1
|
Yeh JK, Tsou YL, Liu MH, Chen WS, Cheng CI, Pan KL, Wang CH, Hsieh IC. Prognostic Significance of Phenylalanine in Heart Failure: Clinical Insights and Inter-Organ Crosstalk Snapshot. J Clin Med 2024; 13:4251. [PMID: 39064291 PMCID: PMC11277683 DOI: 10.3390/jcm13144251] [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: 05/14/2024] [Revised: 07/14/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Heart failure (HF) remains a leading cause of morbidity and mortality globally, necessitating the identification of reliable prognostic biomarkers to guide therapeutic interventions. Recent clinical observations have underscored phenylalanine (PHE) as a prognostic marker in HF, although the mechanisms involving inter-organ crosstalk remain understood. Methods: This study adopted a dull approach, with a retrospective analysis of 550 HF patients to establish the prognostic value of pre-discharge PHE levels and a study on the inter-organ crosstalk of PHE among 24 patients. We analyzed the correlations between PHE concentrations and clinical outcomes, alongside a comprehensive examination of PHE metabolism across the skeletal muscle, liver, heart, kidney, and lung. Results: In the clinical prognostic analysis of 550 patients hospitalized for acute decompensated HF, elevated PHE levels (≥65.6 μM) were significantly and independently associated with increased all-cause mortality during a median follow-up of 4.5 years (log rank = 36.7, p < 0.001), underscoring its value as a prognostic marker in HF. The inter-organic crosstalk study elucidated the mechanism associated with PHE elevation in patients with HF, characterized by an increase in PHE output in skeletal muscle and a decrease in hepatic and cardiac PHE uptakes. Notably, PHE concentration gradients across these organs were correlated with HF severity, such as the NYHA functional class, B-type natriuretic peptide levels, and the presence of acute HF. Conclusions: Our findings confirm the prognostic significance of PHE in patients with HF and unveil the complex metabolic interplay among key organs that contribute to PHE dysregulation. These insights not only reinforce the importance of metabolic monitoring in HF management but also open avenues for therapeutic targets.
Collapse
Affiliation(s)
- Jih-Kai Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Yi-Liang Tsou
- Heart Failure Research Center, Department of Cardiology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (Y.-L.T.); (M.-H.L.); (W.-S.C.)
| | - Min-Hui Liu
- Heart Failure Research Center, Department of Cardiology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (Y.-L.T.); (M.-H.L.); (W.-S.C.)
- Department of Nursing, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Wei-Siang Chen
- Heart Failure Research Center, Department of Cardiology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (Y.-L.T.); (M.-H.L.); (W.-S.C.)
| | - Cheng-I Cheng
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Kuo-Li Pan
- Division of Cardiovascular Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
| | - Chao-Hung Wang
- Heart Failure Research Center, Department of Cardiology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (Y.-L.T.); (M.-H.L.); (W.-S.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| |
Collapse
|
2
|
Deogharia M, Gurha P. Epigenetic regulation of heart failure. Curr Opin Cardiol 2024; 39:371-379. [PMID: 38606626 PMCID: PMC11150090 DOI: 10.1097/hco.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW The studies on chromatin-modifying enzymes and how they respond to different stimuli within the cell have revolutionized our understanding of epigenetics. In this review, we provide an overview of the recent studies on epigenetic mechanisms implicated in heart failure. RECENT FINDINGS We focus on the major mechanisms and the conceptual advances in epigenetics as evidenced by studies in humans and mouse models of heart failure. The significance of epigenetic modifications and the enzymes that catalyze them is also discussed. New findings from the studies of histone lysine demethylases demonstrate their significance in regulating fetal gene expression, as well as their aberrant expression in adult hearts during HF. Similarly, the relevance of histone deacetylases inhibition in heart failure and the role of HDAC6 in cardio-protection are discussed. Finally, the role of LMNA (lamin A/C), a nuclear membrane protein that interacts with chromatin to form hundreds of large chromatin domains known as lamin-associated domains (LADs), and 3D genome structure in epigenetic regulation of gene expression and heart failure is discussed. SUMMARY Epigenetic modifications provide a mechanism for responding to stress and environmental variation, enabling reactions to both external and internal stimuli, and their dysregulation can be pathological as in heart failure. To gain a thorough understanding of the pathological mechanisms and to aid in the development of targeted treatments for heart failure, future research on studying the combined effects of numerous epigenetic changes and the structure of chromatin is warranted.
Collapse
Affiliation(s)
- Manisha Deogharia
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, The University of Texas Health Sciences Center at Houston, Texas, USA
| | | |
Collapse
|
3
|
Wei FF, Chen X, Cheng W, Chen S, Wu Y, Yu Z, Huang J, Zhao J, He J, Cauwenberghs N, Dong Y, Liu C. Associations of long-term mortality with serum uric acid at admission in acute decompensated heart failure with different phenotypes. Nutr Metab Cardiovasc Dis 2023; 33:1998-2005. [PMID: 37544872 DOI: 10.1016/j.numecd.2023.06.007] [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: 02/12/2023] [Revised: 04/12/2023] [Accepted: 06/12/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS It remains unclear whether the long-term prognostic value of serum uric acid (SUA) at admission differs in acute decompensated heart failure (HF) patients across the spectrum of left ventricular ejection fraction (EF). METHODS AND RESULTS In 2375 patients (38.9% women; mean age, 68.8 years), we assessed the risk of long-term (>1 year) all-cause mortality associated with per 1-SD increase in SUA at admission, using multivariable Cox regression in HF with preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) EF. During a median follow-up of 4.1 years, the long-term mortality rate was 39.9%. In all patients, the multivariable-adjusted hazard ratio (HR) expressing the risk of long-term mortality associated with SUA was 1.18 (95% CI, 1.11-1.26; P < 0.001). Compared with the low tertile of the SUA distribution, the sex- and age-adjusted cumulative incidence of long-term mortality was higher in the top tertile. In patients with HFpEF and HFrEF, SUA predicted the risk of long-term mortality with HRs amounting to 1.12 (95% CI, 1.02-1.21; P = 0.012) and 1.28 (95% CI, 1.12-1.47; P < 0.001), respectively. However, there were no associations between the risk of mortality and SUA in HFmrEF. Furthermore, age, sex, NYHA class, and the prevalence of coronary heart disease interacted significantly with SUA for predicting long-term mortality. CONCLUSION Higher levels of SUA at admission were associated with higher risk of long-term mortality in patients with different HF subtypes. The risk conferred by SUA was age and sex dependent. Our observations highlight that measuring SUA at admission may help to improve risk stratification.
Collapse
Affiliation(s)
- Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuwei Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Winglam Cheng
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shilan Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuzhong Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongping Yu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiale Huang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingjing Zhao
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiangui He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
| |
Collapse
|
4
|
Zhou X, Nakamura K, Sahara N, Asami M, Toyoda Y, Enomoto Y, Hara H, Noro M, Sugi K, Moroi M, Nakamura M, Huang M, Zhu X. Exploring and Identifying Prognostic Phenotypes of Patients with Heart Failure Guided by Explainable Machine Learning. Life (Basel) 2022; 12:life12060776. [PMID: 35743806 PMCID: PMC9224610 DOI: 10.3390/life12060776] [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: 05/07/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
Identifying patient prognostic phenotypes facilitates precision medicine. This study aimed to explore phenotypes of patients with heart failure (HF) corresponding to prognostic condition (risk of mortality) and identify the phenotype of new patients by machine learning (ML). A unsupervised ML was applied to explore phenotypes of patients in a derivation dataset (n = 562) based on their medical records. Thereafter, supervised ML models were trained on the derivation dataset to classify these identified phenotypes. Then, the trained classifiers were further validated on an independent validation dataset (n = 168). Finally, Shapley additive explanations were used to interpret decision making of phenotype classification. Three patient phenotypes corresponding to stratified mortality risk (high, low, and intermediate) were identified. Kaplan−Meier survival curves among the three phenotypes had significant difference (pairwise comparison p < 0.05). Hazard ratio of all-cause mortality between patients in phenotype 1 (n = 91; high risk) and phenotype 3 (n = 329; intermediate risk) was 2.08 (95%CI 1.29−3.37, p = 0.003), and 0.26 (95%CI 0.11−0.61, p = 0.002) between phenotype 2 (n = 142; low risk) and phenotype 3. For phenotypes classification by random forest, AUCs of phenotypes 1, 2, and 3 were 0.736 ± 0.038, 0.815 ± 0.035, and 0.721 ± 0.03, respectively, slightly better than the decision tree. Then, the classifier effectively identified the phenotypes for new patients in the validation dataset with significant difference on survival curves and hazard ratios. Finally, age and creatinine clearance rate were identified as the top two most important predictors. ML could effectively identify patient prognostic phenotypes, facilitating reasonable management and treatment considering prognostic condition.
Collapse
Affiliation(s)
- Xue Zhou
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu 965-8580, Japan;
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
- Correspondence: (K.N.); (X.Z.); Tel.: +81-3-468-1251 (K.N.); +81-242-37-2771 (X.Z.)
| | - Naohiko Sahara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Masako Asami
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Yasutake Toyoda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Yoshinari Enomoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Mahito Noro
- Division of Cardiovascular Medicine, Odawara Cardiovascular Hospital, Odawara 250-0873, Japan; (M.N.); (K.S.)
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Odawara Cardiovascular Hospital, Odawara 250-0873, Japan; (M.N.); (K.S.)
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan; (N.S.); (M.A.); (Y.T.); (Y.E.); (H.H.); (M.M.); (M.N.)
| | - Ming Huang
- Division of Information Science, Nara Institute of Science and Technology, Ikoma 630-0192, Japan;
| | - Xin Zhu
- Biomedical Information Engineering Lab, The University of Aizu, Aizuwakamatsu 965-8580, Japan;
- Correspondence: (K.N.); (X.Z.); Tel.: +81-3-468-1251 (K.N.); +81-242-37-2771 (X.Z.)
| |
Collapse
|
5
|
Abstract
The left atrium (LA) plays an important role in facilitating left ventricular (LV) filling by acting as a reservoir, passive conduit, and active booster pump, as well as a regulator of blood volume through A-type natriuretic peptide secretion in response to stimulation by mechanical stretch of the cavity. LA myopathy has emerged as one of the most important non-LV contributors to disease progression in heart failure with preserved ejection fraction (HFpEF). LA dysfunction is common in HFpEF and is associated with more severe pulmonary vascular disease and right ventricular dysfunction, and increases the risk of incident atrial fibrillation or atrial functional mitral regurgitation, leading to limitations in cardiac output reserve and reduced exercise capacity. LA deformation assessed by 2-dimensional speckle-tracking echocardiography is useful for estimating abnormal hemodynamics or exercise capacity, discriminating HFpEF from non-cardiac dyspnea and is an independent predictor of adverse outcome in HFpEF. Thus, interventions directly targeting LA myopathy may improve outcomes in HFpEF with LA myopathy. This review provides information regarding the physiology of the LA in patients with HFpEF and discusses the importance of evaluation of LA function, management issues, and future directions through ongoing trials of medical interventions.
Collapse
|
6
|
Unterhuber M, Kresoja KP, Rommel KP, Besler C, Baragetti A, Klöting N, Ceglarek U, Blüher M, Scholz M, Catapano AL, Thiele H, Lurz P. Proteomics-Enabled Deep Learning Machine Algorithms Can Enhance Prediction of Mortality. J Am Coll Cardiol 2021; 78:1621-1631. [DOI: 10.1016/j.jacc.2021.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/18/2023]
|