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Li GY, Elimam AM, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Chao TF, Lin CY, Liu CM, Liao JN, Ton AKN, Yugo D, Lin L, Tuan TC, Kao PH, Liu SH, Chhay C, Kuo L, Cheng WH, Chen WT, Chen SA. Factors predicting the progression from paroxysmal to persistent atrial fibrillation despite an index catheter ablation. J Cardiovasc Electrophysiol 2023; 34:2504-2513. [PMID: 37822117 DOI: 10.1111/jce.16100] [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: 06/03/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Despite undergoing an index ablation, some patients progress from paroxysmal atrial fibrillation (PAF) to persistent AF (PersAF), and the mechanism behind this is unclear. The aim of this study was to investigate the predictors of progression to PersAF after catheter ablation in patients with PAF. METHODS This study included 400 PAF patients who underwent an index ablation between 2015 and 2019. The patients were classified into three groups based on their outcomes: Group 1 (PAF to sinus rhythm, n = 226), Group 2 (PAF to PAF, n = 146), and Group 3 (PAF to PersAF, n = 28). Baseline and procedural characteristics were collected, and predictors for AF recurrence and progression were evaluated. RESULTS The mean age of the patients was 58.4 ± 11.1 years, with 272 males. After 3 years of follow-up, 7% of the PAF cases recurred and progressed to PersAF despite undergoing an index catheter ablation. In the multivariable analysis, a larger left atrial (LA) diameter and the presence of non-pulmonary vein (PV) triggers during the index procedure independently predicted recurrence. Moreover, a larger LA diameter, the presence of non-PV triggers, and a history of thyroid disease independently predicted AF progression. CONCLUSION The progression from PAF to PersAF after catheter ablation is associated with a larger LA diameter, history of thyroid disease, and the presence of non-PV triggers. Meticulous preprocedural evaluation, patient selection, and comprehensive provocation tests during catheter ablation are recommended.
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Affiliation(s)
- Guan-Yi Li
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ahmed Moustafa Elimam
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Cardiology, King Abdulaziz Universty Hospital, Jeddah, Saudi Arabia
| | - Li-Wei Lo
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fa-Po Chung
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - An Khanh-Nu Ton
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Cardiology, Tam Duc Cardiology Hospital, Ho Chi Minh City, Vietnam
| | - Dony Yugo
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Cardiology and Vascular Medicine, Division of Arrhythmia, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Linda Lin
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Cardiology, Northern Beaches Hospital, Sydney, Australia
| | - Ta-Chuan Tuan
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei Heng Kao
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shin-Huei Liu
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chheng Chhay
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Cardiology, Khmer Soviet-Friendship Hospital, Phnom Penh, Cambodia
| | - Ling Kuo
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Tso Chen
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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D'Angelo V, Martinez C, Arreche N, Balaszczuk AM, del Carmen Fernández M, Burgos JI, Petroff MV, Fellet A. Thyroid hormone disorder and the heart: The role of cardiolipin in calcium handling. Exp Physiol 2023; 108:412-419. [PMID: 36651722 PMCID: PMC10103858 DOI: 10.1113/ep090817] [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: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
NEW FINDINGS What is the central question of this study? Do alterations in thyroid status affect haemodynamic parameters and echocardiographic measurements in the rat postnatal heart, and calcium handling, contractility, relaxation and cardiolipin content in isolated rat cardiomyocytes? What is the main finding and its importance? An imbalance in phospholipids of the mitochondrial membrane such as cardiolipin is related to defects in mitochondrial function. T3 -dependent cardiolipin signals contribute to the maintenance of mitochondrial homeostasis and involve Ca2+ handling, this pathway being more important in hypothyroidism. ABSTRACT The objective of this study was to evaluate whether alterations in thyroid status affect (1) haemodynamic parameters and echocardiographic measurements in the rat postnatal heart, and (2) calcium handling, contractility, relaxation and cardiolipin content in isolated rat cardiomyocytes. Sprague-Dawley rats aged 2 months treated with T3 (hyperthyroid, 20 μg/100 g body weight) or 0.02% methimazole (hypothyroid, w/v) for 28 days. Heart function was evaluated by echocardiography. Measurements of mean arterial pressure (MAP), heart rate, Ca2+ transients, cardiomyocyte shortening, number of spontaneous contractions per minute and cardiolipin (CL) content were performed. Thyroid disorders were associated with changes in pacemaker activity without modifications of MAP. Thyroid disorder induced changes in left ventricular diameter which were correlated with modifications of cardiac contractility (altered cell shortening and sarcoplasmic reticulum Ca2+ content). Endocrine disorders altered cardiomyocyte relaxation (reduction in the time to 50% re-lengthening and the time to 50% Ca2+ decay). Thyroid disorder increased the number of spontaneous contractions per minute (an index of pro-arrhythmogenic behaviour). CL content was increased only in hypothyroid rats. Changes in CL content, CL composition and CL-protein interaction in mitochondria from hypothyroid animals are responsible for alterations of contractile and relaxation cardiac function. This mechanism may be not be involved in T3 -treated rats. Maintenance of euthyroidism is of crucial importance to preserve cardiac performance. An imbalance in relation to phospholipids of the mitochondrial membrane such as CL is related to defects in mitochondrial function. T3 -dependent CL signals contribute to the maintenance of mitochondrial homeostasis and involve Ca2+ handling, this pathway being more important in hypothyroidism.
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Affiliation(s)
- Valentina D'Angelo
- Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, IQUIMEFA‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
| | - Candela Martinez
- Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, IQUIMEFA‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
| | - Noelia Arreche
- Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, IQUIMEFA‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
| | - Ana María Balaszczuk
- Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, IQUIMEFA‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
| | - María del Carmen Fernández
- Cátedra de Biología Celular y MolecularFacultad de Farmacia y BioquímicaIQUIFIB‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
| | - Juan Ignacio Burgos
- Centro de Investigaciones Cardiovasculares Horacio Cingolani. Facultad de Ciencias MédicasUniversidad Nacional de La PlataCONICETLa PlataArgentina
| | - Martin Vila Petroff
- Centro de Investigaciones Cardiovasculares Horacio Cingolani. Facultad de Ciencias MédicasUniversidad Nacional de La PlataCONICETLa PlataArgentina
| | - Andrea Fellet
- Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, IQUIMEFA‐CONICETCiudad Autónoma de Buenos AiresUniversidad de Buenos AiresBuenos AiresArgentina
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Navarro-Navajas A, Cruz JD, Ariza-Ordoñez N, Giral H, Palmezano J, Bolívar-Mejía A, Santana Q, Fernandez R, Durango L, Saldarriaga C, Mateus JC, Garnica D, Sarta-García JG, Lizcano F, Tapias CA. Cardiac manifestations in hyperthyroidism. Rev Cardiovasc Med 2022; 23:136. [PMID: 39076244 PMCID: PMC11273775 DOI: 10.31083/j.rcm2304136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 07/31/2024] Open
Abstract
Thyroid hormones have a fundamental impact on cardiac function that is mediated by genomic and nongenomic effects, alterations that condition physiological repercussions that lead to changes in frequency, contractility, rhythm and cardiac output as well as an increase in the incidence and prevalence of different cardiovascular diseases. This document presents an updated review of the implications that hyperthyroidism has in different cardiac conditions, including its importance in the evaluation of perioperative cardiovascular risk.
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Affiliation(s)
- Alberto Navarro-Navajas
- Escuela de medicina, Universidad del Bosque, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - José David Cruz
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Nicolas Ariza-Ordoñez
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Helman Giral
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Jorge Palmezano
- Escuela de medicina, Universidad Pontificia Bolivariana, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Adrián Bolívar-Mejía
- Escuela de medicina, Universidad Pontificia Bolivariana, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Quindo Santana
- Departamento de cardiología, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Ricardo Fernandez
- Departamento de cardiología, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Luisa Durango
- Departamento de cardiología, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Clara Saldarriaga
- Programa de falla cardiaca, Cardio-VID Clinic, 050010 Medellin, Colombia
| | - Juan Camilo Mateus
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Diego Garnica
- Escuela de medicina, Universidad del Bosque, Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - José Guillermo Sarta-García
- Centro de Investigación Biomédica Universidad de La Sabana (CIBUS), Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Fernando Lizcano
- Centro de Investigación Biomédica Universidad de La Sabana (CIBUS), Fundación Cardioinfantil, 110131 Bogota, Colombia
| | - Carlos Andrés Tapias
- Departamento de electrofisiología, Centro Internacional de Arritmias, Fundación Cardioinfantil, 110131 Bogota, Colombia
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Lisco G, Giagulli VA, Iovino M, Zupo R, Guastamacchia E, De Pergola G, Iacoviello M, Triggiani V. Endocrine system dysfunction and chronic heart failure: a clinical perspective. Endocrine 2022; 75:360-376. [PMID: 34713389 PMCID: PMC8553109 DOI: 10.1007/s12020-021-02912-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
Chronic heart failure (CHF) leads to an excess of urgent ambulatory visits, recurrent hospital admissions, morbidity, and mortality regardless of medical and non-medical management of the disease. This excess of risk may be attributable, at least in part, to comorbid conditions influencing the development and progression of CHF. In this perspective, the authors examined and described the most common endocrine disorders observed in patients with CHF, particularly in individuals with reduced ejection fraction, aiming to qualify the risks, quantify the epidemiological burden and discuss about the potential role of endocrine treatment. Thyroid dysfunction is commonly observed in patients with CHF, and sometimes it could be the consequence of certain medications (e.g., amiodarone). Male and female hypogonadism may also coexist in this clinical context, contributing to deteriorating the prognosis of these patients. Furthermore, growth hormone deficiency may affect the development of adult myocardium and predispose to CHF. Limited recommendation suggests to screen endocrine disorders in CHF patients, but it could be interesting to evaluate possible endocrine dysfunction in this setting, especially when a high suspicion coexists. Data referring to long-term safety and effectiveness of endocrine treatments in patients with CHF are limited, and their impact on several "hard" endpoints (such as hospital admission, all-cause, and cardiovascular mortality) are still poorly understood.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Iovino
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Clinical Nutrition Unit, Medical Oncology, Department of Internal Medicine and Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, Cardiology Department, University of Foggia, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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TG68, a Novel Thyroid Hormone Receptor-β Agonist for the Treatment of NAFLD. Int J Mol Sci 2021; 22:ijms222313105. [PMID: 34884910 PMCID: PMC8657920 DOI: 10.3390/ijms222313105] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022] Open
Abstract
Activation of thyroid hormone receptor β (THRβ) has shown beneficial effects on metabolic alterations, including non-alcoholic fatty liver disease (NAFLD). Here, we investigated the effect of TG68, a novel THRβ agonist, on fatty liver accumulation and liver injury in mice fed a high-fat diet (HFD). C57BL/6 mice fed HFD for 17 or 18 weeks, a time when all mice developed massive steatohepatitis, were then given TG68 at a dose of 9.35 or 2.8 mg/kg for 2 or 3 weeks, respectively. As a reference compound, the same treatment was adopted using equimolar doses of MGL-3196, a selective THRβ agonist currently in clinical phase III. The results showed that treatment with TG68 led to a reduction in liver weight, hepatic steatosis, serum transaminases, and circulating triglycerides. qRT-PCR analyses demonstrated activation of THRβ, as confirmed by increased mRNA levels of Deiodinase-1 and Malic enzyme-1, and changes in lipid metabolism, as revealed by increased expression of Acyl-CoA Oxidase-1 and Carnitine palmitoyltransferase-1. The present results showed that this novel THRβ agonist exerts an anti-steatogenic effect coupled with amelioration of liver injury in the absence of extra-hepatic side effects, suggesting that TG68 may represent a useful tool for the treatment of NAFLD.
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Khaleel EF. l-Thyroxine induces left ventricular remodeling and fibrosis in rats by upregulating miR-21 in a reactive oxygen-dependent mechanism: a protective role of N-acetylcysteine. Drug Chem Toxicol 2021; 45:2758-2768. [PMID: 34641738 DOI: 10.1080/01480545.2021.1986251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
miR-21 is the most studied pro-fibrotic marker in the majority of mammalian tissues. The precise mechanism by which hyperthyroidism induces left ventricular LV fibrosis and remodeling remains unclear. In this study, we have investigated the role of miR-21 on l-thyroxine (l-Thy)-induced cardiac fibrosis in rats. Adult male Sprague-Dawley rats were divided into four groups as control, l-Thy, l-Thy + miR antagomir (inhibitor), and l-Thy + N-acetylcysteine (NAC/glutathione (GSH) precursor). Administration of l-Thy significantly increased mRNA levels of miR-21 in the LVs of the treated rats. Also, it impaired the LV systolic and diastolic function and increased the production of reactive oxygen species (ROS), the transactivation of NF-κB p65, the expression of NRLP3 inflammasome, and levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in these LVs. Concomitantly, l-Thy increased the ventricular collagen deposition, and stimulated the expression of collagen 1/3, alpha-smooth actin (α-SMA), transforming growth factor-β1, and Smad3/p-Smad3 but suppressed the expression of Smad7. All these effects were reversed by pre-treatment with miR-21 antagomir or co-administration of NAC. In conclusion, l-Thy-induced LV remodeling and fibrosis include a ROS-dependent upregulation of miR-21 which in turns activates NF-κB/NRLP3 inflammasome and suppresses SMad7.
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Affiliation(s)
- Eman F Khaleel
- Department of Medical Physiology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.,Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mayyas FA, Aljohmani AI, Alzoubi KH. The Impact of Spironolactone on Markers of Myocardial Oxidative Status, Inflammation and Remodeling in Hyperthyroid Rats. Curr Mol Pharmacol 2021; 13:206-215. [PMID: 31729306 DOI: 10.2174/1874467212666191113150553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hyperthyroidism promotes the development and progression of cardiovascular diseases (CVD). Aldosterone, a key mediator of myocardial inflammation, oxidative stress and fibrosis, may be activated in hyperthyroidism. OBJECTIVE To assess the impact of hyperthyroidism on aldosterone levels and myocardial oxidative status, inflammatory and fibrotic markers in hyperthyroid rats, and to test if the use of spironolactone (an aldosterone antagonist) attenuates these changes. METHODS Adult Wistar rats were randomly distributed into 4 groups; controls, spironolactone treated rats (Spir, 50mg/kg/day), hyperthyroid rats (Hyper, daily intraperitoneal levothyroxine 0.3mg/kg/day), and spironolactone treated hyperthyroid rats (Hyper+Spir) for 4 weeks. Blood pressure (Bp), and levels of serum and myocardial aldosterone, oxidants/antioxidants, inflammatory and fibrotic markers were measured. RESULTS Levothyroxine increased serum thyroid hormones and increased Bp, heart rate and heart to bodyweight ratio. Relative to control, serum aldosterone levels were increased in Hyper and Hyper+ Spir groups. In parallel, cardiac lipid peroxides and serum endothelin-1 were increased whereas cardiac superoxide dismutase, catalase, glutathione, and matrix metalloproteinase -2 were reduced in the Hyper group. Spironolactone decreased serum thyroid hormones and improved cardiac lipid peroxides and metalloproteinase -2 levels. The use of spironolactone decreased serum nitrite levels and increased cardiac SOD and glutathione. Cardiac levels of aldosterone, endothelin-1, transforming growth factor-beta and nitrite were similar among all groups. CONCLUSION Hyperthyroid status was associated with an increase in aldosterone and oxidant/ inflammatory biomarkers. The use of spironolactone enhanced antioxidant defenses. Aldosterone antagonists may serve as potential drugs to attenuate the development of cardiac disease in hyperthyroidism.
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Affiliation(s)
- Fadia A Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad I Aljohmani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Shu Z, Chen M, Wang Q, Lai J, Zhao J, Zhuo C, Huang Y, Lv N, Wu M, Zheng L. High-Normal Thyroid Function and Recurrence of Atrial Fibrillation after Catheter Ablation: A Prospective Observational Study. Cardiology 2021; 146:607-615. [PMID: 34237718 DOI: 10.1159/000517092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid function is increasingly recognized as an important modifiable factor for atrial fibrillation (AF); however, it is unclear if the changes in thyroid hormones, even within the normal range, are associated with AF recurrence after catheter ablation. METHODS Consecutive paroxysmal AF patients who underwent catheter ablation were enrolled. Patients with abnormal thyroid hormones or previous thyroid illnesses were excluded. Patients were followed for 12 months or until they presented with the first episode of atrial tachyarrhythmia after a blanking period. RESULTS The study included 448 patients with a mean age of 61 (14) years, and 46% were women. After a 1-year follow-up, 104 (23.2%) patients experienced atrial tachyarrhythmia recurrences after an ablation procedure. Recurrence was significantly different among quartile groups of thyroid function, with highest FT4 and FT3 levels associated with the greatest risk of recurrence (p < 0.001 and p = 0.024, respectively). FT4 and FT3 levels were independent predictors of atrial tachyarrhythmia recurrence (hazard ratio 1.07 per 1 pmol/L increase in FT4, 95% confidence interval [CI] 1.01-1.15, p = 0.036 and 1.31 per 1 pmol/L increase in FT3, 95% CI 1.01-1.71, p = 0.032). CONCLUSIONS High-normal FT3 and FT4 levels are associated with AF recurrence after catheter ablation in this Chinese population. Attention to thyroid hormones could be valuable to assist in the management of AF.
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Affiliation(s)
- Zheyue Shu
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Miao Chen
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qiqi Wang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiangtao Lai
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jianqiang Zhao
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chengui Zhuo
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuan Huang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ning Lv
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Minglan Wu
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Research Center for Clinical Pharmacy, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Liangrong Zheng
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
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Wu L, Wang W, Leng Q, Tang N, Zhou N, Wang Y, Wang DW. Focus on Autoimmune Myocarditis in Graves' Disease: A Case-Based Review. Front Cardiovasc Med 2021; 8:678645. [PMID: 34307494 PMCID: PMC8292634 DOI: 10.3389/fcvm.2021.678645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
The manifestations of hyperthyroidism-related myocardial damage are multitudinous, including arrhythmia, dilated cardiomyopathy, valvular diseases, and even cardiogenic shock. Acute myocarditis induced by thyrotoxicosis had been reported in a few studies. However, attention on its prevalence and underlying mechanisms is sorely lacking. Its long-term harm is often ignored, and it may eventually develop into dilated cardiomyopathy and heart failure. We report a case of Graves' disease with a progressive elevation of hypersensitive cardiac troponin-I at several days after discontinuation of the patient's anti-thyroid drugs. Cardiac magnetic resonance imaging (CMRI) showed inflammatory edema of some cardiomyocytes (stranded enhanced signals under T2 mapping), myocardial necrosis (scattered enhanced signals under T1 late gadolinium enhancement) in the medial and inferior epicardial wall, with a decreased left ventricular systolic function (48%), which implied a possibility of acute myocarditis induced by thyrotoxicosis. The patient was then given a transient glucocorticoid (GC) treatment and achieved a good curative effect. Inspired by this case, we aim to systematically elaborate the pathogenesis, diagnosis, and treatment of hyperthyroidism-induced autoimmune myocarditis. Additionally, we emphasize the importance of CMRI and GC therapy in the diagnosis and treatment of hyperthyroidism-related myocarditis.
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Affiliation(s)
- Lujin Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Qianru Leng
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Nana Tang
- Nursing Teaching Office of Internal Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China
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10
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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11
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Bano A, Chaker L, Muka T, Mattace-Raso FUS, Bally L, Franco OH, Peeters RP, Razvi S. Thyroid Function and the Risk of Fibrosis of the Liver, Heart, and Lung in Humans: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:806-820. [PMID: 31910097 DOI: 10.1089/thy.2019.0572] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Fibrotic diseases have an unclear etiology and poor prognosis. Fluctuations in thyroid function may play a role in the development of fibrosis, but evidence is fragmented and inconclusive. This systematic review and meta-analysis aimed to investigate the association of thyroid function with fibrotic diseases of the liver, heart, and lung in humans. Methods: We searched PubMed, Medline Ovid, Embase Ovid, and Web-of-Science for studies published from inception to 14 June 2019, to identify observational studies that investigated the association of thyroid function with fibrosis of the liver, heart, and lung in humans. Study quality was evaluated by the Newcastle-Ottawa Scale. The Mantel-Haenszel method was used to pool the odds ratios (ORs) of studies investigating the association of hypothyroidism with liver fibrosis. Results: Of the 2196 identified articles, 18 studies were included in the systematic review, of which 11 studies reported on liver fibrosis, 4 on myocardial fibrosis, and 3 on pulmonary fibrosis. The population sample size ranged from 36 to 7259 subjects, with median mean age 51 years (range, 36-69) and median percentage of women 53 (range, 17-100). The risk of bias of studies was low to moderate to high. Higher serum thyrotropin and lower thyroid hormone levels were generally associated with higher likelihood of fibrosis. Compared with euthyroidism, overt and subclinical hypothyroidism was associated with a higher likelihood of fibrosis in the liver (six of seven studies), heart (three of three studies), and lung (three of three studies). Based on the results of the seven studies included in the meta-analysis, overt and subclinical hypothyroidism was associated with an increased risk of liver fibrosis (pooled OR, 2.81; 95% confidence interval [CI], 1.74-4.53; heterogeneity, I2 31.4%; pooled OR, 2.12; CI, 1.45-3.12; heterogeneity, I2 0%; respectively), without evidence of publication bias. Conclusions: This study suggests that low thyroid function is associated with increased likelihood of chronic fibrotic diseases of the liver, heart, and lung. However, the evidence is mainly based on cross-sectional data. Prospective studies and randomized clinical trials are needed to investigate the potential efficacy of thyroid hormone and its analogs on the occurrence and progression of fibrosis.
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Affiliation(s)
- Arjola Bano
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Internal Medicine, Department of Epidemiology, and Academic Center for Thyroid Diseases; Rotterdam, the Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, University of Bern; Endocrinology, Clinical Nutrition and Metabolism; Bern University Hospital, Bern, Switzerland
| | - Layal Chaker
- Department of Internal Medicine, Department of Epidemiology, and Academic Center for Thyroid Diseases; Rotterdam, the Netherlands
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism; Bern University Hospital, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Robin P Peeters
- Department of Internal Medicine, Department of Epidemiology, and Academic Center for Thyroid Diseases; Rotterdam, the Netherlands
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, United Kingdom
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12
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Khan R, Sikanderkhel S, Gui J, Adeniyi AR, O'Dell K, Erickson M, Malpartida J, Mufti Z, Khan T, Mufti H, Al-Adwan SA, Alvarez D, Davis J, Pendley J, Patel D. Thyroid and Cardiovascular Disease: A Focused Review on the Impact of Hyperthyroidism in Heart Failure. Cardiol Res 2020; 11:68-75. [PMID: 32256913 PMCID: PMC7092768 DOI: 10.14740/cr1034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/21/2020] [Indexed: 12/12/2022] Open
Abstract
The association between thyroid hormones and cardiovascular conditions has been well studied, specifically, the effects of hypothyroidism on cardiomyopathy, and hyperthyroidism with arrhythmias. Nonetheless, an explicit correlation between hyperthyroidism and cardiomyopathy has yet to be established. Medical databases MEDLINE and PubMed were accessed and queried as primary sources for data acquisition. Search criteria consisted of “hyperthyroidism”, “heart failure”, and “thyroid and cardiovascular system”, which allowed the retrieval of relevant and recent works. From these sources, a consensus was developed and employed to yield an updated review of the etiology of heart failure in the setting of hyperthyroidism. It is rare for patients with hyperthyroidism to remain in a chronic hyperthyroid state, making it difficult to analyze subsequent long-term effects on the cardiovascular system. Related to heart failure, some studies have demonstrated no change in ejection fraction, while others have shown an acute change along with diastolic dysfunction, with or without an underlying rhythm abnormality. Further investigation is warranted to elucidate the mechanism driving such cardiac dysfunction, and whether it is due to vascular changes, tachyarrhythmias, or myocyte remodeling and fibrosis. The intent of this review article is to improve our understanding of how a hyperthyroid state affects cardiovascular function. An enhanced understanding of the effects on cardiovascular physiology will afford physicians the ability to provide more comprehensive care in consideration of both endocrine and cardiovascular pathologies.
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Affiliation(s)
- Rafay Khan
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Saad Sikanderkhel
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Junhong Gui
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Abdul-Razaq Adeniyi
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Kimberly O'Dell
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Marc Erickson
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Juan Malpartida
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Zarmina Mufti
- Frontier Medical College, Karakoram Highway, Mansehra Rd, Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Taiba Khan
- Bucknell University, 701 Moore Ave, Lewisburg, PA 17837, USA
| | - Harris Mufti
- Frontier Medical College, Karakoram Highway, Mansehra Rd, Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Saif Aldeen Al-Adwan
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Diana Alvarez
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Joshua Davis
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Joseph Pendley
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
| | - Dharmendra Patel
- Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA
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13
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Teixeira RB, Barboza TE, DE Araujo CC, Siqueira R, DE Castro AL, Bonetto JHP, DE Lima-Seolin BG, Carraro CC, Bello-Klein A, Singal PK, Araujo ASDAR. Decreased PGC1- α levels and increased apoptotic protein signaling are associated with the maladaptive cardiac hypertrophy in hyperthyroidism. J Biosci 2018; 43:887-895. [PMID: 30541949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hyperthyroidism can lead to the activation of proteins which are associated with inflammation, apoptosis, hypertrophy, and heart failure. This study aimed to explore the inflammatory and apoptotic proteins involved in the hyperthyroidism-induced cardiac hypertrophy establishment. Male Wistar rats were divided into control and hyperthyroid (12 mg/L L-thyroxine, in drinking water for 28 days) groups. The expression of inflammatory and apoptotic signaling proteins was quantified in the left ventricle by Western blot. Hyperthyroidism was confirmed by evaluation of T3 and T4 levels, as well as cardiac hypertrophy development. There was no change in the expression of HSP70, HIF1-α, TNF-α, MyD88, p-NFκB, NFκB, p-p38, and p38. Reduced expression of p53 and PGC1-α was associated with increased TLR4 and decreased IL-10 expression. Decreased Bcl-2 expression and increased Bax/Bcl-2 ratio were also observed. The results suggest that reduced PGC1-α and IL-10, and elevated TLR4 proteins expression could be involved with the diminished mitochondrial biogenesis and anti-inflammatory response, as well as cell death signaling, in the establishment of hyperthyroidism-induced maladaptive cardiac hypertrophy.
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Affiliation(s)
- Rayane Brinck Teixeira
- Laboratorio de Fisiologia Cardiovascular, Departamento de Fisiologia, Instituto de Ciencias Basicas da Saude, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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14
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Decreased PGC1-α levels and increased apoptotic protein signaling are associated with the maladaptive cardiac hypertrophy in hyperthyroidism. J Biosci 2018. [DOI: 10.1007/s12038-018-9816-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Memantine, an NMDA Receptor Antagonist, Prevents Thyroxin-induced Hypertension, but Not Cardiac Remodeling. J Cardiovasc Pharmacol 2018; 70:305-313. [PMID: 29112047 DOI: 10.1097/fjc.0000000000000521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Stimulation of glutamatergic tone has been causally linked to myocardial pathogenesis and amplified systemic blood pressure (BP). Memantine, a noncompetitive N-methyl-D-aspartate glutamatergic receptor (NMDA-R) antagonist, has been proposed to be an active cardioprotective drug. However, the efficacy of memantine and subsequently the possible involvement of the NMDA-R in the thyroxin (T4)-induced cardiovascular complications have never been investigated. We examined the effect of memantine (30 mg·kg·d) on the T4 (500 μg·kg·d)-provoked increase in mouse BP, cardiac hypertrophy indicated by enlarged overall myocardial mass, and reformed reactions of the contractile myocardium both in vivo and ex vivo after 2 weeks of treatment. Memantine alone did not result in any cardiovascular pathology in mice. Instead, memantine significantly prevented the T4-triggered systemic hypertension. But, it did not reverse cardiac hypertrophy, coupled in vivo left ventricular dysfunction (LV) or ex vivo right ventricular (RV) papillary muscle contractile alterations of the T4-treated mice. Our results openly direct the cardiovascular safety and tolerability of memantine therapy. Yet, extra research is necessary to endorse these prospective advantageous outcomes. Also, we believe that this is the first study to inspect the possible role of NMDA-R in the T4-stimulated cardiovascular disorders and concluded that NMDA-R could play a key role in the T4-induced hypertension.
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16
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Wei SB, Wang W, Liu N, Chen J, Guo XY, Tang RB, Yu RH, Long DY, Sang CH, Jiang CX, Li SN, Wen SN, Wu JH, Bai R, Du X, Dong JZ, Ma CS. U-shaped association between serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol 2018; 51:263-270. [PMID: 29480346 DOI: 10.1007/s10840-018-0337-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Thyroid dysfunction affects the outcomes of atrial fibrillation (AF) catheter ablation. However, it remains unclear if the variations in thyroid function, especially in the triiodothyronine levels, are associated with AF recurrence in euthyroid subjects. This study investigated the associations of thyroid hormone levels with arrhythmia recurrence after AF catheter ablation in euthyroid patients. METHODS A total of 1115 consecutive AF patients who underwent catheter ablation were prospectively enrolled and had their thyroid function measured prior to the procedure. The serum free triiodothyronine (FT3), free tetraiodothyronine (FT4), and thyroid-stimulating hormone (TSH) levels were assessed as predictors of recurrence and were adjusted for potential confounders. The subjects were divided into five quintile groups according to the FT3, FT4, and TSH levels, respectively. RESULTS After a median follow-up of 723 days (interquartile range, 180-1070), 47.2% of patients experienced recurrence. After multivariate adjustment, subject in the lowest and highest FT3 quintiles showed increased risk of recurrence (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.26-2.03, P < 0.01, and HR 1.47, 95% CI 1.16-1.87, P < 0.01, respectively), compared to the median quintile of FT3 levels. Regarding the FT4 level, the highest quintile group showed a higher risk of recurrence (HR 1.27, 95% CI 1.01-1.60, P = 0.04). The TSH levels were not associated with AF recurrence. CONCLUSIONS Both high and low FT3 levels were associated with AF recurrence after catheter ablation. High-normal FT4 levels were also related to AF recurrence; however, no association was found between normal TSH levels and AF recurrence.
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Affiliation(s)
- Shao-Bin Wei
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ji Chen
- School of Statistics, East China Normal University, 500 Dongchuan Road, Shanghai, 200241, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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17
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Janssen R, Muller A, Simonides WS. Cardiac Thyroid Hormone Metabolism and Heart Failure. Eur Thyroid J 2017; 6:130-137. [PMID: 28785539 PMCID: PMC5527173 DOI: 10.1159/000469708] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/07/2017] [Indexed: 12/18/2022] Open
Abstract
The heart is a principal target of thyroid hormone, and a reduction of cardiac thyroid hormone signaling is thought to play a role in pathological ventricular remodeling and the development of heart failure. Studies in various rodent models of heart disease have identified increased activity of cardiac type III deiodinase as a possible cause of diminished levels and action of thyroid hormone. Recent data indicate novel mechanisms underlying the induction of this thyroid hormone-degrading enzyme in the heart as well as post-transcriptional regulation of its expression by microRNAs. In addition, the relevance of diminished thyroid hormone signaling for cardiac remodeling is suggested to include miRNA-mediated effects on pathological signaling pathways. These and other recent studies are reviewed and discussed in the context of other processes and factors that have been implicated in the reduction of cardiac thyroid hormone signaling in heart failure.
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Affiliation(s)
| | | | - Warner S. Simonides
- *Warner S. Simonides, PhD, Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1118, NL–1081 HV Amsterdam (The Netherlands), E-Mail
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18
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Carbone A, D’Andrea A, Riegler L, Scarafile R, Pezzullo E, Martone F, America R, Liccardo B, Galderisi M, Bossone E, Calabrò R. Cardiac damage in athlete’s heart: When the “supernormal” heart fails! World J Cardiol 2017; 9:470-480. [PMID: 28706583 PMCID: PMC5491465 DOI: 10.4330/wjc.v9.i6.470] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/05/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete’s blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete’s heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded.
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19
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Rajagopalan V, Zhang Y, Pol C, Costello C, Seitter S, Lehto A, Savinova OV, Chen YF, Gerdes AM. Modified Low-Dose Triiodo-L-thyronine Therapy Safely Improves Function Following Myocardial Ischemia-Reperfusion Injury. Front Physiol 2017; 8:225. [PMID: 28446882 PMCID: PMC5388763 DOI: 10.3389/fphys.2017.00225] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
Background: We have shown that thyroid hormones (THs) are cardioprotective and can be potentially used as safe therapeutic agents for diabetic cardiomyopathy and permanent infarction. However, no reliable, clinically translatable protocol exists for TH treatment of myocardial ischemia-reperfusion (IR) injury. We hypothesized that modified low-dose triiodo-L-thyronine (T3) therapy would confer safe therapeutic benefits against IR injury. Methods: Adult female rats underwent left coronary artery ligation for 60 min or sham surgeries. At 2 months following surgery and T3 treatment (described below), the rats were subjected to functional, morphological, and molecular examination. Results: Following surgery, the rats were treated with T3 (8 μg/kg/day) or vehicle in drinking water ad libitum following IR for 2 months. Oral T3 significantly improved left ventricular (LV) contractility, relaxation, and relaxation time constant, and decreased beta-myosin heavy chain gene expression. As it takes rats ~6 h post-surgery to begin drinking water, we then investigated whether modified T3 dosing initiated immediately upon reperfusion confers additional improvement. We injected an intraperitoneal bolus of T3 (12 μg/kg) upon reperfusion, along with low-dose oral T3 (4.5 μg/kg/day) in drinking water for 2 months. Continuous T3 therapy (bolus + low-dose oral) enhanced LV contractility compared with oral T3 alone. Relaxation parameters were also improved compared to vehicle. Importantly, these were accomplished without significant increases in hypertrophy, serum free T3 levels, or blood pressure. Conclusions: This is the first study to provide a safe cardiac therapeutic window and optimized, clinically translatable treatment-monitoring protocol for myocardial IR using commercially available and inexpensive T3. Low-dose oral T3 therapy supplemented with bolus treatment initiated upon reperfusion is safer and more efficacious.
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Affiliation(s)
- Viswanathan Rajagopalan
- Department of Basic Sciences, New York Institute of Technology-College of Osteopathic MedicineJonesboro, AR, USA.,Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Christine Pol
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Clifford Costello
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Samantha Seitter
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Ann Lehto
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Olga V Savinova
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Yue-Feng Chen
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
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Takano APC, Munhoz CD, Moriscot AS, Gupta S, Barreto-Chaves MLM. S100A8/MYD88/NF-қB: a novel pathway involved in cardiomyocyte hypertrophy driven by thyroid hormone. J Mol Med (Berl) 2017; 95:671-682. [DOI: 10.1007/s00109-017-1511-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 01/02/2017] [Accepted: 01/18/2017] [Indexed: 01/25/2023]
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Hong KS, Son JW, Ryu OH, Choi MG, Hong JY, Lee SJ. Cardiac Effects of Thyrotropin Oversuppression with Levothyroxine in Young Women with Differentiated Thyroid Cancer. Int J Endocrinol 2016; 2016:9846790. [PMID: 27418929 PMCID: PMC4935911 DOI: 10.1155/2016/9846790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/02/2016] [Accepted: 04/26/2016] [Indexed: 01/25/2023] Open
Abstract
Background. We investigated the cardiac effects of TSH (thyroid-stimulating hormone) oversuppression in women with thyroidectomized differentiated thyroid cancer (DTC) during levothyroxine suppression therapy. Methods. Fourteen young female patients with DTC were enrolled. The duration of TSH-suppressive therapy was 5 to 9 years. They satisfied the following criteria: (1) a serum level of TSH < 0.1 mU/L in the intermediate-risk or TSH < 0.3 mU/L in the low-recurrence-risk group and (2) having been receiving a fixed dose of LT4 before the study. Controls matched for age, sex, and body mass index (BMI) were compared in terms of the levels of serum free T4, free T3, TSH, plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and cardiac functions and structures. Results. DTC patients and control subjects were well matched in heart rate and blood pressure. There were marked differences in serum TSH (P = 0.001) and free T4 (P = 0.002). However, there were no differences between the groups in serum free T3 and plasma NT-pro-BNP. Furthermore, there were nonsignificant differences in cardiac functions and structures between the groups. Conclusions. This study shows that TSH suppression therapy in women with DTC may be safe with respect to cardiac functions and structures despite intermittent oversuppression of TSH during long-term suppressive therapy. Trial Registration. This trial is registered with clinicaltrials.gov identifier NCT02645786.
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Affiliation(s)
- Kyung-Soon Hong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Ohk Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Moon-Gi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Ji Yeon Hong
- Division of Cardiology, Department of Internal Medicine, Hanil General Hospital, Seoul 01450, Republic of Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 14068, Republic of Korea
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23
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Gonçalves A, Tolentino CC, Souza FRD, Huss JCDC, Zinato KDL, Lopes LTP, Furlanetto Júnior R, Neves FDAR. The thyroid hormone receptor β-selective agonist GC-1 does not affect tolerance to exercise in hypothyroid rats. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:141-7. [DOI: 10.1590/2359-3997000000027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 11/22/2022]
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Hübner NS, Merkle A, Jung B, von Elverfeldt D, Harsan LA. Analysis of left ventricular function of the mouse heart during experimentally induced hyperthyroidism and recovery. NMR IN BIOMEDICINE 2015; 28:116-123. [PMID: 25394338 DOI: 10.1002/nbm.3233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 06/04/2023]
Abstract
Many of the clinical manifestations of hyperthyroidism are due to the ability of thyroid hormones to alter myocardial contractility and cardiovascular hemodynamics, leading to cardiovascular impairment. In contrast, recent studies highlight also the potential beneficial effects of thyroid hormone administration for clinical or preclinical treatment of different diseases such as atherosclerosis, obesity and diabetes or as a new therapeutic approach in demyelinating disorders. In these contexts and in the view of developing thyroid hormone-based therapeutic strategies, it is, however, important to analyze undesirable secondary effects on the heart. Animal models of experimentally induced hyperthyroidism therefore represent important tools for investigating and monitoring changes of cardiac function. In our present study we use high-field cardiac MRI to monitor and follow-up longitudinally the effects of prolonged thyroid hormone (triiodothyronine) administration focusing on murine left ventricular function. Using a 9.4 T small horizontal bore animal scanner, cinematographic MRI was used to analyze changes in ejection fraction, wall thickening, systolic index and fractional shortening. Cardiac MRI investigations were performed after sustained cycles of triiodothyronine administration and treatment arrest in adolescent (8 week old) and adult (24 week old) female C57Bl/6 N mice. Triiodothyronine supplementation of 3 weeks led to an impairment of cardiac performance with a decline in ejection fraction, wall thickening, systolic index and fractional shortening in both age groups but with a higher extent in the group of adolescent mice. However, after a hormonal treatment cessation of 3 weeks, only young mice are able to partly restore cardiac performance in contrast to adult mice lacking this recovery potential and therefore indicating a presence of chronically developed heart pathology.
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Affiliation(s)
- Neele Saskia Hübner
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
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Gerdes AM. Restoration of thyroid hormone balance: a game changer in the treatment of heart failure? Am J Physiol Heart Circ Physiol 2014; 308:H1-10. [PMID: 25380818 DOI: 10.1152/ajpheart.00704.2014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The link between low thyroid hormone (TH) function and heart failure is reviewed in the present report. The idea that TH dysfunction may contribute to diseases leading to HF has been discussed for over 60 yr. A growing body of evidence from animal and human studies, particularly in recent years, suggests that TH treatment may improve clinical outcomes. Indeed, if a similar amount of positive information were available for a newly developed heart drug, there is little doubt that large-scale clinical trials would be underway with considerable excitement. THs offer the promise of improving ventricular contraction and relaxation, improving coronary blood flow, and inhibiting atherosclerosis, and new results suggest they may even reduce the incidence of arrhythmias in heart diseases. Are the potential clinical benefits worth the risk of possible overdosing? After so many years, why has this question not been answered? Clearly, the concept has not been disproven. This review explores the body of clinical evidence related to TH dysfunction and heart failure, discuss insights into pathophysiological, cellular, and molecular mechanisms provided by animal research, and discuss what is needed to resolve this long-standing issue in cardiology and move forward.
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Affiliation(s)
- A Martin Gerdes
- Department of Biomedical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York
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26
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Hajje G, Saliba Y, Itani T, Moubarak M, Aftimos G, Farès N. Hypothyroidism and its rapid correction alter cardiac remodeling. PLoS One 2014; 9:e109753. [PMID: 25333636 PMCID: PMC4198123 DOI: 10.1371/journal.pone.0109753] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/06/2014] [Indexed: 01/12/2023] Open
Abstract
The cardiovascular effects of mild and overt thyroid disease include a vast array of pathological changes. As well, thyroid replacement therapy has been suggested for preserving cardiac function. However, the influence of thyroid hormones on cardiac remodeling has not been thoroughly investigated at the molecular and cellular levels. The purpose of this paper is to study the effect of hypothyroidism and thyroid replacement therapy on cardiac alterations. Thirty Wistar rats were divided into 2 groups: a control (n = 10) group and a group treated with 6-propyl-2-thiouracil (PTU) (n = 20) to induce hypothyroidism. Ten of the 20 rats in the PTU group were then treated with L-thyroxine to quickly re-establish euthyroidism. The serum levels of inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL6) and pro-fibrotic transforming growth factor beta 1 (TGF-β1), were significantly increased in hypothyroid rats; elevations in cardiac stress markers, brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) were also noted. The expressions of cardiac remodeling genes were induced in hypothyroid rats in parallel with the development of fibrosis, and a decline in cardiac function with chamber dilation was measured by echocardiography. Rapidly reversing the hypothyroidism and restoring the euthyroid state improved cardiac function with a decrease in the levels of cardiac remodeling markers. However, this change further increased the levels of inflammatory and fibrotic markers in the plasma and heart and led to myocardial cellular infiltration. In conclusion, we showed that hypothyroidism is related to cardiac function decline, fibrosis and inflammation; most importantly, the rapid correction of hypothyroidism led to cardiac injuries. Our results might offer new insights for the management of hypothyroidism-induced heart disease.
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Affiliation(s)
- Georges Hajje
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | - Youakim Saliba
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | - Tarek Itani
- Institut National de Pathologie, Baabda, Lebanon
| | - Majed Moubarak
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | | | - Nassim Farès
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
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27
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Roth GM, Bader DM, Pfaltzgraff ER. Isolation and physiological analysis of mouse cardiomyocytes. J Vis Exp 2014:e51109. [PMID: 25225886 DOI: 10.3791/51109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cardiomyocytes, the workhorse cell of the heart, contain exquisitely organized cytoskeletal and contractile elements that generate the contractile force used to pump blood. Individual cardiomyocytes were first isolated over 40 years ago in order to better study the physiology and structure of heart muscle. Techniques have rapidly improved to include enzymatic digestion via coronary perfusion. More recently, analyzing the contractility and calcium flux of isolated myocytes has provided a vital tool in the cellular and sub-cellular analysis of heart failure. Echocardiography and EKGs provide information about the heart at an organ level only. Cardiomyocyte cell culture systems exist, but cells lack physiologically essential structures such as organized sarcomeres and t-tubules required for myocyte function within the heart. In the protocol presented here, cardiomyocytes are isolated via Langendorff perfusion. The heart is removed from the mouse, mounted via the aorta to a cannula, perfused with digestion enzymes, and cells are introduced to increasing calcium concentrations. Edge and sarcomere detection software is used to analyze contractility, and a calcium binding fluorescent dye is used to visualize calcium transients of electrically paced cardiomyocytes; increasing understanding of the role cellular changes play in heart dysfunction. Traditionally used to test drug effects on cardiomyocytes, we employ this system to compare myocytes from WT mice and mice with a mutation that causes dilated cardiomyopathy. This protocol is unique in its comparison of live cells from mice with known heart function and known genetics. Many experimental conditions are reliably compared, including genetic or environmental manipulation, infection, drug treatment, and more. Beyond physiologic data, isolated cardiomyocytes are easily fixed and stained for cytoskeletal elements. Isolating cardiomyocytes via perfusion is an extremely versatile method, useful in studying cellular changes that accompany or lead to heart failure in a variety of experimental conditions.
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Affiliation(s)
| | - David M Bader
- Department of Medicine, Vanderbilt University; Department of Cell and Developmental Biology, Vanderbilt University;
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Freitas F, Estato V, Carvalho VF, Torres RC, Lessa MA, Tibiriçá E. Cardiac microvascular rarefaction in hyperthyroidism-induced left ventricle dysfunction. Microcirculation 2014; 20:590-8. [PMID: 23510303 DOI: 10.1111/micc.12057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The pathophysiology underlying hyperthyroidism-induced left ventricle (LV) dysfunction and hypertrophy directly involves the heart and indirectly involves the neuroendocrine systems. The effects of hyperthyroidism on the microcirculation are still controversial in experimental models. We investigated the effects of hyperthyroidism on the cardiac function and microcirculation of an experimental rat model. METHODS Male Wistar rats (170-250 g) were divided into two groups: the euthyroid group (n = 10), which was treated with 0.9% saline solution, and the hyperthyroid group (n = 10), which was treated with l-thyroxine (600 μg/kg/day, i.p.) during 14 days. An echocardiographic study was performed to evaluate the alterations in cardiac function, structure and geometry. The structural capillary density and the expression of angiotensin II AT1 receptor in the LV were analyzed using histochemistry and immunohistochemistry, respectively. RESULTS Hyperthyroidism was found to induce profound cardiovascular alterations, such as systolic hypertension, tachycardia, LV dysfunction, cardiac hypertrophy, and myocardial fibrosis. This study demonstrates the existence of structural capillary rarefaction and the down-regulation of the cardiac angiotensin II AT1 receptor in the myocardium of hyperthyroid rats in comparison with euthyroid rats. CONCLUSIONS Microvascular rarefaction may be involved in the pathophysiology of hyperthyroidism-induced cardiovascular alterations.
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Affiliation(s)
- Felipe Freitas
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
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Szkudlarek AC, Aldenucci B, Miyagui NI, Silva IK, Moraes RN, Ramos HE, Fogaça RTH. Short-term thyroid hormone excess affects the heart but does not affect adrenal activity in rats. Arq Bras Cardiol 2014; 102:270-8. [PMID: 24676225 PMCID: PMC3987310 DOI: 10.5935/abc.20140014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/19/2013] [Indexed: 12/26/2022] Open
Abstract
Background Hyperthyroidism (Hy) exerts a broad range of influences on a variety of
physiological parameters. Its disruptive effect on cardiovascular system is one of
its most remarkable impacts. Moreover, Hy has been clinically associated with
stress - induced hyperactivation of the hypothalamic-pituitary-adrenal axis. Objective Evaluate the impact of short-term Hy on cardiac performance and adrenal activity
of rats. Methods Induction of Hy in Wistar rats through injections of T3 (150
µg/kg) for 10 days (hyperthyroid group - HG) or vehicle (control
group). The cardiovascular performance was evaluated by: echocardiography (ECHO);
heart weight/body weight (mg/gr) ratio; contractility of isolated papillary
muscles (IPM) and direct measurement of blood pressures. Adrenal activity was
evaluated by adrenal weight/body weight (mg/gr) ratio and 24-hour fecal
corticosterone (FC) levels on the, 5th and 10th days of T3
treatment. Results In HG, the ECHO showed reduction of the End Systolic and End Diastolic Volumes,
Ejection, Total Diastolic and Isovolumic Relaxation Times, Diastolic and Systolic
Areas and E/A ratio. Heart Rate, Ejection Fraction and Cardiac Output increased.
The heart weight/body weight ratio was higher. Similarly, in IPM, the maximum rate
of force decay during relaxation was higher in all extracellular calcium
concentrations. Systolic blood pressure (SBP) levels were higher. (p ≤ 0.05). On
the other hand, there was no difference in the adrenal weight/body weight ratio or
in the 24-hour FC levels. Conclusions Hy induces positive inotropic, chronotropic and lusitropic effects on the heart by
direct effects of T3 and increases SBP. Those alterations are not correlated with
changes in the adrenal activity.
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Zhang Y, Dedkov EI, Teplitsky D, Weltman NY, Pol CJ, Rajagopalan V, Lee B, Gerdes AM. Both hypothyroidism and hyperthyroidism increase atrial fibrillation inducibility in rats. Circ Arrhythm Electrophysiol 2013; 6:952-9. [PMID: 24036190 DOI: 10.1161/circep.113.000502] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence indicates that cardiac hypothyroidism may contribute to heart failure progression. It is also known that heart failure is associated with an increased risk of atrial fibrillation (AF). Although it is established that hyperthyroidism increases AF incidence, the effect of hypothyroidism on AF is unclear. This study investigated the effects of different thyroid hormone levels, ranging from hypothyroidism to hyperthyroidism on AF inducibility in thyroidectomized rats. METHODS AND RESULTS Thyroidectomized rats with serum-confirmed hypothyroidism 1 month after surgery were randomized into hypothyroid (N=9), euthyroid (N=9), and hyperthyroid (N=9) groups. Rats received placebo, 3.3-mg l-thyroxine (T4), or 20-mg T4 pellets (60-day release form) for 2 months, respectively. At the end of treatment, hypothyroid, euthyroid, and hyperthyroid status was confirmed. Hypothyroid animals showed cardiac atrophy and reduced cardiac systolic and diastolic functions, whereas hyperthyroid rats exhibited cardiac hypertrophy and increased cardiac function. Hypothyroidism and hyperthyroidism produced opposite electrophysiological changes in heart rates and atrial effective refractory period, but both significantly increased AF susceptibility. AF incidence was 78% in hypothyroid, 67% in hyperthyroid, and the duration of induced AF was also longer, compared with 11% in the euthyroid group (all P<0.05). Hypothyroidism increased atrial interstitial fibrosis, but connexin 43 was not affected. CONCLUSIONS Both hypothyroidism and hyperthyroidism lead to increased AF vulnerability in a rat thyroidectomy model. Our results stress that normal thyroid hormone levels are required to maintain normal cardiac electrophysiology and to prevent cardiac arrhythmias and AF.
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Affiliation(s)
- Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
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31
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Weltman NY, Ojamaa K, Savinova OV, Chen YF, Schlenker EH, Zucchi R, Saba A, Colligiani D, Pol CJ, Gerdes AM. Restoration of cardiac tissue thyroid hormone status in experimental hypothyroidism: a dose-response study in female rats. Endocrinology 2013; 154:2542-52. [PMID: 23594789 PMCID: PMC3689280 DOI: 10.1210/en.2012-2087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thyroid hormones (THs) play a pivotal role in regulating cardiovascular homeostasis. To provide a better understanding of the coordinated processes that govern cardiac TH bioavailability, this study investigated the influence of serum and cardiac TH status on the expression of TH transporters and cytosolic binding proteins in the myocardium. In addition, we sought to determine whether the administration of T(3) (instead of T(4)) improves the relationship between THs in serum and cardiac tissue and cardiac function over a short-term treatment period. Adult female Sprague Dawley rats were made hypothyroid by 7 weeks treatment with the antithyroid drug 6-n-propyl-2-thiouracil (PTU). After establishing hypothyroidism, rats were assigned to 1 of 5 graded T(3) dosages plus PTU for a 2-week dose-response experiment. Untreated, age-matched rats served as euthyroid controls. PTU was associated with depressed serum and cardiac tissue T(3) and T(4) levels, arteriolar atrophy, altered TH transporter and cytosolic TH binding protein expression, fetal gene reexpression, and cardiac dysfunction. Short-term administration of T(3) led to a mismatch between serum and cardiac tissue TH levels. Normalization of serum T(3) levels was not associated with restoration of cardiac tissue T(3) levels or cardiac function. In fact, a 3-fold higher T(3) dosage was necessary to normalize cardiac tissue T(3) levels and cardiac function. Importantly, this study provides the first comprehensive data on the relationship between altered TH status (serum and cardiac tissue), cardiac function, and the coordinated in vivo changes in cardiac TH membrane transporters and cytosolic TH binding proteins in altered TH states.
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Affiliation(s)
- Nathan Y Weltman
- Department of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
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