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Sun B, Si N, Wei X, Wang H, Wang H, Liu Y, Jiang S, Liu H, Yang J, Xia B, Chen L, Bian B, Zhao H. Multi-omics reveals bufadienolide Q-markers of Bufonis Venenum based on antitumor activity and cardiovascular toxicity in zebrafish. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 133:155914. [PMID: 39121534 DOI: 10.1016/j.phymed.2024.155914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Bufonis Venenum (BV) is a traditional animal-based Chinese medicine with therapeutic effects against cancer. However, its clinical use is significantly restricted due to associated cardiovascular risks. BV's value in China's market is typically assessed based on "content priority," focusing on indicator components. However, these components of BV possess both antitumor activity and toxicity, and the correlation between the antitumor activity and toxicity of BV has not yet been elucidated. PURPOSE This study employs an integrated multi-omics approach to identify bufadienolide Q-markers and explore the correlation between BV's antitumor activity and toxicity. The aim is to establish a more comprehensive method for BV's quality. METHODS Normal zebrafish and HepG2 xenograft zebrafish were chosen as activity and toxicity evaluation models. Ultra-high performance liquid chromatography (UHPLC) coupled with a linear ion trap orbitrap (LTQ-Orbitrap) mass spectrometry was used to quantify eight batches of BV and key "toxic and effective" components were screened out. Transcriptomic and metabolomic analyses were performed to elucidate the regulatory mechanisms underlying the antitumor activity and cardiovascular toxicity of the key components in BV. RESULTS Eight key "toxic and effective" compounds were identified: resibufogenin, cinobufagin, arenobufagin, bufotalin, bufalin, gamabufotalin, desacetylcinobufagin, and telocinobufagin. The findings showed that bufalin and cinobufagin interfered with calcium homeostasis through CaV and CaSR, induced cardiotoxicity, and upregulated CASP9 to activate myocardial cell apoptosis. However, desacetylcinobufagin exhibited greater potential in terms of anti-tumor effects. Combining the results of untargeted and targeted metabolomics revealed that desacetylcinobufagin could have a callback effect on differential lipids and correct abnormal energy and amino acid metabolism caused by cancer, similar to cinobufagin and bufalin. Microscale thermophoresis (MST) ligand binding measurements also showed that the binding of desacetylcinobufagin to GPX4 has a more potent ability to induce ferroptosis in tumor cells compared to cinobufagin. CONCLUSION An innovative evaluation method based on the zebrafish was developed to investigate the relationship between the toxicity and efficacy of BV. This study identified toxicity and activity Q-markers and explored the mechanism between the two effects of BV. The research data could offer valuable insights into the efficacy of BV. Additionally, desacetylcinobufagin, an active ingredient with low toxicity, was found to enhance the quality of BV.
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Affiliation(s)
- Bo Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Nan Si
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xiaolu Wei
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Huijun Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hongjie Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuyang Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shan Jiang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Huining Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jiaying Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Bo Xia
- Hunter Biotechnology Inc., Zhejiang Hangzhou 310051, China
| | - Lihua Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Baolin Bian
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Haiyu Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Zhao L, Qian X, Ren Z, Wang A. miR-31-5p suppresses myocardial hypertrophy by targeting Nfatc2ip. J Cell Mol Med 2024; 28:e18413. [PMID: 38894694 PMCID: PMC11187844 DOI: 10.1111/jcmm.18413] [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: 02/05/2024] [Revised: 04/20/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024] Open
Abstract
Cardiac hypertrophy, worldwide known as an adaptive functional compensatory state of myocardial stress, is mainly believed to proceed to severe heart diseases, even to sudden death. Emerging studies have explored the microRNA alteration during hypertrophy. However, the mechanisms of microRNAs involved in cardiac hypertrophy are still uncertain. We studied young rats to establish abdominal aorta coarctation (AAC) for 4 weeks. With the significant downregulated cardiac function and upregulated hypertrophic biomarkers, AAC-induced rats showed enlarged myocardiocytes and alterations in microRNAs, especially downregulated miR-31-5p. miR-31-5p targets the 3'UTR of Nfatc2ip and inhibits myocardial hypertrophy in vitro and in vivo. Furthermore, we verified that Nfatc2ip is necessary and sufficient for cardiac hypertrophy in neonatal rat cardiomyocytes. Moreover, we found miR-31-5p inhibited the colocalization of Nfatc2ip and hypertrophic gene β-Mhc. Luciferase assay and ChiP-qPCR test demonstrated that Nfatc2ip binded to the core-promoter of β-Mhc and enhanced its transcriptional activity. Above all, our study found a new pathway, mir-31-5p/Nfatc2ip/β-Mhc, which is involved in cardiac hypertrophy, suggesting a potential target for intervention of cardiac hypertrophy.
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Affiliation(s)
- Lamei Zhao
- Department of Cardiology1st Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Xiaotao Qian
- Department of Oncology, Hefei Cancer HospitalChinese Academy of SciencesHefeiAnhuiChina
| | - Zhenxing Ren
- Department of Anatomy, The Research Center of Basic Integrative MedicineGuangzhou University of Traditional Chinese MedicineGuangzhouGuangdongChina
| | - Ailing Wang
- Department of Cardiology1st Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Barbuto S, Hu L, Abenavoli C, Picotti M, Manna GL, Nicola LD, Genovesi S, Provenzano M. Coronary Artery Disease in Patients Undergoing Hemodialysis: A Problem that Sounds the Alarm. Rev Cardiovasc Med 2024; 25:200. [PMID: 39076335 PMCID: PMC11270123 DOI: 10.31083/j.rcm2506200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 07/31/2024] Open
Abstract
Chronic kidney disease (CKD) is affecting more and more individuals over time. The importance of the increased prevalence is enhanced by the close association with the increased risk of poor individual outcomes such as death, fatal and non-fatal cardiovascular (CV) events and progression to end stage kidney disease (ESKD). ESKD requires replacement treatment such as hemodialysis (HD), a particular and complex context that unfortunately has been rarely considered in observational studies in the last few decades. The current perspective of HD as a bridge to kidney transplant requires greater attention from observational and experimental research both in the prevention and treatment of CV events in ESKD patients. We present a narrative review by performing a literature review to extrapolate the most significant articles exploring the CV risk, in particular coronary artery disease (CAD), in ESKD and evaluating possible innovative diagnostic and therapeutic tools in these patients. The risk of CAD increases linearly when the estimated glomerular filtration rate (eGFR) declines and reached the most significant level in ESKD patients. Several diagnostic techniques have been evaluated to predict CAD in ESKD such as laboratory tests (Troponin-T, N-terminal pro b-type natriuretic peptide, alkaline phosphatase), echocardiography and imaging techniques for vascular calcifications evaluation. Similarly, treatment is based on lifestyle changes, medical therapy and invasive techniques such as coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Unfortunately in the literature there are no clear indications of the usefulness and validity of biomarkers and possible treatments in ESKD patients. Considering the ESKD weight in terms of prevalence and costs it is necessary to implement clinical research in order to develop prognostic reliable biomarkers for CV and CAD risk prediction, in patients with ESKD. It should be highlighted that HD is a peculiar setting that offers the opportunity to implement research and facilitates patient monitoring by favoring the design of clinical trials.
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Affiliation(s)
- Simona Barbuto
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Lilio Hu
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Chiara Abenavoli
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Matilde Picotti
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Luca De Nicola
- Division of Nephrology, University of Campania “Luigi Vanvitelli”, 80137 Naples, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, University of Milano Bicocca, 20900 Monza, Italy
- Istituto Auxologico Italiano, IRCCS, 20095 Milan, Italy
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Nephrology Unit, Department of Medical and Surgical Science (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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Madsen JM, Obling LER, Rytoft L, Folke F, Hassager C, Andersen LB, Vejlstrup N, Bang LE, Engstrøm T, Lønborg JT. Pre-hospital pulse glucocorticoid therapy in patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention: a randomized controlled trial (PULSE-MI). Trials 2023; 24:808. [PMID: 38102687 PMCID: PMC10724922 DOI: 10.1186/s13063-023-07830-y] [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: 06/23/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Inflammation in ST-segment elevation myocardial infarction (STEMI) is an important contributor to both acute myocardial ischemia and reperfusion injury after primary percutaneous coronary intervention (PCI). Methylprednisolone is a glucocorticoid with potent anti-inflammatory properties with an acute effect and is used as an effective and safe treatment of a wide range of acute diseases. The trial aims to investigate the cardioprotective effects of pulse-dose methylprednisolone administered in the pre-hospital setting in patients with STEMI transferred for primary PCI. METHODS This trial is a randomized, blinded, placebo-controlled prospective clinical phase II trial. Inclusion will continue until 378 patients with STEMI have been evaluated for the primary endpoint. Patients will be randomized 1:1 to a bolus of 250 mg methylprednisolone intravenous or matching placebo over a period of 5 min in the pre-hospital setting. All patients with STEMI transferred for primary PCI at Rigshospitalet, Copenhagen University Hospital, Denmark, will be screened for eligibility. The main eligibility criteria are age ≥ 18 years, acute onset of chest pain with < 12 h duration, STEMI on electrocardiogram, no known allergy to glucocorticoids or no previous coronary artery bypass grafting, previous acute myocardial infarction in assumed culprit, or a history with previous maniac/psychotic episodes. Primary outcome is final infarct size measured by late gadolinium enhancement on cardiac magnetic resonance (CMR) 3 months after STEMI. Secondary outcomes comprise key CMR efficacy parameters, clinical endpoints at 3 months, the peak of cardiac biomarkers, and safety. DISCUSSION We hypothesize that pulse-dose methylprednisolone administrated in the pre-hospital setting decreases inflammation and thus reduces final infarct size in patients with STEMI treated with primary PCI. TRIAL REGISTRATION EU-CT number: 2022-500762-10-00; Submitted May 5, 2022. CLINICALTRIALS gov Identifier: NCT05462730; Submitted July 7, 2022, first posted July 18, 2022.
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Affiliation(s)
- Jasmine Melissa Madsen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Laura Rytoft
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark, and Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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A X, Li K, Yan LL, Chandramouli C, Hu R, Jin X, Li P, Chen M, Qian G, Chen Y. Machine learning-based prediction of infarct size in patients with ST-segment elevation myocardial infarction: A multi-center study. Int J Cardiol 2023; 375:131-141. [PMID: 36565958 DOI: 10.1016/j.ijcard.2022.12.037] [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] [Received: 07/25/2022] [Revised: 11/19/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (CMR) is the gold standard for measuring infarct size (IS). However, this method is expensive and requires a specially trained technologist to administer. We therefore sought to quantify the IS using machine learning (ML) based analysis on clinical features, which is a convenient and cost-effective alternative to CMR. METHODS AND RESULTS We included 315 STEMI patients with CMR examined one week after morbidity in final analysis. After feature selection by XGBoost on fifty-six clinical features, we used five ML algorithms (random forest (RF), light gradient boosting decision machine, deep forest, deep neural network, and stacking) to predict IS with 26 (selected by XGBoost with information gain greater than average level of 56 features) and the top 10 features, during which 5-fold cross-validation were used to train and optimize models. We then evaluated the value of actual and ML-IS for the prediction of adverse remodeling. Our finding indicates that MLs outperform the linear regression in predicting IS. Specifically, the RF with five predictors identified by the exhaustive method performed better than linear regression (LR) with 10 indicators (R2 of RF: 0.8; LR: 0). The finding also shows that both actual and ML-IS were independently associated with adverse remodeling. ML-IS ≥ 21% was associated with a twofold increase in the risk of LV remodeling (P < 0.01) compared with patients with reference IS (1st tertile). CONCLUSION ML-based methods can predict IS with widely available clinical features, which provide a proof-of-concept tool to quantitatively assess acute phase IS.
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Affiliation(s)
- Xin A
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kangshuo Li
- Department of Statistics, Columbia University, New York, NY, United States of America
| | - Lijing L Yan
- Global Heath Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu Province 215347, China; Wuhan University School of Health Sciences, Wuhan, Hubei Province, China
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore; Duke-National University Medical School, Singapore
| | - Rundong Hu
- Global Heath Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu Province 215347, China
| | | | - Ping Li
- Department of Cardiology, The first people's hospital of Yulin, Guangxi, China
| | - Mulei Chen
- Department of Cardiology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Geng Qian
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
| | - Yundai Chen
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
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6
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Ferdinandy P, Andreadou I, Baxter GF, Bøtker HE, Davidson SM, Dobrev D, Gersh BJ, Heusch G, Lecour S, Ruiz-Meana M, Zuurbier CJ, Hausenloy DJ, Schulz R. Interaction of Cardiovascular Nonmodifiable Risk Factors, Comorbidities and Comedications With Ischemia/Reperfusion Injury and Cardioprotection by Pharmacological Treatments and Ischemic Conditioning. Pharmacol Rev 2023; 75:159-216. [PMID: 36753049 PMCID: PMC9832381 DOI: 10.1124/pharmrev.121.000348] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022] Open
Abstract
Preconditioning, postconditioning, and remote conditioning of the myocardium enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and the potential to provide novel therapeutic paradigms for cardioprotection. While many signaling pathways leading to endogenous cardioprotection have been elucidated in experimental studies over the past 30 years, no cardioprotective drug is on the market yet for that indication. One likely major reason for this failure to translate cardioprotection into patient benefit is the lack of rigorous and systematic preclinical evaluation of promising cardioprotective therapies prior to their clinical evaluation, since ischemic heart disease in humans is a complex disorder caused by or associated with cardiovascular risk factors and comorbidities. These risk factors and comorbidities induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury and responses to cardioprotective interventions. Moreover, some of the medications used to treat these comorbidities may impact on cardioprotection by again modifying cellular signaling pathways. The aim of this article is to review the recent evidence that cardiovascular risk factors as well as comorbidities and their medications may modify the response to cardioprotective interventions. We emphasize the critical need for taking into account the presence of cardiovascular risk factors as well as comorbidities and their concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple comorbidities. SIGNIFICANCE STATEMENT: Ischemic heart disease is a major cause of mortality; however, there are still no cardioprotective drugs on the market. Most studies on cardioprotection have been undertaken in animal models of ischemia/reperfusion in the absence of comorbidities; however, ischemic heart disease develops with other systemic disorders (e.g., hypertension, hyperlipidemia, diabetes, atherosclerosis). Here we focus on the preclinical and clinical evidence showing how these comorbidities and their routine medications affect ischemia/reperfusion injury and interfere with cardioprotective strategies.
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Affiliation(s)
- Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Ioanna Andreadou
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gary F Baxter
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Hans Erik Bøtker
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Sean M Davidson
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Dobromir Dobrev
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Bernard J Gersh
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Gerd Heusch
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Sandrine Lecour
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Marisol Ruiz-Meana
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Coert J Zuurbier
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Derek J Hausenloy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
| | - Rainer Schulz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary (P.F.); Pharmahungary Group, Szeged, Hungary (P.F.); Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece (I.A.); Division of Pharmacology, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK (G.F.B.); Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark (H.E.B.); The Hatter Cardiovascular Institute, University College London, London, UK (S.M.D.); Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada (D.D.); Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas (D.D.); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (B.J.G.); Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany (G.H.); Cape Heart Institute and Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa (S.L.); Cardiovascular Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Spain (M.R-M.); Laboratory of Experimental Intensive Care Anesthesiology, Department Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (C.J.Z.); Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore (D.J.H.); National Heart Research Institute Singapore, National Heart Centre, Singapore (D.J.H.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Institute of Physiology, Justus-Liebig University, Giessen, Germany (R.S.)
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7
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Juul AS, Kyhl K, Ekström K, Madsen JM, Sabbah M, Ahtarovski KA, Nepper-Christensen L, Vejlstrup N, Høfsten D, Kelbaek H, Køber L, Lønborg J, Engstrøm T. The Incidence and Impact of Permanent Right Ventricular Infarction on Left Ventricular Infarct Size in Patients With Inferior ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 186:43-49. [PMID: 36343445 DOI: 10.1016/j.amjcard.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Mounting evidence shows that right ventricle (RV) function carries independent prognostic influence in various disease states. This study aimed to investigate the incidence and impact of permanent RV infarction in patients with inferior ST-segment elevation myocardial infarction (STEMI) and culprit lesion in the right coronary artery (RCA). In this substudy of the DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) trial, cardiac magnetic resonance was performed in 291 patients at day 1 and follow-up 3 months after primary percutaneous coronary intervention of 674 patients with STEMI with the culprit lesion in the RCA. Final infarct was assessed using late gadolinium enhancement on cardiac magnetic resonance at 3 months. Patients with permanent RV infarction (20%) had lower ventricular function at follow-up; RV ejection fraction (EF) 47% ±6 versus 50% ± 5 (p <0.005) and left ventricular (LV) EF 56% ± 8 versus 60% ± 9 (p <0.006). Furthermore, patients with permanent RV infarction had a higher incidence of microvascular obstruction 39 (67%) versus 81 (39%) (p <0.001), larger final LV infarct size 16% ±8 versus 10% ± 8 (p <0.001) and larger LV area at risk 33% ± 10 versus 29% ± 9 (p <0.001). Permanent RV infarction was an independent predictor of final LV infarct size (p <0.001) but was not associated with LVEF (β = -0.0; p = 0.13) in multivariable analyses. In conclusion, permanent RV infarction was seen in 20% of patients with inferior STEMI and culprit lesion in RCA and independently predicted final LV infarct size. However, permanent RV infarction did not predict overall LV function. LGE was used to detect infarct location and quantify infarct size.17 LGE in RV free wall on follow-up CMR was considered as permanent infarction. LGE images were obtained 10 minutes after intravenous injection of 0.1-mmol/kg body weight of gadolinium-based contrast (Gadovist; Bayer Schering, Berlin, Germany) using an electrocardiogram (ECG)-triggered inversion-recovery sequence. The inversion time was adjusted to null the signal from the normal myocardium. Short-axis images were acquired from the atrioventricular plane to the apex with adjacent 8-mm slices. The remaining protocol has been described previously.16.
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Affiliation(s)
- Anne-Sophie Juul
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health Science, University of Copenhagen.
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kathrine Ekström
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Muhammad Sabbah
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbaek
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
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8
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Mazhar J, Ekström K, Kozor R, Grieve SM, Nepper-Christensen L, Ahtarovski KA, Kelbæk H, Høfsten DE, Køber L, Vejlstrup N, Vernon ST, Engstrøm T, Lønborg J, Figtree GA. Cardiovascular magnetic resonance characteristics and clinical outcomes of patients with ST-elevation myocardial infarction and no standard modifiable risk factors–A DANAMI-3 substudy. Front Cardiovasc Med 2022; 9:945815. [PMID: 35990971 PMCID: PMC9383416 DOI: 10.3389/fcvm.2022.945815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionA higher 30-day mortality has been observed in patients with first-presentation ST elevation myocardial infarction (STEMI) who have no standard modifiable cardiovascular risk factors (SMuRFs), i. e., diabetes, hypertension, hyperlipidemia, and current smoker. In this study, we evaluate the clinical outcomes and CMR imaging characteristics of patients with and without SMuRFs who presented with first-presentation STEMI.MethodsPatients from the Third DANish Study of Acute Treatment of Patients With ST-Segment Elevation Myocardial Infarction (DANAMI-3) with first-presentation STEMI were classified into those with no SMuRFs vs. those with at least one SMuRF.ResultsWe identified 2,046 patients; 283 (14%) SMuRFless and 1,763 (86%) had >0 SMuRF. SMuRFless patients were older (66 vs. 61 years, p < 0.001) with more males (84 vs. 74%, p < 0.001), more likely to have left anterior descending artery (LAD) as the culprit artery (50 vs. 42%, p = 0.009), and poor pre-PCI (percutaneous coronary intervention) TIMI (thrombolysis in myocardial infarction) flow ≤1 (78 vs. 64%; p < 0.001). There was no difference in all-cause mortality, non-fatal reinfarction, or hospitalization for heart failure at 30 days or at long-term follow-up. CMR imaging was performed on 726 patients. SMuRFless patients had larger acute infarct size (17 vs. 13%, p = 0.04) and a smaller myocardial salvage index (42 vs. 50%, p = 0.02). These differences were attenuated when the higher LAD predominance and/or TIMI 0-1 flow were included in the model.ConclusionDespite no difference in 30-day mortality, SMuRFless patients had a larger infarct size and a smaller myocardial salvage index following first-presentation STEMI. This association was mediated by a larger proportion of LAD culprits and poor TIMI flow pre-PCI.Clinical trial registrationclinicaltrials.gov, unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
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Affiliation(s)
- Jawad Mazhar
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Kathrine Ekström
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rebecca Kozor
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kiril A. Ahtarovski
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Dan E. Høfsten
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stephen T. Vernon
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Jacob Lønborg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gemma A. Figtree
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Gemma A. Figtree
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9
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Sivakumar B, Kurian GA. Inhalation of PM 2.5 from diesel exhaust promote impairment of mitochondrial bioenergetics and dysregulate mitochondrial quality in rat heart: implications in isoproterenol-induced myocardial infarction model. Inhal Toxicol 2022; 34:107-119. [PMID: 35290147 DOI: 10.1080/08958378.2022.2049931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aim: Ambient exposure of PM2.5 from diesel exhaust (termed as diesel particulate matter [DPM]) can induce cardiotoxicity that can be manifested into myocardial ischemia/infarction, where the survival depends on mitochondrial function. The mechanism for DPM-induced mitochondrial dysfunction is yet to be elucidated and the consequential impact of impaired mitochondria on the severity of myocardial infarction (MI) has not been established.Materials and methods: Female Wistar rats were exposed to DPM (0.5 mg/ml) for 3 h daily (to achieve a PM2.5 concentration of 250 µg/m3) for 21 d trailed by an induction of MI using isoproterenol (ISO).Conclusion: DPM exposure altered the basal ECG pattern and increased heart weight (HW) to body weight (BW) ratio from control. Loss of mitochondrial quality in the cardiac tissue was observed in DPM exposed animals, measured via declined ETC enzyme activity, reduced ATP levels, high oxidative stress, low mitochondrial copy number, and low expression of the mitochondrial genes involved in mitophagy (PINK and PARKIN) and mitochondrial fusion (MFN-1). Subsequent induction of MI in DPM exposed animals (DPM + ISO) further deteriorated the normal sinus rhythm, accompanied by elevated plasma CK and LDH level, increased myocardial caspase activity, downregulation of Peroxisome proliferator-activated receptor-gamma coactivator (PGC1-α), transcription factor A (TFAM), DNA polymerase subunit gamma (POLG), and other mitochondrial quality control genes. Based on these results, we conclude that DPM alters the electrophysiology and ultrastructure of the heart that aggravates the MI-induced cardiotoxicity, where the diminished mitochondrial quality can be the potential contributor.
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Affiliation(s)
- Bhavana Sivakumar
- School of Chemical and Biotechnology, Vascular Biology lab, SASTRA Deemed University, Thanjavur, India
| | - Gino A Kurian
- School of Chemical and Biotechnology, Vascular Biology lab, SASTRA Deemed University, Thanjavur, India.,School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, India
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10
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Sundaresan S, John S, Paneerselvam G, Andiapppan R, Christopher G, Selvam GS. Gallic acid attenuates cadmium mediated cardiac hypertrophic remodelling through upregulation of Nrf2 and PECAM-1signalling in rats. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 87:103701. [PMID: 34237468 DOI: 10.1016/j.etap.2021.103701] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
Gallic acid (GA) is an abundant natural polyphenolic compound found in vegetable and fruits that reduces the cardiac disease risk factor. This study aims to evaluate GA's role on cadmium (Cd) induced cardiac remodelling in experimental rats. Male Wistar rats were exposed to Cd (15 ppm) in drinking water and administered with GA orally (15 mg/kg/d) for 60 days. The results showed that GA regulated the lipid profile and reduced the LDL to 57 % compared with Cd treated rats. GA inhibited cardiac marker enzymes activity of CK-NAC (to 72.7 %) and CK-MB (to 100.3 %). Moreover, GA attenuated lipid peroxidation and enhanced the cardiac glutathione S transferase (GST) activity (89.2 %), glutathione peroxidase (GPx) (87 %), superoxide dismutase (SOD) (88.4 %) and catalase (CAT) activity (86.5 %). Histopathological examination showed that GA impaired the ventricular hypertrophy and fibrotic proliferation induced by Cd in rats. The combination of GA + Cd, decreased the gene expression of ANP (1-fold), BNP (0.5-fold) and β- MHC (0.9-fold). Furthermore, GA significantly reduced the expression of profibrotic (TGF-β) and proinflammatory (MCP-1) gene in Cd intoxicated rats. GA upregulated the expression of Nrf2 (2-fold), HO-1 (3-fold), and PECAM-1 (0.6-fold), which augments the detoxifying enzyme activity and cellular immunity in Cd intoxicated rats. The increased protein expression of Nrf2, PECAM-1 and decreased AKT-1 levels confirmed the mechanical action of GA during the hypertrophic condition. Thus, our results suggest that GA could act as a potential therapeutic agent regulating Nrf2 and PECAM-1 signalling pathways, thereby ameliorating Cd-induced pathological cardiac remodelling.
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Affiliation(s)
- Sasikumar Sundaresan
- Department of Biochemistry, Molecular Cardiology Unit, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | - Samu John
- Rajiv Gandhi Center for Biotechnology, Thycaud, Poojapura, P.O, Thiruvananthapuram, Kerala, India
| | - Gomathi Paneerselvam
- Department of Biochemistry, Molecular Cardiology Unit, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | | | | | - Govindan Sadasivam Selvam
- Department of Biochemistry, Molecular Cardiology Unit, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India.
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11
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Sone M, Saito C, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. Association between elevated left ventricular mass index and increased cardiovascular events in patients with acute coronary syndrome: A sub-analysis of the HIJ-PROPER study. Echocardiography 2021; 38:1567-1573. [PMID: 34346521 DOI: 10.1111/echo.15173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
AIM This study aimed to assess the association between left ventricular mass index (LVMI) and cardiovascular events in patients with acute coronary syndrome (ACS) under standard ACS management. METHODS AND RESULTS This study is the sub-analysis of the HIJ-PROPER study. A total of 299 patients who had echocardiographic LVMI data were included in the current analysis. The participants were divided into four groups according to the LVMI quartile [quartile 1 (Q1), 77 (25.8%); quartile 2 (Q2), 73 (24.4%); quartile 3 (Q3), 74 (24.7%); and quartile 4 (Q4), 75 (25.1%)]. The incidence of cardiovascular events was compared among the four groups. The primary endpoint was defined as the composite endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure. Mean LVMI in the four groups was 68.1±8.6, 86.2±3.8, 101.1±4.9, and 126.0±18.5 g/m2 , respectively. The primary endpoint was noted in 4, 4, 7, and 14 patients in Q1, Q2, Q3, and Q4, corresponding to an incidence of 5.2%, 5.5%, 9.5%, and 18.7%, respectively (p = 0.03 for difference among four groups). The cumulative incidence of the primary endpoint was significantly higher in patients in Q4 than in those in Q1 and Q2 [hazard ratio (HR) 3.75; 95% confidence interval (CI), 1.23-11.4; p = 0.02 for Q4 vs Q1; HR 3.43; 95% CI, 1.13-10.4; p = 0.03 for Q4 vs Q2]. This tendency was noted even after adjusting for patient characteristics and echocardiography parameters (p = 0.039 for Q4 vs Q1). CONCLUSION Elevated LVMI was associated with increased cardiovascular events in patients with ACS under standard management. Adequately powered studies are warranted to validate these findings.
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Affiliation(s)
- Maiko Sone
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Ogawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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12
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Ekström K, Nielsen JVW, Nepper-Christensen L, Ahtarovski KA, Kyhl K, Göransson C, Bertelsen L, Ghotbi AA, Kelbæk H, Høfsten DE, Køber L, Schoos MM, Vejlstrup N, Lønborg J, Engstrøm T. Ischemia From Nonculprit Stenoses Is Not Associated With Reduced Culprit Infarct Size in Patients with ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2021; 14:e012290. [PMID: 33951923 DOI: 10.1161/circimaging.120.012290] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with ST-segment-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention, reperfusion injury accounts for a significant fraction of the final infarct size, which is directly related to patient prognosis. In animal studies, brief periods of ischemia in noninfarct-related (nonculprit) coronary arteries protect the culprit myocardium via remote ischemic preconditioning. Positive fractional flow reserve (FFR) documents functional significant coronary nonculprit stenosis, which may offer remote ischemic preconditioning of the culprit myocardium. The aim of the study was to investigate the association between functional significant, multivessel disease (MVD) and reduced culprit final infarct size or increased myocardial salvage (myocardial salvage index [MSI]) in a large contemporary cohort of STEMI patients. METHODS Cardiac magnetic resonance was performed in 610 patients with STEMI at day 1 and 3 months after primary percutaneous coronary intervention. Patients were stratified into 3 groups according to FFR measurements in nonculprit stenosis (if any): angiographic single vessel disease (SVD), FFR nonsignificant MVD (functional SVD), or FFR-significant, functional MVD. RESULTS A total of 431 (71%) patients had SVD, 35 (6%) had functional SVD, and 144 (23%) had functional MVD. There was no difference in final infarct size (mean infarct size [%left ventricular mass] SVD, 9±3%; functional SVD, 9±3%; and functional MVD, 9±3% [P=0.82]) or in MSI between groups (mean MSI [%left] SVD, 66±23%; functional SVD, 68±19%; and functional MVD, 69±19% [P=0.62]). In multivariable analyses, functional MVD was not associated with larger MSI (P=0.56) or smaller infarct size (P=0.55). CONCLUSIONS Functional MVD in nonculprit myocardium was not associated with reduced culprit final infarct size or increased MSI following STEMI. This is important knowledge for future studies examining a cardioprotective treatment in patients with STEMI, as a possible confounding effect of FFR-significant, functional MVD can be discarded. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
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Affiliation(s)
- Kathrine Ekström
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Julie V W Nielsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Kiril A Ahtarovski
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Kasper Kyhl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Christoffer Göransson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Litten Bertelsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Adam A Ghotbi
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (H.K.)
| | - Dan E Høfsten
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Mikkel M Schoos
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Jacob Lønborg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.)
- Department of Cardiology, Lund University Hospital, Sweden (T.E.)
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13
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Topal DG, Aleksov Ahtarovski K, Lønborg J, Høfsten D, Nepper-Christensen L, Kyhl K, Schoos M, Ghotbi AA, Göransson C, Bertelsen L, Holmvang L, Helqvist S, Pedersen F, Schnabel R, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T, Clemmensen P. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study. IJC HEART & VASCULATURE 2021; 33:100731. [PMID: 33732867 PMCID: PMC7937772 DOI: 10.1016/j.ijcha.2021.100731] [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: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Background Coronary collateral circulation and conditioning from
remote ischemic coronary territories may protect culprit myocardium in the
elderly, and younger STEMI patients could suffer from larger infarcts. We
evaluated the impact of age on myocardial salvage and long-term prognosis in a
contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac
magnetic resonance. To assess the impact of age on infarct size and left
ventricular ejection fraction (LVEF) as well as the composite endpoint of death
and re-hospitalization for heart failure we stratified the patients by an age
cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10%
vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After
adjusting for multiple potential confounders age did not remain significantly
associated with infarct size and LVEF. During 4-year follow-up, the composite
endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a
univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event
estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below
median) showed a gradual increase in the occurrence of the composite endpoint
depending on both age and acute infarct size (log-rank
p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life
more than quadrupled the risk of future death or re-hospitalization for heart
failure. Risk of death and re-hospitalization depended on both advanced age and
infarct size, albeit no substantial difference was found in infarct size, LVEF
and salvage potential between younger and elderly patients with
STEMI.
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Affiliation(s)
- Divan Gabriel Topal
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Renate Schnabel
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Peter Clemmensen
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine, Nykøbing F Hospital, Nykøbing F, Institute for Regional Research, University of Southern Denmark, Odense, Denmark
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14
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Wang Y, Newsome GS. The Rise of ST-Elevation Myocardial Infarction in Women of Northeast China. Gerontol Geriatr Med 2021; 7:2333721421992250. [PMID: 33644258 PMCID: PMC7894685 DOI: 10.1177/2333721421992250] [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: 10/12/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
The women of China's Liaoning province display some morbidities in ways that defy medical explanation. Women have higher rates of hypertension, hypercholesterolemia, and metabolic syndrome than men, an anomaly for all three conditions. Most of these patients also suffer from Type 2 Diabetes Mellitus (T2DM) while there was a negative association between being female and T2DM for the rest of China. Each of these conditions can exist independently, but the increase in both their rates and congruence is a recent phenomenon. Stranger still is that Liaoning women are now presenting in hospital emergency departments with ST-Elevation Myocardial Infarction (STEMI), while diabetics predominantly suffer more benign Non-STEMI (NSTEMI) events. Confounding factors in any attempt to study this phenomenon include trace metals like manganese that have been shown to reduce systolic blood pressure in Asian men and raise it in Asian women. Some of the phenomenon may also be associated with the gene for Apolipoprotein 5, but its recent nature suggests other factors besides lipid profiles. Trace metals in the air, water, and diet of Liaoning province, or any urban environment, could play a role.
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Affiliation(s)
- Yihe Wang
- Liaoning Health Industry Group, Shenyang, China
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15
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Nair AR, Johnson EA, Yang HJ, Cokic I, Francis J, Dharmakumar R. Reperfused hemorrhagic myocardial infarction in rats. PLoS One 2020; 15:e0243207. [PMID: 33264359 PMCID: PMC7710030 DOI: 10.1371/journal.pone.0243207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intramyocardial hemorrhage following reperfusion is strongly associated with major adverse cardiovascular events in myocardial infarction (MI) patients; yet the mechanisms contributing to these outcomes are not well understood. Large animal models have been used to investigate intramyocardial hemorrhage, but they are exorbitantly expensive and difficult to use for mechanistic studies. In contrast, rat models are widely used to investigate mechanistic aspects of cardiovascular physiology, but a rat model that consistently recapitulates the characteristics of an hemorrhagic MI does not exist. To bridge this gap, we investigated the physiological conditions of MI that would create intramyocardial hemorrhage in rats so that a reliable model of hemorrhagic MI would become available for basic research. METHODS & RESULTS Sprague-Dawley rats underwent either a 90-minute (90-min) ischemia and then reperfusion (I/R) (n = 22) or 30-minute (30-min) I/R (n = 18) of the left anterior descending coronary artery. Sham rats (n = 12) were used as controls. 90-min I/R consistently yielded hemorrhagic MI, while 30-min I/R consistently yielded non-hemorrhagic MI. Twenty-four hours post-reperfusion, ex-vivo late-gadolinium-enhancement (LGE) and T2* cardiac MRI performed on excised hearts from 90-min I/R rats revealed colocalization of iron deposits within the scarred tissue; however, in 30-min I/R rats scar was evident on LGE but no evidence of iron was found on T2* CMR. Histological studies verified tissue damage (H&E) detected on LGE and the presence of iron (Perl's stain) observed on T2*-CMR. At week 4 post-reperfusion, gene and protein expression of proinflammatory markers (TNF-α, IL-1β and MMP-9) were increased in the 90-min I/R group when compared to 30-min I/R groups. Further, transmission electron microscopy performed on 90-min I/R myocardium that were positive for iron on T2* CMR and Perl's stain showed accumulation of granular iron particles within the phagosomes. CONCLUSION Ischemic time prior to reperfusion is a critical factor in determining whether a MI is hemorrhagic or non-hemorrhagic in rats. Specifically, a period of 90-min of ischemia prior to reperfusion can produce rat models of hemorrhagic MI, while 30-minutes of ischemia prior to reperfusion can ensure that the MIs are non-hemorrhagic. Hemorrhagic MIs in rats result in marked increase in iron deposition, proinflammatory burden and adverse left-ventricular remodeling compared to rats with non-hemorrhagic MIs.
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Affiliation(s)
- Anand R. Nair
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Eric A. Johnson
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
- Department of Bioengineering, University of California, Los Angeles, CA, United States of America
| | - Hsin-Jung Yang
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
| | - Ivan Cokic
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - Joseph Francis
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | - Rohan Dharmakumar
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Biomedical Imaging Research Institute, Los Angeles, CA, United States of America
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, United States of America
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16
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Sabbah M, Nepper-Christensen L, Lønborg J, Helqvist S, Køber L, Høfsten DE, Ahtarovski KA, Göransson C, Kyhl K, Schoos MM, Vejlstrup N, Kelbæk H, Engstrøm T. Fractional flow reserve-guided PCI in patients with and without left ventricular hypertrophy: a DANAMI-3-PRIMULTI substudy. EUROINTERVENTION 2020; 16:584-590. [PMID: 31746761 DOI: 10.4244/eij-d-19-00577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this substudy was to investigate the correlation between fractional flow reserve (FFR) and diameter stenosis in patients with STEMI with and without left ventricular hypertrophy (LVH), and the influence of LVH on complete FFR-guided revascularisation versus culprit only, in terms of risk of clinical outcome. METHODS AND RESULTS In this DANAMI-3-PRIMULTI substudy, 279 patients with STEMI had cardiac magnetic resonance (CMR) imaging for assessment of left ventricular mass index. Ninety-six patients had FFR evaluation of a non-culprit lesion. Diameter stenosis of the non-culprit lesion was determined with two-dimensional quantitative coronary analysis. The diameter stenosis (56.9% vs 54.3%, p=0.38) and FFR value (0.83 vs 0.85, p=0.34) were significantly correlated in both groups (Spearman's ρ=-0.40 and -0.41 without LVH and with LVH, respectively; p<0.001) but were not different between patients without and with LVH (p for interaction=0.87). FFR-guided complete revascularisation was associated with reduced risk of death, myocardial infarction or ischaemia-driven revascularisation both for patients without LVH (HR 0.42, 95% CI: 0.20-0.85) and for patients with LVH (HR 0.50, 95% CI: 0.17-1.47), with no interaction between the FFR-guided complete revascularisation and LVH (p for interaction=0.82). CONCLUSIONS LVH did not interact with the correlation between diameter stenosis and FFR and did not modify the impact of complete revascularisation on the occurrence of subsequent clinical events.
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Affiliation(s)
- Muhammad Sabbah
- Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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17
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Wu L, Luan Y, Li Y, Wang M, He J, Jin C, Zhang W. Effects of trimetazidine on ventricular remodeling in coronary artery disease patients with left ventricular hypertrophy: the rationale and design of a randomized controlled trial. BMC Cardiovasc Disord 2020; 20:273. [PMID: 32503494 PMCID: PMC7275498 DOI: 10.1186/s12872-020-01557-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background Trimetazidine is a metabolic anti-ischemic agent, which increases the tolerance of cardiomyocytes to ischemia. However, few studies have explored the effect of trimetazidine on ventricular remodeling in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with left ventricular hypertrophy (LVH). Methods It is a randomized, placebo-controlled trial, and we propose to recruit one hundred and twenty-four CAD patients undergoing PCI with LVH during a 12-month period. They will be randomized to receive either trimetazidine (35 mg twice a day) or placebo in the following 12 months after PCI. Blood tests, echocardiography, symptom of angina and major adverse cardiovascular events (MACEs) will be collected at follow-up visit at 3 and 12 months. The primary end point will be the left ventricular remodeling measured by left ventricular mass index (LVMI) at 3- and 12-month follow-up compared with the baseline. The secondary end points will be the symptom of angina assessed by Seattle Angina Questionnaire, myocardial ischemia measured by 6-min walk test and exercise electrocardiography test, as well as MACEs (defined as a composite of death, myocardial infarction, stroke, recurrent angina, re-hospitalization, change of viable myocardium). Discussion This study aims to demonstrate the effect of trimetazidine on left ventricular remodeling and myocardial ischemia in CAD patients undergoing PCI with LVH. Trimetazidine treatment is likely to improve the left ventricular remodeling, symptoms of angina and myocardial ischemia. It might also reduce the risk of MACEs in CAD patients undergoing PCI with LVH. Trial registration http://www.chictr.org.cn, Chinese Clinical Trial Registry (ChiCTR1800017876). Registered on 19 Aug 2018.
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Affiliation(s)
- Lili Wu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Yi Luan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Ya Li
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Min Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Jialin He
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Chongying Jin
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China
| | - Wenbin Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang, 310016, P.R. China.
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18
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Sabbah M, Nepper-Christensen L, Køber L, Høfsten DE, Ahtarovski KA, Göransson C, Kyhl K, Ghotbi AA, Schoos MM, Sadjadieh G, Kelbæk H, Lønborg J, Engstrøm T. Infarct size following loading with Ticagrelor/Prasugrel versus Clopidogrel in ST-segment elevation myocardial infarction. Int J Cardiol 2020; 314:7-12. [PMID: 32389767 DOI: 10.1016/j.ijcard.2020.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment with newer direct-acting anti-platelet drugs (Ticagrelor and Prasugrel) prior to primary percutaneous coronary intervention (PCI) is associated with improved outcome in patients with ST-segment elevation myocardial infarction (STEMI) when compared with Clopidogrel. We compared infarct size following treatment with Ticagrelor/Prasugrel versus Clopidogrel in the DANish trial in Acute Myocardial Infarction (DANAMI-3) population of STEMI patients treated with primary PCI. METHODS AND RESULTS Patients were loaded with Clopidogrel, Ticagrelor or Prasugrel in the ambulance before primary PCI. Infarct size and myocardial salvage index were calculated using cardiac magnetic resonance (CMR) during index admission and at three-month follow-up. Six-hundred-and-ninety-three patients were included in this analysis. Clopidogrel was given to 351 patients and Ticagrelor/Prasugrel to 342 patients. The groups were generally comparable in terms of baseline and procedural characteristics. Median infarct size at three-month follow-up was 12.9% vs 10.0%, in patients treated with Clopidogrel and Ticagrelor/ Prasugrel respectively (p < 0.001), and myocardial salvage index was 66% vs 71% (p < 0.001). Results remained significant in a multiple regression model (p < 0.001). CONCLUSIONS Pre-hospital loading with Ticagrelor or Prasugrel compared to Clopidogrel, was associated with smaller infarct size and larger myocardial salvage index at three-month follow-up in patients with STEMI treated with primary PCI.
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Affiliation(s)
- Muhammad Sabbah
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark.
| | - Lars Nepper-Christensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Lars Køber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Dan Eik Høfsten
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | - Christoffer Göransson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Kasper Kyhl
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Mikkel Malby Schoos
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Golnaz Sadjadieh
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Henning Kelbæk
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - Jacob Lønborg
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Thomas Engstrøm
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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19
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Alzuhairi KS, Lønborg J, Ahtarovski KA, Nepper-Christensen L, Kyhl K, Lassen JF, Sørensen R, Joshi F, Ghotbi AA, Schoos M, Goransson C, Bertelsen L, Helqvist S, Holmvang L, Jørgensen E, Pedersen F, Tilsted HH, Høfsten D, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T. Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction: A DANAMI-3 sub-study. Int J Cardiol 2020; 301:215-219. [PMID: 31748187 DOI: 10.1016/j.ijcard.2019.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
AIMS To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). METHODS AND RESULTS A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47-36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07-50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27-47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83-328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. CONCLUSION Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.
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Affiliation(s)
| | - Jacob Lønborg
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | | | | | - Kasper Kyhl
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Jens F Lassen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Rikke Sørensen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Francis Joshi
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Adam Ali Ghotbi
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Mikkel Schoos
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | | | - Litten Bertelsen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Steffen Helqvist
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Lene Holmvang
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Erik Jørgensen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Frants Pedersen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Hans-Henrik Tilsted
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Dan Høfsten
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Lars Køber
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Niels Vejlstrup
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Thomas Engstrøm
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark; University of Lund, Sweden.
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20
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Abstract
Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.
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21
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Bakhtiari F, Davarmoin G, Ghaffari S, Aslanabadi N, Separham A. Electrocardiographic left ventricular hypertrophy is not associated with increased in-hospital adverse events in patients with first Non-ST segment elevation myocardial infarction: A single center study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:289-294. [PMID: 31558990 PMCID: PMC6729159 DOI: 10.22088/cjim.10.3.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: There is conflicting data about prognostic implication of electrocardiographic (ECG) left ventricular hypertrophy (LVH) in patients with first non- ST-segment elevation myocardial infarction (NSTEMI). We aimed to examine the association of left ventricular hypertrophy (LVH) on admission electrocardiogram with adverse outcomes in patients with NSTEMI. Methods: In the present study, 460 patients (77.5% males with mean age of 65.44±13.15 years) with first NSTEMI were evaluated. ECG left ventricular hypertrophy (LVH) was diagnosed based on Sokolow-Lyon voltage criteria. Baseline laboratory and clinical results, angiographic data, as well as in- hospital adverse events were compared between the patients with and without LVH. Results: Electrocardiographic LVH was observed in 74 (16.1%) patients. Patients with LVH had higher admission systolic blood pressure (132.91±21.08 vs 125.80±21.78; P=0.01) and higher peak troponin (6.42±1.03 vs 4.41±0.28; P=0.004), but less likely to undergo coronary angiography (54.1% vs 66.8%; P=0.03) .Patients with electrocardiographic LVH had similar in-hospital mortality (5.4% vs 3.6%, P=0.5) and heart failure/ pulmonary edema (2.7% vs 2.07%, P=0.6) compared to patients without LVH. Conclusion: The present study showed that among the patients with first NSTEMI, electrocardiographic LVH was not associated with increased in-hospital adverse events.
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Affiliation(s)
- Fatemeh Bakhtiari
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Ghiti Davarmoin
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Ahmad Separham
- Cardiovascular Research Center, Cardiology Department, Tabriz University of Medical Science, Tabriz, Iran
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22
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Kyhl K, Ahtarovski KA, Nepper-Christensen L, Ekström K, Ghotbi AA, Schoos M, Göransson C, Bertelsen L, Helqvist S, Holmvang L, Jørgensen E, Pedersen F, Saunamäki K, Clemmensen P, De Backer O, Høfsten DE, Køber L, Kelbæk H, Vejlstrup N, Lønborg J, Engstrøm T. Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy. JACC Cardiovasc Interv 2019; 12:721-730. [PMID: 31000010 DOI: 10.1016/j.jcin.2019.01.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of fractional flow reserve (FFR)-guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions. BACKGROUND Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown. METHODS In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up. RESULTS A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). CONCLUSIONS Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.
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Affiliation(s)
- Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Medicine, Nykoebing F Hospital, Nykoebing F and University of Southern Denmark, Odense, Denmark; University Clinic of Hamburg-Eppendorf, The Heart Centre, Hamburg, Germany
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Zealand University, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, University of Lund, Lund, Sweden
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23
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Eskerud I, Gerdts E, Larsen TH, Lønnebakken MT. Left ventricular hypertrophy contributes to Myocardial Ischemia in Non-obstructive Coronary Artery Disease (the MicroCAD study). Int J Cardiol 2019; 286:1-6. [PMID: 30952529 DOI: 10.1016/j.ijcard.2019.03.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/15/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The underlying mechanisms causing myocardial ischemia in non-obstructive coronary artery disease (CAD) are still unclear. We explored whether left ventricular hypertrophy (LVH) was associated with myocardial ischemia in patients with stable angina and non-obstructive CAD. METHODS 132 patients (mean age 63 ± 8 years, 56% women) with stable angina and non-obstructive CAD diagnosed as <50% stenosis by coronary computed tomography angiography (CCTA) underwent myocardial contrast stress echocardiography. Left ventricular (LV) hypertrophy (LVH) was identified by LV mass index >46.7 g/m2.7 in women and >49.2 g/m2.7 in men. Patients were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. The number of LV segments with ischemia at peak stress was taken as a measure of the extent of myocardial ischemia. RESULTS Myocardial ischemia was found in 52% of patients, with on average 5 ± 3 ischemic LV segments per patient. The group with myocardial ischemia had higher prevalence of LVH (23 vs. 10%, p = 0.035), while age, sex and prevalence of hypertension did not differ between groups (all p > 0.05). In multivariable regression analyses, LVH was associated with presence of myocardial ischemia (odds ratio 3.27, 95% confidence interval [1.11-9.60], p = 0.031), and larger extent of myocardial ischemia (β = 0.22, p = 0.012), independent of confounders including age, hypertension, obesity, hypercholesterolemia, calcium score and segment involvement score by CCTA. CONCLUSIONS LVH was independently associated with both presence and extent of myocardial ischemia in patients with stable angina and non-obstructive CAD by CCTA. These results suggest LVH as an independent contributor to myocardial ischemia in non-obstructive CAD. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov, identifier NCT018535271.
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Affiliation(s)
- Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway.
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway
| | - Terje H Larsen
- Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway; Department of Biomedicine, University of Bergen, PO box 7804, N-5020 Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, PO box 7804, N-5020 Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, PO box 1400, N-5021 Bergen, Norway
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24
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Al‐Shafei AIM, El‐Gendy OAA. Regular consumption of green tea improves pulse pressure and induces regression of left ventricular hypertrophy in hypertensive patients. Physiol Rep 2019; 7:e14030. [PMID: 30912296 PMCID: PMC6434072 DOI: 10.14814/phy2.14030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022] Open
Abstract
This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex- and age-matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects.
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Affiliation(s)
- Ahmad I. M. Al‐Shafei
- Istanbul Medipol UniversityIstanbulTurkey
- Bahrain UniversitySouthern GovernorateBahrain
- Qassim UniversityQassimSaudi Arabia
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25
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Nepper-Christensen L, Lønborg J, Høfsten DE, Ahtarovski KA, Bang LE, Helqvist S, Kyhl K, Køber L, Kelbæk H, Vejlstrup N, Holmvang L, Engstrøm T. Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2018; 11:e006842. [DOI: 10.1161/circinterventions.118.006842] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Dan E. Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Kiril A. Ahtarovski
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Lia E. Bang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (H.K.)
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.N.-C., J.L., D.E.H., K.A.A., L.E.B., S.H., K.K., L.K., N.V., L.H., T.E.)
- Department of Cardiology, University of Lund, Sweden (T.E.)
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26
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Nepper-Christensen L, Lønborg J, Ahtarovski KA, Høfsten DE, Kyhl K, Schoos MM, Göransson C, Laursen PN, Sadjadieh G, Ghotbi AA, Bertelsen L, Køber L, Helqvist S, Pedersen F, Jørgensen E, Kelbæk H, Vejlstrup N, Holmvang L, Engstrøm T. Importance of elevated heart rate in the very early phase of ST-segment elevation myocardial infarction: Results from the DANAMI-3 trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:318-328. [DOI: 10.1177/2048872618795515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome. Methods: In this DANAMI-3 substudy, 1560 ST-segment elevation myocardial infarction patients in sinus rhythm without cardiogenic shock were included in the analyses of clinical outcome and 796 patients underwent cardiovascular magnetic resonance to evaluate area at risk, infarct size and left ventricular ejection fraction. Heart rate was assessed on the first electrocardiogram with ST-elevation (time of diagnosis). Results: Despite equal area at risk (33%±11 versus 36%±16, p=0.174) patients with a pre-hospital heart rate ⩾100 beats per minute developed larger infarcts (19% (interquartile range, 9–17) versus 11% (interquartile range, 10–28), p=0.001) and a lower left ventricular ejection fraction (54%±12 versus 58%±9, p=0.047). Pre-hospital heart rate ⩾100 beats per minute was independently associated with an increased risk of all-cause mortality and heart failure (hazard ratio 2.39 (95% confidence interval 1.58–3.62), p<0.001). Conclusions: Very early heart rate ⩾100 beats per minute in ST-segment elevation myocardial infarction was independently associated with larger infarct size, reduced left ventricular ejection fraction and an increased risk of all-cause mortality and heart failure, and thus serves as an easily obtainable and powerful tool to identify ST-segment elevation myocardial infarction patients at high risk.
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Affiliation(s)
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kiril A Ahtarovski
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel M Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Peter N Laursen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Golnaz Sadjadieh
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- University of Lund, Sweden
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Nepper-Christensen L, Lønborg J, Høfsten DE, Ahtarovski KA, Kyhl K, Göransson C, Køber L, Helqvist S, Pedersen F, Kelbæk H, Vejlstrup N, Holmvang L, Engstrøm T. Impact of diagnostic ECG-to-wire delay in STEMI patients treated with primary PCI: a DANAMI-3 substudy. EUROINTERVENTION 2018; 14:700-707. [DOI: 10.4244/eij-d-17-00857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Göransson C, Ahtarovski KA, Kyhl K, Lønborg J, Nepper-Christensen L, Bertelsen L, Ghotbi AA, Schoos MM, Køber L, Høfsten D, Helqvist S, Kelbæk H, Engstrøm T, Vejlstrup N. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy. Eur Heart J Cardiovasc Imaging 2018; 20:361-366. [DOI: 10.1093/ehjci/jey106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/01/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christoffer Göransson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kiril Aleksov Ahtarovski
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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Árnadóttir Á, Schoos M, Lønborg J, Ahtarovski K, Kelbæk H, Helqvist S, Høfsten D, Clemmensen P, Engstrøm T, Nepper-Christensen L, Vejlstrup N, Køber L, Iversen K. Can copeptin and troponin T ratio predict final infarct size and myocardial salvage index in patients with ST-elevation myocardial infarction: A sub-study of the DANAMI-3 trial. Clin Biochem 2018; 59:37-42. [PMID: 29932892 DOI: 10.1016/j.clinbiochem.2018.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (pPCI) is recommended in patients presenting with ST-elevation myocardial infarction (STEMI) within <12 h of symptom onset. However, patients-reported symptom duration is not always reliable. Cardiac specific troponin T (cTnT) and the endogenous stress marker copeptin have different temporal release patterns for myocardial infarction MI. We hypothesized that copeptin/troponin-ratio is associated to the duration of coronary occlusion and therefore inversely proportional to myocardial salvage. METHOD Patients older than 18 years with first time STEMI referred to pPCI were eligible. cTnT and copeptin values were measured at admission. A cardiac magnetic resonance scanning (CMR) was done during the index admission for assessment of area at risk (AAR), and later 3 months to assess final infarct size (FIS). Myocardial salvage index (MSI) was calculated based on these measurements. RESULTS A total of 468 patients were included. The median time from patient-reported onset of symptoms to pPCI was 192 min (IQR 150 min - 290 min). At presentation 416 (89%) patients had hs-cTnT values above the 99th percentile, median hs-cTnT was 53 ng/l (IQR 24 ng/l-146 ng/l) and 318 (68%) patients had copeptin values above the 99th percentile (18.9 pmol/l), median copeptin was 50 pmol/l (IQR 14 pmol/l-131 pmol/l). Symptom duration showed a weak but significant association with AAR (R2 = 0.02, p = .04), FIS (R2 = 0.03, p < .01) and MSI (R2 = 0.04, p < .01). Copeptin/troponin-ratio was significantly associated with symptom duration (R2 = 0.19, p < .01), but not AAR (R2 = 0.02, p = .19), FIS (R2 = 0.02, p = .12), or MSI (R2 = 0.01, p = .25). CONCLUSION Copeptin/troponin-ratio is associated with patient-reported symptom duration, but there was no association with area at risk, final infarct size or myocardial salvage index.
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Affiliation(s)
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany; Department of Medicine, Division of Cardiology, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
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Stiermaier T, Pöss J, Eitel C, de Waha S, Fuernau G, Desch S, Thiele H, Eitel I. Impact of left ventricular hypertrophy on myocardial injury in patients with ST-segment elevation myocardial infarction. Clin Res Cardiol 2018; 107:1013-1020. [DOI: 10.1007/s00392-018-1273-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
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31
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Ma L, Ma X, Kong F, Guo J, Shi H, Zhu J, Zou Y, Ge J. Mammalian target of rapamycin inhibition attenuates myocardial ischaemia-reperfusion injury in hypertrophic heart. J Cell Mol Med 2018; 22:1708-1719. [PMID: 29314656 PMCID: PMC5824378 DOI: 10.1111/jcmm.13451] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/06/2017] [Indexed: 01/08/2023] Open
Abstract
Pathological cardiac hypertrophy aggravated myocardial infarction and is causally related to autophagy dysfunction and increased oxidative stress. Rapamycin is an inhibitor of serine/threonine kinase mammalian target of rapamycin (mTOR) involved in the regulation of autophagy as well as oxidative/nitrative stress. Here, we demonstrated that rapamycin ameliorates myocardial ischaemia reperfusion injury by rescuing the defective cytoprotective mechanisms in hypertrophic heart. Our results showed that chronic rapamycin treatment markedly reduced the phosphorylated mTOR and ribosomal protein S6 expression, but not Akt in both normal and aortic-banded mice. Moreover, chronic rapamycin treatment significantly mitigated TAC-induced autophagy dysfunction demonstrated by prompted Beclin-1 activation, elevated LC3-II/LC3-I ratio and increased autophagosome abundance. Most importantly, we found that MI/R-induced myocardial injury was markedly reduced by rapamycin treatment manifested by the inhibition of myocardial apoptosis, the reduction of myocardial infarct size and the improvement of cardiac function in hypertrophic heart. Mechanically, rapamycin reduced the MI/R-induced iNOS/gp91phox protein expression and decreased the generation of NO and superoxide, as well as the cytotoxic peroxynitrite. Moreover, rapamycin significantly mitigated MI/R-induced endoplasmic reticulum stress and mitochondrial impairment demonstrated by reduced Caspase-12 activity, inhibited CHOP activation, decreased cytoplasmic Cyto-C release and preserved intact mitochondria. In addition, inhibition of mTOR also enhanced the phosphorylated ERK and eNOS, and inactivated GSK3β, a pivotal downstream target of Akt and ERK signallings. Taken together, these results suggest that mTOR signalling protects against MI/R injury through autophagy induction and ERK-mediated antioxidative and anti-nitrative stress in mice with hypertrophic myocardium.
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Affiliation(s)
- Lei‐Lei Ma
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
- Department of Critical Care MedicineZhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical CollegeHangzhouChina
| | - Xin Ma
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
| | - Fei‐Juan Kong
- Department of Endocrinology and MetabolismShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Jun‐Jie Guo
- Department of CardiologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Hong‐Tao Shi
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
| | - Jian‐Bing Zhu
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
| | - Yun‐Zeng Zou
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
| | - Jun‐Bo Ge
- Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital and Institute of Biomedical ScienceFudan UniversityShanghaiChina
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32
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Hypertrophied myocardium is vulnerable to ischemia/reperfusion injury and refractory to rapamycin-induced protection due to increased oxidative/nitrative stress. Clin Sci (Lond) 2018; 132:93-110. [PMID: 29175946 DOI: 10.1042/cs20171471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022]
Abstract
Left ventricular hypertrophy (LVH) is causally related to increased morbidity and mortality following acute myocardial infarction (AMI) via still unknown mechanisms. Although rapamycin exerts cardioprotective effects against myocardial ischemia/reperfusion (MI/R) injury in normal animals, whether rapamycin-elicited cardioprotection is altered in the presence of LVH has yet to be determined. Pressure overload induced cardiac hypertrophied mice and sham-operated controls were exposed to AMI by coronary artery ligation, and treated with vehicle or rapamycin 10 min before reperfusion. Rapamycin produced marked cardioprotection in normal control mice, whereas pressure overload induced cardiac hypertrophied mice manifested enhanced myocardial injury, and was refractory to rapamycin-elicited cardioprotection evidenced by augmented infarct size, aggravated cardiomyocyte apoptosis, and worsening cardiac function. Rapamycin alleviated MI/R injury via ERK-dependent antioxidative pathways in normal mice, whereas cardiac hypertrophied mice manifested markedly exacerbated oxidative/nitrative stress after MI/R evidenced by the increased iNOS/gp91phox expression, superoxide production, total NO metabolites, and nitrotyrosine content. Moreover, scavenging superoxide or peroxynitrite by selective gp91phox assembly inhibitor gp91ds-tat or ONOO- scavenger EUK134 markedly ameliorated MI/R injury, as shown by reduced myocardial oxidative/nitrative stress, alleviated myocardial infarction, hindered cardiomyocyte apoptosis, and improved cardiac function in aortic-banded mice. However, no additional cardioprotective effects were achieved when we combined rapamycin and gp91ds-tat or EUK134 in ischemic/reperfused hearts with or without LVH. These results suggest that cardiac hypertrophy attenuated rapamycin-induced cardioprotection by increasing oxidative/nitrative stress and scavenging superoxide/peroxynitrite protects the hypertrophied heart from MI/R.
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