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Mirzohreh ST, Panahi P, Zafardoust H, Zavvar M, Fathi N, Dehghan M, Sarbakhsh P. The role of polycystic ovary syndrome in preclinical left ventricular diastolic dysfunction: an echocardiographic approach: a systematic review and meta-analysis. Cardiovasc Endocrinol Metab 2023; 12:e0294. [PMID: 37900050 PMCID: PMC10611352 DOI: 10.1097/xce.0000000000000294] [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: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age, causing hormonal imbalances, reproductive issues, and metabolic disturbances. Women with PCOS have an increased risk of cardiovascular disease due to insulin resistance, obesity, and hyperandrogenism. Detecting impaired left ventricular (LV) function is important in managing this condition. Echocardiography, a non-invasive imaging technique, can effectively detect LV dysfunction. Aim The goal of this systematic review was to assess whether there are any variations in echocardiographic measures between women with PCOS and those without the condition in order to determine the potential impact of PCOS on LV function. Methods This review followed the PRISMA reporting guidelines. A thorough search of databases including PubMed, Scopus, Web of Science, and Cochrane was conducted. The quality of the selected studies was assessed using the Joanna Briggs Institute appraisal instruments. After applying strict eligibility criteria, data were extracted and organized in Microsoft Excel sheets. Review Manager (RevMan) software was used for the analysis. Results Analysis of 29 studies revealed significant differences in echocardiographic measures related to diastolic function between women with PCOS and healthy controls. However, there were no significant differences in measures of systolic function. Conclusion These findings indicate that PCOS may be linked to impaired LV function, thereby increasing the risk of cardiovascular disease. Further research is necessary to better understand this association and its clinical implications. Early detection and management of PCOS could potentially help prevent cardiovascular complications in affected women.
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Affiliation(s)
- Seyedeh-Tarlan Mirzohreh
- Student Research Committee, Tabriz University of Medical Sciences
- Cardiovascular Research Center, Shahid Madani Heart Center, Tabriz University of Medical Sciences
| | - Padideh Panahi
- Student Research Committee, Tabriz University of Medical Sciences
| | | | - Morteza Zavvar
- Student Research Committee, Tabriz University of Medical Sciences
| | - Nima Fathi
- Student Research Committee, Tabriz University of Medical Sciences
| | - Mahshid Dehghan
- Student Research Committee, Tabriz University of Medical Sciences
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Angelopoulos A, Oikonomou E, Antonopoulos AS, Theofilis P, Kalogeras K, Papanikolaou P, Lazaros G, Siasos G, Tousoulis D, Tsioufis K, Vlachopoulos C. The Role of Right Ventriculo-Arterial Coupling in Symptoms Presentation of Patients with Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:4796. [PMID: 37510912 PMCID: PMC10381822 DOI: 10.3390/jcm12144796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. The hallmark of HCM is myocardial fibrosis which contributes to heart failure, arrhythmias, and sudden cardiac death (SCD). OBJECTIVE To identify the factors implicated in heart failure symptoms and functional capacity of patients with HCM. METHODS In this cohort study, 43 patients with HCM were recruited. According to functional capacity and symptoms presentation, patients were categorized according to New York Heart Association (NYHA) classification, and echocardiographic measurements of left ventricle systolic and diastolic function were conducted. The echocardiographic assessment of right ventriculo-arterial coupling (RVAC) was made by calculating the tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP) ratio. RESULTS Almost half (51%) of our study population present symptoms of heart failure and were categorized as the symptomatic group-NYHA 2 or higher. Maximum LVOT gradient, RVSP, and the ratio of E/e' were higher in the symptomatic group compared with the asymptomatic group. TASV was lower in the symptomatic group compared with the asymptomatic group (11 ± 1 cm/s vs. 13 ± 2 cm/s, p = 0.04). However, there was no difference in other potentially influential factors, such as heart rate or systemic blood pressure. The SCD risk score does not differ between the two studied groups. The RVAC (estimated with the TASV/RVSP ratio) was lower in the symptomatic group compared with the asymptomatic group (0.32 ± 0.09 vs. 0.46 ± 0.11, p < 0.001). CONCLUSION A low RVAC (as estimated with TASV/RVSP ratio) value could represent an echocardiographic marker of right ventricular-arterial uncoupling in patients with HCM and impaired functional status.
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Affiliation(s)
- Andreas Angelopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexios S Antonopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Theofilis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Paraskevi Papanikolaou
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Lazaros
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitris Tousoulis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Charalambos Vlachopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
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Edelberg JM, Sehnert AJ, Mealiffe ME, Del Rio CL, McDowell R. The Impact of Mavacamten on the Pathophysiology of Hypertrophic Cardiomyopathy: A Narrative Review. Am J Cardiovasc Drugs 2022; 22:497-510. [PMID: 35435607 PMCID: PMC9467968 DOI: 10.1007/s40256-022-00532-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a chronic, progressive disease of the cardiomyocyte with a diverse and heterogeneous clinical presentation and course. This diversity and heterogeneity have added to the complexity of modeling the pathophysiological pathways that contribute to the disease burden. The development of novel therapeutic approaches targeting precise mechanisms within the underlying biology of HCM provides a tool to model and test these pathways. Here, we integrate the results of clinical observations with mavacamten, an allosteric, selective, and reversible inhibitor of cardiac myosin, the motor unit of the sarcomere, to develop an integrated pathophysiological pathway model of HCM, confirming the key role of excess sarcomeric activity. This model may serve as a foundation to understand the role of HCM pathophysiological pathways in the clinical presentation of the disease, and how a targeted therapeutic intervention capable of normalizing sarcomeric activity and repopulating low-energy utilization states may reduce the impact of these pathways in HCM and potentially related disease states.
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Affiliation(s)
- Jay M Edelberg
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Amy J Sehnert
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Matthew E Mealiffe
- Early Clinical Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Carlos L Del Rio
- Clinical Development, Cardiovascular Global Drug Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Robert McDowell
- Research & Early Development, MyoKardia, Inc., A Wholly Owned Subsidiary of Bristol Myers Squibb, 1000 Sierra Point Parkway, Brisbane, CA, 94005, USA.
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Chacko BR, Karur GR, Connelly KA, Yan RT, Kirpalani A, Wald R, Jimenez-Juan L, Jacob JR, Deva DP, Yan AT. Left ventricular structure and diastolic function by cardiac magnetic resonance imaging in hypertrophic cardiomyopathy. Indian Heart J 2017; 70:75-81. [PMID: 29455792 PMCID: PMC5902823 DOI: 10.1016/j.ihj.2016.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/01/2016] [Accepted: 12/28/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Diastolic dysfunction is common in hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD), but its relationships with left ventricular (LV) parameters have not been well studied. Our objective was to assess the relationship of various measures of diastolic function, and maximum left ventricular wall thickness (MLVWT) and left ventricular mass index (LVMI) in HCM, HHD and normal controls using cardiac magnetic resonance imaging (CMR). We also assessed LV parameters and diastolic function in relation to late gadolinium enhancement (LGE) and right ventricular (RV) hypertrophy in HCM. METHODS 41 patients with HCM, 21 patients with HHD and 20 controls were studied. Peak filling rate (PFR), time to peak filling (TPF), MLVWT and LVMI were measured using CMR. LGE and RV morphology were assessed in HCM patients. RESULTS MLVWT correlated with TPF in HCM (r=0.38; p=0.02), HHD (r=0.58; p=0.01) and controls (r=0.54; p=0.01); correlation between MLVWT and TPF was weaker in HCM than HHD. LVMI did not correlate with diastolic function. In HCM, LGE extent correlated with MLVWT (τ=0.41; p=0.002) and with TPF (τ=0.29; p=0.02). The HCM patients with RV hypertrophy had higher MLVWT (p<0.001) and TPF (p=0.03) than patients without RV hypertrophy. CONCLUSION MLVWT correlates with diastolic function (TPF) in HCM, HHD and controls. LVMI did not show significant correlation with TPF. The diastolic dysfunction in HCM is not entirely explained by wall thickening. LGE and RV involvement are associated with worse LV diastolic function, suggesting that these may be markers of more severe underlying myocardial disarray and fibrosis that contribute to diastolic dysfunction.
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Affiliation(s)
- Binita Riya Chacko
- Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada; Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gauri R Karur
- Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada
| | - Kim A Connelly
- Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Rachel Wald
- University of Toronto, Toronto, Canada; Division of Cardiology, Toronto General Hospital, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - John Roshan Jacob
- Department of Cardiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Djeven P Deva
- Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
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