1
|
Moriyama S, Hieda M, Kisanuki M, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K, Fukuda H. Both New-Onset and Pre-Existing Hypertension Indicate Favorable Clinical Outcomes in Patients Treated With Anti-Vascular Endothelial Growth Factor Therapy. Circ J 2024; 88:217-225. [PMID: 36476830 DOI: 10.1253/circj.cj-22-0628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Hypertension is a frequent adverse event caused by vascular endothelial growth factor signaling pathway (VSP) inhibitors. However, the impact of hypertension on clinical outcomes during VSP inhibitor therapy remains controversial.Methods and Results: We reviewed 3,460 cancer patients treated with VSP inhibitors from the LIFE Study database, comprising Japanese claims data between 2016 and 2020. Patients were stratified into 3 groups based on the timing of hypertension onset: (1) new-onset hypertension (n=569; hypertension developing after VSP inhibitor administration); (2) pre-existing hypertension (n=1,790); and (3) no hypertension (n=1,101). Time to treatment failure (TTF) was used as the primary endpoint as a surrogate for clinical outcomes. The median (interquartile range) TTF in the new-onset and pre-existing hypertension groups was 301 (133-567) and 170 (72-358) days, respectively, compared with 146 (70-309) days in the non-hypertensive group (P<0.001 among all groups). In an adjusted Cox proportional hazard model, new-onset (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.50-0.68; P<0.001) and pre-existing (HR 0.85; 95% CI 0.73-0.98; P=0.026) hypertension were independent factors for prolonged TTF. The TTF of new-onset hypertension was longer than that of pre-existing hypertension (HR 0.68; 95% CI 0.62-0.76; P<0.001). CONCLUSIONS This study highlighted that new-onset hypertension induced by VSP inhibitors was an independent factor for favorable clinical outcomes. Pre-existing hypertension before VSP inhibitor initiation was also a significant factor.
Collapse
Affiliation(s)
- Shohei Moriyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Michinari Hieda
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Megumi Kisanuki
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Shotaro Kawano
- Division of Immunology and Rheumatology, Hamanomachi Hospital
| | - Taku Yokoyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Hitoshi Kusaba
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
- Division of Oncology, Hamanomachi Hospital
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
- Division of Cardiology, Haradoi Hospital
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University
| | - Koichi Akashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University
| |
Collapse
|
2
|
Wakeham DJ, Ivey E, Saland SA, Lewis JS, Palmer D, Morris M, Bleich JL, Weyand PG, Brazile TL, Hearon CM, Sarma S, MacNamara JP, Hieda M, Levine BD. Effects of Synchronizing Foot Strike and Cardiac Phase on Exercise Hemodynamics in Patients With Cardiac Resynchronization Therapy: A Within-Subjects Pilot Study to Fine-Tune Cardio-Locomotor Coupling for Heart Failure. Circulation 2023; 148:2008-2016. [PMID: 37830218 PMCID: PMC11032184 DOI: 10.1161/circulationaha.123.066170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Despite advances in medical and cardiac resynchronization therapy (CRT), individuals with chronic congestive heart failure (CHF) have persistent symptoms, including exercise intolerance. Optimizing cardio-locomotor coupling may increase stroke volume and skeletal muscle perfusion as previously shown in healthy runners. Therefore, we tested the hypothesis that exercise stroke volume and cardiac output would be higher during fixed-paced walking when steps were synchronized with the diastolic compared with systolic portion of the cardiac cycle in patients with CHF and CRT. METHODS Ten participants (58±17 years of age; 40% female) with CHF and previously implanted CRT pacemakers completed 5-minute bouts of walking on a treadmill (range, 1.5-3 mph). Participants were randomly assigned to first walking to an auditory tone to synchronize their foot strike to either the systolic (0% or 100±15% of the R-R interval) or diastolic phase (45±15% of the R-R interval) of their cardiac cycle and underwent assessments of oxygen uptake (V̇o2; indirect calorimetry) and cardiac output (acetylene rebreathing). Data were compared through paired-samples t tests. RESULTS V̇o2 was similar between conditions (diastolic 1.02±0.44 versus systolic 1.05±0.42 L/min; P=0.299). Compared with systolic walking, stroke volume (diastolic 80±28 versus systolic 74±26 mL; P=0.003) and cardiac output (8.3±3.5 versus 7.9±3.4 L/min; P=0.004) were higher during diastolic walking; heart rate (paced) was not different between conditions. Mean arterial pressure was significantly lower during diastolic walking (85±12 versus 98±20 mm Hg; P=0.007). CONCLUSIONS In patients with CHF who have received CRT, diastolic stepping increases stroke volume and oxygen delivery and decreases afterload. We speculate that, if added to pacemakers, this cardio-locomotor coupling technology may maximize CRT efficiency and increase exercise participation and quality of life in patients with CHF.
Collapse
Affiliation(s)
- Denis J Wakeham
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Erika Ivey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Sophie A Saland
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Joshua S Lewis
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | | | - Peter G Weyand
- Locomotor Performance Laboratory, Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, TX (P.G.W.)
| | - Tiffany L Brazile
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Christopher M Hearon
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Satyam Sarma
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - James P MacNamara
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Benjamin D Levine
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| |
Collapse
|
3
|
MacNamara JP, Dias KA, Hearon CM, Ivey E, Delgado VA, Saland S, Samels M, Hieda M, Turer AT, Link MS, Sarma S, Levine BD. Randomized Controlled Trial of Moderate- and High-Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise. J Am Heart Assoc 2023; 12:e031399. [PMID: 37830338 PMCID: PMC10757533 DOI: 10.1161/jaha.123.031399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
Background Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy. Methods and Results Patients with hypertrophic cardiomyopathy were randomized to either 5 months of MIT, or 1 month of MIT followed by 4 months of progressive HIT. Peak oxygen uptake (V˙O2; Douglas bags), cardiac output (acetylene rebreathing), and arteriovenous oxygen difference (Fick equation) were measured before and after training. Left ventricular outflow gradient and volumes were measured by echocardiography. Fifteen patients completed training (MIT, n=8, age 52±7 years; HIT, n=7, age 42±8 years). Both HIT and MIT improved peak V˙O2 by 1.3 mL/kg per min (P=0.009). HIT (+1.5 mL/kg per min) had a slightly greater effect than MIT (+1.1 mL/kg per min) but with no statistical difference (group×exercise P=0.628). A greater augmentation of arteriovenous oxygen difference occurred with exercise (Δ1.6 mL/100 mL P=0.005). HIT increased left ventricular end-diastolic volume (+17 mL, group×exercise P=0.015) compared with MIT. No serious arrhythmias or adverse cardiac events occurred. Conclusions This randomized trial of exercise training in patients with hypertrophic cardiomyopathy demonstrated that both HIT and MIT improved fitness without clear superiority of either. Although the study was underpowered for safety outcomes, no serious adverse events occurred. Exercise training resulted in salutary peripheral and cardiac adaptations. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03335332.
Collapse
Affiliation(s)
- James P. MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Katrin A. Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Christopher M. Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Erika Ivey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | | | - Sophie Saland
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of MedicineKyushu UniversityFukuokaJapan
| | - Aslan T. Turer
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Mark S. Link
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| |
Collapse
|
4
|
Futami S, Hieda M, Fukata M, Shiose A. A rare case of cardiac myxoma with light bulb-like cystic morphology: a case report. Eur Heart J Case Rep 2023; 7:ytad331. [PMID: 37547377 PMCID: PMC10398420 DOI: 10.1093/ehjcr/ytad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background Cystic myxomas are quite rare. Moreover, few reports have evaluated the causes that constituted them. Case summary A 73-year-old Asian man presented for pre-operative examination of osteoarthritis, and transthoracic echocardiography (TTE) revealed an incidental intracardiac mass. Therefore, he was referred to our department for further evaluation. He had no specific symptoms or family history related to tumours and heart failure. The TTE showed a 32 × 24 mm spherical mass adherent to the left atrial septum. The upper part of the mass was cystic in formation and hypoechoic inside and resembled a light bulb. Transoesophageal echocardiography showed the feeding arteries flowing from the bottom into the cystic part. In addition, two jet strips drained from the cystic part in the direction of the mitral valve. Coronary angiography revealed the feeding arteries, which consisted mainly of the right coronary artery conus branch and the left circumflex branch, and the blood flowed into the saccular area from the feeding arteries and excreted towards the mitral valve. Surgical resection was performed due to the mobility, and the histopathology confirmed a cystic myxoma. Discussion We described the unique anatomical formation of a cystic myxoma, which consisted of an exquisite balance between the tumour-feeding arteries and the draining outlet vessels.
Collapse
Affiliation(s)
- Shutaro Futami
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Clinical Research Building B6F, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
| | | | - Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Clinical Research Building B6F, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
| | | |
Collapse
|
5
|
Sarma S, MacNamara JP, Hieda M, Howden EJ, Lawley JS, Livingston S, Samels M, Levine BD. SERCA2a Agonist Effects on Cardiac Performance During Exercise in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2023:S2213-1779(23)00090-2. [PMID: 37086245 DOI: 10.1016/j.jchf.2023.02.006] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Impaired ventricular relaxation influences left ventricular pressures during exercise in heart failure with preserved ejection fraction (HFpEF). Sarco/endoplasmic reticulum calcium-adenosine triphosphatase (SERCA2a) facilitates myocardial relaxation by increasing calcium reuptake and is impaired in HFpEF. OBJECTIVES This study sought to investigate the effects of istaroxime, a SERCA2 agonist, on lusitropic and hemodynamic function during exercise in patients with HFpEF and control subjects. METHODS Eleven control subjects (7 male, 4 female) and 15 patients with HFpEF (8 male, 7 female) performed upright cycle exercise with right-sided heart catheterization. Participants received istaroxime (0.5 mg/kg/min) or saline placebo (single-blind, crossover design). Cardiac output, pulmonary capillary wedge pressure (PCWP), and diastolic function were measured at rest and during submaximal exercise. In an exploratory analysis (Hedges' g), 7 patients with HFpEF received higher-dose istaroxime (1.0 mg/kg/min). End-systolic elastance (Ees) was calculated by dividing systolic blood pressure (SBP) × 0.9 by end-systolic volume (ESV; on 3-dimensional echocardiography). RESULTS Patients with HFpEF had higher PCWP (25 ± 10 mm Hg vs 12 ± 5 mm Hg; P < 0.001) and lower tissue Doppler velocities during exercise. Istaroxime (0.5 mg/kg/min) had no effect on resting or exercise measures in patients with HFpEF or control subjects. Control subjects had a larger increase in Ees (Δ 1.55 ± 0.99 mm Hg/mL vs D 0.86 ± 1.31 mm Hg/mL; P = 0.03), driven by lower ESV. Comparing placebo and istaroxime 1.0 mg /kg/min during exercise, PCWP during the 1.0 mg /kg/min istaroxime dose was slightly lower (Δ 2.2 mm Hg; Hedges' g = 0.30). There were no effects on diastolic function, but there were increases in SBP and s', suggesting a mild inotropic effect. CONCLUSIONS Low-dose istaroxime had no effect on cardiac filling pressure or parameters of relaxation in patients with HFpEF during exercise. Higher doses of istaroxime may have been more effective in reducing exercise PCWP in patients with HFpEF. (Hemodynamic Response to Exercise in HFpEF Patients After Upregulation of SERCA2a; NCT02772068).
Collapse
Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, School of Medicine, Kyushu University, Fukuoka, Japan; Department of Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Justin S Lawley
- Department Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
6
|
Maruyama T, Hieda M, Eiraku K, Uozumi Y, Nomura H. Constipation and heart failure: An overlooked but important linkage. Geriatr Gerontol Int 2023; 23:255-256. [PMID: 36697380 DOI: 10.1111/ggi.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | - Yuki Uozumi
- Department of Medicine, Hara Doi Hospital, Japan
| | | |
Collapse
|
7
|
McKenna ZJ, Moralez G, Romero SA, Hieda M, Huang M, Cramer MN, Sarma S, MacNamara JP, Jaffery MF, Atkins WC, Foster J, Crandall CG. Cardiac remodeling in well-healed burn survivors after 6 months of unsupervised progressive exercise training. J Appl Physiol (1985) 2023; 134:405-414. [PMID: 36633867 PMCID: PMC9902219 DOI: 10.1152/japplphysiol.00630.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training improves cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Secondary analyses explored relations between burn surface area and changes in cardiac structure in the cohort of burn survivors. V̇o2peak assessments and cardiac magnetic resonance imaging were performed at baseline and following 6 months of progressive exercise training from 19 well-healed burn survivors and 10 nonburned control participants. V̇o2peak increased following 6 months of training in both groups (Control: Δ5.5 ± 5.8 mL/kg/min; Burn Survivors: Δ3.2 ± 3.6 mL/kg/min, main effect of training, P < 0.001). Left ventricle (LV) mass (Control: Δ1.7 ± 3.1 g/m2; Burn survivors: Δ1.8 ± 2.7 g/m2), stroke volume (Control: Δ5.8 ± 5.2 mL/m2; Burn Survivors: Δ2.8 ± 4.2 mL/m2), and ejection fraction (Control: Δ2.4 ± 4.0%; Burn Survivors: Δ2.2 ± 4.3%) similarly increased following 6 months of exercise training in both cohorts (main effect of training P < 0.05 for all indexes). LV end-diastolic volume increased in the control group (Δ6.5 ± 4.5 mL/m2) but not in the cohort of burn survivors (Δ1.9 ± 2.7 mL/m2, interaction, P = 0.040). Multiple linear regression analyses revealed that burn surface area had little to no effect on changes in ventricular mass or end-diastolic volumes in response to exercise training. Our findings provide initial evidence of physiological cardiac remodeling, which is not impacted by burn size, in response to exercise training in individuals with well-healed burn injuries.NEW & NOTEWORTHY Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training would improve cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Our findings highlight the ability of exercise training to modify cardiac structure and function in well-healed burn survivors and nonburned sedentary controls alike.
Collapse
Affiliation(s)
- Zachary J McKenna
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Gilbert Moralez
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven A Romero
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | | | - Mu Huang
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Satyam Sarma
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - James P MacNamara
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Manall F Jaffery
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Whitley C Atkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| |
Collapse
|
8
|
Sato T, Hieda M, Futami S, Fukata M, Shiose A. Evaluation of coronary flow is useful in patients with left coronary cusp thrombus formation after left ventricular assist device implantation. Eur Heart J Case Rep 2023; 7:ytad025. [PMID: 36727124 PMCID: PMC9883730 DOI: 10.1093/ehjcr/ytad025] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/22/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Left ventricular assist device (LVAD) is essential for patients with severe heart failure, but there is a risk of thrombus formation on the aortic root and cusps, leading to coronary artery occlusion. Even with the narrowing of the echo-window due to LVAD, careful observation of coronary flow by transthoracic echocardiography can evaluate the patency of coronary flow non-invasively and immediately.
Collapse
Affiliation(s)
- Tasuku Sato
- Heart Center, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Corresponding author. Tel: +81 92 642 5235, Fax: +81 92 642 5247,
| | - Shutaro Futami
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, Kyushu University Hospital, School of Medicine, Kyushu University, 3-1-1 Maidashi Higashi-Ku Fukuoka City, Clinical Research Building B7F, Fukuoka 812-8586, Japan
| | - Mitsuhiro Fukata
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, Kyushu University Hospital, School of Medicine, Kyushu University, 3-1-1 Maidashi Higashi-Ku Fukuoka City, Clinical Research Building B7F, Fukuoka 812-8586, Japan
| | | |
Collapse
|
9
|
Moriyama S, Hieda M, Kisanuki M, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K, Fukuda H. Effect of renin-angiotensin system inhibitors in patients with cancer treated with anti-VEGF therapy. Open Heart 2022; 9:openhrt-2022-002135. [PMID: 36600585 PMCID: PMC9743396 DOI: 10.1136/openhrt-2022-002135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer treatment with vascular endothelial growth factor signalling pathway (VSP) inhibitors frequently causes hypertension. Although previous reports suggested that the antihypertensive drug renin-angiotensin system inhibitor (RASI) may have a positive synergistic effect with VSP inhibitors, the actual impact on clinical outcomes is unknown. OBJECTIVES The study aims to clarify whether RASIs exhibit clinical benefits for patients with cancer with hypertension. METHOD From the Longevity Improvement and Fair Evidence Study database, comprising Japanese claims data between 2016 and 2020, we reviewed 2380 patients treated with VSP inhibitors who received antihypertensive treatment during cancer therapy. The patients were classified into two groups: with-RASI (n=883) and without-RASI (n=1497). In addition, 1803 of these patients treated for hypertension with RASI-only (n=707) or calcium channel blocker-only (n=1096) were also reviewed. The time-to-treatment failure (TTF), the interval from initiation of chemotherapy to its discontinuation, was applied as the primary endpoint. RESULTS The median TTFs were 167 (60-382) days in the with-RASI group and 161 (63-377) days in the without-RASI group (p=0.587). All models, including Cox proportional hazard models and multiple propensity score models, did not reveal the superiority of with-RASI treatment. In the propensity score matching model, the HR for treatment with-RASI compared with that for without-RASI was 0.96 (95% CI 0.86 to 1.06, p=0.386). In addition, the TTFs of RASI-only were not superior to calcium channel blocker-only (p=0.584). CONCLUSIONS RASIs for hypertension do not benefit clinical outcomes during cancer therapy with VSP inhibitors. In addition, RASIs and calcium channel blockers have comparable clinical efficacy as first-line antihypertensive.
Collapse
Affiliation(s)
- Shohei Moriyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Megumi Kisanuki
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shotaro Kawano
- Division of Immunology and Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| | - Taku Yokoyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsuhiro Fukata
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hitoshi Kusaba
- Division of Oncology, Hamanomachi Hospital, Fukuoka, Japan
| | - Toru Maruyama
- Campus Life Health Center, Kyushu University, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
| |
Collapse
|
10
|
Hieda M, Futami S, Tanaka H, Moriyama S, Masui S, Kisanuki M, Hatakeyama K, Irie K, Yokoyama T, Fukata M, Arita T, Maruyama T, Nomura H, Akashi K. Natural history of severe aortic stenosis in elderly heart failure patients who declined transcatheter aortic valve implantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is an established minimally invasive treatment for elderly patients with severe aortic stenosis (AS). Although it is a relatively minimally invasive procedure, many elderly patients cannot undergo TAVI due to advanced age, advanced dementia, significantly impaired ADL, or because the patient or family does not wish to undergo TAVI. In general, severe AS patients died 5 years after an angina attack, 3 years after syncope symptoms, and 2 years after heart failure symptoms. However, few studies have investigated the prognosis of elderly patients with severe AS who declined TAVI.
Purpose
This study aimed to comprehend the natural history of elderly severe AS patients who declined aortic valve intervention and identify risk factors for death in the TAVI era.
Methods
We retrospectively reviewed 2,786 echocardiographic data from our hospital between 2017 and 2021. We identified 504 patients with AS in the echocardiography database. The severe AS was defined by the following echocardiography parameters: peak aortic flow velocity ≥4.0 m/s, aortic valve mean gradient ≥40 mmHg, aortic valve area (AVA)<1.0 cm2, or AVA index<0.6 cm2/m2. Patients with mild and moderate AS and patients who underwent surgical or transcatheter aortic valve intervention were excluded. Eventually, 82 patients fulfilled the study criteria and were analyzed in this study. Clinical events were investigated, and Cox proportional hazards analysis was performed to elucidate risk factors for mortality.
Results
The mean age was 89±6 years, and 63 (77%) were women. AHA/ACC classification was Stage A/B/C/D: 0%/52.4%/39.0%/8.5%. As event occurrence, we detected 34 (41.5%) all-cause deaths, 41 (50.0%) major adverse cardiovascular events, 32 (39.0%) development of heart failure, 13 (15.9%) chest pain attacks, and 3 (3.7%) syncope. The time from diagnosis of severe AS to all-cause death was 227±273 days, and the 1-, 2-, and 3-year survival rates were 61.5%, 46.2%, and 36.9%, respectively. Of the heart failure-onset population, 16 (50.0%) were found to have severe AS on initial heart failure admission. The incidence of heart failure at 1, 2, and 3 years after diagnosis of severe AS was 60.1%, 56.7%, and 45.4%, respectively. The time from heart failure to death was 107±147 days. Cox proportional hazards analysis adjusted with age, sex, comorbidities revealed that dementia (HR 4.5, P=0.014) and Katz index <5 (HR7.8, P=0.009) were independent risk factors for mortality.
Conclusions
Compared to the comprehension of the natural history of AS patients, the prognosis in severe AS patients who declined TAVI was extremely poor. Although the elderly patients did not have a high rate of angina attacks or syncope symptoms, probably due to their reduced ADL, the results suggest that dementia prevention and maintenance of exercise tolerance are essential since dementia and reduced ADL (Katz<5) are independent risk factors for mortality.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Clinical Research Promotion Foundation Reiwa 2 Michinari Hieda
Collapse
Affiliation(s)
- M Hieda
- Kyushu University Hospital , Fukuoka , Japan
| | - S Futami
- Kyushu University Hospital , Fukuoka , Japan
| | - H Tanaka
- Kyushu University Hospital , Fukuoka , Japan
| | - S Moriyama
- Kyushu University Hospital , Fukuoka , Japan
| | - S Masui
- Kyushu University Hospital , Fukuoka , Japan
| | - M Kisanuki
- Kyushu University Hospital , Fukuoka , Japan
| | | | - K Irie
- Kyushu University Hospital , Fukuoka , Japan
| | - T Yokoyama
- Kyushu University Hospital , Fukuoka , Japan
| | - M Fukata
- Kyushu University Hospital , Fukuoka , Japan
| | - T Arita
- Fukuoka Wajiro Hospital , Fukuoka , Japan
| | - T Maruyama
- Kyushu University Hospital , Fukuoka , Japan
| | - H Nomura
- Haradoi Hospital , Fukuoka , Japan
| | - K Akashi
- Kyushu University Hospital , Fukuoka , Japan
| |
Collapse
|
11
|
Eiraku K, Uozumi Y, Hieda M, Maruyama T, Nomura H. A senile case of heart failure associated with hypermagnesemia induced by magnesium-containing laxative agent. Geriatr Gerontol Int 2022; 22:897-899. [PMID: 36071490 PMCID: PMC9826176 DOI: 10.1111/ggi.14478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
|
12
|
Fischer M, Moralez G, Sarma S, MacNamara JP, Cramer MN, Huang M, Romero SA, Hieda M, Shibasaki M, Ogoh S, Crandall CG. Altered cardiac β1 responsiveness in hyperthermic older adults. Am J Physiol Regul Integr Comp Physiol 2022; 323:R581-R588. [PMID: 36094450 PMCID: PMC9602700 DOI: 10.1152/ajpregu.00040.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
Abstract
Compared with younger adults, passive heating induced increases in cardiac output are attenuated by ∼50% in older adults. This attenuated response may be associated with older individuals' inability to maintain stroke volume through ionotropic mechanisms and/or through altered chronotropic mechanisms. The purpose of this study was to identify the interactive effect of age and hyperthermia on cardiac responsiveness to dobutamine-induced cardiac stimulation. Eleven young (26 ± 4 yr) and 8 older (68 ± 5 yr) participants underwent a normothermic and a hyperthermic (baseline core temperature +1.2°C) trial on the same day. In both thermal conditions, after baseline measurements, intravenous dobutamine was administered for 12 min at 5 µg/kg/min, followed by 12 min at 15 µg/kg/min. Primary measurements included echocardiography-based assessments of cardiac function, gastrointestinal and skin temperatures, heart rate, and mean arterial pressure. Heart rate responses to dobutamine were similar between groups in both thermal conditions (P > 0.05). The peak systolic mitral annular velocity (S'), i.e., an index of left ventricular longitudinal systolic function, was similar between groups for both thermal conditions at baseline. While normothermic, the increase in S' between groups was similar with dobutamine administration. However, while hyperthermic, the increase in S' was attenuated in the older participants with dobutamine (P < 0.001). Healthy, older individuals show attenuated inotropic, but maintained chronotropic responsiveness to dobutamine administration during hyperthermia. These data suggest that older individuals have a reduced capacity to increase cardiomyocyte contractility, estimated by changes in S', via β1-adrenergic mechanisms while hyperthermic.
Collapse
Affiliation(s)
- Mads Fischer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- School of Medicine, Kyushu University, Fukuoka, Japan
| | - Manabu Shibasaki
- Department of Environmental Health, Nara Women's University, Nara, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
13
|
MacNamara JP, Dias KA, Hearon CM, Hieda M, Turer AT, Link MS, Sarma S, Levine BD. Limits to Submaximal and Maximal Exercise in Patients with Hypertrophic Cardiomyopathy. J Appl Physiol (1985) 2022; 133:787-797. [PMID: 35952351 DOI: 10.1152/japplphysiol.00566.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) often have reduced exercise capacity, and it is unclear whether cardiovascular regulation during exercise is intact in these patients. We aimed to determine the relationship between cardiac output (Q̇c) and oxygen uptake (V̇O2), and stroke volume (SV) reserve in HCMcompared to healthy participants and participants with left ventricular hypertrophy (LVH) but not HCM. METHODS Sixteen patients with HCM (48±7 years, 44% female), 16 participants with LVH (49±5 years, 44% female), and 61 healthy controls (CON: 52±5 years, 52% female) completed submaximal steady-state treadmill exercise followed by a maximal exercise test. V̇O2, Q̇c,SV and arterio-venous oxygen difference were measured during rest and exercise, and Q̇c/V̇O2 slopes were constructed. RESULTS The Q̇c/V̇O2 slopewas blunted in HCM compared to CON and LVH (HCM 4.9±0.7 vs. CON 5.5± 1.0 [P = 0.027], vs LVH 6.0±1.0AU [P = 0.002]) and participants with HCM had a lower SV reserve (HCM 53±33%, controls 83±33%, LVH 82±22%; HCM vs. controls P = 0.002; HCM vs. LVH P = 0.015). Despite a blunted Q̇c/V̇O2 slope, 75% of patients with HCM achieved ≥80% predicted V̇O2max by augmenting a-vO2 difference at maximal exercise (16.0±0.8 mL/100mL vs 13.8±2.7 mL/100mL, P = 0.021). CONCLUSIONS Patients with HCM do not appropriately match Q̇c to metabolic demand, primarily due to inadequate stroke volume augmentation. Despite this central limitation, many patients achieve normal exercise capacities by significantly increasing peripheral oxygen extraction.
Collapse
Affiliation(s)
- James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States.,Kyushu University, School of Medicine, Department of Medicine and Biosystemic Science, Fukuoka, Japan
| | - Aslan T Turer
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
14
|
Kusaba H, Moriyama S, Hieda M, Ito M, Ohmura H, Isobe T, Tsuchihashi K, Fukata M, Ariyama H, Baba E. IMPROVE bleeding score predicts major bleeding in advanced gastrointestinal cancer patients with venous thromboembolism. Jpn J Clin Oncol 2022; 52:1183-1190. [PMID: 35766165 DOI: 10.1093/jjco/hyac103] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of venous thromboembolism has been reported as 20% in cancer patients. Anticoagulation therapy is the standard treatment for venous thromboembolism. On the other hand, bleeding should be carefully managed, because advanced cancer, particularly gastrointestinal cancer, carries a high risk of bleeding. However, the optimal management for cancer-associated thromboembolism remains to be clarified. METHODS We retrospectively examined patients with advanced gastrointestinal cancer, including gastric cancer and colorectal cancer, who were treated with chemotherapy between 2014 and 2018 for the incidence and characteristics of venous thromboembolism and bleeding. RESULTS In total, 194 patients (120 men, 74 women) were enrolled in this study. The underlying pathology was gastric cancer in 74 cases and colorectal cancer in 120 cases. Of the 194 patients, 40 patients (20.6%) were diagnosed with venous thromboembolism and 10 patients (5.2%) were diagnosed with concomitant pulmonary thromboembolism. Conversely, bleeding was observed in 29 patients (15%). The location of bleeding was the primary tumor in 17 cases, metastatic tumor in 9 and hemorrhagic gastric ulcer in 3. Within the venous thromboembolism group (n = 40), bleeding was observed in 10 patients (25%). Multivariate analysis showed that International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding score ≥7 correlated significantly with major bleeding (P = 0.01). In patients with a low risk of bleeding, major bleeding was observed in only three patients. CONCLUSIONS IMPROVE bleeding score may predict the risk for bleeding in gastrointestinal cancer patients with venous thromboembolism. Selecting patients with a low risk of bleeding using with IMPROVE bleeding score is expected to contribute to the safer management of anticoagulation therapy for cancer-associated thromboembolism.
Collapse
Affiliation(s)
- Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuroinflammation and Brain Fatigue Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mamoru Ito
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Ohmura
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taichi Isobe
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kenji Tsuchihashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuhiro Fukata
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Ariyama
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| |
Collapse
|
15
|
Fukudome Y, Hieda M, Masui S, Yokoyama T, Futami S, Moriyama S, Irie K, Fukata M, Ushijima T, Shiose A, Akashi K. Case Report: Bronchogenic Cyst in the Right Atrium of a Young Woman. Front Cardiovasc Med 2022; 9:915876. [PMID: 35711360 PMCID: PMC9197382 DOI: 10.3389/fcvm.2022.915876] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 12/03/2022] Open
Abstract
A 31-year-old woman was referred to our hospital for evaluation of a cardiac mass in the right atrium. Cardiac magnetic resonance imaging indicated a cystic mass filled with fluid accumulation in the right atrium. The mass was identified as a cardiac cyst and was surgically removed. Pathological examination revealed an extremely rare bronchogenic cyst. Bronchogenic cysts are benign congenital abnormalities of primitive foregut origins that form in the mediastinum during embryonic development. There is unusual clinical dilemmas surrounding the treatment plan for cardiac surgery or biopsy of cardiac masses, especially in patients with rare cardiac cysts. The anatomical location of the cyst can be related to various clinical symptoms and complications. In cases of indeterminate cardiac cysts, direct cyst removal without prior biopsy is of utmost importance.
Collapse
Affiliation(s)
- Yuya Fukudome
- Heart Center, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
- *Correspondence: Michinari Hieda,
| | - Shiho Masui
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Taku Yokoyama
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shutaro Futami
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kei Irie
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsuhiro Fukata
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Koichi Akashi
- Department of Medicine and Bio-systemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University Hospital, Fukuoka, Japan
| |
Collapse
|
16
|
Moriyama S, Fukata M, Hieda M, Yokoyama T, Yoshimoto G, Kusaba H, Nakashima Y, Miyamoto T, Maruyama T, Akashi K. Early-onset cardiac dysfunction following allogeneic haematopoietic stem cell transplantation. Open Heart 2022; 9:openhrt-2022-002007. [PMID: 35606045 PMCID: PMC9125755 DOI: 10.1136/openhrt-2022-002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveHeart failure following allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a serious complication that requires early detection; however, the clinical implications of early-onset cancer therapy-related cardiac dysfunction (CTRCD) following allo-HSCT remain unclear. We investigated the determinants and prognostic impact of early-onset CTRCD in allo-HSCT recipients.MethodsThe records of 136 patients with haematological malignancies who underwent allo-HSCT at our institute were retrospectively reviewed. Early-onset CTRCD was defined as a decrease in left ventricular ejection fraction (LVEF) of ≥10% and an LVEF of ≤53% within 100 days after HSCT.ResultsEarly-onset CTRCD was diagnosed in 23 out of 136 included patients (17%), and the median duration from HSCT to CTRCD diagnosis was 24 (9–35) days. Patients were followed up for 347 (132–1268) days. In multivariate logistic regression analysis, cumulative doxorubicin dosage (each 10 mg/m2) and severity of acute graft-versus-host disease (GVHD/grade) were independent indicators of early-onset CTRCD (OR (95% CI) 1.04 (1.00 to 1.07); p=0.032; OR (95% CI) 1.87 (1.19 to 2.95), p=0.004, respectively). The overall and primary disease death rates were significantly higher in allo-HSCT recipients with early-onset CTRCD than in those without early-onset CTRCD (HR (95% CI) 1.98 (1.11 to 3.52), p=0.016; HR (95% CI) 2.96 (1.40 to 6.29), p=0.005, respectively), independent of primary disease type, remission status and transplantation type.ConclusionsSevere acute GVHD and higher cumulative anthracycline are two significant determinants of early-onset CTRCD. Early-onset CTRCD following allo-HSCT regulates survival in patients with haematological malignancies.
Collapse
Affiliation(s)
- Shohei Moriyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsuhiro Fukata
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Taku Yokoyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Goichi Yoshimoto
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hitoshi Kusaba
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuhiro Nakashima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshihiro Miyamoto
- Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Toru Maruyama
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| |
Collapse
|
17
|
Hearon CM, Dias KA, MacNamara JP, Hieda M, Mantha Y, Harada R, Samels M, Morris M, Szczepaniak LS, Levine BD, Sarma S. 1 Year HIIT and Omega-3 Fatty Acids to Improve Cardiometabolic Risk in Stage-A Heart Failure. JACC Heart Fail 2022; 10:238-249. [PMID: 35361442 DOI: 10.1016/j.jchf.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aims to determine whether 1 year of high-intensity interval training (HIIT) and omega-3 fatty acid (n-3 FA) supplementation would improve fitness, cardiovascular structure/function, and body composition in obese middle-aged adults at high-risk of heart failure (HF) (stage A). BACKGROUND It is unclear if intensive lifestyle interventions begun in stage A HF can improve key cardiovascular and metabolic risk factors. METHODS High-risk obese adults (n = 80; age 40 to 55 years; N-terminal pro-B-type natriuretic peptide >40 pg/mL or high-sensitivity cardiac troponin T >0.6 pg/mL; visceral fat >2 kg) were randomized to 1 year of HIIT exercise or attention control, with n-3 FA (1.6 g/daily omega-3-acid ethyl esters) or placebo supplementation (olive oil 1.6 g daily). Outcome variables were exercise capacity quantified as peak oxygen uptake (V.O2), left ventricular (LV) mass, LV volume, myocardial triglyceride content (magnetic resonance spectroscopy), arterial stiffness/function (central pulsed-wave velocity; augmentation index), and body composition (dual x-ray absorptiometry scan). RESULTS Fifty-six volunteers completed the intervention. There was no detectible effect of HIIT on visceral fat or myocardial triglyceride content despite a reduction in total adiposity (Δ: -2.63 kg, 95% CI: -4.08 to -0.46, P = 0.018). HIIT improved exercise capacity by ∼24% (ΔV.O2: 4.46 mL/kg per minute, 95% CI: 3.18 to 5.56; P < 0.0001), increased LV mass (Δ: 9.40 g, 95% CI: 4.36 to 14.44; P < 0.001), and volume (Δ: 12.33 mL, 95 % CI: 5.61 to 19.05; P < 0.001) and reduced augmentation index (Δ: -4.81%, 95% CI: -8.63 to -0.98; P = 0.009). There was no independent or interaction effect of n-3 FA on any outcome. CONCLUSIONS One-year HIIT improved exercise capacity, cardiovascular structure/function, and adiposity in stage A HF with no independent or additive effect of n-3 FA administration. (Improving Metabolic Health in Patients With Diastolic Dysfunction [MTG]; NCT03448185).
Collapse
Affiliation(s)
- Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yogamaya Mantha
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Rakushumimarika Harada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Lidia S Szczepaniak
- Biomedical Research Consulting in Magnetic Resonance Spectroscopy, Albuquerque, New Mexico, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
18
|
Hatakeyama K, Hieda M, Semba Y, Moriyama S, Wang Y, Maeda T, Kato K, Miyamoto T, Akashi K, Kikushige Y. TET2 Clonal Hematopoiesis Is Associated With Anthracycline-Induced Cardiotoxicity in Patients With Lymphoma. JACC CardioOncol 2022; 4:141-143. [PMID: 35492814 PMCID: PMC9040099 DOI: 10.1016/j.jaccao.2022.01.098] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yoshikane Kikushige
- Kyushu University Graduate School of Medicine, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
19
|
Hieda M, Levine BD. Response by Hieda and Levine to Letter Regarding Article, "One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients With Stage B Heart Failure With Preserved Ejection Fraction". Circulation 2022; 145:e644. [PMID: 35226555 DOI: 10.1161/circulationaha.122.058733] [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: 11/16/2022]
Affiliation(s)
- Michinari Hieda
- Department of Medicine and Biosystemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan (M.H.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (B.D.L.).,University of Texas Southwestern Medical Center, Dallas (B.D.L.)
| |
Collapse
|
20
|
Maruyama T, Hieda M, Mawatari S, Fujino T. Rheological Abnormalities in Human Erythrocytes Subjected to Oxidative Inflammation. Front Physiol 2022; 13:837926. [PMID: 35283782 PMCID: PMC8905344 DOI: 10.3389/fphys.2022.837926] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/31/2022] [Indexed: 12/26/2022] Open
Abstract
Erythrocytes are oxygen carriers and exposed to redox cycle in oxygenation and deoxygenation of hemoglobin. This indicates that circulating erythrocytes are vulnerable to the oxidative injury occurring under the imbalance of redox homeostasis. In this review article, two topics are presented concerning the human erythrocytes exposed to the oxidative inflammation including septic and sterile conditions. First, we demonstrate rheological derangement of erythrocytes subjected to acute oxidative injury caused by exogenous generators of reactive oxygen species (ROS). Erythrocyte filterability as whole-cell deformability has been estimated by the gravity-based nickel mesh filtration technique in our laboratory and was dramatically impaired in a time-dependent manner after starting exposure to the ROS generators, that is associated with concurrent progression of membrane protein degradation, phospholipid peroxidation, erythrocyte swelling, methemoglobin formation, and oxidative hemolysis. Second, we introduce an impairment of erythrocyte filterability confirmed quantitatively in diabetes mellitus and hypertension of animal models and patients under treatment. Among the cell geometry, internal viscosity, and membrane property as the three major determinants of erythrocyte deformability, erythrocyte membrane alteration is supposed to be the primary cause of this impairment in these lifestyle-related diseases associated with persistent oxidative inflammation. Excessive ROS trigger the inflammatory responses and reduce the erythrocyte membrane fluidity. Oxidative inflammation increasing erythrocyte membrane rigidity underlies the impaired systemic microcirculation, which is observed in diabetic and/or hypertensive patients. On the other hand, elevated internal viscosity caused by sickle hemoglobin polymerization is a primary cause of impaired erythrocyte filterability in sickle cell disease (SCD). However, oxidative inflammation is also involved in the pathophysiology of SCD. The physiologic level of ROS acts as signaling molecules for adaptation to oxidative environment, but the pathological level of ROS induces suicidal erythrocyte death (eryptosis). These findings provide further insight into the ROS-related pathophysiology of many clinical conditions.
Collapse
Affiliation(s)
- Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shiro Mawatari
- Institute of Rheological Function of Foods Co., Ltd., Hisayama, Japan
| | - Takehiko Fujino
- Institute of Rheological Function of Foods Co., Ltd., Hisayama, Japan
| |
Collapse
|
21
|
Mantha Y, Futami S, Moriyama S, Hieda M. Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis. Front Cardiovasc Med 2021; 8:742297. [PMID: 34926605 PMCID: PMC8674501 DOI: 10.3389/fcvm.2021.742297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Abstract
The hemodynamic effects of aortic stenosis (AS) consist of increased left ventricular (LV) afterload, reduced myocardial compliance, and increased myocardial workload. The LV in AS patients faces a double load: valvular and arterial loads. As such, the presence of symptoms and occurrence of adverse events in AS should better correlate with calculating the global burden faced by the LV in addition to the transvalvular gradient and aortic valve area (AVA). The valvulo-arterial impedance (Zva) is a useful parameter providing an estimate of the global LV hemodynamic load that results from the summation of the valvular and vascular loads. In addition to calculating the global LV afterload, it is paramount to estimate the stenosis severity accurately. In clinical practice, the management of low-flow low-gradient (LF-LG) severe AS with preserved LV ejection fraction requires careful confirmation of stenosis severity. In addition to the Zva, the dimensionless index (DI) is a very useful parameter to express the size of the effective valvular area as a proportion of the cross-section area of the left ventricular outlet tract velocity-time integral (LVOT-VTI) to that of the aortic valve jet (dimensionless velocity ratio). The DI is calculated by a ratio of the sub-valvular velocity obtained by pulsed-wave Doppler (LVOT-VTI) divided by the maximum velocity obtained by continuous-wave Doppler across the aortic valve (AV-VTI). In contrast to AVA measurement, the DI does not require the calculation of LVOT cross-sectional area, a major cause of erroneous assessment and underestimation of AVA. Hence, among patients with LG severe AS and preserved LV ejection fraction, calculation of DI in routine echocardiographic practice may be useful to identify a subgroup of patients at higher risk of mortality who may derive benefit from aortic valve replacement. This article aims to elucidate the Zva and DI in different clinical situations, correlate with the standard indexes of AS severity, LV geometry, and function, and thus prove to improve risk stratification and clinical decision making in patients with severe AS.
Collapse
Affiliation(s)
- Yogamaya Mantha
- Division of Cardiovascular Medicine, University of Texas Health Sciences, San Antonio, TX, United States
| | - Shutaro Futami
- Department of Medicine and Biosystemic Science, Hematology, Oncology and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan
| | - Shohei Moriyama
- Department of Medicine and Biosystemic Science, Hematology, Oncology and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, Hematology, Oncology and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan
| |
Collapse
|
22
|
Moriyama S, Hieda M, Fukuda H, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K. Impact of hypertension on clinical outcome in patients treated with vascular endothelial growth factor inhibitors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vascular endothelial growth factor (VEGF) family is overexpressed in the tumor microenvironment and induces tumor angiogenesis.1 VEGF signaling pathway (VSP) inhibitors are essential therapeutic drugs for solid cancer patients.2 However, VSP inhibitors often provoke drug-specific anti-angiogenesis in normal tissues, which was referred to as on-target toxicity.2 Hypertension (HTN) is one of the most frequent adverse events caused by VSP inhibitors. A previous report demonstrated that VSP inhibitor-induced hypertension is a favorable prognostic factor, contrarily.3However, multiple VSP inhibitors are administered in various cancer types, and then the relation between VSP inhibitor-associated hypertension and clinical outcome is still controversial.
Purpose
The aim of this study is to elucidate the impacts of HTN and the timing of onset on clinical outcome during cancer therapy with VSP inhibitors.
Method
We reviewed 2,348 patients who were treated with VSP inhibitors from the LIFE Study database, consisting of 14 municipality-level information from claims data between 2016 and 2020. According to the timing of HTN onset mode, the patients were stratified into 3 groups; (1) new-onset HTN group (n=334): de novo development after VSP inhibitor administration, (2) pre-existing HTN group (n=1,363): existing HTN at baseline, including aggravation after VSP inhibitor initiation, and (3) no HTN group (n=651) (Figure 1). The time to treatment failure (TTF) was applied as a surrogate clinical indicator of overall survival. Event-free survival analysis with the log-rank test was conducted for time to first treatment failure amongst the 3 groups. In addition, Cox proportional hazard models adjusted with clinical characteristics were performed to investigate independent factors for TTF.
Results
In the event-free survival analysis, both the new-onset HTN and the pre-existing HTN were associated with prolongation of TTF, compared to the non-HTN (p<0.001 and p<0.001, respectively, by Bonferroni correction) (Figure 2). The New-onset HTN was significantly associated with longer TTF than pre-existing HTN (p<0.001). In Cox proportional hazard model adjusted with age, sex, past medical history, primary cancer lesion, and type of VSP inhibitors, the new-onset HTN and the pre-existing HTN were independent favorable factors, compared to the non-HTN [new-onset HTN: Hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.54 - 0.71, p<0.001; and pre-existing HTN: HR 0.85, 95% CI 0.77 - 0.94, p<0.005]. Moreover, the New-onset HTN was also a significant factor for longer TTF, compared to the pre-existing HTN [HR 0.72, 95% CI 0.64 - 0.82, p<0.001].
Conclusion
In patients treated with VSP inhibitors, both new-onset and pre-existing HTN are independent factors for a favorable clinical outcome, especially new-onset HTN after VSP inhibitors administration.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) Figure 1. Patient screening and enrollmentFigure 2. HTN & TTF
Collapse
Affiliation(s)
- S Moriyama
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - M Hieda
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - H Fukuda
- Kyushu University, Health Care Administration and Management, Fukuoka, Japan
| | - S Kawano
- Kyushu University Hospital, Department of Clinical Immunology & Rheumatology/Infectious Disease, Fukuoka, Japan
| | - T Yokoyama
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - M Fukata
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - H Kusaba
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - T Maruyama
- Kyushu University, Campus Life Health Center, Fukuoka, Japan
| | - E Baba
- Kyushu University, Department of Oncology and Social Medicine, Fukuoka, Japan
| | - K Akashi
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| |
Collapse
|
23
|
Hieda M, Sarma S, Hearon CM, MacNamara JP, Dias KA, Samels M, Palmer D, Livingston S, Morris M, Levine BD. One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients With Stage B Heart Failure With Preserved Ejection Fraction. Circulation 2021; 144:934-946. [PMID: 34543068 DOI: 10.1161/circulationaha.121.054117] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with left ventricular (LV) hypertrophy and elevated cardiac biomarkers in middle age are at increased risk for the development of heart failure with preserved ejection fraction. Prolonged exercise training reverses the LV stiffening associated with healthy but sedentary aging; however, whether it can also normalize LV myocardial stiffness in patients at high risk for heart failure with preserved ejection fraction is unknown. In a prospective, randomized controlled trial, we hypothesized that 1-year prolonged exercise training would reduce LV myocardial stiffness in patients with LV hypertrophy. METHODS Forty-six patients with LV hypertrophy (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or high-sensitivity troponin T [>0.6 pg/mL]) were randomly assigned to either 1 year of high-intensity exercise training (n=30) or attention control (n=16). Right-heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using both lower body negative pressure and rapid saline infusion to define the LV end-diastolic pressure-volume relationship. A constant representing LV myocardial stiffness was calculated from the following: P=S×[Exp {a (V-V0)}-1], where "P" is transmural pressure (pulmonary capillary wedge pressure - right atrial pressure), "S" is the pressure asymptote of the curve, "V" is the LV end-diastolic volume index, "V0" is equilibrium volume, and "a" is the constant that characterizes LV myocardial stiffness. RESULTS Thirty-one participants (exercise group [n=20]: 54±6 years, 65% male; and controls (n=11): 51±6 years, 55% male) completed the study. One year of exercise training increased max by 21% (baseline 26.0±5.3 to 1 year later 31.3±5.8 mL·min-1·kg-1, P<0.0001, interaction P=0.0004), whereas there was no significant change in max in controls (baseline 24.6±3.4 to 1 year later 24.2±4.1 mL·min-1·kg-1, P=0.986). LV myocardial stiffness was reduced (right and downward shift in the end-diastolic pressure-volume relationship; LV myocardial stiffness: baseline 0.062±0.020 to 1 year later 0.031±0.009), whereas there was no significant change in controls (baseline 0.061±0.033 to 1 year later 0.066±0.031, interaction P=0.001). CONCLUSIONS In patients with LV hypertrophy and elevated cardiac biomarkers (stage B heart failure with preserved ejection fraction), 1 year of exercise training reduced LV myocardial stiffness. Thus, exercise training may provide protection against the future risk of heart failure with preserved ejection fraction in such patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03476785.
Collapse
Affiliation(s)
- Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.).,Kyushu University, School of Medicine, Fukuoka, Japan (M.H.)
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., J.P.M., K.A.D., M.S., D.P., S.L., M.M., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., J.P.M., B.D.L.)
| |
Collapse
|
24
|
Tanaka H, Hieda M, Futami S, Takaoka S, Tabata T, Moriyama S, Fukata M, Maruyama T, Akashi K. EFFECTS OF LIFELONG LOW-LEVEL METHYLMERCURY EXPOSURE ON CARDIAC FUNCTION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02978-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Mantha Y, Tayon K, Hieda M, Assaf A, Tatiraju U, Saland K. ACUTE STENT THROMBOSIS AFTER ADMINISTRATION OF RECOMBINANT VON WILLEBRAND FACTOR IN A PATIENT WITH VON WILLEBRAND DISEASE TYPE I: A CASE REPORT AND CAUTIONARY TALE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03746-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
26
|
Tran T, Muralidhar A, Hunter K, Buchanan C, Coe G, Hieda M, Tompkins C, Zipse M, Spotts MJ, Laing SG, Fosmark K, Hoffman J, Ambardekar AV, Wolfel EE, Lawley J, Levine B, Kohrt WM, Pal J, Cornwell WK. Right ventricular function and cardiopulmonary performance among patients with heart failure supported by durable mechanical circulatory support devices. J Heart Lung Transplant 2021; 40:128-137. [PMID: 33281029 DOI: 10.1016/j.healun.2020.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Patients with continuous-flow left ventricular assist devices (CF-LVADs) experience limitations in functional capacity and frequently, right ventricular (RV) dysfunction. We sought to characterize RV function in the context of global cardiopulmonary performance during exercise in this population. METHODS A total of 26 patients with CF-LVAD (aged 58 ± 11 years, 23 males) completed a hemodynamic assessment with either conductance catheters (Group 1, n = 13) inserted into the right ventricle to generate RV pressure‒volume loops or traditional Swan‒Ganz catheters (Group 2, n = 13) during invasive cardiopulmonary exercise testing. Hemodynamics were collected at rest, 2 sub-maximal levels of exercise, and peak effort. Breath-by-breath gas exchange parameters were collected by indirect calorimetry. Group 1 participants also completed an invasive ramp test during supine rest to determine the impact of varying levels of CF-LVAD support on RV function. RESULTS In Group 1, pump speed modulations minimally influenced RV function. During upright exercise, there were modest increases in RV contractility during sub-maximal exercise, but there were no appreciable increases at peak effort. Ventricular‒arterial coupling was preserved throughout the exercise. In Group 2, there were large increases in pulmonary arterial, left-sided filling, and right-sided filling pressures during sub-maximal and peak exercises. Among all participants, the cardiac output‒oxygen uptake relationship was preserved at 5.8:1. Ventilatory efficiency was severely abnormal at 42.3 ± 11.6. CONCLUSIONS Patients with CF-LVAD suffer from limited RV contractile reserve; marked elevations in pulmonary, left-sided filling, and right-sided filling pressures during exercise; and severe ventilatory inefficiency. These findings explain mechanisms for persistent reductions in functional capacity in this patient population.
Collapse
Affiliation(s)
- Tomio Tran
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Akshay Muralidhar
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kendall Hunter
- Department of Bioengineering, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cullen Buchanan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Greg Coe
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michinari Hieda
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas
| | - Christine Tompkins
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Matthew Zipse
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melanie J Spotts
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie G Laing
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristina Fosmark
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jordan Hoffman
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eugene E Wolfel
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Justin Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Benjamin Levine
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jay Pal
- Department of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William K Cornwell
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| |
Collapse
|
27
|
Abstract
Hyperbaric oxygen therapy (HBOT) is a well-established treatment for a variety of conditions. Hyperbaric oxygen therapy is the administration of 100% oxygen breathing in a pressure vessel at higher than atmospheric pressure (1 atmosphere absolute = 101 kPa). Typically, treatment is given daily for between 1 and 2 h at pressures of 2.0 to 2.8 ATA, depending on the indication. Sporting injuries are often treated over 3 to 10 sessions. Hyperbaric oxygen therapy has been documented to be effective and is approved in 14 medical indications by the Undersea and Hyperbaric Medical Society, including, but not limited to, carbon monoxide poisoning, compromised skin grafts and flaps, crush injuries, necrotizing soft tissue infections, and nonhealing ulcers with arterial insufficiencies. Recently, HBOT for sports musculoskeletal injuries is receiving increased attention. Hyperbaric oxygen therapy may allow injured athletes to recover faster than normal rehabilitation methods. Any reduction in collegiate and professional athletes' rehabilitation period can be financially significant for top-level sports teams; however, further research is required to confirm HBOT's benefits on sports musculoskeletal injuries. The purpose of this review to discuss the current understanding of HBOT as a treatment modality for common musculoskeletal injuries in sport medicine. Moreover, we will highlight the advantages and disadvantages of this modality, as well as relevant clinical and research applications.
Collapse
Affiliation(s)
- Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IRAN
| | | | - Lindsay Ramey
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | |
Collapse
|
28
|
Hieda M, Goto Y. Cardiac Mechanoenergetics in Patients with Acute Myocardial Infarction: From Pressure-Volume Loop Diagram Related to Cardiac Oxygen Consumption. Heart Fail Clin 2020; 16:255-269. [PMID: 32503750 DOI: 10.1016/j.hfc.2020.02.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Acute myocardial infarction (AMI) results in significant changes in cardiac structure and functions, leading to left ventricular remodeling and subsequent systolic and diastolic dysfunction. To improve current approaches in diagnoses, treatments, and prevention of cardiovascular diseases, a better understanding of cardiac mechanoenergetics, including systolic performance and energy demand, becomes paramount. In this review, we summarize cardiac mechanics, cardiac energetics, and their relationship in complications related to AMI using 2 important physiologic frameworks, pressure-volume loops and the Vo2-pressure-volume area relationship diagram, as they are powerful tools for understanding physiologic behavior and mechanoenergetics of the left ventricle.
Collapse
Affiliation(s)
- Michinari Hieda
- University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, 7232 Greenville Avenue, Dallas, TX 75231, USA
| | - Yoichi Goto
- Yoka Municipal Hospital, 1187-1 Yoka, Yabu-City, Hyogo 667-8555, Japan.
| |
Collapse
|
29
|
Rao P, Katz D, Hieda M, Sabe M. How to Manage Temporary Mechanical Circulatory Support Devices in the Critical Care Setting: Translating Physiology to the Bedside. Heart Fail Clin 2020; 16:283-293. [PMID: 32503752 DOI: 10.1016/j.hfc.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock.
Collapse
Affiliation(s)
- Prashant Rao
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Katz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX 75231, USA
| | - Marwa Sabe
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
30
|
Mantha Y, Harada R, Hieda M, Assaf A, Tatiraju U, Feldman M, Kawalsky D. Masson Tumor in the Left Atrial Appendage Presenting as Cardioembolic Cerebral Infarction. JACC Case Rep 2020; 2:1969-1973. [PMID: 34317091 PMCID: PMC8299123 DOI: 10.1016/j.jaccas.2020.05.044] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 12/03/2022]
Abstract
A 70-year-old woman presented with aphasia caused by acute infarction in the left middle cerebral artery. Cardiac investigation revealed progressively increasing mobile mass in the left atrial appendage over 2 months (from 9 to 15 mm). Decision was made to proceed with mass resection, and pathological evaluation confirmed Masson tumor. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Yogamaya Mantha
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Rakushumimarika Harada
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Michinari Hieda
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
- Division of Cardiology, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Dallas, Texas
| | - Andrew Assaf
- Division of Cardiology, Ascension Providence Hospital, Southfield, Michigan
| | - Uday Tatiraju
- Research and Development, Oracle Corporation, Redwood City, California
| | - Mark Feldman
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Darryl Kawalsky
- Division of Cardiology, North Texas Heart Center, Dallas, Texas
| |
Collapse
|
31
|
Hardin EA, Stoller D, Lawley J, Howden EJ, Hieda M, Pawelczyk J, Jarvis S, Prisk K, Sarma S, Levine BD. Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement. J Am Heart Assoc 2020; 9:e015794. [PMID: 32851906 PMCID: PMC7660774 DOI: 10.1161/jaha.120.015794] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration.
Collapse
Affiliation(s)
- E Ashley Hardin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Douglas Stoller
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Justin Lawley
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Erin J Howden
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Michinari Hieda
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - James Pawelczyk
- Department of Physiology Pennsylvania State University University Park and Hershey PA
| | - Sara Jarvis
- Department of Biological Sciences Northern Arizona University Flagstaff AZ
| | - Kim Prisk
- Department of Medicine University of California at San Diego La Jolla CA
| | - Satyam Sarma
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Benjamin D Levine
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| |
Collapse
|
32
|
Cramer MN, Hieda M, Huang M, Moralez G, Crandall CG. Dietary nitrate supplementation does not influence thermoregulatory or cardiovascular strain in older individuals during severe ambient heat stress. Exp Physiol 2020; 105:1730-1741. [PMID: 32816341 DOI: 10.1113/ep088834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does dietary nitrate supplementation with beetroot juice attenuate thermoregulatory and cardiovascular strain in older adults during severe heat stress? What is the main finding and its importance? A 7-day nitrate supplementation regimen lowered resting mean arterial pressure in thermoneutral conditions. During heat stress, core and mean skin temperatures, vasodilatory responses, sweat loss, heart rate and left ventricular function were unchanged, and mean arterial pressure was only transiently reduced, post-supplementation. These data suggest nitrate supplementation with beetroot juice does not mitigate thermoregulatory or cardiovascular strain in heat-stressed older individuals. ABSTRACT This study tested the hypothesis that dietary nitrate supplementation with concentrated beetroot juice attenuates thermoregulatory and cardiovascular strain in older individuals during environmental heat stress. Nine healthy older individuals (six females, three males; aged 67 ± 5 years) were exposed to 42.5 ± 0.1°C and 34.0 ± 0.5% relative humidity conditions for 120 min before (CON) and after 7 days of dietary nitrate supplementation with concentrated beetroot juice (BRJ; 280 ml, ∼16.8 mmol of nitrate daily). Core and skin temperatures, body mass changes (indicative of whole-body sweat loss), skin blood flow and cutaneous vascular conductance, forearm blood flow and vascular conductance, heart rate, arterial blood pressures and indices of cardiac function were measured. The 7-day beetroot juice regimen increased plasma nitrate/nitrite levels from 27.4 ± 15.2 to 477.0 ± 102.5 μmol l-1 (P < 0.01) and lowered resting mean arterial pressure from 90 ± 7 to 83 ± 10 mmHg at baseline under thermoneutral conditions (P = 0.02). However, during subsequent heat stress, no differences in core and skin temperatures, skin blood flow and vascular conductance, forearm blood flow and vascular conductance, whole-body sweat loss, heart rate, and echocardiographic indices of systolic function and diastolic filling were evident following nitrate supplementation (all P > 0.05). Mean arterial pressure was lower in BRJ vs. CON during heat stress (treatment-by-time interaction: P = 0.02). Overall, these findings suggest that dietary nitrate supplementation with concentrated beetroot juice does not attenuate thermoregulatory or cardiovascular strain in older individuals exposed to severe ambient heat stress.
Collapse
Affiliation(s)
- Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.,School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.,Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.,Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
33
|
Dias KA, MacNamara JP, Hieda M, Hearon CM, Howden EJ, Turer AT, Link MS, Sarma S, Levine BD. Hypertrophic Cardiomyopathy And Heart Failure With Preserved Ejection Fraction: A Common Phenotype Explaining Exercise Intolerance. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676016.52599.6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
Hieda M, Esposito G. Cardiovascular Emergencies, Part II. Heart Fail Clin 2020. [DOI: 10.1016/s1551-7136(20)30026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Samels M, Dias KA, Hearon CM, MacNamara JP, Hieda M, Turer AT, Link MS, Sarma S, Levine BD. High Intensity Exercise Training In Patients With Hypertrophic Cardiomyopathy. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000684776.97439.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Samuel TJ, Nelson MD, Nasirian A, Jaffery M, Moralez G, Romero SA, Cramer MN, Huang M, Kouda K, Hieda M, Sarma S, Crandall CG. Cardiac Structure and Function in Well-Healed Burn Survivors. J Burn Care Res 2020; 40:235-241. [PMID: 30649454 DOI: 10.1093/jbcr/irz008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Long-term burn survivors have reduced aerobic capacity, placing them at increased risk for cardiovascular disease, morbidity, and mortality. However, the exact mechanism contributing to a reduced aerobic capacity remains incompletely understood, but may be related to adverse cardiovascular remodeling. Therefore, it was hypothesized that well-healed burn survivors would exhibit adverse left ventricular (LV) remodeling and impaired LV function. To test this hypothesis, 22 well-healed moderately burned individuals (age: 41 ± 14 years; BMI: 27.7 ± 5.4 kg/m2; male/female: 12/10; extent of burn: 37 ± 12 %BSA), 11 well-healed severely burned individuals (age: 43 ± 12 years; BMI: 29.5 ± 5.8 kg/m2; male/female: 8/3; extent of burn: 73 ± 11 %BSA), and 12 healthy, age-matched controls (age: 34 ± 9 years; BMI: 28.6 ± 5.2 kg/m2; male/female: 5/7) were enrolled in the study. All subjects were sedentary, performing less than 30 minutes of aerobic exercise per day, 3 days per week. LV morphology and function were assessed via cardiac magnetic resonance imaging. In contrast to the hypothesis, neither the presence nor severity of burn injury adversely affected LV morphology or function, when compared with equally sedentary nonburned controls. However, of note, LV mass of all three groups was in the lowest 5th percentile compared with normative values. Finally, group differences in LV morphology were largely explained by differences in aerobic capacity. Taken together, these data suggest a prior burn injury itself does not result in pathological remodeling of the LV and support a role for aerobic exercise training to improve cardiac function.
Collapse
Affiliation(s)
- T Jake Samuel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Aida Nasirian
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Manall Jaffery
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas.,Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Ken Kouda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| |
Collapse
|
37
|
Hieda M, Esposito G, Bossone E. Novel Clinical and Pathophysiologic Concepts in Cardiovascular Emergencies. Heart Fail Clin 2020; 16:xi-xii. [PMID: 32503759 DOI: 10.1016/j.hfc.2020.04.001] [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: 11/17/2022]
Affiliation(s)
- Michinari Hieda
- Kyushu University, School of Medicine, Kyushu University Hospital, 3-1-1 Maidashi Higashi-ku Fukuoka City, Clinical Research Building B6F, Fukuoka 812-8582, Japan.
| | - Giovanni Esposito
- University Federico II of Naples, Via Pansini 5, Naples 80131, Italy.
| | - Eduardo Bossone
- Division of Cardiology, Cardarelli Hospital, Via A. Cardarelli, 9, Naples 80131, Italy.
| |
Collapse
|
38
|
Arita T, Maruyama T, Yokoyama T, Hieda M, Fukata M, Fujino T, Mawatari S, Akashi K. Impaired deformability and association with density distribution of erythrocytes in patients with type 2 diabetes mellitus under treatment. Clin Hemorheol Microcirc 2020; 76:73-83. [PMID: 32417767 DOI: 10.3233/ch-200873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Disturbed microcirculation is related to diabetic complications, and erythrocyte deformability is a critical factor regulating microcirculation. OBJECTIVES To know the relationship between the impaired deformability and density profile in diabetic erythrocytes. METHODS We recruited patients with type 2 diabetes (n = 15, diabetic group) and age- and sex-matched non-diabetic subjects (n = 15, control group). Erythrocyte density (ED) profile was obtained by the phthalate ester separation technique. ED distribution was fitted by sigmoidal curve, yielding specific gravity of phthalate ester allowing passage of half erythrocytes population (ED50) and slope factor. Erythrocyte deformability was estimated by our specific filtration technique. RESULTS Diabetic group showed significantly (p < 0.001) higher HbA1c and fasting blood glucose concentration. Erythrocyte deformability in diabetic group was impaired as compared with that in control group (p < 0.001) and proportional to HbA1c (p = 0.009). However, ED50 and the slope factor in diabetic group did not differ from respective parameters in control group. CONCLUSIONS This study demonstrated that erythrocyte deformability was impaired in diabetic patients even under treatment. HbA1c up to 7.5% is concluded not to alter the erythrocyte density but to impair the deformability, which might be a warning to clinicians for prevention of diabetic complications.
Collapse
|
39
|
Hieda M, Esposito G. Cardiovascular Emergencies, Part I. Heart Fail Clin 2020. [DOI: 10.1016/s1551-7136(20)30004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
40
|
Mantha Y, Feldman M, Assaf A, Harada R, Musselman D, Hieda M, Kawalsky D. Anomalous Origin of a Right Coronary Artery from the Pulmonary Artery in a Middle-Aged Woman. JACC Case Rep 2020; 2:464-467. [PMID: 34317265 PMCID: PMC8311615 DOI: 10.1016/j.jaccas.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
A 53-year-old female patient presented for evaluation of a murmur. The examination revealed a 2/6 systolic ejection murmur in the left upper sternal border. Transthoracic echocardiography with color Doppler showed increased blood flow around the apex of the right ventricle. Further imaging revealed the right coronary artery emerging from the pulmonary artery. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Yogamaya Mantha
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Mark Feldman
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Andrew Assaf
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Rakushumimarika Harada
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - David Musselman
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
| | - Michinari Hieda
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas.,Division of Cardiology, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Darryl Kawalsky
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
| |
Collapse
|
41
|
Abstract
This article reviews treatment and management of common cardiovascular emergencies in critically ill patients, focusing on acute decompensated heart failure, cardiogenic shock, pulmonary embolism, and hypertensive crisis management with inotropes, vasopressors, diuretics, and antiarrhythmic drugs. Clinicians frequently come across challenging clinical scenarios, and there is a gap between evidence-based medicine and clinical practice. Inotropic and vasopressor agents are useful in the acute setting but must be weaned off or used as a bridge for mechanical circulation support devices. Clinicians should aim to lower complications by choosing medications with respect to comorbidities and close the gap between evidence-based medicine and clinical practice.
Collapse
Affiliation(s)
- Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Rakushumimarika Harada
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Michinari Hieda
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, 7232 Greenville Avenue, Dallas, TX 75231, USA.
| |
Collapse
|
42
|
Hieda M, Esposito G, Bossone E. The Latest Clinical Understandings and Theory of the Cardiovascular Systems for Cardiovascular Emergencies and Their Management. Heart Fail Clin 2020; 16:ix-x. [PMID: 32143769 DOI: 10.1016/j.hfc.2020.01.001] [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: 11/17/2022]
Affiliation(s)
- Michinari Hieda
- University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX 75231, USA.
| | - Giovanni Esposito
- University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Eduardo Bossone
- Division of Cardiology, AORN A Cardarelli Hospital, Via A. Cardarelli 9, Naples 80131, Italy.
| |
Collapse
|
43
|
Harada R, Mantha Y, Hieda M. Back to Basics: Key Physical Examinations and Theories in Patients with Heart Failure. Heart Fail Clin 2020; 16:139-151. [PMID: 32143759 DOI: 10.1016/j.hfc.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral hypoperfusion need to be considered in selecting pharmacologic therapy. By applying the pretest probability and likelihood ratios of unique physical findings of HF to a Markov model, a definite posttest probability can be obtained. This article focuses on the findings of S3, jugular venous pressure, proportional pulse pressure, bendopnea, trepopnea, and various heart murmurs. Incorporating statistical precision in physical assessments, diagnoses of HF can be further refined, providing a sophisticated approach to evaluate patients hemodynamics status noninvasively.
Collapse
Affiliation(s)
- Rakushumimarika Harada
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, 7232 Greenville Avenue, Dallas, TX 75231, USA.
| |
Collapse
|
44
|
Mantha Y, Harada R, Assaf A, Hieda M, Gill R, Feldman M. A RARE CASE OF ASPERGILLUS ENDOCARDITIS OF NATIVE AORTIC VALVE WITH EMBOLIC SHOWER. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
McNamara DA, Aiad N, Howden E, Hieda M, Link MS, Palmer D, Samels M, Everding B, Ng J, Adams-Huet B, Opondo M, Sarma S, Levine BD. Left Atrial Electromechanical Remodeling Following 2 Years of High-Intensity Exercise Training in Sedentary Middle-Aged Adults. Circulation 2019; 139:1507-1516. [PMID: 30586729 DOI: 10.1161/circulationaha.118.037615] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Moderate intensity exercise is associated with a decreased incidence of atrial fibrillation. However, extensive training in competitive athletes is associated with an increased atrial fibrillation risk. We evaluated the effects of 24 months of high intensity exercise training on left atrial (LA) mechanical and electric remodeling in sedentary, healthy middle-aged adults. METHODS Sixty-one participants (53±5 years) were randomized to 10 months of exercise training followed by 14 months of maintenance exercise or stretching/balance control. Fourteen Masters athletes were added for comparison. Left ventricular (LV) and LA volumes underwent 3D echocardiographic assessment, and signal-averaged electrocardiographs for filtered P-wave duration and atrial late potentials were completed at 0, 10, and 24 months. Extended ambulatory monitoring was performed at 0 and 24 months. Within and between group differences from baseline were compared using mixed-effects model repeated-measures analysis. RESULTS Fifty-three participants completed the study (25 control, 28 exercise) with 88±11% adherence to assigned exercise sessions. In the exercise group, both LA and LV end diastolic volumes increased proportionately (19% and 17%, respectively) after 10 months of training (peak training load). However, only LA volumes continued to increase with an additional 14 months of exercise training (LA volumes 55%; LV end diastolic volumes 15% at 24 months versus baseline; P<0.0001 for all). The LA:LV end diastolic volumes ratio did not change from baseline to 10 months, but increased 31% from baseline in the Ex group ( P<0.0001) at 24 months, without a change in controls. There were no between group differences in the LA ejection fraction, filtered P-wave duration, atrial late potentials, and premature atrial contraction burden at 24 months and no atrial fibrillation was detected. Compared with Masters athletes, the exercise group demonstrated lower absolute LA and LV volumes, but had a similar LA:LV ratio after 24 months of training. CONCLUSIONS Twenty-four months of high intensity exercise training resulted in LA greater than LV mechanical remodeling with no observed electric remodeling. Together, these data suggest different thresholds for electrophysiological and mechanical changes may exist in response to exercise training, and provide evidence supporting a potential mechanism by which high intensity exercise training leads to atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02039154.
Collapse
Affiliation(s)
- David A McNamara
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Norman Aiad
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Erin Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mark S Link
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Braden Everding
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Jason Ng
- University of Illinois at Chicago School of Medicine (J.N.)
| | - Beverley Adams-Huet
- Division of Biostatistics, Department of Clinical Sciences and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.A.-H.)
| | - Mildred Opondo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.).,Stanford University School of Medicine, CA (M.O.)
| | - Satyam Sarma
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Benjamin D Levine
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| |
Collapse
|
46
|
Hieda M, Sarma S, Hearon CM, Dias KA, Martinez J, Samels M, Everding B, Palmer D, Livingston S, Morris M, Howden E, Levine BD. Increased Myocardial Stiffness in Patients With High-Risk Left Ventricular Hypertrophy: The Hallmark of Stage-B Heart Failure With Preserved Ejection Fraction. Circulation 2019; 141:115-123. [PMID: 31865771 DOI: 10.1161/circulationaha.119.040332] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers in middle age are at high risk for the development of heart failure with preserved ejection fraction (HFpEF). However, it is unknown what the pathophysiological underpinnings of this high-risk state may be. We tested the hypothesis that patients with LVH and elevated cardiac biomarkers would demonstrate elevated left ventricular (LV) myocardial stiffness in comparison with healthy controls as a key marker for future HFpEF. METHODS Forty-six patients with LVH (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or troponin T [>0.6 pg/mL]) were recruited, along with 61 age- and sex-matched (by cohort) healthy controls. To define LV pressure-volume relationships, right heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using lower body negative pressure and rapid saline infusion. RESULTS There were significant differences in body size, blood pressure, and baseline pulmonary capillary wedge pressure between groups (eg, pulmonary capillary wedge pressure: LVH, 13.4±2.7 versus control, 11.7±1.7 mm Hg, P<0.0001). The LV was less distensible in LVH than in controls (smaller volume for the same filling pressure). When preload was expressed as transmural filling pressure (pulmonary capillary wedge pressure - right atrial pressure), LV myocardial stiffness was nearly 30% greater in LVH than in controls (LVH stiffness constant, 0.053±0.027 versus controls, 0.042±0.020, P=0.028). CONCLUSIONS LV myocardial stiffness in patients with LVH and elevated biomarkers (stage-B HFpEF) is greater than in age- and sex-matched controls and thus appears to represent a transitional state from a normal healthy heart to HFpEF. Although the LV myocardial stiffness of patients with LVH is greater than that of healthy controls at this early stage, further studies are required to clarify whether interventions such as exercise training to improve LV compliance may prevent the full manifestation of the HFpEF syndrome in these high-risk individuals. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifiers: NCT03476785 and NCT02039154.
Collapse
Affiliation(s)
- Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., E.H., B.D.L.)
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., E.H., B.D.L.)
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., E.H., B.D.L.)
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Jose Martinez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Braden Everding
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.)
| | - Erin Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., E.H., B.D.L.).,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.H.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).,The University of Texas Southwestern Medical Center, Dallas (M.H., S.S., C.M.H., E.H., B.D.L.)
| |
Collapse
|
47
|
Badrov MB, Park SY, Yoo JK, Hieda M, Okada Y, Jarvis SS, Stickford AS, Best SA, Nelson DB, Fu Q. Role of Corin in Blood Pressure Regulation in Normotensive and Hypertensive Pregnancy. Hypertension 2019; 73:432-439. [PMID: 30580684 DOI: 10.1161/hypertensionaha.118.12137] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/22/2022]
Abstract
Corin (an atrial natriuretic peptide-converting enzyme) represents a potential biomarker for gestational hypertensive disorders; yet, its role in blood pressure (BP) regulation throughout pregnancy remains unclear. We investigated the time course of change in blood corin content in relation to BP and sympathetic nerve activity throughout pregnancy. Forty-four women (29±0.9 years) participated. Following-term, 23 had low-risk (no personal history of gestational hypertensive disorders) normal pregnancies, 13 had high-risk (personal history of gestational hypertensive disorders) normal pregnancies, and 8 developed gestational hypertension. BP, heart rate, muscle sympathetic nerve activity, and serum corin were measured before pregnancy, during early (4-8 weeks) and late pregnancy (32-36 weeks), and postpartum (6-10 weeks). Overall, compared with prepregnancy, corin remained unchanged during early pregnancy, increased markedly during late pregnancy ( P<0.001), and returned to prepregnancy levels postpartum. In women who developed gestational hypertension, the change in corin from early to late pregnancy was greater than those with low-risk normal pregnancies (Δ971±134 versus Δ486±79 pg/mL; P<0.05). Throughout pregnancy, BP and muscle sympathetic nerve activity were augmented in women with gestational hypertension (all P<0.05). Finally, changes in corin from early to late pregnancy were related to all indices of BP ( R=0.454-0.551; all P<0.01) in late pregnancy, whereas burst frequency, burst incidence, and total muscle sympathetic nerve activity ( R=0.576-0.614; all P<0.001) in early pregnancy were related to changes in corin from early to late pregnancy. Corin plays a unique role in BP regulation throughout normotensive and, especially, hypertensive pregnancy and may represent a promising biomarker for determining women at high risk of adverse pregnancy outcome.
Collapse
Affiliation(s)
- Mark B Badrov
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Sun Young Park
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Jeung-Ki Yoo
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Michinari Hieda
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Yoshiyuki Okada
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Dentistry, Hiroshima University, Japan (Y.O.)
| | - Sara S Jarvis
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Biological Sciences, Northern Arizona University, Flagstaff (S.S.J.)
| | - Abigail S Stickford
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Health and Exercise Science, Appalachian State University, Boone, NC (A.S.S.)
| | - Stuart A Best
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - David B Nelson
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Qi Fu
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| |
Collapse
|
48
|
Opondo MA, Aiad N, Cain MA, Sarma S, Howden E, Stoller DA, Ng J, van Rijckevorsel P, Hieda M, Tarumi T, Palmer MD, Levine BD. Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function. Circ Arrhythm Electrophysiol 2019; 11:e005598. [PMID: 29748195 DOI: 10.1161/circep.117.005598] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. METHODS Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. RESULTS LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15%, 17%, and 16%, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5%; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. CONCLUSIONS Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.
Collapse
Affiliation(s)
- Mildred A Opondo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.).,Department of Cardiovascular Medicine, Stanford University School of Medicine, CA (M.A.O.)
| | - Norman Aiad
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Matthew A Cain
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Satyam Sarma
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Erin Howden
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Douglas A Stoller
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Jason Ng
- Department of Medicine, University of Illinois at Chicago (J.N.)
| | - Pieter van Rijckevorsel
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Michinari Hieda
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Takashi Tarumi
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - M Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| | - Benjamin D Levine
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (N.A., M.A.C., S.S., E.H., D.A.S., M.H., T.T., B.D.L.). .,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (M.A.O., N.A., M.A.C., S.S., E.H., D.A.S., P.v.R., M.H., T.T., M.D.P., B.D.L.)
| |
Collapse
|
49
|
Aiad NN, Hearon C, Hieda M, Dias K, Levine BD, Sarma S. Mechanisms of Left Atrial Enlargement in Obesity. Am J Cardiol 2019; 124:442-447. [PMID: 31133275 DOI: 10.1016/j.amjcard.2019.04.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
Left atrial (LA) enlargement is common in obesity. We sought to determine the influence of ventricular (LV) remodeling on LA size in obesity. We studied 50 otherwise healthy obese subjects (body mass index 37.2 ± 4.6 kg/m2, 50 ± 6 years) and 58 age and gender-matched nonobese controls (body mass index 26.2 ± 2.9 kg/m2, 52 ± 5 years). Diastolic function, relative wall thickness (RWT), and LV mass were assessed using echocardiography. LA and LV volume was measured by 3D-echocardiography. Primary outcome was the ratio of LA volume indexed to LV volume in obese and control subjects. Obese subjects had substantially larger LA volumes compared with control subjects (61.0 ± 16.9 vs 38.9 ± 9.2 ml, p < 0.0001). When scaled to body size or lean mass, differences in LA size persisted. However, when indexed to LV end-diastolic volume, LA volumes between control and obese subjects were comparable (obese vs controls: 0.44 ± 0.15 vs 0.42 ± 0.10, p = 0.46). A small subset of obese subjects (26%) had LA volume markedly out of proportion to LV volume (LA/LV volume ratio ≥0.5) and displayed concentric LV remodeling with larger RWT and LV mass compared with obese subjects with LA/LV <0.5 (RWT: 0.46 ± 0.09 vs 0.36 ± 0.06, p < 0.0001; LV mass: 79 ± 18 vs 62 ± 13 g/m2 p < 0.01). In conclusion, LA enlargement in patients with obesity generally occurs commensurate with LV enlargement and parallels eccentric LV remodeling. LA enlargement out of proportion to LV size is associated with increased RWT and mass. This unique signature may identify obese subjects with pathologic LA remodeling.
Collapse
Affiliation(s)
- Norman N Aiad
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Christopher Hearon
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Katrin Dias
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Benjamin D Levine
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Satyam Sarma
- University of Texas Southwestern Medical Center, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.
| |
Collapse
|
50
|
Hieda M, Yoo JK, Badrov MB, Parker RS, Anderson EH, Wiblin JL, Kawalsky J, North CS, Suris A, Fu Q. Reduced left ventricular diastolic function in women with posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2019; 317:R108-R112. [DOI: 10.1152/ajpregu.00002.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Women are two to three times more likely to develop posttraumatic stress disorder (PTSD) compared with men after exposure to a major trauma, and PTSD is associated with increased risk for cardiovascular disease in later life. The underlying mechanisms are unclear, but alterations in cardiac function may be involved. We hypothesized that women with PTSD have reduced left ventricular (LV) diastolic function. We studied 14 women with PTSD (PTSD group) and 14 women without PTSD (controls) using echocardiography Doppler to evaluate LV diastolic function, including peak velocities (E and A waves) in transmitral flow; diastolic, atrial kick, and systolic waveform velocities (e′, a′, and s′) in tissue Doppler; the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e′); and velocity of propagation ( Vp) . Baseline characteristics including age, body size, blood pressure, and heart rate were not significantly different between the two groups. Compared with the control group, women with PTSD showed greater E/e′ (controls vs. PTSD group: 7.0 ± 1.3 vs. 9.1 ± 1.3, P = 0.002) and smaller Vp (controls vs. PTSD group: 63.7 ± 11.3 vs. 47.5 ± 6.9 cm/s, P = 0.003). These results suggest that women with PTSD have reduced LV diastolic function, which may contribute, at least in part, to the increased risk of cardiovascular disease later in life.
Collapse
Affiliation(s)
- Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark B. Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rosemary S. Parker
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
| | - Elizabeth H. Anderson
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Jessica L. Wiblin
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Jason Kawalsky
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
| | - Carol S. North
- Metrocare Services and the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alina Suris
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- The University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|