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Goh VJ, Tromp J, Teng THK, Tay WT, Van Der Meer P, Ling LH, Siswanto BB, Hung CL, Shimizu W, Zhang S, Narasimhan C, Yu CM, Park SW, Ngarmukos T, Liew HB, Reyes E, Yap J, MacDonald M, Richards MA, Anand I, Lam CSP. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC Heart Fail 2018; 5:570-578. [PMID: 29604185 PMCID: PMC6073031 DOI: 10.1002/ehf2.12279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Aims Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. Methods and results We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33–54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96–4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all‐cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08–1.50) compared with non‐anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14–2.91). Conclusions Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.
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Affiliation(s)
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Peter Van Der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shu Zhang
- Fuwai Cardiovascular Hospital, Beijing, China
| | | | | | | | | | - Houng Bang Liew
- Queen Elizabeth II Hospital, Clinical Research Center, Sabah, Malaysia
| | | | | | | | - Mark A Richards
- National University Heart Centre, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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Goh VJ, Le TT, Bryant J, Wong JI, Su B, Lee CH, Pua CJ, Sim CPY, Ang B, Aw TC, Cook SA, Chin CWL. Novel Index of Maladaptive Myocardial Remodeling in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006840. [PMID: 28847911 PMCID: PMC5617557 DOI: 10.1161/circimaging.117.006840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients. METHODS AND RESULTS The RI was derived using LaPlace's Law (), and normal RI ranges were established in 180 healthy volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive patients and 10 patients with heart failure with preserved ejection fraction. Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure accounted for only 20% of the variance observed in LV mass. Although there was no association between blood pressure and myocardial fibrosis, LV mass was independently associated with fibrosis. Compared with hypertensive patients without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%), patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified myocardial response: elevated indexed LV masses (83±24 g/m2), more fibrosis (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for all). RI was similar in HTN-LVH/low RI and heart failure with preserved ejection fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). CONCLUSIONS We suggest that RI provides an approach for stratifying hypertensive patients and is suitable for testing in other disease cohorts to assess its clinical utility. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02670031.
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Affiliation(s)
- Vera J Goh
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Thu-Thao Le
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jennifer Bryant
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jia Ing Wong
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Boyang Su
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chi-Hang Lee
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chee Jian Pua
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chloe P Y Sim
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Briana Ang
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Tar Choon Aw
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Stuart A Cook
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Calvin W L Chin
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.).
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Goh VJ, Tan JSY, Tan BC, Seow C, Ong WY, Lim YC, Sun L, Ghosh S, Silver DL. Postnatal Deletion of Fat Storage-inducing Transmembrane Protein 2 (FIT2/FITM2) Causes Lethal Enteropathy. J Biol Chem 2015; 290:25686-99. [PMID: 26304121 DOI: 10.1074/jbc.m115.676700] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 07/06/2015] [Indexed: 02/03/2023] Open
Abstract
Lipid droplets (LDs) are phylogenetically conserved cytoplasmic organelles that store neutral lipids within a phospholipid monolayer. LDs compartmentalize lipids and may help to prevent cellular damage caused by their excess or bioactive forms. FIT2 is a ubiquitously expressed transmembrane endoplasmic reticulum (ER) membrane protein that has previously been implicated in LD formation in mammalian cells and tissue. Recent data indicate that FIT2 plays an essential role in fat storage in an in vivo constitutive adipose FIT2 knock-out mouse model, but the physiological effects of postnatal whole body FIT2 depletion have never been studied. Here, we show that tamoxifen-induced FIT2 deletion using a whole body ROSA26CreER(T2)-driven FIT2 knock-out (iF2KO) mouse model leads to lethal intestinal pathology, including villus blunting and death of intestinal crypts, and loss of lipid absorption. iF2KO mice lose weight and die within 2 weeks after the first tamoxifen dose. At the cellular level, LDs failed to form in iF2KO enterocytes after acute oil challenge and instead accumulated within the ER. Intestinal bile acid transporters were transcriptionally dysregulated in iF2KO mice, leading to the buildup of bile acids within enterocytes. These data support the conclusion that FIT2 plays an essential role in regulating intestinal health and survival postnatally.
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Affiliation(s)
- Vera J Goh
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Jolene S Y Tan
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Bryan C Tan
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Colin Seow
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Wei-Yi Ong
- the Department of Anatomy and Neurobiology and Aging Research Programme, National University of Singapore, Singapore 119260, Singapore
| | - Yen Ching Lim
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Lei Sun
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - Sujoy Ghosh
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
| | - David L Silver
- From the Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857 Singapore and
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Kim HJ, Cho H, Alexander R, Patterson HC, Gu M, Lo KA, Xu D, Goh VJ, Nguyen LN, Chai X, Huang CX, Kovalik JP, Ghosh S, Trajkovski M, Silver DL, Lodish H, Sun L. MicroRNAs are required for the feature maintenance and differentiation of brown adipocytes. Diabetes 2014; 63:4045-56. [PMID: 25008181 PMCID: PMC4238002 DOI: 10.2337/db14-0466] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Brown adipose tissue (BAT) is specialized to burn lipids for heat generation as a natural defense against cold and obesity. Previous studies established microRNAs (miRNAs) as essential regulators of brown adipocyte differentiation, but whether miRNAs are required for the feature maintenance of mature brown adipocytes remains unknown. To address this question, we ablated Dgcr8, a key regulator of the miRNA biogenesis pathway, in mature brown as well as in white adipocytes. Adipose tissue-specific Dgcr8 knockout mice displayed enlarged but pale interscapular brown fat with decreased expression of genes characteristic of brown fat and were intolerant to cold exposure. Primary brown adipocyte cultures in vitro confirmed that miRNAs are required for marker gene expression in mature brown adipocytes. We also demonstrated that miRNAs are essential for the browning of subcutaneous white adipocytes in vitro and in vivo. Using this animal model, we performed miRNA expression profiling analysis and identified a set of BAT-specific miRNAs that are upregulated during brown adipocyte differentiation and enriched in brown fat compared with other organs. We identified miR-182 and miR-203 as new regulators of brown adipocyte development. Taken together, our study demonstrates an essential role of miRNAs in the maintenance as well as in the differentiation of brown adipocytes.
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Affiliation(s)
- Hye-Jin Kim
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Hyunjii Cho
- Whitehead Institute for Biomedical Research, Cambridge, MA Department of Biology, Massachusetts Institute of Technology, Cambridge, MA
| | - Ryan Alexander
- Whitehead Institute for Biomedical Research, Cambridge, MA Department of Biology, Massachusetts Institute of Technology, Cambridge, MA
| | - Heide Christine Patterson
- Whitehead Institute for Biomedical Research, Cambridge, MA Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Minxia Gu
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | | | - Dan Xu
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Vera J Goh
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Long N Nguyen
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Xiaoran Chai
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Cher X Huang
- Whitehead Institute for Biomedical Research, Cambridge, MA Department of Biology, Massachusetts Institute of Technology, Cambridge, MA
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Sujoy Ghosh
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Mirko Trajkovski
- University of Geneva, Medical Faculty, Department of Cell Physiology and Metabolism, Centre Médical Universitaire (CMU), Geneva, Switzerland
| | - David L Silver
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Harvey Lodish
- Whitehead Institute for Biomedical Research, Cambridge, MA Department of Biology, Massachusetts Institute of Technology, Cambridge, MA
| | - Lei Sun
- Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, Singapore Institute of Molecular and Cell Biology, Singapore
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