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De Bosscher R, Dausin C, Claus P, Bogaert J, Dymarkowski S, Goetschalckx K, Ghekiere O, Van De Heyning CM, Van Herck P, Paelinck B, Addouli HE, La Gerche A, Herbots L, Willems R, Heidbuchel H, Claessen G, Claeys M, Hespel P, Dresselaers T, Miljoen H, Belmans A, Favere K, Vermeulen D, Witvrouwen I, Hansen D, Eijnde BO, Thijs D, Vanvoorden P, Van Soest S. Lifelong endurance exercise and its relation with coronary atherosclerosis. Eur Heart J 2023; 44:2388-2399. [PMID: 36881712 PMCID: PMC10327878 DOI: 10.1093/eurheartj/ehad152] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial. METHODS AND RESULTS The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. The median age was 55 (50-60) years in all groups. Lifelong and late-onset athletes had higher peak oxygen uptake than non-athletes [159 (143-177) vs. 155 (138-169) vs. 122 (108-138) % predicted]. Lifelong endurance sports was associated with having ≥1 coronary plaque [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.17-2.94], ≥ 1 proximal plaque (OR 1.96, 95% CI 1.24-3.11), ≥ 1 calcified plaques (OR 1.58, 95% CI 1.01-2.49), ≥ 1 calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), ≥ 1 non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), ≥ 1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and ≥1 mixed plaque (OR 1.78, 95% CI 1.06-2.99) as compared to a healthy non-athletic lifestyle. CONCLUSION Lifelong endurance sport participation is not associated with a more favourable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.
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Affiliation(s)
- Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christophe Dausin
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Bogaert
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steven Dymarkowski
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kaatje Goetschalckx
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Olivier Ghekiere
- Division of Radiology, Jessa Ziekenhuis, Stadsomvaat 11, 3500 Hasselt, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Caroline M Van De Heyning
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul Van Herck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Bernard Paelinck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Haroun El Addouli
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lieven Herbots
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hein Heidbuchel
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Peter Hespel
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Tom Dresselaers
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hielko Miljoen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kasper Favere
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dorien Vermeulen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Isabel Witvrouwen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dominique Hansen
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Bert Op’t Eijnde
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Daisy Thijs
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Peter Vanvoorden
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Sofie Van Soest
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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2
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Witvrouwen I, Gevaert AB, Possemiers N, Ectors B, Stoop T, Goovaerts I, Boeren E, Hens W, Beckers PJ, Vorlat A, Heidbuchel H, Van Craenenbroeck AH, Van Craenenbroeck EM. Plasma-Derived microRNAs Are Influenced by Acute and Chronic Exercise in Patients With Heart Failure With Reduced Ejection Fraction. Front Physiol 2021; 12:736494. [PMID: 34646160 PMCID: PMC8502864 DOI: 10.3389/fphys.2021.736494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Exercise training improves VO2peak in heart failure with reduced ejection fraction (HFrEF), but the effect is highly variable as it is dependent on peripheral adaptations. We evaluated changes in plasma-derived miRNAs by acute and chronic exercise to investigate whether these can mechanistically be involved in the variability of exercise-induced adaptations. Methods: Twenty-five male HFrEF patients (left ventricular ejection fraction < 40%, New York Heart Association class ≥ II) participated in a 15-week combined strength and aerobic training program. The effect of training on plasma miRNA levels was compared to 21 male age-matched sedentary HFrEF controls. Additionally, the effect of a single acute exercise bout on plasma miRNA levels was assessed. Levels of 5 miRNAs involved in pathways relevant for exercise adaptation (miR-23a, miR-140, miR-146a, miR-191, and miR-210) were quantified using RT-qPCR and correlated with cardiopulmonary exercise test (CPET), echocardiographic, vascular function, and muscle strength variables. Results: Expression levels of miR-146a decreased with training compared to controls. Acute exercise resulted in a decrease in miR-191 before, but not after training. Baseline miR-23a predicted change in VO2peak independent of age and left ventricular ejection fraction (LVEF). Baseline miR-140 was independently correlated with change in load at the respiratory compensation point and change in body mass index, and baseline miR-146a with change in left ventricular mass index. Conclusion: Plasma-derived miRNAs may reflect the underlying mechanisms of exercise-induced adaptation. In HFrEF patients, baseline miR-23a predicted VO2peak response to training. Several miRNAs were influenced by acute or repeated exercise. These findings warrant exploration in larger patient populations and further mechanistic in vitro studies on their molecular involvement.
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Affiliation(s)
- Isabel Witvrouwen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Nadine Possemiers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
| | - Bert Ectors
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Tibor Stoop
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Inge Goovaerts
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Evi Boeren
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Wendy Hens
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
| | - Paul J Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
| | - Anne Vorlat
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
| | - Amaryllis H Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
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3
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Gevaert AB, Witvrouwen I, Van Craenenbroeck AH, Van Laere SJ, Boen JRA, Van de Heyning CM, Belyavskiy E, Mueller S, Winzer E, Duvinage A, Edelmann F, Beckers PJ, Heidbuchel H, Wisløff U, Pieske B, Adams V, Halle M, Van Craenenbroeck EM. miR-181c level predicts response to exercise training in patients with heart failure and preserved ejection fraction: an analysis of the OptimEx-Clin trial. Eur J Prev Cardiol 2021; 28:1722-1733. [PMID: 34508569 DOI: 10.1093/eurjpc/zwab151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/04/2021] [Revised: 08/11/2021] [Indexed: 12/12/2022]
Abstract
AIMS In patients with heart failure with preserved ejection fraction (HFpEF), exercise training improves the quality of life and aerobic capacity (peakV·O2). Up to 55% of HF patients, however, show no increase in peakV·O2 despite adequate training. We hypothesized that circulating microRNAs (miRNAs) can distinguish exercise low responders (LR) from exercise high responders (HR) among HFpEF patients. METHODS AND RESULTS We selected HFpEF patients from the Optimizing Exercise Training in Prevention and Treatment of Diastolic HF (OptimEx) study which attended ≥70% of training sessions during 3 months (n = 51). Patients were defined as HR with a change in peakV·O2 above median (6.4%), and LR as below median (n = 30 and n = 21, respectively). Clinical, ergospirometric, and echocardiographic characteristics were similar between LR and HR. We performed an miRNA array (n = 377 miRNAs) in 14 age- and sex-matched patients. A total of 10 miRNAs were upregulated in LR, of which 4 correlated with peakV·O2. Validation in the remaining 37 patients indicated that high miR-181c predicted reduced peakV·O2 response (multiple linear regression, β = -2.60, P = 0.011), and LR status (multiple logistic regression, odds ratio = 0.48, P = 0.010), independent of age, sex, body mass index, and resting heart rate. Furthermore, miR-181c decreased in LR after exercise training (P-group = 0.030, P-time = 0.048, P-interaction = 0.037). An in silico pathway analysis identified several downstream targets involved in exercise adaptation. CONCLUSIONS Circulating miR-181c is a marker of the response to exercise training in HFpEF patients. High miR-181c levels can aid in identifying LR prior to training, providing the possibility for individualized management.
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Affiliation(s)
- Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Isabel Witvrouwen
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Amaryllis H Van Craenenbroeck
- Research Group Nephrology and Renal Transplantation, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Steven J Van Laere
- Translational Cancer Research Unit, Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Jente R A Boen
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Research Group Physiopharmacology, GENCOR Department, University of Antwerp, Antwerp, Belgium
| | - Caroline M Van de Heyning
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Ephraim Winzer
- Heart Center Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - André Duvinage
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Paul J Beckers
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ulrik Wisløff
- Cardiac Exercise Research Group at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Volker Adams
- Heart Center Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
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Faes E, Mannaerts D, Witvrouwen I, Van Berendoncks A, Jacquemyn Y, Van Craenenbroeck EM. Assessment of vascular function in formerly pre-eclamptic women as a novel marker of future cardiovascular risk. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.392] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Women with a history of pre-eclampsia (PE) are at increased risk of cardiovascular disease (CVD). The association between PE and CVD in later life may be explained by vascular dysfunction, either pre-existing or elicited by PE. Several small studies have shown that vascular dysfunction may persist for years in some patients, indicator of future CVD risk, while other studies could not confirm these findings.
Purpose
In this longitudinal prospective cohort study, we aim to comprehensively assess vascular function in previously pre-eclamptic women (early (<34 weeks) and late (>34 weeks)) and healthy controls. We hypothesize that vascular dysfunction is both more persistent and pronounced in early PE compared to late PE since different pathophysiologic mechanisms underlie both subtypes of PE.
Methods
For this first analysis, 63 PE patients were compared to 16 non-pregnant healthy controls. Endothelial function was determined by flow-mediated dilatation (FMD), modified FMD (mFMD) and low-flow mediated constriction (L-FMC). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) and augmentation index using pulse wave analysis of the brachial artery, and corrected for heart-rate (Aix75).
Results
Average post-partum period was 11 months (1.4-111.5 months). Thirty-five presented with early PE, 28 with late PE.
In the total PE group, FMD was significantly decreased compared to healthy controls (7.1 ± 2.8 vs 8.9 ± 3.8; p = 0.037), but no difference between early and late PE was observed. Likewise, Aix75 remained elevated after PE (16.5 ± 11.5 vs 5.8 ± 10.1; p < 0.001), again, without difference between early and late PE. cfPWV was not different after PE compared to healthy controls (p > 0.05) but was significantly higher in the early PE group compared to the late PE group (6.9 ± 1.0 vs 6.4 ± 1.0; p = 0.045).
Conclusion
Even in the postpartum, PE is characterized by overt and persisting endothelial dysfunction and arterial stiffness. Arterial stiffness is more pronounced in early PE compared to late PE.
This reaffirms that PE has consequences beyond placental impairment and that the persisting vascular impairment in the postpartum could reflect the risk of CVD later in life.
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Affiliation(s)
- E Faes
- University Hospital Antwerp, Antwerp, Belgium
| | - D Mannaerts
- University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Y Jacquemyn
- University Hospital Antwerp, Antwerp, Belgium
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5
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Witvrouwen I, Gevaert AB, Possemiers N, Beckers PJ, Vorlat A, Heidbuchel H, Van Laere SJ, Van Craenenbroeck AH, Van Craenenbroeck EM. Circulating microRNA as predictors for exercise response in heart failure with reduced ejection fraction. Eur J Prev Cardiol 2021; 28:1673-1681. [PMID: 33742210 DOI: 10.1093/eurjpc/zwaa142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/27/2020] [Revised: 10/26/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
AIMS Exercise training is a powerful adjunctive therapy in patients with heart failure with reduced ejection fraction (HFrEF), but ca. 55% of patients fail to improve VO2peak. We hypothesize that circulating microRNAs (miRNAs), as epigenetic determinants of VO2peak, can distinguish exercise responders (ER) from exercise non-responders (ENR). METHODS AND RESULTS We analysed 377 miRNAs in 18 male HFrEF patients (9 ER and 9 ENR) prior to 15 weeks of exercise training using a miRNA array. ER and ENR were defined as change in VO2peak of >20% or <6%, respectively. First, unsupervised clustering analysis of the miRNA pattern was performed. Second, differential expression of miRNA in ER and ENR was analysed and related to percent change in VO2peak. Third, a gene set enrichment analysis was conducted to detect targeted genes and pathways. Baseline characteristics and training volume were similar between ER and ENR. Unsupervised clustering analysis of miRNAs distinguished ER from ENR with 83% accuracy. A total of 57 miRNAs were differentially expressed in ENR vs. ER. A panel of seven miRNAs up-regulated in ENR (Let-7b, miR-23a, miR-140, miR-146a, miR-191, miR-210, and miR-339-5p) correlated with %changeVO2peak (all P < 0.05) and predicted ENR with area under the receiver operating characteristic curves ≥0.77. Multiple pathways involved in exercise adaptation processes were identified. CONCLUSION A fingerprint of seven miRNAs involved in exercise adaptation processes is highly correlated with VO2peak trainability in HFrEF, which holds promise for the prediction of training response and patient-targeted exercise prescription.
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Affiliation(s)
- Isabel Witvrouwen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Nadine Possemiers
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul J Beckers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Anne Vorlat
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Steven J Van Laere
- Translational Cancer Research Unit, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Amaryllis H Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Nephrology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital Drie Eikenstraat 655, 2650 Edegem, Belgium
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6
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Favere K, Bosman M, Delputte PL, Favoreel HW, Van Craenenbroeck EM, De Sutter J, Witvrouwen I, De Meyer GRY, Heidbuchel H, Guns PJDF. A systematic literature review on the effects of exercise on human Toll-like receptor expression. Exerc Immunol Rev 2021; 27:84-124. [PMID: 33965901] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Toll-like receptors (TLRs) are a family of transmembrane pattern recognition receptors that are mainly expressed on immune cells. Recognition of various exogenous and endogenous molecular patterns activates the TLR signalling cascade, which orchestrates an inflammatory immune response. Dysfunctional immune responses, including aberrant TLR signalling, are increasingly implicated in the associations between sedentarism, chronic low-grade systemic inflammation and various non-communicable diseases. Conversely, exercise exerts anti-inflammatory effects, which could be conferred through its immunomodulatory properties, potentially affecting TLRs. This study aims to systematically review the effects of exercise on human TLR expression. METHOD A systematic literature search of Pubmed, Embase, The Cochrane Library and SPORTDiscus for articles addressing the impact of exercise (as isolated intervention) on TLRs in humans was conducted, ending in February 2020. RESULTS A total of 66 articles were included. The publications were categorised according to exercise modality and duration: acute resistance exercise (4 studies), acute aerobic exercise (26 studies), resistance training program (9 studies), aerobic training program (16 studies), combined (i.e. resistance and aerobic) training program (8 studies) and chronic exercise not otherwise classifiable (9 studies). Five articles investigated more than one of the aforementioned exercise categories. Several trends could be discerned with regard to the TLR response in the different exercise categories. Acute resistance exercise seemed to elicit TLR upregulation, whereas acute aerobic exercise had less activating potential with the majority of responses being neutral or, especially in healthy participants, downregulatory. Chronic resistance and combined exercise programs predominantly resulted in unaltered or decreased TLR levels. In the chronic aerobic exercise category, mixed effects were observed, but the majority of measurements demonstrated unchanged TLR expression. CONCLUSION Currently published research supports an interplay between exercise and TLR signalling, which seems to depend on the characteristics of the exercise. However, there was large heterogeneity in the study designs and methodologies. Therefore, additional research is required to further corroborate these findings, to define its pathophysiological implications and to elucidate the mechanism(s) linking exercise to TLR signalling.
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Affiliation(s)
- Kasper Favere
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
- Department of Internal Medicine, Ghent University, Belgium
| | - Matthias Bosman
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, Belgium
| | - Peter L Delputte
- Laboratory of Microbiology, Parasitology and Hygiene, University of Antwerp, Belgium
| | - Herman W Favoreel
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
| | | | - Isabel Witvrouwen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
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7
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Witvrouwen I, Boeren E, Possemiers N, Hens W, Beckers P, Heidbuchel H, Van Craenenbroeck A, Van Craenenbroeck E. The effect of an acute exercise bout on plasme miRNA and its relation with cardiovascular adaptation to exercise training in heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1074] [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
Exercise training (ET) improves aerobic capacity (VO2peak) in heart failure with reduced ejection fraction (HFrEF), but the individual response is highly variable. Underlying mechanisms of this variability are still not fully elucidated yet. Specific miRNA might be involved in cardiovascular adaptation to exercise, as changes in miRNA levels with repetitive acute exercise bouts have been described. miR-23a, -140, -146a, -191 and -210 have been related to aerobic capacity, endothelial function and angiogenesis.
Purpose
First, to evaluate if vascular function-associated miRNAs are related to vascular function and aerobic capacity in HFrEF patients. Second, to evaluate the effect of a single exercise bout on the miR profile. Third, to evaluate if miRNA changes in response to acute exercise are related to aerobic and vascular response to training.
Methods
Plasma levels of miR-23a, -140, -146a, -191 and -210 were analyzed using RT-qPCR in 24 HFrEF patients, before and immediately after a cardiopulmonary exercise test (CPET) and repeated after 15 weeks of ET. At baseline and after 15 weeks, VO2peak, flow-mediated dilation (FMD), pulsed wave velocity (PWV) and heart rate-corrected augmentation index (Aix@75) were recorded.
Results
In this prospective study, 24 HFrEF patients were included. Mean age was 56.9±12.9 years, mean left ventricular ejection fraction 31.7±7.0% and median adherence to ET was 41 sessions (30–43).
Mean percent change in VO2peak was 2.86% (±13.5), in Aix@75 −9.8% (±80.9), in FMD 79.1% (±223.7) and in PWV −3.1% (±11.2), however these changes were not significant compared to baseline (p>0.05).
At baseline, none of the miRNA were correlated with percent change in VO2peak (all p>0.05), however, miR-140 showed a trend towards correlation (r=−0.385, p=0.063). miR-191was significantly correlated with Aix@75 at baseline and after 15 weeks (respectively r=0.588, p=0.013 and r=0.609, p=0.006) and miR-23a was significantly correlated with FMD at baseline and showed a trend at 15 weeks (respectively r=0.462, p=0.040 and r=0.417, p=0.076). An acute exercise bout resulted in a significant decrease of miR-191 (1.82 before and 1.58 after CPET; 14% decrease, p=0.043). This change was significantly correlated with percent change in Aix@75 (r=−0.730, p=0.005) after ET. In a linear regression model adjusted for age, change in miR-191 significantly predicted percent change in Aix@75 (B=−84.5, p=0.043).
Conclusion
In HFrEF patients, plasma levels of miR-191 significantly decrease in response to an acute exercise bout. Baseline levels of vascular function-associated miRNAs were correlated with arterial stiffness and endothelial function before and after exercise training, which may suggest that these miRNAs are implicated in the vascular adaptations due to repetitive acute exercise bouts. However, these findings need to be validated in larger cohorts.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fund for scientific research-Flanders (FWO)
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Affiliation(s)
| | - E Boeren
- University of Antwerp, Antwerp, Belgium
| | | | - W Hens
- University of Antwerp, Antwerp, Belgium
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Witvrouwen I, Mannaerts D, Van Berendoncks AM, Jacquemyn Y, Van Craenenbroeck EM. The Effect of Exercise Training During Pregnancy to Improve Maternal Vascular Health: Focus on Gestational Hypertensive Disorders. Front Physiol 2020; 11:450. [PMID: 32457655 PMCID: PMC7225346 DOI: 10.3389/fphys.2020.00450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/03/2020] [Accepted: 04/09/2020] [Indexed: 12/22/2022] Open
Abstract
Hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia, occur in up to 10% of pregnancies and are associated with increased life-long cardiovascular risk. Physical activity improves cardiovascular health in pregnancy and may lower the risk of developing hypertensive disorders of pregnancy. However, a minority of pregnant women comply with the recommended level of physical activity. Adequate knowledge on the physiological effects of exercise in healthy pregnancy could help to overcome potential barriers as pregnancy is a unique window of opportunity to improve health outcomes for both mother and child. In this mini review, we discuss structural and functional vascular adaptations during healthy and hypertensive pregnancies, we elaborate on the effects of exercise on the vasculature and review the safety and existing evidence of exercise training as preventive therapy for gestational hypertensive disorders.
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Affiliation(s)
- Isabel Witvrouwen
- Research Group Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Dominique Mannaerts
- Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium
| | - An M Van Berendoncks
- Research Group Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Yves Jacquemyn
- Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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Witvrouwen I, Van Craenenbroeck EM, Abreu A, Moholdt T, Kränkel N. Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective. Eur J Prev Cardiol 2019; 28:779-790. [PMID: 30889981 DOI: 10.1177/2047487319838221] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 12/15/2018] [Accepted: 02/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation has a class 1A recommendation in coronary artery disease and heart failure based on its beneficial effects on mortality, morbidity and quality of life. However, the inter-individual response to exercise training is highly variable and influenced by both training and patient characteristics. Notably, men and women display a different training response, even when accounting for age, height and lean muscle mass. Most studies investigating exercise effects on various physiological outcomes focus on male patients. Because women are understudied, the scientific evidence for tailored exercise prescription in women is still limited. METHODS This narrative review summarises: (a) the underlying physiological determinants of the response to exercise training in women with cardiovascular disease, in which women rely more on fat than on carbohydrate oxidation during exercise, have lower aerobic capacities and smaller increases in cardiac function during exercise; (b) the benefits and barriers of exercise in women, in whom improving cardiometabolic risk and quality of life is weighed against socioeconomic and psychological needs; and (c) the relevance of different clinical endpoints in exercise trials such as maximum oxygen uptake, morbidity, mortality, training characteristics, quality of life and metabolic or vascular endpoints. RESULTS Finally, we provide a perspective on how to improve referral, enrolment and adherence to exercise training in women, with structured approaches to inform the referring physician as well as the patient, and offering more flexible, gender-tailored or tele/smartphone-based programmes while addressing the socioeconomic and psychological needs of the patients. This may ultimately improve the admission, adherence and outcome of exercise-based cardiac rehabilitation in women.
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Affiliation(s)
- Isabel Witvrouwen
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Emeline M Van Craenenbroeck
- 1 Laboratory of Cellular and Molecular Cardiology, University of Antwerp, Belgium.,2 Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Ana Abreu
- 3 Serviço de Cardiologia, Hospital Santa Maria/HPV, CHLN, Lisboa, Portugal
| | - Trine Moholdt
- 4 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Norway
| | - Nicolle Kränkel
- 5 Department of Cardiology, Charité Universitätsmedizin, Germany.,6 German Center for Cardiovascular Research, partner site Berlin, Germany
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Witvrouwen I, Pattyn N, Gevaert AB, Possemiers N, Van Craenenbroeck AH, Cornelissen VA, Beckers PJ, Vanhees L, Van Craenenbroeck EM. Predictors of response to exercise training in patients with coronary artery disease – a subanalysis of the SAINTEX-CAD study. Eur J Prev Cardiol 2019; 26:1158-1163. [DOI: 10.1177/2047487319828478] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Isabel Witvrouwen
- Laboratory of Cellular and Molecular Cardiology, Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - Nele Pattyn
- Department of Rehabilitation Sciences, University of Leuven, Belgium
| | - Andreas B Gevaert
- Laboratory of Cellular and Molecular Cardiology, Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
| | | | - Amaryllis H Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Belgium
- Department of Nephrology, Antwerp University Hospital, Belgium
| | | | - Paul J Beckers
- Cardiac Rehabilitation Centre, Antwerp University Hospital, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, University of Leuven, Belgium
| | - Emeline M Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology, Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Belgium
- Cardiac Rehabilitation Centre, Antwerp University Hospital, Belgium
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Witvrouwen I, Gevaert AB, Van Craenenbroeck EM, Van Craenenbroeck AH. MicroRNA Isolation from Plasma for Real-Time qPCR Array. ACTA ACUST UNITED AC 2018; 99:e69. [DOI: 10.1002/cphg.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Isabel Witvrouwen
- Laboratory of Cellular and Molecular Cardiology, Research Group Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp; Antwerp Belgium
- Department of Cardiology, Antwerp University Hospital (UZA); Edegem Belgium
| | - Andreas B. Gevaert
- Laboratory of Cellular and Molecular Cardiology, Research Group Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp; Antwerp Belgium
- Department of Cardiology, Antwerp University Hospital (UZA); Edegem Belgium
| | - Emeline M. Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology, Research Group Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp; Antwerp Belgium
- Department of Cardiology, Antwerp University Hospital (UZA); Edegem Belgium
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology, Research Group Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp; Antwerp Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp; Antwerp Belgium
- Department of Nephrology, Antwerp University Hospital (UZA); Edegem Belgium
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