = 0.227, P = 0.041) after full adjustment for covariates. CONCLUSIONS In CHF+ patients we observed augmented vascular remodelling and functional impairment compared with CHF- patients independently of cardiovascular risk factors, age, and gender, and the extent of vascular remodelling and impairment was related to the severity of CHF.
Collapse
Affiliation(s)
- Robert Pietschner
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Agnes Bosch
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Dennis Kannenkeril
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Kristina Striepe
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Mario Schiffer
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Stephan Achenbach
- Department of CardiologyUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Roland E. Schmieder
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Julie Kolwelter
- Clinical Research Centre, Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany,Department of CardiologyUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| |
Collapse
|
6
|
Popevska S, Rademakers F. Prolonged Asynchronous Left Ventricular Isovolumic Relaxation Constant in Ascending Compared to Descending Thoracic Aortic Stenosis for Chronic Early Left Ventricular Afterload and Late Left Ventricular Afterload Increase. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:89-99. [PMID: 35843925 DOI: 10.2478/prilozi-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: In arterial hypertension, left ventricular relaxation is affected early on in relation to a chronic difference in peak left ventricular afterload with early development of HF. Objective: in ascending compares to descending thoracic aortic stenosis, resulting in chronic late and early LV afterload increase, to assess the left ventricular isovolumic relaxation pressure decay constant through regression analysis, a parameter of left ventricular relaxation on the 4th and 8th week period from invasive left ventricular pressure measurements. Methods: fourteen pigs underwent posterolateral thoracotomy for ascending aortic stenosis, resulting in chronic early left ventricular afterload increase (EL = 6], or descending thoracic aortic stenosis creating chronic late systolic left ventricular load (LL = 8]. Exponential regression with nonzero asymptote for τ assessment, with linear and nonlinear regression were performed on isovolumic relaxation pressure decay from the left ventricular invasive pressure measurements on 4th and 8th week. Two-way repeated measurement ANOVA, post-hoc Tukey test and linear regression were performed for statistical analysis. Results presented are mean ± SEM or median (quartiles], with significance is at p < 0.05. Results: The ascending aortic stenosis associated with prolonged biexponential asynchronous τ, compared to the descending thoracic aorta stenosis, resulted in data that were different at the 8th week in presence of respirations (interaction p < 0.05]. Monoexponential and linear τ were not different in either respiration being preserved or suspended transitionally and in preload reduction. Preload sensitive response of τ was found in ascending compared to descending thoracic aortic banding that reduced in EL and in LL it increased with load reduction (p < 0.05]. These results indicated that τ is not different in and between LV afterloading conditions in a chronic setting, although it indicates that myocardial ischemia is present and that it is greater in ascending aortic banding, compared to descending thoracic aorta banding at the 8th week. Conclusion: In different sequence of the left ventricular afterload, ventricular relaxation is affected early on, having in EL compared to LL prolonged biexponential asynchronous left ventricular relaxation constant, thus indicating the development left ventricular myocardial ischemia and different elastic recoil in an invasive left ventricular hemodynamic assessment.
Collapse
Affiliation(s)
- Sofija Popevska
- Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universitet Leuven, Medical Faculty Leuven, Belgium
| | - Frank Rademakers
- Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universitet Leuven, Medical Faculty Leuven, Belgium
| |
Collapse
|
7
|
Zhou G, Chen J, Wu C, Jiang P, Wang Y, Zhang Y, Jiang Y, Li X. Deciphering the Protein, Modular Connections and Precision Medicine for Heart Failure With Preserved Ejection Fraction and Hypertension Based on TMT Quantitative Proteomics and Molecular Docking. Front Physiol 2021; 12:607089. [PMID: 34721049 PMCID: PMC8552070 DOI: 10.3389/fphys.2021.607089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Exploring the potential biological relationships between heart failure with preserved ejection fraction (HFpEF) and concomitant diseases has been the focus of many studies for the establishment of personalized therapies. Hypertension (HTN) is the most common concomitant disease in HFpEF patients, but the functional connections between HFpEF and HTN are still not fully understood and effective treatment strategies are still lacking. Methods: In this study, tandem mass tag (TMT) quantitative proteomics was used to identify disease-related proteins and construct disease-related networks. Furthermore, functional enrichment analysis of overlapping network modules was used to determine the functional similarities between HFpEF and HTN. Molecular docking and module analyses were combined to identify therapeutic targets for HFpEF and HTN. Results: Seven common differentially expressed proteins (co-DEPs) and eight overlapping modules were identified in HFpEF and HTN. The common biological processes between HFpEF and HTN were mainly related to energy metabolism. Myocardial contraction, energy metabolism, apoptosis, oxidative stress, immune response, and cardiac hypertrophy were all closely associated with HFpEF and HTN. Epinephrine, sulfadimethoxine, chloroform, and prednisolone acetate were best matched with the co-DEPs by molecular docking analyses. Conclusion: Myocardial contraction, energy metabolism, apoptosis, oxidative stress, immune response, and cardiac hypertrophy were the main functional connections between HFpEF and HTN. Epinephrine, sulfadimethoxine, chloroform, and prednisolone acetate could potentially be effective for the treatment of HTN and HFpEF.
Collapse
Affiliation(s)
- Guofeng Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiye Chen
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chuanhong Wu
- The Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Ping Jiang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongjian Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuehua Jiang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
8
|
Kim H, Kim IC, Hwang J, Lee CH, Cho YK, Park HS, Chung JW, Nam CW, Han S, Hur SH. Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease. J Hum Hypertens 2021; 35:994-1002. [PMID: 33408327 DOI: 10.1038/s41371-020-00472-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP-CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ -8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.
Collapse
Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Keimyung University Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| |
Collapse
|
9
|
Bojer AS, Soerensen MH, Gaede P, Myerson S, Madsen PL. Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function. Diagnostics (Basel) 2021; 11:diagnostics11071282. [PMID: 34359363 PMCID: PMC8305340 DOI: 10.3390/diagnostics11071282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.
Collapse
Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
- Correspondence:
| | - Martin Heyn Soerensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
| | - Saul Myerson
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX1 2JD, UK;
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, 2730 Herlev, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| |
Collapse
|
10
|
Conductance artery stiffness impairs atrio-ventriculo-arterial coupling before manifestation of arterial hypertension or left ventricular hypertrophic remodelling. Sci Rep 2021; 11:14467. [PMID: 34262077 PMCID: PMC8280135 DOI: 10.1038/s41598-021-93614-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/09/2021] [Indexed: 12/02/2022] Open
Abstract
As part of normal ageing, conductance arteries lose their cushion function, left ventricle (LV) filling and also left atrial emptying are impaired. The relation between conductance artery stiffness and LV diastolic function is normally explained by arterial hypertension and LV hypertrophy as needed intermediaries. We examined whether age-related aortic stiffening may influence LV diastolic function in normal healthy subjects. Aortic distensibility and pulse wave velocity (PWV) were related to LV emptying and filling parameters and left atrial emptying parameters as determined by magnetic resonance imaging in 36 healthy young (< 35 years) and 16 healthy middle-aged and elderly (> 35 years) with normal arterial blood pressure and myocardial mass. In the overall cohort, total aorta PWV correlated to a decrease in LV peak-emptying volume (r = 0.43), LV peak-filling (r = 0.47), passive atrial emptying volume (r = 0.66), and an increase in active atrial emptying volume (r = 0.47) (all p < 0.001). PWV was correlated to passive atrial emptying volume even if only the > 35-year-old were considered (r = 0.53; p < 0.001). Total peripheral resistance demonstrated similar correlations as PWV, but in a regression analysis only the total aorta PWV was related to left atrial (LA) passive emptying volume. Via impaired ventriculo-arterial coupling, the increased aortic PWV seen with normal ageing hence affects atrio-ventricular coupling, before increased aortic PWV is associated with significantly increased arterial blood pressure or LV hypertrophic remodelling. Our findings reinforce the existence of atrio-ventriculo-arterial coupling and suggest aortic distensibility should be considered an early therapeutic target to avoid diastolic dysfunction of the LV.
Collapse
|
11
|
Xu L, Keenan BT, Maislin D, Gislason T, Benediktsdóttir B, Gudmundsdóttir S, Gardarsdottir M, Staley B, Pack FM, Guo X, Feng Y, Chahwala J, Manaktala P, Hussein A, Reddy-Koppula M, Hashmath Z, Lee J, Townsend RR, Schwab RJ, Pack AI, Kuna ST, Chirinos JA. Effect of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Cardiac Remodeling as Assessed by Cardiac Biomarker and Magnetic Resonance Imaging in Nonobese and Obese Adults. Hypertension 2021; 77:980-992. [PMID: 33461313 DOI: 10.1161/hypertensionaha.120.15882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m2) and obese (n=136; body mass index ≥30 kg/m2) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP (P<0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index (P=0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01578031.
Collapse
Affiliation(s)
- Liyue Xu
- From the Sleep Center, Peking University People's Hospital, Beijing, China (L.X.).,Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - David Maislin
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Thorarinn Gislason
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Bryndís Benediktsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Sigrun Gudmundsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik
| | | | - Bethany Staley
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Frances M Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Xiaofeng Guo
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.F.)
| | - Jugal Chahwala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Pritika Manaktala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Anila Hussein
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Maheshwara Reddy-Koppula
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Zeba Hashmath
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Jonathan Lee
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia.,Sleep Medicine Section, Crescenz Veterans Affairs Medical Center, Philadelphia (S.T.K.)
| | - Julio A Chirinos
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| |
Collapse
|
12
|
Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1237-1263. [PMID: 31466622 DOI: 10.1016/j.jacc.2019.07.012] [Citation(s) in RCA: 464] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022]
Abstract
A healthy aorta exerts a powerful cushioning function, which limits arterial pulsatility and protects the microvasculature from potentially harmful fluctuations in pressure and blood flow. Large-artery (aortic) stiffening, which occurs with aging and various pathologic states, impairs this cushioning function, and has important consequences on cardiovascular health, including isolated systolic hypertension, excessive penetration of pulsatile energy into the microvasculature of target organs that operate at low vascular resistance, and abnormal ventricular-arterial interactions that promote left ventricular remodeling, dysfunction, and failure. Large-artery stiffness independently predicts cardiovascular risk and represents a high-priority therapeutic target to ameliorate the global burden of cardiovascular disease. This paper provides an overview of key physiologic and biophysical principles related to arterial stiffness, the impact of aortic stiffening on target organs, noninvasive methods for the measurement of arterial stiffness, mechanisms leading to aortic stiffening, therapeutic approaches to reduce it, and clinical applications of arterial stiffness measurements.
Collapse
|
13
|
Ta HT, Alsaied T, Steele JM, Truong VT, Mazur W, Nagueh SF, Kutty S, Tretter JT. Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease. Pediatr Cardiol 2020; 41:654-668. [PMID: 32342149 DOI: 10.1007/s00246-020-02351-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
Diastolic dysfunction has correlated with adverse outcomes in various forms of unrepaired and repaired or palliated congenital heart disease (CHD). The non-invasive assessment of diastolic function in pediatric and adult patients with CHD remains challenging. Atrial size has a pivotal role in the evaluation of diastolic function; however, a growing body of evidence supports the additional role of atrial function as a more sensitive parameter of ventricular diastolic dysfunction. While the importance of atrial function is becoming clearer in adult acquired heart disease, it remains ambiguous in those with CHD. In this review we set the stage with the current understanding of diastolic function assessment in CHD, followed by insight into atrial form and function including its non-invasive assessment, and conclude with the current knowledge of atrial function in CHD. A general pattern of decrease in reservoir and conduit function with compensatory increase followed by decompensatory decrease in contractile function seems to be the common pathway of atrial dysfunction in most forms of CHD.
Collapse
Affiliation(s)
- Hieu T Ta
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeremy M Steele
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Vien T Truong
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Wojciech Mazur
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
14
|
Chirinos JA, Bhattacharya P, Kumar A, Proto E, Konda P, Segers P, Akers SR, Townsend RR, Zamani P. Impact of Diabetes Mellitus on Ventricular Structure, Arterial Stiffness, and Pulsatile Hemodynamics in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2020; 8:e011457. [PMID: 30764699 PMCID: PMC6405670 DOI: 10.1161/jaha.118.011457] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Heterogeneity in the underlying processes that contribute to heart failure with preserved ejection fraction ( HF p EF ) is increasingly recognized. Diabetes mellitus is a frequent comorbidity in HF p EF , but its impact on left ventricular and arterial structure and function in HF p EF is unknown. Methods and Results We assessed the impact of diabetes mellitus on left ventricular cellular and interstitial hypertrophy (assessed with cardiac magnetic resonance imaging, including T1 mapping pregadolinium and postgadolinium administration), arterial stiffness (assessed with arterial tonometry), and pulsatile arterial hemodynamics (assessed with in-office pressure-flow analyses and 24-hour ambulatory monitoring) among 53 subjects with HF p EF (32 diabetic and 21 nondiabetic subjects). Despite few differences in clinical characteristics, diabetic subjects with HFpEF exhibited a markedly greater left ventricular mass index (78.1 [95% CI , 70.4-85.9] g versus 63.6 [95% CI , 55.8-71.3] g; P=0.0093) and indexed extracellular volume (23.6 [95% CI , 21.2-26.1] mL/m2 versus 16.2 [95% CI , 13.1-19.4] mL/m2; P=0.0008). Pronounced aortic stiffening was also observed in the diabetic group (carotid-femoral pulse wave velocity, 11.86 [95% CI , 10.4-13.1] m/s versus 8.8 [95% CI , 7.5-10.1] m/s; P=0.0027), with an adverse pulsatile hemodynamic profile characterized by increased oscillatory power (315 [95% CI , 258-373] mW versus 190 [95% CI , 144-236] mW; P=0.0007), aortic characteristic impedance (0.154 [95% CI , 0.124-0.183] mm Hg/mL per second versus 0.096 [95% CI , 0.072-0.121] mm Hg/mL per second; P=0.0024), and forward (59.5 [95% CI , 52.8-66.1] mm Hg versus 40.1 [95% CI , 31.6-48.6] mm Hg; P=0.0010) and backward (19.6 [95% CI , 16.2-22.9] mm Hg versus 14.1 [95% CI , 10.9-17.3] mm Hg; P=0.0169) wave amplitude. Abnormal pulsatile hemodynamics were also evident in 24-hour ambulatory monitoring, despite the absence of significant differences in 24-hour systolic blood pressure between the groups. Conclusions Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular-arterial interactions in HF p EF . Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 01516346.
Collapse
Affiliation(s)
- Julio A Chirinos
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA.,2 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA.,3 Department of Radiology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA
| | - Priyanka Bhattacharya
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA
| | - Anupam Kumar
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA.,2 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Elizabeth Proto
- 2 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Prasad Konda
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA
| | - Patrick Segers
- 4 Biofluid, Tissue and Solid Mechanics for Medical Applications Ghent University Ghent Belgium
| | - Scott R Akers
- 3 Department of Radiology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA
| | - Raymond R Townsend
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA.,2 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Payman Zamani
- 1 Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia PA.,2 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| |
Collapse
|
15
|
Cohen JB, Schrauben SJ, Zhao L, Basso MD, Cvijic ME, Li Z, Yarde M, Wang Z, Bhattacharya PT, Chirinos DA, Prenner S, Zamani P, Seiffert DA, Car BD, Gordon DA, Margulies K, Cappola T, Chirinos JA. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC. HEART FAILURE 2020; 8:172-184. [PMID: 31926856 PMCID: PMC7058514 DOI: 10.1016/j.jchf.2019.09.009] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to assess if clinical phenogroups differ in comprehensive biomarker profiles, cardiac and arterial structure/function, and responses to spironolactone therapy. BACKGROUND Previous studies identified distinct subgroups (phenogroups) of patients with heart failure with preserved ejection fraction (HFpEF). METHODS Among TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial) participants, we performed latent-class analysis to identify HFpEF phenogroups based on standard clinical features and assessed differences in multiple biomarkers measured from frozen plasma; cardiac and arterial structure/function measured with echocardiography and arterial tonometry; prognosis; and response to spironolactone. RESULTS Three HFpEF phenogroups were identified. Phenogroup 1 (n = 1,214) exhibited younger age, higher prevalence of smoking, preserved functional class, and the least evidence of left ventricular (LV) hypertrophy and arterial stiffness. Phenogroup 2 (n = 1,329) was older, with normotrophic concentric LV remodeling, atrial fibrillation, left atrial enlargement, large-artery stiffening, and biomarkers of innate immunity and vascular calcification. Phenogroup 3 (n = 899) demonstrated more functional impairment, obesity, diabetes, chronic kidney disease, concentric LV hypertrophy, high renin, and biomarkers of tumor necrosis factor-alpha-mediated inflammation, liver fibrosis, and tissue remodeling. Compared with phenogroup 1, phenogroup 3 exhibited the highest risk of the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest (hazard ratio [HR]: 3.44; 95% confidence interval [CI]: 2.79 to 4.24); phenogroups 2 and 3 demonstrated similar all-cause mortality (phenotype 2 HR: 2.36; 95% CI: 1.89 to 2.95; phenotype 3 HR: 2.26, 95% CI: 1.77 to 2.87). Spironolactone randomized therapy was associated with a more pronounced reduction in the risk of the primary endpoint in phenogroup 3 (HR: 0.75; 95% CI: 0.59 to 0.95; p for interaction = 0.016). Results were similar after excluding participants from Eastern Europe. CONCLUSIONS We identified important differences in circulating biomarkers, cardiac/arterial characteristics, prognosis, and response to spironolactone across clinical HFpEF phenogroups. These findings suggest distinct underlying mechanisms across clinically identifiable phenogroups of HFpEF that may benefit from different targeted interventions.
Collapse
Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah J Schrauben
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lei Zhao
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | | | | | - Zhuyin Li
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | - Melissa Yarde
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | - Zhaoqing Wang
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | - Priyanka T Bhattacharya
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hospital Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana A Chirinos
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stuart Prenner
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Payman Zamani
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bruce D Car
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | | | - Kenneth Margulies
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Cappola
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
16
|
Chirinos JA, Akers SR, Schelbert E, Snyder BS, Witschey WR, Jacob RM, Jamis-Dow C, Ansari B, Lee J, Segers P, Schnall M, Cavalcante JL. Arterial Properties as Determinants of Left Ventricular Mass and Fibrosis in Severe Aortic Stenosis: Findings From ACRIN PA 4008. J Am Heart Assoc 2020; 8:e03742. [PMID: 30590991 PMCID: PMC6405727 DOI: 10.1161/jaha.118.010271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The role of arterial load in severe aortic stenosis is increasingly recognized. However, patterns of pulsatile load and their implications in this population are unknown. We aimed to assess the relationship between the arterial properties and both (1) left ventricular remodeling and fibrosis and (2) the clinical course of patients with severe aortic stenosis undergoing aortic valve replacement (AVR). Methods and Results We enrolled 38 participants with symptomatic severe aortic stenosis scheduled to undergo surgical AVR. Aortic root characteristic impedance, wave reflections parameters (reflection magnitude, reflected wave transit time), and myocardial extracellular mass were measured with cardiac magnetic resonance imaging and arterial tonometry Cardiac magnetic resonance imaging was repeated at 6 months in 30 participants. A reduction in cellular mass (133.6 versus 113.9 g; P=0.002) but not extracellular mass (42.3 versus 40.6 g; P=0.67) was seen after AVR. Participants with higher extracellular mass exhibited greater reflection magnitude (0.68 versus 0.54; P=0.006) and lower aortic root characteristic impedance (56.3 versus 96.9 dynes/s per cm5; P=0.006). Reflection magnitude was a significant predictor of smaller improvement in the quality of life (Kansas City Cardiomyopathy Questionnaire score) after AVR (R=−0.51; P=0.0026). The 6‐minute walk distance at 6 months after AVR was positively correlated with the reflected wave transit time (R=0.52; P=0.01). Conclusions Consistent with animal studies, arterial wave reflections are associated with interstitial volume expansion in severe aortic stenosis and predict a smaller improvement in quality of life following AVR. Future trials should assess whether wave reflections represent a potential therapeutic target to mitigate myocardial interstitial remodeling and to improve the clinical status of this patient population.
Collapse
Affiliation(s)
- Julio A Chirinos
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Scott R Akers
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA.,7 Department of Radiology Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Erik Schelbert
- 2 Department of Cardiovascular Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Bradley S Snyder
- 5 Center for Statistical Sciences Brown University School of Public Health Providence RI
| | - Walter R Witschey
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Ron M Jacob
- 3 Department of Cardiovascular Medicine Lancaster General Health, Penn Medicine Lancaster PA
| | - Carlos Jamis-Dow
- 4 Department of Cardiovascular Medicine Penn State Milton S. Hershey Medical Center Hershey PA
| | - Bilal Ansari
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Jonathan Lee
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Patrick Segers
- 6 Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech Ghent University Ghent Belgium
| | - Mitchell Schnall
- 1 Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - João L Cavalcante
- 2 Department of Cardiovascular Medicine University of Pittsburgh Medical Center Pittsburgh PA
| |
Collapse
|
17
|
Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, Hoshide S, Kabutoya T, Tomiyama H, Node K, Ohishi M, Ito S, Kishi T, Rakugi H, Li Y, Chen CH, Park JB, Wang JG. Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia. Prog Cardiovasc Dis 2020; 63:22-32. [DOI: 10.1016/j.pcad.2019.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
|
18
|
Weber T, Chirinos JA. Pulsatile arterial haemodynamics in heart failure. Eur Heart J 2019; 39:3847-3854. [PMID: 29947746 DOI: 10.1093/eurheartj/ehy346] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022] Open
Abstract
Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.
Collapse
Affiliation(s)
- Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen, Austria
| | - Julio A Chirinos
- University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
19
|
Chirinos JA, Sardana M, Ansari B, Satija V, Kuriakose D, Edelstein I, Oldland G, Miller R, Gaddam S, Lee J, Suri A, Akers SR. Left Atrial Phasic Function by Cardiac Magnetic Resonance Feature Tracking Is a Strong Predictor of Incident Cardiovascular Events. Circ Cardiovasc Imaging 2019; 11:e007512. [PMID: 30562112 DOI: 10.1161/circimaging.117.007512] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prognostic importance of left atrial (LA) dysfunction is increasingly recognized. Magnetic resonance imaging can provide excellent visualization of the LA wall. We aimed to study the association of LA dysfunction measured using feature-tracking magnetic resonance imaging with incident adverse cardiovascular events among subjects with or without heart failure (HF) at baseline. METHODS AND RESULTS We prospectively studied 640 adults without HF (n=419), HF with preserved ejection fraction (n=101), or HF with reduced ejection fraction (n=120). We measured phasic LA function by volumetric and feature-tracking methods to derive longitudinal strain. The composite outcome of incident HF hospitalization or death was adjudicated during a median follow-up of 37.1 months. Measures of LA phasic function were more prominently impaired in subjects with HF with reduced ejection fraction than among subjects with HF with preserved ejection fraction. In unadjusted Cox proportional hazards models, all measures of phasic LA function and volumes (maximum, minimum, and diastatic) were associated with the composite outcome. However, in analyses that adjusted for clinical risk factors, HF status, maximum LA volume, left ventricular mass, and left ventricular ejection fraction, measures of conduit and reservoir LA function, but not booster-pump function, were associated with the composite outcome. The strongest associations were observed for conduit longitudinal strain (standardized hazard ratio, 0.66; 95% CI, 0.49-0.88; P=0.004), conduit strain rate (standardized hazard ratio, 1.59; 95% CI, 1.16-2.16; P=0.0035), and reservoir strain (standardized hazard ratio, 0.68; 95% CI, 0.52-0.89; P=0.0055). CONCLUSIONS Phasic LA function measured using magnetic resonance imaging feature tracking is independently predictive of the risk of incident HF admission or death, even after adjusting for LA volume and left ventricular remodeling.
Collapse
Affiliation(s)
- Julio A Chirinos
- Department of Radiology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia (J.A.C., G.O., R.M., S.G., S.R.A.).,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.).,Hospital of the University of Pennsylvania, Philadelphia (J.A.C., G.O., R.M., S.G.)
| | - Mayank Sardana
- Department of Medicine, University of Massachusetts Medical School, Worcester (M.S.)
| | - Bilal Ansari
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Vaibhav Satija
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Daniel Kuriakose
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Ilaina Edelstein
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Garrett Oldland
- Department of Radiology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia (J.A.C., G.O., R.M., S.G., S.R.A.).,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.).,Hospital of the University of Pennsylvania, Philadelphia (J.A.C., G.O., R.M., S.G.)
| | - Rachana Miller
- Department of Radiology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia (J.A.C., G.O., R.M., S.G., S.R.A.).,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.).,Hospital of the University of Pennsylvania, Philadelphia (J.A.C., G.O., R.M., S.G.)
| | - Swetha Gaddam
- Department of Radiology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia (J.A.C., G.O., R.M., S.G., S.R.A.).,Hospital of the University of Pennsylvania, Philadelphia (J.A.C., G.O., R.M., S.G.)
| | - Jonathan Lee
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Arpita Suri
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.A.C., B.A., V.S., D.K., I.E., G.O., R.M., J.L., A.S.)
| | - Scott R Akers
- Department of Radiology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia (J.A.C., G.O., R.M., S.G., S.R.A.)
| |
Collapse
|
20
|
Ikonomidis I, Aboyans V, Blacher J, Brodmann M, Brutsaert DL, Chirinos JA, De Carlo M, Delgado V, Lancellotti P, Lekakis J, Mohty D, Nihoyannopoulos P, Parissis J, Rizzoni D, Ruschitzka F, Seferovic P, Stabile E, Tousoulis D, Vinereanu D, Vlachopoulos C, Vlastos D, Xaplanteris P, Zimlichman R, Metra M. The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association. Eur J Heart Fail 2019; 21:402-424. [PMID: 30859669 DOI: 10.1002/ejhf.1436] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Ventricular-arterial coupling (VAC) plays a major role in the physiology of cardiac and aortic mechanics, as well as in the pathophysiology of cardiac disease. VAC assessment possesses independent diagnostic and prognostic value and may be used to refine riskstratification and monitor therapeutic interventions. Traditionally, VAC is assessed by the non-invasive measurement of the ratio of arterial (Ea) to ventricular end-systolic elastance (Ees). With disease progression, both Ea and Ees may become abnormal and the Ea/Ees ratio may approximate its normal values. Therefore, the measurement of each component of this ratio or of novel more sensitive markers of myocardial (e.g. global longitudinal strain) and arterial function (e.g. pulse wave velocity) may better characterize VAC. In valvular heart disease, systemic arterial compliance and valvulo-arterial impedance have an established diagnostic and prognostic value and may monitor the effects of valve replacement on vascular and cardiac function. Treatment guided to improve VAC through improvement of both or each one of its components may delay incidence of heart failure and possibly improve prognosis in heart failure. In this consensus document, we describe the pathophysiology, the methods of assessment as well as the clinical implications of VAC in cardiac diseases and heart failure. Finally, we focus on interventions that may improve VAC and thus modify prognosis.
Collapse
Affiliation(s)
- Ignatios Ikonomidis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Jacque Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Dirk L Brutsaert
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Julio A Chirinos
- Perelman School of Medicine and Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SantTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - John Lekakis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Petros Nihoyannopoulos
- NHLI - National Heart and Lung Institute, Imperial College London, London, UK.,1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John Parissis
- Heart Failure Unit, School of Medicine and Department of Cardiology, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, Zurich, University Heart Center, Zurich, Switzerland
| | - Petar Seferovic
- Cardiology Department, Clinical Centre Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dragos Vinereanu
- University of Medicine and Pharmacy 'Carol Davila', and Department of Cardiology, University and Emergency Hospital, Bucharest, Romania
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Vlastos
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Xaplanteris
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Reuven Zimlichman
- Department of Medicine and Hypertension Institute, Brunner Institute for Cardiovascular Research, Sackler Faculty of Medicine, The E. Wolfson Medical Center, Institute for Quality in Medicine, Israeli Medical Association, Tel Aviv University, Tel Aviv, Israel
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
21
|
Purohit SN, Cornwell WK, Pal JD, Lindenfeld J, Ambardekar AV. Living Without a Pulse: The Vascular Implications of Continuous-Flow Left Ventricular Assist Devices. Circ Heart Fail 2018; 11:e004670. [PMID: 29903893 PMCID: PMC6007027 DOI: 10.1161/circheartfailure.117.004670] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.
Collapse
Affiliation(s)
- Suneet N Purohit
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
| | | | - Jay D Pal
- Division of Cardiothoracic Surgery, Department of Surgery (J.D.P.)
| | - JoAnn Lindenfeld
- University of Colorado, Aurora. Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine (S.N.P., W.K.C, A.V.A.)
- Consortium for Fibrosis Research and Translation (A.V.A.)
| |
Collapse
|
22
|
Clinical Applications of Patient-Specific Models: The Case for a Simple Approach. J Cardiovasc Transl Res 2018; 11:71-79. [PMID: 29453747 DOI: 10.1007/s12265-018-9787-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 01/08/2023]
Abstract
Over the past several decades, increasingly sophisticated models of the heart have provided important insights into cardiac physiology and are increasingly used to predict the impact of diseases and therapies on the heart. In an era of personalized medicine, many envision patient-specific computational models as a powerful tool for personalizing therapy. Yet the complexity of current models poses important challenges, including identifying model parameters and completing calculations quickly enough for routine clinical use. We propose that early clinical successes are likely to arise from an alternative approach: relatively simple, fast, phenomenologic models with a small number of parameters that can be easily (and automatically) customized. We discuss examples of simple yet foundational models that have already made a tremendous impact on clinical education and practice, and make the case that reducing rather than increasing model complexity may be the key to realizing the promise of patient-specific modeling for clinical applications.
Collapse
|
23
|
Rademakers FE. Regional Myocardial Contractility. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006906. [DOI: 10.1161/circimaging.117.006906] [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)
- Frank E. Rademakers
- From the Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Belgium
| |
Collapse
|
24
|
Marwick TH, Sharman JE. Arterial Loading and the Prevention of Atrial Dysfunction. Circ Cardiovasc Imaging 2017; 10:e006546. [PMID: 28592594 DOI: 10.1161/circimaging.117.006546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H Marwick
- From the Baker Heart and Diabetes Institute, Melbourne, Australia (T.H.M.); and Menzies Institute for Medical Research, Hobart, Australia (J.E.S.).
| | - James E Sharman
- From the Baker Heart and Diabetes Institute, Melbourne, Australia (T.H.M.); and Menzies Institute for Medical Research, Hobart, Australia (J.E.S.)
| |
Collapse
|