1
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Li D, Wang C. Advances in symptomatic therapy for left ventricular non-compaction in children. Front Pediatr 2023; 11:1147362. [PMID: 37215603 PMCID: PMC10192632 DOI: 10.3389/fped.2023.1147362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Left ventricular non-compaction is a complex cardiomyopathy and the third largest childhood cardiomyopathy, for which limited knowledge is available. Both pathogenesis and prognosis are still under investigation. Currently, no effective treatment strategy exists to reduce its incidence or severity, and symptomatic treatment is the only clinical treatment strategy. Treatment strategies are constantly explored in clinical practice, and some progress has been made in coping with the corresponding symptoms because the prognosis of children with left ventricular non-compaction is usually poor if there are complications. In this review, we summarized and discussed the coping methods for different left ventricular non-compaction symptoms.
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Affiliation(s)
| | - Ce Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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2
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Lander K, Thakeria P, Nayyar S. Prophylactic anticoagulation in sinus rhythm for stroke prevention in cardiovascular disease: contemporary meta-analysis of large randomized trials. Eur J Prev Cardiol 2022; 28:1939-1948. [PMID: 34223629 DOI: 10.1093/eurjpc/zwab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022]
Abstract
AIMS Anticoagulation with non-vitamin K oral anticoagulants (NOACs) to prevent stroke is a mainstay of atrial fibrillation (AF) management. However, multiple cardiovascular diseases (CVDs) are associated with elevated ischaemic stroke risk even in sinus rhythm. In this meta-analysis, we assess efficacy and safety of prophylactic NOAC agents for stroke prevention in patients without AF. METHODS AND RESULTS A search was conducted for randomized controlled trials (RCTs) that evaluated an NOAC and control drug (placebo or antiplatelet) in non-AF patients with mixed CVD. The primary efficacy and safety outcomes were ischaemic stroke and major bleeding, respectively. Results were stratified based on primary- and mini-NOAC doses. Thirteen RCTs were identified with a total of 89 383 patients with CVD in sinus rhythm (53 778 on NOAC, 35 605 on control drug; mean age 65.5 ± 2.7 years). Over a mean follow-up of 18.3 months, 1429 (1.6%) ischaemic strokes occurred. Use of NOAC was associated with 26% reduction in stroke [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.62-0.87; 1.1 vs. 1.8 events per 100 person-years], with numbers needed to treat of 153 patients to prevent one stroke. Major bleeding was increased with NOAC (OR 1.74, 95% CI 1.44-2.09; 2.1 vs. 1.0 events per 100 person-years). The weighted net clinical benefit (wNCB, composite of ischaemic stroke and bleeding) did not suggest a favourable effect with any NOAC dose (wNCB for primary-dose: -0.35; mini-dose: -0.06). CONCLUSION Current evidence does not support use of NOACs for stroke prevention in non-AF CVD population as risk of major bleeding still exceeds ischaemic stroke benefit.
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Affiliation(s)
- Krystle Lander
- Department of Cardiology, Townsville University Hospital, James Cook University, 100, Angus Smith Drive, Townsville, QLD 4814, Australia
| | - Priyanka Thakeria
- Department of Cardiology, Townsville University Hospital, James Cook University, 100, Angus Smith Drive, Townsville, QLD 4814, Australia
| | - Sachin Nayyar
- Department of Cardiology, Townsville University Hospital, James Cook University, 100, Angus Smith Drive, Townsville, QLD 4814, Australia
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3
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Baker AD, Schwamm LH, Sanborn DY, Furie K, Stretz C, Mac Grory B, Yaghi S, Kleindorfer D, Sucharew H, Mackey J, Walsh K, Flaherty M, Kissela B, Alwell K, Khoury J, Khatri P, Adeoye O, Ferioli S, Woo D, Martini S, De Los Rios La Rosa F, Demel SL, Madsen T, Star M, Coleman E, Slavin S, Jasne A, Mistry EA, Haverbusch M, Merkler AE, Kamel H, Schindler J, Sansing LH, Faridi KF, Sugeng L, Sheth KN, Sharma R. Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns. Stroke 2022; 53:1883-1891. [PMID: 35086361 DOI: 10.1161/strokeaha.121.036706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data about the epidemiology and secondary stroke prevention strategies used for patients with depressed left ventricular ejection fraction (LVEF) and sinus rhythm following an acute ischemic stroke (AIS). We sought to describe the prevalence of LVEF ≤40% and sinus rhythm among patients with AIS and antithrombotic treatment practice in a multi-center cohort from 2002 to 2018. METHODS This was a multi-center, retrospective cohort study comprised of patients with AIS hospitalized in the Greater Cincinnati Northern Kentucky Stroke Study and 4 academic, hospital-based cohorts in the United States. A 1-stage meta-analysis of proportions was undertaken to calculate a pooled prevalence. Univariate analyses and an adjusted multivariable logistic regression model were performed to identify demographic, clinical, and echocardiographic characteristics associated with being prescribed an anticoagulant upon AIS hospitalization discharge. RESULTS Among 14 338 patients with AIS with documented LVEF during the stroke hospitalization, the weighted pooled prevalence of LVEF ≤40% and sinus rhythm was 5.0% (95% CI, 4.1-6.0%; I2, 84.4%). Of 524 patients with no cardiac thrombus and no prior indication for anticoagulant who survived postdischarge, 200 (38%) were discharged on anticoagulant, 289 (55%) were discharged on antiplatelet therapy only, and 35 (7%) on neither. There was heterogeneity by site in the proportion discharged with an anticoagulant (22% to 45%, P<0.0001). Cohort site and National Institutes of Health Stroke Severity scale >8 (odds ratio, 2.0 [95% CI, 1.1-3.8]) were significant, independent predictors of being discharged with an anticoagulant in an adjusted analysis. CONCLUSIONS Nearly 5% of patients with AIS have a depressed LVEF and are in sinus rhythm. There is significant variation in the clinical practice of antithrombotic therapy prescription by site and stroke severity. Given this clinical equipoise, further study is needed to define optimal antithrombotic treatment regimens for secondary stroke prevention in this patient population.
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Affiliation(s)
- Anna D Baker
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT
| | | | - Danita Y Sanborn
- Division of Cardiology (D.Y.S.), Massachusetts General Hospital and Harvard Medical School Boston
| | - Karen Furie
- Department of Neurology (K.F., C.S., S.Y.), Alpert Medical School of Brown University, Providence, RI
| | - Christoph Stretz
- Department of Neurology (K.F., C.S., S.Y.), Alpert Medical School of Brown University, Providence, RI
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine (B.M.G.)
| | - Shadi Yaghi
- Department of Neurology (K.F., C.S., S.Y.), Alpert Medical School of Brown University, Providence, RI
| | - Dawn Kleindorfer
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor (D.K.).,Department of Neurology, University of Cincinnati, OH (D.K., K.A., F.D.L.R.L.R., M.H.)
| | - Heidi Sucharew
- Department of Pediatrics, Division of Biostatistics and Epidemiology (H.S.), Cincinnati Children's Hospital Medical Center, OH
| | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis (J.M.)
| | - Kyle Walsh
- Department of Emergency Medicine (K.W.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Matt Flaherty
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Brett Kissela
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Kathleen Alwell
- Department of Neurology, University of Cincinnati, OH (D.K., K.A., F.D.L.R.L.R., M.H.)
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati Medical Center (J.K.), Cincinnati Children's Hospital Medical Center, OH
| | - Pooja Khatri
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO (O.A.)
| | - Simona Ferioli
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Daniel Woo
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Sharyl Martini
- Department of Neurology, Baylor College of Medicine and VA National TeleStroke Program, Houston, TX (S.M.)
| | - Felipe De Los Rios La Rosa
- Department of Neurology, University of Cincinnati, OH (D.K., K.A., F.D.L.R.L.R., M.H.).,Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL (F.D.L.R.L.R.)
| | - Stacie L Demel
- Department of Neurology & Rehabilitation Medicine and Comprehensive Stroke Center (M.F., B.K., P.K., S.F., D.W., S.L.D.), University of Cincinnati Gardner Neuroscience Institute, OH
| | - Tracy Madsen
- Department of Emergency Medicine, Division of Sex and Gender (T.M.), Alpert Medical School of Brown University, Providence, RI
| | - Michael Star
- Department of Neurology, Soroka Medical Center, Beersheva, Israel (M.S.)
| | - Elisheva Coleman
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL (E.C.)
| | - Sabreena Slavin
- Department of Neurology, University of Kansas Medical Center (S.S.)
| | - Adam Jasne
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (E.A.M.)
| | - Mary Haverbusch
- Department of Neurology, University of Cincinnati, OH (D.K., K.A., F.D.L.R.L.R., M.H.)
| | | | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, NY (A.E.M., H.K.)
| | - Joseph Schindler
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT
| | - Lauren H Sansing
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT.,Department of Neurology and Comprehensive Stroke Center (L.H.S.), Massachusetts General Hospital and Harvard Medical School Boston
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine (K.F.F., L.S.), Yale School of Medicine, New Haven, CT
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine (K.F.F., L.S.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT
| | - Richa Sharma
- Department of Neurology (A.D.B., A.J., J.S., L.H.S., K.N.S., R.S.), Yale School of Medicine, New Haven, CT
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Mehana EM, Shawky AM, Abdelrahman HS. Insights on the left ventricular thrombus in patients with ischemic dilated cardiomyopathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Left ventricular thrombus (LVT) formation represents a common complication of dilated cardiomyopathy (DCM). LVT is usually underestimated with transthoracic echocardiography (TTE) while cardiac magnetic resonance imaging (CMRI) is promising as an alternative imaging modality for cardiac thrombus detection. The study aims to compare TTE and CMRI in their ability to detect LVT, also, to assess the clinical and imaging parameters to determine variables that may predispose for thrombus formation. The study population includes seventy-six patients with ischemic DCM. They were divided into 2 groups based on the presence of LVT as detected by delayed-enhancement CMRI (DE-CMRI) [Group A included 20 patients with a LVT and Group B included 56 patients without].
Results
All of the current study population had ischemic DCM with left ventricular ejection fraction (LVEF) < 50%. DE-CMR detected thrombus in 20 cases of the studied population that represented group A. From group A, conventional TTE detected LVT only in 8 and cine-CMR detected 13 cases out of the out of 20 cases. The ejection fraction of the left ventricle as measured by functional CMRI was significantly lower in group A (P = 0.045). Interestingly, the myocardial scarring in group A was seen significantly more extensive than in group B (the P value is < 0.00001), paralleling the increased prevalence of thrombus.
Conclusions
DE-CMRI provides superiority for the detection of LVT compared with standard TTE or cine-CMRI and the amount of myocardial scarring detected by DE-CMRI can be considered an independent marker for thrombus presence.
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5
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Berger JS, Peterson E, LalibertÉ F, Germain G, Lejeune D, Schein J, Lefebvre P, Zhao Q, Weir MR. Risk of Ischemic Stroke in Patients Newly Diagnosed With Heart Failure: Focus on Patients Without Atrial Fibrillation. J Card Fail 2019; 25:436-447. [DOI: 10.1016/j.cardfail.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 12/25/2022]
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6
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Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left Ventricular Thrombus After Acute Decompensated Heart Failure in the Setting of Ischemic Cardiomyopathy. Cureus 2019; 11:e4537. [PMID: 31263645 PMCID: PMC6592471 DOI: 10.7759/cureus.4537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 70-year-old male with a medical history significant for long-standing ischemic cardiomyopathy (ICM) and heart failure with reduced ejection fraction (HFrEF) was admitted to the hospital with shortness of breath (SOB) five days after an acute heart failure (HF) exacerbation. He had non-radiating chest pressure now at rest, but without evidence of an acute coronary syndrome (ACS). Diagnostic work-up on readmission included a transthoracic echocardiogram (TTE), which revealed worsening left ventricular (LV) systolic dysfunction with new wall motion abnormalities and an incidental echo density in the LV apex, suggestive of an LV thrombus. These findings were unseen on imaging 20 months prior. The patient was initiated on warfarin to be maintained for three months, and discharged in stable condition after optimization of his anginal symptoms. Cardiac catheterization was not attempted secondary to the patient's chronic kidney disease (CKD). The incidental finding of an LV thrombus occurred despite compliance with guideline-directed medical therapy of HFrEF and ICM, including adjunctive use of clopidogrel. With the poor survival associated with thromboembolism, the prevention, risk stratification and appropriate therapeutic approach to LV thrombus are poorly delineated in patients with HFrEF in sinus rhythm. Currently, the screening guidelines for the identification of LV thrombus in patients with HFrEF are also unknown. Given mixed evidence regarding prophylactic anticoagulation, we present this case of an incidental LV thrombus found during an episode of acute decompensated HF in the setting of long-standing ICM to emphasize the need to suspect LV thrombus formation after such presentations with closer follow-up for prompt detection and timely treatment.
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Affiliation(s)
- Mohan Satish
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Naveen Vukka
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Dinesh Apala
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Jaya Gupta
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
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7
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Kido K, Guglin M. Anticoagulation Therapy in Specific Cardiomyopathies: Isolated Left Ventricular Noncompaction and Peripartum Cardiomyopathy. J Cardiovasc Pharmacol Ther 2018; 24:31-36. [PMID: 29911432 DOI: 10.1177/1074248418783745] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In 2 distinct entities, left ventricular noncompaction (LVNC) and peripartum cardiomyopathy (PPCM), routine anticoagulation therapy is often used in current practices. However, our systematic review showed that LVNC itself was not associated with the increase in thromboembolism event rates and therapeutic anticoagulation therapy should not be considered only for LVNC, unless there is risk factor for thromboembolism. Current literature justifies prophylactic therapeutic anticoagulation in LVNC with low left ventricular ejection fraction (EF < 40%) and/or atrial fibrillation. Although not specifically studied, the presence of intracardiac thrombi by echocardiography or other imaging studies should also prompt anticoagulation therapy. There is limited evidence available for the use of anticoagulation in patients with PPCM, but our systematic review showed that anticoagulation should be recommended only for patients with PPCM especially with an EF < 35% until EF is recovered, as well as for patients with PPCM treated with bromocriptine.
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Affiliation(s)
- Kazuhiko Kido
- 1 Department of Pharmacy Practice, South Dakota State University, Sioux Falls, SD, USA.,2 Department of Pharmacy, Avera McKennan Hospital, Sioux Falls, SD, USA
| | - Maya Guglin
- 3 Gill Heart Institute, University of Kentucky HealthCare, Lexington, KY, USA
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8
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Doehner W, Ural D, Haeusler KG, Čelutkienė J, Bestetti R, Cavusoglu Y, Peña-Duque MA, Glavas D, Iacoviello M, Laufs U, Alvear RM, Mbakwem A, Piepoli MF, Rosen SD, Tsivgoulis G, Vitale C, Yilmaz MB, Anker SD, Filippatos G, Seferovic P, Coats AJS, Ruschitzka F. Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. Eur J Heart Fail 2017; 20:199-215. [PMID: 29280256 DOI: 10.1002/ejhf.1100] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.
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Affiliation(s)
- Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany
| | - Dilek Ural
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Centre of Cardiology, Vilnius University, Lithuania
| | - Reinaldo Bestetti
- Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Yuksel Cavusoglu
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Duska Glavas
- Cardiology Department, University Hospital Split, Croatia
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Amam Mbakwem
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Stuart D Rosen
- Ealing and Royal Brompton Hospitals and NHLI, Imperial College, London, UK
| | | | - Cristiana Vitale
- Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy
| | - M Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine Cumhuriyet University, Sivas, Turkey
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Gerasimos Filippatos
- Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Petar Seferovic
- University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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9
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Wang B, Xu M, Li W, Li X, Zheng Q, Niu X. Aerobic exercise protects against pressure overload-induced cardiac dysfunction and hypertrophy via β3-AR-nNOS-NO activation. PLoS One 2017. [PMID: 28622359 PMCID: PMC5473571 DOI: 10.1371/journal.pone.0179648] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aerobic exercise confers sustainable protection against cardiac hypertrophy and heart failure (HF). Nitric oxide synthase (NOS) and nitric oxide (NO) are known to play an important role in exercise-mediated cardioprotection, but the mechanism of NOS/NO stimulation during exercise remains unclear. The aim of this study is to determine the role of β3-adrenergic receptors (β3-ARs), NOS activation, and NO metabolites (nitrite and nitrosothiols) in the sustained cardioprotective effects of aerobic exercise. An HF model was constructed by transverse aortic constriction (TAC). Animals were treated with either moderate aerobic exercise by swimming for 9 weeks and/or the β3-AR-specific inhibitor SR59230A at 0.1 mg/kg/hour one day after TAC operation. Myocardial fibrosis, myocyte size, plasma catecholamine (CA) level, cardiac function and geometry were assessed using Masson’s trichrome staining, FITC-labeled wheat germ agglutinin staining, enzyme-linked immuno sorbent assay (ELISA) and echocardiography, respectively. Western blot analysis was performed to elucidate the expression of target proteins. The concentration of myocardial NO production was evaluated using the nitrate reductase method. Myocardial oxidative stress was assessed by detecting the concentration of myocardial super oxidative dismutase (SOD), malonyldialdehyde (MDA), and reactive oxygen species (ROS). Aerobic exercise training improved dilated left ventricular function and partially attenuated the degree of cardiac hypertrophy and fibrosis in TAC mice. Moreover, the increased expression of β3-AR, activation of neuronal NOS (nNOS), and production of NO were detected after aerobic exercise training in TAC mice. However, selective inhibition of β3-AR by SR59230A abolished the upregulation and activation of nNOS induced NO production. Furthermore, aerobic exercise training decreased the myocardial ROS and MDA contents and increased myocardial levels of SOD; both effects were partially attenuated by SR59230A. Our study suggested that aerobic exercise training could improve cardiac systolic function and alleviate LV chamber dilation, cardiac fibrosis and hypertrophy in HF mice. The mechanism responsible for the protective effects of aerobic exercise is associated with the activation of the β3-AR-nNOS-NO pathway.
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Affiliation(s)
- Bin Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Ming Xu
- Department of Physiology, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenju Li
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaoli Li
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Qiangsun Zheng
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
- Department of Cardiology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- * E-mail: (XN); (QZ)
| | - Xiaolin Niu
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
- * E-mail: (XN); (QZ)
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10
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Yu A, Zhang J, Liu H, Liu B, Meng L. Identification of nondiabetic heart failure-associated genes by bioinformatics approaches in patients with dilated ischemic cardiomyopathy. Exp Ther Med 2016; 11:2602-2608. [PMID: 27284354 DOI: 10.3892/etm.2016.3252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/03/2016] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a common pathological condition affecting 4% of the worldwide population. However, approaches for predicting or treating nondiabetic HF (ND-HF) progression are insufficient. In the current study, the gene expression profile GSE26887 was analyzed, which contained samples from 5 healthy controls, 7 diabetes mellitus-HF patients and 12 ND-HF patients with dilated ischemic cardiomyopathy. The dataset of 5 healthy controls and 12 ND-HF patients was normalized with robust multichip average analysis and the differentially expressed genes (DEGs) were screened by unequal variance t-test and multiple-testing correction. In addition, the protein-protein interaction (PPI) network of the upregulated and downregulated genes was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database and the Cytoscape software platform. Subsequently, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. A total of 122 upregulated and 133 downregulated genes were detected. The most significantly up- and downregulated genes were EIF1AY and SERPINE1, respectively. In addition, 38 and 77 nodes were obtained in the up- and downregulated PPI network. DEGs that owned the highest connectivity degree were USP9Y and UTY in the upregulated network, and CD44 in the downregulated networks, respectively. NPPA and SERPINE1 were also found to be hub genes in the PPI network. Several GO terms and pathways that were enriched by DEGs were identified, and the most significantly enriched KEGG pathways were drug metabolism and extracellular matrix-receptor interaction. In conclusion, the two DEGs, NPPA and SERPINE1, may be important in the pathogenesis of HF and may be used for the diagnosis and treatment of HF.
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Affiliation(s)
- Anzhong Yu
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
| | - Jingyao Zhang
- Department of Blood Purification, Jinan Infectious Disease Hospital, Jinan, Shandong 250021, P.R. China
| | - Haiyan Liu
- Department of Internal Medicine, Jinan Minzu Hospital, Jinan, Shandong 250014, P.R. China
| | - Bing Liu
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
| | - Lingdong Meng
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
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11
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Katsanos AH, Parissis J, Frogoudaki A, Vrettou AR, Ikonomidis I, Paraskevaidis I, Triantafyllou N, Kargiotis O, Voumvourakis K, Alexandrov AV, Tsivgoulis G. Heart failure and the risk of ischemic stroke recurrence: A systematic review and meta-analysis. J Neurol Sci 2016; 362:182-7. [DOI: 10.1016/j.jns.2016.01.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 01/14/2023]
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12
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Pagano G, Rengo G, Pasqualetti G, Femminella GD, Monzani F, Ferrara N, Tagliati M. Cholinesterase inhibitors for Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2015; 86:767-73. [PMID: 25224676 DOI: 10.1136/jnnp-2014-308764] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/23/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative movement disorder frequently associated with a wide variety of non-motor symptoms related to non-dopaminergic pathways. Although the depletion of dopamine is the key neurochemical impairment in PD and anticholinergic medications are used for symptomatic treatment, significant deficits in cholinergic transmission are also present and have been associated with cognitive decline and gait dysfunction. Therefore, use of a cholinesterase inhibitor (ChI) might improve cognitive function and reduce the risk of falls in patients with PD, although it could plausibly worsen motor features. Our objective was to conduct a systematic review of prospective, randomised controlled trials, in order to assess the efficacy and safety of ChIs compared with placebo in patients with PD. METHODS AND RESULTS MEDLINE, Web of Science, CENTRAL and Scopus databases were searched to identify studies published before 5 May 2014 and including patients with PD treated with ChIs. From 945 references identified and screened, 19 were assessed for eligibility and 4 trials were included for a total of 941 patients with PD. ChIs significantly slowed Mini-Mental State Examination decline without effect on risk of falls. Tremor rates and adverse drug reactions favoured the placebo group. Alzheimer Disease Assessment Scale-cognitive subscale, global assessment and behavioural disturbance improved in the ChI group without effect on disability. There was no significant difference between the groups for Unified Parkinson Disease Rating Scale III. A significantly reduced death rate was observed in the treated cohort as compared with placebo. CONCLUSIONS ChIs are effective in the treatment of cognitive impairment in patients with PD, but do not affect risk of falls. The choice of treatment has to be balanced considering the increased tremor and adverse drug reactions.
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Affiliation(s)
- Gennaro Pagano
- Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Rengo
- Salvatore Maugeri Foundation, IRCCS Institute of Telese Terme, Telese Terme, Benevento, Italy
| | | | | | | | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy Salvatore Maugeri Foundation, IRCCS Institute of Telese Terme, Telese Terme, Benevento, Italy
| | - Michele Tagliati
- Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, California, USA
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13
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Caldeira D, Cruz I, Calé R, Martins C, Pereira H, Ferreira JJ, Pinto FJ, Costa J. Antithrombotic treatment in chronic heart failure and sinus rhythm: Systematic review. World J Meta-Anal 2015; 3:36-42. [DOI: 10.13105/wjma.v3.i1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/17/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the efficacy and safety of antithrombotic drugs (antiplatelet or anticoagulant drugs) compared to no antithrombotic treatment or placebo in patients with heart failure (HF) and sinus rhythm.
METHODS: We searched Medline and Cochrane Library for randomized controlled trials evaluating antithrombotic treatment and no antithrombotic treatment in patients with HF and sinus rhythm. Risk ratio (RR) and 95%CIs were estimated performing meta-analysis with random effects method.
RESULTS: Two studies met the inclusion criteria: Heart failure Long-term Antithrombotic Study and Warfarin/Aspirin Study in Heart failure, with 336 patients and mean follow-up 1.8-2.25 years. Stroke risk was not reduced by acetylsalicylic acid (RR = 1.18, 95%CI: 0.17-8.15), oral anticoagulation (RR = 0.30, 95%CI: 0.03-2.65) or overall antithrombotic drugs (RR = 0.52, 95%CI: 0.10-2.74). Acetylsalicylic acid showed a significant increased risk of worsening HF (RR = 1.78, 95%CI: 1.08-2.92), while oral anticoagulation had no impact in this outcome (RR = 1.03, 95%CI: 0.61-1.75). Overall antithrombotic drugs showed a significant risk increase of major bleeding (RR = 6.99, 95%CI: 0.89-54.64).
CONCLUSION: Best available evidence does not support the routine use of antithrombotic drugs in patients with HF and sinus rhythm. These drugs, particularly oral anticoagulation has the hazard of increase significantly major bleeding risk.
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14
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Blann A. Prevention and treatment of venous thromboembolism: the nurse's role in management. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjca.2014.9.11.534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andrew Blann
- Senior Lecturer and Consultant in Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham
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15
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Corriveau S, Cooray M, Douketis J. To Thin or Not to Thin: A Case of Peripartum Cardiomyopathy. Can J Cardiol 2014; 30:835.e1-2. [DOI: 10.1016/j.cjca.2013.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
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16
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Betts TR, Gamble JHP, Khiani R, Bashir Y, Rajappan K. Development of a technique for left ventricular endocardial pacing via puncture of the interventricular septum. Circ Arrhythm Electrophysiol 2014; 7:17-22. [PMID: 24425419 DOI: 10.1161/circep.113.001110] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) pacing through the coronary sinus is the standard approach for cardiac resynchronization therapy. When this route is unavailable, the alternatives have major limitations. LV endocardial pacing through the interventriuclar septum may offer a simpler solution. We describe an initial case series to demonstrate technical feasibility and to describe our refinement of the puncture technique. METHODS AND RESULTS Ten patients with previous failed coronary sinus lead implant or with nonresponse to cardiac resynchronization therapy and a suboptimal LV lead position were selected. All patients were anticoagulated. Left ventriculography and coronary angiography were performed to identify LV borders and septal vessels. Subclavian vein access was used for a superior approach ventricular transseptal puncture under fluoroscopic guidance, using a steerable sheath and a standard transseptal needle, radiofrequency needle, or radiofrequency energy delivered through a guidewire. An active-fixation pacing lead was successfully delivered to the endocardial wall of the lateral LV in all patients (9 men; age, 62±10 years). LV lead implant procedure time shortened with experience. The use of radiofrequency energy delivered through a guidewire was the most effective technique. Mean threshold and R wave at implant were 0.8±0.3 V and 10.8±3.9 mV. At follow-up (mean, 8.7 months; minimum, 0; and maximum 19), thresholds were stable, and there were no thromboembolic events. Of 9 patients, 8 were classed as clinical responders (1 had inadequate follow-up to assess response). CONCLUSIONS LV endocardial pacing through a ventricular septal puncture is a feasible approach for cardiac resynchronization therapy.
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Affiliation(s)
- Tim R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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17
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Femminella GD, de Lucia C, Iacotucci P, Formisano R, Petraglia L, Allocca E, Ratto E, D'Amico L, Rengo C, Pagano G, Bonaduce D, Rengo G, Ferrara N. Neuro-hormonal effects of physical activity in the elderly. Front Physiol 2013; 4:378. [PMID: 24391595 PMCID: PMC3868730 DOI: 10.3389/fphys.2013.00378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/04/2013] [Indexed: 01/14/2023] Open
Abstract
Thanks to diagnostic and therapeutic advances, the elderly population is continuously increasing in the western countries. Accordingly, the prevalence of most chronic age-related diseases will increase considerably in the next decades, thus it will be necessary to implement effective preventive measures to face this epidemiological challenge. Among those, physical activity exerts a crucial role, since it has been proven to reduce the risk of cardiovascular diseases, diabetes, obesity, cognitive impairment and cancer. The favorable effects of exercise on cardiovascular homeostasis can be at least in part ascribed to the modulation of the neuro-hormonal systems implicated in cardiovascular pathophysiology. In the elderly, exercise has been shown to affect catecholamine secretion and biosynthesis, to positively modulate the renin-angiotensin-aldosterone system and to reduce the levels of plasma brain natriuretic peptides. Moreover, drugs modulating the neuro-hormonal systems may favorably affect physical capacity in the elderly. Thus, efforts should be made to actually make physical activity become part of the therapeutic tools in the elderly.
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Affiliation(s)
- Grazia D Femminella
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Claudio de Lucia
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Paola Iacotucci
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Roberto Formisano
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Elena Allocca
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Enza Ratto
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Loreta D'Amico
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Carlo Rengo
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy ; Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN) Telese Terme, Italy
| | - Gennaro Pagano
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy ; Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN) Telese Terme, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples Federico II Naples, Italy ; Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN) Telese Terme, Italy
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18
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Leosco D, Parisi V, Femminella GD, Formisano R, Petraglia L, Allocca E, Bonaduce D. Effects of exercise training on cardiovascular adrenergic system. Front Physiol 2013; 4:348. [PMID: 24348425 PMCID: PMC3842896 DOI: 10.3389/fphys.2013.00348] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/12/2013] [Indexed: 12/20/2022] Open
Abstract
In heart failure (HF), exercise has been shown to modulate cardiac sympathetic hyperactivation which is one of the earliest features of neurohormonal derangement in this syndrome and correlates with adverse outcome. An important molecular alteration related to chronic sympathetic overstimulation in HF is represented by cardiac β-adrenergic receptor (β-AR) dysfunction. It has been demonstrated that exercise reverses β-AR dysfunction by restoring cardiac receptor membrane density and G-protein-dependent adenylyl cyclase activation. In particular, several evidence indicate that exercise reduces levels of cardiac G-protein coupled receptor kinase-2 (GRK2) which is known to be involved in both β1-AR and β2-AR dysregulation in HF. Similar alterations of β-AR system have been described also in the senescent heart. It has also been demonstrated that exercise training restores adrenal GRK2/α-2AR/catecholamine (CA) production axis. At vascular level, exercise shows a therapeutic effect on age-related impairment of vascular reactivity to adrenergic stimulation and restores β-AR-dependent vasodilatation by increasing vascular β-AR responsiveness and reducing endothelial GRK2 activity. Sympathetic nervous system overdrive is thought to account for >50% of all cases of hypertension and a lack of balance between parasympathetic and sympathetic modulation has been observed in hypertensive subjects. Non-pharmacological, lifestyle interventions have been associated with reductions in SNS overactivity and blood pressure in hypertension. Several evidence have highlighted the blood pressure lowering effects of aerobic endurance exercise in patients with hypertension and the significant reduction in sympathetic neural activity has been reported as one of the main mechanisms explaining the favorable effects of exercise on blood pressure control.
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Affiliation(s)
- Dario Leosco
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Grazia D Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Roberto Formisano
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Elena Allocca
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
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19
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Corbi G, Conti V, Russomanno G, Longobardi G, Furgi G, Filippelli A, Ferrara N. Adrenergic signaling and oxidative stress: a role for sirtuins? Front Physiol 2013. [PMID: 24265619 DOI: 10.3389/fphys.2013.00324.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The adrenergic system plays a central role in stress signaling and stress is often associated with increased production of ROS. However, ROS overproduction generates oxidative stress, that occurs in response to several stressors. β-adrenergic signaling is markedly attenuated in conditions such as heart failure, with downregulation and desensitization of the receptors and their uncoupling from adenylyl cyclase. Transgenic activation of β2-adrenoceptor leads to elevation of NADPH oxidase activity, with greater ROS production and p38MAPK phosphorylation. Inhibition of NADPH oxidase or ROS significantly reduced the p38MAPK signaling cascade. Chronic β2-adrenoceptor activation is associated with greater cardiac dilatation and dysfunction, augmented pro-inflammatory and profibrotic signaling, while antioxidant treatment protected hearts against these abnormalities, indicating ROS production to be central to the detrimental signaling of β2-adrenoceptors. It has been demonstrated that sirtuins are involved in modulating the cellular stress response directly by deacetylation of some factors. Sirt1 increases cellular stress resistance, by an increased insulin sensitivity, a decreased circulating free fatty acids and insulin-like growth factor (IGF-1), an increased activity of AMPK, increased activity of PGC-1a, and increased mitochondrial number. Sirt1 acts by involving signaling molecules such P-I-3-kinase-Akt, MAPK and p38-MAPK-β. βAR stimulation antagonizes the protective effect of the AKT pathway through inhibiting induction of Hif-1α and Sirt1 genes, key elements in cell survival. More studies are needed to better clarify the involvement of sirtuins in the β-adrenergic response and, overall, to better define the mechanisms by which tools such as exercise training are able to counteract the oxidative stress, by both activation of sirtuins and inhibition of GRK2 in many cardiovascular conditions and can be used to prevent or treat diseases such as heart failure.
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Affiliation(s)
- Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise Campobasso, Italy
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20
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Corbi G, Conti V, Russomanno G, Longobardi G, Furgi G, Filippelli A, Ferrara N. Adrenergic signaling and oxidative stress: a role for sirtuins? Front Physiol 2013; 4:324. [PMID: 24265619 PMCID: PMC3820966 DOI: 10.3389/fphys.2013.00324] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/18/2013] [Indexed: 12/17/2022] Open
Abstract
The adrenergic system plays a central role in stress signaling and stress is often associated with increased production of ROS. However, ROS overproduction generates oxidative stress, that occurs in response to several stressors. β-adrenergic signaling is markedly attenuated in conditions such as heart failure, with downregulation and desensitization of the receptors and their uncoupling from adenylyl cyclase. Transgenic activation of β2-adrenoceptor leads to elevation of NADPH oxidase activity, with greater ROS production and p38MAPK phosphorylation. Inhibition of NADPH oxidase or ROS significantly reduced the p38MAPK signaling cascade. Chronic β2-adrenoceptor activation is associated with greater cardiac dilatation and dysfunction, augmented pro-inflammatory and profibrotic signaling, while antioxidant treatment protected hearts against these abnormalities, indicating ROS production to be central to the detrimental signaling of β2-adrenoceptors. It has been demonstrated that sirtuins are involved in modulating the cellular stress response directly by deacetylation of some factors. Sirt1 increases cellular stress resistance, by an increased insulin sensitivity, a decreased circulating free fatty acids and insulin-like growth factor (IGF-1), an increased activity of AMPK, increased activity of PGC-1a, and increased mitochondrial number. Sirt1 acts by involving signaling molecules such P-I-3-kinase-Akt, MAPK and p38-MAPK-β. βAR stimulation antagonizes the protective effect of the AKT pathway through inhibiting induction of Hif-1α and Sirt1 genes, key elements in cell survival. More studies are needed to better clarify the involvement of sirtuins in the β-adrenergic response and, overall, to better define the mechanisms by which tools such as exercise training are able to counteract the oxidative stress, by both activation of sirtuins and inhibition of GRK2 in many cardiovascular conditions and can be used to prevent or treat diseases such as heart failure.
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Affiliation(s)
- Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise Campobasso, Italy
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21
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Conti V, Russomanno G, Corbi G, Izzo V, Vecchione C, Filippelli A. Adrenoreceptors and nitric oxide in the cardiovascular system. Front Physiol 2013; 4:321. [PMID: 24223559 PMCID: PMC3818479 DOI: 10.3389/fphys.2013.00321] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/16/2013] [Indexed: 02/03/2023] Open
Abstract
Nitric Oxide (NO) is a small molecule that continues to attract much attention from the scientific community. Since its discovery, it has been evident that NO has a crucial role in the modulation of vascular tone. Moreover, NO is involved in multiple signal transduction pathways thus contributing to the regulation of many cellular functions. NO effects can be either dependent or independent on cGMP, and rely also upon several mechanisms such as the amount of NO, the compartmentalization of the enzymes responsible for its biosynthesis (NOS), and the local redox conditions. Several evidences highlighted the correlation among adrenoreceptors activity, vascular redox status and NO bioavailability. It was suggested a possible crosstalk between NO and oxidative stress hallmarks in the endothelium function and adaptation, and in sympathetic vasoconstriction control. Adrenergic vasoconstriction is a balance between a direct vasoconstrictive effect on smooth muscle and an indirect vasorelaxant action caused by α2- and β-adrenergic endothelial receptor-triggered NO release. An increased oxidative stress and a reduction of NO bioavailability shifts this equilibrium causing the enhanced vascular adrenergic responsiveness observed in hypertension. The activity of NOS contributes to manage the adrenergic pathway, thus supporting the idea that the endothelium might control or facilitate β-adrenergic effects on the vessels and the polymorphic variants in β2-receptors and NOS isoforms could influence aging, some pathological conditions and individual responses to drugs. This seems to be dependent, almost in part, on differences in the control of vascular tone exerted by NO. Given its involvement in such important mechanisms, the NO pathway is implicated in aging process and in both cardiovascular and non-cardiovascular conditions. Thus, it is essential to pinpoint NO involvement in the regulation of vascular tone for the effective clinical/therapeutic management of cardiovascular diseases (CVD).
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Affiliation(s)
- Valeria Conti
- Department of Medicine and Surgery, University of Salerno Baronissi, Italy
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22
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de Lucia C, Femminella GD, Rengo G, Ruffo A, Parisi V, Pagano G, Liccardo D, Cannavo A, Iacotucci P, Komici K, Zincarelli C, Rengo C, Perrone-Filardi P, Leosco D, Iacono F, Romeo G, Amato B, Ferrara N. Risk of acute myocardial infarction after transurethral resection of prostate in elderly. BMC Surg 2013; 13 Suppl 2:S35. [PMID: 24267821 PMCID: PMC3851236 DOI: 10.1186/1471-2482-13-s2-s35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Benign prostatic hyperplasia is a frequent disease among elderly, and is responsible for considerable disability. Benign prostatic hyperplasia can be clinically significant due to lower urinary tract symptoms that take place because the gland is enlarged and obstructs urine flow. Transurethral resection of the prostate remains the gold standard treatment for patients with moderate or severe symptoms who need active treatment or who either fail or do not want medical therapy. Moreover, perioperative and postoperative surgery complications as cardiovascular ones still occur. The incidence of acute myocardial infarction in patients undergoing transurethral resection of the prostate is controversial. The first studies showed an increase in mortality and relative risk of death from myocardial infarction in transurethral resection of the prostate group vs open prostatectomy but these results are in contrast with more recent data. Discussion Given the conflicting evidence of the studies in the literature, in this review we are going to discuss the factors that may influence the risk of myocardial infarction in elderly patients undergoing prostate surgery. We analyzed the possible common factors that lead to the development of myocardial infarction and benign prostatic hyperplasia (cardiovascular and metabolic), the stressor factors related to prostatectomy (surgical and haemodynamic) and the risk factors specific of the elderly population (comorbidity and therapies). Summary Although transurethral resection of the prostate is considered at low risk for severe complications, there are several reports indicating that cardiovascular events in elderly patients undergoing this surgical operation are more common than in the general population. Several cardio-metabolic, surgical and aging-related factors may help explain this observation but results in literature are not concord, especially due to the fact that most data derive from retrospective studies in which selection bias cannot be excluded. Subsequently, further studies are necessary to clarify the incidence of acute myocardial infarction in old people.
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Pagano G, Leosco D, Ferrara N, Rocco N, Rispoli C, Iannone L, Testa S, Compagna R, Accurso A, Amato B. Effect of beta blockers on the incidence of atrial fibrillation in elderly patients after abdominal surgery. BMC Surg 2013. [PMCID: PMC3847197 DOI: 10.1186/1471-2482-13-s1-a32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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24
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Pagano G, Leosco D, Ferrara N, Rocco N, Rispoli C, Iannone L, Testa S, Accurso A, Compagna R, Amato B. Exercise training and post-operative prognosis after coronary intervention. BMC Surg 2013. [PMCID: PMC3847182 DOI: 10.1186/1471-2482-13-s1-a33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Psotka MA, Teerlink JR. Strategies to Prevent Postdischarge Adverse Events Among Hospitalized Patients with Heart Failure. Heart Fail Clin 2013; 9:303-20, vi. [DOI: 10.1016/j.hfc.2013.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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26
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Conti M, Trippoli S, Messori A. Warfarin and aspirin for primary prevention in patients with heart failure in sinus rhythm. Cardiovasc Diagn Ther 2013; 3:111-2. [PMID: 24282754 PMCID: PMC3839199 DOI: 10.3978/j.issn.2223-3652.2013.05.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/03/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Margherita Conti
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, 50100 Firenze, Italy
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27
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Rengo G, Galasso G, Femminella GD, Parisi V, Zincarelli C, Pagano G, De Lucia C, Cannavo A, Liccardo D, Marciano C, Vigorito C, Giallauria F, Ferrara N, Furgi G, Filardi PP, Koch WJ, Leosco D. Reduction of lymphocyte G protein-coupled receptor kinase-2 (GRK2) after exercise training predicts survival in patients with heart failure. Eur J Prev Cardiol 2013; 21:4-11. [PMID: 23689525 DOI: 10.1177/2047487313491656] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increased cardiac G protein-coupled receptor kinase-2 (GRK2) expression has a pivotal role at inducing heart failure (HF)-related β-adrenergic receptor (βAR) dysfunction. Importantly, abnormalities of βAR signalling in the failing heart, including GRK2 overexpression, are mirrored in circulating lymphocytes and correlate with HF severity. Exercise training has been shown to exert several beneficial effects on the failing heart, including normalization of cardiac βAR function and GRK2 protein levels. In the present study, we evaluated whether lymphocyte GRK2 levels and short-term changes of this kinase after an exercise training programme can predict long-term survival in HF patients. METHODS For this purpose, we prospectively studied 193 HF patients who underwent a 3-month exercise training programme. Lymphocyte GRK2 protein levels, plasma N-terminal pro-brain natriuretic peptide, and norepinephrine were measured at baseline and after training along with clinical and functional parameters (left ventricular ejection fraction, NYHA class, and peak-VO2). Cardiac-related mortality was evaluated during a mean follow-up period of 37 ± 20 months. RESULTS Exercise was associated with a significant reduction of lymphocyte GRK2 protein levels (from 1.29 ± 0.52 to 1.16 ± 0.65 densitometric units, p < 0.0001). Importantly, exercise related changes of GRK2 (delta values) robustly predicted survival in our study population. Interestingly, HF patients who did not show reduced lymphocyte GRK2 protein levels after training presented the poorest outcome. CONCLUSIONS Our data offer the first demonstration that changes of lymphocyte GRK2 after exercise training can strongly predict outcome in advanced HF.
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Affiliation(s)
- Giuseppe Rengo
- Fondazione S. Maugeri, Istituto di Telese, Benevento, Italy
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Pagano G, Leosco D, Ferrara N, Rocco N, Rispoli C, Iannone L, Testa S, Compagna R, Accurso A, Amato B. Prevention of perioperative atrial fibrillation with beta blockers in elderly patient during abdominal surgery. BMC Surg 2013. [PMCID: PMC3847447 DOI: 10.1186/1471-2482-13-s1-a34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pagano G, Leosco D, Ferrara N, Rocco N, Rispoli C, Iannone L, Testa S, Compagna R, Accurso A, Amato B. When should we discontinue antiarrhythmic therapy for atrial fibrillation after abdominal surgery? BMC Surg 2013. [PMCID: PMC3847354 DOI: 10.1186/1471-2482-13-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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