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Happl B, Balber T, Heffeter P, Denk C, Welch JM, Köster U, Alliot C, Bonraisin AC, Brandt M, Haddad F, Sterba JH, Kandioller W, Mitterhauser M, Hacker M, Keppler BK, Mindt TL. Synthesis and preclinical evaluation of BOLD-100 radiolabeled with ruthenium-97 and ruthenium-103. Dalton Trans 2024; 53:6031-6040. [PMID: 38470348 DOI: 10.1039/d4dt00118d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BOLD-100 (formerly IT-139, KP1339), a well-established chemotherapeutic agent, is currently being investigated in clinical trials for the treatment of gastric, pancreatic, colorectal, and bile duct cancer. Despite numerous studies, the exact mode of action is still the subject of discussions. Radiolabeled BOLD-100 could be a powerful tool to clarify pharmacokinetic pathways of the compound and to predict therapy responses in patients using nuclear molecular imaging prior to the therapy. In this study, the radiosyntheses of carrier-added (c.a.) [97/103Ru]BOLD-100 were performed with the two ruthenium isotopes ruthenium-103 (103Ru; β-, γ) and ruthenium-97 (97Ru; EC, γ), of which in particular the latter isotope is suitable for imaging by single-photon emission computed tomography (SPECT). To identify the best tumor-to-background ratio for diagnostic imaging, biodistribution studies were performed with two different injected doses of c.a. [103Ru]BOLD-100 (3 and 30 mg kg-1) in Balb/c mice bearing CT26 allografts over a time period of 72 h. Additionally, ex vivo autoradiography of the tumors (24 h p.i.) was conducted. Our results indicate that the higher injected dose (30 mg kg-1) leads to more unspecific accumulation of the compound in non-targeted tissue, which is likely due to an overload of the albumin transport system. It was also shown that lower amounts of injected c.a. [103Ru]BOLD-100 resulted in a relatively higher tumor uptake and, therefore, a better tumor-to-background ratio, which are encouraging results for future imaging studies using c.a. [97Ru]BOLD-100.
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Affiliation(s)
- B Happl
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2 and Währinger Straße 42, 1090 Vienna, Austria
| | - T Balber
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Joint Applied Medicinal Radiochemistry Facility of the University of Vienna and the Medical University of Vienna, Vienna, Austria
| | - P Heffeter
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8A, 1090 Vienna, Austria
- Research cluster "Translational Cancer Therapy Research", Währinger Straße 42, 1090 Vienna, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, Technische Universität (TU) Wien, Getreidemarkt 9, 1060 Vienna, Austria
- Center for Labelling and Isotope Production, TRIGA Center Atominstitut, TU Wien, Vienna, Austria
| | - J M Welch
- Center for Labelling and Isotope Production, TRIGA Center Atominstitut, TU Wien, Vienna, Austria
| | - U Köster
- Institut Laue-Langevin, 71 avenue des Martyrs, 38042 Grenoble Cedex 9, France
| | - C Alliot
- GIP ARRONAX, 1 rue Aronnax, CS10112, 44817, Saint-Herblain Cedex, France
- CRCI2NA, Inserm/CNRS/Nantes Université, 8 quai Moncousu, 44007, Nantes Cedex 1, France
| | - A-C Bonraisin
- GIP ARRONAX, 1 rue Aronnax, CS10112, 44817, Saint-Herblain Cedex, France
| | - M Brandt
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Joint Applied Medicinal Radiochemistry Facility of the University of Vienna and the Medical University of Vienna, Vienna, Austria
| | - F Haddad
- GIP ARRONAX, 1 rue Aronnax, CS10112, 44817, Saint-Herblain Cedex, France
- Laboratoire Subatech, UMR 6457, IMT Nantes Atlantique/CNRS-IN2P3/Nantes Université, 4 Rue A. Kastler, BP 20722, 44307, Nantes Cedex 3, France
| | - J H Sterba
- Center for Labelling and Isotope Production, TRIGA Center Atominstitut, TU Wien, Vienna, Austria
| | - W Kandioller
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2 and Währinger Straße 42, 1090 Vienna, Austria
- Research cluster "Translational Cancer Therapy Research", Währinger Straße 42, 1090 Vienna, Austria
| | - M Mitterhauser
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2 and Währinger Straße 42, 1090 Vienna, Austria
- Joint Applied Medicinal Radiochemistry Facility of the University of Vienna and the Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - B K Keppler
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2 and Währinger Straße 42, 1090 Vienna, Austria
- Research cluster "Translational Cancer Therapy Research", Währinger Straße 42, 1090 Vienna, Austria
| | - T L Mindt
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2 and Währinger Straße 42, 1090 Vienna, Austria
- Joint Applied Medicinal Radiochemistry Facility of the University of Vienna and the Medical University of Vienna, Vienna, Austria
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de la Guía-Galipienso F, Palau P, Berenguel-Senen A, Perez-Quilis C, Christle JW, Myers J, Haddad F, Baggish A, D'Ascenzi F, Lavie CJ, Lippi G, Sanchis-Gomar F. Being fit in the COVID-19 era and future epidemics prevention: Importance of cardiopulmonary exercise test in fitness evaluation. Prog Cardiovasc Dis 2024; 83:84-91. [PMID: 38452909 DOI: 10.1016/j.pcad.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
Endurance and resistance physical activity have been shown to stimulate the production of immunoglobulins and boost the levels of anti-inflammatory cytokines, natural killer cells, and neutrophils in the bloodstream, thereby strengthening the ability of the innate immune system to protect against diseases and infections. Coronavirus disease 19 (COVID-19) greatly impacted people's cardiorespiratory fitness (CRF) and health worldwide. Cardiopulmonary exercise testing (CPET) remains valuable in assessing physical condition, predicting illness severity, and guiding interventions and treatments. In this narrative review, we summarize the connections and impact of COVID-19 on CRF levels and its implications on the disease's progression, prognosis, and mortality. We also emphasize the significant contribution of CPET in both clinical evaluations of recovering COVID-19 patients and scientific investigations focused on comprehending the enduring health consequences of SARS-CoV-2 infection.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; REMA Sports Cardiology Clinic, Denia, Alicante, Spain; Ergospirometry Working Group Spanish Society of Cardiology, Madrid, Spain
| | - Patricia Palau
- Ergospirometry Working Group Spanish Society of Cardiology, Madrid, Spain; Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain
| | - Alejandro Berenguel-Senen
- Ergospirometry Working Group Spanish Society of Cardiology, Madrid, Spain; Cardiovascular Prevention and Sports Cardiology Unit, University Hospital of Toledo, Toledo, Spain
| | - Carme Perez-Quilis
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, CA, USA
| | - François Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA; Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Millington SJ, Aissaoui N, Bowcock E, Brodie D, Burns KEA, Douflé G, Haddad F, Lahm T, Piazza G, Sanchez O, Savale L, Vieillard-Baron A. High and intermediate risk pulmonary embolism in the ICU. Intensive Care Med 2024; 50:195-208. [PMID: 38112771 DOI: 10.1007/s00134-023-07275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
Pulmonary embolism (PE) is a common and important medical emergency, encountered by clinicians across all acute care specialties. PE is a relatively uncommon cause of direct admission to the intensive care unit (ICU), but these patients are at high risk of death. More commonly, patients admitted to ICU develop PE as a complication of an unrelated acute illness. This paper reviews the epidemiology, diagnosis, risk stratification, and particularly the management of PE from a critical care perspective. Issues around prevention, anticoagulation, fibrinolysis, catheter-based techniques, surgical embolectomy, and extracorporeal support are discussed.
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Affiliation(s)
- Scott J Millington
- Critical Care, The University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada
| | - Nadia Aissaoui
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre & Université Paris Cité, Paris, France
| | - Emma Bowcock
- Department of Intensive Care, Nepean Hospital, University of Sydney, Sydney, Australia
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karine E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Canada
| | - Ghislaine Douflé
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - François Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University, Stanford, CA, USA
| | - Tim Lahm
- Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | - Gregory Piazza
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Sanchez
- Service de pneumologie et soins intensifs, Hopital Européen Georges Pompidou, APHP, Paris, France
- INSERM UMR S 1140, Innovative Therapies in Hemostasis, Université Paris Cité, Paris, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Antoine Vieillard-Baron
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France.
- Inserm U1018, CESP, Universite Versailles Saint-Quentin en Yvelines, Guyancourt, France.
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Richa S, Khairallah C, Khoury E, Kassab A, Haddad F, Kerbage H, Richa N, Benmassoud D, Oussedik A, Gernay MM, El Hage W, Mercier M. Social representations of intellectual disability; a comparison between cultures. Encephale 2023; 49:466-473. [PMID: 35970643 DOI: 10.1016/j.encep.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES People with Intellectual disability consistently appear to be one of the most looked-down upon and repressed subgroups of society in many cultures. The main aim of this study was to compare social representations of intellectual disability in its various aspects between different cultures. MATERIALS AND METHODS The study was conducted in four different sites: Beirut-Lebanon, Algiers-Algeria, Tours-France and Namur-Belgium. Participants were asked to complete a questionnaire evaluating social representations of intellectual disability. RESULTS A total of 755 participants consented to take part in the study. Gender only affected social representations in the Lebanese population. Overall, Algerians appeared to have the least positive social representations and Lebanon to have more positive attitudes, while France and Belgium tended to have the most favourable representations. DISCUSSION AND CONCLUSIONS Findings highlight the imbalance between a European and a non-European country showing the importance of developing tailored interventions to improve general attitudes towards intellectual disability.
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Affiliation(s)
- S Richa
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | - C Khairallah
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | - E Khoury
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | - A Kassab
- Facuty of Medicine, Saint-Joseph University, Lebanon.
| | - F Haddad
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | - H Kerbage
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | - N Richa
- Facuty of Medicine, Saint-Joseph University, Lebanon
| | | | - A Oussedik
- Faculty of Medicine, Alger University, Algeria
| | - M-M Gernay
- Faculty of Psychology, Namur University, Namur, Belgium
| | - W El Hage
- Faculty of Medicine, Tours University, France
| | - M Mercier
- Faculty of Psychology, Namur University, Namur, Belgium
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Celestin B, Ichimura K, Sweatt A, Chun L, Haddad F. Grading Severity of Right Ventricular Dysfunction in Pulmonary Hypertension, a Mechanical Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Elmi-Sarabi M, Jarry S, Couture EJ, Haddad F, Cogan J, Sweatt AJ, Rousseau-Saine N, Beaubien-Souligny W, Fortier A, Denault AY. Pulmonary Vasodilator Response of Combined Inhaled Epoprostenol and Inhaled Milrinone in Cardiac Surgical Patients. Anesth Analg 2023; 136:282-294. [PMID: 36121254 DOI: 10.1213/ane.0000000000006192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are major complications in cardiac surgery. Intraoperative management of patients at high risk of RV failure should aim to reduce RV afterload and optimize RV filling pressures, while avoiding systemic hypotension, to facilitate weaning from cardiopulmonary bypass (CPB). Inhaled epoprostenol and inhaled milrinone (iE&iM) administered in combination before CPB may represent an effective strategy to facilitate separation from CPB and reduce requirements for intravenous inotropes during cardiac surgery. Our primary objective was to report the rate of positive pulmonary vasodilator response to iE&iM and, second, how it relates to perioperative outcomes in cardiac surgery. METHODS This is a retrospective cohort study of consecutive patients with PH or RV dysfunction undergoing on-pump cardiac surgery at the Montreal Heart Institute from July 2013 to December 2018 (n = 128). iE&iM treatment was administered using an ultrasonic mesh nebulizer before the initiation of CPB. Demographic and baseline clinical data, as well as hemodynamic, intraoperative, and echocardiographic data, were collected using electronic records. An increase of 20% in the mean arterial pressure (MAP) to mean pulmonary artery pressure (MPAP) ratio was used to indicate a positive response to iE&iM. RESULTS In this cohort, 77.3% of patients were responders to iE&iM treatment. Baseline systolic pulmonary artery pressure (SPAP) (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.24-2.16 per 5 mm Hg; P = .0006) was found to be a predictor of pulmonary vasodilator response, while a European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score >6.5% was a predictor of nonresponse to treatment (≤6.5% vs >6.5% [reference]: OR, 5.19; 95% CI, 1.84-14.66; P = .002). Severity of PH was associated with a positive response to treatment, where a higher proportion of responders had MPAP values >30 mm Hg (42.4% responders vs 24.1% nonresponders; P = .0237) and SPAP values >55 mm Hg (17.2% vs 3.4%; P = .0037). Easier separation from CPB was also associated with response to iE&iM treatment (69.7% vs 58.6%; P = .0181). A higher proportion of nonresponders had a very difficult separation from CPB and required intravenous inotropic drug support compared to responders, for whom easy separation from CPB was more frequent. Use of intravenous inotropes after CPB was lower in responders to treatment (8.1% vs 27.6%; P = .0052). CONCLUSIONS A positive pulmonary vasodilator response to treatment with a combination of iE&iM before initiation of CPB was observed in 77% of patients. Higher baseline SPAP was an independent predictor of pulmonary vasodilator response, while EuroSCORE II >6.5% was a predictor of nonresponse to treatment.
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Affiliation(s)
- Mahsa Elmi-Sarabi
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Jarry
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Etienne J Couture
- Department of Anesthesiology, Department of Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - François Haddad
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Jennifer Cogan
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California
| | - Nicolas Rousseau-Saine
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal (CHUM) and Innovation Hub, Research Centre CHUM, Montreal, Quebec, Canada
| | - Annik Fortier
- Department of Statistics, Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - André Y Denault
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Cauwenberghs N, Daubert MA, Salerno M, Haddad F, Kuznetsova T, Douglas PS. Echocardiographic diversity associated with exercise capacity in heart failure precursor stage B: the Project Baseline Health Study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The current paradigm to stage heart failure (HF) defines precursor stage B (or “pre-HF”) as having any subclinical change in cardiac structure or function. Yet, HF risk factors and type of cardiac abnormality may induce clinically relevant heterogeneity in HF stage B. Therefore, we assessed clinical and echocardiographic heterogeneity within stage B HF and its association with exercise capacity in a large community-based sample.
Methods
2071 participants to the Baseline Health Study (50.4±17.0 years, 56.2% women, 37.8% hypertensive) underwent echocardiography and physical performance testing including 6-minute walk (6MWT) and treadmill exercise test. We defined echocardiographic profiles of left and right heart remodeling and dysfunction using sex-specific internal reference values. We assessed HF stages (0-A-B-C-D) following HF societies recommendations. stage B participants were stratified according to presence/absence of HF risk factors and to the most severe echocardiographic abnormality present (reduced ejection fraction (EF), left ventricular (LV) hypertrophy/diastolic dysfunction or other abnormalities). We reported associations between physical performance metrics and HF (sub)stages.
Results
Stage B HF was present in 516 participants (24.9%). Within stage B HF, we observed a large diversity in echocardiographic profiles. Yet, stage B participants without HF risk factors (n=96, 18.6% of stage B) predominantly presented echo abnormalities other than LV diastolic dysfunction, hypertrophy and reduced EF, while their physical performance profile resembled that of people with normal echocardiography without HF risk factors. In contrast, stage B participants with HF risk factors (n=420) were characterized by LV diastolic dysfunction, hypertrophy or reduced EF, three phenotypes associated with lower 6MWT distance and lower exercise capacity. Concomitant presence of HF risk factors and LV dysfunction/hypertrophy was associated with worst physical performance.
Conclusions
We observed a wide clinical and echocardiographic diversity affecting physical performance in HF precursor stage B when defined by the current staging paradigm. Concomitant presence of HF risk factors and LV dysfunction/hypertrophy may mark individuals at highest risk for progression towards overt HF.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This research was made supported by an institutional research grant from Verily Inc. (CA, USA) and by the Research Foundation Flanders (Belgium).
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Affiliation(s)
- N Cauwenberghs
- University of Leuven, Hypertension and Cardiovascular Epidemiology , Leuven , Belgium
| | - M A Daubert
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
| | - M Salerno
- School of Medicine, Cardiovascular Institute , Stanford , United States of America
| | - F Haddad
- School of Medicine, Cardiovascular Institute , Stanford , United States of America
| | - T Kuznetsova
- University of Leuven, Hypertension and Cardiovascular Epidemiology , Leuven , Belgium
| | - P S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
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Dual SA, Verdonk C, Amsallem M, Pham J, Obasohan C, Nataf P, McElhinney DB, Arunamata A, Kuznetsova T, Zamanian R, Feinstein JA, Marsden A, Haddad F. Elucidating tricuspid Doppler signal interpolation and its implication for assessing pulmonary hypertension. Pulm Circ 2022; 12:e12125. [PMID: 36016669 PMCID: PMC9395694 DOI: 10.1002/pul2.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
Doppler echocardiography plays a central role in the assessment of pulmonary hypertension (PAH). We aim to improve quality assessment of systolic pulmonary arterial pressure (SPAP) by applying a cubic polynomial interpolation to digitized tricuspid regurgitation (TR) waveforms. Patients with PAH and advanced lung disease were divided into three cohorts: a derivation cohort (n = 44), a validation cohort (n = 71), an outlier cohort (n = 26), and a non-PAH cohort (n = 44). We digitized TR waveforms and analyzed normalized duration, skewness, kurtosis, and first and second derivatives of pressure. Cubic polynomial interpolation was applied to three physiology-driven phases: the isovolumic phase, ejection phase, and "shoulder" point phase. Coefficients of determination and a Bland-Altman analysis was used to assess bias between methods. The cubic polynomial interpolation of the TR waveform correlated strongly with expert read right ventricular systolic pressure (RVSP) with R 2 > 0.910 in the validation cohort. The biases when compared to invasive SPAP measured within 24 h were 6.03 [4.33; 7.73], -2.94 [1.47; 4.41], and -3.11 [-4.52; -1.71] mmHg, for isovolumic, ejection, and shoulder point interpolations, respectively. In the outlier cohort with more than 30% difference between echocardiographic estimates and invasive SPAP, cubic polynomial interpolation significantly reduced underestimation of RVSP. Cubic polynomial interpolation of the TR waveform based on isovolumic or early ejection phase may improve RVSP estimates.
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Affiliation(s)
- Seraina A. Dual
- Department of Cardiothoracic SurgeryStanford University School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Constance Verdonk
- Department of Medicine, Division of Cardiovascular MedicineStanford University School of MedicineStanfordCaliforniaUSA
- Department of Cardiothoracic SurgeryHospital BichatParisFrance
- INSERM U1148, Cardiovascular BioengineeringParisFrance
| | - Myriam Amsallem
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford University School of MedicineStanfordCaliforniaUSA
- KU Leuven Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular EpidemiologyUniversity of LeuvenLeuvenBelgium
| | - Jonathan Pham
- Department of PediatricsDivision of Pediatric Cardiology, Stanford University School of MedicinePalo AltoCaliforniaUSA
- Department of BioengineeringStanford University School of MedicineStanfordCaliforniaUSA
| | - Courtney Obasohan
- Department of MedicineDivision of Pulmonary and Critical Care Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Patrick Nataf
- Department of Cardiothoracic SurgeryHospital BichatParisFrance
- INSERM U1148, Cardiovascular BioengineeringParisFrance
| | - Doff B. McElhinney
- Department of Cardiothoracic SurgeryStanford University School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Alisa Arunamata
- Department of PediatricsDivision of Pediatric Cardiology, Stanford University School of MedicinePalo AltoCaliforniaUSA
| | - Tatiana Kuznetsova
- KU Leuven Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular EpidemiologyUniversity of LeuvenLeuvenBelgium
| | - Roham Zamanian
- Department of Mechanical EngineeringStanford UniversityCaliforniaStanfordUSA
- Vera Moulton Wall Center for Pulmonary Vascular Disease at StanfordStanfordCaliforniaUSA
| | - Jeffrey A. Feinstein
- Department of PediatricsDivision of Pediatric Cardiology, Stanford University School of MedicinePalo AltoCaliforniaUSA
- Department of BioengineeringStanford University School of MedicineStanfordCaliforniaUSA
- Department of Mechanical EngineeringStanford UniversityCaliforniaStanfordUSA
| | - Alison Marsden
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of PediatricsDivision of Pediatric Cardiology, Stanford University School of MedicinePalo AltoCaliforniaUSA
- Department of BioengineeringStanford University School of MedicineStanfordCaliforniaUSA
- Department of Mechanical EngineeringStanford UniversityCaliforniaStanfordUSA
| | - François Haddad
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Nassani B, Azar C, Daniel P, Haddad F, Samaha D, Maalouly G. Les survivants du syndrome catastrophique des antiphospholipides : une série de cinq cas. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Brunet D, Van SD, Masson B, Antigny F, Haddad F, Kloeckner M, Fadel E, Mercier O, Guihaire J. Left Ventricular Diastolic Dysfunction in Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Saade G, Macaeva E, Chiavassa S, Bongrand A, Koumeir C, Servagent N, Haddad F, Sterpin E, Bogaerts E, Delpon G, Supiot S, Potiron V. CALIBRATION OF THE ZEBRAFISH EMBRYO MODEL FOR RADIOTHERAPY WITH TESTING ON FLASH PROTONTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Macaeva E, Potiron V, Bogaerts E, Koumeir C, Haddad F, Haustermans K, Sterpin E. FISHING FOR THE FLASH EFFECT: DEFINING THE CRITICAL PARAMETERS TO OBSERVE THE FLASH EFFECT WITH PROTONS IN A ZEBRAFISH EMBRYO MODEL. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Dror N, Carbone J, Haddad F, Falk B, Klentrou P, Radom-Aizik S. Sclerostin and bone turnover markers response to cycling and running at the same moderate-to-vigorous exercise intensity in healthy men. J Endocrinol Invest 2022; 45:391-397. [PMID: 34390461 DOI: 10.1007/s40618-021-01659-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/02/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recreational cycling is a popular activity which stimulates and improves cardiovascular fitness. The corresponding benefits for bone are unclear. PURPOSE This study examined the effect of running (high-impact) vs. cycling (low-impact), at the same moderate-to-vigorous exercise intensity, on markers of bone formation (N-terminal propeptide of type I collagen, PINP) and bone resorption (C-telopeptide of type I collagen, CTX-1), a non-collagenous bone remodeling marker (osteocalcin), as well as bone-modulating factors, including parathyroid hormone (PTH), irisin (myokine) and sclerostin (osteokine). METHODS Thirteen healthy men (23.7 ± 1.0 y) performed two progressive exercise tests to exhaustion (peak VO2) on a cycle ergometer (CE) and on a treadmill (TM). On subsequent separate days, in randomized order, participants performed 30-min continuous running or cycling at 70% heart rate reserve (HRR). Blood was drawn before, immediately post- and 1 h into recovery. RESULTS PTH transiently increased (CE, 51.7%; TM, 50.6%) immediately after exercise in both exercise modes. Sclerostin levels increased following running only (27.7%). Irisin increased following both running and cycling. In both exercise modes, CTX-1 decreased immediately after exercise, with no significant change in PINP and osteocalcin. CONCLUSION At the same moderate-to-vigorous exercise intensity, running appears to result in a greater transient sclerostin response compared with cycling, while the responses of bone markers, PTH and irisin are similar. The longer-term implications of this differential bone response need to be further examined.
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Affiliation(s)
- N Dror
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, 101 Academy, Suite 150, Irvine, CA, 92617, USA
| | - J Carbone
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, 101 Academy, Suite 150, Irvine, CA, 92617, USA
| | - F Haddad
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, 101 Academy, Suite 150, Irvine, CA, 92617, USA
| | - B Falk
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - P Klentrou
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - S Radom-Aizik
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, 101 Academy, Suite 150, Irvine, CA, 92617, USA.
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Poirier F, Koumeir C, Blain G, Bulteau-Harel F, Bongrand A, Chiavassa S, Delpon G, Goiziou X, Guertin A, Metivier V, Potiron V, Servagent N, Villoing D, Haddad F. THE ARRONAX PLATFORM FOR PROTON FLASH IRRADIATION: FROM BEAM PRODUCTION TO THE TARGET. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Servagent N, Koumeir C, Blain G, Bongrand A, Chiavassa S, Deffet S, Delpon G, Guertin A, Lucas S, Metivier V, Mouchard Q, Poirier F, Potiron V, Schoenauen L, Sterpin E, Villoing D, Labarbe R, Rossomme S, Haddad F. FLASH Modalities Track (Oral Presentations) PROTON BEAM FLASH ONLINE MONITORING AT ARRONAX CYCLOTRON. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Verdonk C, Dual S, Amsallem M, Nataf P, Marsden A, Haddad F. A novel semi-automated method to improve estimation of right ventricular systolic pressure by Doppler ultrasound. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Cauwenberghs N, Sabovcik F, Haddad F, Kuznetsova T. Proteomic profiling for detection of early-stage heart failure in the community. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Biomarkers may provide insight into the molecular mechanisms underlying cardiac remodelling and dysfunction. Using a targeted proteomic approach, we aimed to identify circulating biomarkers associated with early-stage heart failure and extract a proteome-based risk classifier for this condition.
Methods
575 community-based participants (mean age, 57 years; 51.7% women) underwent echocardiography and proteomic profiling (CVD II panel, Olink Proteomics). We applied partial least squares-discriminant analysis (PLS-DA) and a machine learning algorithm (extreme gradient boosting, XGBoost) to identify key proteins associated with echocardiographic abnormalities. We used Gaussian Mixture modelling for unbiased clustering to construct phenogroups based on influential proteins in PLS-DA and XGBoost.
Results
Of 87 proteins, 13 were important in PLS-DA and XGBoost modelling for detection of left ventricular (LV) remodelling, LV diastolic dysfunction and/or left atrial reservoir dysfunction: placenta growth factor, kidney injury molecule-1, prostasin, angiotensin-converting enzyme-2, galectin-9, cathepsin L1, matrix metalloproteinase-7, TNFR superfamily members 10A, 10B and 11A, interleukins-6 and 16 and alpha-1-microglobulin/bikunin precursor. Based on these proteins, the clustering algorithm divided the cohort into two distinct phenogroups, with each cluster grouping individuals with a similar protein profile. Participants belonging to the second cluster (n=118) were characterized by an unfavourable cardiovascular risk profile and adverse cardiac structure and function. The adjusted risk of presenting cardiac maladaptation was higher in this phenogroup than in the other cluster (P<0.0001).
Conclusion
We identified proteins reflecting renal function, extracellular matrix remodelling, angiogenesis and inflammation to be associated with echocardiographic signs of early-stage heart failure. Focused proteomic phenomapping discriminated individuals at high risk for cardiac maladaptation in the community.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders
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Affiliation(s)
- N Cauwenberghs
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - F Sabovcik
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - T Kuznetsova
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
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18
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Sabovcik F, Miller R, Cauwenberghs N, Hoffmann R, Haddad F, Kuznetsova T. Temporal shift and accuracy of machine learning in heart transplant outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Accurate prediction of outcomes following a heart transplant is critical to explaining risks and benefits to patients and decision-making when considering potential organ offers. Given the large number of potential variables to be considered, this task may be most efficiently performed using machine learning (ML).
Purpose
We trained and tested different ML algorithms to accurately predict outcomes following a cardiac transplant using the United Network of Organ Sharing (UNOS) database.
Methods
We included 67 939 adult and pediatric patients enrolled in the UNOS database between January 1994 and December 2016 who underwent cardiac transplantation (median age 53 [IQR 38 – 60], 72.7% males). In our models, as an input, we included 114 features that have been collected from recipients and donors prior to transplant. The primary outcome was all-cause mortality at one-year post-transplant. We evaluated three different ML methods: XGBoost, Random Forest (RF) and L2 regularized logistic regression. Algorithms were trained and tested using shuffled 10-fold cross-validation (CV) as well as rolling CV. In the rolling CV, to mimic prospective procedure, ML models were trained by incrementally adding patients according to transplant year and testing models on the data in the following year. The hyperparameters, controlling the learning process, were tuned using Bayesian optimization. Prognostic accuracy for one-year all-cause mortality was characterized using the area under the receiver-operating characteristic curve (AUC).
Results
In total, 8,394 patients died within 1 year of transplant. We observed a substantial difference in prognostic accuracy between the shuffled 10-fold CV and the rolling CV. In the 10-fold CV, XGBoost and RF achieved high predictive performance with AUC of 0.848 (95% CI: 0.842–0.854) and 0.891 (95% CI: 0.886–0.896), respectively. In the rolling CV, which is a more realistic setting, AUC dropped to 0.673 (95% CI: 0.661–0.684) for XGBoost and 0.670 (0.657–0.683) for RF. Predictive performance of L2 regularized logistic regression remained stable across the two CV procedures, achieving AUC 0.669 (95% CI: 0.662–0.676) in the 10-fold shuffled CV and 0.665 (95% CI: 0.649–0.680) in the rolling CV procedure (Figure).
Conclusions
Our study suggests that ML models could be used to predict mortality in the first year post-transplant. We also show that the choice of CV procedure is crucial for evaluating ML models, particularly in data collected over a long period of time. The difference between the shuffled and rolling CV in the predictive performance of the tree-based ML models might indicate temporal dataset shift. In the rolling CV, all three methods achieved similar predictive performance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO)
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Affiliation(s)
- F Sabovcik
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - R Miller
- Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - N Cauwenberghs
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - R Hoffmann
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - F Haddad
- Stanford University, Department of Medicine, Palo Alto, United States of America
| | - T Kuznetsova
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
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19
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Cauwenberghs N, Prunicki M, Sabovcik F, Perelman D, Contrepois K, Li X, Snyder MP, Nadeau KC, Kuznetsova T, Haddad F, Gardner CD. The association of soluble ACE2 change with metabolic health, body composition and proteome dynamics during a weight loss diet intervention: implications for the COVID-19 pandemic. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Angiotensin-converting enzyme 2 (ACE2) serves protective functions in metabolic, cardiovascular, renal and pulmonary diseases and is linked to COVID-19 pathology. We explored the association between soluble AC2 (sACE2) and metabolic health and proteome dynamics during a weight loss diet intervention.
Methods
We analyzed 457 healthy individuals (mean age 39.8±6.6) with BMI 28–40 kg/m2 who participated in the Diet Intervention Examining the Factors Interacting with Treatment Success (DIETFITS). Biochemical markers of metabolic health and 236 proteins measured by Olink CVD II, CVD III and Inflammation arrays were available at baseline and 6 months following dietary intervention. We determined clinical and routine biochemical correlates of the diet-induced change in sACE2 (ΔsACE2) using stepwise linear regression. We then combined feature selection models and multivariable-adjusted linear regression to identify protein dynamics associated with ΔsACE2.
Results
sACE2 decreased significantly on average at 6-months in the diet intervention. A stronger decline in sACE2 during the diet intervention was independently associated with female sex, lower HOMA-IR and LDL cholesterol at baseline, and a stronger decline in HOMA-IR, triglycerides, HDL-cholesterol and fat mass. In line, participants with decreasing HOMA-IR and triglycerides had significantly higher odds for a decrease in sACE2 during the diet intervention than those who did not (P≤0.0073 for both). Feature selection models linked ΔsACE2 to changes in AMBP, E-selectin, HAOX1, KIM-1, MERTK, PGF, thrombomodulin and TRAIL-R2. ΔsACE2 remained independently associated with these protein changes in multivariable-adjusted linear regression.
Conclusion
Decrease in sACE2 during a weight loss diet intervention was associated with improvements in metabolic health, fat mass and markers of angiotensin peptide metabolism, vascular injury, renal function, chronic inflammation and oxidative stress. Our findings may improve the risk stratification, prevention, and management of cardiometabolic and COVID-19-related complications.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHResearch Foundation Flanders
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Affiliation(s)
- N Cauwenberghs
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - M Prunicki
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, United States of America
| | - F Sabovcik
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - D Perelman
- Stanford University, Medicine, Stanford, United States of America
| | - K Contrepois
- Stanford University School of Medicine, Genetics, Stanford, CA, United States of America
| | - X Li
- Case Western Reserve University, Center for RNA Science and Therapeutics, Cleveland, OH, United States of America
| | - M P Snyder
- Stanford University School of Medicine, Genetics, Stanford, CA, United States of America
| | - K C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, United States of America
| | - T Kuznetsova
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - C D Gardner
- Stanford Prevention Research Center, Medicine, Stanford, United States of America
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20
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Sayed N, Huang Y, Nguyen K, Krejciova-Rajaniemi Z, Grawe AP, Gao T, Tibshirani R, Hastie T, Alpert A, Cui L, Kuznetsova T, Rosenberg-Hasson Y, Ostan R, Monti D, Lehallier B, Shen-Orr SS, Maecker HT, Dekker CL, Wyss-Coray T, Franceschi C, Jojic V, Haddad F, Montoya JG, Wu JC, Davis MM, Furman D. Author Correction: An inflammatory aging clock (iAge) based on deep learning tracks multimorbidity, immunosenescence, frailty and cardiovascular aging. Nat Aging 2021; 1:748. [PMID: 37117770 DOI: 10.1038/s43587-021-00102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Nazish Sayed
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yingxiang Huang
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
| | - Khiem Nguyen
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Anissa P Grawe
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
| | - Tianxiang Gao
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Tibshirani
- Department of Statistics and Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Trevor Hastie
- Department of Statistics and Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Ayelet Alpert
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Lu Cui
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Rita Ostan
- Interdepartmental Centre L. Galvani (CIG), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daniela Monti
- Department of Experimental Clinical and Biomedical Sciences, Mario Serio, University of Florence, Florence, Italy
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Shai S Shen-Orr
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Holden T Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Cornelia L Dekker
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA
- Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, USA
- Paul F. Glenn Center for Aging Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Claudio Franceschi
- Institute of Information Technologies, Mathematics and Mechanics, Lobachevsky University, Nizhny, Russia
| | - Vladimir Jojic
- Calico Life Sciences L.L.C, South San Francisco, CA, USA
| | - François Haddad
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - José G Montoya
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark M Davis
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA
- Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - David Furman
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA.
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA.
- Edifice Health Inc., San Mateo, CA, USA.
- Austral Institute for Applied Artificial Intelligence, Institute for Research in Translational Medicine (IIMT), Universidad Austral, CONICET, Pilar, Buenos Aires, Argentina.
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21
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Sayed N, Huang Y, Nguyen K, Krejciova-Rajaniemi Z, Grawe AP, Gao T, Tibshirani R, Hastie T, Alpert A, Cui L, Kuznetsova T, Rosenberg-Hasson Y, Ostan R, Monti D, Lehallier B, Shen-Orr SS, Maecker HT, Dekker CL, Wyss-Coray T, Franceschi C, Jojic V, Haddad F, Montoya JG, Wu JC, Davis MM, Furman D. An inflammatory aging clock (iAge) based on deep learning tracks multimorbidity, immunosenescence, frailty and cardiovascular aging. ACTA ACUST UNITED AC 2021; 1:598-615. [PMID: 34888528 PMCID: PMC8654267 DOI: 10.1038/s43587-021-00082-y] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
While many diseases of aging have been linked to the immunological system, immune metrics capable of identifying the most at-risk individuals are lacking. From the blood immunome of 1,001 individuals aged 8-96 years, we developed a deep-learning method based on patterns of systemic age-related inflammation. The resulting inflammatory clock of aging (iAge) tracked with multimorbidity, immunosenescence, frailty and cardiovascular aging, and is also associated with exceptional longevity in centenarians. The strongest contributor to iAge was the chemokine CXCL9, which was involved in cardiac aging, adverse cardiac remodeling and poor vascular function. Furthermore, aging endothelial cells in human and mice show loss of function, cellular senescence and hallmark phenotypes of arterial stiffness, all of which are reversed by silencing CXCL9. In conclusion, we identify a key role of CXCL9 in age-related chronic inflammation and derive a metric for multimorbidity that can be utilized for the early detection of age-related clinical phenotypes.
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22
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Mikolajczak R, Huclier-Markai S, Alliot C, Haddad F, Szikra D, Forgacs V, Garnuszek P. Production of scandium radionuclides for theranostic applications: towards standardization of quality requirements. EJNMMI Radiopharm Chem 2021; 6:19. [PMID: 34036449 PMCID: PMC8149571 DOI: 10.1186/s41181-021-00131-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/26/2021] [Indexed: 01/23/2023] Open
Abstract
In the frame of "precision medicine", the scandium radionuclides have recently received considerable interest, providing personalised adjustment of radiation characteristics to optimize the efficiency of medical care or therapeutic benefit for particular groups of patients. Radionuclides of scandium, namely scandium-43 and scandium-44 (43/44Sc) as positron emitters and scandium-47 (47Sc), beta-radiation emitter, seem to fit ideally into the concept of theranostic pair. This paper aims to review the work on scandium isotopes production, coordination chemistry, radiolabeling, preclinical studies and the very first clinical studies. Finally, standardized procedures for scandium-based radiopharmaceuticals have been proposed as a basis to pave the way for elaboration of the Ph.Eur. monographs for perspective scandium radionuclides.
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Affiliation(s)
- R Mikolajczak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Andrzej Soltan 7, 05-400, Otwock, Poland
| | - S Huclier-Markai
- Laboratoire Subatech, UMR 6457, IMT Nantes Atlantique /CNRS-IN2P3 / Université de Nantes, 4 Rue A. Kastler, BP 20722, 44307, Nantes Cedex 3, France.
- ARRONAX GIP, 1 rue Aronnax, 44817, Nantes Cedex, France.
| | - C Alliot
- ARRONAX GIP, 1 rue Aronnax, 44817, Nantes Cedex, France
- CRCINA, Inserm / CNRS / Université de Nantes, 8 quai Moncousu, 44007, Nantes Cedex 1, France
| | - F Haddad
- Laboratoire Subatech, UMR 6457, IMT Nantes Atlantique /CNRS-IN2P3 / Université de Nantes, 4 Rue A. Kastler, BP 20722, 44307, Nantes Cedex 3, France
- ARRONAX GIP, 1 rue Aronnax, 44817, Nantes Cedex, France
| | - D Szikra
- Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Scanomed Ltd., Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - V Forgacs
- Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - P Garnuszek
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Andrzej Soltan 7, 05-400, Otwock, Poland
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Patti A, Blumberg Y, Moneghetti KJ, Neunhaeuserer D, Haddad F, Myers J, Ashley E, Christle JW. Assessing post-exercise respiratory gas kinetics in clinical sample - a pilot study. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiopulmonary exercise testing (CPX) is established in the evaluation of patients with cardiac and pulmonary diseases, and its clinical utility seems to be expanding. Currently the most important diagnostic and prognostic ventilatory metrics of CPX rely on the exercise phase. Nevertheless, a consistent body of evidence suggests that important information can be derived from the recovery phase, especially in the first few minutes after exercise. In this context, patients with heart failure (HF) demonstrate a slower recovery of the oxygen consumption (VO2) compared with healthy individuals. Purpose: To comprehensively investigate the behavior of respiratory gases during recovery from CPX in a diverse cohort of HF patients. Methods: All individuals who performed CPX at the department of cardiology of Stanford University Hospital were eligible for the study. Patients were included in the experimental group if they (i) were recorded for five minutes after the exercise phase of CPX and (ii) had documented heart failure. They were excluded if they had other clinical diagnoses which may be responsible for exercise intolerance or symptoms or were unable to give informed consent. Healthy controls were recruited from the local community and were included if they did not have documented or suspected disease. Respiratory gases were collected on a breath-by-breath basis and analysed after applying a 30 second rolling average filter. Metrics were analyzed as absolute values, percentage change from peak and the half-time of recovery (T ½; i.e. the duration until a metric had returned to ½ of its value at peak). Data was analyzed over time within patients and averages between groups using parametric statistical methods. In accordance with previous studies, the amount of change in a metric after exercise is presented as the "magnitude" of overshoot. Results: 32 patients with HF (11 Female, 47 ± 13 yrs) and 30 healthy subjects (14 Female, 43 ± 12 yrs) were included. A comparison of ventilatory metrics during recovery between HF and controls is depicted in Figure 1. Peak VO2 was 1135 ± 419 mL/min (13.5 ± 3.8 mL/Kg/min) vs 2408 ± 787 mL/min (32.5 ± 9.0 mL/Kg/min); P <0.01. A significant difference between patients with HF and healthy subjects was found in T ½ of VO2 (111.3 ± 51.0s vs 58.0 ± 13.2s, p < 0.01) and VCO2 (132.0 ± 38.8s vs 74.3 ± 21.1s, p < 0.01). The magnitude of the overshoot was also found to be significantly reduced in patients with HF for VE/VO2 (41.9 ± 29.1% vs 62.1 ± 17.7%, P < 0.01), RQ (25.0 ± 13.6% vs 38.7 ± 15.1%, p < 0.01) and PETO2 (7.2 ± 3.3% vs 10.1 ± 4.6%, p < 0.01). Finally, the magnitude of the RQ overshoot showed a moderate correlation with peak VO2 (ϱ=0.58, p < 0.01). Conclusions: We observed that ventilatory kinetics measured in early recovery after CPX differ significantly between healthy subjects and patients with HF. The assessment of post exercise respiratory gases in a clinical setting may add to the prognostic and diagnostic value of CPX in heart failure.
Abstract Figure.
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Affiliation(s)
- A Patti
- Stanford University, Palo Alto, United States of America
| | - Y Blumberg
- Bar Ilan University, The Azrieli faculty of Medicine, Ramat Gan, Israel
| | - KJ Moneghetti
- Stanford University, Palo Alto, United States of America
| | | | - F Haddad
- Stanford University, Palo Alto, United States of America
| | - J Myers
- Stanford University, Palo Alto, United States of America
| | - E Ashley
- Stanford University, Palo Alto, United States of America
| | - JW Christle
- Stanford University, Palo Alto, United States of America
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Poglajen G, Frljak S, Andročec V, Haddad F, Vrtovec B. Non-Pulsatile Flow is Associated with Lower Levels of Circulating CD34+ Cells in LVAD-Supported Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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25
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Frljak S, Poglajen G, Zemljic G, Cerar A, Haddad F, Jorde U, Vrtovec B. Papillary Muscle Viability Correlates with Changes of Functional Mitral Regurgitation in Patients with Nonischemic Dilated Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Arthur Ataam J, Mercier O, Lamrani L, Amsallem M, Arthur Ataam J, Arthur Ataam S, Guihaire J, Lecerf F, Capuano V, Ghigna MR, Haddad F, Fadel E, Eddahibi S. Retraction notice to ICAM-1 PROMOTES THE ABNORMAL ENDOTHELIAL CELL PHENOTYPE IN CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION. J Heart Lung Transplant 2021; 40:318. [PMID: 33810826 DOI: 10.1016/j.healun.2021.01.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Authors. This request follows an examination by The Editors of the uncut gels provided by the authors, which led the Editors to conclude that data were compromised in the following western blot images: Figure 3C, Figure 5B and Figure 6B. Duplicated data for the beta actin images were found in Figures 5 and 6. Examination of the raw data used for the western blot quantification also revealed frequent duplicated data. The microscopy data in Figure 5A also has features compatible with compromised data although the raw data were not available to the Editors due to the regrettable death of Dr. Saadia Eddahibi. All of the remaining authors agree with the retraction and apologize to the Editors and the readers of The Journal for difficulties this issue has caused.
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Affiliation(s)
- Jennifer Arthur Ataam
- Research and Innovation Unit; Department of Medicine, Stanford University, Stanford, California
| | - Olaf Mercier
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
| | | | - Myriam Amsallem
- Research and Innovation Unit; Department of Medicine, Stanford University, Stanford, California
| | | | | | - Julien Guihaire
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
| | | | | | - Maria Rosa Ghigna
- Research and Innovation Unit; Department of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Haddad
- Department of Medicine, Stanford University, Stanford, California
| | - Elie Fadel
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
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Kuznetsova T, Cauwenberghs N, Sabovcik F, Haddad F. Left atrial reservoir strain in relation to metabolic and inflammatory biomarkers: a community-based study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The pathophysiological mechanisms that underlie progressive left atrium (LA) remodelling and dysfunction are only partially understood. Metabolic disturbances and chronic inflammation might mediate LA dysfunction. To date, population data investigating the contribution of these processes to LA reservoir dysfunction remain scarce.
Purpose
In a large population sample, we investigated the association between LA reservoir function and a panel of 38 metabolic and inflammatory biomarkers.
Methods
In 1236 community-dwelling individuals (mean age, 51.0 years; 51.5% women), we echocardiographically assessed LA reservoir strain (LARS) using 2D speckle-tracking analysis. LA reservoir dysfunction was defined as having LARS <23%. We applied partial least squares-discriminant analysis (PLS-DA) to identify biomarkers associated with LA dysfunction. We further explored the associations between LARS and selected biomarkers that were the most influential in PLS-DA, while adjusting for important clinical correlates such as age, sex, body mass index (BMI), heart rate, systolic blood pressure (BP) and antihypertensive treatment. We applied stepwise regression to identify the clinical features and circulating biomarkers most valuable for prediction of abnormal LARS.
Results
The three latent factors constructed from the panel of 38 biomarkers during PLS-DA explained 16.9% of the variation between the normal and the impaired LA function group. The PLS-DA model discriminated between normal and abnormal LA reservoir strain with 79% accuracy (P<0.0001). In PLS-DA, serum uric acid, serum insulin, γ-glutamyl transferase, interleukin-6, D-dimer and triglycerides were the top biomarkers responsible for class discrimination. On average, these top biomarkers were higher in the LA dysfunction group as compared to their normal counterparts (P<0.0001 for all). In multivariable-adjusted continuous analyses, LARS decreased significantly with the level of serum insulin, serum uric acid and γ-glutamyl transferase (P≤0.0035 for all). Of the clinical correlates and the top biomarkers selected in PLS-DA, stepwise regression models highlighted age, BMI, systolic BP, serum insulin, serum uric acid and interleukin-6 as the main predictors of an impaired LA reservoir function (see figure). Conjointly, these clinical and biochemical features identified LA reservoir dysfunction with an overall accuracy of 85%.
Conclusions
Circulating markers of insulin resistance, hyperuricemia and chronic inflammation were independently associated with impaired LA reservoir function. These markers may help to further unravel the pathophysiological processes behind LA maladaptation and improve the management of early LA dysfunction in the community.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders
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Affiliation(s)
| | | | | | - F Haddad
- Stanford University Medical Center, Stanford, United States of America
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Cauwenberghs N, Haddad F, Sabovcik F, Kobayashi Y, Amsallem M, Morris D, Voigt J, Kuznetsova T. Subclinical left atrial dysfunction profiles for prediction of cardiac outcome in the general population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Echocardiographic screening for subclinical left atrial (LA) dysfunction might enhance the prediction of cardiac diseases such as atrial fibrillation (AFib) in the community. To date, however, outcome-driven definitions of early-stage LA dysfunction remain scarce.
Purpose
In a large population sample, we sought to extract outcome-driven thresholds for echocardiographic indexes of LA function to define subclinical left atrial (LA) dysfunction and assess the prognostic value of these echocardiographic criteria for prediction of cardiac events.
Methods
In 1306 community-dwelling individuals (mean age, 50.7 years; 51.6% women), we assessed LA function and left ventricular (LV) global longitudinal strain (LS) by echocardiography. Using receiver-operating curve threshold analysis, we derived outcome-driven cut-offs for LA emptying fraction (LAEF) and LA reservoir strain (LARS) that best balanced the cardiac event prediction (i.e. cut-offs yielding the highest Youden index (=sensitivity+specificity-1)). Next, we constructed LA dysfunction profiles and integrative LA/LV strain profiles based on the extracted cut-offs for LAEF and LARS and a validated definition of impaired LV global LS. We assessed the prognostic performance of these profiles in predicting the incidence of cardiac events and AFib (mean follow-up, 8.5 years).
Results
During follow-up, 93 participants experienced a cardiac event (8.3 events/1000 person-years) and 27 developed AFib (2.3 events/1000 person-years). LAEF<55% and LARS<23% yielded the highest Youden indexes and thus provided the most balanced prediction of incident AFib. When applying these cut-offs, abnormal LAEF and LARS were respectively present in 27.0% and 18.1% of the cohort. Abnormal LARS was independently associated with higher risk for cardiac events (hazard ratio (HR) versus normal LA phenotype: 2.11, P=0.0021). Both abnormal LAEF (HR: 2.57) and abnormal LARS (HR: 3.28) predicted incident AFib (P≤0.029). As compared to subjects free from any LA dysfunction, those with both LAEF<55% and LARS<23% had a significantly higher risk to develop cardiac events (HR: 2.10; P=0.014) and AFib (HR: 6.45; P=0.0036). Of the integrative LA/LV strain profiles, the concomitant presence of an impaired LARS and LV global LS independently elevated the risk for cardiac events (HR: 2.81; P=0.0012) and AFib (HR: 4.36, P=0.0071) as compared to normal counterparts. Both the degree of LA dysfunction and the integrative LA/LV strain profiles improved the prognostic accuracy beyond clinical risk models and risk scores.
Conclusions
We validated population-based and outcome-driven definitions of subclinical LA dysfunction predicting cardiac events independent of conventional risk factors. Echocardiographic screening for subclinical LA and LV systolic dysfunction might enhance the prediction of cardiac diseases such as AFib in the community, empowering clinicians to timely intervene with the disease development.
Prediction of cardiac events
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders, Internal Funds KU Leuven
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Affiliation(s)
- N Cauwenberghs
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - F Sabovcik
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - Y Kobayashi
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - M Amsallem
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - D.A Morris
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - J.U Voigt
- University of Leuven, Cardiology, Leuven, Belgium
| | - T Kuznetsova
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
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Abstract
BACKGROUND The left ventricular ejection fraction (LVEF) guides treatment of heart failure, yet this data has not been systematically collected in large data sets. We sought to characterize the epidemiology of incident heart failure using the initial LVEF. METHODS We identified 219 537 patients in the Veterans Affairs system between 2011 and 2017 who had an LVEF documented within 365 days before and 30 days after the heart failure diagnosis date. LVEF was obtained from natural language processing from imaging and provider notes. In multivariate analysis, we assessed characteristics associated with having an initial LVEF <40%. RESULTS Most patients were male and White; a plurality were within the 60 to 69 year age decile. A majority of patients had ischemic heart disease and a high burden of co-morbidities. Over time, presentation with an LVEF <40% became slightly less common, with a nadir in 2015. Presentation with an initial LVEF <40% was more common in younger patients, men, Black and Hispanic patients, an inpatient presentation, lower systolic blood pressure, lower pulse pressure, and higher heart rate. Ischemic heart disease, alcohol use disorder, peripheral arterial disease, and ventricular arrhythmias were associated with an initial LVEF <40%, while most other comorbid conditions (eg, atrial fibrillation, chronic obstructive pulmonary disease, malignancy) were more strongly associated with an initial LVEF >50%. CONCLUSIONS For patients with heart failure, particularly at the extremes of age, an initial preserved LVEF is common. In addition to clinical characteristics, certain races (Black and Hispanic) were more likely to present with a reduced LVEF. Further studies are needed to determine if racial differences are due to patient or health systems issues such as access to care.
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Affiliation(s)
- Rebecca L Tisdale
- Department of Medicine, Stanford University School of Medicine, CA (R.L.T., F.H., P.A.H.).,Veterans Affairs Palo Alto Health Care System, Stanford, CA (R.L.T., P.A.H.)
| | - François Haddad
- Department of Medicine, Stanford University School of Medicine, CA (R.L.T., F.H., P.A.H.)
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan (S.K.)
| | - Paul A Heidenreich
- Department of Medicine, Stanford University School of Medicine, CA (R.L.T., F.H., P.A.H.).,Veterans Affairs Palo Alto Health Care System, Stanford, CA (R.L.T., P.A.H.)
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Rézaiguia-Delclaux S, Haddad F, Pilorge C, Amsallem M, Fadel E, Stéphan F. Limitations of right ventricular annular parameters in the early postoperative period following pulmonary endarterectomy: an observational study. Interact Cardiovasc Thorac Surg 2020; 31:191-198. [PMID: 32577738 DOI: 10.1093/icvts/ivaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Echocardiographic right ventricular (RV) annular parameters are probably not as reliable to evaluate the surgical success in the postoperative period after pulmonary endarterectomy (PEA), whereas RV end-diastolic/left ventricular end-diastolic area ratio (RVEDA/LVEDA ratio) could be more useful. This study examined the relationship between RV annular parameters or RVEDA/LVEDA ratio and ideal cardiac index (ICI), before and after PEA. METHODS Among 80 patients who underwent PEA, the relationships between RVEDA/LVEDA ratio (21 patients), or tricuspid annular plane systolic excursion (32 patients), or systolic tricuspid annular velocity (55 patients) and ICI were modelled. RESULTS Forty-eight hours following PEA, mean pulmonary artery pressure decreased (26 ± 6 vs 46 ± 12 mmHg, P < 0.0001) and ICI improved (2.8 ± 0.8 vs 3.0 ± 0.9 l/min/m2, P = 0.02). In contrast to the moderate association between RV annular indices and ICI in the preoperative period, no significant relationship was found in the postoperative period (r = 0.54 and 0.17 for tricuspid annular plane systolic excursion and r = 0.46 and 0.16 for systolic tricuspid annular velocity, respectively). The RVEDA/LVEDA ratio significantly decreased postoperatively (0.97 ± 0.21 vs 1.19 ± 0.43, P = 0.002) and was correlated with ICI both in preoperative and postoperative periods (r = 0.57 and 0.57, respectively). There was a significant correlation between changes in RVEDA/LVEDA ratio and changes in total pulmonary resistance. CONCLUSIONS Improved ICI and RVEDA/LVEDA ratio reflected the surgical success of PEA and lowering of total pulmonary resistances. In contrast to the RV/left ventricular area ratio, annular RV indices associated poorly with postoperative ICI. Recognizing this limitation is important in minimizing the overdiagnosis of RV dysfunction after PEA.
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Affiliation(s)
| | - François Haddad
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Catherine Pilorge
- Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Stéphan
- Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
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31
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Choucair J, Waked R, Saliba G, Haddad F, Haddad E, Makhoul J. Discrepancy in reports of COVID-19 onset of symptoms: are faulty data being collected? Clin Microbiol Infect 2020; 26:1433-1434. [PMID: 32526276 PMCID: PMC7834183 DOI: 10.1016/j.cmi.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 01/06/2023]
Affiliation(s)
- J Choucair
- Department of Infectious Diseases, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - R Waked
- Department of Infectious Diseases, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - G Saliba
- Department of Infectious Diseases, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - F Haddad
- Department of Internal Medicine and Clinical Immunology, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E Haddad
- Department of Infectious Diseases, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - J Makhoul
- Department of Infectious Diseases, Hotel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Guihaire J, Haddad F, Mercier O. Are pressure-volume loops relevant for hemodynamic assessment during ex vivo heart perfusion? J Heart Lung Transplant 2020; 39:1165-1166. [PMID: 32418863 DOI: 10.1016/j.healun.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Julien Guihaire
- Department of Cardiac Surgery, Pulmonary Hypertension National Referral Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris, France; Research and Innovation Unit, RHU BioArt Lung 2020, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France; Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, Paris, France.
| | - François Haddad
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California; Research and Innovation Unit, RHU BioArt Lung 2020, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Olaf Mercier
- Research and Innovation Unit, RHU BioArt Lung 2020, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France; Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, Paris, France; Department of Thoracic and Vascular Surgery, Pulmonary Hypertension National Referral Center, Heart and Lung Transplantation, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris, France
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Arthur Ataam J, Amsallem M, Contrepois K, Guihaire J, Haddad F, Dorfmuller P, Fadel E, Mercier O. Targeted Angiogenesis Gene Expression Profiling of Patients with Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Amsallem M, Sweatt A, Arthur Ataam J, Mercier O, Lecerf F, Rucker-Martin C, Ghigna M, Spiekerkoetter E, Rabinovitch M, Kuznetsova T, Fadel E, Haddad F, Zamanian R. Targeted Immune and Growth Factor Proteomics of Right Heart Adaptation to Pulmonary Arterial Hypertension Reveals a Potential Role of the Hepatic Growth Factor. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Miller R, Hedman K, Vrotec B, Ingelsson E, Heidenreich P, Hiesinger W, Oyer P, Teuteberg J, Haddad F. Novel Methods for Donor and Recipient Size Matching in Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mathi K, Ataam J, Kobayashi Y, Amsallem M, Vrtovec B, Martin B, Guihaire J, Fadel E, Mercier O, Nadeau K, Maecker H, Haddad F. High Dimensional Flow Cytometry Characterization of Cardiac Allograft Vasculopathy Highlights Monocyte Activation Pathways. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Poglajen G, Frljak S, Andročec V, Haddad F, Vrtovec B. Non-Pulsatile Flow is Associated with Lower Levels of Circulating CD34+ Cells in LVAD-Supported Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Thiebaux C, Blain G, Boyer B, Delagnes E, Geerebaert Y, Gevin O, Haddad F, Koumeir C, Magniette F, Manigot P, Michel N, Poirier F, Servagent N, Sounalet T, Verderi M. 68 A new transparent beam profiler based on secondary electrons emission for hadrontherapy charged particles beams. Phys Med 2019. [DOI: 10.1016/j.ejmp.2019.09.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cauwenberghs N, Hedman K, Kobayashi Y, Haddad F, Kuznetsova T. P2488The 2013 ACC/AHA pooled cohort equations and insulin resistance status for detection of early-stage heart failure in the community. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Detection of heart failure (HF) in its subclinical phase would allow timely initiation of preventive measures that counter its pathophysiology. Here, we assessed the usefulness of traditional cardiovascular (CV) risk assessment and insulin resistance status to detect early-stage HF.
Methods
In 984 participants (mean age, 57.0 years, 52.3% women), we derived echocardiographic indexes of left ventricular (LV) structure and function and calculated the 10-year risk for a first atherosclerotic CV disease (ASCVD) using the 2013 ACC/AHA risk score. We assessed the discriminatory value of this risk score to detect LV maladaptation and the improvements in reclassification by insulin resistance status (HOMA-IR).
Results
The probability for LV maladaptation rose progressively with the 10-year ASCVD risk increasing. Participants at high 10-year ASCVD risk (>7.5%) had indeed significantly higher odds for LV concentric remodeling (odds ratio, 4.84), LV hypertrophy (OR, 5.93), abnormal LV longitudinal strain (OR, 2.04) and LV diastolic dysfunction (OR, 25.3) as compared to those at low ASCVD risk (<2.5%; P≤0.0003). Adding markers of insulin resistance to the ACC/AHA risk score moderately improved the integrated discrimination and net reclassification of all LV maladaptive phenotypes (P≤0.022) except LV diastolic dysfunction (P≥0.059). LV remodeling and abnormal LS was particularly more likely in insulin-resistant participants with a 10-year ASCVD risk between 5% and 15% than in their insulin-sensitive counterparts.
Prediction of early-stage HF profiles 2013 ACC/AHA risk score Addition of insulin resistance status to the 2013 ACC/AHA risk score AUC (95% CI) Integrated Discrimination Improvement Net Reclassification Improvement Absolute IDI (%) P value NRI (95% CI) P value LV concentric remodeling 0.70 (0.66 to 0.74) 0.0083 (11.3%) 0.022 0.23 (0.067 to 0.39) 0.0058 LV hypertrophy 0.70 (0.66 to 0.74) 0.017 (20.7%) 0.0033 0.27 (0.11 to 0.43) 0.0011 Abnormal LV LS 0.56 (0.53 to 0.62) 0.022 (202.0%) <0.0001 0.33 (0.18 to 0.49) <0.0001 LV diastolic dysfunction 0.82 (0.78 to 0.86) 0.0007 (0.45%) 0.84 0.093 (−0.11 to 0.30) 0.38 ≥2 LV abnormalities 0.76 (0.72 to 0.80) 0.0087 (7.3%) 0.071 0.22 (0.042 to 0.40) 0.016 The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) reflect the improvements in classification by adding insulin resistance (by HOMA-IR) to the 2013 ACC/AHA risk score. HOMA-IR, Homeostatic Model for Assessment of Insulin Resistance; LS, longitudinal strain; LV, left ventricular.
Risk enhancers of LV maladaptation
Conclusions
The 2013 ACC/AHA risk score adequately captured the risk for echocardiographic phenotypes of early-stage HF. As risk enhancer, insulin resistance might improve risk stratification of subclinical HF in subjects at intermediate risk.
Acknowledgement/Funding
The European Union, European Research Council and the Flanders Scientific Research Fund supported this study.
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Affiliation(s)
- N Cauwenberghs
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - K Hedman
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - Y Kobayashi
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - T Kuznetsova
- University of Leuven, Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
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Hedman K, Moneghetti KJ, Hsu D, Christle JW, Haddad F, Froelicher VF. P4419The association between ECG voltage and left-ventricular mass, sex, body size and the distance between the heart and chest wall in college athletes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ECG is widely used in pre-participation evaluation (PPE) of athletes (ATH). While it is assumed that greater than normal QRS voltages reflect physiologically increased left ventricular mass (LVM), this has not been adequately demonstrated in ATH.
Purpose
To examine the relation between QRS voltage on surface ECG and LVM and explore if the distance from the chest wall to mid-LV (CWLVdis) affects QRS voltage in ATH.
Methods
We examined digitized ECG data and echocardiograms in college ATH, obtained as part of routine PPE in years 2010–16. ECG parameters included R and S-wave voltage components of the Sokolow-Lyon (S-L) and Cornell criteria for LV hypertrophy (i.e. SV1 + RV5-V6 and RaVL + SV3, respectively). Transthoracic 2D echocardiography was used to determine LVM (area-length method) and the CWLVdis (detailed in Fig1A). S-L positive (SV1 + RV5-V6 >35 mV or RaVL >11 mV) ATH were compared to S-L negative by t-test, and univariate correlation and multivariable regression analysis was used to explore independent effects of body characteristics, sex, LVM and CWLVdis on QRS voltage.
Results
Included were 227 ATH (age 18.6±0.7 yr; 85% male; 60%/33% Caucasian/Afro-american). Of these, 66% played American football, 18% volleyball and 16% basketball.
Overall, mean LVM was 174±37 g (range 96–284 g), and BSA-indexed LVM was 78±12 g/m2 (range 49–108 g/m2). Mean CWLVdis was 8.5±1.1 cm (range 5.6–11.3 cm) and was greater in males (p<0.001, Fig1B).
Forty-six ATH (24%, all male) were S-L positive and no ATH were positive according to Cornell criteria. S-L positive ATH had lower BMI (25.3±3.5 vs 26.9±4.9, p=0.012), greater absolute LVM (189.1±31.3 vs. 170.1±37.4 g, p=0.002) and greater BSA-indexed LVM (85.3±10.3 vs. 76.6±11.7 g/m2, p<0.001) than S-L negative ATH. The CWLVdis was similar between S-L positive and negative ATH (8.4±1.2 vs. 8.6±1.1, respectively, p=0.213).
CWLVdis was more strongly correlated to body mass (r=0.73, p<0.001, Fig. 1C) than to height (r=0.34, p<0.001). LVM correlated weakly to ECG voltage as combined in the S-L or Cornell criteria (Fig. 1C). CWLVdis was weakly correlated with R in aVL, V5 and V6 (r=0.21, 0.16 and 0.16, all p<0.02).
In multivariate analysis, male sex (β=0.31), LVM (β=0.45) and body mass index (β=-0.37) were independently associated with the S-L summed voltage (R2 0.26, p<0.001). For Cornell summed voltage, only sex was an independent predictor (β=0.48, R2 0.22, p<001).
Figure 1
Conclusion
The R and S wave ECG amplitudes used in the two most common ECG criteria for LV hypertrophy were weakly related in the highest to lowest order to sex, LVM, body size and the distance from the LV to the chest wall in our college ATH.
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Affiliation(s)
- K Hedman
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - K J Moneghetti
- School of Medicine, Division of Sports Cardiology, Stanford, United States of America
| | - D Hsu
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - J W Christle
- School of Medicine, Division of Sports Cardiology, Stanford, United States of America
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - V F Froelicher
- School of Medicine, Division of Sports Cardiology, Stanford, United States of America
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41
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Kuznetsova T, Cauwenberghs N, Haddad F, Alonso-Betanzos A, Vens C. P3819Machine learning for predicting early left ventricular abnormalities in the general population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current heart failure guidelines emphasize the importance of timely detection of subclinical left ventricular (LV) remodelling and dysfunction for more precise risk stratification of asymptomatic subjects. Both LV diastolic dysfunction (LVDD) and LV hypertrophy (LVH) as assessed by echocardiography are known independent prognostic markers of future cardiovascular events in the community. However, selective screening strategies of individuals at risk who would benefit most from in-depth cardiac phenotyping are lacking.
Purpose
We assess the utility of several Machine Learning (ML) classifiers built on clinical and biochemical features for detecting subclinical LV abnormalities.
Methods
We included 1407 participants (mean age, 51 years, 51% women) randomly recruited from the general population. We used echocardiographic parameters reflecting LV diastolic function and structure to define LV abnormalities (LVDD, n=239; LVH, n=135). After that four supervised ML algorithms (Random Forest (RF), Gradient Boosting (GD), Stochastic Gradient Descent (SGD) and Support Vector Machines (SV)) were built based on routine clinical, hemodynamic and laboratory data (features; n=61) to categorize LVDD and LVH (two prediction tasks). We applied a 10-fold stratified cross-validation set-up.
Results
ML classifiers exhibited a high area under the ROC (AUC) for predicting LVDD with values between 88.5% and 93.1% (Figure, left panel). Age, BMI, different components of blood pressure, antihypertensive treatment, routine biomarkers such as serum electrolytes, creatinine, blood sugar, leptin, uric acid, lipid profile, as well as blood cell counts were the top selected features for predicting LVDD. Prediction AUC of ML algorithms for detection of LVH was somewhat lower than for LVDD and ranged from 72.5% to 78.7% (Figure, right panel). The top selected features for LVH classifier were similar to those of LVDD, but also included social class, serum gamma-glutamyl transferase, fasting insulin, plasma renin activity and cortisol.
ROC curves (sensitivity-1-specificity)
Conclusions
ML algorithms combining routinely measured clinical and laboratory data have shown high accuracy of LVDD and LVH prediction. These ML classifiers might be useful to preselect individuals at risk for further in depth echocardiographic examination, monitoring and implementation of preventive strategies in order to delay transition to disease symptoms.
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Affiliation(s)
| | | | - F Haddad
- Stanford University Medical Center, Stanford, United States of America
| | - A Alonso-Betanzos
- University of A Coruña, Department of Computer Science, A Coruña, Spain
| | - C Vens
- KU Leuven, Leuven, Belgium
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Hedman K, Cauwenberghs N, Christle JW, Tun AM, Kuznetsova T, Haddad F, Myers J. 6075Workload adjusted blood pressure response rather than peak systolic blood pressure is associated with increased all-cause mortality in males; results from 7097 treadmill exercise tests. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Systolic blood pressure (SBP) is routinely measured during exercise testing (ET) and is in part determined by cardiac output and peripheral vascular resistance. A frequently used threshold for defining hypertensive response to exercise is ≥210 mmHg but this does not account for the fact that SBP is related to workload, via cardiac output.
Purpose
To examine the prognostic implications of considering external workload (METs) adjusted SBP response to exercise.
Methods
We reviewed all symptom-limited treadmill ET in males between 1987 and 2007 at a single centre (inclusion/exclusion criteria detailed in figure 1A). SBP was measured standing at rest and at peak exercise. Workload adjusted BP response with exercise (SBP/MET slope) was calculated as ΔSBP/ΔMET. METs were calculated from peak speed and grade according to the standard American College of Sports Medicine (ACSM) formula. Age-predicted peak METs was calculated as: 18 - 0.15 × age. Ten-year Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and adjusted as outlined in figure 1B.
Results
7097 subjects were included, of which 1559 (22%) died within 10 years. Survivors were younger (57.2±10.6 y vs. 64.5±10.3 y, p<0.001) and reached higher % of age-predicted METs (97±33% vs. 82±33%, p<0.001). Survivors had higher peak SBP (181±26 vs. 176±27 mmHg, p<0.001) as well as greater ΔSBP (49±22 vs. 42±22 mmHg, p<0.001), while they had lower SBP/MET slope (7.0±4.4 vs. 8.9±6.5 mmHg/MET, p<0.001). A peak SBP ≥210 mmHg was associated with better survival; 10-yr adjusted HR: 0.76 (0.64–0.88, p<0.001). In contrast, a higher SBP/MET slope was associated with increased mortality (table 1).
Table 1. Ten year adjusted hazard ratios Variable HR (95% CI) P Variable HR (95% CI) P Variable HR (95% CI) P Peak SBP, Q1: 100–159 mmHg REF REF Delta SBP, Q1: 1–29 mmHg REF REF SBP/MET slope, Q1: 0.2–4.2 REF REF Peak SBP, Q2: 160–179 mmHg 0.81 (0.71–0.94) 0.006 Delta SBP, Q2: 30–46 mmHg 0.80 (0.70–0.91) 0.001 SBP/MET slope, Q2: 4.3–6.2 0.95 (0.81–1.12) 0.562 Peak SBP, Q3: 180–199 mmHg 0.68 (0.58–0.78) <0.001 Delta SBP, Q3: 47–61 mmHg 0.76 (0.66–0.88) <0.001 SBP/MET slope, Q3: 6.2–9.1 1.18 (1.01–1.37) 0.032 Peak SBP, Q4: ≥200 mmHg 0.60 (0.51–0.69) <0.001 Delta SBP, Q4: ≥62 mmHg 0.59 (0.50–0.69) <0.001 SBP/MET slope, Q4: ≥9.1 1.40 (1.22– 1.62) <0.001 HR, hazard ratio (adjusted according to figure 1B); SBP, systolic blood pressure; MET, metabolic equivalent of task; Q1–Q4, quartiles (Q1 as reference).
Figure 1
Conclusion
Workload adjusted blood pressure response to exercise in contrast to peak BP response was associated with increased mortality in male patients referred for ET. Of note, reaching a BP of at least 210 mmHg (suggested to define a hypertensive response to exercise) was associated with a 24% reduction in all-cause mortality.
Acknowledgement/Funding
K Hedman was supported by post-doc. grants from the Fulbright Commission, the Swedish Society of Medicine, County Council of Östergötland, Sweden
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Affiliation(s)
- K Hedman
- Stanford University, Cardiovascular Institute, Palo Alto, United States of America
| | - N Cauwenberghs
- KU Leuven, Research Unit Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - J W Christle
- School of Medicine, Division of Sports Cardiology, Stanford, United States of America
| | - A M Tun
- Veterans Affairs Palo Alto Health Care System, Division of Cardiology, Palo Alto, United States of America
| | - T Kuznetsova
- KU Leuven, Research Unit Hypertension and Cardiovascular Epidemiology, Leuven, Belgium
| | - F Haddad
- School of Medicine, Cardiovascular Institute, Stanford, United States of America
| | - J Myers
- Veterans Affairs Palo Alto Health Care System, Division of Cardiology, Palo Alto, United States of America
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Beaubien-Souligny W, Brand FZA, Lenoir M, Amsallem M, Haddad F, Denault AY. Assessment of Left Ventricular Diastolic Function by Transesophageal Echocardiography Before Cardiopulmonary Bypass: Clinical Implications of a Restrictive Profile. J Cardiothorac Vasc Anesth 2019; 33:2394-2401. [DOI: 10.1053/j.jvca.2019.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 12/23/2022]
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44
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Zermout S, Mokhtari F, Nehari A, Lasloudji I, Haddad F, Merah A. 3D Anisotropic Stress Analysis during Kyropoulos Growth of Sapphire Single Crystal. Crystal Research and Technology 2019. [DOI: 10.1002/crat.201900058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S. Zermout
- Department of Mechanical Engineering; Mouloud Mammeri University of Tizi-Ouzou; B.P.N°17 RP 15000 Tizi-Ouzou Algeria
| | - F. Mokhtari
- LTSE Laboratory; University of Science and Technology Houari Boumediene; BP 32 Elalia Bab Ezzouar 16000 Algiers Algeria
| | - A. Nehari
- Institut Lumière Matière (UMR 5306); Université de Lyon, Université Claude Bernard Lyon 1; Centre National de la Recherche Scientifique; F-69622 Villeurbanne France
| | - I. Lasloudji
- LTSE Laboratory; University of Science and Technology Houari Boumediene; BP 32 Elalia Bab Ezzouar 16000 Algiers Algeria
| | - F. Haddad
- LTSE Laboratory; University of Science and Technology Houari Boumediene; BP 32 Elalia Bab Ezzouar 16000 Algiers Algeria
| | - A. Merah
- Université M'hamed Bougara; Avenue de l'Indépendance 35000 Boumerdès Algeria
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45
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Arthur Ataam J, Mercier O, Lamrani L, Amsallem M, Arthur Ataam J, Arthur Ataam S, Guihaire J, Lecerf F, Capuano V, Ghigna MR, Haddad F, Fadel E, Eddahibi S. ICAM-1 promotes the abnormal endothelial cell phenotype in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2019; 38:982-996. [PMID: 31324443 DOI: 10.1016/j.healun.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/21/2019] [Accepted: 06/16/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pulmonary endothelial cells play a key role in the pathogenesis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Increased synthesis and/or the release of intercellular adhesion molecule-1 (ICAM-1) by pulmonary endothelial cells of patients with CTEPH has been recently reported, suggesting a potential role for ICAM-1 in CTEPH. METHODS We studied pulmonary endarterectomy specimens from 172 patients with CTEPH and pulmonary artery specimens from 97 controls undergoing lobectomy for low-stage cancer without metastasis. RESULTS ICAM-1 was overexpressed in vitro in isolated and cultured endothelial cells from endarterectomy specimens. Endothelial cell growth and apoptosis resistance were significantly higher in CTEPH specimens than in the controls (p < 0.001). Both abnormalities were abolished by pharmacological inhibition of ICAM-1 synthesis or activity. The overexpression of ICAM-1 contributed to the acquisition and maintenance of abnormal EC growth and apoptosis resistance via the phosphorylation of SRC, p38 and ERK1/2 and the overproduction of survivin. Regarding the ICAM-1 E469K polymorphism, the KE heterozygote genotype was significantly more frequent in CTEPH than in the controls, but it was not associated with disease severity among patients with CTEPH. CONCLUSIONS ICAM-1 contributes to maintaining the abnormal endothelial cell phenotype in CTEPH.
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Affiliation(s)
- Jennifer Arthur Ataam
- Research and Innovation Unit; Department of Medicine, Stanford University, Stanford, California.
| | - Olaf Mercier
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
| | | | - Myriam Amsallem
- Research and Innovation Unit; Department of Medicine, Stanford University, Stanford, California
| | | | | | - Julien Guihaire
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
| | | | | | - Maria Rosa Ghigna
- Research and Innovation Unit; Department of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Haddad
- Department of Medicine, Stanford University, Stanford, California
| | - Elie Fadel
- Research and Innovation Unit; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation
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46
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Arthur J, Amsallem M, Guihaire J, Haddad F, Lamrani L, Feuillet S, Stephan F, Jais X, Humbert M, Simonneau G, Mercier O, Fadel E. Preoperative C-Reactive Protein Predicts Early Postoperative Outcomes after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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47
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Frljak S, Jaklic M, Zemljic G, Cerar A, Poglajen G, Haddad F, Vrtovec B. Right Ventricular Dysfunction Correlates with Decreased Endothelial Progenitor Cell Mobilisation and Impaired Angiogenesis in Patients with Dilated Cardiomyopathy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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48
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Currie M, Banerjee D, Shudo Y, Lingala B, Zhu Y, Haddad F, Woo J. Comparison of Patients Undergoing Multiorgan Transplantation with or without Prior Ventricular Assist Device. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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49
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Noly PE, Piquereau J, Coblence M, Ataam JA, Guihaire J, Rucker-Martin C, Decante B, Haddad F, Fadel E, Mercier O. Right ventricular mitochondrial respiratory function in a piglet model of chronic pulmonary hypertension. J Thorac Cardiovasc Surg 2019; 159:129-140. [PMID: 30979421 DOI: 10.1016/j.jtcvs.2019.02.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/23/2019] [Accepted: 02/17/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We aimed to assess the mitochondrial respiratory capacities in the right ventricle in the setting of ventricular remodeling induced by pressure overload. METHODS Chronic thromboembolic pulmonary hypertension was induced in 8 piglets over a 12-week period (chronic thromboembolic pulmonary hypertension model). Right ventricular remodeling, right ventricular function, and mitochondrial respiratory function were assessed at 3, 6, and 12 weeks after induction of pulmonary hypertension and were compared with sham animals (n = 5). Right ventricular cardiomyocytes and mitochondrial structure were studied in transmission electronic microscopy after 12 weeks. RESULTS As of 3 weeks, chronic pressure overload induced right ventricular dilatation, right ventricular hypertrophy, and right ventricular dysfunction. Maladaptive remodeling in the chronic thromboembolic pulmonary hypertension model was confirmed by the decrease of right ventricular pulmonary artery coupling and right fractional area change. Mitochondrial functional assays in permeabilized right ventricular myocardial fibers revealed that oxidative phosphorylation capacities (complex I, complex II, and IV of the mitochondrial respiratory chain) were degraded. Furthermore, no change in substrate preference of mitochondria was found in the overloaded right ventricle. There was a good correlation between maximal mitochondrial oxygen consumption rate and right ventricular pulmonary artery coupling (Pearson coefficient r = 0.83). Transmission electronic microscopy analysis showed that the composition of cardiomyocytes was no different between the chronic thromboembolic pulmonary hypertension group and the sham group. However, mitochondrial structure anomalies were significantly increased in the chronic thromboembolic pulmonary hypertension group. CONCLUSIONS Mitochondrial respiratory function impairment is involved early in the development of right ventricular dysfunction in a piglet model of chronic thromboembolic pulmonary hypertension. Underlying mechanisms remain to be elucidated.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
| | - Jerôme Piquereau
- UMR-S 1180, INSERM, Paris Sud University, Châtenay-Malabry, France
| | - Matthieu Coblence
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Jennifer Arthur Ataam
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Julien Guihaire
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Catherine Rucker-Martin
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Benoit Decante
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Elie Fadel
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Thoracic and Vascular Surgery and Heart-lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Olaf Mercier
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Thoracic and Vascular Surgery and Heart-lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France
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50
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Vonk Noordegraaf A, Chin KM, Haddad F, Hassoun PM, Hemnes AR, Hopkins SR, Kawut SM, Langleben D, Lumens J, Naeije R. Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: an update. Eur Respir J 2019; 53:13993003.01900-2018. [PMID: 30545976 PMCID: PMC6351344 DOI: 10.1183/13993003.01900-2018] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/07/2023]
Abstract
The function of the right ventricle determines the fate of patients with pulmonary hypertension. Since right heart failure is the consequence of increased afterload, a full physiological description of the cardiopulmonary unit consisting of both the right ventricle and pulmonary vascular system is required to interpret clinical data correctly. Here, we provide such a description of the unit and its components, including the functional interactions between the right ventricle and its load. This physiological description is used to provide a framework for the interpretation of right heart catheterisation data as well as imaging data of the right ventricle obtained by echocardiography or magnetic resonance imaging. Finally, an update is provided on the latest insights in the pathobiology of right ventricular failure, including key pathways of molecular adaptation of the pressure overloaded right ventricle. Based on these outcomes, future directions for research are proposed. State of the art and research perspectives in pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension with theoretical and practical aspectshttp://ow.ly/18v830mgLiP
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Affiliation(s)
- Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kelly Marie Chin
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - François Haddad
- Division of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, CA, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Steven Mark Kawut
- Penn Cardiovascular Institute, Dept of Medicine, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Langleben
- Center for Pulmonary Vascular Disease, Cardiology Division, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Joost Lumens
- Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Université de Bordeaux, LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Bordeaux, France
| | - Robert Naeije
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium.,Laboratory of Cardiorespiratory Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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