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Monzo L, Tupy M, Borlaug BA, Reichenbach A, Jurcova I, Benes J, Mlateckova L, Ters J, Kautzner J, Melenovsky V. Pressure overload is associated with right ventricular dyssynchrony in heart failure with reduced ejection fraction. ESC Heart Fail 2024; 11:1097-1109. [PMID: 38263857 DOI: 10.1002/ehf2.14682] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/19/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS The determinants and relevance of right ventricular (RV) mechanical dyssynchrony in heart failure with reduced ejection fraction (HFrEF) are poorly understood. We hypothesized that increased afterload may adversely affect the synchrony of RV contraction. METHODS AND RESULTS A total of 148 patients with HFrEF and 36 controls underwent echocardiography, right heart catheterization, and gated single-photon emission computed tomography to measure RV chamber volumes and mechanical dyssynchrony (phase standard deviation of systolic displacement timing). Exams were repeated after preload (N = 135) and afterload (N = 15) modulation. Patients with HFrEF showed higher RV dyssynchrony compared with controls (40.6 ± 17.5° vs. 27.8 ± 9.1°, P < 0.001). The magnitude of RV dyssynchrony in HFrEF correlated with larger RV and left ventricular (LV) volumes, lower RV ejection fraction (RVEF) and LV ejection fraction, reduced intrinsic contractility, increased heart rate, higher pulmonary artery (PA) load, and impaired RV-PA coupling (all P ≤ 0.01). Low RVEF was the strongest predictor of RV dyssynchrony. Left bundle branch block (BBB) was associated with greater RV dyssynchrony than right BBB, regardless of QRS duration. RV afterload reduction by sildenafil improved RV dyssynchrony (P = 0.004), whereas preload change with passive leg raise had modest effect. Patients in the highest tertiles of RV dyssynchrony had an increased risk of adverse clinical events compared with those in the lower tertile [T2/T3 vs. T1: hazard ratio 1.98 (95% confidence interval 1.20-3.24), P = 0.007]. CONCLUSIONS RV dyssynchrony is associated with RV remodelling, dysfunction, adverse haemodynamics, and greater risk for adverse clinical events. RV dyssynchrony is mitigated by acute RV afterload reduction and could be a potential therapeutic target to improve RV performance in HFrEF.
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Affiliation(s)
- Luca Monzo
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France
| | - Marek Tupy
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Adrian Reichenbach
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Ivana Jurcova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Benes
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Lenka Mlateckova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiri Ters
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Klimentova J, Rehulka P, Stulik J, Vozandychova V, Rehulkova H, Jurcova I, Lazarova M, Aiglova R, Dokoupil J, Hrecko J, Pudil R. Proteomic Profiling of Dilated Cardiomyopathy Plasma Samples ─ Searching for Biomarkers with Potential to Predict the Outcome of Therapy. J Proteome Res 2024; 23:971-984. [PMID: 38363107 PMCID: PMC10913098 DOI: 10.1021/acs.jproteome.3c00691] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Determination of the prognosis and treatment outcomes of dilated cardiomyopathy is a serious problem due to the lack of valid specific protein markers. Using in-depth proteome discovery analysis, we compared 49 plasma samples from patients suffering from dilated cardiomyopathy with plasma samples from their healthy counterparts. In total, we identified 97 proteins exhibiting statistically significant dysregulation in diseased plasma samples. The functional enrichment analysis of differentially expressed proteins uncovered dysregulation in biological processes like inflammatory response, wound healing, complement cascade, blood coagulation, and lipid metabolism in dilated cardiomyopathy patients. The same proteome approach was employed in order to find protein markers whose expression differs between the patients well-responding to therapy and nonresponders. In this case, 45 plasma proteins revealed statistically significant different expression between these two groups. Of them, fructose-1,6-bisphosphate aldolase seems to be a promising biomarker candidate because it accumulates in plasma samples obtained from patients with insufficient treatment response and with worse or fatal outcome. Data are available via ProteomeXchange with the identifier PXD046288.
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Affiliation(s)
- Jana Klimentova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Pavel Rehulka
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
| | - Jiri Stulik
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- Charles
University, Faculty of Medicine in Hradec Kralove, Simkova 870, Hradec Kralove 50003, Czech Republic
| | - Vera Vozandychova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Helena Rehulkova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Ivana Jurcova
- Institute
for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague 14021, Czech Republic
| | - Marie Lazarova
- Department
of Internal Medicine I − Cardiology, Faculty of Medicine and
Dentistry, Palacky University and University
Hospital Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Renata Aiglova
- Department
of Internal Medicine I − Cardiology, Faculty of Medicine and
Dentistry, Palacky University and University
Hospital Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Jiri Dokoupil
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Juraj Hrecko
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Radek Pudil
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
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3
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Monzo L, Reichenbach A, Al-Hiti H, Jurcova I, Huskova Z, Kautzner J, Melenovsky V. Pulmonary Vasculature Responsiveness to Phosphodiesterase-5A Inhibition in Heart Failure With Reduced Ejection Fraction: Possible Role of Plasma Potassium. Front Cardiovasc Med 2022; 9:883911. [PMID: 35722098 PMCID: PMC9204350 DOI: 10.3389/fcvm.2022.883911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/25/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Phosphodiesterase-5a inhibition (PDE5i) leads to favorable changes in pulmonary hemodynamic and cardiac output (CO) in patients with advanced heart failure (HF) and reduced ejection fraction (HFrEF). The hemodynamic response to PDE5i could be heterogeneous and the clinical variables associated with these changes are scarcely investigated. Materials and Methods Of 260 patients with advanced HFrEF referred for advanced therapies [cardiac transplant/left ventricular assist device (LVAD)], 55 had pulmonary hypertension (PH) and fulfilled the criteria for the PDE5i vasoreactivity test. Right heart catheterization (RHC) was performed as a part of clinical evaluation before and after 20-mg intravenous sildenafil. Absolute and relative changes in pulmonary vascular resistance (PVR) were evaluated to assess hemodynamic response to PDE5i. Clinical, biochemical, and hemodynamic factors associated with PVR changes were identified. Results Sildenafil administration reduced PVR (− 45.3%) and transpulmonary gradient (TPG; − 34.8%) and increased CO (+ 13.6%). Relative change analysis showed a negative moderate association between baseline plasma potassium and changes in PVR (r = − 0.48; p = 0.001) and TPG (r = − 0.43; p = 0.005) after PDE5i. Aldosterone concentration shows a direct moderate association with PVR changes after PDE5i. A significant moderate association was also demonstrated between CO improvement and the severity of mitral (r = 0.42; p = 0.002) and tricuspid (r = 0.39; p = 0.004) regurgitation. Conclusion We identified plasma potassium, plasma aldosterone level, and atrioventricular valve regurgitations as potential cofounders of hemodynamic response to acute administration of PDE5i. Whether modulation of potassium levels could enhance pulmonary vasoreactivity in advanced HFrEF deserves further research.
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Affiliation(s)
- Luca Monzo
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Adrian Reichenbach
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Hikmet Al-Hiti
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Ivana Jurcova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Zuzana Huskova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
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Hughes DM, Won T, Jurcova I, Talor MV, Szarszoi O, Curnova L, Striz I, Hooper JE, Melenovsky V, Cihakova D. Pericardial macrophages and their role in myocardial infarction. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.95.02] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Each year an estimated 790,000 people suffer a heart attack in the United States. With such a high incidence, it is important to understand the underlying cellular mechanisms at play during myocardial infarction. In this project we examined the role of pericardial macrophages in modulating the pathogenesis of myocardial infarction. We found that pericardial macrophages expressing the transcription factor GATA6 make up a majority of the cells in the healthy human’s pericardial fluid and have a regulatory function. However, patients with chronic ischemic cardiac disease had their GATA6+ macrophages replaced by inflammatory monocytes in the pericardial fluid. GATA6+ macrophages can be also isolated from murine pericardial fluid. We modeled myocardial infarction through permanent ligation of the left anterior descending artery in adult mice utilizing GATA6+ macrophage deficient LysCreGATA6fl/fl mice. LysCreGATA6fl/fl mice had worse fibrosis and more severe EKG abnormalities compared to control mice following myocardial infarction. Thrombi were also apparent in the hearts of LysCreGATA6fl/fl mice that were not present in control mice. In addition, mice lacking GATA6+ pericardial macrophages had a higher influx of inflammatory Ly6Chi monocytes to the myocardium during the early inflammatory phase of the disease, while pericardial macrophages did not traffic to the myocardium directly at any point. Therefore, we propose that pericardial macrophages inhibit late-stage cardiac remodeling following myocardial infarction by preventing the trafficking of inflammatory monocytes to the site of injury.
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Affiliation(s)
- David M Hughes
- 1Johns Hopkins Univ
- 2Department of Pathology, Johns Hopkins School of Medicine
| | - Taejoon Won
- 3Johns Hopkins University School of Medicine
| | - Ivana Jurcova
- 4Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Monica V Talor
- 2Department of Pathology, Johns Hopkins School of Medicine
| | - Ondrej Szarszoi
- 4Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Lenka Curnova
- 4Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Ilza Striz
- 4Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Vojtech Melenovsky
- 4Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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5
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Janovska P, Melenovsky V, Svobodova M, Havlenova T, Kratochvilova H, Haluzik M, Hoskova E, Pelikanova T, Kautzner J, Monzo L, Jurcova I, Adamcova K, Lenkova L, Buresova J, Rossmeisl M, Kuda O, Cajka T, Kopecky J. Dysregulation of epicardial adipose tissue in cachexia due to heart failure: the role of natriuretic peptides and cardiolipin. J Cachexia Sarcopenia Muscle 2020; 11:1614-1627. [PMID: 33084249 PMCID: PMC7749591 DOI: 10.1002/jcsm.12631] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cachexia worsens long-term prognosis of patients with heart failure (HF). Effective treatment of cachexia is missing. We seek to characterize mechanisms of cachexia in adipose tissue, which could serve as novel targets for the treatment. METHODS The study was conducted in advanced HF patients (n = 52; 83% male patients) undergoing heart transplantation. Patients with ≥7.5% non-intentional body weight (BW) loss during the last 6 months were rated cachectic. Clinical characteristics and circulating markers were compared between cachectic (n = 17) and the remaining, BW-stable patients. In epicardial adipose tissue (EAT), expression of selected genes was evaluated, and a combined metabolomic/lipidomic analysis was performed to assess (i) the role of adipose tissue metabolism in the development of cachexia and (ii) potential impact of cachexia-associated changes on EAT-myocardium environment. RESULTS Cachectic vs. BW-stable patients had higher plasma levels of natriuretic peptide B (BNP; 2007 ± 1229 vs. 1411 ± 1272 pg/mL; P = 0.010) and lower EAT thickness (2.1 ± 0.8 vs. 2.9 ± 1.4 mm; P = 0.010), and they were treated with ~2.5-fold lower dose of both β-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE/ARB-inhibitors). The overall pattern of EAT gene expression suggested simultaneous activation of lipolysis and lipogenesis in cachexia. Lower ratio between expression levels of natriuretic peptide receptors C and A was observed in cachectic vs. BW-stable patients (0.47 vs. 1.30), supporting activation of EAT lipolysis by natriuretic peptides. Fundamental differences in metabolome/lipidome between BW-stable and cachectic patients were found. Mitochondrial phospholipid cardiolipin (CL), specifically the least abundant CL 70:6 species (containing C16:1, C18:1, and C18:2 acyls), was the most discriminating analyte (partial least squares discriminant analysis; variable importance in projection score = 4). Its EAT levels were higher in cachectic as compared with BW-stable patients and correlated with the degree of BW loss during the last 6 months (r = -0.94; P = 0.036). CONCLUSIONS Our results suggest that (i) BNP signalling contributes to changes in EAT metabolism in cardiac cachexia and (ii) maintenance of stable BW and 'healthy' EAT-myocardium microenvironment depends on the ability to tolerate higher doses of both ACE/ARB inhibitors and β-adrenergic blockers. In line with preclinical studies, we show for the first time in humans the association of cachexia with increased adipose tissue levels of CL. Specifically, CL 70:6 could precipitate wasting of adipose tissue, and thus, it could represent a therapeutic target to ameliorate cachexia.
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Affiliation(s)
- Petra Janovska
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Michaela Svobodova
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Tereza Havlenova
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Helena Kratochvilova
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Martin Haluzik
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Eva Hoskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Terezie Pelikanova
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Luca Monzo
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Ivana Jurcova
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Katerina Adamcova
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Lucie Lenkova
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Jana Buresova
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Martin Rossmeisl
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Ondrej Kuda
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Tomas Cajka
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
| | - Jan Kopecky
- Institute of Physiology of the Czech Academy of Sciences, Prague 4, Czech Republic
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Jurcova I, Rocek J, Bracamonte-Baran W, Zelizko M, Netuka I, Maluskova J, Kautzner J, Cihakova D, Melenovsky V, Maly J. Complete recovery of fulminant cytotoxic CD8 T-cell-mediated myocarditis after ECMELLA unloading and immunosuppression. ESC Heart Fail 2020; 7:1976-1981. [PMID: 32485066 PMCID: PMC7373888 DOI: 10.1002/ehf2.12697] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/20/2020] [Accepted: 03/13/2020] [Indexed: 01/23/2023] Open
Abstract
A 19‐year‐old woman with no previous cardiac history was admitted to the hospital with third‐degree atrioventricular block and left ventricular dysfunction. Her condition quickly deteriorated to severe biventricular failure and cardiogenic shock requiring mechanical circulatory support. An endomyocardial biopsy revealed lymphocytic myocarditis with no PCR‐detectable viral genomes, with CD8 T‐cell predominance and pro‐inflammatory macrophage expansion shown by myocardial flow cytometry. The therapy consisted of immunosuppression (high‐dose methylprednisolone) and temporary mechanical circulatory support with enhanced ability to achieve left ventricular unloading by combination of extracorporeal membrane oxygenation with Impella (ECMELLA). After 2 weeks of support, complete and sustained recovery from myocarditis was observed.
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Affiliation(s)
- Ivana Jurcova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Jan Rocek
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | | | - Michael Zelizko
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Ivan Netuka
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Jana Maluskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Daniela Cihakova
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Jiri Maly
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic
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Monzo L, Kotrc M, Benes J, Sedlacek K, Jurcova I, Franekova J, Jarolim P, Kautzner J, Melenovsky V. Clinical and Humoral Determinants of Congestion in Heart Failure: Potential Role of Adiponectin. Kidney Blood Press Res 2019; 44:1271-1284. [PMID: 31553971 DOI: 10.1159/000502975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/22/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Some patients with heart failure (HF) are more prone to systemic congestion than others. The goal of this study was to identify clinical and humoral factors linked to congestion and its prognostic impact in HF patients. METHODS A total of 371 advanced HF patients underwent physical examination, echocardiography, right heart catheterization, blood samplings, and Minnesota Living with HF Questionnaire. Subjects were followed-up for adverse events (death, urgent transplantation, or assist device implantation without heart transplantation). RESULTS Thirty-one percent of patients were classified as prone to congestion. During a median follow-up of 1,093 days, 159 (43%) patients had an adverse event. In the Cox analysis, the congestion-prone (CP) status was associated with a 43% higher event risk. The CP status was strongly (p ˂ 0.001) associated with body weight loss, right ventricular dysfunction (RVD), dilated inferior vena cava (IVC), diuretics, and beta-blockers prescription and the majority of tested hormones in the univariate analysis. In the multivariate analysis, the only independent variables associated with the CP status were adiponectin, albumin, IVC diameter, and RVD. Adiponectin by itself was predictive of adverse events. In a multivariate model, CP status was no longer predictive of adverse events, in contrast to adiponectin. CONCLUSIONS CP patients experienced more severe symptoms and had shorter survival. Potential role of adiponectin, a new independent predictor of CP status, should be further examined.
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Affiliation(s)
- Luca Monzo
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia, .,Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, "Sapienza" University, Rome, Italy,
| | - Martin Kotrc
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Jan Benes
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Kamil Sedlacek
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Ivana Jurcova
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Janka Franekova
- Department of Laboratory Methods, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Josef Kautzner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
| | - Vojtech Melenovsky
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia
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