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Abel N, Schupp T, Schmitt A, Reinhardt M, Lau F, Weidner K, Ayoub M, Mashayekhi K, Akin I, Behnes M. Left ventricular diastolic dysfunction in patients with heart failure with mildly reduced ejection fraction. Int J Cardiol 2024; 414:132386. [PMID: 39079587 DOI: 10.1016/j.ijcard.2024.132386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE This study investigates the prevalence and prognostic impact of diastolic dysfunction (DD) in patients hospitalized with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) in sinus rhythm. BACKGROUND Data regarding the prognostic impact of DD in patients with HFmrEF is limited. METHODS From 2016 to 2022, all patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution. Patients with DD were compared to patients without (i.e., non-DD), further risk stratification was performed according to the severity of DD. The primary endpoint was all-cause mortality at 30 months (interquartile range (IQR) 15-61 months), key secondary endpoint was rehospitalization for worsening HF. RESULTS From a total of 1154 patients (median age 68 years, 68% males) hospitalized with HFmrEF, concomitant DD was present in 72% (grade I: 56%, grade II: 14%, grade III: 2%). Patients with DD were older (71 years vs. 65 years; p = 0.001) and presented with higher rates of cardiovascular comorbidities. The presence of DD was not associated with the risk of long-term all-cause mortality (adjusted HR = 0.815; 95% CI 0.612-1.085; p = 0.161) or HF-related rehospitalization (adjusted HR = 0.736; 95% CI 0.442-1.225; p = 0.238). Furthermore, the outcome did not differ in patients with more advanced stages of DD. CONCLUSION DD is commonly prevalent in patients with HFmrEF, but not associated with long-term prognosis.
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Affiliation(s)
- Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen 32545, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Centre Lahr, Lahr 77933, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
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Simats A, Zhang S, Messerer D, Chong F, Beşkardeş S, Chivukula AS, Cao J, Besson-Girard S, Montellano FA, Morbach C, Carofiglio O, Ricci A, Roth S, Llovera G, Singh R, Chen Y, Filser S, Plesnila N, Braun C, Spitzer H, Gokce O, Dichgans M, Heuschmann PU, Hatakeyama K, Beltrán E, Clauss S, Bonev B, Schulz C, Liesz A. Innate immune memory after brain injury drives inflammatory cardiac dysfunction. Cell 2024:S0092-8674(24)00702-5. [PMID: 39043180 DOI: 10.1016/j.cell.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 04/22/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
The medical burden of stroke extends beyond the brain injury itself and is largely determined by chronic comorbidities that develop secondarily. We hypothesized that these comorbidities might share a common immunological cause, yet chronic effects post-stroke on systemic immunity are underexplored. Here, we identify myeloid innate immune memory as a cause of remote organ dysfunction after stroke. Single-cell sequencing revealed persistent pro-inflammatory changes in monocytes/macrophages in multiple organs up to 3 months after brain injury, notably in the heart, leading to cardiac fibrosis and dysfunction in both mice and stroke patients. IL-1β was identified as a key driver of epigenetic changes in innate immune memory. These changes could be transplanted to naive mice, inducing cardiac dysfunction. By neutralizing post-stroke IL-1β or blocking pro-inflammatory monocyte trafficking with a CCR2/5 inhibitor, we prevented post-stroke cardiac dysfunction. Such immune-targeted therapies could potentially prevent various IL-1β-mediated comorbidities, offering a framework for secondary prevention immunotherapy.
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Affiliation(s)
- Alba Simats
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Cerebrovascular Research Laboratory, Institute of Biomedical Research of Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona, Spain
| | - Sijia Zhang
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Denise Messerer
- Medizinische Klinik und Poliklinik I, University Hospital, LMU Munich, Munich, Germany
| | - Faye Chong
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
| | - Sude Beşkardeş
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
| | | | - Jiayu Cao
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Simon Besson-Girard
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Felipe A Montellano
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, Julius-Maximilian-University Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Olga Carofiglio
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Alessio Ricci
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Stefan Roth
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Gemma Llovera
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Rashween Singh
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Yiming Chen
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Severin Filser
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Christian Braun
- Institute of Legal Medicine, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Hannah Spitzer
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Ozgun Gokce
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Sites Munich and Bonn, Germany; Department of Old Age Psychiatry and cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Sites Munich and Bonn, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilian-University Würzburg, Würzburg, Germany; Institute for Medical Data Sciences, University Hospital Würzburg, Würzburg, Germany; Clinical Trial Centre Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Eduardo Beltrán
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany; Biomedical Center (BMC), Faculty of Medicine, LMU Munich, Martinsried, Germany
| | - Sebastian Clauss
- Medizinische Klinik und Poliklinik I, University Hospital, LMU Munich, Munich, Germany; Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany; Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Munich, Germany
| | - Boyan Bonev
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Physiological Genomics, Biomedical Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Schulz
- Medizinische Klinik und Poliklinik I, University Hospital, LMU Munich, Munich, Germany; Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany; Department of Immunopharmacology, Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arthur Liesz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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3
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Henry JP, Carlier F, Higny J, Benoit M, Xhaët O, Blommaert D, Telbis AM, Robaye B, Gabriel L, Guedes A, Michaux I, Demeure F, Luchian ML. Impact of Pre-Transplant Left Ventricular Diastolic Pressure on Primary Graft Dysfunction after Lung Transplantation: A Narrative Review. Diagnostics (Basel) 2024; 14:1340. [PMID: 39001230 PMCID: PMC11240543 DOI: 10.3390/diagnostics14131340] [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: 05/29/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Lung transplantation (LT) constitutes the last therapeutic option for selected patients with end-stage respiratory disease. Primary graft dysfunction (PGD) is a form of severe lung injury, occurring in the first 72 h following LT and constitutes the most common cause of early death after LT. The presence of pulmonary hypertension (PH) has been reported to favor PGD development, with a negative impact on patients' outcomes while complicating medical management. Although several studies have suggested a potential association between pre-LT left ventricular diastolic dysfunction (LVDD) and PGD occurrence, the underlying mechanisms of such an association remain elusive. Importantly, the heterogeneity of the study protocols and the various inclusion criteria used to define the diastolic dysfunction in those patients prevents solid conclusions from being drawn. In this review, we aim at summarizing PGD mechanisms, risk factors, and diagnostic criteria, with a further focus on the interplay between LVDD and PGD development. Finally, we explore the predictive value of several diastolic dysfunction diagnostic parameters to predict PGD occurrence and severity.
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Affiliation(s)
- Jean Philippe Henry
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - François Carlier
- Department of Pneumology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium;
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Alin-Mihail Telbis
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Isabelle Michaux
- Department of Intensive Care, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium;
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
| | - Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium; (J.H.); (M.B.); (O.X.); (D.B.); (A.-M.T.); (B.R.); (L.G.); (A.G.); (F.D.); (M.-L.L.)
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4
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Cadour F, Cour A, Senlis J, Rapacchi S, Chennoufi H, Michelin P, McQuade C, Demeyere M, Dacher JN. How to use MRI in cardiac disease with diastolic dysfunction? Br J Radiol 2024; 97:1203-1213. [PMID: 38574383 PMCID: PMC11186565 DOI: 10.1093/bjr/tqae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/14/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Left ventricular (LV) diastolic dysfunction (DD) is an initially asymptomatic condition that can progress to heart failure, either with preserved or reduced ejection fraction. As such, DD is a growing public health problem. Impaired relaxation, the first stage of DD, is associated with altered LV filling. With progression, reducing LV compliance leads to restrictive cardiomyopathy. While cardiac magnetic resonance (CMR) imaging is the reference for LV systolic function assessment, transthoracic echocardiography (TTE) with Doppler flow measurements remains the standard for diastolic function assessment. Rather than simply replicating TTE measurements, CMR should complement and further advance TTE findings. We provide herein a step-by-step review of CMR findings in DD as well as imaging features which may help identify the underlying cause.
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Affiliation(s)
- Farah Cadour
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
- UNIROUEN, Inserm U1096, UFR Médecine Pharmacie, Rouen 76000, France
| | - Adrien Cour
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Jules Senlis
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Stanislas Rapacchi
- Aix-Marseille University, CNRS, CRMBM, Marseille 13005, France
- APHM, CHU Timone, CEMEREM, Marseille 13005, France
| | - Hajer Chennoufi
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Paul Michelin
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Colin McQuade
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Matthieu Demeyere
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Jean-Nicolas Dacher
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
- UNIROUEN, Inserm U1096, UFR Médecine Pharmacie, Rouen 76000, France
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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Aggarwal R, Potel KN, Jackson S, Lemke NT, Kelly RF, Soule M, Diaz-Gutierrez I, Shumway SJ, Patil J, Hertz M, Nijjar PS, Huddleston SJ. Impact of lung transplantation on diastolic dysfunction in recipients with pretransplant pulmonary hypertension. J Thorac Cardiovasc Surg 2024; 167:1643-1653.e2. [PMID: 37741317 DOI: 10.1016/j.jtcvs.2023.09.031] [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: 05/05/2023] [Revised: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Pulmonary hypertension can cause left ventricular diastolic dysfunction through ventricular interdependence. Moreover, diastolic dysfunction has been linked to adverse outcomes after lung transplant. The impact of lung transplant on diastolic dysfunction in recipients with pretransplant pulmonary hypertension is not defined. In this cohort, we aimed to assess the prevalence of diastolic dysfunction, the change in diastolic dysfunction after lung transplant, and the impact of diastolic dysfunction on lung transplant outcomes. METHODS In a large, single-center database from January 2011 to September 2021, single or bilateral lung transplant recipients with pulmonary hypertension (mean pulmonary artery pressure > 20 mm Hg) were retrospectively identified. Those without a pre- or post-transplant echocardiogram within 1 year were excluded. Diastolic dysfunction was diagnosed and graded according to the American Society of Echocardiography 2016 guideline on assessment of diastolic dysfunction (present, absent, indeterminate). McNemar's test was used to examine association between diastolic dysfunction pre- and post-transplant. Kaplan-Meier and Cox regression analysis were used to assess associations between pre-lung transplant diastolic dysfunction and post-lung transplant 1-year outcomes, including mortality, major adverse cardiac events, and bronchiolitis obliterans syndrome grade 1 or higher-free survival. RESULTS Of 476 primary lung transplant recipients, 205 with pulmonary hypertension formed the study cohort (mean age, 56.6 ± 11.9 years, men 61.5%, mean pulmonary artery pressure 30.5 ± 9.8 mm Hg, left ventricular ejection fraction < 55% 9 [4.3%]). Pretransplant, diastolic dysfunction was present in 93 patients (45.4%) (grade I = 8, II = 84, III = 1), absent in 16 patients (7.8%), and indeterminate in 89 patients (43.4%), and 7 patients (3.4%) had missing data. Post-transplant, diastolic dysfunction was present in 7 patients (3.4%) (grade I = 2, II = 5, III = 0), absent in 164 patients (80.0%), and indeterminate in 15 patients (7.3%), and 19 patients (9.3%) had missing data. For those with diastolic dysfunction grades in both time periods (n = 180), there was a significant decrease in diastolic dysfunction post-transplant (148/169 patients with resolved diastolic dysfunction; McNemar's test P < .001). Pretransplant diastolic dysfunction was not associated with major adverse cardiac events (hazard ratio [HR], 1.08, 95% CI, 0.72-1.62; P = .71), bronchiolitis obliterans syndrome-free survival (HR, 0.67, 95% CI, 0.39-1.56; P = .15), or mortality (HR, 0.70, 95% CI, 0.33-1.46; P = .34) at 1 year. CONCLUSIONS Diastolic dysfunction is highly prevalent in lung transplant candidates with normal left ventricular systolic function and pulmonary hypertension, and resolves in most patients after lung transplant regardless of patient characteristics. Pre-lung transplant diastolic dysfunction was not associated with adverse lung or cardiac outcomes after lung transplant. Collectively, these findings suggest that the presence of diastolic dysfunction in lung transplant recipients with pulmonary hypertension has no prognostic significance, and as such diastolic dysfunction and the associated clinical syndrome of heart failure with preserved ejection fraction should not be considered a relative contraindication to lung transplant in such patients.
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Affiliation(s)
- Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Koray N Potel
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Scott Jackson
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minn
| | - Nicholas T Lemke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Rosemary F Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Matthew Soule
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Ilitch Diaz-Gutierrez
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Sara J Shumway
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Jagadish Patil
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Stephen J Huddleston
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn.
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7
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Xiang J, Lamy J, Qiu M, Galiana G, Peters DC. K-t PCA accelerated in-plane balanced steady-state free precession phase-contrast (PC-SSFP) for all-in-one diastolic function evaluation. Magn Reson Med 2024; 91:911-925. [PMID: 37927206 PMCID: PMC10803002 DOI: 10.1002/mrm.29897] [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: 05/31/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Diastolic function evaluation requires estimates of early and late diastolic mitral filling velocities (E and A) and of mitral annulus tissue velocity (e'). We aimed to develop an MRI method for simultaneous all-in-one diastolic function evaluation in a single scan by generating a 2D phase-contrast (PC) sequence with balanced steady-state free precession (bSSFP) contrast (PC-SSFP). E and A could then be measured with PC, and e' estimated by valve tracking on the magnitude images, using an established deep learning framework. METHODS Our PC-SSFP used in-plane flow-encoding, with zeroth and first moment nulling over each TR. For further acceleration, different k-t principal component analysis (PCA) methods were investigated with both retrospective and prospective undersampling. PC-SSFP was compared to separate balanced SSFP cine and PC-gradient echo acquisitions in phantoms and in 10 healthy subjects. RESULTS Phantom experiments showed that PC-SSFP measured accurate velocities compared to PC-gradient echo (r = 0.98 for a range of pixel-wise velocities -80 cm/s to 80 cm/s). In subjects, PC-SSFP generated high SNR and myocardium-blood contrast, and excellent agreement for E (limits of agreement [LOA] 0.8 ± 2.4 cm/s, r = 0.98), A (LOA 2.5 ± 4.1 cm/s, r = 0.97), and e' (LOA 0.3 ± 2.6 cm/s, r = 1.00), versus the standard methods. The best k-t PCA approach processed the complex difference data and substituted in raw k-space data. With prospective k-t PCA acceleration, higher frame rates were achieved (50 vs. 25 frames per second without k-t PCA), yielding a 13% higher e'. CONCLUSION The proposed PC-SSFP method achieved all-in-one diastolic function evaluation.
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Affiliation(s)
- Jie Xiang
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | - Jerome Lamy
- Université de Paris, Cardiovascular Research Center, INSERM, 75015 Paris, France
| | - Maolin Qiu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Gigi Galiana
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Dana C. Peters
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
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8
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Ahlers CG, Patel P, Parikh K, Fudim M. Use of invasive cardiopulmonary exercise testing to diagnose preload reserve failure in patients with liver disease. ESC Heart Fail 2024; 11:587-593. [PMID: 38012064 PMCID: PMC10804147 DOI: 10.1002/ehf2.14598] [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: 05/01/2023] [Revised: 10/02/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
In this case series, we describe the use of invasive cardiopulmonary exercise testing (iCPET) to diagnose heart failure due to preload reserve failure in two patients with progressive dyspnoea. We demonstrate that underlying liver disease contributes to preload reserve failure as a cause of exertional dysfunction. In liver diseases such as non-alcoholic fatty liver disease (NAFLD), fibrotic changes to the sinusoidal liver architecture occur leading to an increased transhepatic sinusoidal pressure gradient. Even at the earliest stage of hepatic fibrosis in patients with NAFLD, changes in hepatic blood flow are seen due to outflow block in the sinusoidal area. In this way, changes to the sinusoidal liver architecture can lead to limitations in preload reserve. This case series describes two patients with exertional dyspnoea found to have preload failure on iCPET due to underlying liver disease.
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Affiliation(s)
| | - Priyesh Patel
- Atrium Health Sanger Heart and Vascular InstituteConcordNCUSA
| | - Kishan Parikh
- Department of MedicineDuke University HospitalDurhamNCUSA
- Duke Clinical Research InstituteDurhamNCUSA
| | - Marat Fudim
- Department of MedicineDuke University HospitalDurhamNCUSA
- Duke Clinical Research InstituteDurhamNCUSA
- Department of CardiologyUniversity of WrocławWrocławPoland
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9
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Salyer LG, Salhi HE, Brundage EA, Shettigar V, Sturgill SL, Zanella H, Templeton B, Abay E, Emmer KM, Lowe J, Rafael-Fortney JA, Parinandi N, Foster DB, McKinsey TA, Woulfe KC, Ziolo MT, Biesiadecki BJ. Troponin I Tyrosine Phosphorylation Beneficially Accelerates Diastolic Function. Circ Res 2024; 134:33-45. [PMID: 38095088 PMCID: PMC10872382 DOI: 10.1161/circresaha.123.323132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND A healthy heart is able to modify its function and increase relaxation through post-translational modifications of myofilament proteins. While there are known examples of serine/threonine kinases directly phosphorylating myofilament proteins to modify heart function, the roles of tyrosine (Y) phosphorylation to directly modify heart function have not been demonstrated. The myofilament protein TnI (troponin I) is the inhibitory subunit of the troponin complex and is a key regulator of cardiac contraction and relaxation. We previously demonstrated that TnI-Y26 phosphorylation decreases calcium-sensitive force development and accelerates calcium dissociation, suggesting a novel role for tyrosine kinase-mediated TnI-Y26 phosphorylation to regulate cardiac relaxation. Therefore, we hypothesize that increasing TnI-Y26 phosphorylation will increase cardiac relaxation in vivo and be beneficial during pathological diastolic dysfunction. METHODS The signaling pathway involved in TnI-Y26 phosphorylation was predicted in silico and validated by tyrosine kinase activation and inhibition in primary adult murine cardiomyocytes. To investigate how TnI-Y26 phosphorylation affects cardiac muscle, structure, and function in vivo, we developed a novel TnI-Y26 phosphorylation-mimetic mouse that was subjected to echocardiography, pressure-volume loop hemodynamics, and myofibril mechanical studies. TnI-Y26 phosphorylation-mimetic mice were further subjected to the nephrectomy/DOCA (deoxycorticosterone acetate) model of diastolic dysfunction to investigate the effects of increased TnI-Y26 phosphorylation in disease. RESULTS Src tyrosine kinase is sufficient to phosphorylate TnI-Y26 in cardiomyocytes. TnI-Y26 phosphorylation accelerates in vivo relaxation without detrimental structural or systolic impairment. In a mouse model of diastolic dysfunction, TnI-Y26 phosphorylation is beneficial and protects against the development of disease. CONCLUSIONS We have demonstrated that tyrosine kinase phosphorylation of TnI is a novel mechanism to directly and beneficially accelerate myocardial relaxation in vivo.
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Affiliation(s)
- Lorien G Salyer
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Hussam E Salhi
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Elizabeth A Brundage
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Vikram Shettigar
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Sarah L Sturgill
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Helena Zanella
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Benjamin Templeton
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Eaman Abay
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Kathryn M Emmer
- University Laboratory Animal Resources (K.M.E.), Ohio State University, Columbus
| | - Jeovanna Lowe
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Jill A Rafael-Fortney
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Narasimham Parinandi
- Division of Pulmonary, Critical Care and Sleep Medicine (N.P.), Ohio State University, Columbus
| | - D Brian Foster
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD (D.B.F.)
| | - Timothy A McKinsey
- Department of Medicine, Division of Cardiology (T.A.M., K.C.W.), University of Colorado Anschutz Medical Campus, Aurora
- Consortium for Fibrosis Research and Translation (T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Kathleen C Woulfe
- Department of Medicine, Division of Cardiology (T.A.M., K.C.W.), University of Colorado Anschutz Medical Campus, Aurora
| | - Mark T Ziolo
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
| | - Brandon J Biesiadecki
- Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute (L.G.S., H.E.S., E.A.B., V.S., S.L.S., H.Z., B.T., E.A., J.L., J.A.R.-F., M.T.Z., B.J.B.), Ohio State University, Columbus
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10
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Rajanathan R, Riera CVI, Pedersen TM, Staehr C, Bouzinova EV, Nyengaard JR, Thomsen MB, Bøtker HE, Matchkov VV. Hypercontractile Cardiac Phenotype in Mice with Migraine-Associated Mutation in the Na +,K +-ATPase α 2-Isoform. Cells 2023; 12:cells12081108. [PMID: 37190017 DOI: 10.3390/cells12081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Two α-isoforms of the Na+,K+-ATPase (α1 and α2) are expressed in the cardiovascular system, and it is unclear which isoform is the preferential regulator of contractility. Mice heterozygous for the familial hemiplegic migraine type 2 (FHM2) associated mutation in the α2-isoform (G301R; α2+/G301R mice) have decreased expression of cardiac α2-isoform but elevated expression of the α1-isoform. We aimed to investigate the contribution of the α2-isoform function to the cardiac phenotype of α2+/G301R hearts. We hypothesized that α2+/G301R hearts exhibit greater contractility due to reduced expression of cardiac α2-isoform. Variables for contractility and relaxation of isolated hearts were assessed in the Langendorff system without and in the presence of ouabain (1 µM). Atrial pacing was performed to investigate rate-dependent changes. The α2+/G301R hearts displayed greater contractility than WT hearts during sinus rhythm, which was rate-dependent. The inotropic effect of ouabain was more augmented in α2+/G301R hearts than in WT hearts during sinus rhythm and atrial pacing. In conclusion, cardiac contractility was greater in α2+/G301R hearts than in WT hearts under resting conditions. The inotropic effect of ouabain was rate-independent and enhanced in α2+/G301R hearts, which was associated with increased systolic work.
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Affiliation(s)
| | - Clàudia Vilaseca I Riera
- Department of Basic Science, School of Medicine and Health Sciences, International University of Catalonia, 08195 Barcelona, Spain
| | | | - Christian Staehr
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | | | - Jens Randel Nyengaard
- Department of Clinical Medicine, Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, 8000 Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Morten B Thomsen
- Biomedical Sciences, University of Copenhagen, 1168 Copenhagen, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
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11
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Radike M, Sutelman P, Ben-Aicha S, Gutiérrez M, Mendieta G, Alcover S, Casaní L, Arderiu G, Borrell-Pages M, Padró T, Badimon L, Vilahur G. A comprehensive and longitudinal cardiac magnetic resonance imaging study of the impact of coronary ischemia duration on myocardial damage in a highly translatable animal model. Eur J Clin Invest 2023; 53:e13860. [PMID: 35986736 DOI: 10.1111/eci.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We performed a comprehensive assessment of the effect of myocardial ischemia duration on cardiac structural and functional parameters by serial cardiac magnetic resonance (CMR) and characterized the evolving scar. BACKGROUND CMR follow-up on the cardiac impact of time of ischemia in a closed-chest animal model of myocardial infarction with human resemblance is missing. METHODS Pigs underwent MI induction by occlusion of the left anterior descending (LAD) coronary artery for 30, 60, 90 or 120 min and then revascularized. Serial CMR was performed on day 3 and day 42 post-MI. CMR measurements were also run in a sham-operated group. Cellular and molecular changes were investigated. RESULTS On day 3, cardiac damage and function were similar in sham and pigs subjected to 30 min of ischemia. Cardiac damage (oedema and necrosis) significantly increased from 60 min onwards. Microvascular obstruction was extensively seen in animals with ≥90 min of ischemia and correlated with cardiac damage. A drop in global systolic function and wall motion of the jeopardized segments was seen in pigs subjected to ≥60 min of ischemia. On day 42, scar size and cardiac dysfunction followed the same pattern in the animals subjected to ≥60 min of ischemia. Adverse left ventricular remodelling (worsening of both LV volumes) was only present in animals subjected to 120 min of ischemia. Cardiac fibrosis, myocyte hypertrophy and vessel rarefaction were similar in the infarcted myocardium of pigs subjected to ≥60 min of ischemia. No changes were observed in the remote myocardium. CONCLUSION Sixty-minute LAD coronary occlusion already induces cardiac structural and functional alterations with longer ischemic time (120 min) causing adverse LV remodelling.
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Affiliation(s)
- Monika Radike
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Pablo Sutelman
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Soumaya Ben-Aicha
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Gutiérrez
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Guiomar Mendieta
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sebastià Alcover
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Casaní
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Arderiu
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Borrell-Pages
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Padró
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
| | - Lina Badimon
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain.,Cardiovascular Research Chair UAB, Barcelona, Spain
| | - Gemma Vilahur
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
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12
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Wu J, Wang J, Wang Y, Fan W, Li H, Wu H. Echocardiography E/A Abnormality is Associated with the Development of Primary Left Ventricle Remodeling in Middle-Aged and Elderly Women: A Longitudinal Study. Clin Interv Aging 2023; 18:629-638. [PMID: 37096218 PMCID: PMC10122471 DOI: 10.2147/cia.s399996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/02/2023] [Indexed: 04/26/2023] Open
Abstract
Background Impaired left ventricular (LV) relaxation is indicative of grade I diastolic dysfunction, which is mainly assessed by late diastolic transmitral flow velocity (E/A ratio). Although the E/A ratio has important diagnostic and prognostic implications with cardiac outcomes, the causal link between abnormal E/A ratio and left ventricle remodeling (LV remodeling) remains unclear. Methods A longitudinal analysis of 869 eligible women aged ≥45 years, who had received echocardiography scans as well as 5-year follow-up assessments between 2015 and 2020. Women with pre-existing cardiac abnormalities including grade II/III diastolic dysfunction as diagnosed by echocardiography, or structural heart disease were excluded. E/A abnormality was defined as baseline E/A ratio <0.8. The classification of LV remodeling was based on the measurements of left ventricular mass index (LVMI) and relative wall thickness (RWT). Logistic and linear regression models were used. Results Among the 869 women (60.71±10.01 years), 164 (18.9%) had developed LV remodeling after the 5-year follow-up. The proportion of women with E/A abnormality versus non-abnormality was also significantly different (27.13% vs 16.59%, P=0.007). Multivariable-adjusted regression models showed that E/A abnormality (OR: 4.14, 95%Cl:1.80-9.20, P=0.009) was significantly associated with higher risk of concentric hypertrophy (CH) after follow-up. No such association was found in either concentric remodeling (CR) or eccentric hypertrophy (EH). Higher baseline E/A ratio was correlated with lower ΔRWT during the 5-year follow-up (β=-0.006 m/s, 95% CI: -0.012 to -0.002, P=0.025), which was independent of demographics and biological factors. Conclusion E/A abnormality is associated with a higher risk of CH. Higher baseline E/A ratio may be associated with decreased relative changes in RWT.
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Affiliation(s)
- Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jiaqi Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yiyan Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wenjing Fan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Husheng Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Correspondence: Hengjing Wu, Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, 2209 Xing Guang Road, Shanghai, 201613, People’s Republic of China, Tel +8615821525700, Email
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13
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Shin J, Suh SW. Influence of fluid balance on postoperative outcomes after hepatic resection in patients with left ventricular diastolic dysfunction. Front Surg 2022; 9:1036850. [PMID: 36468074 PMCID: PMC9709119 DOI: 10.3389/fsurg.2022.1036850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/31/2022] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE The maintenance of low central venous pressure (CVP) during hepatic resection is associated with a reduction in estimated blood loss. After completion of the hepatic parenchymal transection, fluid is rapidly administered to replace the surgical blood loss and fluid deficit to prevent subsequent organ injury risk. However, this perioperative fluid strategy may influence on the postoperative outcomes of patients with left ventricular diastolic dysfunction (LVDD) who cannot tolerate volume adjustment. METHOD A total of 206 patients with who underwent hepatic resection between March 2015 and February 2021 were evaluated. LVDD was defined according to the American Society of Echocardiography and the European Association of Cardiovascular Imaging 2016 recommendations as LVDD (group A, n = 39), or normal LV diastolic function and indeterminate decision (group B, n = 153). We compared the clinical outcomes of patients between two groups, and then analyzed the risk factors for postoperative complications. RESULT Postoperative acute kidney injury (AKI, 10.3% vs. 1.3%, P = 0.004) and pleural effusion or edema (51.3% vs. 30.1%, P = 0.013) were more common in group A than in group B. Further, creatinine levels from postoperative day 1 to day 7 were significantly higher and daily urine outputs at postoperative day 1 (P = 0.038) and day 2 (P = 0.025) were significantly lower in group A than in group B. LVDD was the only significant risk factor for postoperative AKI after hepatic resection (odds ratio, 10.181; 95% confidence interval, 1.570-66.011, P = 0.015). CONCLUSIONS The rates of renal dysfunction and pulmonary complications after hepatic resection are higher in patients with LVDD than in those with normal LV diastolic function. Thus, these patients require individualized fluid management.
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Affiliation(s)
- Jungho Shin
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Suk-Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
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14
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Woldeyes E, Fisseha H, Mulatu HA, Ephrem A, Benti H, Alem MW, Ahmed AI. Echocardiographic findings and associated factors in HIV-infected patients at a tertiary hospital in Ethiopia. Medicine (Baltimore) 2022; 101:e30081. [PMID: 35984157 PMCID: PMC9387985 DOI: 10.1097/md.0000000000030081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Noncommunicable diseases including cardiovascular diseases are becoming an important part of human immunodeficiency virus (HIV) care. Echocardiography is a useful noninvasive tool to assess cardiac disease and different echocardiographic abnormalities have been seen previously. The aim of this study was to investigate the echocardiographic abnormalities in HIV-infected patients and factors associated with the findings. A cross-sectional study was conducted on 285 patients with HIV infection including collection of clinical and echocardiographic data. Logistic regression was used to examine the association between echocardiographic abnormalities and associated factors with variables with a P value of <.05 in the multivariate model considered statistically significant. Diastolic dysfunction was the most common abnormality seen in 30% of the participants followed by ischemic heart disease (19.3%), left ventricular hypertrophy (10.2%), enlarged left atrium (8.1%), pulmonary hypertension (3.6%), and pericardial effusion (2.1%). Diastolic dysfunction was independently associated with increasing age, elevated blood pressure, and left ventricular hypertrophy while ischemic heart disease was associated with male gender, increasing age, and abnormal fasting blood glucose. Left ventricular hypertrophy was associated with increasing age and blood pressure and the later was associated with left atrial enlargement. The level of immunosuppression did not affect echocardiography findings. A high prevalence of echocardiographic abnormalities was found. Male gender, age >50 years, elevated blood pressure, and elevated fasting blood glucose were associated with echocardiographic abnormalities. Appropriate follow-up and treatment of echocardiographic abnormalities is needed.
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Affiliation(s)
- Esubalew Woldeyes
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Fisseha
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- *Correspondence: Henok Fisseha, Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Swaziland Street, 1000 Addis Ababa, Ethiopia (e-mail: )
| | - Hailu Abera Mulatu
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abiy Ephrem
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Benti
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mehari Wale Alem
- Department of Neurosurgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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15
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Gangitano E, Barbaro G, Susi M, Rossetti R, Spoltore ME, Masi D, Tozzi R, Mariani S, Gnessi L, Lubrano C. Growth Hormone Secretory Capacity Is Associated with Cardiac Morphology and Function in Overweight and Obese Patients: A Controlled, Cross-Sectional Study. Cells 2022; 11:cells11152420. [PMID: 35954264 PMCID: PMC9367721 DOI: 10.3390/cells11152420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 12/10/2022] Open
Abstract
Obesity is associated with increased cardiovascular morbidity. Adult patients with growth hormone deficiency (GHD) show morpho-functional cardiological alterations. A total of 353 overweight/obese patients are enrolled in the period between 2009 and 2019 to assess the relationships between GH secretory capacity and the metabolic phenotype, cardiovascular risk factors, body composition and cardiac echocardiographic parameters. All patients underwent GHRH + arginine test to evaluate GH secretory capacity, DEXA for body composition assessment and transthoracic echocardiography. Blood samples are also collected for the evaluation of metabolic parameters. In total, 144 patients had GH deficiency and 209 patients had normal GH secretion. In comparing the two groups, we found significant differences in body fat distribution with predominantly visceral adipose tissue accumulation in GHD patients. Metabolic syndrome is more prevalent in the GHD group. In particular, fasting glycemia, triglycerides and systolic and diastolic blood pressure are found to be linearly correlated with GH secretory capacity. Epicardial fat thickness, E/A ratio and indexed ventricular mass are worse in the GHD group. In the population studied, metabolic phenotype, body composition, cardiovascular risk factors and cardiac morphology are found to be related to the GH secretory capacity. GH secretion in the obese patient seems to be an important determinant of metabolic health.
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Affiliation(s)
- Elena Gangitano
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Giuseppe Barbaro
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Susi
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rebecca Rossetti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Elena Spoltore
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Davide Masi
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rossella Tozzi
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Stefania Mariani
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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16
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Iyengar-Kapuganti RL, Maceda CS, Croft LB, Sawit ST, Crowley LE, Woodward M, McLaughlin MA. Obstructive sleep apnoea and left ventricular diastolic dysfunction among first responders to the 9/11 World Trade Center terrorist attack: a cross-sectional study. BMJ Open 2022; 12:e058366. [PMID: 35440460 PMCID: PMC9020304 DOI: 10.1136/bmjopen-2021-058366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA) is often linked to cardiovascular disease. A limited number of studies have reported an association between OSA and left ventricular diastolic dysfunction (LVDD). However, prior studies were performed on small patient populations. Studies have shown a high prevalence of OSA among first responders to the 9/11 World Trade Center (WTC) terrorist attack. We investigated the relationship between OSA and LVDD in a large population of WTC responders. DESIGN Cross-sectional study. SETTING One-time screening programme as part of the WTC-CHEST Study (NCT10466218), performed at a quaternary medical centre in New York City, from November 2011 to June 2014. PARTICIPANTS A total of 1007 participants with mean age of 51 years of mostly non-Hispanic white men were evaluated. Patients from the WTC Health Program-Clinical Center of Excellence, who were over the age of 39 years, were eligible to participate. RESULTS Evaluation of those without OSA diagnosis showed no significant association with LVDD when comparing those screened (Berlin Questionnaire) as OSA high risk versus OSA low risk (p=0.101). Among those diagnosed with LVDD, there was a significant association when comparing those with and without patient-reported OSA (OR 1.50, 95% CI 1.13 to 2.00, p=0.005), but the significance was not maintained after adjusting for pertinent variables (OR 1.3, 0.94 to 1.75, p=0.119). Notably, comparing those with OSA diagnosis and those low risk of OSA, the OR for LVDD was significant (1.69, 1.24 to 2.31, p=0.001), and after adjusting for waist-hip ratio, diabetes and coronary artery calcium score percentile, the relationship remained significant (OR 1.45, 1.03 to 2.04, p=0.032). CONCLUSION The strong association of OSA with LVDD in this population may inform future guidelines to recommend screening for LVDD in high-risk asymptomatic patients with OSA.
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Affiliation(s)
| | - Cynara S Maceda
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lori B Croft
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Laura E Crowley
- Department of Environmental Medicine and Public Health, Icahn Shcool of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Woodward
- Department of Medicine, The George Institute of Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medicine, The George Institute of Global Health, Imperial College of London, London, UK
| | - Mary Ann McLaughlin
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Horodinschi RN, Diaconu CC. Heart Failure and Atrial Fibrillation: Diastolic Function Differences Depending on Left Ventricle Ejection Fraction. Diagnostics (Basel) 2022; 12:diagnostics12040839. [PMID: 35453886 PMCID: PMC9027500 DOI: 10.3390/diagnostics12040839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/19/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Heart failure (HF) and atrial fibrillation (AF) are prevalent cardiovascular diseases, and their association is common. Diastolic dysfunction may be present in patients with AF and all types of HF, leading to elevated intracardiac pressures. The objective of this study was to analyze diastolic dysfunction in patients with HF and AF depending on left ventricle ejection fraction (LVEF). Material and methods: This prospective study included 324 patients with chronic HF and AF (paroxysmal, persistent, or permanent) hospitalized between January 2018 and March 2021. The inclusion criteria were age older than 18 years, diagnosis of chronic HF and AF, and available echocardiographic data. The exclusion criteria were a suboptimal echocardiographic view, other cardiac rhythms than AF, congenital heart disease, or coronavirus 2 infection. Patients were divided into three subgroups according to LVEF: subgroup 1 included 203 patients with HF with reduced ejection fraction (HFrEF) and AF (62.65%), subgroup 2 included 42 patients with HF with mildly reduced ejection fraction (HFmrEF) and AF (12.96%), and subgroup 3 included 79 patients with HF with preserved ejection fraction (HFpEF) and AF (24.38%). We performed 2D transthoracic echocardiography in all patients. Statistical analysis was performed using R software. Results: The E/e′ ratio (p = 0.0352, OR 1.9) and left atrial volume index (56.4 mL/m2 vs. 53.6 mL/m2) were higher in patients with HFrEF than in those with HFpEF. Conclusions: Patients with HFrEF and AF had more severe diastolic dysfunction and higher left ventricular filling pressures than those with HFpEF and AF.
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Affiliation(s)
- Ruxandra-Nicoleta Horodinschi
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Cardiology Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
- Correspondence: ; Tel.: +40-726-377-300
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18
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Costa BM, Mengal V, Brasil GA, Peluso AA, Treebak JT, Endlich PW, de Almeida SA, de Abreu GR. Ellagic Acid Prevents Myocardial Infarction-induced Left Ventricular Diastolic Dysfunction in Ovariectomized Rats. J Nutr Biochem 2022; 105:108990. [PMID: 35331902 DOI: 10.1016/j.jnutbio.2022.108990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/07/2022]
Abstract
Estrogen deficiency is associated with increased oxidative stress, which can contribute to left ventricular diastolic dysfunction (LVDD). We hypothesized that oral treatment with ellagic acid (EA), a potent and natural antioxidant compound, can improve MI-induced LVDD in ovariectomized rats, by reducing the formation of reactive oxygen species (ROS). Ovariectomized rats MI-induced LVDD followed by treatment with vehicle (DD) or EA (DD+EA) for 4 weeks. Non-LVDD-induced rats treated with vehicle (S) or EA (S+EA) were used as controls. Left ventricular systolic pressure: LVSP; left ventricular end-diastolic pressure: LVEDP; maximum rate of pressure rise: +dP/dt and fall: -dP/dt) were evaluated in all animals after treatment. Left ventricle superoxide anion formation was quantified in situ by fluorescence. Phospho-CAMKII, SOD2, catalase and gp91-phox abundances were evaluated by Western blot analyses. SOD and catalase activities were measured by spectrophotometry. The results showed that the LVEDP was significantly increased in both DD and DD+EA groups compared to S and S+EA. However, LVEDP in the DD+EA group was significantly decreased compared to DD, indicating an EA-mediated effect. In the DD group, superoxide production and gp91-phox protein abundance were increased while SOD2 abundance was decreased when compared to the S and S+EA groups. An increase in SOD activity was also observed in the DD+EA group. EA treatment reduced CaMKII phosphorylation in the DD+EA group compared to the DD. We concluded that EA treatment attenuated diastolic dysfunction in our experimental model, via reduction of ROS and CaMKII activity, indicating EA as a promising natural therapeutic option for cardiac dysfunction.
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Affiliation(s)
- Bruno Maia Costa
- Department of Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Vinícius Mengal
- Department of Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | | | - Antônio Augusto Peluso
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas T Treebak
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Patrick Wander Endlich
- Faculdade de Medicina do Mucuri, Multicentric Post-Graduate Program in Physiological Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG, Brazil
| | - Simone Alves de Almeida
- Department of Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil.
| | - Gláucia Rodrigues de Abreu
- Department of Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
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19
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Park J, Kang M, Ahn J, Kim MY, Choi MS, Lee YB, Kim G, Hur KY, Kim JH, Yang JH, Jin SM. Mean and Variability of Lipid Measurements and Risk for Development of Subclinical Left Ventricular Diastolic Dysfunction. Diabetes Metab J 2022; 46:286-296. [PMID: 34802217 PMCID: PMC8987686 DOI: 10.4093/dmj.2021.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Subclinical left ventricular diastolic dysfunction (LVDD) is an emerging consequence of increased insulin resistance, and dyslipidemia is one of the few correctable risk factors of LVDD. This study evaluated the role of mean and visit-to-visit variability of lipid measurements in risk of LVDD in a healthy population. METHODS This was a 3.7-year (interquartile range, 2.1 to 4.9) longitudinal cohort study including 2,817 adults (median age 55 years) with left ventricular ejection fraction >50% who underwent an annual or biannual health screening between January 2008 and July 2016. The mean, standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB), non-HDL-C, and triglycerides were obtained from three to six measurements during the 5 years preceding the first echocardiogram. RESULTS Among the 2,817 patients, 560 (19.9%) developed LVDD. The mean of no component of lipid measurements was associated with risk of LVDD. CV (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.10 to 1.67), SD (HR, 1.27; 95% CI, 1.03 to 1.57), and VIM (HR, 1.26; 95% CI, 1.03 to 1.55) of LDL-C and all the variability parameters of apoB were significantly associated with development of LVDD. The association between CV-LDL and risk of LVDD did not have significant interaction with sex, increasing/decreasing trend at baseline, or use of stain and/or lipid-modifying agents. CONCLUSION The variability of LDL-C and apoB, rather than their mean, was associated with risk for LVDD.
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Affiliation(s)
- Jiyun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mira Kang
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Mira Kang https://orcid.org/0000-0002-7842-0035 Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea E-mail:
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Min Young Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding authors: Sang-Man Jin https://orcid.org/0000-0001-5929-3627 Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea E-mail:
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20
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Redwine LS, Hong S, Kohn J, Martinez C, Hurwitz BE, Pung MA, Wilson K, Pruitt C, Greenberg BH, Mills PJ. Systemic Inflammation and Cognitive Decrements in Patients With Stage B Heart Failure. Psychosom Med 2022; 84:133-140. [PMID: 34654027 DOI: 10.1097/psy.0000000000001033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the role of systemic inflammation in reduced cognitive functioning in patients with early-stage heart failure (HF) while determining associations with other cardiovascular risk factors. METHODS Patients with stage B HF (n = 270; mean [standard deviation] age = 66.1 [10.1] years) were examined cross-sectionally for relationships among cardiovascular disease (CVD) and psychological risk factors, C-reactive protein (CRP), and Montreal Cognitive Assessment (MoCA) scores. A subsample (n = 83) at high risk for stage C HF (B-type natriuretic peptide levels ≥65 pg/ml) were followed up for 12 months for relationships between CRP levels and cognitive function. RESULTS Baseline smoking (χ2 = 6.33), unmarried (χ2 = 12.0), hypertension (χ2 = 5.72), greater body mass index (d = 0.45), and physical fatigue (d = 0.25) were related to higher CRP levels (p values < .05). Cross-sectionally, CRP levels were negatively related to MoCA scores, beyond CVD (ΔR2 = 0.022, β = -0.170, p < .010) and psychological risk factors (ΔR2 = 0.016, β = 0.145, p < .027), and related to mild cognitive impairment criteria (odds ratio = 1.35, 95% confidence interval [CI] = 1.00-1.81, p = .046). Across 12 months, B-type natriuretic peptide high-risk patients with CRP levels ≥3 mg/L had lower MoCA scores (23.6; 95% CI = 22.4-24.8) than did patients with CRP levels <3 mg/L (25.4; 95% CI = 24.4-26.5; p = .024). CONCLUSIONS Patients with stage B HF and heightened CRP levels had greater cognitive impairment at baseline and follow-up, independent of CVD and potentially psychological risk factors. Low-grade systemic inflammation may be one mechanism involved in cognitive dysfunction at early stages of HF.
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Affiliation(s)
- Laura S Redwine
- From the College of Behavioral and Community Sciences (Redwine), University of South Florida, Tampa, Florida; Departments of Psychiatry (Hong, Kohn) and Family Medicine and Public Health (Hong, Kohn, Pung, Pruitt, Mills), University of California School of Medicine, San Diego, California; Division of Cardiology (Martinez), University of Miami Miller School of Medicine; Behavioral Medicine Research Center (Hurwitz), University of Miami, Miami; Department of Psychology (Hurwitz), University of Miami, Coral Gables; Division of Endocrinology, Diabetes and Metabolism (Hurwitz), Miller School of Medicine, University of Miami, Miami, Florida; Department of Medicine (Greenberg), University of California School of Medicine, San Diego, California; and Department of Public Health Sciences (Redwine), University of Miami Miller School of Medicine, Miami, Florida
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21
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Role of ranolazine in heart failure: From cellular to clinic perspective. Eur J Pharmacol 2022; 919:174787. [PMID: 35114190 DOI: 10.1016/j.ejphar.2022.174787] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/25/2021] [Accepted: 01/25/2022] [Indexed: 12/17/2022]
Abstract
Ranolazine was approved by the US Food and Drug Administration as an antianginal drug in 2006, and has been used since in certain groups of patients with stable angina. The therapeutic action of ranolazine was initially attributed to inhibitory effects on fatty acids metabolism. As investigations went on, however, it developed that the main beneficial effects of ranolazine arise from its action on the late sodium current in the heart. Since late sodium currents were discovered to be involved in various heart pathologies such as ischemia, arrhythmias, systolic and diastolic dysfunctions, and all these conditions are associated with heart failure, ranolazine has in some way been tested either directly or indirectly on heart failure in numerous experimental and clinical studies. As the heart continuously remodels following any sort of severe injury, the inhibition by ranolazine of the underlying mechanisms of cardiac remodeling including ion disturbances, oxidative stress, inflammation, apoptosis, fibrosis, metabolic dysregulation, and neurohormonal impairment are discussed, along with unresolved issues. A projection of pathologies targeted by ranolazine from cellular level to clinical is provided in this review.
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22
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Al-Ghamdi S, Alzubaidi FK, Alharthai SA, Alzahim MS, Al Bahily FM, Alsifaee MI, Alshehri HA, Anazi MS. Prevalence and correlates of diastolic dysfunction in patients with hypertension: a cross-sectional study from in The Kingdom of Saudi Arabia. Pan Afr Med J 2022; 40:159. [PMID: 34970401 PMCID: PMC8683461 DOI: 10.11604/pamj.2021.40.159.31089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction diastolic dysfunction refers to impaired ventricular relaxation or filling regardless of ejection fraction and symptoms. It accounts for 8% and 25% in the hospitalized and general population, respectively. The present study was conducted to determine the prevalence and correlates of diastolic dysfunction in hypertensive patients living in Saudi Arabia. Methods a multicentric, cross-sectional study was conducted from February 2019 to February 2020 at King Khalid Hospital and Prince Sultan Center for Health Services, Prince Sattam Bin Abdulaziz University hospital in Al Kharj, and Al Kharj Military Industries Corporation hospital, KSA. All patients with hypertension who underwent an echocardiography were included in the study. Logistic regression analysis was performed to determine factors associated with left ventricular diastolic dysfunction (LVDD). Results the study included a total of 104 participants, where 51.9% were females and the mean age of the patients was 48.01±12.81 years. Most patients had an abnormal echocardiography finding (64.4%, n = 67). The most common abnormalities were left ventricular (LV) hypertrophy (44.2%, n = 46), and diastolic dysfunction, (35.6%, n = 37). The study revealed that age (aOR: 6.1, 95% CI 1.17-31.3; p = 0.032) and dyslipidemia (aOR: 3.45, 95% CI 1.16-10.24; p = 0.026) have significant association with LVDD in the patients with hypertension. Conclusion in conclusion, diastolic dysfunction is prevalent among older hypertensive patients and those with dyslipidaemia. Age and dyslipidaemia were non-modifiable and modifiable factors associated with LVDD in hypertensive patients, respectively.
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Affiliation(s)
- Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | | | | | | | | | | | - Muath Salman Anazi
- Imam Muhammad Ibn Saud Islamic University, College of Medicine, Riyadh, Saudi Arabia
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23
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Oeun B, Hikoso S, Nakatani D, Mizuno H, Suna S, Kitamura T, Okada K, Dohi T, Sotomi Y, Kojima T, Kida H, Sunaga A, Sato T, Takeda Y, Kurakami H, Yamada T, Tamaki S, Abe H, Nakagawa Y, Higuchi Y, Fuji H, Mano T, Uematsu M, Yasumura Y, Yamada T, Sakata Y. Prognostic Impact of Echocardiographic Diastolic Dysfunction on Outcomes in Patients With Heart Failure With Preserved Ejection Fraction - Insights From the PURSUIT-HFpEF Registry. Circ J 2021; 86:23-33. [PMID: 34456213 DOI: 10.1253/circj.cj-21-0300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although diastolic dysfunction is important pathophysiology in heart failure with preserved ejection fraction (HFpEF), its prognostic impact in HFpEF patients, including those with atrial fibrillation (AF), remains to be elucidated.Methods and Results:We included the data for 863 patients (321 patients with AF) registered in a prospective multicenter observational study of patients with HFpEF. Patients were divided into 3 groups according to the 2016 ASE/EACVI recommendations. The primary endpoint was a composite of all-cause death or HF rehospitalization. Median age was 83 years, and 55.5% were female. 196 (22.7%) were classified with normal diastolic function (ND), 253 (29.3%) with indeterminate (ID) and 414 (48.0%) with diastolic dysfunction (DD). The primary endpoint occurred more frequently in patients with DD than in those with ND or ID (log-rank P<0.001 for DD vs. ND, and log-rank P=0.007 for DD vs. ID, respectively). Taking ND as the reference, multivariable Cox regression analysis revealed that DD (hazard ratio (HR): 1.57, 95% confidence interval (CI):1.06-2.32, P=0.024) was independently associated with the composite endpoint, whereas ID (HR: 1.28, 95% CI: 0.84-1.95, P=0.255) was not. DD was associated with the composite endpoint in both patients with and without AF. CONCLUSIONS HFpEF patients classified with DD using the 2016 ASE/EACVI recommendations had worse clinical outcomes than those with ND or ID. DD may be considered a prognostic marker in patients with HFpEF regardless of AF.
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Affiliation(s)
- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital
| | | | | | | | | | | | | | | | | | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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24
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Yang Y, Guo XM, Wang H, Zheng YN. Deep Learning-Based Heart Sound Analysis for Left Ventricular Diastolic Dysfunction Diagnosis. Diagnostics (Basel) 2021; 11:2349. [PMID: 34943586 PMCID: PMC8699866 DOI: 10.3390/diagnostics11122349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
The aggravation of left ventricular diastolic dysfunction (LVDD) could lead to ventricular remodeling, wall stiffness, reduced compliance, and progression to heart failure with a preserved ejection fraction. A non-invasive method based on convolutional neural networks (CNN) and heart sounds (HS) is presented for the early diagnosis of LVDD in this paper. A deep convolutional generative adversarial networks (DCGAN) model-based data augmentation (DA) method was proposed to expand a HS database of LVDD for model training. Firstly, the preprocessing of HS signals was performed using the improved wavelet denoising method. Secondly, the logistic regression based hidden semi-Markov model was utilized to segment HS signals, which were subsequently converted into spectrograms for DA using the short-time Fourier transform (STFT). Finally, the proposed method was compared with VGG-16, VGG-19, ResNet-18, ResNet-50, DenseNet-121, and AlexNet in terms of performance for LVDD diagnosis. The result shows that the proposed method has a reasonable performance with an accuracy of 0.987, a sensitivity of 0.986, and a specificity of 0.988, which proves the effectiveness of HS analysis for the early diagnosis of LVDD and demonstrates that the DCGAN-based DA method could effectively augment HS data.
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Affiliation(s)
- Yang Yang
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.Y.); (H.W.)
| | - Xing-Ming Guo
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.Y.); (H.W.)
| | - Hui Wang
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China; (Y.Y.); (H.W.)
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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25
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Tsai YL, Chou RH, Lu YW, Chang CC, Kuo CS, Huang PH, Chen JW, Lin SJ. Associations between galectin-1, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction. J Cardiol 2021; 79:371-375. [PMID: 34774386 DOI: 10.1016/j.jjcc.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2021] [Accepted: 09/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Galectin-1 is a glycan-binding protein with broad anti-inflammatory properties. Left ventricular diastolic dysfunction (DD) is associated with heart failure and mortality. The pathophysiology of DD is complex and our study aimed to investigate the associations between serum galectin-1 level, DD, and heart failure with preserved ejection fraction (HFpEF). METHODS Patients with symptoms of angina pectoris were enrolled. Serum galectin-1 levels and echocardiography were assessed. The study endpoint was a composite of all-cause mortality or new-onset HFpEF. RESULTS In total, 258 patients were enrolled (63% male; mean age 68±12 years) and grouped into tertiles based on galectin-1 levels. Patients in the highest galectin-1 group had increased left ventricular mass indexes, left atrial diameters, and prevalence of DD compared to those in the lower tertiles (all p<0.05). Moreover, elevated galectin-1 levels were significantly associated with the composite endpoint (p=0.039). After adjusting for confounding factors, high galectin-1 levels remained significantly associated with DD (odds ratio 2.44, p=0.005). The Kaplan-Meier analysis revealed patients in the highest galectin-1 group had lowest cumulative survival of composite endpoint (log rank p=0.043). CONCLUSIONS Elevated serum galectin-1 levels were associated with DD and the composite endpoint of all-cause mortality and incident HFpEF.
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Affiliation(s)
- Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Sung Kuo
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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Elsanhoury A, Nelki V, Kelle S, Van Linthout S, Tschöpe C. Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction-A Specific HFpEF Phenotype. Front Cardiovasc Med 2021; 8:720690. [PMID: 34604353 PMCID: PMC8484763 DOI: 10.3389/fcvm.2021.720690] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with diverse etiologies and pathophysiological factors. Obesity and type 2 diabetes mellitus (T2DM), conditions that coexist frequently, induce a cluster of metabolic and non-metabolic signaling derangements which are in favor to induce inflammation, fibrosis, myocyte stiffness, all hallmarks of HFpEF. In contrast to other HFpEF risk factors, obesity and T2DM are often associated with the generation of enlarged epicardial adipose tissue (EAT). EAT acts as an endocrine tissue that may exacerbate myocardial inflammation and fibrosis via various paracrine and vasocrine signals. In addition, an abnormally large EAT poses mechanical stress on the heart via pericardial restrain. HFpEF patients with enlarged EAT may belong to a unique phenotype that can benefit from specific EAT-targeted interventions, including life-style modifications and pharmacologically via statins and fat modifying anti-diabetics drugs; like metformin, sodium-glucose cotransporter 2 inhibitors, or glucagon-like peptide-1 receptor agonists, respectively.
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Affiliation(s)
- Ahmed Elsanhoury
- Berlin Institute of Health at Charite (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Vivian Nelki
- Department of Cardiology, Campus Virchow Klinikum (CVK), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health at Charite (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health at Charite (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum (CVK), Charité Universitätsmedizin Berlin, Berlin, Germany
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Tee NGZ, Loo SJ, Su LP, Tao ZH, Gui F, Luo JH, Ye L. A diastolic dysfunction model in non-human primates with transverse aortic constriction. Exp Anim 2021; 70:498-507. [PMID: 34135271 PMCID: PMC8614021 DOI: 10.1538/expanim.21-0050] [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] [Indexed: 11/03/2022] Open
Abstract
Transverse aortic constriction (TAC) has been widely used to study cardiac hypertrophy, fibrosis, diastolic dysfunction, and heart failure in rodents. Few studies have been reported in preclinical animal models. The similar physiology and anatomy between non-human primates (NHPs) and humans make NHPs valuable models for disease modeling and testing of drugs and devices. In the current study, we aimed to establish a TAC model in NHPs and characterize the structural and functional profiles of the heart after TAC. A non-absorbable suture was placed around the aorta between the brachiocephalic artery and left common carotid artery to create TAC. NHPs were divided into 2 groups according to pressure gradient (PG): the Mild Group (PG=31.01 ± 12.40 mmHg, n=3) and the Moderate Group (PG=53.00 ± 9.37 mmHg, n=4). At 4 weeks after TAC, animals in both TAC groups developed cardiac hypertrophy: enlarged myocytes and increased wall thickness of the left ventricular (LV) anterior wall. Although both TAC groups had normal systolic function that was similar to a Sham Group, the Moderate Group showed diastolic dysfunction that was associated with more severe cardiac fibrosis, as evidenced by a reduced A wave velocity, large E wave velocity/A wave velocity ratio, and short isovolumic relaxation time corrected by heart rate. Furthermore, no LV arrhythmia was observed in either animal group after TAC. A diastolic dysfunction model with cardiac hypertrophy and fibrosis was successfully developed in NHPs.
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Affiliation(s)
- Nicole Gee-Zhi Tee
- National Heart Research Institute Singapore, National Heart Centre Singapore
| | - Sze-Jie Loo
- National Heart Research Institute Singapore, National Heart Centre Singapore
| | - Li-Ping Su
- National Heart Research Institute Singapore, National Heart Centre Singapore
| | - Zhong-Hao Tao
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University
| | - Fu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University
| | - Jun-Hua Luo
- Jiangxi Hospital of Integrated Traditional Chinese and Western Medicine
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore
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Li Z, Bai X, Han L, Han W, Hu W. Association Between Left Atrial Volume Index and Ventricular Repolarization Heterogeneity: A Cross-Sectional Study of a Healthy Chinese Population. Int J Gen Med 2021; 14:2117-2125. [PMID: 34079353 PMCID: PMC8166315 DOI: 10.2147/ijgm.s310220] [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: 03/10/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Electromechanical coupling may play a significant role in the association between abnormal myocardial mechanics and heterogeneity of repolarization. This study sought to assess the potential relationship between the left atrial volume index (LAVI), which is an important marker of cardiac diastolic function, and ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, in an apparently healthy Chinese population. Methods This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years, including 186 men (44.9%), were enrolled. In addition to performing clinical and laboratory measurements, all subjects underwent comprehensive echocardiography and standard 12-lead electrocardiography. Echocardiographic and electrocardiographic results were analysed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations. Results Subjects were divided into four groups according to quartile of LAVI levels (<16.0, 16.0-18.9, 19.0-22.5 and >22.5 mL/m2). Ventricular repolarization variables, such as QT interval and QTc interval, gradually increased with the progression from low to high LAVI levels (P<0.05). LAVI was positively and significantly correlated with the QT interval, the QTc interval, and the Tpe interval (P<0.01). After adjusting for age and other possible confounders, LAVI showed significant and independent associations with the QT interval and the QTc interval (P<0.001; P=0.003). Conclusion Echocardiographic LAVI is linearly associated with ventricular repolarization variables even in healthy people.
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Affiliation(s)
- Zhidan Li
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaojuan Bai
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lulu Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wen Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Weina Hu
- Department of Cardiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
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Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The heart is one of the most important oxygen delivery organs, and dysfunction significantly increases the mortality of the body. Hence, the heart has been studied in sepsis for over half a century. However, the definition of sepsis-induced cardiomyopathy is not unified yet, and the conventional conception seems outdated: left ventricular systolic dysfunction (LVSD) along with enlargement of the left ventricle, recovering in 7 to 10 days. With the application of echocardiography in intensive care units, not only LVSD but also left ventricular diastolic dysfunction, right ventricular dysfunction, and even diffuse ventricular dysfunction have been seen. The recognition of sepsis-induced cardiomyopathy is gradually becoming complete, although our understanding of it is not deep, which has made the diagnosis and treatment stagnate. In this review, we summarize the research on sepsis-induced cardiomyopathy. Women and young people with septic cardiomyopathy are more likely to have LVSD, which may have the same mechanism as stress cardiomyopathy. Elderly people with ischemic cardiomyopathy and hypertension tend to have left ventricular diastolic dysfunction. Patients with mechanical ventilation, acute respiratory distress syndrome or other complications of increased right ventricular afterload mostly have right ventricular dysfunction. Diffuse cardiac dysfunction has also been shown in some studies; patients with mixed or co-existing cardiac dysfunction are more common, theoretically. Thus, understanding the pathophysiology of sepsis-induced cardiomyopathy from the perspective of critical care echocardiography is essential.
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30
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The Heart Failure with Preserved Ejection Fraction Conundrum-Redefining the Problem and Finding Common Ground? Curr Heart Fail Rep 2021; 17:34-42. [PMID: 32112345 DOI: 10.1007/s11897-020-00454-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure (DHF) makes up more than half of all congestive heart failure presentations (CHF). With an ageing population, the case load and the financial burden is projected to increase, even to epidemic proportions. CHF hospitalizations add too much of the financial and infrastructure strain. Unlike systolic heart failure (SHF), much is still either uncertain or unknown. Specifically, in epidemiology, the disease burden is established; however, risk factors and pathophysiological associations are less clear; diagnostic tools are based on rigid parameters without the ability to accurately monitor treatments effects and disease progression; finally, therapeutics are similar to SHF but without prognostic data for efficacy. RECENT FINDINGS The last several years have seen guidelines changing to account for greater epidemiological observations. Most of these remain general observation of shortness of breath symptom matched to static echocardiographic parameters. The introduction of exercise diastolic stress test has been welcome and warrants greater focus. HFpEF is likely to see new thinking in the coming decades. This review provides some of perspective on this topic.
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31
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Travers JG, Wennersten SA, Peña B, Bagchi RA, Smith HE, Hirsch RA, Vanderlinden LA, Lin YH, Dobrinskikh E, Demos-Davies KM, Cavasin MA, Mestroni L, Steinkühler C, Lin CY, Houser SR, Woulfe KC, Lam MPY, McKinsey TA. HDAC Inhibition Reverses Preexisting Diastolic Dysfunction and Blocks Covert Extracellular Matrix Remodeling. Circulation 2021; 143:1874-1890. [PMID: 33682427 DOI: 10.1161/circulationaha.120.046462] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diastolic dysfunction (DD) is associated with the development of heart failure and contributes to the pathogenesis of other cardiac maladies, including atrial fibrillation. Inhibition of histone deacetylases (HDACs) has been shown to prevent DD by enhancing myofibril relaxation. We addressed the therapeutic potential of HDAC inhibition in a model of established DD with preserved ejection fraction. METHODS Four weeks after uninephrectomy and implantation with deoxycorticosterone acetate pellets, when DD was clearly evident, 1 cohort of mice was administered the clinical-stage HDAC inhibitor ITF2357/Givinostat. Echocardiography, blood pressure measurements, and end point invasive hemodynamic analyses were performed. Myofibril mechanics and intact cardiomyocyte relaxation were assessed ex vivo. Cardiac fibrosis was evaluated by picrosirius red staining and second harmonic generation microscopy of left ventricle (LV) sections, RNA sequencing of LV mRNA, mass spectrometry-based evaluation of decellularized LV biopsies, and atomic force microscopy determination of LV stiffness. Mechanistic studies were performed with primary rat and human cardiac fibroblasts. RESULTS HDAC inhibition normalized DD without lowering blood pressure in this model of systemic hypertension. In contrast to previous models, myofibril relaxation was unimpaired in uninephrectomy/deoxycorticosterone acetate mice. Furthermore, cardiac fibrosis was not evident in any mouse cohort on the basis of picrosirius red staining or second harmonic generation microscopy. However, mass spectrometry revealed induction in the expression of >100 extracellular matrix proteins in LVs of uninephrectomy/deoxycorticosterone acetate mice, which correlated with profound tissue stiffening based on atomic force microscopy. ITF2357/Givinostat treatment blocked extracellular matrix expansion and LV stiffening. The HDAC inhibitor was subsequently shown to suppress cardiac fibroblast activation, at least in part, by blunting recruitment of the profibrotic chromatin reader protein BRD4 (bromodomain-containing protein 4) to key gene regulatory elements. CONCLUSIONS These findings demonstrate the potential of HDAC inhibition as a therapeutic intervention to reverse existing DD and establish blockade of extracellular matrix remodeling as a second mechanism by which HDAC inhibitors improve ventricular filling. Our data reveal the existence of pathophysiologically relevant covert or hidden cardiac fibrosis that is below the limit of detection of histochemical stains such as picrosirius red, highlighting the need to evaluate fibrosis of the heart using diverse methodologies.
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Affiliation(s)
- Joshua G Travers
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Sara A Wennersten
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Brisa Peña
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Rushita A Bagchi
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Harrison E Smith
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (H.E.S., R.A.H., C.Y.L.).,Department of Biostatistics and Informatics (H.E.S., L.A.V.), Colorado School of Public Health, Aurora
| | - Rachel A Hirsch
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (H.E.S., R.A.H., C.Y.L.)
| | - Lauren A Vanderlinden
- Department of Biostatistics and Informatics (H.E.S., L.A.V.), Colorado School of Public Health, Aurora
| | - Ying-Hsi Lin
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Evgenia Dobrinskikh
- Department of Medicine, Division of Pulmonary Sciences & Critical Care (E.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Kimberly M Demos-Davies
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Maria A Cavasin
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Luisa Mestroni
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | | | - Charles Y Lin
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (H.E.S., R.A.H., C.Y.L.).,now with Kronos Bio, Cambridge, MA (C.Y.L.)
| | - Steven R Houser
- Cardiovascular Research Center (S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Kathleen C Woulfe
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Maggie P Y Lam
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Timothy A McKinsey
- Department of Medicine, Division of Cardiology (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., K.M.D.-D., M.A.C., L.M., K.C.W., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora.,Consortium for Fibrosis Research & Translation (J.G.T., S.A.W., B.P., R.A.B., Y.-H.L., M.A.C., M.P.Y.L., T.A.M.), University of Colorado Anschutz Medical Campus, Aurora
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Gold AK, Kiefer JJ, Feinman JW, Augoustides JG. Left Atrial Strain-A Valuable Window on Left Ventricular Diastolic Function. J Cardiothorac Vasc Anesth 2021; 35:1626-1627. [PMID: 33750662 DOI: 10.1053/j.jvca.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Andrew K Gold
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jesse J Kiefer
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes. J Clin Med 2020; 9:jcm9123924. [PMID: 33287316 PMCID: PMC7761650 DOI: 10.3390/jcm9123924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Left ventricular diastolic dysfunction (LVDD) is caused by a decreased left ventricle relaxation and is associated with an increased risk of symptomatic heart failure (HF) and excessive mortality. Aim: To evaluate the frequency and factors related to LVDD in the population with chronic coronary syndromes (CCS). Methods: 200 patients (mean age 63.18 ± 8.12 years, 75.5% male) with CCS were included. LVDD was diagnosed based on the recent echocardiography guidelines. Results: LVDD was diagnosed in 38.5% of CCS population. From the studied factors, after adjustment for age, sex, and N-terminal pro-brain natriuretic peptide (NT-proBNP), LVDD associated positively with android/gynoid (A/G) fat mass ratio, left ventricular mass index (LVMI), and negatively with Z-score and left ventricular ejection fraction (LVEF). In stepwise backward logistic regression analysis, the strongest factors associated with LVDD were pulse wave velocity value, handgrip strength and waist to hip ratio (WHR). Conclusions: LVDD is common among CCS patients and it is associated with parameters reflecting android type fat distribution regardless of NT-proBNP and high-sensitivity troponin T concentrations. Deterioration in diastolic dysfunction is linked with increased aortic stiffness independently of age and sex. Further studies evaluating the effects of increasing physical fitness and lowering abdominal fat accumulations on LVDD in CCS patients should be considered.
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Guan X, Guan X, Lu C, Shang B, Zhao Y, Meng Y, Zhang Z. Nebivolol combined with tetrahydrobiopterin affects diastolic function in spontaneously hypertensive rats via the nitric oxide/cyclic guanosine monophosphate signalling pathway. BMC Pharmacol Toxicol 2020; 21:84. [PMID: 33267901 PMCID: PMC7709331 DOI: 10.1186/s40360-020-00460-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/12/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hypertension is the the primary cause of diastolic heart failure. Oxidative stress plays an important role in cardiac diastolic dysfunction caused by hypertension. The occurrence of oxidative stress is related to the level of nitric oxide (NO) in the body. Tetrahydrobiopterin (BH4) is an essential cofactor for NO synthesis. Nebivolol can reduce myocardial oxidative stress and increase NO activity. Therefore, we investigated the effects of monotherapy or combination therapy of different doses of BH4 and nebivolol on cardiac diastolic function in spontaneously hypertensive rats, and preliminarily expounded the related mechanisms. METHODS Left ventricular function was evaluated by non-invasive echocardiographic assessment and invasive right carotid artery catheterization methods. ELISA was used to measure myocardial 3-nitrotyrosine content, NO production, and cyclic guanosine monophosphate (cGMP) concentration in the myocardium; quantitative real-time PCR (qRT-PCR) was used to determine endothelial nitric oxide synthase (eNOS), phospholamban and sarcoplasmic reticulum Ca2+-ATPase 2a (SERCA2a) mRNA expression levels; Western blot was used to detect the protein expression levels of eNOS and eNOS dimers in myocardial tissue, and immunohistochemical detection of cGMP expression in the myocardium was performed. RESULTS Studies have shown that compared with those in the control group, NO generation and the expression level of myocardial eNOS mRNA, eNOS expression of dimers, phospholamban, SERCA2a and cGMP increased significantly after the combined intervention of BH4 and nebivolol, while the expression of 3-nitrotyrosine was significantly decreased. CONCLUSIONS The combined treatment group had a synergistic effect on reducing myocardial oxidative stress, increasing eNOS content, and increasing NO production, and had a more obvious protective effect on diastolic dysfunction through the nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway.
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Affiliation(s)
- Xiaoli Guan
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiaoying Guan
- Pathology Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Changhong Lu
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Bo Shang
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yuan Zhao
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Ying Meng
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhengyi Zhang
- General Medicine Department, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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Hamza M, Fatima M, Masood M, Masood HU, Tasleem G, Ahmed H, Nadir M, Satti Z. Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above). Afr Health Sci 2020; 20:1749-1753. [PMID: 34394235 PMCID: PMC8351830 DOI: 10.4314/ahs.v20i4.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD. Methods A case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography. Results Patients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35–1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS. Conclusion IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.
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Dhot J, Ferron M, Prat V, Persello A, Roul D, Stévant D, Guijarro D, Piriou N, Aillerie V, Erraud A, Toumaniantz G, Erfanian M, Tesse A, Grabherr A, Tesson L, Menoret S, Anegon I, Trochu J, Steenman M, De Waard M, Rozec B, Lauzier B, Gauthier C. Overexpression of endothelial β 3 -adrenergic receptor induces diastolic dysfunction in rats. ESC Heart Fail 2020; 7:4159-4171. [PMID: 33034410 PMCID: PMC7754894 DOI: 10.1002/ehf2.13040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Diastolic dysfunction is common in cardiovascular diseases, particularly in the case of heart failure with preserved ejection fraction. The challenge is to develop adequate animal models to envision human therapies in the future. It has been hypothesized that this diastolic dysfunction is linked to alterations in the nitric oxide (• NO) pathway. To investigate this issue further, we investigated the cardiac functions of a transgenic rat model (Tgβ3 ) that overexpresses the human β3 -adrenoceptor (hβ3 -AR) in the endothelium with the underlying rationale that the • NO pathway should be stimulated in the endothelium. METHODS AND RESULTS Transgenic rats (Tgβ3 ) that express hβ3 -AR under the control of intercellular adhesion molecule 2 promoter were developed for a specific expression in endothelial cells. Transcriptomic analyses were performed on left ventricular tissue from 45-week-old rats. Among all altered genes, we focus on • NO synthase expression and endothelial function with arterial reactivity and evaluation of • NO and O2 •- production. Cardiac function was characterized by echocardiography, invasive haemodynamic studies, and working heart studies. Transcriptome analyses illustrate that several key genes are regulated by the hβ3 -AR overexpression. Overexpression of hβ3 -AR leads to a reduction of Nos3 mRNA expression (-72%; P < 0.05) associated with a decrease in protein expression (-19%; P < 0.05). Concentration-dependent vasodilation to isoproterenol was significantly reduced in Tgβ3 aorta (-10%; P < 0.05), while • NO and O2 •- production was increased. In the same time, Tgβ3 rats display progressively increasing diastolic dysfunction with age, as shown by an increase in the E/A filing ratio [1.15 ± 0.01 (wild type, WT) vs. 1.33 ± 0.04 (Tgβ3 ); P < 0.05] and in left ventricular end-diastolic pressure [5.57 ± 1.23 mmHg (WT) vs. 11.68 ± 1.11 mmHg (Tgβ3 ); P < 0.05]. In isolated working hearts, diastolic stress using increasing preload levels led to a 20% decrease in aortic flow [55.4 ± 1.9 mL/min (WT) vs. 45.8 ± 2.5 mL/min (Tgβ3 ); P < 0.05]. CONCLUSIONS The Tgβ3 rat model displays the expected increase in • NO production upon ageing and develops diastolic dysfunction. These findings provide a further link between endothelial and cardiac dysfunction. This rat model should be valuable for future preclinical evaluation of candidate drugs aimed at correcting diastolic dysfunction.
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Affiliation(s)
- Justine Dhot
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Marine Ferron
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Valentine Prat
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Antoine Persello
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - David Roul
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - David Stévant
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Damien Guijarro
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Nicolas Piriou
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Virginie Aillerie
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Angélique Erraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Gilles Toumaniantz
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Morteza Erfanian
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Angela Tesse
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Amandine Grabherr
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Laurent Tesson
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de NantesNantesFrance
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU NantesNantesFrance
| | - Séverine Menoret
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de NantesNantesFrance
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU NantesNantesFrance
- CNRS, SFR de NantesNantesFrance
| | - Ignacio Anegon
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de NantesNantesFrance
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU NantesNantesFrance
| | - Jean‐Noël Trochu
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Marja Steenman
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Michel De Waard
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
- LabEx ‘Ion Channels, Science & Therapeutics’NiceFrance
| | - Bertrand Rozec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Benjamin Lauzier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
| | - Chantal Gauthier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’institut du thoraxNantesF‐44000France
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Ramos JG, Fyrdahl A, Wieslander B, Thalén S, Reiter G, Reiter U, Jin N, Maret E, Eriksson M, Caidahl K, Sörensson P, Sigfridsson A, Ugander M. Comprehensive Cardiovascular Magnetic Resonance Diastolic Dysfunction Grading Shows Very Good Agreement Compared With Echocardiography. JACC Cardiovasc Imaging 2020; 13:2530-2542. [DOI: 10.1016/j.jcmg.2020.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023]
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Dong Z, Zheng S, Shen Z, Luo Y, Hai X. Trimethylamine N-Oxide is Associated with Heart Failure Risk in Patients with Preserved Ejection Fraction. Lab Med 2020; 52:346-351. [PMID: 33135738 DOI: 10.1093/labmed/lmaa075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO) has been considered to be an independent risk factor of heart failure (HF). OBJECTIVES To further determine the plasma levels of TMAO in patients who have HF with preserved ejection fraction (HFpEF), and to analyze the relationship between TMAO and HFpEF risk. METHODS A total of 57 control participants and 61 patients with HFpEF were recruited. We measured and analyzed plasma levels of TMAO and performed biochemical examination of all patients. RESULTS The mean (SD) plasma levels of TMAO in patients with HFpEF (6.84 [1.12] μmol/L) were significantly higher than in controls (1.63 [0.08] μmol/L; P <.01). The area under the curve (AUC) of TMAO and N-terminal pro b-type natriuretic peptide (NT-proBNP) was 0.817 and 0.924, respectively, which were determined by receiver operating characteristic (ROC) analysis. TMAO was an independent risk factor in patients with HFpEF, as revealed by univariate and multivariate logistic regression analysis. The level of TMAO was correlated with blood urea nitrogen (BUN), creatinine, and NT-proBNP. CONCLUSIONS TMAO level was highly associated with HFpEF risk.
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Affiliation(s)
- Zengxiang Dong
- Departments of Pharmacy and First Affiliated Hospital of Harbin Medical University, Harbin, China.,Departments of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sijia Zheng
- Departments of Pharmacy and First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhaoqian Shen
- Departments of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingchun Luo
- Departments of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Hai
- Departments of Pharmacy and First Affiliated Hospital of Harbin Medical University, Harbin, China
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Han J, Su GH, Wang YH, Lu YX, Zhao HL, Shuai XX. 18β-Glycyrrhetinic Acid Improves Cardiac Diastolic Function by Attenuating Intracellular Calcium Overload. Curr Med Sci 2020; 40:654-661. [PMID: 32862375 DOI: 10.1007/s11596-020-2232-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022]
Abstract
Ranolazine, a late sodium current inhibitor, has been demonstrated to be effective on heart failure. 18β-glycyrrhetinic acid (18β-GA) has the similar inhibitory effect on late sodium currents. However, its effect on diastolic function is still unknown. This study aimed to determine whether 18β-GA can improve the diastolic function and to explore the underlying mechanisms. Eighty male Sprague Dawley (SD) rats of Langendorff model were randomly divided into the following groups: group A, normal cardiac perfusion group; group B, ischemia-reperfusion group; group C, ischemia-reperfusion with anemoniasulcata toxin II (ATX-II); group D, ranolazine group; and group E, 18β-GA group with four different concentrations. Furthermore, a pressure-overloaded rat model induced by trans-aortic constriction (TAC) was established. Echocardiography and hemodynamics were used to evaluate diastolic function at 14th day after TAC. Changes of free intracellular calcium (Ca2+) concentration was indirectly detected by laser scanning confocal microscope to confirm the inhibition of late sodium currents. With the intervention of ATX-II on ischemia reperfusion injury group, 5 µmol/L ranolazine, and 5, 10, 20, 40 µmol/L 18β-GA could improve ATX-II-induced cardiac diastolic dysfunction. 630 mg/kg glycyrrhizin tablets could improve cardiac diastolic function in the pressure-overloaded rats. 18β-GA and ranolazine had similar effects on reducing the free calcium in cardiomyocytes. The study demonstrates that 18β-GA and glycyrrhizin could improve diastolic dysfunction induced by ischemia-reperfusion injury in Langendorff-perfused rat hearts and pressure-overloaded rats. The mechanism may be attributed to the inhibition of enhanced late sodium currents.
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Affiliation(s)
- Jun Han
- Department of Cardiology, Wuhan Fourth Hospital Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430033, China
| | - Guan-Hua Su
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Hui Wang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong-Xin Lu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong-Liang Zhao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin-Xin Shuai
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Kadry K, Pagoulatou S, Mercier Q, Rovas G, Bikia V, Müller H, Adamopoulos D, Stergiopulos N. Biomechanics of diastolic dysfunction: a one-dimensional computational modeling approach. Am J Physiol Heart Circ Physiol 2020; 319:H882-H892. [PMID: 32822212 DOI: 10.1152/ajpheart.00172.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diastolic dysfunction (DD) is a major component of heart failure with preserved ejection fraction (HFpEF). Accordingly, a profound understanding of the underlying biomechanical mechanisms involved in DD is needed to elucidate all aspects of HFpEF. In this study, we have developed a computational model of DD by leveraging the power of an advanced one-dimensional arterial network coupled to a four-chambered zero-dimensional cardiac model. The two main pathologies investigated were linked to the active relaxation of the myocardium and the passive stiffness of the left ventricular wall. These pathologies were quantified through two parameters for the biphasic delay of active relaxation, which simulate the early and late-phase relaxation delay, and one parameter for passive stiffness, which simulates the increased nonlinear stiffness of the ventricular wall. A parameter sensitivity analysis was conducted on each of the three parameters to investigate their effect in isolation. The three parameters were then concurrently adjusted to produce the three main phenotypes of DD. It was found that the impaired relaxation phenotype can be replicated by mainly manipulating the active relaxation, the pseudo-normal phenotype was replicated by manipulating both the active relaxation and passive stiffness, and, finally, the restricted phenotype was replicated by mainly changing the passive stiffness. This article presents a simple model producing a holistic and comprehensive replication of the main DD phenotypes and presents novel biomechanical insights on how key parameters defining the relaxation and stiffness properties of the myocardium affect the development and manifestation of DD.NEW & NOTEWORTHY This study uses a complete and validated computational model of the cardiovascular system to simulate the two main pathologies involved in diastolic dysfunction (DD), i.e., abnormal active relaxation and increased ventricular diastolic stiffness. The three phenotypes of DD were successfully replicated according to literature data. We elucidate the biomechanical effect of the relaxation pathologies involved and how these pathologies interact to create the various phenotypes of DD.
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Affiliation(s)
- Karim Kadry
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stamatia Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Mercier
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Georgios Rovas
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Vasiliki Bikia
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Hajo Müller
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Association of Hypertensive Intracerebral Hemorrhage with Left Ventricular Hypertrophy on Transthoracic Echocardiography. J Clin Med 2020; 9:jcm9072148. [PMID: 32650380 PMCID: PMC7408960 DOI: 10.3390/jcm9072148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Arterial hypertension is the most frequent cause for spontaneous intracerebral hemorrhage (sICH) and may also cause left ventricular hypertrophy (LVH). We sought to analyze whether hypertensive sICH etiology is associated with LVH. METHODS We analyzed consecutive patients with sICH who were admitted to our tertiary stroke center during a four-year period and underwent transthoracic echocardiography (TTE) as part of the diagnostic work-up. We defined hypertensive sICH as typical localization of hemorrhage in patients with arterial hypertension and no other identified sICH etiology. We defined an increased end-diastolic interventricular septal wall thickness of ≥11 mm on TTE as a surrogate parameter for LVH. RESULTS Among 395 patients with sICH, 260 patients (65.8%) received TTE as part of their diagnostic work-up. The median age was 71 years (interquartile range (IQR) 17), 160 patients (61.5%) were male, the median baseline National Institute of Health Stroke Scale (NIHSS) score was 8 (IQR 13). Of these, 159 (61.2%) patients had a hypertensive sICH and 156 patients (60%) had LVH. In univariable (113/159 (71.1%) vs. 43/101 (42.6%); odds ratio (OR) 3.31; 95% confidence interval (CI95%) 1.97-5.62); and multivariable (adjusted OR 2.95; CI95% 1.29-6.74) analysis, hypertensive sICH was associated with LVH. CONCLUSIONS In patients with sICH, LVH is associated with hypertensive bleeding etiology. Performing TTE is meaningful for diagnosis of comorbidities and clarification of bleeding etiology in these patients. Future studies should include long-term outcome parameters and assess left ventricular mass as main indicator for LVH.
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Kalinin RE, Suchkov IA, Laut MV, Mzhavanadze ND, Shanaev IN. Varicose Veins: A Local or Systemic Hemodynamic Disorder? JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320912683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the capabilities of a sonographic examination to evaluate local and systemic hemodynamic disorders in patients with varicose disease. Materials and Methods: This study included 583 patients with varicose veins, among whom 348 had trophic disorders. All subjects underwent lower limb duplex sonography and superficial, perforator, and deep venous diameter measurements, as well as had a calculated velocity for antegrade and reflux flow. Peripheral resistive index (RI) in the arteries, accompanying perforator veins (PVs), was analyzed. In addition, echocardiography was performed on 46 of the participants. Results: A statistically significant difference in the diameter of the great saphenous vein was obtained between class C2 and C4 varicose veins ( P < .05). Similar findings were obtained for the diameter of the PVs and the velocity reflux flow through PVs. Arteries in the perforator bundles demonstrated low RI, which may be attributed to the presence of arteriovenous shunts. Varicose veins were associated with an increased incidence of nonrestrictive type of blood flow through the tricuspid valve. Conclusions: Sonography demonstrated that additional factors rather than hemodynamics may be attributable to the development of venous ulcers. The most informative parameters of cardiac function, in a patient with varicose veins, are the indicators of diastolic function in both ventricles.
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Affiliation(s)
| | | | - Marina V. Laut
- Ryazan Regional Clinical Cardiologic Dispensary, Ryazan, Russia
| | | | - Ivan N. Shanaev
- Ryazan State Medical University, Ryazan, Russia
- Ryazan Regional Clinical Cardiologic Dispensary, Ryazan, Russia
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Cannatà A, Gentile P, Paldino A, Nuzzi V, Camparini L, Ciucci G, Manca P, Artico J, Dal Ferro M, Marcon G, Tettamanti M, Merlo M, Sinagra G, Loffredo FS. Echocardiographic evaluation of centenarians in Trieste. J Cardiovasc Med (Hagerstown) 2020; 21:556-561. [PMID: 32520856 DOI: 10.2459/jcm.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Population aging has increased together with the need for cardiovascular care. Understanding the relevance of cardiovascular conditions in the very old is crucial to developing a specific and rationale therapeutic approach. Centenarians can be considered a model of successful aging, although the impact of cardiovascular disease in this population is still unclear. AIM To evaluate the cardiovascular health status of a subset of centenarians enrolled in the Centenari a Trieste study and living in the province of Trieste to describe the prevalence of cardiovascular conditions among them. METHODS The current study included 20 individuals born before 1919 and living in the province of Trieste as of 1 May 2019. All centenarians were able to give consent and were subjected to an in-home complete clinical assessment focused on cardiovascular conditions, ECG and echocardiography. RESULTS The majority of centenarians were women (85%) and were not taking any chronic cardiovascular medication (55%). No centenarians had a history of ischemic heart disease while about one-third had signs suggestive of heart failure at examination (20%). Atrial fibrillation was present in 20% of individuals and conduction disorders were uncommon. Although the majority of individuals had a preserved left ventricular function, diastolic function was abnormal in 80% of enrolled centenarians that, however, was mild in 73% of cases. CONCLUSION This is the second study to perform in-home echocardiography in centenarians and the first to characterize the cardiovascular status of centenarians living in Trieste. The majority of centenarians had asymptomatic diastolic dysfunction and were naïve from cardiovascular therapy. The recruitment of new individuals from the Trieste area is continuing to perform analyses on clinical, genetic and environmental factors that may predict greater longevity in this geographical context and unveil mechanisms that regulate cardiac aging associated with increased lifespan.
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Affiliation(s)
- Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste.,Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy.,Department of Cardiovascular Sciences - Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Piero Gentile
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Luca Camparini
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Giulio Ciucci
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Jessica Artico
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Gabriella Marcon
- Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste, Trieste.,Department of Medicine, University of Udine, Udine
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste
| | - Francesco S Loffredo
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy.,Division of Cardiology, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
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44
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Kaya BC, Elkan H. Impact of Weight Loss with Laparoscopic Sleeve Gastrectomy on Left Ventricular Diastolic Function: a Prospective Study. Obes Surg 2020; 30:3280-3286. [DOI: 10.1007/s11695-020-04573-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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45
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Elgharabaw RM, Aldubayan MA, Alshaifani MA, Ahmed AS. Beneficial Role of Rosemary Aqueous Extracts Against Boldenone Induced Cardiac Toxicity, Injury and Oxidative Stress, in Male Rats. INT J PHARMACOL 2020. [DOI: 10.3923/ijp.2020.136.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Grossini E, Farruggio S, Pierelli D, Bolzani V, Rossi L, Pollesello P, Monaco C. Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients. J Clin Med 2020; 9:jcm9020373. [PMID: 32019057 PMCID: PMC7073614 DOI: 10.3390/jcm9020373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/16/2022] Open
Abstract
The beneficial effects exerted by levosimendan against cardiac failure could be related to the modulation of oxidative balance. We aimed to examine the effects of levosimendan in patients with cardiogenic shock or low cardiac output on cardiac systo-diastolic function and plasma oxidants/antioxidants (glutathione, GSH; thiobarbituric acid reactive substances, TBARS). In four patients undergoing coronary artery bypass grafting or angioplasty, cardiovascular parameters and plasma GSH and TBARS were measured at T0 (before levosimendan infusion), T1 (1 h after the achievement of the therapeutic dosage of levosimendan), T2 (end of levosimendan infusion), T3 (72 h after the end of levosimendan infusion), and T4 (end of cardiogenic shock). We found an improvement in the indices of systolic (ejection fraction, cardiac output, cardiac index) and diastolic (E to early diastolic mitral annular tissue velocity, E/'; early to late diastolic transmitral flow velocity, EA) cardiac function at early T2. A reduction of central venous pressure and pulmonary wedge pressure was also observed. Plasma levels of GSH and TBARS were restored by levosimendan at T1, as well. The results obtained indicate that levosimendan administration can regulate oxidant/antioxidant balance as an early effect in cardiogenic shock/low cardiac output patients. Modulation of oxidative status on a mitochondrial level could thus play a role in exerting the cardio-protection exerted by levosimendan in these patients.
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Affiliation(s)
- Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, UPO, 28100 Novara, Italy;
- Correspondence: ; Tel.: +390321660526; Fax: +3903213733537
| | - Serena Farruggio
- Laboratory of Physiology, Department of Translational Medicine, UPO, 28100 Novara, Italy;
| | - Daniele Pierelli
- Cardiothoracic Intensive Care Unit, AOU, 28100 Novara, Italy; (D.P.); (C.M.)
| | | | - Lidia Rossi
- Cardiology Division, AOU, 28100 Novara, Italy; (V.B.); (L.R.)
| | | | - Carolina Monaco
- Cardiothoracic Intensive Care Unit, AOU, 28100 Novara, Italy; (D.P.); (C.M.)
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47
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Cellular and Molecular Differences between HFpEF and HFrEF: A Step Ahead in an Improved Pathological Understanding. Cells 2020; 9:cells9010242. [PMID: 31963679 PMCID: PMC7016826 DOI: 10.3390/cells9010242] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Heart failure (HF) is the most rapidly growing cardiovascular health burden worldwide. HF can be classified into three groups based on the percentage of the ejection fraction (EF): heart failure with reduced EF (HFrEF), heart failure with mid-range-also called mildly reduced EF- (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). HFmrEF can progress into either HFrEF or HFpEF, but its phenotype is dominated by coronary artery disease, as in HFrEF. HFrEF and HFpEF present with differences in both the development and progression of the disease secondary to changes at the cellular and molecular level. While recent medical advances have resulted in efficient and specific treatments for HFrEF, these treatments lack efficacy for HFpEF management. These differential response rates, coupled to increasing rates of HF, highlight the significant need to understand the unique pathogenesis of HFrEF and HFpEF. In this review, we summarize the differences in pathological development of HFrEF and HFpEF, focussing on disease-specific aspects of inflammation and endothelial function, cardiomyocyte hypertrophy and death, alterations in the giant spring titin, and fibrosis. We highlight the areas of difference between the two diseases with the aim of guiding research efforts for novel therapeutics in HFrEF and HFpEF.
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48
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Han X, Wang Y, Fu M, Song Y, Wang J, Cui X, Fan Y, Cao J, Luo J, Sun A, Zou Y, Hu K, Zhou J, Ge J. Effects of Adiponectin on Diastolic Function in Mice Underwent Transverse Aorta Constriction. J Cardiovasc Transl Res 2019; 13:225-237. [PMID: 31621035 PMCID: PMC7166206 DOI: 10.1007/s12265-019-09913-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
Diastolic dysfunction is common in various cardiovascular diseases, which could be affected by adiponectin (APN). Nevertheless, the effects of APN on diastolic dysfunction in pressure overload model induced by transverse aorta constriction (TAC) remain to be further elucidated. Here, we demonstrated that treatment of APN attenuated diastolic dysfunction and cardiac hypertrophy in TAC mice. Notably, APN also improved active relaxation of adult cardiomyocytes, increased N2BA/N2B ratios of titin isoform, and reduced collagen type I to type III ratio and lysyl oxidase (Lox) expressions in the myocardial tissue. Moreover, APN supplementation suppressed TAC-induced oxidative stress. In vitro, inhibition of AMPK by compound C (Cpc) abrogated the effect of APN on modulation of titin isoform shift and the anti-hypertrophic effect of APN on cardiomyocytes induced by AngII. In summary, our findings indicate that APN could attenuate diastolic dysfunction in TAC mice, which are at least partially mediated by AMPK pathway.
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Affiliation(s)
- Xueting Han
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanyan Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingqiang Fu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Song
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaotong Cui
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Fan
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Juan Cao
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jie Luo
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Aijun Sun
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunzeng Zou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Hu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
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49
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Zhou Y, Liu L, Cheng T, Wang DX, Yang HY, Zhang BW, Yang Y, Chen F, Li XY. Grade 3 Echocardiographic Diastolic Dysfunction Is Associated With Increased Risk of Major Adverse Cardiovascular Events After Surgery: A Retrospective Cohort Study. Anesth Analg 2019; 129:651-658. [PMID: 31425203 PMCID: PMC6693928 DOI: 10.1213/ane.0000000000003807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Diastolic dysfunction is common and may increase the risk of cardiovascular complications. This study investigated the hypothesis that, in patients with isolated left ventricular diastolic dysfunction, higher grade diastolic dysfunction was associated with greater risk of major adverse cardiovascular events (MACEs) after surgery. METHODS This was a retrospective cohort study. Data of adult patients with isolated echocardiographic diastolic dysfunction (ejection fraction, ≥50%) who underwent noncardiac surgery from January 1, 2015 to December 31, 2015 were collected. The primary end point was the occurrence of postoperative MACEs during hospital stay, which included acute myocardial infarction, congestive heart failure, stroke, nonfatal cardiac arrest, and cardiac death. The association between the grade of diastolic dysfunction and the occurrence of MACEs was assessed with a multivariable logistic model. RESULTS A total of 2976 patients were included in the final analysis. Of these, 297 (10.0%) developed MACEs after surgery. After correction for confounding factors, grade 3 diastolic dysfunction was associated with higher risk of postoperative MACEs (odds ratio, 1.71; 95% confidence interval, 1.28-2.27; P < .001) when compared with grades 1 and 2. Patients with grade 3 diastolic dysfunction developed more non-MACE complications when compared with grades 1 and 2 (uncorrected odds ratio, 1.44; 95% confidence interval, 1.07-1.95; P = .017). CONCLUSIONS In patients with isolated diastolic dysfunction undergoing noncardiac surgery, 10.0% develop MACEs during hospital stay after surgery; grade 3 diastolic dysfunction is associated with greater risk of MACEs.
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Affiliation(s)
- Yan Zhou
- From the Departments of Anesthesiology and Critical Care Medicine
| | | | - Tong Cheng
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Dong-Xin Wang
- From the Departments of Anesthesiology and Critical Care Medicine
| | | | | | | | | | - Xue-Ying Li
- Biostatistics, Peking University First Hospital, Beijing, China
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50
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Hong L, Xing L, Li R, Zhang L, Ma C, An J, Zhao L, Yang J, Liu S. Subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking echocardiography in asymptomatic patients with carotid stenosis. Int J Cardiovasc Imaging 2019; 35:2205-2212. [PMID: 31342237 DOI: 10.1007/s10554-019-01677-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
The relationship between subclinical left ventricular (LV) dysfunction and atherosclerosis may have been underestimated in the past, which might be responsible for the high incidence of premature death in individuals with carotid stenosis. We sought to evaluate the underlying myocardial dysfunction in asymptomatic carotid stenosis patients using speckle tracking echocardiography (STE). Fifty patients with carotid stenosis ≥ 50% and a preserved LV ejection fraction (LVEF), and 45 controls without carotid stenosis who were matched in terms of vascular comorbidities were enrolled. All participants underwent carotid ultrasound and echocardiographic examination. The global LV longitudinal strain (GLS) was measured using STE. Compared with the control group, the e' of the mitral annular velocity and GLS were decreased in asymptomatic carotid stenosis patients (p < 0.05), however, the LVEF was well preserved. Based on a predefined cutoff for subclinical LV systolic dysfunction that was defined at a GLS < - 18%, this dysfunction was detected in 22 patients with carotid stenosis (44%) and in 10 patients in the control group (22%) (p < 0.05). The GLS was negatively correlated with the levels of low-density lipoprotein cholesterol (r = - 0.356, p < 0.05) and triglyceride (r = - 0.396, p < 0.05). In conclusion, LV diastolic and systolic functioning were significantly decreased in patients with asymptomatic carotid stenosis, and dyslipidemia likely contributed to the subclinical LV dysfunction in these patients. Our findings indicated the importance of detecting LV subclinical dysfunction and early intervention in this patient population.
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Affiliation(s)
- Linwei Hong
- Department of Ultrasound, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, People's Republic of China
| | - Liying Xing
- Department of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, 110005, People's Republic of China
| | - Ru Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Limin Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jing An
- Department of Ultrasound, Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110034, People's Republic of China
| | - Lanting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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