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Tang S, Li R, Ma W, Lian L, Gao J, Cao Y, Gan L. Cardiac-to-adipose axis in metabolic homeostasis and diseases: special instructions from the heart. Cell Biosci 2023; 13:161. [PMID: 37667400 PMCID: PMC10476430 DOI: 10.1186/s13578-023-01097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023] Open
Abstract
Adipose tissue is essential for maintaining systemic metabolic homeostasis through traditional metabolic regulation, endocrine crosstalk, and extracellular vesicle production. Adipose dysfunction is a risk factor for cardiovascular diseases. The heart is a traditional pump organ. However, it has recently been recognized to coordinate interorgan cross-talk by providing peripheral signals known as cardiokines. These molecules include specific peptides, proteins, microRNAs and novel extracellular vesicle-carried cargoes. Current studies have shown that generalized cardiokine-mediated adipose regulation affects systemic metabolism. Cardiokines regulate lipolysis, adipogenesis, energy expenditure, thermogenesis during cold exposure and adipokine production. Moreover, cardiokines participate in pathological processes such as obesity, diabetes and ischemic heart injury. The underlying mechanisms of the cardiac-to-adipose axis mediated by cardiokines will be further discussed to provide potential therapeutic targets for metabolic diseases and support a new perspective on the need to correct adipose dysfunction after ischemic heart injury.
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Affiliation(s)
- Songling Tang
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China
| | - Ruixin Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China
| | - Wen Ma
- Sichuan University-The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China
| | - Liu Lian
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China
| | - Jiuyu Gao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China
| | - Yu Cao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China.
- Sichuan University-The Hong Kong Polytechnic University Institute for Disaster Management and Reconstruction, Chengdu, China.
| | - Lu Gan
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, West China School of Medicine, Sichuan University Chengdu, Chengdu, 610041, People's Republic of China.
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Forde H, Davenport C, Rochfort KD, Wallace RG, Durkan E, Agha A, Thompson CJ, Tormey WT, O'Gorman DJ, Cummins PM, Smith D. Serum OPG/TRAIL ratio predicts the presence of cardiovascular disease in people with type 2 diabetes mellitus. Diabetes Res Clin Pract 2022; 189:109936. [PMID: 35662613 DOI: 10.1016/j.diabres.2022.109936] [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: 11/25/2021] [Revised: 04/28/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM). Epidemiological studies suggest serum Osteoprotegrin (OPG)/Tumour-necrosis-factor-related-apoptosis-inducing- ligand (TRAIL) ratio may be a useful marker of cardiovascular risk. This study aimed to compare serum levels of TRAIL, OPG and OPG/TRAIL ratio in people with T2DM, with and without a history of CVD, and controls; and to determine which of these indices, if any, predict cardiovascular risk. METHODS In this single centre observational study of 133 participants, people with T2DM, with and without a history of a cardiovascular event in the last 5 years, were recruited along with a control cohort without T2DM or CVD. Demographic information and anthropometric measurements were recorded. Blood samples were taken and OPG and TRAIL were measured using ELISA. RESULTS People with T2DM and CVD had higher OPG/TRAIL ratios compared to controls or those with a new diagnosis of T2DM. After adjustment for potential confounding factors, OPG/TRAIL ratio was significantly associated with the presence of CVD in people with T2DM and an OPG/TRAIL ratio cut-off > 38.6 predicted the presence of CVD in this cohort with a sensitivity of 80% and specificity of 82%. CONCLUSION This study suggests that OPG/TRAIL ratio may have a role as a biomarker of CVD in people with T2DM.
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Affiliation(s)
- H Forde
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland; School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - C Davenport
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland; School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - K D Rochfort
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - R G Wallace
- School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - E Durkan
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - A Agha
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
| | - C J Thompson
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
| | - W T Tormey
- Department of Chemical Pathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - D J O'Gorman
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland; National Institute for Cellular Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - P M Cummins
- School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - D Smith
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
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Jørgensen NR, Diemar SS, Christensen GL, Kimer N, Danielsen KV, Møller S. Patients With Cirrhosis Have Elevated Bone Turnover but Normal Hepatic Production of Osteoprotegerin. J Clin Endocrinol Metab 2022; 107:e980-e995. [PMID: 34718621 DOI: 10.1210/clinem/dgab788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/18/2023]
Abstract
CONTEXT Severe osteodystrophy is common in patients with liver dysfunction. Markers of bone metabolism may help in early diagnosis of osteodystrophy and in understanding underlying pathophysiological mechanisms. OBJECTIVE To elucidate changes in bone metabolism associated with cirrhosis and to determine the route of elimination for the markers. METHODS Case-control study at a public university hospital. Fifty-nine patients with cirrhosis (47 alcoholic and 12 nonalcoholic cirrhosis) and 20 controls were included. Participants underwent catheterization of the femoral artery, and the hepatic, renal, and femoral veins with collection of blood from all 4 sites. Regional arteriovenous differences in concentrations of bone metabolism markers were determined: procollagen of type I collagen propeptide (PINP), C-terminal cross-linking telopeptide of type I collagen (CTX), osteocalcin, tartrate-resistant acid phosphatase isoform 5b (TRAcP5b), osteoprotegerin (OPG), and sclerostin and correlated with degree of disease (Child-Pugh classification). RESULTS PINP concentration was higher (median: 87.9 µg/L) in patients with cirrhosis than in controls (52.6 µg/L) (P = .001), while hepatic extraction was lower (4.3% vs 14.5%) (P < .001). Both CTX and TRAcP5b were higher in patients with cirrhosis (340 ng/L and 3.20 U/L) than in controls (215 ng/L and 1.60 U/L) (P < .001 and P < .0001). Hepatic sclerostin extraction was lower in patients with cirrhosis (14.6%) than in controls (28.7%) (P < .0001). In both groups OPG showed a hepatic release rate (production) of 6%. CONCLUSION Patients with cirrhosis have increased bone resorption, but unaltered bone formation. Sclerostin is eliminated through the liver while OPG is produced in the liver. Bone markers may prove useful in evaluating bone turnover in patients with cirrhosis.
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Affiliation(s)
- Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Nina Kimer
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - Karen Vagner Danielsen
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark
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Increased osteoprotegerin level is associated with impaired cardiovagal modulation in type-2 diabetic patients treated with oral antidiabetic drugs. BMC Cardiovasc Disord 2020; 20:453. [PMID: 33081726 PMCID: PMC7574185 DOI: 10.1186/s12872-020-01729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background An increased osteoprotegerin (OPG) level has been reported in both type-2 diabetes mellitus (T2DM) and cardiovascular diease (CVD) that are linked to sympathovagal imbalance (SVI). We explored the link of osteoprotegerin with cardiovagal modulation in T2DM.
Methods We assessed fasting serum OPG, high-sensitive C-reactive protein (hsCRP), glucose, insulin and lipid profile in patients having T2DM receiving oral antidiabetic drugs (OAD) (n = 42) compared with age, gender and body composition-matched healthy participants without diabetes (n = 42). Rate pressure product (RPP), spectral indices of heart rate variability (HRV) and body composition were recorded in both the groups. Association of HOMA-IR and OPG with various parameters were assessed. Results Osteoprotegerin, HOMA-IR, hsCRP, coronary lipid risk factor were significantly increased, markers of cardiovagal modulation (TP, SDNN, RMSSD) were considerably decreased, ratio of low-frequency to high-frequency (LH-HF ratio), the indicator of SVI, and RPP, the marker of myocardial work stress were significantly higher in patients with diabetes, suggesting an overall elevated CVD risks in them. HOMA-IR was correlated with RMSSD, lipid risk factors and OPG. Rise in OPG was correlated with decreased cardiovagal modulation in patients with diabetes. There was significant contribution of OPG in decreasing TP, suggesting impaired cardiovagal modulation. Conclusion T2DM patients receiving OAD had higher cardiometabolic risks compared to age, gender and body composition-matched healthy individuals. Increased level of OPG is linked to decreased cardiovagal modulation in T2DM patients.
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Oduro PK, Fang J, Niu L, Li Y, Li L, Zhao X, Wang Q. Pharmacological management of vascular endothelial dysfunction in diabetes: TCM and western medicine compared based on biomarkers and biochemical parameters. Pharmacol Res 2020; 158:104893. [PMID: 32434053 DOI: 10.1016/j.phrs.2020.104893] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 12/20/2022]
Abstract
Diabetes, a worldwide health concern while burdening significant populace of countries with time due to a hefty increase in both incidence and prevalence rates. Hyperglycemia has been buttressed both in clinical and experimental studies to modulate widespread molecular actions that effect macro and microvascular dysfunctions. Endothelial dysfunction, activation, inflammation, and endothelial barrier leakage are key factors contributing to vascular complications in diabetes, plus the development of diabetes-induced cardiovascular diseases. The recent increase in molecular, transcriptional, and clinical studies has brought a new scope to the understanding of molecular mechanisms and the therapeutic targets for endothelial dysfunction in diabetes. In this review, an attempt made to discuss up to date critical and emerging molecular signaling pathways involved in the pathophysiology of endothelial dysfunction and viable pharmacological management targets. Importantly, we exploit some Traditional Chinese Medicines (TCM)/TCM isolated bioactive compounds modulating effects on endothelial dysfunction in diabetes. Finally, clinical studies data on biomarkers and biochemical parameters involved in the assessment of the efficacy of treatment in vascular endothelial dysfunction in diabetes was compared between clinically used western hypoglycemic drugs and TCM formulas.
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Affiliation(s)
- Patrick Kwabena Oduro
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China
| | - Jingmei Fang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China
| | - Lu Niu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China
| | - Yuhong Li
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China; Tianjin Key Laboratory of Chinese medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China
| | - Lin Li
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China; Tianjin Key Laboratory of Chinese medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China
| | - Xin Zhao
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China; Tianjin Key Laboratory of Chinese medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China
| | - Qilong Wang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin 301617, PR China; Tianjin Key Laboratory of Chinese medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, PR China.
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Paulus WJ, Dal Canto E. Distinct Myocardial Targets for Diabetes Therapy in Heart Failure With Preserved or Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 6:1-7. [PMID: 29284577 DOI: 10.1016/j.jchf.2017.07.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 01/09/2023]
Abstract
Noncardiac comorbidities such as diabetes mellitus (DM) have different outcomes in heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). These different outcomes are the result of distinct myocardial effects of DM on HFpEF and HFrEF, which relate to different mechanisms driving myocardial remodeling in each heart failure phenotype. Myocardial remodeling is driven by microvascular endothelial inflammation in HFpEF and by cardiomyocyte cell death in HFrEF. Evidence consists of: different biomarker profiles, in which inflammatory markers are prominent in HFpEF and markers of myocardial injury or wall stress are prominent in HFrEF; reduced coronary flow reserve with microvascular rarefaction in HFpEF; and upregulation of free radical-producing enzymes in endothelial cells in HFpEF and in cardiomyocytes in HFrEF. As biopsies from patients with diabetic cardiomyopathy reveal, DM affects failing myocardium by phenotype-specific mechanisms. In HFpEF, DM mainly increases cardiomyocyte hypertrophy and stiffness, probably because of hyperinsulinemia and microvascular endothelial inflammation. In HFrEF, DM augments replacement fibrosis because of cardiomyocyte cell death induced by lipotoxicity or advanced glycation end products. Because DM exerts distinct effects on myocardial remodeling in HFpEF and HFrEF, the heart failure phenotype is important for DM therapy.
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Affiliation(s)
- Walter J Paulus
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Elisa Dal Canto
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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Sawada N, Daimon M, Kawata T, Nakao T, Kimura K, Nakanishi K, Kurano M, Hirokawa M, Xu B, Yamanaka Y, Kato TS, Watanabe M, Yatomi Y, Komuro I. The Significance of the Effect of Visceral Adiposity on Left Ventricular Diastolic Function in the General Population. Sci Rep 2019; 9:4435. [PMID: 30872595 PMCID: PMC6418254 DOI: 10.1038/s41598-018-37137-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/27/2018] [Indexed: 02/08/2023] Open
Abstract
We evaluated the association between visceral adiposity and left ventricular (LV) diastolic function in association with plasma adiponectin levels in 213 subjects without overt cardiac diseases. Abdominal visceral fat area was quantified by computed tomography. Excessive visceral fat was significantly associated with impaired diastolic parameters including E/A, E′ and E/E′. Although serum adiponectin levels decreased with increased visceral adiposity, there was no independent association between serum adiponectin levels and diastolic parameters, which suggest that the role of adiponectin in this association might be indirect.
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Affiliation(s)
- Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan. .,Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan.
| | - Takayuki Kawata
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichi Kimura
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Boqing Xu
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuko Yamanaka
- Department of Cardiovascular Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomoko S Kato
- Department of Cardiology, The Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Hur S, Cho SH, Song BK, Cho BJ. Effect of Resistance Exercise on Serum Osteoprotegerin Levels and Insulin Resistance in Middle-Aged Women with Metabolic Syndrome. Med Sci Monit 2018; 24:9385-9391. [PMID: 30582576 PMCID: PMC6320661 DOI: 10.12659/msm.911548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Osteoprotegerin (OPG) is a soluble glycoprotein that belongs to the tumor necrosis factor (TNF) receptor superfamily. OPG is mainly secreted by bone. The relationship between acute resistance training, serum OPG levels and metabolic syndrome, including insulin resistance, remains unclear. The purpose of this study was to determine the effect of resistance exercise on serum OPG levels and insulin resistance in middle-aged women with metabolic syndrome. Material/Methods Twenty-four middle-aged women were divided into those with metabolic syndrome (n=12) and a normal control group without metabolic syndrome or insulin resistance (n=12). Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The quantitative insulin-sensitivity check index (QUICKI) and the homeostatic model assessment (HOMA) index for assessing beta-cell function and insulin resistance were used. The intensity of the resistance exercise was 60–70% of the repetition maximum, for 40 minutes with 10–12 repetitions, performed three times per week. Venous blood samples were tested using standard laboratory procedures. Results Before exercise, the metabolic syndrome group showed a significant increase in waist circumference (P=0.030) and serum triglyceride (TG) (P=0.014), and lower high-density lipoprotein-cholesterol (HDL-C) (P=0.010) compared with the control group. After the eight-week resistance exercise program, waist circumference, and the QUICKI decreased and OPG levels were significantly increased in the metabolic syndrome group compared with the normal control group. Conclusions A resistance exercise program was effective in reducing factors associated with metabolic syndrome including insulin resistance and increases serum levels of OPG in middle-aged women.
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Affiliation(s)
- Sun Hur
- Department of Sports Science, College of Art and Culture, Kangwon National University, Kangwon, South Korea
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, Gwangju, South Korea
| | - Bo-Kyung Song
- Department of Occupational Therapy, Kangwon National University, Kangwon, South Korea
| | - Byung-Jun Cho
- Department of Emergency Medical Technology, Kangwon National University, Kangwon, South Korea
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The Role of Serum Adiponectin for Outcome Prediction in Patients with Dilated Cardiomyopathy and Advanced Heart Failure. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3818292. [PMID: 29318144 PMCID: PMC5727561 DOI: 10.1155/2017/3818292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 11/17/2022]
Abstract
Clinical interpretation of patients' plasma adiponectin (APN) remains challenging; its value as biomarker in dilated cardiomyopathy (DCM) is equivocal. We evaluated whether circulating APN level is an independent predictor of composite outcome: death, left ventricle assist device (LVAD) implantation, and heart transplantation (HT) in patients with nonischemic DCM. 57 patients with nonischemic DCM (average LV diastolic diameter 6.85 cm, LV ejection fraction 26.63%, and pulmonary capillary wedge pressure 22.06 mmHg) were enrolled. Patients underwent echocardiography, right heart catheterization, and endomyocardial biopsy. During a mean follow-up of 33.42 months, 15 (26%) patients died, 12 (21%) patients underwent HT, and 8 (14%) patients were implanted with LVAD. APN level was significantly higher in patients who experienced study endpoints (23.4 versus 10.9 ug/ml, p = 0.01). APN was associated with worse outcome in univariate Cox proportional hazards model (HR 1.04, CI 1.02-1.07, p = 0.001) but lost significance adjusting for other covariates. Average global strain (AGS) is an independent outcome predictor (HR 1.42, CI 1.081-1.866, p = 0.012). Increased circulating APN level was associated with higher mortality and may be an additive prognostic marker in DCM with advanced HF. Combination of serum (APN, BNP, TNF-α) and echocardiographic (AGS) markers may increase the HF predicting power for the nonischemic DCM patients.
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Niu Y, Yang Z, Li X, Zhang W, Lu S, Zhang H, Chen X, Zhu L, Xing Y, Ning G, Qin L, Su Q. Association of osteoprotegerin with impaired glucose regulation and microalbuminuria: the REACTION study. BMC Endocr Disord 2015; 15:75. [PMID: 26626139 PMCID: PMC4665817 DOI: 10.1186/s12902-015-0067-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/13/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High osteoprotegerin (OPG) has been reported in association with insulin resistance and type 2 diabetes. We aimed to evaluate the association of serum OPG with impaired glucose regulation (IGR) and microalbuminuria among middle-aged and older Chinese. METHODS Serum OPG was measured in 599 individuals with normal glucose regulation, 730 with impaired glucose regulation and 327 newly diagnosed patients with diabetes. Serum OPG was measured using ELISA methods and urine albumin/creatinine ratio was used to determine the urinary albumin excretion. RESULTS Serum OPG levels were significantly higher in subjects with isolated impaired fasting glucose, isolated impaired glucose tolerance, combined impaired fasting glucose/impaired glucose tolerance and diabetes than in those with normal glucose regulation, whereas serum OPG levels were not different in the four groups with dysregulation of glucose metabolism. OPG was associated with a higher risk for IGR (OR 1.108 for each 0.1 μg/l increase in OPG, 95% CI 1.009-1.117, p = 0.01) after adjustment for gender, age, BMI, current smoking and alcohol intake, family history of diabetes, homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile; the corresponding OR of combined impaired glucose regulation and type 2 diabetes was 1.121 (95% CI 1.101-1.141, p = 0.0005). OPG was associated with the risk of microalbuminuria (OR 1.025, 95% CI 1.006-1.044, p = 0.02) after adjustment for gender, age, current smoking, current alcohol intake, family history of diabetes, BMI, waist/hip ratio, HOMA-IR, eGFR and lipid profile. CONCLUSIONS Serum OPG level is closely and independently associated with IGR and is an independent risk factor for microalbuminuria.
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Affiliation(s)
- Yixin Niu
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Zhen Yang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Weiwei Zhang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shuai Lu
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xueru Chen
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lingfei Zhu
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yin Xing
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guang Ning
- Shanghai Institute of Endocrinology and Metabolism, Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Key Laboratory of Endocrine Tumors and the Division of Endocrine and Metabolic Diseases, E-Institute of Shanghai Universities, Shanghai, China
| | - Li Qin
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Seferović PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J 2015; 36:1718-27, 1727a-1727c. [PMID: 25888006 DOI: 10.1093/eurheartj/ehv134] [Citation(s) in RCA: 350] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/02/2015] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus-related cardiomyopathy (DMCMP) was originally described as a dilated phenotype with eccentric left ventricular (LV) remodelling and systolic LV dysfunction. Recently however, clinical studies on DMCMP mainly describe a restrictive phenotype with concentric LV remodelling and diastolic LV dysfunction. Both phenotypes are not successive stages of DMCMP but evolve independently to respectively heart failure with preserved left ventricular ejection fraction (HFPEF) or reduced left ventricular ejection fraction (HFREF). Phenotype-specific pathophysiological mechanisms were recently proposed for LV remodelling and dysfunction in HFPEF and HFREF consisting of coronary microvascular endothelial dysfunction in HFPEF and cardiomyocyte cell death in HFREF. A similar preferential involvement of endothelial or cardiomyocyte cell compartments explains DMCMP development into distinct restrictive/HFPEF or dilated/HFREF phenotypes. Diabetes mellitus (DM)-related metabolic derangements such as hyperglycaemia, lipotoxicity, and hyperinsulinaemia favour development of DMCMP with restrictive/HFPEF phenotype, which is more prevalent in obese type 2 DM patients. In contrast, autoimmunity predisposes to a dilated/HFREF phenotype, which manifests itself more in autoimmune-prone type 1 DM patients. Finally, coronary microvascular rarefaction and advanced glycation end-products deposition are relevant to both phenotypes. Diagnosis of DMCMP requires impaired glucose metabolism and exclusion of coronary, valvular, hypertensive, or congenital heart disease and of viral, toxic, familial, or infiltrative cardiomyopathy. In addition, diagnosis of DMCMP with restrictive/HFPEF phenotype requires normal systolic LV function and diastolic LV dysfunction, whereas diagnosis of DMCMP with dilated/HFREF phenotype requires systolic LV dysfunction. Treatment of DMCMP with restrictive/HFPEF phenotype is limited to diuretics and lifestyle modification, whereas DMCMP with dilated/HFREF phenotype is treated in accordance to HF guidelines.
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Affiliation(s)
| | - Walter J Paulus
- Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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12
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Pérez de Ciriza C, Lawrie A, Varo N. Osteoprotegerin in Cardiometabolic Disorders. Int J Endocrinol 2015; 2015:564934. [PMID: 26078757 PMCID: PMC4442310 DOI: 10.1155/2015/564934] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Osteoprotegerin (OPG), a glycoprotein traditionally implicated in bone remodelling, has been recently related to cardiovascular disease (CVD). Human studies show a positive relationship between circulating OPG, vascular damage, and CVD, and as such OPG has emerged as a potential biomarker for CVD. This review focuses on the relationship between circulating OPG and different endocrine cardiometabolic alterations such as type 1 and 2 diabetes. The association of OPG with diabetic complications (neuropathy, nephropathy, or retinopathy) as well as with atherosclerosis, coronary artery calcification, morbidity, and mortality is pointed out. Moreover, OPG modulation by different treatments is also established. Besides, other associated diseases such as obesity, hypertension, and metabolic syndrome, which are known cardiovascular risk factors, are also considered.
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Affiliation(s)
- C. Pérez de Ciriza
- Department of Clinical Chemistry, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008 Pamplona, Spain
| | - A. Lawrie
- Department of Cardiovascular Science, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - N. Varo
- Department of Clinical Chemistry, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008 Pamplona, Spain
- *N. Varo:
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13
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Genre F, López-Mejías R, García-Bermúdez M, Castañeda S, González-Juanatey C, Llorca J, Corrales A, Ubilla B, Miranda-Filloy JA, Pina T, Gómez-Vaquero C, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Balsa A, Pascual-Salcedo D, López-Longo FJ, Carreira P, Blanco R, González-Álvaro I, Martín J, González-Gay MA. Osteoprotegerin CGA haplotype protection against cerebrovascular complications in anti-CCP negative patients with rheumatoid arthritis. PLoS One 2014; 9:e106823. [PMID: 25184828 PMCID: PMC4153690 DOI: 10.1371/journal.pone.0106823] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/01/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction Rheumatoid arthritis is an inflammatory disease with high incidence of cardiovascular disease due to accelerated atherosclerosis. Osteoprotegerin (OPG) has been associated with increased risk of atherosclerotic disease in the general population. Several polymorphisms in the OPG gene with functional effects on cardiovascular disease in non-rheumatic individuals have been described. Therefore, we aimed to analyze the effect of three of these functional OPG polymorphisms on the risk of cardiovascular disease in a large and well-characterized cohort of Spanish patients with rheumatoid arthritis. Methods Three OPG gene variants (rs3134063, rs2073618 and rs3134069) were genotyped by TaqMan assays in 2027 Spanish patients with rheumatoid arthritis. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing was positive in 997 of 1714 tested. Also, 18.3% of the whole series had experienced cardiovascular events, including 5.4% with cerebrovascular accidents. The relationship between OPG variants and cardiovascular events was assessed using Cox regression. Results No association between OPG gene variants and cardiovascular disease was observed in the whole group of rheumatoid arthritis patients or in anti-CCP positive patients. Nevertheless, a protective effect of CGA haplotype on the risk of cardiovascular disease in general, and specifically in the risk of cerebrovascular complications after adjusting for sex, age at disease diagnosis and traditional cardiovascular risk factors was disclosed in anti-CCP negative patients (HR = 0.54; 95%CI: 0.31–0.95; p = 0.032 and HR = 0.17; 95%CI: 0.04–0.78; p = 0.022, respectively). Conclusion Our results indicate a protective effect of the OPG CGA haplotype on cardiovascular risk, mainly due to a protective effect against cerebrovascular events in anti-CCP negative rheumatoid arthritis patients.
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Affiliation(s)
- Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | - Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | | | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario la Princesa, IIS-Princesa, Madrid, Spain
| | | | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | - Begoña Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | | | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | | | | | | | - Alejandro Balsa
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Patricia Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
| | | | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Granada, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain
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Kalaycıoğlu E, Gökdeniz T, Aykan AÇ, Hatem E, Gürsoy MO, Ören A, Yaman H, Karadeniz AG, Çelik Ş. Osteoprotegerin is associated with subclinical left ventricular systolic dysfunction in diabetic hypertensive patients: a speckle tracking study. Can J Cardiol 2014; 30:1529-34. [PMID: 25442456 DOI: 10.1016/j.cjca.2014.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/11/2014] [Accepted: 08/19/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. METHODS The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. RESULTS Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients (P = 0.009, P = 0.049, P < 0.001, P = 0.004, and P < 0.001, respectively). Diabetic hypertensive patients were divided into 2 groups according to median GLS value (> 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P < 0.001), and hemoglobin A1c (%; P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS (P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. CONCLUSIONS Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
| | - Tayyar Gökdeniz
- Department of Cardiology, Kafkas University, Faculty of Medicine, Kars, Turkey
| | - Ahmet Çağrı Aykan
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Engin Hatem
- Department of Cardiology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Gaziemir Salih Nevvar İşgören State Hospital, İzmir, Turkey
| | - Asım Ören
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Hüseyin Yaman
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ayşe Gül Karadeniz
- Department of Radiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Şükrü Çelik
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
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15
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Abstract
Cardiovascular disease, including heart failure, is a principal cause of death in individuals with obesity and diabetes. However, the mechanisms of obesity- and diabetes-induced heart disease are multifaceted and remain to be clearly defined. Of relevance to this review, there is currently great research and clinical interest in the endocrine effects of adipokines on the myocardium and their role in heart failure. We will discuss the potential significance of adipokines in the pathogenesis of heart failure via their ability to regulate remodeling events including metabolism, hypertrophy, fibrosis, and cell death. As an excellent example, we will first focus on adiponectin which is best known to confer numerous cardioprotective effects. However, we comprehensively discuss the existing literature that highlights it would be naive to assume that this was always the case. We also focus on lipocalin-2 which mediates pro-inflammatory and pro-apoptotic effects. It is important when studying actions of adipokines to integrate cellular and mechanistic analyses and translate these to physiologically relevant in vivo models and clinical studies. However, assimilating studies on numerous cardiac remodeling events which ultimately dictate cardiac dysfunction into a unifying conclusion is challenging. Nevertheless, there is undoubted potential for the use of adipokines as robust biomarkers and appropriate therapeutic targets in heart failure.
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Affiliation(s)
- Min Park
- Department of Biology, York University, Toronto, ON, M3J 1P3, Canada
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16
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. Clinical Use of Cardiac Magnetic Resonance in Systemic Heart Disease. Eur Cardiol 2014; 9:21-27. [PMID: 30310481 DOI: 10.15420/ecr.2014.9.1.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A systemic disease is one that affects a number of organs and tissues, or the body as a whole. Systemic diseases include endocrine, metabolic, nutritional, multisystem (rheumatic) and HIV disease. Cardiovascular involvement is a common and underestimated problem in systemic diseases, and may present with disease associated cardiac involvement at diagnosis or later in the course of the systemic disease. The cardiac involvement in these diseases is usually silent or oligo-symptomatic and includes different pathophysiological mechanisms such as, myocardial inflammation, infarction, diffuse, subendocardial vasculitis, valvular disease and different patterns of fibrosis. Furthermore, acuity of heart involvement may be underestimated due to non-specific cardiac signs, and finally, most of patients are female and unable to exercise, due to arthritis or muscular discomfort/weakness or may have limited acoustic window, due to increased breast size. Cardiovascular magnetic resonance (CMR), due to its ability to reliably assess cardiac anatomy, function, inflammation, stress perfusion-fibrosis, aortic distensibility, and iron and fat deposition, constitutes an excellent tool for early diagnosis of heart involvement, risk stratification, treatment evaluation and long-term follow-up of patients with cardiac disease due to systemic diseases.
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17
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Bjerre M. Osteoprotegerin (OPG) as a biomarker for diabetic cardiovascular complications. SPRINGERPLUS 2013; 2:658. [PMID: 24349960 PMCID: PMC3863400 DOI: 10.1186/2193-1801-2-658] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/04/2013] [Indexed: 01/27/2023]
Abstract
Osteoprotegerin (OPG) is a glycoprotein involved in bone metabolisms and with a regulatory role in immune, skeletal and vascular systems. Recently, circulating OPG levels have emerged as independent biomarkers of cardiovascular disease (CVD) in patients with acute or chronic heart disease, as well as in the healthy population. Furthermore, OPG has been implicated in various inflammations and linked to diabetes and poor glycaemic control. This review focuses on the relations between circulating OPG levels and cardiovascular complications, with special emphasis on diabetic patients. OPG levels were observed to increase concurrently with the severity of diabetic complications, that is, with the highest circulating OPG levels observed in diabetic patients dying from CVD. Although the clinical prognostic use of OPG may seem far away, OPG does look promising as a biomarker in order to help the cardiologist to a better risk-stratification of the patients.
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Affiliation(s)
- Mette Bjerre
- The Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University, Nørrebrogade 44, Building 3b, DK-8000 Aarhus C, Denmark
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18
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Chen WJY, Greulich S, van der Meer RW, Rijzewijk LJ, Lamb HJ, de Roos A, Smit JWA, Romijn JA, Ruige JB, Lammertsma AA, Lubberink M, Diamant M, Ouwens DM. Activin A is associated with impaired myocardial glucose metabolism and left ventricular remodeling in patients with uncomplicated type 2 diabetes. Cardiovasc Diabetol 2013; 12:150. [PMID: 24134550 PMCID: PMC4015886 DOI: 10.1186/1475-2840-12-150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 12/14/2022] Open
Abstract
Background Activin A released from epicardial adipose tissue has been linked to contractile dysfunction and insulin resistance in cardiomyocytes. This study investigated the role of activin A in clinical diabetic cardiomyopathy by assessing whether circulating activin A levels associate with cardiometabolic parameters in men with uncomplicated type 2 diabetes (T2D), and the effects of treatment with pioglitazone versus metformin on these associations. Methods Seventy-eight men with uncomplicated T2D and fourteen healthy men with comparable age were included, in this randomized, double-blind, active comparator intervention study. All T2D men were on glimipiride monotherapy, and randomized to a 24-week intervention with either pioglitazone or metformin. Cardiac dimensions and -function were measured using magnetic resonance imaging, whilst myocardial glucose metabolism (MMRglu) was determined using [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography during a hyperinsulinemic-euglycemic clamp. Results Circulating activin A levels were comparable in T2D men and controls. Activin A levels were independently inversely associated with MMRglu, and positively with left ventricular mass/volume (LVMV)-ratio in T2D men. Intervention with metformin decreased activin A levels, whereas pioglitazone did not alter activin A levels. The changes in plasma activin A levels were not correlated with the changes in MMRglu following either pioglitazone or metformin treatment. A borderline significant correlation (p = 0.051) of changes in plasma activin A levels and changes in LVMV-ratio was observed after pioglitazone treatment. Conclusions Circulating activin A levels are associated with impaired myocardial glucose metabolism and high LVMV-ratio in patients with uncomplicated T2D, reflecting a potential detrimental role in early human diabetic cardiomyopathy. Trial registration number Current Controlled Trials SRCTN53177482
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - D Margriet Ouwens
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Düsseldorf, Germany.
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19
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Abstract
Osteoprotegerin (OPG) is a 401 amino acid N-glycosylated protein, which is highly expressed in a large number of tissues. OPG mainly binds to two ligands, i.e. RANKL (receptor activator of nuclear factor κB ligand) and TRAIL (tumor necrosis factor- related apoptosis-inducing ligand). Upon binding to the former ligand, OPG inhibits the activation of osteoclasts and promotes apoptosis of osteoclasts, whereas the binding of OPG with TRAIL prevents apoptosis of tumor cells. There is now emerging evidence that OPG participates in the pathogenesis of atherosclerosis and cardiovascular diseases by amplifying the adverse effects of inflammation and several traditional risk factors such as hyperlipidemia, endothelial dysfunction, diabetes mellitus, and hypertension. Some epidemiological studies also showed a positive association between OPG levels and cardiovascular morbidity and mortality. The aim of this article is to provide an overview of the main biochemical, physiological, and pathological aspects of OPG biology in cardiovascular disease.
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Affiliation(s)
- Martina Montagnana
- Chemistry and Clinical Microscopy Section, Department of Life and Reproduction Sciences, University Hospital of Verona, Italy.
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20
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Greulich S, Chen WJY, Maxhera B, Rijzewijk LJ, van der Meer RW, Jonker JT, Mueller H, de Wiza DH, Floerke RR, Smiris K, Lamb HJ, de Roos A, Bax JJ, Romijn JA, Smit JWA, Akhyari P, Lichtenberg A, Eckel J, Diamant M, Ouwens DM. Cardioprotective properties of omentin-1 in type 2 diabetes: evidence from clinical and in vitro studies. PLoS One 2013; 8:e59697. [PMID: 23555749 PMCID: PMC3612072 DOI: 10.1371/journal.pone.0059697] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/17/2013] [Indexed: 12/24/2022] Open
Abstract
Context Adipokines are linked to the development of cardiovascular dysfunction in type 2 diabetes (DM2). In DM2-patients, circulating levels of omentin-1, an adipokine preferentially expressed in epicardial adipose tissue, are decreased. This study investigated whether omentin-1 has a cardioprotective function. Methods Omentin-1 levels in plasma and cardiac fat depots were determined in DM2-patients versus controls. Moreover, the relation between omentin-1 levels and cardiac function was examined in men with uncomplicated DM2. Finally, we determined whether omentin-1 could reverse the induction of cardiomyocyte dysfunction by conditioned media derived from epicardial adipose tissue from patients with DM2. Results Omentin-1 was highly expressed and secreted by epicardial adipose tissue, and reduced in DM2. Circulating omentin-1 levels were lower in DM2 versus controls, and positively correlated with the diastolic parameters early peak filling rate, early deceleration peak and early deceleration mean (all P<0.05). The improved diastolic function following pioglitazone treatment associated with increases in omentin-1 levels (P<0.05). In vitro, exposure of cardiomyocytes to conditioned media derived from epicardial adipose tissue from patients with DM2 induced contractile dysfunction and insulin resistance, which was prevented by the addition of recombinant omentin. Conclusion These data identify omentin-1 as a cardioprotective adipokine, and indicate that decreases in omentin-1 levels could contribute to the induction of cardiovascular dysfunction in DM2.
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Affiliation(s)
- Sabrina Greulich
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Duesseldorf, Germany
| | - Weena J. Y. Chen
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Bujar Maxhera
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Luuk J. Rijzewijk
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jacqueline T. Jonker
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Heidi Mueller
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Duesseldorf, Germany
| | - Daniella Herzfeld de Wiza
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Duesseldorf, Germany
| | - Ralf-Ruediger Floerke
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Duesseldorf, Germany
| | - Konstantinos Smiris
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes A. Romijn
- Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jan W. A. Smit
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Juergen Eckel
- Paul Langerhans Group, German Diabetes Center, Duesseldorf, Germany
| | - Michaela Diamant
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - D. Margriet Ouwens
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Duesseldorf, Germany
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- * E-mail:
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Ichikawa R, Daimon M, Miyazaki T, Kawata T, Miyazaki S, Maruyama M, Chiang SJ, Suzuki H, Ito C, Sato F, Watada H, Daida H. Influencing factors on cardiac structure and function beyond glycemic control in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2013; 12:38. [PMID: 23446214 PMCID: PMC3598845 DOI: 10.1186/1475-2840-12-38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/17/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We hypothesized that clinical factors other than glycemic control may influence abnormal cardiac function in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the independent factors for abnormal cardiac function among clinical factors in T2DM. METHODS We studied 148 asymptomatic patients with T2DM without overt heart disease. Echocardiographic findings were compared between diabetic patients and 68 age-matched healthy subjects. Early (E) and late (A) diastolic mitral flow velocity and early diastolic mitral annular velocity (e') were measured for assessing left ventricular (LV) diastolic function. We evaluated insulin resistance, non-esterified fatty acid, high-sensitive CRP, estimated glomerular filtration rate, waist/hip ratio, abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and other clinical characteristics in addition to glycemic control. VAT and SAT were quantified by computed tomography. RESULTS In T2DM, E/A and e' were significantly lower, and E/e', left atrial volume and LV mass were significantly greater than in control subjects. In multivariate liner regression analysis, VAT was an independent determinant of left atrial volume (β =0.203, p=0.011), E/A (β =-0.208, p=0.002), e' (β =-0.354, p<0.001) and E/e' (β=0.220, p=0.003). Age was also an independent determinant, whereas fasting plasma glucose and hemoglobin A1c levels were not. In addition to systolic blood pressure, waist-hip ratio (β=0.173, p=0.024) and VAT/SAT ratio (β=0.162, p=0.049) were independent determinants of LV mass. CONCLUSION Excessive visceral fat accompanied by adipocyte dysfunction may play a greater role than glycemic control in the development of diastolic dysfunction and LV hypertrophy in T2DM.
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Affiliation(s)
- Ryoko Ichikawa
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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22
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Aoki A, Murata M, Asano T, Ikoma A, Sasaki M, Saito T, Otani T, Jinbo S, Ikeda N, Kawakami M, Ishikawa SE. Association of serum osteoprotegerin with vascular calcification in patients with type 2 diabetes. Cardiovasc Diabetol 2013; 12:11. [PMID: 23302066 PMCID: PMC3558393 DOI: 10.1186/1475-2840-12-11] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/31/2012] [Indexed: 01/22/2023] Open
Abstract
Background Osteoprotegerin is a member of the tumor necrosis factor-related family and inhibits RANK stimulation of osteoclast formation as a soluble decoy receptor. The goal of this study was to determine the relationship of serum osteoprotegerin with vascular calcification in patients with type 2 diabetes. Methods The subjects were 124 patients with type 2 diabetes mellitus, including 88 males and 36 females with a mean (± SD) age of 65.6 ± 8.2 years old. Serum levels of osteoprotegerin, osteocalcin, fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D3 and adiponectin were measured by ELISA. Vascular calcification in the cervical artery was examined by ultrasound sonography. The subjects were divided into 4 quartiles depending on serum osteoprotegerin levels. Results Vascular calcification was significantly higher in the 4th quartile and significantly lower in the 1st quartile of serum osteoprotegerin levels, compared to other quartiles. There were no differences in serum osteoprotegerin and vascular calcification among patients with different stages of diabetic nephropathy, but serum FGF23 levels were elevated in those with stage 4 diabetic nephropathy. Simple regression analysis showed that serum osteoprotegerin levels had significant positive correlations with age, systolic blood pressure and serum adiponectin levels, and significant negative correlations with BMI and serum 25-hydroxyvitamin D3. Conclusions These findings suggest that elevated serum osteoprotegerin may be involved in vascular calcification independently of progression of diabetic nephropathy in patients with type 2 diabetes.
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Affiliation(s)
- Atsushi Aoki
- Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Baldasseroni S, Antenore A, Di Serio C, Orso F, Lonetto G, Bartoli N, Foschini A, Marella A, Pratesi A, Scarantino S, Fumagalli S, Monami M, Mannucci E, Marchionni N, Tarantini F. Adiponectin, diabetes and ischemic heart failure: a challenging relationship. Cardiovasc Diabetol 2012; 11:151. [PMID: 23249664 PMCID: PMC3558365 DOI: 10.1186/1475-2840-11-151] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/01/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Several peptides, named adipokines, are produced by the adipose tissue. Among those, adiponectin (AD) is the most abundant. AD promotes peripheral insulin sensitivity, inhibits liver gluconeogenesis and displays anti-atherogenic and anti-inflammatory properties. Lower levels of AD are related to a higher risk of myocardial infarction and a worse prognosis in patients with coronary artery disease. However, despite a favorable clinical profile, AD increases in relation to worsening heart failure (HF); in this context, higher adiponectinemia is reliably related to poor prognosis. There is still little knowledge about how certain metabolic conditions, such as diabetes mellitus, modulate the relationship between AD and HF.We evaluated the level of adiponectin in patients with ischemic HF, with and without type 2 diabetes, to elucidate whether the metabolic syndrome was able to influence the relationship between AD and HF. RESULTS We demonstrated that AD rises in patients with advanced HF, but to a lesser extent in diabetics than in non-diabetics. Diabetic patients with reduced systolic performance orchestrated a slower rise of AD which began only in face of overt HF. The different behavior of AD in the presence of diabetes was not entirely explained by differences in body mass index. In addition, NT-proBNP, the second strongest predictor of AD, did not differ significantly between diabetic and non-diabetic patients. These data indicate that some other mechanisms are involved in the regulation of AD in patients with type 2 diabetes and coronary artery disease. CONCLUSIONS AD rises across chronic heart failure stages but this phenomenon is less evident in type 2 diabetic patients. In the presence of diabetes, the progressive increase of AD in relation to the severity of LV dysfunction is hampered and becomes evident only in overt HF.
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Affiliation(s)
- Samuele Baldasseroni
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Alessandro Antenore
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Claudia Di Serio
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Francesco Orso
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Giuseppe Lonetto
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Nadia Bartoli
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Alice Foschini
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Andrea Marella
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Alessandra Pratesi
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Salvatore Scarantino
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Stefano Fumagalli
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Matteo Monami
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Edoardo Mannucci
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Niccolò Marchionni
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
| | - Francesca Tarantini
- Department of Critical Care Medicine and Surgery, Geriatric Medicine Unit, University of Florence, Florence, Italy
- Department of Heart and Vessels, Geriatric Cardiology and Medicine Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Viale Morgagni 85, 50134, Florence, Italy
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Caselli C, Lionetti V, Cabiati M, Prescimone T, Aquaro GD, Ottaviano V, Bernini F, Mattii L, Del Ry S, Giannessi D. Regional evidence of modulation of cardiac adiponectin level in dilated cardiomyopathy: pilot study in a porcine animal model. Cardiovasc Diabetol 2012; 11:143. [PMID: 23164042 PMCID: PMC3537584 DOI: 10.1186/1475-2840-11-143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 11/07/2012] [Indexed: 12/30/2022] Open
Abstract
Background The role of systemic and myocardial adiponectin (ADN) in dilated cardiomyopathy is still debated. We tested the regulation of both systemic and myocardial ADN and the relationship with AMP-activated protein kinase (AMPK) activity in a swine model of non-ischemic dilated cardiomyopathy. Methods and results Cardiac tissue was collected from seven instrumented adult male minipigs by pacing the left ventricular (LV) free wall (180 beats/min, 3 weeks), both from pacing (PS) and opposite sites (OS), and from five controls. Circulating ADN levels were inversely related to global and regional cardiac function. Myocardial ADN in PS was down-regulated compared to control (p < 0.05), yet ADN receptor 1 was significantly up-regulated (p < 0.05). No modifications of AMPK were observed in either region of the failing heart. Similarly, myocardial mRNA levels of PPARγ, PPARα, TNFα, iNOS were unchanged compared to controls. Conclusions Paradoxically, circulating ADN did not show any cardioprotective effect, confirming its role as negative prognostic biomarker of heart failure. Myocardial ADN was reduced in PS compared to control in an AMPK-independent fashion, suggesting the occurrence of novel mechanisms by which reduced cardiac ADN levels may regionally mediate the decline of cardiac function.
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Affiliation(s)
- Chiara Caselli
- Consiglio Nazionale delle Ricerche (CNR), Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
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Biomarkers and their involvement in the early diagnosis of right ventricular dysfunction in type 2 Diabetes Mellitus. J Med Life 2012; 5:74-8. [PMID: 22574090 PMCID: PMC3307083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/08/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE During the last years, left ventricular dysfunction in diabetes was intensely studied and it is recognized as a complication of diabetes, while data regarding the right ventricular dysfunction is still incomplete. The aim of this study was to find a correlation between inflammatory biomarkers, adiponectin and right ventricular strain and strain rate properties in patients with diabetes mellitus type 2. METHODS We studied 29 patients with type 2 diabetes mellitus (DM), with coexisting cardiovascular complications, coronary artery disease and high blood pressure (group 1- DM+CV, aged 61.2 ± 4.2 years); and 22 patients with type 2 diabetes and controlled high blood pressure only, with no other coexisting cardiovascular complications (group 2- DM, aged 60.86 ± 4.4 years). We evaluated the right ventricular (rv) function through vector velocity imaging (vvi)and determined the inflammatory profile through assessment of the following biomarkers: high sensitivity C- reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-alfa), lipoprotein associated phospholipase A2 (Lp-PLA2) and adiponectin level for each patient. RESULTS VVI revealed significantly lower values of systolic strain and strain rates (SR) in the basal segment of the RV free wall in group I patients (DM+CV) as compared to group II patients (DM) which indicates higher impairment of RV systolic function in patients with diabetes and other cardiovascular complications. In both groups strain and strain rate values were correlated with Lp-PLA2 activity levels. CONCLUSIONS In Type 2 diabetes mellitus we identified a low-grade inflammatory status correlated with right ventricular systolic dysfunction.
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