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Kerkhof PLM, Peace RA, Handly N. Ratiology and a Complementary Class of Metrics for Cardiovascular Investigations. Physiology (Bethesda) 2020; 34:250-263. [PMID: 31165681 DOI: 10.1152/physiol.00056.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular investigations often involve ratio-based metrics or differences: ejection fraction, arterial pressure augmentation index, coronary fractional flow reserve, pulse pressure. Focusing on a single number (ratio or difference) implies that information is lost. The lost companions constitute a well-defined but thus far unrecognized class, having additive value, a physical dimension, and often a physiological meaning. Physiologists should play a prominent role in exploring these complementary avenues and also define alternatives.
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Affiliation(s)
- Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers , VUmc, Amsterdam , The Netherlands
| | - Richard A Peace
- Department of Nuclear Medicine, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , United Kingdom
| | - Neal Handly
- Department of Emergency Medicine, Drexel University College of Medicine , Philadelphia, Pennsylvania
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Aengevaeren VL, Gommans DHF, Dieker HJ, Timmermans J, Verheugt FWA, Bakker J, Hopman MTE, DE Boer MJ, Brouwer MA, Thompson PD, Kofflard MJM, Cramer GE, Eijsvogels TMH. Association between Lifelong Physical Activity and Disease Characteristics in HCM. Med Sci Sports Exerc 2019; 51:1995-2002. [PMID: 31033902 PMCID: PMC6798742 DOI: 10.1249/mss.0000000000002015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate left ventricular (LV) wall thickness. Adaptations to exercise can occasionally mimic certain HCM characteristics. However, it is unclear whether physical activity affects HCM genotype expression and disease characteristics. Consequently, we compared lifelong physical activity volumes between HCM gene carriers with and without HCM phenotype, and compared disease characteristics among tertiles of physical activity in phenotypic HCM patients. METHODS We enrolled n = 22 genotype positive/phenotype negative (G+/P-) HCM gene carriers, n = 44 genotype positive/phenotype positive (G+/P+) HCM patients, and n = 36 genotype negative/phenotype positive (G-/P+) HCM patients. Lifelong physical activity was recorded using a questionnaire and quantified as metabolic equivalent of task hours per week. RESULTS We included 102 participants (51 ± 16 yr, 49% male). Lifelong physical activity volumes were not different between G+/P+ and G+/P- subjects (16 [10-29] vs 14 [6-26] metabolic equivalent of task-hours per week, P = 0.33). Among phenotypic HCM patients, there was no difference in LV wall thickness, mass, and late gadolinium enhancement across physical activity tertiles. Patients with the highest reported physical activity volumes were younger at the time of diagnosis (tertile 1: 52 ± 14 yr, tertile 2: 49 ± 15 yr, tertile 3: 41 ± 18 yr; P = 0.03), and more often had a history of nonsustained ventricular tachycardia (4% vs 30% vs 30%, P = 0.03). CONCLUSIONS Lifelong physical activity volumes are not associated with genotype-to-phenotype transition in HCM gene carriers. We also found no difference in LV wall thickness across physical activity tertiles. However, the most active HCM patients were younger at the time of diagnosis and had a higher arrhythmic burden. These observations warrant further exploration of the role of exercise in HCM disease development.
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Affiliation(s)
- Vincent L Aengevaeren
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS.,Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - D H Frank Gommans
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Hendrik-Jan Dieker
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Janneke Timmermans
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Freek W A Verheugt
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Jeannette Bakker
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the NETHERLANDS
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Menko-Jan DE Boer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Marc A Brouwer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | | | - Marcel J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the NETHERLANDS
| | - G Etienne Cramer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England, UNITED KINGDOM
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Huke S. Linking myofilaments to sudden cardiac death: recent advances. J Physiol 2017; 595:3939-3947. [PMID: 28205229 DOI: 10.1113/jp273047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/06/2017] [Indexed: 12/11/2022] Open
Abstract
The major goal of this focused review is to highlight some of the recent advances and remaining open questions about how a mutation in a myofilament protein leads to an increased risk for sudden cardiac death (SCD). The link between myofilaments and SCD has been known for over 25 years, but identifying mutation carriers at risk for SCD is still a challenge and currently the only effective prevention is implantation of a defibrillator (ICD). In addition to recognized risk factors, other contributing factors need to be considered and assessed, e.g. 'microvascular dysfunction', to calibrate individual risk more accurately. Similarly, improving our understanding about the underlying mechanisms of SCD in patients with sarcomeric mutations will also allow us to design new and less invasive treatment options that will minimize risk and hopefully make implantation of an ICD unnecessary.
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Affiliation(s)
- Sabine Huke
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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Ait Mou Y, Bollensdorff C, Cazorla O, Magdi Y, de Tombe PP. Exploring cardiac biophysical properties. Glob Cardiol Sci Pract 2015; 2015:10. [PMID: 26779498 PMCID: PMC4448074 DOI: 10.5339/gcsp.2015.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/26/2015] [Indexed: 11/03/2022] Open
Abstract
The heart is subject to multiple sources of stress. To maintain its normal function, and successfully overcome these stresses, heart muscle is equipped with fine-tuned regulatory mechanisms. Some of these mechanisms are inherent within the myocardium itself and are known as intrinsic mechanisms. Over a century ago, Otto Frank and Ernest Starling described an intrinsic mechanism by which the heart, even ex vivo, regulates its function on a beat-to-beat basis. According to this phenomenon, the higher the ventricular filling is, the bigger the stroke volume. Thus, the Frank-Starling law establishes a direct relationship between the diastolic and systolic function of the heart. To observe this biophysical phenomenon and to investigate it, technologic development has been a pre-requisite to scientific knowledge. It allowed for example to observe, at the cellular level, a Frank-Starling like mechanism and has been termed: Length Dependent Activation (LDA). In this review, we summarize some experimental systems that have been developed and are currently still in use to investigate cardiac biophysical properties from the whole heart down to the single myofibril. As a scientific support, investigation of the Frank-Starling mechanism will be used as a case study.
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Affiliation(s)
- Younss Ait Mou
- Qatar Cardiovascular Research Center, Qatar Foundation, Doha, Qatar
| | | | - Olivier Cazorla
- U1046 INSERM - UMR9214 CNRS- Université de Montpellier, Montpellier, France
| | - Yacoub Magdi
- Qatar Cardiovascular Research Center, Qatar Foundation, Doha, Qatar
| | - Pieter P de Tombe
- Department of Cell and Molecular Physiology, Heath Science Division, Loyola University Chicago, Maywood, Illinois 60153
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