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Wang S, Yao Y, Song L, Zhai Z, Li S, Wang Z, Shen L, Zhu Y, Liu W, Gao C. ROS-responsive drug-releasing injectable microgels for ameliorating myocardial infarction. Biomaterials 2024; 307:122534. [PMID: 38518589 DOI: 10.1016/j.biomaterials.2024.122534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
Despite of the recent advances in regulatory T cell (Treg) therapy, a limited number of available cells and specificity at the desired tissue site have severely compromised their efficacy. Herein, an injectable drug-releasing (MTK-TK-drug) microgel system in response to in situ stimulation by reactive oxygen species (ROS) was constructed with a coaxial capillary microfluidic system and UV curing. The spherical microgels with a size of 150 μm were obtained. The MTK-TK-drug microgels efficiently converted the pro-inflammatory Th17 cells into anti-inflammatory regulatory T cells (Treg) cells in vitro, and the ROS-scavenging materials synergistically enhanced the effect by modulating the inflammation microenvironment. Thus, the microgels significantly reduced cardiomyocyte apoptosis and decreased the inflammatory response in the early stages of post-myocardial infarction (MI) in vivo, thereby reducing fibrosis, promoting vascularization, and preserving cardiac function. Overall, our results indicate that the MTK-TK-drug microgels can attenuate the inflammatory response and improve MI therapeutic effects in vivo.
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Affiliation(s)
- Shuqin Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Yuejun Yao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Liang Song
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Zihe Zhai
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Shifen Li
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Zhaolong Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Liyin Shen
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Yang Zhu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China.
| | - Wenxing Liu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China; Center for Healthcare Materials, Shaoxing Institute, Zhejiang University, Shaoxing, 312099, China.
| | - Changyou Gao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310058, China; Center for Healthcare Materials, Shaoxing Institute, Zhejiang University, Shaoxing, 312099, China; Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou, 310058, China.
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2
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Veerapudran S, Damodaran D, Pillai VV, Natarajan G, Pillai PTK, Karunakaran J. Left ventricular mass regression after aortic valve replacement with the TTK Chitra™ monoleaflet tilting disc valve. Indian J Thorac Cardiovasc Surg 2023; 39:238-243. [PMID: 37124592 PMCID: PMC10140195 DOI: 10.1007/s12055-022-01468-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 02/09/2023] Open
Abstract
Objective To study the extent of left ventricular (LV) mass regression in aortic stenosis after aortic valve replacement with the TTK Chitra™ tilting disc valve. Methods and materials This study included patients with severe isolated aortic stenosis (AS), admitted in our department. They had aortic valve replacement (AVR) with the TTK Chitra™ tilting disc valve, between January 2008 and December 2010. Data were collected from consecutive forty-eight patients. LV mass and diametric and functional parameters were recorded preoperatively and compared with echocardiography after 3 months, 6 months, then yearly, up to 3 years. Results 70.8% of the patients were males and 29.2% were females. The mean duration of illness was 37.92 ± 25.87 months. The mean LV ejection fraction increased 3 months after surgery (61.56 ± 10.10% to 69.31 ± 9.34%) with a sustained increase for the next 3 years. The mean LV end-diastolic diameter decreased (50.16 ± 6.05 mm to 45.69 ± 5.93 mm) after 3 months of surgery, with a sustained decrease for the next 3 years. The mean LV end-systolic diameter decreased (32.84 ± 6.96 mm to 29.41 ± 5.86 mm) after 3 months of surgery and then showed a sustained decrease for the next 3 years. The LV mass assessed with echocardiography regressed from 324.65 ± 97.77 g before surgery to 252.64 ± 71.12 g after 3 months and then showed a sustained decrease over the next 3 years. Conclusion Significant LV mass regression occurred after AVR with the TTK Chitra™ valve. The maximum reversal was found to be within the first 3 months after surgery with sustained beneficial improvement for the next 3 years.
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Affiliation(s)
- Sivaprasad Veerapudran
- Department of Cardiovascular and Thoracic Surgery, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
- Trivandrum, India
| | - Deepthi Damodaran
- Department of Physiology, Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala India
| | - Vivek Velayudhan Pillai
- Department of Cardiovascular and Thoracic Surgery, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
| | - Geetha Natarajan
- Department of Physiology, Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala India
| | | | - Jayakumar Karunakaran
- Department of Cardiovascular and Thoracic Surgery, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
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Le TT, Huang W, Singh GK, Toh DF, Ewe SH, Tang HC, Loo G, Bryant JA, Ang B, Tay ELW, Soo WM, Yip JWL, Oon YY, Gong L, Lunaria JB, Yong QW, Lee EM, Yeo PSD, Chai SC, Goh PP, Ling LF, Ong HY, Richards AM, Delgado V, Bax JJ, Ding ZP, Ling LH, Chin CWL. Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis. Front Cardiovasc Med 2021; 8:750016. [PMID: 34859068 PMCID: PMC8631398 DOI: 10.3389/fcvm.2021.750016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′. Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Weiting Huang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - See Hooi Ewe
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Hak Chaw Tang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Germaine Loo
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Briana Ang
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Wern Miin Soo
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - James Wei-Luen Yip
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Kota Samarahan, Malaysia
| | - Lingli Gong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Josephien B Lunaria
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Quek Wei Yong
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Evelyn Min Lee
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Poh Shuan Daniel Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore
| | - Siang Chew Chai
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Ping Ping Goh
- Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Lee Fong Ling
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Hean Yee Ong
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Christchurch, Christchurch, New Zealand
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Zee Pin Ding
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Lieng-Hsi Ling
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
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4
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Tampe D, Schridde L, Korsten P, Ströbel P, Zeisberg M, Hakroush S, Tampe B. Different Patterns of Kidney Fibrosis Are Indicative of Injury to Distinct Renal Compartments. Cells 2021; 10:2014. [PMID: 34440782 PMCID: PMC8392296 DOI: 10.3390/cells10082014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 01/20/2023] Open
Abstract
Kidney fibrosis is a common manifestation and hallmark of a wide variety of chronic kidney disease (CKD) that appears in different morphological patterns, suggesting distinct pathogenic causes. Broad macroscopically visible scars are the sequelae of severe focal injury and complete parenchymal destruction, reflecting a wound healing response as a consequence of infarction. In the kidney, chronic glomerular injury leads to atrophy of the corresponding tubule, degeneration of this specific nephron, and finally interstitial fibrosis/tubular atrophy (IF/TA). Compared to this glomerulus-induced focal replacement scar, diffuse fibrosis independent of tubular atrophy appears to be a different pathogenic process. Kidney fibrosis appears to develop in a compartment-specific manner, but whether focal and diffuse fibrosis has distinct characteristics associated with other glomerular or tubulointerstitial lesions remains elusive. In the present study, we aimed to analyze renal fibrotic patterns related to renal lesions, which directly contribute to renal fibrogenesis, to unravel fibrotic patterns and manifestations upon damage to distinct renal compartments. Patterns of kidney fibrosis were analyzed in experimental models of CKD and various renal pathologies in correlation with histopathological and ultrastructural findings. After the induction of isolated crescentic glomerulonephritis (GN) in nephrotoxic serum-nephritis (NTN), chronic glomerular damage resulted in predominantly focal fibrosis adjacent to atrophic tubules. By contrast, using unilateral ureteral obstruction (UUO) as a model of primary injury to the tubulointerstitial compartment revealed diffuse fibrosis as the predominant pattern of chronic lesions. Finally, folic acid-induced nephropathy (FAN) as a model of primary tubular injury with consecutive tubular atrophy independent of chronic glomerular damage equally induced predominant focal IF/TA. By analyzing several renal pathologies, our data also suggest that focal and diffuse fibrosis appear to contribute as chronic lesions in the majority of human renal disease, mainly being present in antineutrophil cytoplasmic antibody (ANCA)-associated GN, lupus nephritis, and IgA nephropathy (IgAN). Focal IF/TA correlated with glomerular damage and irreversible injury to nephrons, whereas diffuse fibrosis in ANCA GN was associated explicitly with interstitial inflammation independent of glomerular damage and nephron loss. Ultrastructural analysis of focal IF/TA versus diffuse fibrosis revealed distinct matrix compositions, further supported by different collagen signatures in transcriptome datasets. With regard to long-term renal outcome, only the extent of focal IF/TA correlated with the development of end-stage kidney disease (ESKD) in ANCA GN. In contrast, diffuse kidney fibrosis did not associate with the long-term renal outcome. In conclusion, we here provide evidence that a focal pattern of kidney fibrosis seems to be associated with nephron loss and replacement scarring. In contrast, a diffuse pattern of kidney fibrosis appears to result from primary interstitial inflammation and injury.
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Affiliation(s)
- Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Laura Schridde
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Michael Zeisberg
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
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5
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Wei X, Jian X, Xie J, Chen R, Li X, Du Z, Zhong X, Li J, Zhou X, Ren G, Mei Y, Liu H. T1 mapping and feature tracking imaging of left ventricular extracellular remodeling in severe aortic stenosis. Cardiovasc Diagn Ther 2020; 10:1847-1857. [PMID: 33381429 DOI: 10.21037/cdt-20-803] [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] [Indexed: 11/06/2022]
Abstract
Background Left ventricular (LV) extracellular remodeling is a critical process in aortic stenosis (AS), which is related to functional abnormalities. Data regarding the use of combined T1 mapping and feature tracking (FT) to assess LV extracellular remodeling in severe AS are scarce. This study aimed to investigate the ability of T1-derived and FT-derived parameters to identify and assess the changes in process of LV extracellular remodeling in patients with severe AS. Methods A total of 49 patients with severe AS and 20 healthy volunteers were prospectively recruited. Modified look-locker inversion-recovery T1 mapping and FT imaging were performed in all participants using 3.0-T cardiac magnetic resonance imaging. The degree of myocardial fibrosis was quantified using Masson trichrome stain in biopsy specimens obtained intraoperatively from 13 patients and expressed as collagen volume fraction (CVF). Patients were divided into subgroups according to preserved LV ejection fraction (LVEF) (LVEF ≥50%) or reduced LVEF (LVEF <50%). Results Regarding the diffuse fibrosis burden, extracellular volume (ECV) was statistically insignificant between patients with preserved LVEF) and controls (28.0%±3.3% vs. 26.5%±2.3%, P>0.05). ECV in the reduced LVEF group (n=20) was significantly higher than that in the preserved LVEF group (n=29) (30.4%±3.9% vs. 28.0%±3.3%, P<0.05). Regarding the myocardial strain, global longitudinal strain (GLS) showed increasing impairment from the control group to the preserved LVEF AS group to the reduced LVEF AS group (-23.4%±3.3% vs. -18.6%±3.8% vs. -11.2%±4.8%, P<0.05). A significant correlation was found between ECV and CVF (r=0.64, P=0.020), whereas the correlation between GLS and CVF was insignificant. Significant correlations were observed between GLS and LV mass index (r=0.72, P=0.006) and LVEF (r=0.82, P<0.001). However, no correlations were found between ECV and LV mass index (P=0.172) and between ECV and LVEF (P=0.339). Discrimination of patients with preserved LVEF from controls, GLS yielded the best diagnostic performance as defined by the area of under the curve (-0.83), and GLS, ECV, and post-T1 were significant discriminators after regression analysis. Conclusions In the process of LV extracellular remodeling in severe AS, ECV is the structural marker of extracellular fibrosis burden, and GLS is the functional marker before the fibrosis burden intensifies.
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Affiliation(s)
- Xiaoyu Wei
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuhua Jian
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiajun Xie
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Rui Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaodan Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaomei Zhong
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinglei Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobing Zhou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guanmin Ren
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Hui Liu
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Ebenhan T, Kleynhans J, Zeevaart JR, Jeong JM, Sathekge M. Non-oncological applications of RGD-based single-photon emission tomography and positron emission tomography agents. Eur J Nucl Med Mol Imaging 2020; 48:1414-1433. [PMID: 32918574 DOI: 10.1007/s00259-020-04975-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Non-invasive imaging techniques (especially single-photon emission tomography and positron emission tomography) apply several RGD-based imaging ligands developed during a vast number of preclinical and clinical investigations. The RGD (Arg-Gly-Asp) sequence is a binding moiety for a large selection of adhesive extracellular matrix and cell surface proteins. Since the first identification of this sequence as the shortest sequence required for recognition in fibronectin during the 1980s, fundamental research regarding the molecular mechanisms of integrin action have paved the way for development of several pharmaceuticals and radiopharmaceuticals with clinical applications. Ligands recognizing RGD may be developed for use in the monitoring of these interactions (benign or pathological). Although RGD-based molecular imaging has been actively investigated for oncological purposes, their utilization towards non-oncology applications remains relatively under-exploited. METHODS AND SCOPE This review highlights the new non-oncologic applications of RGD-based tracers (with the focus on single-photon emission tomography and positron emission tomography). The focus is on the last 10 years of scientific literature (2009-2020). It is proposed that these imaging agents will be used for off-label indications that may provide options for disease monitoring where there are no approved tracers available, for instance Crohn's disease or osteoporosis. Fundamental science investigations have made progress in elucidating the involvement of integrin in various diseases not pertaining to oncology. Furthermore, RGD-based radiopharmaceuticals have been evaluated extensively for safety during clinical evaluations of various natures. CONCLUSION Clinical translation of non-oncological applications for RGD-based radiopharmaceuticals and other imaging tracers without going through time-consuming extensive development is therefore highly plausible. Graphical abstract.
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Affiliation(s)
- Thomas Ebenhan
- Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa. .,Nuclear Medicine Research Infrastructure, NPC, Pretoria, 0001, South Africa.
| | - Janke Kleynhans
- Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.,Nuclear Medicine Research Infrastructure, NPC, Pretoria, 0001, South Africa
| | - Jan Rijn Zeevaart
- Nuclear Medicine Research Infrastructure, NPC, Pretoria, 0001, South Africa.,DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, 2520, South Africa
| | - Jae Min Jeong
- Department of Nuclear Medicine, Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehangno Jongno-gu, Seoul, 110-744, South Korea
| | - Mike Sathekge
- Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
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7
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Abstract
Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the prevalence of diabetes is substantially increased in patients with aortic stenosis and those with diabetes have increased rates of progression from mild to severe aortic stenosis. There are good data supporting the hypothesis that aortic stenosis and diabetes mellitus are associated with diabetes mellitus being detrimental towards the quality of life and survival of patients. Thus, a thorough understanding of the pathogenesis of both of these disease processes and the relationship between them aids in designing appropriate preventive and therapeutic approaches. This review aims to give a comprehensive and up-to-date insight into the influence of diabetes mellitus on patients with degenerative aortic stenosis, as well as the prognosis and therapeutic approach to these patients.
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Affiliation(s)
- Marko Banovic
- 1 Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- 2 Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Lavanya Athithan
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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8
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Kwiecinski J, Chin CWL, Everett RJ, White AC, Semple S, Yeung E, Jenkins WJ, Shah ASV, Koo M, Mirsadraee S, Lang CC, Mills N, Prasad SK, Jansen MA, Japp AG, Newby DE, Dweck MR. Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 19:347-356. [PMID: 28379401 PMCID: PMC5837366 DOI: 10.1093/ehjci/jex052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Asymmetric wall thickening has been described in patients with aortic stenosis. However, it remains poorly characterized and its prognostic implications are unclear. We hypothesized this pattern of adaptation is associated with advanced remodelling, left ventricular decompenzation, and a poor prognosis. Methods and results In a prospective observational cohort study, 166 patients with aortic stenosis (age 69, 69% males, mean aortic valve area 1.0 ± 0.4 cm2) and 37 age and sex-matched healthy volunteers underwent phenotypic characterization with comprehensive clinical, imaging, and biomarker evaluation. Asymmetric wall thickening on both echocardiography and cardiovascular magnetic resonance was defined as regional wall thickening ≥ 13 mm and > 1.5-fold the thickness of the opposing myocardial segment. Although no control subject had asymmetric wall thickening, it was observed in 26% (n = 43) of patients with aortic stenosis using magnetic resonance and 17% (n = 29) using echocardiography. Despite similar demographics, co-morbidities, valve narrowing, myocardial hypertrophy, and fibrosis, patients with asymmetric wall thickening had increased cardiac troponin I and brain natriuretic peptide concentrations (both P < 0.001). Over 28 [22, 33] months of follow-up, asymmetric wall thickening was an independent predictor of aortic valve replacement (AVR) or death whether detected by magnetic resonance [hazard ratio (HR) = 2.15; 95% confidence interval (CI) 1.29-3.59; P = 0.003] or echocardiography (HR = 1.79; 95% CI 1.08-3.69; P = 0.021). Conclusion Asymmetric wall thickening is common in aortic stenosis and is associated with increased myocardial injury, left ventricular decompenzation, and adverse events. Its presence may help identify patients likely to proceed quickly towards AVR. Clinical Trial Registration https://clinicaltrials.gov/show/NCT01755936: NCT01755936.
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Affiliation(s)
- Jacek Kwiecinski
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- First Department of Cardiology, Poznan University of Medical Sciences, 1/2 Dluga, 61-848 Poznan, Poland
| | - Calvin W L Chin
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Department of Cardiovascular Science, National Heart Center Singapore
| | - Russell J Everett
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Audrey C White
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Scott Semple
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Clinical Research Imaging Centre, University of Edinburgh, UK
| | - Emily Yeung
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - William J Jenkins
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Anoop S V Shah
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Maria Koo
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Saeed Mirsadraee
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, UK
| | - Nicholas Mills
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | | | - Maurits A Jansen
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Alan G Japp
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Marc R Dweck
- BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York
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9
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Cardiac magnetic resonance imaging in myocardial inflammation in autoimmune rheumatic diseases: An appraisal of the diagnostic strengths and limitations of the Lake Louise criteria. Int J Cardiol 2018; 252:216-219. [DOI: 10.1016/j.ijcard.2017.11.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022]
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10
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Abstract
Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence. It is increasingly clear that it is also a disease of the left ventricle (LV) rather than purely the aortic valve. The transition from left ventricular hypertrophy to fibrosis results in the eventual adverse effects on systolic and diastolic function. Appropriate selection of patients for aortic valve intervention is crucial, and current guidelines recommend aortic valve replacement in severe AS with symptoms or in asymptomatic patients with left ventricular ejection fraction (LVEF) <50 %. LVEF is not a sensitive marker and there are other parameters used in multimodality imaging techniques, including longitudinal strain, exercise stress echo and cardiac MRI that may assist in detecting subclinical and subtle LV dysfunction. These findings offer potentially better ways to evaluate patients, time surgery, predict recovery and potentially offer targets for specific therapies. This article outlines the pathophysiology behind the LV response to aortic stenosis and the role of advanced multimodality imaging in describing it.
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11
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Affiliation(s)
- Calvin Woon-Loong Chin
- a Department of Cardiology , National Heart Centre Singapore , Singapore.,b Duke-NUS Medical School , Singapore
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12
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Goh VJ, Le TT, Bryant J, Wong JI, Su B, Lee CH, Pua CJ, Sim CPY, Ang B, Aw TC, Cook SA, Chin CWL. Novel Index of Maladaptive Myocardial Remodeling in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006840. [PMID: 28847911 PMCID: PMC5617557 DOI: 10.1161/circimaging.117.006840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients. METHODS AND RESULTS The RI was derived using LaPlace's Law (), and normal RI ranges were established in 180 healthy volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive patients and 10 patients with heart failure with preserved ejection fraction. Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure accounted for only 20% of the variance observed in LV mass. Although there was no association between blood pressure and myocardial fibrosis, LV mass was independently associated with fibrosis. Compared with hypertensive patients without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%), patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified myocardial response: elevated indexed LV masses (83±24 g/m2), more fibrosis (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for all). RI was similar in HTN-LVH/low RI and heart failure with preserved ejection fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). CONCLUSIONS We suggest that RI provides an approach for stratifying hypertensive patients and is suitable for testing in other disease cohorts to assess its clinical utility. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02670031.
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Affiliation(s)
- Vera J Goh
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Thu-Thao Le
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jennifer Bryant
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jia Ing Wong
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Boyang Su
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chi-Hang Lee
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chee Jian Pua
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chloe P Y Sim
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Briana Ang
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Tar Choon Aw
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Stuart A Cook
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Calvin W L Chin
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.).
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13
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Vassiliou VS, Flynn PD, Raphael CE, Newsome S, Khan T, Ali A, Halliday B, Studer Bruengger A, Malley T, Sharma P, Selvendran S, Aggarwal N, Sri A, Berry H, Donovan J, Lam W, Auger D, Cook SA, Pennell DJ, Prasad SK. Lipoprotein(a) in patients with aortic stenosis: Insights from cardiovascular magnetic resonance. PLoS One 2017; 12:e0181077. [PMID: 28704465 PMCID: PMC5509300 DOI: 10.1371/journal.pone.0181077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
Background Aortic stenosis is the most common age-related valvular pathology. Patients with aortic stenosis and myocardial fibrosis have worse outcome but the underlying mechanism is unclear. Lipoprotein(a) is associated with adverse cardiovascular risk and is elevated in patients with aortic stenosis. Although mechanistic pathways could link Lipoprotein(a) with myocardial fibrosis, whether the two are related has not been previously explored. In this study, we investigated whether elevated Lipoprotein(a) was associated with the presence of myocardial replacement fibrosis. Methods A total of 110 patients with mild, moderate and severe aortic stenosis were assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance to identify fibrosis. Mann Whitney U tests were used to assess for evidence of an association between Lp(a) and the presence or absence of myocardial fibrosis and aortic stenosis severity and compared to controls. Univariable and multivariable linear regression analysis were undertaken to identify possible predictors of Lp(a). Results Thirty-six patients (32.7%) had no LGE enhancement, 38 (34.6%) had midwall enhancement suggestive of midwall fibrosis and 36 (32.7%) patients had subendocardial myocardial fibrosis, typical of infarction. The aortic stenosis patients had higher Lp(a) values than controls, however, there was no significant difference between the Lp(a) level in mild, moderate or severe aortic stenosis. No association was observed between midwall or infarction pattern fibrosis and Lipoprotein(a), in the mild/moderate stenosis (p = 0.91) or severe stenosis patients (p = 0.42). Conclusion There is no evidence to suggest that higher Lipoprotein(a) leads to increased myocardial midwall or infarction pattern fibrosis in patients with aortic stenosis.
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Affiliation(s)
- Vassilios S. Vassiliou
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, Norwich, United Kingdom
- * E-mail: (BH); (VSV)
| | - Paul D. Flynn
- The Lipid Clinic, Addenbrooke’s Hospital, Cambridge University Foundation NHS Trust, UK and University of Cambridge, Cambridge, United Kingdom
| | - Claire E. Raphael
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Simon Newsome
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tina Khan
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Aamir Ali
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Brian Halliday
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- * E-mail: (BH); (VSV)
| | - Annina Studer Bruengger
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Clinic of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Tamir Malley
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Pranev Sharma
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Subothini Selvendran
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Nikhil Aggarwal
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Anita Sri
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Helen Berry
- Department of Biochemistry, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Jackie Donovan
- Department of Biochemistry, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Willis Lam
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Dominique Auger
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Stuart A. Cook
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
- Duke National University Hospital, Singapore, Singapore
- Cardiovascular Magnetic Resonance Imaging and Genetics, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Dudley J. Pennell
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
| | - Sanjay K. Prasad
- CMR Unit, Royal Brompton Hospital and NIHR Biomedical Research Unit, Royal Brompton and Harefield Hospitals and Imperial College London, London, United Kingdom
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14
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Zheng Q, Djohan AH, Lim E, Ding ZP, Ling LH, Shi L, Chan ESY, Chin CWL. Effects of Aortic Valve Replacement on Severe Aortic Stenosis and Preserved Systolic Function: Systematic Review and Network Meta-analysis. Sci Rep 2017; 7:5092. [PMID: 28698585 PMCID: PMC5505951 DOI: 10.1038/s41598-017-05021-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/25/2017] [Indexed: 01/01/2023] Open
Abstract
The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm2) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m2; normal-flow (NL) and low-flow (LF)]. Network meta-analysis was conducted to assess all-cause mortality among each AS sub-type with rate ratio (RR) reported. The effects of AVR on prognosis were examined using network meta-regression. In the pooled analysis (15 studies and 9,737 patients), LF states (both HG and LG) were associated with increased mortality rate (LFLG: RR 1.88; 95% CI: 1.43-2.46; LFHG: RR: 1.77; 95% CI: 1.16-2.70) compared to moderate AS; and NF states in both HG and LG had similar prognosis as moderate AS (NFLG: RR 1.11; 95% CI: 0.81-1.53; NFHG: RR 1.16; 95% CI: 0.82-1.64). AVR conferred different survival benefits: it was most effective in NFHG (RRwith AVR/RRwithout AVR: 0.43; 95% CI: 0.22-0.82) and least in LFLG (RRwith AVR/RRwithout AVR: 1.19; 95% CI: 0.74-1.94).
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Affiliation(s)
- Qishi Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore.,Cochrane Singapore, Singapore, Singapore
| | - Andie H Djohan
- Department of Internal Medicine, National University Hospital, Singapore, Singapore
| | - Enghow Lim
- Duke-NUS Medical School, Singapore, Singapore
| | - Zee Pin Ding
- Duke-NUS Medical School, Singapore, Singapore.,Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore
| | - Lieng H Ling
- Department of Cardiology, National University Heart Center, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Luming Shi
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore.,Cochrane Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Edwin Shih-Yen Chan
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore.,Cochrane Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Duke-NUS Medical School, Singapore, Singapore. .,Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore.
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15
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Musa TA, Plein S, Greenwood JP. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement. Quant Imaging Med Surg 2016; 6:259-73. [PMID: 27429910 PMCID: PMC4929281 DOI: 10.21037/qims.2016.06.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/02/2016] [Indexed: 01/20/2023]
Abstract
Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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16
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Abstract
Calcified aortic stenosis is one of the most common causes of heart failure in the elderly. Current guidelines recommend aortic valve replacement in patients with severe disease and evidence of decompensation based on either symptoms or impaired systolic ejection fraction. However, symptoms are often subjective whilst impaired ejection fraction is not a sensitive marker of ventricular decompensation. Interest has surrounded the use of cardiac biochemical markers as objective measures of left ventricular decompensation in aortic stenosis. We will first examine mechanisms of release of biochemical markers associated with myocardial wall stress (BNP/NT-proBNP), myocardial fibrosis (markers of collagen metabolism, galectin-3, soluble ST2) and myocyte death/myocardial ischemia (high-sensitivity cardiac troponins, heart-type fatty acid binding protein, myosin-binding protein C); and discuss future directions of these markers.
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Affiliation(s)
- Calvin W L Chin
- a Department of Cardiovascular Medicine , National Heart Center Singapore , Singapore .,b Duke-NUS Graduate Medical School , Singapore
| | - Andie H Djohan
- c Barts and the London School of Medicine & Dentistry, Queen Mary, University of London , London , UK , and
| | - Chim C Lang
- d Division of Cardiovascular and Diabetes Medicine , University of Dundee , Dundee , UK
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17
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Chin CWL, Messika-Zeitoun D, Shah ASV, Lefevre G, Bailleul S, Yeung ENW, Koo M, Mirsadraee S, Mathieu T, Semple SI, Mills NL, Vahanian A, Newby DE, Dweck MR. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis. Eur Heart J 2016; 37:713-23. [PMID: 26491110 PMCID: PMC4761400 DOI: 10.1093/eurheartj/ehv525] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/24/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
AIMS Midwall myocardial fibrosis on cardiovascular magnetic resonance (CMR) is a marker of early ventricular decompensation and adverse outcomes in aortic stenosis (AS). We aimed to develop and validate a novel clinical score using variables associated with midwall fibrosis. METHODS AND RESULTS One hundred forty-seven patients (peak aortic velocity (Vmax) 3.9 [3.2,4.4] m/s) underwent CMR to determine midwall fibrosis (CMR cohort). Routine clinical variables that demonstrated significant association with midwall fibrosis were included in a multivariate logistic score. We validated the prognostic value of the score in two separate outcome cohorts of asymptomatic patients (internal: n = 127, follow-up 10.3 [5.7,11.2] years; external: n = 289, follow-up 2.6 [1.6,4.5] years). Primary outcome was a composite of AS-related events (cardiovascular death, heart failure, and new angina, dyspnoea, or syncope). The final score consisted of age, sex, Vmax, high-sensitivity troponin I concentration, and electrocardiographic strain pattern [c-statistic 0.85 (95% confidence interval 0.78-0.91), P < 0.001; Hosmer-Lemeshow χ(2) = 7.33, P = 0.50]. Patients in the outcome cohorts were classified according to the sensitivity and specificity of this score (both at 98%): low risk (probability score <7%), intermediate risk (7-57%), and high risk (>57%). In the internal outcome cohort, AS-related event rates were >10-fold higher in high-risk patients compared with those at low risk (23.9 vs. 2.1 events/100 patient-years, respectively; log rank P < 0.001). Similar findings were observed in the external outcome cohort (31.6 vs. 4.6 events/100 patient-years, respectively; log rank P < 0.001). CONCLUSION We propose a clinical score that predicts adverse outcomes in asymptomatic AS patients and potentially identifies high-risk patients who may benefit from early valve replacement.
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Affiliation(s)
- Calvin W L Chin
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK National Heart Center Singapore, Singapore, Singapore
| | | | - Anoop S V Shah
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | | | - Sophie Bailleul
- Biochemistry Department, AP-HP, Tenon Hospital, Paris, France
| | - Emily N W Yeung
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Maria Koo
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Saeed Mirsadraee
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Tiffany Mathieu
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France
| | - Scott I Semple
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Alec Vahanian
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France
| | - David E Newby
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Marc R Dweck
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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19
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Chin CWL, Pawade TA, Newby DE, Dweck MR. Risk Stratification in Patients With Aortic Stenosis Using Novel Imaging Approaches. Circ Cardiovasc Imaging 2015. [PMID: 26198161 DOI: 10.1161/circimaging.115.003421] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Calvin W L Chin
- From the BHF/Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (C.W.L.C., T.A.P., D.E.N., M.R.D.); and Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore (C.W.L.C.).
| | - Tania A Pawade
- From the BHF/Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (C.W.L.C., T.A.P., D.E.N., M.R.D.); and Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore (C.W.L.C.)
| | - David E Newby
- From the BHF/Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (C.W.L.C., T.A.P., D.E.N., M.R.D.); and Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore (C.W.L.C.)
| | - Marc R Dweck
- From the BHF/Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (C.W.L.C., T.A.P., D.E.N., M.R.D.); and Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore (C.W.L.C.)
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Lee M, Choi JO, Park SJ, Kim EY, Park P, Oh JK, Jeon ES. N-terminal pro-B-type natriuretic peptide measurement is useful in predicting left ventricular hypertrophy regression after aortic valve replacement in patients with severe aortic stenosis. HEART ASIA 2015; 7:23-8. [PMID: 27326209 DOI: 10.1136/heartasia-2014-010593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The predictive factors for early left ventricular hypertrophy (LVH) regression after aortic valve replacement (AVR) have not been fully elucidated. This study was conducted to investigate which preoperative parameters predict early LVH regression after AVR. METHODS AND RESULTS 87 consecutive patients who underwent AVR due to isolated severe aortic stenosis (AS) were analysed. Patients with ejection fraction <50% or concomitant coronary artery disease were excluded from the analysis. Preoperative evaluation including echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement was performed and midterm follow-up echocardiography was done at a median of 9 months after AVR. The presence of complete regression of LVH at the midterm follow-up was determined. In multivariate analysis, including preoperative echocardiographic parameters, only E/e' ratio was associated with midterm LVH regression (OR 1.11, 95% CI 1.01 to 1.22; p=0.035). When preoperative NT-proBNP was added to the analysis, logNT-proBNP was found to be the single significant predictor of midterm LVH regression (OR 2.00, 95% CI 1.08 to 3.71; p=0.028). By receiver operating characteristic curve analysis, a cut-off value of 440 pg/mL for NT-proBNP yielded a sensitivity of 72% and a specificity of 77% for the prediction of LVH regression after AVR. CONCLUSIONS Preoperative NT-proBNP was an independent predictor for early LVH regression after AVR in patients with isolated severe AS.
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Affiliation(s)
- Mirae Lee
- Division of Cardiology , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Jin-Oh Choi
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Sung-Ji Park
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Eun Young Kim
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - PyoWon Park
- Department of Thoracic and Cardiovascular Surgery , Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Jae K Oh
- Division of Cardiovascular Diseases , Mayo Clinic College of Medicine , Rochester, Minnesota , USA
| | - Eun-Seok Jeon
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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