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Henry JA, Levelt E, Rayner JJ, Hundertmark MJ, Peterzan MA, Green PG, Watson W, Burrage MK, Arvidsson P, Lewis AJM, Chamley R, Neubauer S, Valkovic L, Rider OJ. Investigating myocardial energetic deficit across the spectrum of cardiac disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.244] [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
Introduction
The phosphocreatine-to-adenosine triphosphate ratio (PCr/ATP) is a sensitive marker of the energetic state of the heart and can be reliably measured non-invasively using 31Phosphorus magnetic resonance spectroscopy (31P-MRS). Derangements in cardiac energetics are a distinctive feature in the pathophysiology of several cardiac diseases, and thus potential therapeutic targets.
Purpose
We sought to compare cardiac PCr/ATP across a range of cardiac pathologies.
Methods
Using a 3D chemical shift 31P spectral acquisition we recorded PCr/ATP in 515 participants: athletes (n=17), healthy controls with normal weight (n=148), overweight (n=67) and with obesity (n=73), diabetes (n=23), heart failure with preserved ejection fraction (HFpEF) (n=33), heart failure with reduced ejection fraction (HFrEF) (n=63), amyloid (n=9), severe aortic stenosis (AS) (n=29), severe mitral regurgitation (MR) (n=18), and hypertrophic cardiomyopathy (HCM) (n=35).
Results
A spectrum of myocardial PCr/ATP exists ranging from normal in athletes (2.23±0.28) and those with normal weight (2.05±0.38) to severely impaired in severe MR (1.56±0.32) and cardiac amyloid (1.34±0.19, Figure 1). Despite normal systolic function (all LVEF >57%) those living with obesity and diabetes have lower PCr/ATP than normal (all p<0.001). In all groups with HF, regardless of aetiology, myocardial energetics were impaired (all p<0.001). Across the whole cohort PCr/ATP was negatively correlated with body mass index (r −0.28, p<0.001), age (r −0.34, p<0.001) and LV mass (r −0.1, p<0.001). PCr/ATP was not related to systolic or diastolic blood pressure in these cohorts.
Conclusions
We demonstrate a spectrum of energetic deficit in cardiac disease and this is affected by not only myocardial pathology but also by obesity and age. Derangements in myocardial energetics are present in myocardial pathologies independent of underlying aetiology.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): We acknowledge support from the British Heart Foundation Oxford Center of Research Excellence.
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Affiliation(s)
- J A Henry
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - E Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine , Leeds , United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P G Green
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - W Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - M K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - P Arvidsson
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - A J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - R Chamley
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - L Valkovic
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
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Henry JA, Abdesselam I, Sorimachi H, Rayner JJ, Deal O, Byrne J, Neubauer S, Borlaug BA, Rider OJ. Changes in adipose tissue depots and cardiac geometry following bariatric surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2388] [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
Introduction
Cardiac geometry is affected by body composition, with total body adipose volume being related to left ventricular (LV) dilatation (due to increased intravascular volume and cardiac output), and visceral adipose tissue (VAT) to smaller LV cavity size and concentric remodelling (because of insulin resistance) [1]. As such we hypothesised that changes in VAT and total body weight during weight loss would have a differential impact on cardiac geometry. Alongside this, we hypothesised that, as the pericardium is a fixed volume, changes in epicardial adipose tissue (EAT), may have an additional mechanical effect by reducing pericardial restraint.
Purpose
We sought to investigate long term changes in VAT, total weight and EAT following bariatric surgery and relate them to changes in cardiac geometry.
Methods
Forty patients underwent cardiac magnetic resonance (CMR) imaging before and after bariatric surgery, including 21 who underwent short-term (median 209 days), 28 medium-term (median 428 days) and 12 long-term (median 1030 days) imaging follow up. Cardiac volumes (left atrial (LA), LV end-diastolic volume (LVEDV) and stroke volume (LVSV)) were assessed using cardiac MRI. VAT was assessed at L5 using a T1 weighted, water suppressed sequence. EAT volumes were calculated by manual contouring in end-ventricular systole on short axis slices from the mitral valve to the apex. Percentage changes in volumes were calculated between scans for each individual.
Results
Patients on average lost 32kg within the first 428 days following bariatric surgery (54% excess weight loss, p<0.0001), with no significant change in weight at the longer-term time point (Figure 1A). Most VAT loss occurred in the first 209 days (−42%, p<0.0001) with no subsequent change observed at the final two timepoints (Figure 1B). Similarly, EAT loss occurred in the first 209 days (−13%, mean 10ml, p<0.0001) with non-significant changes thereafter (Figure 1C).
There was a significant decrease in both LA (13%, mean 12ml, p<0.0001) and LVEDV (4%, mean 8ml, p=0.0249) at 209 days post-surgery. Both LA volume and LVEDV had returned to baseline by the longest term time point of 1030 days (Figure 2). LVSV followed a similar pattern being reduced at 209 days (by 10%, mean 9ml, p=0.0019), then returning to levels similar to those pre-weight loss at 1030 days (p=0.44) (Figure 2C).
Conclusions
Cardiac volumes show a biphasic response to weight loss, initially becoming smaller and then returning to baseline by 1030 days. We hypothesise that the early drop in LA and LV cavity size is a response to reduced volume from body mass reduction. In contrast, we propose that the increase in LA and LVEDV that follows results from the longer-term effects of reducing VAT, and increased space within the pericardium resulting from EAT loss allowing expansion to occur.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): We acknowledge support from the British Heart Foundation Oxford Center of Research Excellence
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Affiliation(s)
- J A Henry
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - I Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - H Sorimachi
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - O Deal
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - J Byrne
- University Hospital Southampton NHS Foundation Trust, Division of Surgery , Southampton , United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
| | - B A Borlaug
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford , United Kingdom
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Lewis AJM, Abdesselam I, Rayner JJ, Byrne J, Borlaug BA, Neubauer S, Rider OJ. Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2022; 23:1383-1390. [PMID: 34453521 PMCID: PMC9463995 DOI: 10.1093/ehjci/jeab175] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). METHODS AND RESULTS We first determined the effects of World Health Organization class III obesity [body mass index (BMI) > 40 kg/m2, n = 54] vs. healthy weight (BMI < 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P < 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P < 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). CONCLUSION Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure.
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Affiliation(s)
- Andrew J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Ines Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Jennifer J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - James Byrne
- University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton SO16 6YDUK
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Headley Way, Oxford OX3 9DU, UK
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Cardiac Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Oliver J Rider
- Oxford Centre for Cardiac Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Rayner JJ, Peterzan MA, Clarke WT, Rodgers CT, Neubauer S, Rider OJ. Obesity modifies the energetic phenotype of dilated cardiomyopathy. Eur Heart J 2021; 43:ehab663. [PMID: 34542592 PMCID: PMC8885325 DOI: 10.1093/eurheartj/ehab663] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/23/2021] [Revised: 07/13/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS We sought to determine if myocardial energetics could distinguish obesity cardiomyopathy as a distinct entity from dilated cardiomyopathy. METHODS AND RESULTS Sixteen normal weight participants with dilated cardiomyopathy (DCMNW), and 27 with DCM and obesity (DCMOB), were compared to 26 normal weight controls (CTLNW). All underwent cardiac magnetic resonance imaging and 31P spectroscopy to assess function and energetics. Nineteen DCMOB underwent repeat assessment after a dietary weight loss intervention. Adenosine triphosphate (ATP) delivery through creatine kinase (CK flux) was 55% lower in DCMNW than in CTLNW (P = 0.004), correlating with left ventricular ejection fraction (LVEF, r = 0.4, P = 0.015). In contrast, despite similar LVEF (DCMOB 41 ± 7%, DCMNW 38 ± 6%, P = 0.14), CK flux was two-fold higher in DCMOB (P < 0.001), due to higher rate through CK [median kf 0.21 (0.14) vs. 0.11 (0.12) s-1, P = 0.002]. During increased workload, the CTLNW heart increased CK flux by 97% (P < 0.001). In contrast, CK flux was unchanged in DCMNW and fell in DCMOB (by >50%, P < 0.001). Intentional weight loss was associated with positive left ventricular remodelling, with reduced left ventricular end-diastolic volume (by 8%, P < 0.001) and a change in LVEF (40 ± 9% vs. 45 ± 10%, P = 0.002). This occurred alongside a fall in ATP delivery rate with weight loss (by 7%, P = 0.049). CONCLUSIONS In normal weight, DCM is associated with reduced resting ATP delivery. In obese DCM, ATP demand through CK is greater, suggesting reduced efficiency of energy utilization. Dietary weight loss is associated with significant improvement in myocardial contractility, and a fall in ATP delivery, suggesting improved metabolic efficiency. This highlights distinct energetic pathways in obesity cardiomyopathy, which are both different from dilated cardiomyopathy, and may be reversible with weight loss.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christopher T Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Box 65, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Lewis AJM, Rayner JJ, Abdesselam I, Neubauer S, Rider OJ. Obesity in the absence of comorbidities is not related to clinically meaningful left ventricular hypertrophy. Int J Cardiovasc Imaging 2021; 37:2277-2281. [PMID: 33730330 PMCID: PMC8286928 DOI: 10.1007/s10554-021-02207-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
Obesity is associated with the development of left ventricular (LV) hypertrophy. Whether obesity in in the absence of comorbidities can cause LV hypertrophy to an extent which could create diagnostic uncertainty with pathological states (such as hypertrophic cardiomyopathy) is unknown. We used cine cardiovascular magnetic resonance imaging to precisely measure LV wall thickness in the septum and lateral wall in 764 people with body mass indices ranging from 18.5 kg/m2 to 59.2 kg/m2 in the absence of major comorbidities. Obesity was related to LV wall thickness across the cohort (basal septum r 0.30, P < 0.001 and basal lateral wall r 0.18, P < 0.001). Although no participant had hypertension, these associations remained highly significant after controlling for systolic blood pressure (all P < 0.01). Each 10 kg/m2 increase in BMI was associated with an increase in basal septal wall thickness of 1.0 mm males and 0.8 mm in females, with no statistically significant difference between genders (P = 0.1). Even in class 3 obesity (BMI > 40 kg/m2), no LV wall thickness > 13.4 mm in males or > 12.7 mm in females was observed in this cohort. We confirm that obesity in the absence of comorbidities is associated with LV hypertrophy, and establish that the magnitude of this change is modest even in severe obesity. LV hypertrophy > 14 mm cannot safely be attributed to obesity alone and alternative diagnoses should be considered.
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Affiliation(s)
- Andrew J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, OX3 9DU, UK.
| | - Jennifer J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, OX3 9DU, UK
| | - Ines Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, OX3 9DU, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, OX3 9DU, UK
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Raisi-Estabragh Z, Biasiolli L, Cooper J, Aung N, Fung K, Paiva JM, Sanghvi MM, Thomson RJ, Curtis E, Paccou J, Rayner JJ, Werys K, Puchta H, Thomas KE, Lee AM, Piechnik SK, Neubauer S, Munroe PB, Cooper C, Petersen SE, Harvey NC. Poor Bone Quality is Associated With Greater Arterial Stiffness: Insights From the UK Biobank. J Bone Miner Res 2021; 36:90-99. [PMID: 32964541 PMCID: PMC7613252 DOI: 10.1002/jbmr.4164] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - Luca Biasiolli
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jackie Cooper
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - Nay Aung
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - Kenneth Fung
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - José M Paiva
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - Ross J Thomson
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Elizabeth Curtis
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Julien Paccou
- Rheumatology Department, Lille University Hospital, CHU Lille, MABlab ULR 4490, 59037 Lille, France
| | - Jennifer J Rayner
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Konrad Werys
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Henrike Puchta
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aaron M Lee
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Patricia B Munroe
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, National Institute for Health Research (NIHR) Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, UK
| | - Nicholas C Harvey
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
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Rayner JJ, Abdesselam I, d'Arcy J, Myerson SG, Neubauer S, Watkins H, Ferreira VM, Rider OJ. Obesity-related ventricular remodelling is exacerbated in dilated and hypertrophic cardiomyopathy. Cardiovasc Diagn Ther 2020; 10:559-567. [PMID: 32695637 DOI: 10.21037/cdt-19-587] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Obesity causes significant cardiac remodelling even in health, and yet the contribution of this maladaptation in the setting of an additional cardiomyopathic process is poorly understood. Cardiovascular magnetic resonance is the gold-standard tool for assessing cardiac geometry, especially in an obese population, and hence perfectly suited to investigate this important question. Methods Using data from our extensive imaging registry (n=1,554), we documented the relationship between increasing BMI and left ventricular (LV) remodelling in patients with dilated (DCM; n=529) and hypertrophic cardiomyopathy (HCM; n=297), compared to the normal heart (n=728). Results Regardless of cardiac status, increasing BMI resulted in similar increases in LV stroke volume (P>0.18). However, there was a difference in the degree of LV cavity dilatation associated with this change in stroke volume; when compared to normal hearts [increase in end-diastolic volume of 0.7 mL per unit of rising BMI (mL/kg/m2)], there was a threefold greater LV cavity dilatation in DCM (+2.2 mL/kg/m2) and twofold greater in HCM (+1.9 mL/kg/m2, all P<0.04). Whilst obesity was related to LV hypertrophy in all groups (normal +1.3 g, DCM +2.2g, HCM +2.3 g/kg/m2, all P<0.001), additional obesity-related concentric LV remodelling only occurred in normal hearts and DCM (normal +0.006 vs. +0.003 mass:volume ratio, both P<0.001). Conclusions In both DCM and HCM, the increase in stroke volume required by obesity appears to be achieved by excessive LV cavity dilatation. The impact of obesity on LV geometry was more pronounced in concomitant cardiovascular disease, and therefore carries potential to become an important therapeutic target in cardiomyopathy.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ines Abdesselam
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Joanna d'Arcy
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Saul G Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Lau JYC, Miller JJ, Johnson E, Rayner JJ, Hundertmark MJ, Sayeed R, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. Cardiac Energetics in Patients With Aortic Stenosis and Preserved Versus Reduced Ejection Fraction. Circulation 2020; 141:1971-1985. [PMID: 32438845 PMCID: PMC7294745 DOI: 10.1161/circulationaha.119.043450] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Why some but not all patients with severe aortic stenosis (SevAS) develop otherwise unexplained reduced systolic function is unclear. We investigate the hypothesis that reduced creatine kinase (CK) capacity and flux is associated with this transition.
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Affiliation(s)
- Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences (W.T.C.), University of Oxford, United Kingdom
| | | | - Hannah A Lake
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (H.A.L.), University of Oxford, United Kingdom
| | - Justin Y C Lau
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Jack J Miller
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Errin Johnson
- Dunn School of Pathology (E.J.), University of Oxford, United Kingdom
| | - Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Moritz J Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Mario Petrou
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom (M.P.)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Vivek Srivastava
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, United Kingdom (R.S., G.K., V.S.)
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
| | | | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine (M.A.P., J.Y.C.L., J.J.M., J.J.R., M.J.H., S.N., O.J.R.), University of Oxford, United Kingdom
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Rayner JJ, Peterzan MA, Watson WD, Clarke WT, Neubauer S, Rodgers CT, Rider OJ. Myocardial Energetics in Obesity: Enhanced ATP Delivery Through Creatine Kinase With Blunted Stress Response. Circulation 2020; 141:1152-1163. [PMID: 32138541 PMCID: PMC7144750 DOI: 10.1161/circulationaha.119.042770] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is strongly associated with exercise intolerance and the development of heart failure. Whereas myocardial energetics and diastolic function are impaired in obesity, systolic function is usually preserved. This suggests that the rate of ATP delivery is maintained, but this has never been explored in human obesity. We hypothesized that ATP transfer rate through creatine kinase (CK) (kfCKrest) would be increased, compensating for depleted energy stores (phosphocreatine/ATP), but potentially limiting greater ATP delivery during increased workload. We hypothesized that these changes would normalize with weight loss. METHODS We recruited 80 volunteers (35 controls [body mass index 24±3 kg/m2], 45 obese [body mass index 35±5 kg/m2]) without coexisting cardiovascular disease. Participants underwent body composition analysis, magnetic resonance imaging of abdominal, liver, and myocardial fat content, left ventricular function, and 31P magnetic resonance spectroscopy to assess phosphocreatine/ATP and CK kinetics, at rest and during dobutamine stress. Obese volunteers were assigned to a dietary weight loss intervention, before reexamination. RESULTS At rest, although myocardial phosphocreatine/ATP was 14% lower in obesity (1.9±0.3 versus 2.2±0.2, P<0.001), kfCkrest was 33% higher (0.23±0.07 s-1 versus 0.16±0.08 s-1, P=0.002), yielding no difference in overall resting ATP delivery (obese 2.5±0.9 µmol·g-1·s-1 versus control 2.2±1.1 µmol·g-1·s-1, P=0.232). In controls, increasing cardiac workload led to an increase in both kfCK (+86%, P<0.001) and ATP delivery (+80%, P<0.001). However, in obesity, similar stress led to no significant increase in either kfCK (P=0.117) or ATP delivery (P=0.608). This was accompanied by reduced systolic augmentation (absolute increase in left ventricular ejection fraction, obese +16±7% versus control +21±4%, P=0.031). Successful weight loss (-11±5% body weight) was associated with improvement of these energetic changes such that there was no significant difference in comparison with controls. CONCLUSIONS In the obese resting heart, the myocardial CK reaction rate is increased, maintaining ATP delivery despite reduced phosphocreatine/ATP. During increased workload, although the nonobese heart increases ATP delivery through CK, the obese heart does not; this is associated with reduced systolic augmentation and exercise tolerance. Weight loss reverses these energetic changes. This highlights myocardial energy delivery through CK as a potential therapeutic target to improve symptoms in obesity-related heart disease, and a fascinating modifiable pathway involved in the progression to heart failure, as well.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - William D Watson
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - William T Clarke
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain (W.T.C.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Christopher T Rodgers
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, United Kingdom (C.T.R.)
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.J.R, M.A.P., W.D.W., S.N., O.J.R.), University of Oxford, John Radcliffe Hospital, United Kingdom
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11
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Lau JYC, Johnson E, Rayner JJ, Hundertmark MJ, Sayeed RA, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. P2272Determinants of left ventricular ATP availability measured in vivo and ex vivo in patients with severe aortic stenosis: correlation of creatine kinase activity with LVEF and ATP diffusion distance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0749] [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
Introduction
The transition to systolic failure in severe aortic stenosis (AS) increases mortality. There are currently no reliable markers of transition, and the guideline LVEF <50% threshold for intervention in asymptomatic severe AS does not capture all subjects at increased risk. In animal models, reduced ATP delivery capacity through creatine kinase (CK) is important, with modest increases in CK capacity conferring cardioprotection. ATP may also diffuse (independent of CK) from mitochondria to the contractile site. We have performed the first human study to test whether ATP diffusion distance relates to CK activity and whether CK activity is reduced in low LVEF severe AS.
Methods
19 patients with severe AS, LVEF ≥55% (AS-pEF, mean±SD LVEF 63±5%, mean gradient 48±14 mmHg) and 10 with severe AS, LVEF <55% (AS-rEF, LVEF 42±8%, mean gradient 32±11) underwent 31P-MRS for CK rate constant (kf) and phosphocreatine/ATP (PCr/ATP) ratio, and MRI for LV volumes. LV biopsies were taken during AVR and analysed for CK total activity, CK isoforms, total creatine, and citrate synthase (CS) activity. 9 biopsies also underwent serial block face scanning electron microscopy and mitochondria-sarcomere 3D distance distributions were plotted. Results were compared to 24 controls (LVEF 61±4%), of which 4 had LV biopsy (3 severe MS, 1 LA myxoma, MS-pEF). Surgical patients had flow-limiting atheroma excluded with invasive angiography and prior myocardial infarction excluded with late gadolinium enhancement MRI.
Results
When compared to controls, both CK total activity and CS activity were lower in AS-pEF (by 27% and 23% respectively, both p<0.05, Panels A-B). Although PCr/ATP reduced in AS-pEF (by 20%, p<0.001, panel C), kf (panel D) and CK flux estimated by kf × total creatine were not different. CK-MB expression reduced in AS-pEF (19 vs 27% of total CK, p=0.003), reflecting compensatory increases in CK-MM (p=0.26) and CK-BB (p=0.18) in the face of reduced CK activity.
AS-rEF was associated with further reduction in both CK and CS activities (by 32% and 22% respectively, both p<0.05, Panels A-B), but no differences in PCr/ATP, CK kf or relative CK isozyme expression were seen. There were no significant between-group differences in total creatine (Panel E). Overall this suggests that CK reserve and oxidative capacity potentially reduce in pressure overload, with further falls commensurate with systolic dysfunction.
When median mitochondria-sarcomere ATP diffusion distances were plotted against CK total activity a strong positive correlation was observed (r=0.86, p=0.003, Panel F). This suggests a compensatory reduction in diffusion distance develops when CK activity falls.
Conclusions
Transition to failure in severe AS is associated with lower oxidative capacity and maximal ATP delivery capacity through CK. Despite compensatory falls in ATP diffusion distance and altered CK isozyme expression, these changes may underlie susceptibility to EF decline in AS.
Acknowledgement/Funding
British Heart Foundation Clinical Research Training Fellowship (FS/15/80/31803) and Programme Grant (RG/18/12/34040).
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Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J Y C Lau
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - E Johnson
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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12
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Peterzan MA, Clarke WT, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Sayeed RA, Petrou M, Krasopoulos G, Srivastava V, Neubauer S, Rodgers CT, Rider OJ. P1611Non-invasive predictors of LV biopsy-obtained creatine kinase activity in patients with non-failing and failing myocardial hypertrophy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0370] [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
Introduction
Myocardial creatine kinase (CK) activity represents an important metabolic reserve: it correlates closely with contractile reserve and post-ischaemic function, keeps cytosolic [ADP] low, and optimises the free energy for ATP hydrolysis. It may also contribute to the transition to failure in the heart hypertrophied by chronic haemodynamic overload; modest up-regulation has been shown to be cardio-protective.
Total CK activity measurement requires chemical freeze-and-extract methods, which destroy tissue, precluding repeated measures. To date, non-invasive assessments of human myocardial CK flux (calculated as kf × [PCr], where kf is the pseudo-first-order forward rate constant measured by 31P-magnetic resonance spectroscopy (MRS) have not assessed creatine content or total CK activity. Thus we aimed to validate kf measurement against total CK activity and investigate predictors of CK activity.
Methods
39 subjects (median age 71, range 43–84) undergoing clinically indicated cardiac surgery had CK total activity measured from LV biopsy. 31 had severe AS (10 with impaired LVEF); 2 had severe primary MR; 5 had severe mitral stenosis (2 with impaired LVEF) and 1 had an LA mass. 35 of 39 contributed triplicate datasets: CK total activity, kf (31P-MRS TRiST sequence at 3T) and LV volumes (cine-MRI, 3T Siemens). 27 had severe AS (8 with impaired LVEF); other groups were the same. Exclusion criteria were prior myocardial infarction and flow-limiting coronary disease. Flash-frozen LV biopsies obtained within 15 min of cardiopulmonary bypass were analysed for CK total activity, total creatine, and citrate synthase (CS) activity (a marker of oxidative phosphorylation capacity).
Results
Multiple, novel correlations were observed between CK total activity (IU/mg protein) and CS activity (r=0.87, p=9e-13), total creatine (r=0.59, p=8e-5), kf (r=0.42, p=0.013), total creatine × kf (r=0.64, p=4e-5), LVESVi (r=−0.52, p=8e-4), LVEF (r=0.48, p=0.002) and LVMi (r=−0.42, p=0.009) (Panels A-E) (LVEDVi and non-indexed counterparts were also significant correlates.) The most predictive linear regression model incorporating elements of the CK rate equation included total creatine (nmol/mg protein), kf (/s), and kf × LVESVi (ml/m2) (adjusted R2=0.56, beta=0.426, 0.618, −1.968 and p=0.001, 5e-5, 0.003 respectively, Panel F).
Figure 1
Conclusions
These results are the first evidence of agreement between non-invasive estimates of human cardiac CK activity (kf) and freeze-extracted chemical methods. The key original finding is that it is feasible to attempt to predict CK capacity in vivo by using a combination of techniques (creatine by 1H MRS, CK kf by 31P-MRS and LVESVi by cine imaging). The key insight is that CK capacity is best estimated not simply from what the rate equation would predict (creatine and kf), but that other factors relating to failing contractility reduce CK activity independently from creatine content and enzyme kf.
Acknowledgement/Funding
British Heart Foundation Clinical Research Training Fellowship (FS/15/80/31803) and Programme Grant (RG/18/12/34040).
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Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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13
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Rayner JJ, Banerjee R, Holloway CJ, Lewis AJM, Peterzan MA, Francis JM, Neubauer S, Rider OJ. Correction: The Relative Contribution of Metabolic and Structural Abnormalities to Diastolic Dysfunction in Obesity. Int J Obes (Lond) 2019; 43:1652. [PMID: 31227797 PMCID: PMC7608285 DOI: 10.1038/s41366-019-0404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - R Banerjee
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - C J Holloway
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A J M Lewis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - M A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - J M Francis
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.
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14
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Fung K, Biasiolli L, Aung N, Hann E, Paiva JM, Lukaschuk E, Sanghvi MM, Carapella V, Rayner JJ, Werys K, Thomas K, Moon NO, Neubauer S, Piechnik SK, Petersen SE. 282Reference values for aortic distensibility derived from UK Biobank cardiovascular magnetic resonance (CMR) imaging cohort. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/15/2022] Open
Affiliation(s)
- K Fung
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - L Biasiolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M M Sanghvi
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Werys
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N O Moon
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
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15
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Clarke WT, Peterzan MA, Rayner JJ, Sayeed RA, Petrou M, Krasopoulos G, Lake HA, Raman B, Watson WD, Cox P, Hundertmark MJ, Apps AP, Lygate CA, Neubauer S, Rider OJ, Rodgers CT. Localized rest and stress human cardiac creatine kinase reaction kinetics at 3 T. NMR Biomed 2019; 32:e4085. [PMID: 30920054 PMCID: PMC6542687 DOI: 10.1002/nbm.4085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 05/11/2023]
Abstract
Changes in the kinetics of the creatine kinase (CK) shuttle are sensitive markers of cardiac energetics but are typically measured at rest and in the prone position. This study aims to measure CK kinetics during pharmacological stress at 3 T, with measurement in the supine position. A shorter "stressed saturation transfer" (StreST) extension to the triple repetition time saturation transfer (TRiST) method is proposed. We assess scanning in a supine position and validate the MR measurement against biopsy assay of CK activity. We report normal ranges of stress CK forward rate (kfCK ) for healthy volunteers and obese patients. TRiST measures kfCK in 40 min at 3 T. StreST extends the previously developed TRiST to also make a further kfCK measurement during <20 min of dobutamine stress. We test our TRiST implementation in skeletal muscle and myocardium in both prone and supine positions. We evaluate StreST in the myocardium of six healthy volunteers and 34 obese subjects. We validated MR-measured kfCK against biopsy assays of CK activity. TRiST kfCK values matched literature values in skeletal muscle (kfCK = 0.25 ± 0.03 s-1 vs 0.27 ± 0.03 s-1 ) and myocardium when measured in the prone position (0.32 ± 0.15 s-1 ), but a significant difference was found for TRiST kfCK measured supine (0.24 ± 0.12 s-1 ). This difference was because of different respiratory- and cardiac-motion-induced B0 changes in the two positions. Using supine TRiST, cardiac kfCK values for normal-weight subjects were 0.15 ± 0.09 s-1 at rest and 0.17 ± 0.15 s-1 during stress. For obese subjects, kfCK was 0.16 ± 0.07 s-1 at rest and 0.17 ± 0.10 s-1 during stress. Rest myocardial kfCK and CK activity from LV biopsies of the same subjects correlated (R = 0.43, p = 0.03). We present an independent implementation of TRiST on the Siemens platform using a commercially available coil. Our extended StreST protocol enables cardiac kfCK to be measured during dobutamine-induced stress in the supine position.
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Affiliation(s)
- William T. Clarke
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wellcome Centre for Integrative Neuroimaging, FMRIBUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Mark A. Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Jennifer J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Rana A. Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Hannah A. Lake
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - William D. Watson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Pete Cox
- Department of Physiology AnatomyUniversity of OxfordParks Road, Sherrington BuildingOxfordUK
| | - Moritz J. Hundertmark
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Andrew P. Apps
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Craig A. Lygate
- Department of Cardiovascular MedicineUniversity of Oxford, Wellcome Trust Centre for Human GeneticsRoosevelt DriveOxfordUK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine RDMUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Wolfson Brain Imaging CentreUniversity of CambridgeBox 65, Cambridge Biomedical CampusCambridgeUK
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16
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Sanghvi M, Biasiolli L, Aung N, Cooper JA, Fung K, Lukaschuk E, Paiva JM, Carapella V, Hann E, Rayner JJ, Werys K, Puchta H, Piechnik SK, Neubauer S, Petersen SE. 345The impact of modifiable cardiovascular risk factors on aortic distensibility: insights from the UK Biobank. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- M Sanghvi
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - L Biasiolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J A Cooper
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - E Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Werys
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - H Puchta
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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17
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Biasiolli L, Hann E, Lukaschuk E, Carapella V, Paiva JM, Aung N, Rayner JJ, Werys K, Fung K, Puchta H, Sanghvi MM, Moon NO, Thomson RJ, Thomas KE, Robson MD, Grau V, Petersen SE, Neubauer S, Piechnik SK. Automated localization and quality control of the aorta in cine CMR can significantly accelerate processing of the UK Biobank population data. PLoS One 2019; 14:e0212272. [PMID: 30763349 PMCID: PMC6375606 DOI: 10.1371/journal.pone.0212272] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Aortic distensibility can be calculated using semi-automated methods to segment the aortic lumen on cine CMR (Cardiovascular Magnetic Resonance) images. However, these methods require visual quality control and manual localization of the region of interest (ROI) of ascending (AA) and proximal descending (PDA) aorta, which limit the analysis in large-scale population-based studies. Using 5100 scans from UK Biobank, this study sought to develop and validate a fully automated method to 1) detect and locate the ROIs of AA and PDA, and 2) provide a quality control mechanism. Methods The automated AA and PDA detection-localization algorithm followed these steps: 1) foreground segmentation; 2) detection of candidate ROIs by Circular Hough Transform (CHT); 3) spatial, histogram and shape feature extraction for candidate ROIs; 4) AA and PDA detection using Random Forest (RF); 5) quality control based on RF detection probability. To provide the ground truth, overall image quality (IQ = 0–3 from poor to good) and aortic locations were visually assessed by 13 observers. The automated algorithm was trained on 1200 scans and Dice Similarity Coefficient (DSC) was used to calculate the agreement between ground truth and automatically detected ROIs. Results The automated algorithm was tested on 3900 scans. Detection accuracy was 99.4% for AA and 99.8% for PDA. Aorta localization showed excellent agreement with the ground truth, with DSC ≥ 0.9 in 94.8% of AA (DSC = 0.97 ± 0.04) and 99.5% of PDA cases (DSC = 0.98 ± 0.03). AA×PDA detection probabilities could discriminate scans with IQ ≥ 1 from those severely corrupted by artefacts (AUC = 90.6%). If scans with detection probability < 0.75 were excluded (350 scans), the algorithm was able to correctly detect and localize AA and PDA in all the remaining 3550 scans (100% accuracy). Conclusion The proposed method for automated AA and PDA localization was extremely accurate and the automatically derived detection probabilities provided a robust mechanism to detect low quality scans for further human review. Applying the proposed localization and quality control techniques promises at least a ten-fold reduction in human involvement without sacrificing any accuracy.
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Affiliation(s)
- Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Valentina Carapella
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Jennifer J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Henrike Puchta
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Niall O. Moon
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ross J. Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Katharine E. Thomas
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vicente Grau
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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18
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Rayner JJ, Abdesselam I, Peterzan MA, Akoumianakis I, Akawi N, Antoniades C, Tomlinson JW, Neubauer S, Rider OJ. Very low calorie diets are associated with transient ventricular impairment before reversal of diastolic dysfunction in obesity. Int J Obes (Lond) 2018; 43:2536-2544. [PMID: 30464235 PMCID: PMC6892735 DOI: 10.1038/s41366-018-0263-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/06/2023]
Abstract
Objectives Very low calorie diets (VLCDs) are effective at clearing hepatic steatosis and improving insulin sensitivity. Whilst long-term weight loss is beneficial to the cardiovascular system, the acute elevation in fatty acids during caloric restriction is potentially detrimental to cardiac metabolism and function. We sought to investigate any cardiovascular changes occurring over the course of a modern VLCD regime, alongside the expected peripheral metabolic improvements. Methods 25 obese volunteers (BMI 36.8 ± 5.8 kg/m2) underwent magnetic resonance imaging, echocardiography, metabolic profiling, and bio-impedance analysis before 1 and 8 weeks following a VLCD (800 kcal/day). Results were compared to 15 age- and sex-matched controls. Results After 1 week of VLCD, despite only modest weight loss, significant drops occurred in liver fat and insulin resistance (HOMA-IR; by 14–50%, all p < 0.01). In contrast, myocardial triglyceride content (MTGC) increased (by 48%, p = 0.030), and was associated with deterioration in both systolic (LVEF by 4%, p = 0.041) and diastolic function (e/e′ 8.6 ± 1.4 to 9.4 ± 1.7, p = 0.019). Aortic stiffness also increased by 35% (p = 0.015). At 8 weeks, liver steatosis and visceral fat were lower than baseline (by 20–55%, p < 0.001), and peripheral metabolic improvements continued. MTGC also fell to below baseline (1.5 ± 0.6 vs 2.1 ± 1%, p = 0.05) with improved myocardial function (e/e′ 8.6 ± 1.4 to 7.5 ± 1.5, p = 0.003). Conclusions Whilst VLCDs result in dramatic improvements in insulin resistance, they are associated with transient but significant cardiovascular functional decline, which may have an impact on those with the coexisting cardiac disease. However, after 8 weeks, the diet was associated with normalisation of cardiac function, suggesting they may form a potential therapeutic intervention for diastolic dysfunction in obesity and diabetes.
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Affiliation(s)
- Jennifer J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Ines Abdesselam
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mark A Peterzan
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nadia Akawi
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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19
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Rayner JJ, Abdesselam I, Peterzan MA, Tomlinson JW, Neubauer S, Rider OJ. 107Very low calorie diets lead to temporary and reversible left ventricular impairment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - I Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - J W Tomlinson
- Oxford Centre for Diabetes, Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
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20
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Peterzan MA, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Neubauer S, Clarke WT, Rodgers CT, Rider OJ. P5449ATP delivery rate is maintained in severe aortic stenosis with preserved systolic function despite reduced PCr/ATP ratio. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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21
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Watson WD, Rayner JJ, Peterzan MA, Neubauer S, Rider OJ. 5219Visceral fat is the strongest predictor of diastolic dysfunction in a preserved ejection fraction group. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
- W D Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
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22
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Peterzan MA, Lygate CA, Lake HA, Rayner JJ, Hundertmark MJ, Apps AP, Sayeed RA, Petrou M, Krasopoulos G, Neubauer S, Clarke WT, Rodgers CT, Rider OJ. 6161Reduced myocardial ATP delivery in severe primary mitral regurgitation: a novel marker to guide timing of surgery? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Affiliation(s)
- M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Oxford, United Kingdom
| | - H A Lake
- University of Oxford, Oxford, United Kingdom
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M J Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A P Apps
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - R A Sayeed
- John Radcliffe Hospital, Oxford, United Kingdom
| | - M Petrou
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | - S Neubauer
- John Radcliffe Hospital, Oxford, United Kingdom
| | - W T Clarke
- University of Oxford, Oxford, United Kingdom
| | - C T Rodgers
- University of Cambridge, Wolfson Brain Imaging Centre, Cambridge, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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23
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Rayner JJ, Peterzan MA, Watson WD, Abdesselam I, Neubauer S, Rider OJ. 5220Intentional weight loss substantially improves left ventricular systolic function in obese patients with heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Affiliation(s)
- J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - M A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - W D Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - I Abdesselam
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - O J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford, United Kingdom
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24
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Rider O, Bull SC, Nethononda RM, Ntusi NA, Ferreira VM, Holloway C, Holdsworth DA, Mahmod M, Rayner JJ, Banerjee R, Myerson SG, Neubauer S, Watkins H. Using CMR to improve the diagnostic accuracy of the ECG for the detection of left ventricular hypertrophy; production of a simple adjustment for body mass index. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032553 DOI: 10.1186/1532-429x-18-s1-q35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Rayner JJ, Banerjee R, Francis JM, Neubauer S, Rider O. A pathway linking liver fat and arterial stiffness - direct as well as indirect effects. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032224 DOI: 10.1186/1532-429x-18-s1-q39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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26
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Rider OJ, Ntusi N, Bull SC, Nethononda R, Ferreira V, Holloway CJ, Holdsworth D, Mahmod M, Rayner JJ, Banerjee R, Myerson S, Watkins H, Neubauer S. Improvements in ECG accuracy for diagnosis of left ventricular hypertrophy in obesity. Heart 2016; 102:1566-72. [PMID: 27486142 PMCID: PMC5037604 DOI: 10.1136/heartjnl-2015-309201] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/25/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The electrocardiogram (ECG) is the most commonly used tool to screen for left ventricular hypertrophy (LVH), and yet current diagnostic criteria are insensitive in modern increasingly overweight society. We propose a simple adjustment to improve diagnostic accuracy in different body weights and improve the sensitivity of this universally available technique. METHODS Overall, 1295 participants were included-821 with a wide range of body mass index (BMI 17.1-53.3 kg/m(2)) initially underwent cardiac magnetic resonance evaluation of anatomical left ventricular (LV) axis, LV mass and 12-lead surface ECG in order to generate an adjustment factor applied to the Sokolow-Lyon criteria. This factor was then validated in a second cohort (n=520, BMI 15.9-63.2 kg/m(2)). RESULTS When matched for LV mass, the combination of leftward anatomical axis deviation and increased BMI resulted in a reduction of the Sokolow-Lyon index, by 4 mm in overweight and 8 mm in obesity. After adjusting for this in the initial cohort, the sensitivity of the Sokolow-Lyon index increased (overweight: 12.8% to 30.8%, obese: 3.1% to 27.2%) approaching that seen in normal weight (37.8%). Similar results were achieved in the validation cohort (specificity increased in overweight: 8.3% to 39.1%, obese: 9.4% to 25.0%) again approaching normal weight (39.0%). Importantly, specificity remained excellent (>93.1%). CONCLUSIONS Adjusting the Sokolow-Lyon index for BMI (overweight +4 mm, obesity +8 mm) improves the diagnostic accuracy for detecting LVH. As the ECG, worldwide, remains the most widely used screening tool for LVH, implementing these findings should translate into significant clinical benefit.
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Affiliation(s)
- Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Ntobeko Ntusi
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK Division of Cardiology, Department of Medicine Research, University of Capetown, South Africa
| | - Sacha C Bull
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Richard Nethononda
- Chris Hani Baragwanath Hospital, Soweto & University of Witwatersrand, Johannesburg, South Africa
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | | | - David Holdsworth
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Jennifer J Rayner
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Rajarshi Banerjee
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Saul Myerson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine and University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
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27
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Rayner JJ, Banerjee R, Francis JM, Shah R, Murthy VL, Byrne J, Neubauer S, Rider OJ. Normalization of Visceral Fat and Complete Reversal of Cardiovascular Remodeling Accompany Gastric Bypass, not Banding. J Am Coll Cardiol 2016; 66:2569-70. [PMID: 26653633 DOI: 10.1016/j.jacc.2015.09.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/08/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022]
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28
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Rayner JJ, Banerjee R, Francis JM, Shah RV, Murthy VL, Byrne J, Neubauer S, Rider O. Disproportionate abdominal visceral fat mass reduction and complete reversal of cardiovascular remodelling accompany Roux-en-Y gastric bypass but not gastric banding - benefits beyond simply weight loss. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032724 DOI: 10.1186/1532-429x-18-s1-o135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Rayner JJ, Banerjee R, Francis JM, Neubauer S, Rider O. Differential effects of body composition on left ventricular geometric remodelling and aortic elastic dysfunction in obesity. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032040 DOI: 10.1186/1532-429x-18-s1-q38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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30
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Rider OJ, Banerjee R, Rayner JJ, Shah R, Murthy VL, Robson MD, Neubauer S. Investigating a Liver Fat. Arterioscler Thromb Vasc Biol 2016; 36:198-203. [DOI: 10.1161/atvbaha.115.306561] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022]
Abstract
Objective—
To investigate the relationship between hepatic fat content, circulating triglyceride levels and aortic stiffness in adult and childhood obesity.
Approach and Results—
Seventy-seven adults and 18 children across a wide range of body mass index (18.5–52.6 kg/m
2
; percentile 8–100) with no identifiable cardiac risk factors underwent; 1H- magnetic resonance spectroscopy to quantify hepatic fat content and magnetic resonance imaging to assess aortic pulse wave velocity (PWV) and regional distensibility. In adults, multivariable regression showed age (β=0.09;
P
=0.02), liver fat (β=2.5;
P
=0.04), and serum triglyceride (β=0.47;
P
=0.01) to be independent predictors of PWV. Age and blood pressure–adjusted, moderated regression showed that 43% of the total negative effect of hepatic fat on PWV is attributable to indirect effects via increased triglyceride (
P
=0.005). In addition, regional distensibility was positively correlated with hepatic fat (ascending;
r
=−0.35; descending,
r
=−0.23; abdominal,
r
=−0.41; all
P
<0.001). Similar to that seen in adults, PWV (
r
=0.72;
P
<0.001) and abdominal regional distensibility (
r
=−0.52;
P
<0.001) were correlated with liver fat in children.
Conclusions—
Increasing age, liver fat, and triglyceride are all related to increased aortic stiffness in adults. Even when controlling for the effects of age and blood pressure, hepatic fat has a negative effect on PWV, with substantial indirect effect occurring via increased circulating triglyceride level. This relationship between hepatic fat and aortic stiffness occurs early in the obesity process and is also seen in children. As such, hepatic fat content is a potential therapeutic target to treat the elevated vascular risk in obesity.
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Affiliation(s)
- Oliver J. Rider
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Rajarshi Banerjee
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Jennifer J. Rayner
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Ravi Shah
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Venkatesh L. Murthy
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Matthew D. Robson
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
| | - Stefan Neubauer
- From the Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (O.J.R., R.B., J.J.R., M.D.R., S.N.); Beth Israel Deaconess Medical Center, Boston, MA (R.S.); and Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (V.L.M.)
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Rayner JJ, Neubauer S, Rider OJ. The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy. Obes Rev 2015; 16:679-90. [PMID: 26096833 DOI: 10.1111/obr.12292] [Citation(s) in RCA: 15] [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: 03/02/2015] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the 'obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.
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Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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