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Holm H, Magnusson M, Jujić A, Lagrange J, Bozec E, Lamiral Z, Bresso E, Huttin O, Baudry G, Monzo L, Rossignol P, Zannad F, Girerd N. Association of ventricular-arterial coupling with biomarkers involved in heart failure pathophysiology - the STANISLAS cohort. Eur J Heart Fail 2024. [PMID: 39189882 DOI: 10.1002/ejhf.3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
AIMS Impaired left ventricular-arterial coupling (VAC) has been shown to correlate with worse prognosis in cardiac diseases and heart failure (HF). The extent of the relationship between VAC and circulating biomarkers associated with HF has been scarcely documented. We aimed to explore associations of VAC with proteins involved in HF pathophysiology within a large population-based cohort of middle-aged individuals. METHODS AND RESULTS In the forth visit of the STANISLAS family cohort, involving 1309 participants (mean age 48 ± 14 years; 48% male) from parent and children generations, we analysed the association of 32 HF-related proteins with non-invasively assessed VAC using pulse wave velocity (PWV)/global longitudinal strain (GLS) and arterial elastance (Ea)/ventricular end-systolic elastance (Ees). Among the 32 tested proteins, fatty acid-binding protein adipocyte 4, interleukin-6, growth differentiation factor 15, matrix metalloproteinase (MMP)-1, and MMP-9 and adrenomedullin were positively associated with PWV/GLS whereas transforming growth factor beta receptor type 3, MMP-2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were negatively associated. In multivariable models, only MMP-2 and NT-proBNP were significantly and inversely associated with PWV/GLS in the whole population and in the parent generation. Higher levels of NT-proBNP were also negatively associated with Ea/Ees in the whole cohort but this association did not persist in the parent subgroup. CONCLUSION Elevated MMP-2 and NT-proBNP levels correlate with better VAC (lower PWV/GLS), possibly indicating a compensatory cardiovascular response to regulate left ventricular pressure amidst cardiac remodelling and overload.
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Affiliation(s)
- Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Amra Jujić
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Jérémy Lagrange
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Erwan Bozec
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Zohra Lamiral
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Emmanuel Bresso
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Guillaume Baudry
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Luca Monzo
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
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Tang F, Han H, Fu S, Liu Q, Zhou S, Huang J, Xiao Y. Nonpharmacological Approaches to Managing Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2024; 17:e011269. [PMID: 38887946 PMCID: PMC11332382 DOI: 10.1161/circheartfailure.123.011269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common subtype of heart failure marked by impaired left ventricular diastolic function and decreased myocardial compliance. Given the limited availability of evidence-based pharmacological treatments for HFpEF, there is a growing interest in nonpharmacological interventions as viable therapeutic alternatives. This review aims to explore the pathophysiology of HFpEF and present recent advancements in nonpharmacological management approaches, encompassing noninvasive therapies, invasive procedures and targeted treatments for comorbidities. An extensive literature review was undertaken to identify and synthesize emerging nonpharmacological treatment options for HFpEF, assessing their potential to enhance patient outcomes. Nonpharmacological strategies, such as vagus nerve stimulation, percutaneous pulmonary artery denervation, renal denervation, transcatheter insertion of atrial shunts and pericardial resection, demonstrate promising potential for alleviating HFpEF symptoms and improving patient prognosis. Moreover, addressing comorbidities, such as hypertension and diabetes, may offer additional therapeutic benefits. These cutting-edge techniques, in conjunction with well-established exercise therapies, pave the way for future research and clinical applications in the field. Nonpharmacological interventions hold promise for advancing HFpEF patient care and fostering a deeper understanding of these treatment approaches, which will facilitate new clinical applications and contribute to the development of more targeted therapies.
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Affiliation(s)
- Feiyang Tang
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
- Xiangya School of Medicine (F.T., H.H.), Central South University, Changsha, China
| | - Haofu Han
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
- Xiangya School of Medicine (F.T., H.H.), Central South University, Changsha, China
| | - Sheng Fu
- Division of Cardiovascular Medicine, Department of Medicine (S.F.), University of Louisville, KY
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine (J.H.), University of Louisville, KY
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
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Aghezzaf S, Coisne A, Bauters C, Favata F, Delsart P, Coppin A, Seunes C, Schurtz G, Verdier B, Lamblin N, Tazibet A, Le Taillandier de Gabory J, Ninni S, Donal E, Lemesle G, Montaigne D. Feasibility and prognostic significance of ventricular-arterial coupling after myocardial infarction: the RIGID-MI cohort. Eur Heart J Cardiovasc Imaging 2024; 25:668-677. [PMID: 38133627 DOI: 10.1093/ehjci/jead342] [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: 08/25/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS The clinical significance and feasibility of the recently described non-invasive parameters exploring ventricular-arterial coupling (VAC) remain uncertain. This study aimed to assess VAC parameters for prognostic stratification in stable patients with left ventricular ejection fraction (LVEF) ≥40% following myocardial infarction (MI). METHODS AND RESULTS Between 2018 and 2021, patients with LVEF ≥40% were evaluated 1 month following MI using transthoracic echocardiography (TTE) and arterial tonometry at rest and after a handgrip test. VAC was studied via the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees) and between pulse wave velocity (PWV) and global longitudinal strain (GLS). Patients were followed for major adverse cardiovascular events (MACE): all-cause death, acute heart failure, stroke, AMI, and urgent cardiovascular hospitalization. Among the 374 patients included, Ea/Ees and PWV/GLS were obtained at rest for 354 (95%) and 253 patients (68%), respectively. Isometric exercise was workable in 335 patients (85%). During a median follow-up of 32 months (interquartile range: 16-42), 41 (11%) MACE occurred. Patients presenting MACE were significantly older and had a higher prevalence of peripheral arterial disease, lower GLS, higher Ea, PWV, and PWV/GLS ratio. The Ea/Ees ratio and standard TTE parameters during isometric exercise were not associated with MACE. After adjustment, the PWV/GLS ratio was the only VAC parameter independently associated with outcome. Receiver operating characteristic curve analysis identified a PWV/GLS ratio >0.70 (Youden's index = 0.37) as the best threshold to identify patients developing MACE: hazard ratio (95% confidence interval) = 2.2 (1.14-4.27), P = 0.02. CONCLUSION The PWV/GLS ratio, assessed 1 month after MI, identifies a group of patients at higher risk of MACE providing additional value on top of conventional non-invasive parameters.
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Affiliation(s)
- Samy Aghezzaf
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Augustin Coisne
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Christophe Bauters
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1167, F-59000 Lille, France
| | - Francesco Favata
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Pascal Delsart
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Amandine Coppin
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Claire Seunes
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Guillaume Schurtz
- Cardiology Department, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Basile Verdier
- Cardiology Department, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Nicolas Lamblin
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Amine Tazibet
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | | | - Sandro Ninni
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - Erwan Donal
- Cardiology Department, CHU Rennes, Rennes, France
| | - Gilles Lemesle
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
| | - David Montaigne
- Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France
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4
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Soma J. Can the hemodynamic model in heart failure be restored based on analysis of ventricular-arterial coupling? Heart Fail Rev 2024; 29:463-464. [PMID: 38040918 DOI: 10.1007/s10741-023-10374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
The hemodynamic model was inappropriate to explain the disappointing effect of vasodilation and the beneficial effect of beta-blockade in chronic heart failure. A more nuanced hemodynamic analysis, taking both steady and pulsatile hemodynamics into consideration, improves insight into these apparently enigmatic effects. Of particular interest is the velocity of early systolic flow as a determinant of left ventricular afterload. Several drugs, in particular beta-blockers, directly or indirectly, influence the velocity of early systolic flow. Thus, the hemodynamic model in heart failure may deserve reconsideration.
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Affiliation(s)
- Johannes Soma
- Consulting Cardiologist, Medical Department, Section of Cardiology, Central Hospital Vestfold, Tønsberg, 3103, Norway.
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Wakeham DJ, Ivey E, Saland SA, Lewis JS, Palmer D, Morris M, Bleich JL, Weyand PG, Brazile TL, Hearon CM, Sarma S, MacNamara JP, Hieda M, Levine BD. Effects of Synchronizing Foot Strike and Cardiac Phase on Exercise Hemodynamics in Patients With Cardiac Resynchronization Therapy: A Within-Subjects Pilot Study to Fine-Tune Cardio-Locomotor Coupling for Heart Failure. Circulation 2023; 148:2008-2016. [PMID: 37830218 PMCID: PMC11032184 DOI: 10.1161/circulationaha.123.066170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Despite advances in medical and cardiac resynchronization therapy (CRT), individuals with chronic congestive heart failure (CHF) have persistent symptoms, including exercise intolerance. Optimizing cardio-locomotor coupling may increase stroke volume and skeletal muscle perfusion as previously shown in healthy runners. Therefore, we tested the hypothesis that exercise stroke volume and cardiac output would be higher during fixed-paced walking when steps were synchronized with the diastolic compared with systolic portion of the cardiac cycle in patients with CHF and CRT. METHODS Ten participants (58±17 years of age; 40% female) with CHF and previously implanted CRT pacemakers completed 5-minute bouts of walking on a treadmill (range, 1.5-3 mph). Participants were randomly assigned to first walking to an auditory tone to synchronize their foot strike to either the systolic (0% or 100±15% of the R-R interval) or diastolic phase (45±15% of the R-R interval) of their cardiac cycle and underwent assessments of oxygen uptake (V̇o2; indirect calorimetry) and cardiac output (acetylene rebreathing). Data were compared through paired-samples t tests. RESULTS V̇o2 was similar between conditions (diastolic 1.02±0.44 versus systolic 1.05±0.42 L/min; P=0.299). Compared with systolic walking, stroke volume (diastolic 80±28 versus systolic 74±26 mL; P=0.003) and cardiac output (8.3±3.5 versus 7.9±3.4 L/min; P=0.004) were higher during diastolic walking; heart rate (paced) was not different between conditions. Mean arterial pressure was significantly lower during diastolic walking (85±12 versus 98±20 mm Hg; P=0.007). CONCLUSIONS In patients with CHF who have received CRT, diastolic stepping increases stroke volume and oxygen delivery and decreases afterload. We speculate that, if added to pacemakers, this cardio-locomotor coupling technology may maximize CRT efficiency and increase exercise participation and quality of life in patients with CHF.
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Affiliation(s)
- Denis J Wakeham
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Erika Ivey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Sophie A Saland
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Joshua S Lewis
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | | | - Peter G Weyand
- Locomotor Performance Laboratory, Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, TX (P.G.W.)
| | - Tiffany L Brazile
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Christopher M Hearon
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Satyam Sarma
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - James P MacNamara
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Benjamin D Levine
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
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Mynard JP, Kowalski R, Harrington HA, Kondiboyina A, Smolich JJ, Cheung MMH. Superiority of a Representative MRI Flow Waveform over Doppler Ultrasound for Aortic Wave Reflection Assessment in Children and Adolescents With/Without a History of Heart Disease. Ann Biomed Eng 2023; 51:2772-2784. [PMID: 37561232 PMCID: PMC10632254 DOI: 10.1007/s10439-023-03339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
Wave separation analysis (WSA) reveals the impact of forward- and backward-running waves on the arterial pressure pulse, but the calculations require a flow waveform. This study investigated (1) the variability of the ascending aortic flow waveform in children and adolescents with/without a childhood heart disease history (CHD); (2) the accuracy of WSA obtained with a representative flow waveform (RepFlow), compared with the triangulation method and published ultrasound-derived adult representative flow; (3) the impact of limitations in Doppler ultrasound on WSA; and (4) generalizability of results to adults with a history of CHD. Phase contrast MRI was performed in youth without (n = 45, Group 1, 10-19 years) and with CHD (n = 79, Group 2, 7-18 years), and adults with CHD history (n = 29, Group 3, 19-59 years). Segmented aortic cross-sectional area was used as a surrogate for the central pressure waveform in WSA. A subject-specific virtual Doppler ultrasound was performed on MRI data by extracting velocities from a sample volume. Time/amplitude-normalized ascending aortic flow waveforms were highly consistent amongst all groups. WSA with RepFlow therefore yielded errors < 10% in all groups for reflected wave magnitude and return time. Absolute errors were typically 1.5-3 times greater with other methods, including subject-specific (best-case/virtual) Doppler ultrasound, for which velocity profile skewing introduced waveform errors. Our data suggest that RepFlow is the optimal approach for pressure-only WSA in children and adolescents with/without CHD, as well as adults with CHD history, and may even be more accurate than subject-specific Doppler ultrasound in the ascending aorta.
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Affiliation(s)
- Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia.
- Department of Biomedical Engineering, University of Melbourne, Parkville VIC, Australia.
| | - Remi Kowalski
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
| | - Hilary A Harrington
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Avinash Kondiboyina
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
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7
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Mahoney SA, Dey AK, Basisty N, Herman AB. Identification and functional analysis of senescent cells in the cardiovascular system using omics approaches. Am J Physiol Heart Circ Physiol 2023; 325:H1039-H1058. [PMID: 37656130 PMCID: PMC10908411 DOI: 10.1152/ajpheart.00352.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, and senescent cells have emerged as key contributors to its pathogenesis. Senescent cells exhibit cell cycle arrest and secrete a range of proinflammatory factors, termed the senescence-associated secretory phenotype (SASP), which promotes tissue dysfunction and exacerbates CVD progression. Omics technologies, specifically transcriptomics and proteomics, offer powerful tools to uncover and define the molecular signatures of senescent cells in cardiovascular tissue. By analyzing the comprehensive molecular profiles of senescent cells, omics approaches can identify specific genetic alterations, gene expression patterns, protein abundances, and metabolite levels associated with senescence in CVD. These omics-based discoveries provide insights into the mechanisms underlying senescence-induced cardiovascular damage, facilitating the development of novel diagnostic biomarkers and therapeutic targets. Furthermore, integration of multiple omics data sets enables a systems-level understanding of senescence in CVD, paving the way for precision medicine approaches to prevent or treat cardiovascular aging and its associated complications.
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Affiliation(s)
- Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado, United States
| | - Amit K Dey
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
| | - Nathan Basisty
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
| | - Allison B Herman
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States
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8
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Gan S, Zhao L, Salman O, Wang Z, Ebert C, Azzo JD, Dib MJ, Zamani P, Cohen JB, Kammerhoff K, Schafer P, Seiffert DA, Ramirez-Valle F, Gordon DA, Cvijic ME, Gunawardhana K, Liu L, Chang CP, Cappola TP, Chirinos JA. Proteomic Correlates of the Urinary Protein/Creatinine Ratio in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2023; 206:312-319. [PMID: 37734292 PMCID: PMC10874232 DOI: 10.1016/j.amjcard.2023.08.146] [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: 06/23/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023]
Abstract
Proteinuria is common in heart failure with preserved ejection fraction (HFpEF), but its biologic correlates are poorly understood. We assessed the relation between 49 plasma proteins and the urinary protein/creatinine ratio (UPCR) in 365 participants in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial. Linear regression and network analysis were used to represent relations between protein biomarkers and UPCR. Higher UPCR was associated with older age, a greater proportion of female gender, smaller prevalence of previous myocardial infarction, and greater prevalence of diabetes, insulin use, smoking, and statin use, in addition to a lower estimated glomerular filtration rate, hematocrit, and diastolic blood pressure. Growth differentiation factor 15 (GDF-15; β = 0.15, p <0.0001), followed by N-terminal proatrial natriuretic peptide (NT-proANP; β = 0.774, p <0.0001), adiponectin (β = 0.0005, p <0.0001), fibroblast growth factor 23 (FGF-23, β = 0.177; p <0.0001), and soluble tumor necrosis factor receptors I (β = 0.002, p <0.0001) and II (β = 0.093, p <0.0001) revealed the strongest associations with UPCR. Network analysis showed that UPCR is linked to various proteins primarily through FGF-23, which, along with GDF-15, indicated node characteristics with strong connectivity, whereas UPCR did not. In a model that included FGF-23 and UPCR, the former was predictive of the risk of death or heart-failure hospital admission (standardized hazard ratio 1.83, 95% confidence interval 1.49 to 2.26, p <0.0001) and/or all-cause death (standardized hazard ratio 1.59, 95% confidence interval 1.22 to 2.07, p = 0.0005), whereas UPCR was not prognostic. Proteinuria in HFpEF exhibits distinct proteomic correlates, primarily through its association with FGF-23, a well-known prognostic marker in HFpEF. However, in contrast to FGF-23, UPCR does not hold independent prognostic value.
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Affiliation(s)
- Sushrima Gan
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lei Zhao
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | - Oday Salman
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhaoqing Wang
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | | | - Joe David Azzo
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marie Joe Dib
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Payman Zamani
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics
| | | | - Peter Schafer
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | | | | | | | | | | | - Laura Liu
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey
| | | | - Thomas P Cappola
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania.
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9
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Kirkman DL, Stock JM, Shenouda N, Bohmke NJ, Kim Y, Kidd J, Townsend RR, Edwards DG. Effects of a mitochondrial-targeted ubiquinol on vascular function and exercise capacity in chronic kidney disease: a randomized controlled pilot study. Am J Physiol Renal Physiol 2023; 325:F448-F456. [PMID: 37560769 DOI: 10.1152/ajprenal.00067.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/27/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
Mitochondria-derived oxidative stress has been implicated in vascular and skeletal muscle abnormalities in chronic kidney disease (CKD). The purpose of this study was to investigate the effects of a mitochondria-targeted ubiquinol (MitoQ) on vascular function and exercise capacity in CKD. In this randomized controlled trial, 18 patients with CKD (means ± SE, age: 62 ± 3 yr and estimated glomerular filtration rate: 45 ± 3 mL/min/1.73 m2) received 4 wk of 20 mg/day MitoQ (MTQ group) or placebo (PLB). Outcomes assessed at baseline and follow-up included macrovascular function measured by flow-mediated dilation, microvascular function assessed by laser-Doppler flowmetry combined with intradermal microdialysis, aortic hemodynamics assessed by oscillometry, and exercise capacity assessed by cardiopulmonary exercise testing. Compared with PLB, MitoQ improved flow-mediated dilation (baseline vs. follow-up: MTQ, 2.4 ± 0.3% vs. 4.0 ± 0.9%, and PLB, 4.2 ± 1.0% vs. 2.5 ± 1.0%, P = 0.04). MitoQ improved microvascular function (change in cutaneous vascular conductance: MTQ 4.50 ± 2.57% vs. PLB -2.22 ± 2.67%, P = 0.053). Central aortic systolic and pulse pressures were unchanged; however, MitoQ prevented increases in augmentation pressures that were observed in the PLB group (P = 0.026). MitoQ did not affect exercise capacity. In conclusion, this study demonstrates the potential for a MitoQ to improve vascular function in CKD. The findings hold promise for future investigations of mitochondria-targeted therapies in CKD.NEW & NOTEWORTHY In this randomized controlled pilot study, we investigated the effects of a mitochondria-targeted ubiquinol (MitoQ) on vascular function and exercise capacity in chronic kidney disease. Our novel findings showed that 4-wk supplementation of MitoQ was well tolerated and improved macrovascular endothelial function, arterial hemodynamics, and microvascular function in patients with stage 3-4 chronic kidney disease. Our mechanistic findings also suggest that MitoQ improved microvascular function in part by reducing the NADPH oxidase contribution to vascular dysfunction.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Natalie J Bohmke
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jason Kidd
- Department of Internal Medicine, Virginia Commonwealth University Health Systems, Richmond, Virginia, United States
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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10
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Tomiyama H. Vascular function: a key player in hypertension. Hypertens Res 2023; 46:2145-2158. [PMID: 37369849 DOI: 10.1038/s41440-023-01354-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
The major functions of the arterial system are to "efficiently deliver blood to the peripheral organs and maintain vascular homeostasis". Both the endothelial and medial layer contribute to the three major functions, namely, conversion of pulsatile to steady blood flow, appropriate distribution of blood flow to the target organs, and vascular protection and homeostasis. Vascular dysfunction contributes to the development of cardiovascular diseases through a combination of several mechanisms, including impaired coronary perfusion, cardiac systolic/diastolic dysfunction, microvascular damage, and abnormal hemodynamics in the arterial tree. The representative marker of endothelial function is flow-mediated vasodilatation and that of the medial layer function is pulse wave velocity, and that of the blood supply function of the arterial tree is the ankle-brachial pressure index. In hypertension, vascular dysfunction could also lead to the development of isolated systolic hypertension, isolated diastolic hypertension, and systolic/diastolic hypertension. Vascular dysfunction is involved in a vicious cycle with abnormal blood pressure variability. Furthermore, a vicious cycle may also exist between vascular dysfunction and hypertension. While the significances of vascular function tests to predict future cardiovascular events has been established in cases of hypertension, their usefulness in assessing the effectiveness of management of the vascular functions in hypertension on the cardiovascular outcomes has not yet been fully clarified. Thus, vascular dysfunction plays crucial roles in the pathophysiology of hypertension, and further research is warranted to establish strategies to improve vascular dysfunction in cases of hypertension. Vascular functions in the pathophysiology of hypertension. Vascular dysfunction and elevation of blood pressure are components of a vicious cycle even from their early stages, which including abnormal blood pressure variabilities. This vicious cycle is associated with hypertensive organ damage and also adverse cardiovascular outcomes. Strategies to break this vicious cycle have not yet been fully established.
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Affiliation(s)
- Hirofumi Tomiyama
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
- Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Tokyo, Japan.
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11
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Holm H, Magnusson M, Jujić A, Pugliese NR, Bozec E, Lamiral Z, Huttin O, Zannad F, Rossignol P, Girerd N. Ventricular-arterial coupling (VAC) in a population-based cohort of middle-aged individuals: The STANISLAS cohort. Atherosclerosis 2023; 374:11-20. [PMID: 37159989 DOI: 10.1016/j.atherosclerosis.2023.04.010] [Citation(s) in RCA: 1] [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: 01/17/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS Data exploring normal values of different ventricular-arterial coupling (VAC) parameters and their association with anthropometric and cardiovascular (CV) factors are scarce. We aim to report values of two different methods of VAC assessment according to age and sex and explore their association with CV factors within a large population-based cohort of middle-aged individuals. METHODS For 1333 (mean age 48 ± 14) individuals participating in the 4th visit of the STANISLAS cohort, VAC was assessed by two methods [1]: arterial elastance (Ea)/end-systolic elastance (Ees) and [2] Pulse wave velocity (PWV)/Global longitudinal strain (GLS). RESULTS The mean values of Ea/Ees and PWV/GLS were 1.06 ± 0.20 and 0.42 ± 0.12, respectively. The two methods of VAC assessment were poorly correlated (Pearson's correlation coefficient r = 0.14 (0.08; 0.19)). Increased PWV/GLS was associated with older age and a higher degree of cardiovascular risk factors (i.e., BMI, blood pressure, LDL, diabetes, hypertension) in the whole population as well as in the parent generation. In contrast, higher Ea/Ees were associated with decreasing age, and lower prevalence of risk factors in the whole cohort but neutrally associated with risk factors in the parent generation. CONCLUSIONS Higher PWV/GLS is significantly associated with CV factors regardless of age. In contrast, worse Ea/Ees is associated with a better CV risk profile when considering individuals aged 30 to 70 but neutrally associated with CV factors when considering only older patients. These results may suggest that PWV/GLS should preferably be used to explore VAC. In addition, age-individualized threshold of Ea/Ees should be used.
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Affiliation(s)
- H Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
| | - M Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - A Jujić
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | | | - E Bozec
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Z Lamiral
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - O Huttin
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - F Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - P Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - N Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
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12
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Joshi M, Tran P, Barber TM, Ayub W, Kuehl M, Banerjee P. The Role of the Vasculature in Heart Failure. Curr Heart Fail Rep 2023; 20:179-190. [PMID: 37160641 DOI: 10.1007/s11897-023-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
The contribution of the vasculature in the development and progression of heart failure (HF) syndromes is poorly understood and often neglected. Incorporating both arterial and venous systems, the vasculature plays a significant role in the regulation of blood flow throughout the body in meeting its metabolic requirements. A deterioration or imbalance between the cardiac and vascular interaction can precipitate acute decompensated HF in both preserved and reduced ejection fraction phenotypes. This is characterised by the increasingly recognised concept of ventricular-arterial coupling: a well-balanced relationship between ventricular and vascular stiffness, which has major implications in HF. Often, the cause of decompensation is unknown, with international guidelines mainly centred on arrhythmia, infection, acute coronary syndrome and its mechanical complications as common causes of decompensation; the vascular component is often underrecognised. A better understanding of the vascular contribution in cardiovascular failure can improve risk stratification, earlier diagnosis and facilitate earlier optimal treatment. This review focuses on the role of the vasculature by integrating the concepts of ventricular-arterial coupling, arterial stiffness and venous return in a failing heart.
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Affiliation(s)
- Mithilesh Joshi
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Patrick Tran
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
| | - Thomas M Barber
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Waqar Ayub
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael Kuehl
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Prithwish Banerjee
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
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13
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Mazimba S, Bilchick KC. Systemic arterial pulsatility (SAPi) in advanced heart failure: a novel hemodynamic risk stratification tool. Heart Vessels 2022:10.1007/s00380-022-02217-6. [DOI: 10.1007/s00380-022-02217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
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14
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Mukai Y, Nakanishi K, Daimon M, Sawada N, Hirose K, Iwama K, Yamamoto Y, Yoshida Y, Ishiwata J, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Association of arterial properties with left ventricular morphology and function in the community. J Hypertens 2022; 40:2423-2429. [PMID: 35983866 DOI: 10.1097/hjh.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Arterial structural and functional remodeling is recognized as a key determinant of incident heart failure, although the contribution of arterial properties on left ventricular (LV) remodeling is not fully studied. Aortic dilatation is an early manifestation of arterial remodeling and estimated pulse wave velocity (ePWV) is emerging as a simple measure of arterial stiffness. This study aimed to characterize the association of aortic size and ePWV with LV morphology and function. METHODS The study cohort consisted of 539 participants without overt cardiac disease who underwent extensive cardiovascular examination. Aortic root diameter was measured by two-dimensional echocardiography and ePWV was calculated from a regression equation using age and mean blood pressure. LV global longitudinal strain (LVGLS) was obtained by speckle-tracking echocardiography. RESULTS Aortic root diameter and ePWV were correlated with LV mass index and LVGLS, while only ePWV was related to E / e' ratio. In multivariable analysis, aortic root diameter and ePWV were significantly related to LV mass index and LVGLS (all P < 0.05), and the association of aortic root size and ePWV with LVGLS was independent of LV mass index and E / e' ratio. Individuals with both aortic root enlargement and increased ePWV had significantly larger LV mass index and reduced LVGLS compared with those either or those with normal aortic size and ePWV (both P < 0.05). CONCLUSION Aortic root size and ePWV were independently associated with unfavorable LV remodeling in individuals free of cardiac disease, which might provide useful information into the pathogenesis-linking arterial remodeling and heart failure.
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Affiliation(s)
| | | | - Masao Daimon
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Yuriko Yoshida
- Department of Cardiovascular Medicine
- Department of Medicine, Columbia University, New York, New York, USA
| | | | | | - Tomoko Nakao
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | - Marco R Di Tullio
- Department of Medicine, Columbia University, New York, New York, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York, USA
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15
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Kirkman DL, Ramick MG, Muth BJ, Stock JM, Townsend RR, Edwards DG. Sex differences in microvascular function and arterial hemodynamics in nondialysis chronic kidney disease. Am J Physiol Heart Circ Physiol 2022; 323:H1130-H1136. [PMID: 36269643 PMCID: PMC9678402 DOI: 10.1152/ajpheart.00500.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease (CKD). Abnormal arterial hemodynamics contribute to CVD, a relationship that can be mediated by microvascular dysfunction. The purpose of this study was to investigate potential sex differences in arterial hemodynamics and microvascular dysfunction in patients with stages 3 to 4 CKD. Vascular function was assessed in 22 male (mean ± SD; age, 56 ± 13 yr) and 10 female (age, 63 ± 9 yr) patients. Arterial hemodynamics were acquired with combined tonometry and oscillometry. Skin blood flow was used as a model of microvascular function. Participants were instrumented with three microdialysis fibers for the delivery of 1) Ringer's solution; 2) superoxide dismutase mimetic, Tempol; and 3) nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor, apocynin. Blood flow was measured via laser-Doppler flowmetry during standardized local heating (42°C). Central pulse pressure (mean ± SE; 62 ± 9 vs. 46 ± 3 mmHg; P = 0.01) and augmentation index (36 ± 3 vs. 26 ± 3%; P = 0.03) were higher in females. There was a trend for higher central systolic pressures in females (146 ± 9 vs. 131 ± 3 mmHg; P = 0.06). Females reported higher forward (39 ± 4 vs. 29 ± 2 mmHg; P = 0.004) and reflected (27 ± 3 vs. 19 ± 1 mmHg; P < 0.001) wave amplitudes. Cutaneous vascular function was impaired in females compared with males (77 ± 3 vs. 89 ± 1%, P = 0.001). Microvascular function was improved following the delivery of Tempol and apocynin in females but not in males. Female patients with CKD had poorer central hemodynamics and reduced microvascular function compared with their male counterparts. Oxidative stress may contribute to lower microvascular function observed in females.NEW & NOTEWORTHY There are limited data regarding the physiological mechanisms of potential sex differences in central hemodynamics and vascular function in chronic kidney disease (CKD). We report that older female patients with nondialysis CKD have higher central pulse pressures compared with male patients with CKD. In addition, older females with CKD have lower microvascular function compared with their male counterparts, and oxidative stress contributes to the lower microvascular function in older female patients with CKD.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Meghan G Ramick
- Department of Kinesiology, West Chester University, West Chester, Pennsylvania
| | - Bryce J Muth
- School of Health Sciences, Stockton University, Galloway Township, New Jersey
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
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16
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Kim M, Kim HL, Lim WH, Seo JB, Kim SH, Kim MA, Zo JH. Association between arterial stiffness and left ventricular diastolic function: A large population-based cross-sectional study. Front Cardiovasc Med 2022; 9:1001248. [PMID: 36312236 PMCID: PMC9606341 DOI: 10.3389/fcvm.2022.1001248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background The association between arterial stiffness and left ventricular (LV) diastolic function has been demonstrated in several studies, but the samples size in those studies was small. This study aims to verify this issue in a large number of study subjects. Methods A total of 7,013 consecutive participants (mean age 60.6 years and 43.3% female) who underwent both baPWV and transthoracic echocardiography were retrospectively analyzed. Subjects with significant cardiac structural abnormalities were excluded. Results There were significant correlations of baPWV with septal e′ velocity (r = – 0.408; P < 0.001), septal E/e′ (r = 0.349; P < 0.001), left atrial volume index (LAVI) (r = 0.122; P < 0.001) and maximal velocity of tricuspid valve regurgitation (TR Vmax) (r = 0.322; P < 0.001). The baPWV values increased proportionally with an increase in the number of LV diastolic indices meeting LV diastolic dysfunction criteria (P-for-trend < 0.001). In multivariable analyses with adjustment for confounding effects of various clinical covariates, higher baPWV was independently associated with septal e′ < 7 (odds ratio [OR], 1.30; 95% confidence interval [CI] 1.20–1.60; P < 0.001), septal E/e′ ≥ 15 (OR, 1.46; 95% CI, 1.21–1.78; P < 0.001), and TR Vmax > 2.8 m/s (OR, 1.60; 95% CI, 1.23–2.09; P < 0.001) but not with LAVI ≥ 34 mL/m2 (OR, 0.89; 95% CI, 0.76–1.03; P = 0.123). Conclusions Increased arterial stiffness, as measured by baPWV, was associated with abnormal diastolic function parameters in a large number of study participants, providing strong evidence to the existing data about ventricular-vascular coupling.
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Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Hack-Lyoung Kim
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea,Joo-Hee Zo
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17
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Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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18
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Vidula MK, Bravo PE, Chirinos JA. The Role of Multimodality Imaging in the Evaluation of Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:443-457. [DOI: 10.1016/j.ccl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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19
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Marlevi D, Mariscal-Harana J, Burris NS, Sotelo J, Ruijsink B, Hadjicharalambous M, Asner L, Sammut E, Chabiniok R, Uribe S, Winter R, Lamata P, Alastruey J, Nordsletten D. Altered Aortic Hemodynamics and Relative Pressure in Patients with Dilated Cardiomyopathy. J Cardiovasc Transl Res 2022; 15:692-707. [PMID: 34882286 PMCID: PMC9622552 DOI: 10.1007/s12265-021-10181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/20/2021] [Indexed: 12/05/2022]
Abstract
Ventricular-vascular interaction is central in the adaptation to cardiovascular disease. However, cardiomyopathy patients are predominantly monitored using cardiac biomarkers. The aim of this study is therefore to explore aortic function in dilated cardiomyopathy (DCM). Fourteen idiopathic DCM patients and 16 controls underwent cardiac magnetic resonance imaging, with aortic relative pressure derived using physics-based image processing and a virtual cohort utilized to assess the impact of cardiovascular properties on aortic behaviour. Subjects with reduced left ventricular systolic function had significantly reduced aortic relative pressure, increased aortic stiffness, and significantly delayed time-to-pressure peak duration. From the virtual cohort, aortic stiffness and aortic volumetric size were identified as key determinants of aortic relative pressure. As such, this study shows how advanced flow imaging and aortic hemodynamic evaluation could provide novel insights into the manifestation of DCM, with signs of both altered aortic structure and function derived in DCM using our proposed imaging protocol.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Jorge Mariscal-Harana
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Cardio MR, Chile
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Myrianthi Hadjicharalambous
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Liya Asner
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eva Sammut
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Faculty of Health Science, Bristol Heart Institute and Translational Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Radomir Chabiniok
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Inria, Palaiseau, France
- LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Paris, France
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, , Prague, Czech Republic
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, Cardio MR, Chile
- Department of Radiology, School of Medicine, Pontifica Universidad Católica de Chile, Santiago, Chile
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- World-Class Research Center "Digital Biodesign and Personlized Healthcare", Sechenov University, Moscow, Russia
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Cardiac Surgery and Biomedical Engineering, University of Michigan, Plymouth Rd, Ann Arbor, MI, 48109, USA.
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20
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Fengler K, Kresoja KP, Rommel KP, Rosch S, Roeder MV, Desch S, Thiele H, Lurz P. Sympathomodulation in Heart Failure with High vs. Normal Ejection Fraction. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100073. [PMID: 37288333 PMCID: PMC10242566 DOI: 10.1016/j.shj.2022.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 06/09/2023]
Abstract
Background Despite recent advances in the treatment of heart failure with preserved ejection fraction (HFpEF), the overall outcome is poor and evidence-based therapeutic options are scarce. So far, the only evidence-based therapy in HFpEF, sodium glucose linked transporter 2 inhibitors, has only insignificant effects in patients with a high EF (EF > 60%, HEF) when compared to a normal EF (EF 50%-60%, NEF). This could be explained by different biomechanical and cellular phenotypes of HFpEF across the range of EFs rather than a uniform pathophysiology. We aimed to investigate the concept of different phenotypes in the HEF and NEF using noninvasive single-beat estimations and to observe alterations in pressure-volume relations in both groups following sympathomodulation using renal denervation (RDN). Methods Patients from a previous study on RDN in HFpEF were stratified by having HFpEF with an HEF or NEF. Single-beat estimations were used to derive arterial elastance (Ea), end-systolic elastance (Ees), and diastolic capacitance (VPED20). Results Overall, 63 patients were classified as having an HEF, and 36 patients were classified as having an NEF. Ea did not differ between the groups and was reduced at follow-up in both groups (p < 0.01). Ees was higher and VPED20 was lower in the HEF than those in the NEF. Both were changed significantly at follow-up in the HEF but not in the NEF. Ees/Ea was lower in the NEF (0.95 ± 0.22 vs 1.15 ± 0.27, p < 0.01) and was significantly increased in the NEF (by 0.08 ± 0.20, p < 0.05) but not in the HEF. Conclusions Beneficial effects of RDN were observed in the NEF and HEF, supporting the further investigation of sympathomodulating treatments for HFpEF in future trials.
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Affiliation(s)
- Karl Fengler
- Address correspondence to: Karl Fengler, MD, Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.
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21
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Salyamova LI, Khromova AA, Kvasova OG, Korenkova KN, Polezhaeva KN, Donetskaya NA, Pavlenko KI. Pleiotropic vasoprotective effects of high-dose atorvastatin therapy in the context of achieving the target low-density lipoprotein cholesterol in patients after myocardial infarction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study the lipid-lowering and pleiotropic vasoprotective effects of atorvastatin depending on the achievement of the target low-density lipoprotein cholesterol (LDL-C) level in patients after ST-segment elevation myocardial infarction (STEMI) within 48-week follow-up period.Material and methods. A total of 125 patients with STEMI, randomized to receive atorvastatin 40 or 80 mg per day for 48 weeks, were examined. On days 7-9, after 24, 48 weeks, we performed biochemical blood tests, echocardiography, as well as assessed the carotid arteries and endothelial function. The subjects were divided into the following groups: high-efficiency therapy (HET) — 41 patients who reached target LDL-C at control visits; moderate-efficiency therapy (MET) — 35 patients who achieved target LDL-C at one visit; low-efficiency therapy effective (LET) — 49 people who did not reach the target LDL-C. Differences were considered significant at p<0,05.Results. A decrease in detection rate of an elevated brain natriuretic peptide was found in HET group from 41,5 to 17% (p<0,01) and in MET group from 48,6 to 23% (p<0,01), while no changes in the LET were revealed. The glomerular filtration rate in the LET group decreased by 8% (p<0,01). In the HET group, a decrease in arterial elastance by 9,4%, intima-media thickness by 9,9%, a decrease in the frequency of a negative response and an increase in a positive response (p<0,05) were revealed.Conclusion. The results demonstrate the importance of achieving target LDL-C for the most favorable dynamics of brain natriuretic peptide, structural and functional characteristics of the arterial system.
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22
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Mazimba S, Mwansa H, Breathett K, Strickling JE, Shah K, McNamara C, Mehta N, Kwon Y, Lamp J, Feng L, Tallaj J, Pamboukian S, Mubanga M, Matharoo J, Lim S, Salerno M, Mwansa V, Bilchick KC. Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients. Heart Vessels 2022; 37:1719-1727. [PMID: 35534640 DOI: 10.1007/s00380-022-02070-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
Ventriculo-arterial (VA) coupling has been shown to have physiologic importance in heart failure (HF). We hypothesized that the systemic arterial pulsatility index (SAPi), a measure that integrates pulse pressure and a proxy for left ventricular end-diastolic pressure, would be associated with adverse outcomes in advanced HF. We evaluated the SAPi ([systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure) obtained from the final hemodynamic measurement in patients randomized to therapy guided by a pulmonary arterial catheter (PAC) and with complete data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Cox proportional hazards regression was performed for the outcomes of (a) death, transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and (b) DTxLVAD. Among 142 patients (mean age 56.8 ± 13.3 years, 30.3% female), the median SAPi was 2.57 (IQR 1.63-3.45). Increasing SAPi was associated with significant reductions in DTxLVAD (HR 0.60 per unit increase in SAPi, 95% CI 0.44-0.84) and DTxLVADHF (HR 0.81 per unit increase, 95% CI 0.70-0.95). Patients with a SAPi ≤ 2.57 had a marked increase in both outcomes, including more than twice the risk of DTxLVAD (HR 2.19, 95% CI 1.11-4.30) over 6 months. Among advanced heart failure patients with invasive hemodynamic monitoring in the ESCAPE trial, SAPi was strongly associated with adverse clinical outcomes. These findings support further investigation of the SAPi to guide treatment and prognosis in HF undergoing invasive hemodynamic monitoring.
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Affiliation(s)
- Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA.
| | - Hunter Mwansa
- Division of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, IN, USA
| | - Jarred E Strickling
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Kajal Shah
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Coleen McNamara
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Younghoon Kwon
- Division of Cardiovascular Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Josephine Lamp
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Lu Feng
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Jose Tallaj
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy Pamboukian
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Stockholm, Sweden
| | - Jashanjeet Matharoo
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Michael Salerno
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Victor Mwansa
- Division of Cardiology, Heartland Regional Medical Group, Marion, IL, USA
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
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Pugliese NR, Balletti A, Armenia S, De Biase N, Faita F, Mengozzi A, Paneni F, Ruschitzka F, Virdis A, Ghiadoni L, Taddei S, Williams B, Antonini-Canterin F, Masi S. Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum. JACC Cardiovasc Imaging 2022; 15:1545-1559. [DOI: 10.1016/j.jcmg.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 12/27/2022]
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Antohi EL, Chioncel O, Mihaileanu S. Overcoming the Limits of Ejection Fraction and Ventricular-Arterial Coupling in Heart Failure. Front Cardiovasc Med 2022; 8:750965. [PMID: 35127846 PMCID: PMC8813963 DOI: 10.3389/fcvm.2021.750965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022] Open
Abstract
Left ventricular ejection fraction (LVEF) and ventricular-arterial coupling (VAC) [VAC = Ea/Ees; Ea: effective arterial elastance; Ees: left ventricle (LV) elastance] are both dimensionless ratios with important limitations, especially in heart failure setting. The LVEF to VAC relationship is a divergent non-linear function, having a point of intersection at the specific value of 0.62, where V0 = 0 ml (V0: the theoretical extrapolated value of the volume-axis intercept at end-systolic pressure 0 mmHg). For the dilated LV, both LVEF and VAC are highly dependent on V0 which is inconclusive when derived from single-beat Ees formulas. VAC simplification should be avoided. Revisiting the relationship between systolic time intervals (STI), pressure, and volumes could provide simple-to-use guiding formulas, affordable for daily clinical practice. We have analyzed by echocardiography the hemodynamics of 21 patients with severe symptomatic heart failure with reduced ejection (HFrEF) compared to 12 asymptomatic patients (at risk of heart failure with mild structural disease). The groups were unequivocally separated by ‘classic’ measures (LVEF, LV end-systolic volume (ESV), LV mass, STI). Chen's Ees formula was weakly correlated with LVEF and indexed ESV (ESVi) but better correlated to the pre-ejection period (PEP); PEP/total ejection time (PEP/TET); systolic blood pressure/PEP (SBP/PEP) (P < 0.001). Combining the predictability of the LVEF to the determinant role of SBP/PEP on the Ees variations, we obtained: (SBP*LVEF)/PEP mm Hg/ms, with an improved R2 value (R2 = 0.848; P < 0.001). The strongest correlations to VAC were for LVEF (R = −0.849; R2 = 0.722) and PEP/TET (R = 0.925; R2 = 0.857). By multiple regression, the VAC was strongly predicted (N = 33): (R = 0.975; R2 = 0.95): VAC = 0.553–0.009*LVEF + 3.463*PEP/TET, and natural logarithm: Ln (VAC) = 0.147–1.4563*DBP/SBP*0.9–0.010*LVEF + 4.207*PEP/TET (R = 0.987; R2 = 0.975; P = 0) demonstrating its exclusive determinants: LVEF, PEP/TET, and DBP/SBP. Considering Ea as a known value, the VAC-derived Ees formula: Ees_d ≈ Ea/(0.553–0.009*LVEF+3.463*PEP/TET) was strongly correlated to Chen's Ees formula (R = 0.973; R2 = 0.947) being based on SBP, ESV, LVEF, and PEP/TET and no exponential power. Thus, the new index supports our hypothesis, in the limited sample of patients with HFrEF. Indices like SBP/PEP, (SBP*LVEF)/PEP, PEP/TET, and DBP/SBP deserve further experiments, underlining the major role of the forgotten STI.
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Affiliation(s)
- Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu”, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- *Correspondence: Elena-Laura Antohi
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu”, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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25
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Pisesky A, Reichert MJE, de Lange C, Seed M, Yoo SJ, Lam CZ, Grosse-Wortmann L. Adverse fibrosis remodeling and aortopulmonary collateral flow are associated with poor Fontan outcomes. J Cardiovasc Magn Reson 2021; 23:134. [PMID: 34781968 PMCID: PMC8591885 DOI: 10.1186/s12968-021-00782-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The extent and significance in of cardiac remodeling in Fontan patients are unclear and were the subject of this study. METHODS This retrospective cohort study compared cardiovascular magnetic resonance (CMR) imaging markers of cardiac function, myocardial fibrosis, and hemodynamics in young Fontan patients to controls. RESULTS Fifty-five Fontan patients and 44 healthy controls were included (median age 14 years (range 7-17 years) vs 13 years (range 4-14 years), p = 0.057). Fontan patients had a higher indexed end-diastolic ventricular volume (EDVI 129 ml/m2 vs 93 ml/m2, p < 0.001), and lower ejection fraction (EF 45% vs 58%, p < 0.001), circumferential (CS - 23.5% vs - 30.8%, p < 0.001), radial (6.4% vs 8.2%, p < 0.001), and longitudinal strain (- 13.3% vs - 24.8%, p < 0.001). Compared to healthy controls, Fontan patients had higher extracellular volume fraction (ECV) (26.3% vs 20.6%, p < 0.001) and native T1 (1041 ms vs 986 ms, p < 0.001). Patients with a dominant right ventricle demonstrated larger ventricles (EDVI 146 ml/m2 vs 120 ml/m2, p = 0.03), lower EF (41% vs 47%, p = 0.008), worse CS (- 20.1% vs - 25.6%, p = 0.003), and a trend towards higher ECV (28.3% versus 24.1%, p = 0.09). Worse EF and CS correlated with longer cumulative bypass (R = - 0.36, p = 0.003 and R = 0.46, p < 0.001), cross-clamp (R = - 0.41, p = 0.001 and R = 0.40, p = 0.003) and circulatory arrest times (R = - 0.42, p < 0.001 and R = 0.27, p = 0.03). T1 correlated with aortopulmonary collateral (APC) flow (R = 0.36, p = 0.009) which, in the linear regression model, was independent of ventricular morphology (p = 0.9) and EDVI (p = 0.2). The composite outcome (cardiac readmission, cardiac reintervention, Fontan failure or any clinically significant arrhythmia) was associated with increased native T1 (1063 ms vs 1026 ms, p = 0.029) and EDVI (146 ml/m2 vs 118 ml/m2, p = 0.013), as well as decreased EF (42% vs 46%, p = 0.045) and worse CS (- 22% vs - 25%, p = 0.029). APC flow (HR 5.5 CI 1.9-16.2, p = 0.002) was independently associated with the composite outcome, independent of ventricular morphology (HR 0.71 CI 0.30-1.69 p = 0.44) and T1 (HR1.006 CI 1.0-1.13, p = 0.07). CONCLUSIONS Pediatric Fontan patients have ventricular dysfunction, altered myocardial mechanics and increased fibrotic remodeling. Cumulative exposure to cardiopulmonary bypass and increased aortopulmonary collateral flow are associated with myocardial dysfunction and fibrosis. Cardiac dysfunction, fibrosis, and collateral flow are associated with adverse outcomes.
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Affiliation(s)
- Andrea Pisesky
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Marjolein J E Reichert
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Pediatric section, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
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26
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Osuga T, Morita T, Sasaki N, Morishita K, Ohta H, Takiguchi M. Prognostic value of left ventricular-arterial coupling estimated using echocardiography in dogs with myxomatous mitral valve disease. J Vet Intern Med 2021; 35:2607-2615. [PMID: 34741477 PMCID: PMC8692204 DOI: 10.1111/jvim.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background The interaction between the left ventricle (LV) and systemic arterial systems, known as left ventricular‐arterial coupling (VAC), has been evaluated based on the effective arterial elastance (Ea) to LV end‐systolic elastance (Ees) ratio (Ea/Ees). The Ea reflects the total arterial load of LV, whereas Ees reflects the LV systolic function. A recent study found that inappropriate VAC based on increased Ea/Ees estimated by echocardiography is associated with advanced disease severity in dogs with myxomatous mitral valve disease (MMVD). Hypothesis Inappropriate VAC assessed by echocardiographic estimation of Ea/Ees is associated with a worse prognosis in dogs with MMVD. Animals Eighty‐nine dogs with MMVD. Methods Prospective cohort study. Dogs underwent echocardiographic examinations at enrollment. The Ea was estimated using the formula: mean blood pressure/(forward stroke volume/body weight). The Ees was estimated using the formula: mean blood pressure/(LV end‐systolic volume/body weight). The Ea/Ees was calculated. Results By end of study, 22 dogs died of cardiac‐related causes with 67 dogs censored. Dogs with increased Ea/Ees (Ea/Ees >0.34; median survival time, 527 days; 95% confidence interval [CI], 322 days‐not determinable) had a shorter survival time (P < .0001) than those without increased Ea/Ees (Ea/Ees ≤0.34; median survival time, >1112 days; 95% CI, not determinable). Multivariate Cox proportional hazard analysis showed that Ea/Ees, body weight, peak systolic mitral annular velocity, and the peak early diastolic transmitral velocity‐to‐peak early diastolic mitral annular velocity ratio were independent predictors of cardiac‐related death among echocardiographic indices. Conclusions and Clinical Importance Inappropriate VAC assessed based on echocardiographically‐estimated Ea/Ees is associated with a worse prognosis in dogs with MMVD.
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Affiliation(s)
- Tatsuyuki Osuga
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomoya Morita
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Ohta
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Kim H, Kim IC, Hwang J, Lee CH, Cho YK, Park HS, Chung JW, Nam CW, Han S, Hur SH. Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease. J Hum Hypertens 2021; 35:994-1002. [PMID: 33408327 DOI: 10.1038/s41371-020-00472-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP-CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ -8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Keimyung University Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Ventriculo-arterial coupling in patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Int J Cardiovasc Imaging 2021; 38:571-577. [PMID: 34655349 DOI: 10.1007/s10554-021-02437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
To investigate ventriculo-arterial coupling (VAC) and its components (Ea, Ees) in patients with stable ischemic heart disease and changes following percutaneous coronary intervention (PCI). 129 patients with stable ischemic heart disease (SIHD) undergoing PCI (study group) and 40 individuals without IHD (control group) were enrolled. VAC was calculated using echocardiography method at baseline and 1, 3, and 6 months after PCI. A linear mixed-effects models with restricted maximum likelihood were used to assess the impact of PCI on Ea, Ees, VAC over 6-month follow-up. Mean age of the SIHD group was 67.8 ± 8.1 (years), and predominantly men (73.6%). In the SIHD group, baseline median Ea, Ees and VAC were 2.52 (IQR 1.89-3.28) (mmHg/ml), 3.87 (IQR 2.90-4.95) (mmHg/ml), and 0.64 (IQR 0.54-0.79), respectively. Patients with SIHD had significantly lower Ees and higher VAC when compared to the control group (p < 0.05). Ees (p = 0.01) and VAC (p < 0.001) were significantly improved over 6 month follow-up after PCI. Notably, the degree of VAC improvement appears to be related to stented artery (Table 3). VAC obtained from echocardiographic methodology demonstrated a significant increase in patients with SIHD at baseline. This observation may represent a plausible mechanism for the benefit of PCI in SIHD. Hence, VAC may be a feasible parameter in the assessment of patients with SIHD.
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Ajmal M, Ajmal A, Huang L, Zeng L. The Potential Therapeutic Role of Celastrol in Patients With Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2021; 8:725602. [PMID: 34490381 PMCID: PMC8418197 DOI: 10.3389/fcvm.2021.725602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/27/2021] [Indexed: 12/07/2022] Open
Abstract
Analysis of left ventricular systolic dysfunction remained at the centre of heart failure research for many years (also known as heart failure with reduced ejection fraction, HFrEF). Although more than 50% of all heart failure patients experience a form of heart failure characterised by preserved ejection fraction (HFpEF), the pathophysiological mechanisms leading to this form of heart failure remain not well-understood. Several evidence-based treatments for HFrEF are in routine use, but there are limited evidence-based therapies for HFpEF. The effects of these remain controversial, with current treatment options being limited to managing the associated symptoms and conditions. Accumulating evidence demonstrates that pro-inflammatory and oxidative stress pathways play key roles in the development and progression of HFpEF, such as the Unfolded Protein Response (UPR) and inducible nitric oxide synthase. Celastrol, derived from medicinal plants, is a bioactive compound with strong anti-inflammatory properties, which could deem it as fruitful in overcoming the effects of such dysregulated UPR. This literature review therefore focuses on Celastrol's anti-inflammatory and antioxidant activities, alongside its other potential therapeutic activities, and its ability to impede the pathways that are thought to be involved in the development of HFpEF, such as the JAK2/STAT pathway, to elucidate the potential therapeutic role of this bioactive compound, in the treatment of HFpEF.
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Affiliation(s)
- Maryam Ajmal
- GKT School of Medical Education, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
| | - Aisha Ajmal
- St. George's Hospital Medical School, University of London, London, United Kingdom
| | - Lei Huang
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Third Central Hospital, Tianjin, China
| | - Lingfang Zeng
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
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30
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Saeed S, Holm H, Nilsson PM. Ventricular-arterial coupling: definition, pathophysiology and therapeutic targets in cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:753-761. [PMID: 34252318 DOI: 10.1080/14779072.2021.1955351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The heart and arterial system are equally affected by arteriosclerosis/atherosclerosis. There is a constant interaction between the left ventricular (LV) function and the arterial system, termed ventricular-arterial coupling (VAC), which reflects the global cardiovascular efficiency. VAC is traditionally assessed by echocardiography as the ratio of effective arterial elastance (Ea) over end-systolic elastance (Ees) (Ea/Ees). However, the concept of VAC is evolving and new methods have been proposed such as the ratio of pulse wave velocity (PWV) to global longitudinal strain (GLS) and myocardial work index. AREA COVERED This clinical review presents the hemodynamic background of VAC, its clinical implications and the impact of therapeutic interventions to normalize VAC. The review also summarizes the detrimental effects of cardio-metabolic risk factors on the aorta and LV, and provides an update on arterial load and its impact on LV function. The narrative review is based upon a systemic search of the bibliographic database PubMed for publications on VAC. EXPERT OPINION Newer methods such as PWV/GLS-ratio may be a superior marker of VAC than the traditional echocardiographic Ea/Ees in predicting target organ damage and its association with clinical outcomes. Novel anti-diabetic drugs and optimal antihypertensive treatment may normalize VAC in high-risk patients.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hannes Holm
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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31
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Nakano H, Shiina K, Takahashi T, Kumai K, Fujii M, Iwasaki Y, Matsumoto C, Chikamori T, Yamashina A, Tomiyama H. Mediation of Arterial Stiffness for Hyperuricemia-Related Decline of Cardiac Systolic Function in Healthy Men. Circ Rep 2021; 3:227-233. [PMID: 33842728 PMCID: PMC8024016 DOI: 10.1253/circrep.cr-21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background:
This prospective observational study examined whether hyperuricemia may be associated with impaired left ventricular (LV) systolic function and increased cardiac load resulting from increased arterial stiffness. Methods and Results:
In 1,880 middle-aged (mean [±SD] age 45±9 years) healthy men, serum uric acid (UA) levels, pre-ejection period/ejection time (PEP/ET) ratio, serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and brachial-ankle pulse wave velocity (baPWV) were measured at the start and end of the 3-year study period. Linear regression analysis revealed that serum UA levels measured at baseline were significantly associated with the PEP/ET ratio, but not with serum NT-proBNP levels, measured at baseline (β=0.73×10−1, P<0.01) and at the end of the study period (β=0.68×10−1, P<0.01). The change in the PEP/ET ratio during the study period was significantly greater in the High-UA (UA >7 mg/dL in 2009 and 2012) than Low-UA (UA ≤7 mg/dL in 2009 and 2012) group. Mediation analysis demonstrated both direct and indirect (via increases in baPWV) associations between serum UA measured at baseline and the PEP/ET ratio measured at the end of the study period. Conclusions:
In healthy middle-aged Japanese men, hyperuricemia may be associated with an accelerated decline in ventricular systolic function, both directly and indirectly, via increases in arterial stiffness.
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Affiliation(s)
- Hiroki Nakano
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | | | - Kento Kumai
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Masatsune Fujii
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Yoichi Iwasaki
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Chisa Matsumoto
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University Tokyo Japan
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Kresoja KP, Rommel KP, Fengler K, von Roeder M, Besler C, Lücke C, Gutberlet M, Desch S, Thiele H, Böhm M, Lurz P. Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2021; 14:e007421. [PMID: 33706547 DOI: 10.1161/circheartfailure.120.007421] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension. METHODS Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically. RESULTS At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33-48] versus 33 [26-40] mL/m2, P=0.002), pulse pressure (69 [63-77] versus 61 [55-67] mm Hg, P<0.001), but lower LV-VPES100mm Hg (18 [10-28] versus 24 [15-40] mL, P=0.007) and aortic distensibility (1.5 [1.1-2.6] versus 2.7 [1.1-3.5] 10-3 mm Hg-1, P=0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (-9 [-16 to -2], P<0.001). After RDN stroke volume index (-3 [-9 to +3] mL/m2, P=0.011) decreased and aortic distensibility (0.2 [-0.1 to +1.1] 10-3 mm Hg-1, P=0.007) and systolic stiffness (P<0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF (P=0.032, P=0.043, and P<0.001, respectively). CONCLUSIONS Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.
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Affiliation(s)
- Karl-Patrik Kresoja
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl-Philipp Rommel
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl Fengler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Maximilian von Roeder
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Besler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany (M.B.)
| | - Philipp Lurz
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
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33
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Osuga T, Morita T, Sasaki N, Morishita K, Ohta H, Takiguchi M. Echocardiographic estimation of left ventricular-arterial coupling in dogs with myxomatous mitral valve disease. J Vet Intern Med 2021; 35:78-87. [PMID: 33442907 PMCID: PMC7848320 DOI: 10.1111/jvim.16028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022] Open
Abstract
Background The effective arterial elastance (Ea) to left ventricular (LV) end‐systolic elastance (Ees) ratio (Ea/Ees) is an index of the interaction between LV and systemic arterial systems, left ventricular‐arterial coupling (VAC). The Ea is an index of total arterial load of the LV, whereas Ees is an index of LV systolic function. In humans, inappropriate VAC based on increased Ea/Ees estimated using echocardiography is associated with more advanced heart disease severity. Hypothesis Left ventricular‐arterial coupling assessed by echocardiographic estimation of Ea/Ees is associated with disease severity in dogs with myxomatous mitral valve disease (MMVD). Animals Ninety MMVD dogs and 61 healthy dogs. Methods Prospective cross‐sectional study. The MMVD dogs were classified into stages B1, B2, or C according to American College of Veterinary Internal Medicine guidelines. Effective arterial elastance was echocardiographically estimated using the formula: mean blood pressure/(forward stroke volume/body weight). End‐systolic elastance was echocardiographically estimated using the formula: mean blood pressure/(LV end‐systolic volume/body weight). The ratio Ea/Ees was calculated. Results The ratio Ea/Ees was higher in stage B2 dogs than in healthy dogs and dogs stage B1 (both P < .0001), and higher in stage C dogs than in healthy dogs and dogs in the other 2 stages (healthy vs C and B1 vs C, P < .0001; B2 vs C, P = .0005). Multivariable logistic regression analysis showed that Ea/Ees and the peak velocity of early diastolic transmitral flow to isovolumic relaxation time ratio were independent predictors of stage C among echocardiographic indices in MMVD dogs. Conclusions and Clinical Importance Inappropriate VAC assessed by echocardiographically estimated Ea/Ees is associated with advanced disease severity in dogs with MMVD.
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Affiliation(s)
- Tatsuyuki Osuga
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomoya Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Ohta
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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34
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Lawson MA, Hansen DE, Gupta DK, Bell SP, Adkisson DW, Mallugari RR, Sawyer DB, Ooi H, Kronenberg MW. Modification of ventriculo-arterial coupling by spironolactone in nonischemic dilated cardiomyopathy. ESC Heart Fail 2021; 8:1156-1166. [PMID: 33403831 PMCID: PMC8006677 DOI: 10.1002/ehf2.13161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023] Open
Abstract
Aims We sought to clarify the role of ventriculo–arterial (V–A) coupling in the treatment of nonischemic dilated cardiomyopathy (NIDCM) by adding a mineralocorticoid receptor antagonist (MRA) to conventional anti‐failure therapy. Methods and results We employed cardiac magnetic resonance imaging to quantify left ventricular (LV) contractility and V–A coupling in normal subjects at rest (n = 11) and in patients with NIDCM (n = 12) before and after long term anti‐failure therapy, in which MRA was added to conventional anti‐failure therapy. After ≥6 months' treatment in NIDCM patients, LV volumes and mass decreased, and the LV ejection fraction increased from a median of 24% (17, 27) (interquartile range IQR) to 47 (42, 52) (P < 0.002), with a marked reduction in arterial elastance (Ea) from 2.89 mmHg/mL (2.34, 4.0) to 1.50 (1.29, 1.95) (P < 0.002), similar to Ea of normal subjects, 1.53 (1.34, 1.67) (P > 0.05). The V–A coupling ratio, Ea/end‐systolic elastance (single‐beat method), decreased by −1.08 (−1.96, −0.55), (P = 0.003), as did Ea/end‐systolic pressure/end‐systolic pressure ratio, −0.54 (0.35, 0.87), (P = 0.002). The preload recruitable stroke work (PRSW) increased as did PRSW indexed for Ea (both P = 0.002), which reflected ‘total circulatory performance’. Conclusions In NIDCM, adding MRA to conventional anti‐failure therapy markedly improved LV ejection fraction and reduced peripheral vascular resistance, due to both improved LV contractility and especially to enhanced V–A coupling, as Ea decreased to normal. Total circulatory performance was a sensitive indicator of both LV pump performance and the arterial loading conditions.
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Affiliation(s)
- Mark A Lawson
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - David E Hansen
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Deepak K Gupta
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Susan P Bell
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Douglas W Adkisson
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ravinder R Mallugari
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Douglas B Sawyer
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Henry Ooi
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Marvin W Kronenberg
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Cooper LL, Rong J, Pahlevan NM, Rinderknecht DG, Benjamin EJ, Hamburg NM, Vasan RS, Larson MG, Gharib M, Mitchell GF. Intrinsic Frequencies of Carotid Pressure Waveforms Predict Heart Failure Events: The Framingham Heart Study. Hypertension 2021; 77:338-346. [PMID: 33390053 PMCID: PMC7803452 DOI: 10.1161/hypertensionaha.120.15632] [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] [Indexed: 11/18/2022]
Abstract
Supplemental Digital Content is available in the text. Intrinsic frequencies (IFs) derived from arterial waveforms are associated with cardiovascular performance, aging, and prevalent cardiovascular disease (CVD). However, prognostic value of these novel measures is unknown. We hypothesized that IFs are associated with incident CVD risk. Our sample was drawn from the Framingham Heart Study Original, Offspring, and Third Generation Cohorts and included participants free of CVD at baseline (N=4700; mean age 52 years, 55% women). We extracted 2 dominant frequencies directly from a series of carotid pressure waves: the IF of the coupled heart and vascular system during systole (ω1) and the IF of the decoupled vasculature during diastole (ω2). Total frequency variation (Δω) was defined as the difference between ω1 and ω2. We used Cox proportional hazards regression models to relate IFs to incident CVD events during a mean follow-up of 10.6 years. In multivariable models adjusted for CVD risk factors, higher ω1 (hazard ratio [HR], 1.14 [95% CI], 1.03–1.26]; P=0.01) and Δω (HR, 1.16 [95% CI, 1.03–1.30]; P=0.02) but lower ω2 (HR, 0.87 [95% CI, 0.77–0.99]; P=0.03) were associated with higher risk for incident composite CVD events. In similarly adjusted models, higher ω1 (HR, 1.23 [95% CI, 1.07–1.42]; P=0.004) and Δω (HR, 1.26 [95% CI, 1.05–1.50]; P=0.01) but lower ω2 (HR, 0.81 [95% CI, 0.66–0.99]; P=0.04) were associated with higher risk for incident heart failure. IFs were not significantly associated with incident myocardial infarction or stroke. Novel IFs may represent valuable markers of heart failure risk in the community.
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Affiliation(s)
- Leroy L Cooper
- From the Biology Department, Vassar College, Poughkeepsie, NY (L.L.C.)
| | - Jian Rong
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.)
| | - Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering (N.M.P.), University of Southern California, Los Angeles.,Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine (N.M.P.), University of Southern California, Los Angeles
| | - Derek G Rinderknecht
- Graduate Aerospace Laboratories, Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena (D.G.R., M.G.)
| | - Emelia J Benjamin
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA.,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Naomi M Hamburg
- Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA
| | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA.,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Martin G Larson
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA
| | - Morteza Gharib
- Graduate Aerospace Laboratories, Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena (D.G.R., M.G.).,Department of Medical Engineering, California Institute of Technology, Pasadena (M.G.)
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Li S, Wan X, Laudanski K, He P, Yang L. Left-Sided Ventricular-arterial Coupling and Volume Responsiveness in Septic Shock Patients. Shock 2020; 52:577-582. [PMID: 30807525 DOI: 10.1097/shk.0000000000001327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Suboptimal ventricular arterial coupling (VAC) is one of the pivotal determinants of inefficient heart performance despite appropriate administration of fluids or vasopressors in shocks. Here, we investigate the performance of VAC in patients who are unresponsive to fluid administration in septic shock. METHODS This is a retrospective observational study of septic shock patients (n = 35). VAC was evaluated by effective arterial elastance (EaI), left ventricular end-systolic elastance (EesI), and EaI/EesI. Septic shock patients successfully fluid resuscitated after pulse indicator continuous cardiac output (PiCCO) monitoring, defined as an increase in general end-diastolic ventricular volume (GEDVI) more than 10%, were divided into volume responsive (VVr), and volume unresponsive (VVur) groups based on a cardiac index increase above 10%. We hypothesize that two groups of patients will exhibit dissimilarities of VAC variation, defined as EaI/EesI variation (ΔEaI/EesI). RESULTS Variations of EaI (ΔEaI), and EaI/EesI (ΔEaI/EesI), and systemic vascular resistance index (ΔSVRI) were significantly lower in the VVr group than those in the VVur group (P < 0.05). Variations of cardiac index (ΔCI), stroke volume index (ΔSVI), and EesI (ΔEesI) were significantly higher in patients with ΔEaI/EesI ≤ 0. Concomitantly, ΔEaI and ΔSVRI were significantly diminished as compared with patients with ΔEaI/EesI > 0 (P < 0.05). ΔCI has an inverse relationship with both ΔEaI (r = -0.46, P = 0.006), ΔEaI/EesI (r = -0.65, P < 0.001), and ΔSVRI (r = -0.59, P < 0.001). We observed more patients who were fluid responsive in the ΔEaI/EesI ≤ 0 group than in the group with ΔEaI/EesI > 0 (88.89% vs. 26.92%, P = 0.01). CONCLUSIONS Variation of VAC is often related to suboptimal ventricular volume responsiveness among patients with septic shock.
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Affiliation(s)
- Suwei Li
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Xianyao Wan
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ping He
- Department of Critical Care Medicine, First Hospital affiliated to Dalian Medical University, Dalian, People's Republic of China
| | - Lihui Yang
- Department of Critical Care Medicine, Center Hospital of Huludao, Huludao, People's Republic of China
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Mihaileanu S, Antohi E. Revisiting the relationship between left ventricular ejection fraction and ventricular-arterial coupling. ESC Heart Fail 2020; 7:2214-2222. [PMID: 32686316 PMCID: PMC7524249 DOI: 10.1002/ehf2.12880] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of this article was to analyse in‐depth the relationship between left ventricular (LV) ejection fraction (EF) (LVEF) and the most commonly used formulas for the calculation of LV elastance (Ees), volume intercept at 0 mmHg pressure (V0), effective arterial elastance (Ea), and ventricular–arterial coupling (VAC) as are validated today. We analyse the mathematical resulting consequences, raising the question on the physiological validity. To our knowledge, some of the following mathematical consequences have never been published. On the basis of studies demonstrating that normal LV dimensions and LVEF have a Gaussian unimodal distribution, we considered that the normal modal LVEF is 62% or very close to it. Expressed as a fraction, it is 0.62, that is, the reciprocal of the Phi number (namely, 1/Φ ~ 0.618). Applying Euclid's mathematical law on the extreme and mean ratio (the golden ratio), we studied the LVEF–VAC relationship in normal hearts. The simplification of the VAC formula (with V0 = 0) leads to false physiological results; V0 extraction from single‐beat Chen's formula leads to high negative results in normal subjects; based on the Euclid law, LVEF and Ea/Ees will be equal for a ratio value of 0.618 (62%) where V0 cannot be different from 0 mL; LVEF and VAC inverse relationship formula (Ea/Ees = 1/LVEF − 1) is reducible to a fundamental property of Phi: 1/Φ = (Φ − 1), being valid only if LVEF = VAC at a 0.618 value; according to this restriction, Vo can only be 0 mL, thus describing a very limited range. The Ea/Ees ratio, owing to its mathematical more dynamic behaviour, can be more sensitive than LVEF, being a valuable clinical tool in patients with heart failure (HF) with reduced EF, acute unstable haemodynamic situations, where Ees and Ea variations are disproportionate. However, the application is doubtful in HF with preserved EF where Ees and Ea may have same‐direction augmentation. The modified VAC formula suffers from oversimplification, reducing it to a dimensionless ratio, which is supposed to approximate non‐linear time‐varying functions. Thus, we advocate for caution and in‐depth understanding when using simplified formulas in clinical practice.
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Affiliation(s)
| | - Elena‐Laura Antohi
- Emergency Institute for Cardiovascular Diseases ‘C.C. Iliescu’BucharestRomania
- University for Medicine and Pharmacy ‘Carol Davila’BucharestRomania
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Baral R, Loudon B, Frenneaux MP, Vassiliou VS. Ventricular-vascular coupling in heart failure with preserved ejection fraction: A systematic review and meta-analysis. Heart Lung 2020; 50:121-128. [PMID: 32690217 DOI: 10.1016/j.hrtlng.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a complex disease underlined by impaired ventricular-vascular coupling (VVC). OBJECTIVES To evaluate the VVC ratio in HFpEF patients at rest and during exercise and compare it to the healthy and heart failure with reduced ejection fraction (HFrEF) controls. METHODS PubMed and EMBASE databases were searched for trials that matched the inclusion criteria. Random-effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software. RESULTS A total of 13 trials met the inclusion criteria. Although VVC ratio was comparable between HFpEF and healthy controls at rest, it was significantly lower in HFrEF compared to HFpEF. During exercise, there was a significant decline in VVC ratio in HFpEF (-0.119, 95% CI (-0.183 to -0.055), p<0.001). CONCLUSION VVC ratio, although 'preserved' at rest in HFpEF patients, was overtly impaired during exercise highlighting the importance of dynamic testing.
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Affiliation(s)
- Ranu Baral
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Brodie Loudon
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Michael P Frenneaux
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Royal Brompton Hospital and Imperial College London, United Kingdom; Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Oikonomou E, Karlis D, Tsalamadris S, Siasos G, Chrysohoou C, Vogiatzi G, Dimitropoulos S, Charalambous G, Kouskouni E, Tousoulis D. Galectin-3 and Arterial Stiffness in Patients with Heart Failure: A Pilot Study. Curr Vasc Pharmacol 2020; 17:396-400. [PMID: 29968538 DOI: 10.2174/1570161116666180703094919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac performance depends on optimum ventriculoarterial coupling which is impaired in patients with heart failure (HF). Galectin-3 is a mediator of myocardial fibrosis and remodeling, and is associated with clinical status in patients with chronic HF. We examined the association of arterial stiffness with galectin-3 levels in patients with HF of ischemic etiology. METHODS We consecutively enrolled 40 patients with stable ischemic HF and reduced ejection fraction. Central aortic stiffness was evaluated non-invasively by measuring carotid femoral pulse wave velocity (PWV). Among other factors, serum levels of galectin-3 and b-type natriuretic peptide (BNP) were measured. RESULTS The median galectin-3 levels in our study population were 12.9 (10.8-18.7) ng/ml and the mean PWV was 9.31±2.79 m/sec. There was significant association of galectin-3 levels with age (r=0.48, p=0.003), creatinine clearance (r=-0.66, p<0.001) and BNP levels (r=0.36, p=0.05). There was a significant association of galectin-3 levels with PWV (r=0.37, p=0.03) and patients with PWV above median also had significantly increased levels of galectin-3 compared with patients with lower values of PWV [16.1(11.8-25.2) vs. 12.1(10.5-14) ng/ml, p=0.03]. CONCLUSION We found an association of arterial stiffness and PWV with galectin-3 levels in patients with chronic HF of ischemic etiology. These findings suggest a pathway driving arterial stiffening and myocardial remodelling in HF. This may provide insight into the mechanism determining prognosis and clinical status of patients with HF.
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Affiliation(s)
- Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitris Karlis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiris Tsalamadris
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgia Vogiatzi
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stathis Dimitropoulos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Charalambous
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evangelia Kouskouni
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Shah SJ, Borlaug BA, Kitzman DW, McCulloch AD, Blaxall BC, Agarwal R, Chirinos JA, Collins S, Deo RC, Gladwin MT, Granzier H, Hummel SL, Kass DA, Redfield MM, Sam F, Wang TJ, Desvigne-Nickens P, Adhikari B. Research Priorities for Heart Failure With Preserved Ejection Fraction: National Heart, Lung, and Blood Institute Working Group Summary. Circulation 2020; 141:1001-1026. [PMID: 32202936 PMCID: PMC7101072 DOI: 10.1161/circulationaha.119.041886] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF), a major public health problem that is rising in prevalence, is associated with high morbidity and mortality and is considered to be the greatest unmet need in cardiovascular medicine today because of a general lack of effective treatments. To address this challenging syndrome, the National Heart, Lung, and Blood Institute convened a working group made up of experts in HFpEF and novel research methodologies to discuss research gaps and to prioritize research directions over the next decade. Here, we summarize the discussion of the working group, followed by key recommendations for future research priorities. There was uniform recognition that HFpEF is a highly integrated, multiorgan, systemic disorder requiring a multipronged investigative approach in both humans and animal models to improve understanding of mechanisms and treatment of HFpEF. It was recognized that advances in the understanding of basic mechanisms and the roles of inflammation, macrovascular and microvascular dysfunction, fibrosis, and tissue remodeling are needed and ideally would be obtained from (1) improved animal models, including large animal models, which incorporate the effects of aging and associated comorbid conditions; (2) repositories of deeply phenotyped physiological data and human tissue, made accessible to researchers to enhance collaboration and research advances; and (3) novel research methods that take advantage of computational advances and multiscale modeling for the analysis of complex, high-density data across multiple domains. The working group emphasized the need for interactions among basic, translational, clinical, and epidemiological scientists and across organ systems and cell types, leveraging different areas or research focus, and between research centers. A network of collaborative centers to accelerate basic, translational, and clinical research of pathobiological mechanisms and treatment strategies in HFpEF was discussed as an example of a strategy to advance research progress. This resource would facilitate comprehensive, deep phenotyping of a multicenter HFpEF patient cohort with standardized protocols and a robust biorepository. The research priorities outlined in this document are meant to stimulate scientific advances in HFpEF by providing a road map for future collaborative investigations among a diverse group of scientists across multiple domains.
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Affiliation(s)
- Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | - Scott L. Hummel
- University of Michigan and the Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
| | | | | | - Flora Sam
- Boston University School of Medicine, Boston, MA
| | | | | | - Bishow Adhikari
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD
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Gao Y, Xing C, Hao W, Zhao H, Wang L, Luan B, Hou A. The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure. Int Heart J 2020; 61:1-6. [DOI: 10.1536/ihj.19-231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yang Gao
- Department of Cardiology, The People's Hospital of Liaoning Province
| | - Changtai Xing
- Department of Cardiology, The Center Hospital Affiliated to Shenyang Medical College
| | - Wenjun Hao
- Department of Cardiology, The People's Hospital of Liaoning Province
| | - Hongwei Zhao
- Department of Cardiology, The People's Hospital of Liaoning Province
| | - Lili Wang
- Department of Cardiology, The People's Hospital of Liaoning Province
| | - Bo Luan
- Department of Cardiology, The People's Hospital of Liaoning Province
| | - Aijie Hou
- Department of Cardiology, The People's Hospital of Liaoning Province
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Tomiyama H, Ohkuma T, Ninomiya T, Nakano H, Matsumoto C, Avolio A, Kohro T, Higashi Y, Maruhashi T, Takase B, Suzuki T, Ishizu T, Ueda S, Yamazaki T, Furumoto T, Kario K, Inoue T, Koba S, Takemoto Y, Hano T, Sata M, Ishibashi Y, Node K, Maemura K, Ohya Y, Furukawa T, Ito H, Chikamori T, Yamashina A. Brachial-Ankle Pulse Wave Velocity Versus Its Stiffness Index β-Transformed Value as Risk Marker for Cardiovascular Disease. J Am Heart Assoc 2019; 8:e013004. [PMID: 31822217 PMCID: PMC6951050 DOI: 10.1161/jaha.119.013004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The difference in the predictive ability of the brachial‐ankle pulse wave velocity (baPWV) and its stiffness index β‐transformed value (β‐baPWV, ie, baPWV adjusted for the pulse pressure) for the development of pathophysiological abnormalities related to cardiovascular disease or future occurrence of cardiovascular disease was examined. Methods and Results In study 1, a 7‐year prospective observational study in cohorts of 3274 men and 3490 men, the area under the curve in the receiver operator characteristic curve analysis was higher for baPWV than for β‐baPWV for predicting the development of hypertension (0.73, 95% CI=0.70 to 0.75 versus 0.59, 95% CI=0.56 to 0.62; P<0.01) and/or the development of retinopathy (0.78, 95% CI=0.73 to 0.82 versus 0.66, 95% CI=0.60 to 0.71; P<0.01) by the end of the study period. During study 2, a 3‐year observation period on 511 patients with coronary artery disease, 72 cardiovascular events were confirmed. The C statistics of both markers for predicting the development of cardiovascular events were similar. Conclusions Stiffness index β transformation of the baPWV may attenuate the significance of the baPWV as a risk marker for development of pathophysiological abnormalities related to cardiovascular disease in male subjects.
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Affiliation(s)
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Hiroki Nakano
- Department of Cardiology Tokyo Medical University Tokyo Japan
| | - Chisa Matsumoto
- Department of Cardiology Tokyo Medical University Tokyo Japan
| | - Alberto Avolio
- Department of Biomedical Sciences Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Takahide Kohro
- Department of Clinical Informatics Jichi Medical University School of Medicine Tochigi Japan
| | - Yukihito Higashi
- Department of Cardiovascular Physiology and Medicine Hiroshima University Graduate School of Biomedical Science Hiroshima Japan
| | - Tatsuya Maruhashi
- Department of Cardiovascular Physiology and Medicine Hiroshima University Graduate School of Biomedical Science Hiroshima Japan
| | - Bonpei Takase
- Division of Biomedical Engineering National Defense Medical College Research Institute Saitama Japan
| | - Toru Suzuki
- Cardiovascular Medicine University of Leicester United Kingdom
| | - Tomoko Ishizu
- Cardiovascular Division Institute of Clinical Medicine University of Tsukuba Ibaraki Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics University of the Ryukyus School of Medicine Okinawa Japan
| | - Tsutomu Yamazaki
- Department of Clinical Epidemiology and Systems Faculty of Medicine The University of Tokyo Japan
| | - Tomoo Furumoto
- Department of Cardiovascular Medicine Hokkaido University Graduate School of Medicine Hokkaido Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine Dokkyo Medical University Tochigi Japan
| | - Shinji Koba
- Department of Medicine Division of Cardiology Showa University School of Medicine Tokyo Japan
| | - Yasuhiko Takemoto
- Department of Internal Medicine and Cardiology Osaka City University Graduate School of Medicine Osaka Japan
| | - Takuzo Hano
- Department of Medical Education and Population-Based Medicine Postgraduate School of Medicine Wakayama Medical University Wakayama Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine Institute of Health Biosciences The University of Tokushima Graduate School Tokushima Japan
| | - Yutaka Ishibashi
- Department of General Medicine Shimane University Faculty of Medicine Izumo Japan
| | - Koichi Node
- Department of Cardiovascular and Renal Medicine Saga University Saga Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Yusuke Ohya
- The Third Department of Internal Medicine University of the Ryukyus Okinawa Japan
| | - Taiji Furukawa
- Department of Internal Medicine Teikyo University School of Medicine Tokyo Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | | | - Akira Yamashina
- Department of Cardiology Tokyo Medical University Tokyo Japan
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Learning From Each Beat: Ventriculoarterial Coupling. Pediatr Crit Care Med 2019; 20:786-787. [PMID: 31397814 DOI: 10.1097/pcc.0000000000001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Leite S, Cerqueira RJ, Ibarrola J, Fontoura D, Fernández-Celis A, Zannad F, Falcão-Pires I, Paulus WJ, Leite-Moreira AF, Rossignol P, López-Andrés N, Lourenço AP. Arterial Remodeling and Dysfunction in the ZSF1 Rat Model of Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2019; 12:e005596. [PMID: 31525070 DOI: 10.1161/circheartfailure.118.005596] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The interplay between the stiffened heart and vessels has long been viewed as a core mechanism in heart failure with preserved ejection fraction, but the incremental vascular molecular remodeling mechanisms from systemic arterial hypertension to heart failure with preserved ejection fraction remain poorly investigated. Our aim was to characterize central arterial remodeling and dysfunction in ZSF1 obese rats and to compare it with hypertensive ZSF1 lean and healthy Wistar-Kyoto controls. METHODS AND RESULTS Twenty-week-old male ZSF1 obese (n=9), lean (n=9), and Wistar-Kyoto rats (n=9) underwent left ventricular pressure-volume loop evaluation and synchronous acquisition of ascending aortic flow and pressure. Aortic rings underwent functional evaluation, histology, and molecular biology studies. Although mean arterial pressure, characteristic aortic impedance, and reactivity to phenylephrine were similarly increased in hypertensive ZSF1 lean and obese, only ZSF1 obese showed impaired relaxation and upward-shifted end-diastolic pressure-volume relationships despite preserved systolic function indexes, denoting heart failure with preserved ejection fraction. ZSF1 obese phenotype further showed decreased aortic compliance, increased wave reflection, and impaired direct NO donor and endothelial-mediated vasodilation which were accompanied on structural and molecular grounds by aortic media thickening, higher collagen content and collagen/elastin ratio, increased fibronectin and α-5 integrin protein expression and upregulated TGF (transforming growth factor)-β and CTGF (connective tissue growth factor) levels. CONCLUSIONS Functional, molecular, and structural disturbances of central vessels and their potentially underlying pathways were newly characterized in experimental heart failure with preserved ejection fraction rendering the ZSF1 obese rat model suitable for preclinical testing.
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Affiliation(s)
- Sara Leite
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.)
| | - Rui J Cerqueira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.).,Department of Cardiothoracic Surgery (R.C., A.F.L.-M.), São João Hospital Centre, Porto, Portugal
| | - Jaime Ibarrola
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain (J.I., A.F.-C., N.L.-A.)
| | - Dulce Fontoura
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.)
| | - Amaya Fernández-Celis
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain (J.I., A.F.-C., N.L.-A.)
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT, Nancy, France (F.Z., P.R., N.L.-A.)
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.)
| | - Walter J Paulus
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands (W.J.P.)
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.).,Department of Cardiothoracic Surgery (R.C., A.F.L.-M.), São João Hospital Centre, Porto, Portugal
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT, Nancy, France (F.Z., P.R., N.L.-A.)
| | - Natalia López-Andrés
- Cardiovascular Translational Research, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain (J.I., A.F.-C., N.L.-A.).,INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT, Nancy, France (F.Z., P.R., N.L.-A.)
| | - André P Lourenço
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (S.L., R.C., D.F., I.F.-P., A.F.L.-M., A.P.L.).,Department of Anesthesiology (A.P.L.), São João Hospital Centre, Porto, Portugal
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Effects of Apelin on Left Ventricular-Arterial Coupling and Mechanical Efficiency in Rats with Ischemic Heart Failure. DISEASE MARKERS 2019; 2019:4823156. [PMID: 31316680 PMCID: PMC6604493 DOI: 10.1155/2019/4823156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/06/2018] [Indexed: 01/13/2023]
Abstract
Apelin plays important roles in cardiovascular homeostasis. However, its effects on the mechanoenergetics of heart failure (HF) are unavailable. We attempted to investigate the effects of apelin on the left ventricular-arterial coupling (VAC) and mechanical efficiency in rats with HF. HF was induced in rats by the ligation of the left coronary artery. The ischemic HF rats were treated with apelin or saline for 12 weeks. The sham-operated animals served as the control. The left ventricular (LV) afterload and the systolic and diastolic functions, as well as the mechanoenergetic indices were estimated from the pressure-volume loops. Myocardial fibrosis by Masson's trichrome staining, myocardial apoptosis by TUNEL, and collagen content in the aorta as well as media area in the aorta and the mesenteric arteries were determined. Our data indicated that HF rats manifested an increased arterial load (Ea), a declined systolic function (reduced ejection fraction, +dP/dtmax, end-systolic elastance, and stroke work), an abnormal diastolic function (elevated end-diastolic pressure, τ, and declined −dP/dtmax), and decreased mechanical efficiency. Apelin treatment improved those indices. Concomitantly, increased fibrosis in the LV myocardium and the aorta and enhanced apoptosis in the LV were partially restored by apelin treatment. A declined wall-to-lumen ratio in the mesenteric arteries of the untreated HF rats was further reduced in the apelin-treated group. We concluded that the rats with ischemic HF were characterized by deteriorated LV mechanoenergetics. Apelin improved mechanical efficiency, at least in part, due to the inhibiting cardiac fibrosis and apoptosis in the LV myocardium, reducing collagen deposition in the aorta and dilating the resistant artery.
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46
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Reddy YNV, Borlaug BA, O’Connor CM, Gersh BJ. Novel approaches to the management of chronic systolic heart failure: future directions and unanswered questions. Eur Heart J 2019; 41:1764-1774. [DOI: 10.1093/eurheartj/ehz364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/25/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Despite improvements in outcomes in the last few decades for heart failure (HF) with reduced ejection fraction (HFrEF), there still remains a need for novel therapies as many patients incompletely recover with existing therapies and progress to advanced HF. In this review, we will discuss recent advances in the management of HFrEF with a focus on upcoming therapies that hold the greatest promise for clinical use. We will discuss novel pharmacological therapies and areas of uncertainty with existing therapies. We will also discuss the potential utility and controversy surrounding novel interventions for HF such as percutaneous mitral valve repair, atrial fibrillation ablation, and other emerging interventions with positive signals for benefit in HFrEF. Finally, we will summarize the current state of stem cell and gene therapy for HFrEF and future directions.
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Affiliation(s)
- Yogesh N V Reddy
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
| | - Barry A Borlaug
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
| | | | - Bernard J Gersh
- The Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, MN 55906, USA
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Tannvik TD, Rimehaug AE, Wigen MS, Løvstakken L, Kirkeby-Garstad I. Ventriculo-arterial interaction may be assessed by Oscillatory Power Fraction. Clin Physiol Funct Imaging 2019; 39:308-314. [PMID: 31038817 DOI: 10.1111/cpf.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
The rate of energy transfer from the left ventricle to the aorta is viewed in terms of mean power (MP) and total power (TP). The difference between MP and TP is due to the pulsatility of the circulation and is known as oscillatory power (OP). OP is considered the energy spent to accelerate the blood flow. The aim of this study was to investigate the baseline left ventricular oscillatory power fraction (OP/TP) and how this was affected by acute cardiovascular dysfunction and altered preload. Twenty-eight patients undergoing elective coronary artery bypass graft surgery were included. Before administration of anaesthesia, we simultaneously recorded an arterial pressure curve and instantaneous cardiac outflow with pulsed wave Doppler. Postoperatively, prior to extubation, these measurements were repeated in neutral, Trendelenburg and reverse-Trendelenburg position. The final measurements were taken on the awake patient the day after the operation. TP is the mean of the instantaneous product of the flow and pressure curves. MP was calculated by multiplying mean arterial pressure with mean cardiac output. The oscillatory power fraction is therefore calculated as (TP-MP)/TP. The oscillatory power fraction in neutral position decreased from 23% preoperatively to 16% immediately postoperatively (P<0·001) and increased again to 19% the first postoperative day (P = 0·001). The oscillatory power fraction also increased from 16% in neutral to 19% in Trendelenburg (P = 0·001) and decreased comparing to neutral, to 14% in reverse-Trendelenburg (P = 0·04). The oscillatory power fraction is situation-dependent and is influenced by both the operation and the altered preload.
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Affiliation(s)
- Tomas Dybos Tannvik
- Department of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
| | - Audun Eskeland Rimehaug
- Department of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Morten Smedsrud Wigen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
| | - Idar Kirkeby-Garstad
- Department of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
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48
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Redheuil A, Kachenoura N, Bollache E, Yu WC, Opdahl A, Decesare A, Mousseaux E, Bluemke D, Lima JAC. Left ventricular and proximal aorta coupling in magnetic resonance imaging: aging together? Am J Physiol Heart Circ Physiol 2019; 317:H300-H307. [PMID: 30978118 DOI: 10.1152/ajpheart.00694.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The importance of aorta-ventricular coupling in cardiovascular disease is recognized but underestimated. The contribution of the age-related decline in ascending aortic function compared with characteristic impedance and total peripheral resistance on left ventricular function and remodeling is poorly studied. Our aim was to evaluate the relation of proximal aortic distensibility and impedance with left ventricular geometry and function in asymptomatic individuals. We prospectively studied 100 subjects (47 men, 53 women, age: 20-84 yr). Aortic strain, distensibility, arch pulse wave velocity, characteristic impedance (Zc), total peripheral resistance, left ventricular (LV) volumes and mass, wall stress, and peak global circumferential myocardial strain and strain rates were determined by MRI. Central pressures were measured from tonometry. Ea/Ev, an index of vascular-ventricular coupling, and LV wall stress were preserved across age- or aortic-stiffness-stratified groups. Static and pulsatile components of aortic load were differentially associated with age. Increased total vascular resistance was associated with decreased LV strain and increased concentric remodeling [ratio of LV mass to end-diastolic volume (M/V ratio)] in all individuals. In younger individuals (<45 yr), aortic distensibility was related to LV strain and concentric remodeling (M/V ratio), whereas Zc was related to LV strain and concentric remodeling (M/V ratio) in older individuals (>45 yr). Early age-related stiffening of the ascending aorta is a component of LV afterload subsequently associated with increased aortic impedance and alterations in LV geometry, namely concentric remodeling, decreased myocardial strain, and increased stroke work such that LV wall stress and arterial-ventricular coupling are preserved. NEW & NOTEWORTHY Local flow and deformation can both be assessed with high precision noninvasively in the ascending aorta using MRI. Combined with central pressure measurement, they provide distensibility and impedance and simultaneous reference assessment of left ventricular deformation and geometry, hence a comprehensive evaluation of arterial-ventricular coupling to study physiology and disease.
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Affiliation(s)
- Alban Redheuil
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Institut National de la Santé et de la Recherche Médicale 1146, Centre National de la Recherche Scientifique 7371, Paris , France.,Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris , France.,Institute of Cardiometabolism and Nutrition , Paris , France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Institut National de la Santé et de la Recherche Médicale 1146, Centre National de la Recherche Scientifique 7371, Paris , France.,Institute of Cardiometabolism and Nutrition , Paris , France
| | - Emilie Bollache
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Institut National de la Santé et de la Recherche Médicale 1146, Centre National de la Recherche Scientifique 7371, Paris , France.,Institute of Cardiometabolism and Nutrition , Paris , France
| | - Wen-Chung Yu
- Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University , Taipei , Taiwan
| | - Anders Opdahl
- Department of Cardiology, Oslo University Hospital , Oslo , Norway
| | - Alain Decesare
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Institut National de la Santé et de la Recherche Médicale 1146, Centre National de la Recherche Scientifique 7371, Paris , France.,Institute of Cardiometabolism and Nutrition , Paris , France
| | - Elie Mousseaux
- University of Paris Descartes, Georges-Pompidou European Hospital Assistance Publique-Hôpitaux de Paris, and Institut National de la Santé et de la Recherche Médicale U970 , Paris , France
| | - David Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Joao A C Lima
- Cardiovascular Imaging, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
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49
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Chirinos JA, Bhattacharya P, Kumar A, Proto E, Konda P, Segers P, Akers SR, Townsend RR, Zamani P. Impact of Diabetes Mellitus on Ventricular Structure, Arterial Stiffness, and Pulsatile Hemodynamics in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2019; 8:e011457. [PMID: 30764699 PMCID: PMC6405670 DOI: 10.1161/jaha.118.011457] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/22/2019] [Indexed: 01/05/2023]
Abstract
Background Heterogeneity in the underlying processes that contribute to heart failure with preserved ejection fraction ( HF p EF ) is increasingly recognized. Diabetes mellitus is a frequent comorbidity in HF p EF , but its impact on left ventricular and arterial structure and function in HF p EF is unknown. Methods and Results We assessed the impact of diabetes mellitus on left ventricular cellular and interstitial hypertrophy (assessed with cardiac magnetic resonance imaging, including T1 mapping pregadolinium and postgadolinium administration), arterial stiffness (assessed with arterial tonometry), and pulsatile arterial hemodynamics (assessed with in-office pressure-flow analyses and 24-hour ambulatory monitoring) among 53 subjects with HF p EF (32 diabetic and 21 nondiabetic subjects). Despite few differences in clinical characteristics, diabetic subjects with HFpEF exhibited a markedly greater left ventricular mass index (78.1 [95% CI , 70.4-85.9] g versus 63.6 [95% CI , 55.8-71.3] g; P=0.0093) and indexed extracellular volume (23.6 [95% CI , 21.2-26.1] mL/m2 versus 16.2 [95% CI , 13.1-19.4] mL/m2; P=0.0008). Pronounced aortic stiffening was also observed in the diabetic group (carotid-femoral pulse wave velocity, 11.86 [95% CI , 10.4-13.1] m/s versus 8.8 [95% CI , 7.5-10.1] m/s; P=0.0027), with an adverse pulsatile hemodynamic profile characterized by increased oscillatory power (315 [95% CI , 258-373] mW versus 190 [95% CI , 144-236] mW; P=0.0007), aortic characteristic impedance (0.154 [95% CI , 0.124-0.183] mm Hg/mL per second versus 0.096 [95% CI , 0.072-0.121] mm Hg/mL per second; P=0.0024), and forward (59.5 [95% CI , 52.8-66.1] mm Hg versus 40.1 [95% CI , 31.6-48.6] mm Hg; P=0.0010) and backward (19.6 [95% CI , 16.2-22.9] mm Hg versus 14.1 [95% CI , 10.9-17.3] mm Hg; P=0.0169) wave amplitude. Abnormal pulsatile hemodynamics were also evident in 24-hour ambulatory monitoring, despite the absence of significant differences in 24-hour systolic blood pressure between the groups. Conclusions Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular-arterial interactions in HF p EF . Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 01516346.
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Affiliation(s)
- Julio A. Chirinos
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Department of RadiologyCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPA
| | - Priyanka Bhattacharya
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
| | - Anupam Kumar
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Elizabeth Proto
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Prasad Konda
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
| | - Patrick Segers
- Biofluid, Tissue and Solid Mechanics for Medical ApplicationsGhent UniversityGhentBelgium
| | - Scott R. Akers
- Department of RadiologyCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPA
| | - Raymond R. Townsend
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Payman Zamani
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPA
- Division of Cardiovascular MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
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50
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Hashmath Z, Lee J, Gaddam S, Ansari B, Oldland G, Javaid K, Mustafa A, Vasim I, Akers S, Chirinos JA. Vitamin K Status, Warfarin Use, and Arterial Stiffness in Heart Failure. Hypertension 2019; 73:364-370. [PMID: 30580682 PMCID: PMC6326852 DOI: 10.1161/hypertensionaha.118.12157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 01/01/2023]
Abstract
Large artery stiffening contributes to the pathophysiology of heart failure (HF) and associated comorbidities. MGP (matrix Gla-protein) is a potent inhibitor of vascular calcification. MGP activation is vitamin K-dependent. We aimed (1) to compare dp-ucMGP (dephospho-uncarboxylated MGP) levels between subjects with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) and subjects without HF; (2) to assess the relationship between dp-ucMGP levels and arterial stiffness; and (3) to assess the relationship between warfarin use, dp-ucMGP levels, and arterial stiffness in HF. We enrolled 348 subjects with HFpEF (n=96), HFrEF (n=53), or no HF (n=199). Carotid-femoral pulse wave velocity, a measure of large artery stiffness, was measured with arterial tonometry. Dp-ucMGP was measured with ELISA. Dp-ucMGP levels were greater in both HFrEF (582 pmol/L; 95% CI, 444-721 pmol/L) and HFpEF (549 pmol/L; 95% CI, 455-643 pmol/L) compared with controls (426 pmol/L; 95% CI, 377-475 pmol/L; ANCOVA P=0.0067). Levels of dp-ucMGP were positively associated with carotid-femoral pulse wave velocity (standardized β, 0.31; 95% CI, 0.19-0.42; P<0.0001), which was also true in analyses restricted to patients with HF (standardized β, 0.34; 95% CI, 0.16-0.52; P=0.0002). Warfarin use was significantly associated with carotid-femoral pulse wave velocity (standardized β, 0.13; 95% CI, 0.004-0.26; P=0.043), but this relationship was eliminated after adjustment for dp-ucMGP. In conclusion, levels of dp-ucMGP are increased in HFpEF and HFrEF and are independently associated with arterial stiffness. Future studies should investigate whether vitamin K supplementation represents a suitable therapeutic strategy to prevent or reduce arterial stiffness in HFpEF and HFrEF.
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Affiliation(s)
| | - Jonathan Lee
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Swetha Gaddam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Bilal Ansari
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Garrett Oldland
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | | | - Anique Mustafa
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Izzah Vasim
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Scott Akers
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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