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Chen ZW, Liao CW, Pan CT, Tsai CH, Chang YY, Chang CC, Lee BC, Chiu YW, Huang WC, Lai TS, Lu CC, Chueh JS, Wu VC, Hung CS, Lin YH. Reversal of arterial stiffness in medically and surgically treated unilateral primary aldosteronism. J Hypertens 2024; 42:538-545. [PMID: 38088428 DOI: 10.1097/hjh.0000000000003631] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Hyperaldosteronism has adverse effects on cardiovascular structure and function. Laparoscopic adrenalectomy is the gold standard for patients with unilateral primary aldosteronism. For unilateral primary aldosteronism patients unable or unwilling to undergo surgery, the effects of mineralocorticoid receptor antagonists (MRAs) on the reversibility of arterial stiffness and other clinical data remain unclear. We aimed to compare the reversibility of arterial stiffness using pulse wave velocity (PWV) and other clinical parameters between surgically and medically treated unilateral primary aldosteronism patients. METHODS We prospectively enrolled 306 unilateral primary aldosteronism patients, of whom 247 received adrenalectomy and 59 received medical treatment with MRAs. Detailed medical history, basic biochemistry and PWV data were collected in both groups before treatment and 1 year after treatment. After propensity score matching (PSM) for age, sex, SBP and DBPs, 149 patients receiving adrenalectomy and 54 patients receiving MRAs were included for further analysis. RESULTS After PSM, the patients receiving adrenalectomy had a greater reduction in blood pressure, increase in serum potassium, and change in PWV (ΔPWV, -53 ± 113 vs. -10 ± 140 cm/s, P = 0.028) than those receiving MRAs 1 year after treatment. Multivariable regression analysis further identified that surgery (compared with MRA treatment), baseline PWV, baseline DBP, the change in DBP and the use of diuretics were independently correlated with ΔPWV. CONCLUSION Adrenalectomy is superior to MRA treatment with regards to vascular remodeling when treating unilateral primary aldosteronism patients.
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Affiliation(s)
- Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
- Department of Medicine, National Taiwan University Cancer Center, Taipei
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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Lee BC, Tsai HH, Chen ZW, Chang CC, Huang JZ, Chang YY, Tsai CH, Chou CH, Liao CW, Pan CT, Wu VC, Hung CS, Tsai LK, Lin YH. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage. Hypertens Res 2024; 47:608-617. [PMID: 37993592 DOI: 10.1038/s41440-023-01458-w] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023]
Abstract
Primary aldosteronism is associated with various types of cardiovascular and cerebrovascular damage independently of hypertension. Although chronic hypertension and related cerebral arteriosclerosis are the main risk factors for intracerebral hemorrhage, the effects of aldosteronism remain poorly understood. We enrolled 90 survivors of hypertensive intracerebral hemorrhage, 21 of them with aldosteronism and 69 with essential hypertension as controls in this study. Clinical parameters and neuroimaging markers of cerebral small vessel disease were recorded, and its correlations with aldosteronism were investigated. Our results showed that the aldosteronism group (55.2 ± 9.7 years, male 47.6%) had similar hypertension severity but exhibited a higher cerebral microbleed count (interquartile range) (8.5 [2.0‒25.8] vs 3 [1.0‒6.0], P = 0.005) and higher severity of dilated perivascular space in the basal ganglia (severe perivascular space [number >20], 52.4% vs. 24.6%, P = 0.029; large perivascular space [>3 mm], 52.4% vs. 20.3%, P = 0.010), compared to those with essential hypertension (53.8 ± 11.7 years, male 73.9%). In multivariate models, aldosteronism remained an independent predictor of a higher (>10) microbleed count (odds ratio = 8.60, P = 0.004), severe perivascular space (odds ratio = 4.00, P = 0.038); the aldosterone-to-renin ratio was associated with dilated perivascular space (P = 0.043) and large perivascular space (P = 0.008). In conclusions, survivors of intracerebral hemorrhage with aldosteronism showed a tendency towards more severe hypertensive arteriopathy than the essential hypertension counterparts independently of blood pressure; aldosteronism may contribute to dilated perivascular space around the deep perforating arteries. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan, ROC
- National Taiwan University Cancer Center, Taipei, Taiwan, ROC
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Lu JY, Chang YY, Lee TW, Wu MH, Chen ZW, Huang YT, Lai TS, Er LK, Lin YH, Wu VC, Cheng HM, Kao HL, Jia-Yin Hou C, Wu KD, Chen ST, Liu FH. How should anti-hypertensive medications be adjusted before screening for primary aldosteronism? J Formos Med Assoc 2024; 123 Suppl 2:S91-S97. [PMID: 37291044 DOI: 10.1016/j.jfma.2023.05.021] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023] Open
Abstract
Anti-hypertensive medications may affect plasma renin activity and/or plasma aldosterone concentration, misleading the interpretation of the aldosterone-to-renin ratio when screening for primary aldosteronism. The Task Force of Taiwan PA recommends that, when necessary, using α-adrenergic receptor blocking agents, centrally acting α-adrenergic agonists, and/or non-dihydropyridine calcium channel blockers should be considered to control blood pressure before screening for PA. We recommend temporarily holding β-adrenergic receptor blocking agents, mineralocorticoid receptor antagonists, dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and all diuretics before screening for PA. Further large-scale randomized controlled studies are required to confirm the recommendations.
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Affiliation(s)
- Jin-Ying Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Ting-Wei Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ming-Hsien Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital (built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan.
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan.
| | - Leay Kiaw Er
- The Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Yen-Hung Lin
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan.
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taiwan.
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
| | | | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Hsu YF, Chang YY, Wu YW, Tsai CC, Tzeng BH. Hereditary Transthyretin Amyloid Cardiomyopathy with Val142Ile Mutation in Taiwan: A Case Report. Acta Cardiol Sin 2024; 40:123-127. [PMID: 38264073 PMCID: PMC10801421 DOI: 10.6515/acs.202401_40(1).20231020a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Affiliation(s)
| | - Yi-Yao Chang
- Division of Cardiology, Department of Cardiovascular Medical Center
| | - Yen-Wen Wu
- Division of Cardiology, Department of Cardiovascular Medical Center
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- School of Medicine, National Yang Ming Chao Tung University, Taipei
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Chien-Chen Tsai
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City
| | - Bing-Hsiean Tzeng
- Division of Cardiology, Department of Cardiovascular Medical Center
- Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei
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Helmich I, Chang YY, Gemmerich R, Rodrigo L, Funken J, Arun KM, Van de Vliet P. Neurobehavioral consequences of repetitive head impacts in Para swimming: A case report. J Sci Med Sport 2024; 27:16-19. [PMID: 37923648 DOI: 10.1016/j.jsams.2023.10.015] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Para swimmers with limb deficiency are faced with the particular situation that they must use their head to finish each competition by a hit to the wall. Repetitive head impacts may impair behavioral and brain functions. We therefore investigated neurobehavioral functions of a Para swimmer with dysmelia before and after repetitive head impacts (T1) and without (T2). Average head impact at T1 constituted 13.6 g with a mean impact force of 6689.9 N. Behavioral and brain functions decreased from pre to post at T1 but not at T2. Para swimmers with limb deficiency are therefore affected from the same consequences onto brain health that are observed after repeated sport-related concussions.
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Affiliation(s)
- I Helmich
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany.
| | - Y Y Chang
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - R Gemmerich
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - L Rodrigo
- Department of Motor Behavior in Sports, German Sport University (GSU), Germany
| | - J Funken
- Institute of Biomechanics and Orthopaedics, GSU Cologne, Germany
| | - K M Arun
- Department of Biomechanics, University of Nebraska at Omaha, USA
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Kao TW, Liao CW, Tsai CH, Chang YY, Pan CT, Chang CC, Lee BC, Huang WC, Huang KH, Lu CC, Lai TS, Chan CK, Chueh JS, Wu VC, Hung CS, Chen ZW, Lin YH. Synergistic effect of albuminuria on atherosclerosis in patients with primary aldosteronism. Ther Adv Chronic Dis 2023; 14:20406223231210114. [PMID: 38362007 PMCID: PMC10867404 DOI: 10.1177/20406223231210114] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/10/2023] [Indexed: 02/17/2024] Open
Abstract
Background Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. Objective To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Design Prospective cohort study. Methods A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. Results A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria (p = 0.012) and positively correlated with urine albumin-creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM (p = 0.001). The magnitude of improvement in PWV increased with urine albumin-creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Conclusion Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin-creatinine ratio levels, reaching a plateau when the urine albumin-creatinine ratio surpassed 100 mg/g.
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Affiliation(s)
- Ting-Wei Kao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National University Cancer Center, Taipei, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National University Hospital and National University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | | | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Rd., Douliu City, Yun-Lin County 640203
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chen ZW, Pan CT, Liao CW, Tsai CH, Chang YY, Chang CC, Lee BC, Chiu YW, Huang WC, Wang SM, Lu CC, Chueh JS, Wu VC, Hung CS, Lin YH. Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2023; 108:624-632. [PMID: 36333943 DOI: 10.1210/clinem/dgac649] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 09/07/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Primary aldosteronism (PA) patients have a higher degree of arterial stiffness, which can be reversed after adrenalectomy. OBJECTIVE We aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment. METHODS We prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonist (MRA)-treated patients, the relationship between the change in PWV after 1 year (ΔPWV) and posttreatment renin activity was explored using the restricted cubic spline (RCS) method. RESULTS Of the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, posttreatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cutoff value. Therefore, we divided the MRA-treated patients into 2 groups: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (≥ 1.5 ng/mL/h, group 3). Only group 1 and group 3 patients had a statistically significant improvement in PWV after treatment (both P < .001), whereas no significant improvement was noted in group 2 after treatment (P = .151). In analysis of variance and post hoc analysis, group 2 had a significantly lower ΔPWV than group 1 (P = .007) and group 3 (P = .031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed posttreatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV. CONCLUSION The reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.
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Affiliation(s)
- Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City 208, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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Chen UL, Liao CW, Wang SM, Lai TS, Huang KH, Chang CC, Lee BC, Lu CC, Chang YR, Chang YY, Hung CS, Chueh JS, Wu VC, Tsai CH, Lin YH. Diabetes mellitus is associated with more adverse non-hemodynamic left ventricular remodeling and less recovery in patients with primary aldosteronism. J Investig Med 2023; 71:101-112. [PMID: 36647318 DOI: 10.1177/10815589221141840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/18/2023]
Abstract
The elevated aldosterone in primary aldosteronism (PA) is associated with increased insulin resistance and prevalence of diabetes mellitus (DM). Both aldosterone excess and DM lead to left ventricular (LV) pathological remodeling. In this study, we investigated the impact of DM on LV non-hemodynamic remodeling in patients with PA. We enrolled 665 PA patients, of whom 112 had DM and 553 did not. Clinical, biochemical, and echocardiographic data were analyzed at baseline and 1 year after adrenalectomy. LV non-hemodynamic remodeling was represented by inappropriate excess left ventricular mass index (ieLVMI), which was defined as the difference between left ventricular mass index (LVMI) and predicted left ventricular mass index (pLVMI). Propensity score matching (PSM) was used with age, sex, systolic, and diastolic blood pressure to adjust for baseline variables. After PSM, the patient characteristics were balanced between the DM and non-DM groups, except for fasting glucose, HbA1c, and lipid profile. A total of 111 DM and 419 non-DM patients were selected for further analysis. Compared to the non-DM group, the DM group had significantly higher ieLVMI and LVMI. After multivariable linear regression analysis, the presence of DM remained a significant predictor of increased ieLVMI. After adrenalectomy, ieLVMI decreased significantly in the non-DM group but not in DM group. The presence of DM in PA patients was associated with more prominent non-hemodynamic LV remodeling and less recovery after adrenalectomy.
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Affiliation(s)
- Uei-Lin Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Che-Wei Liao
- Department of Medicine, National Taiwan University Cancer Center, Taipei
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei
| | - Yi-Ru Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Yi-Yao Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,Center of General Education, Chihlee University of Technology, New Taipei City
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiovascular Center, National Taiwan University Hospital, Taipei.,National Taiwan University College of Medicine Graduate Institute of Clinical Medicine
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Cardiovascular Center, National Taiwan University Hospital, Taipei
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9
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Kao TW, Wu XM, Liao CW, Tsai CH, Chen ZW, Chang YY, Lee BC, Chiu YW, Lai TS, Wu VC, Lin YH, Hung CS. Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria. Ther Adv Chronic Dis 2023; 14:20406223221143253. [PMID: 36860935 PMCID: PMC9969461 DOI: 10.1177/20406223221143253] [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: 05/22/2022] [Accepted: 11/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. Objective To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria. Design Prospective cohort study. Methods The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations. Results A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m2, p = 0.023), and medial E/e' ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70 < 6.36 cm/s, p = 0.016). Multivariate analysis further revealed that albuminuria was an independent risk factor for elevated LV mass index (p < 0.001) and medial E/e' ratio (p = 0.010). Non-parametric kernel regression also demonstrated that the level of albuminuria was positively correlated with LV mass index. The remodeling of LV mass and diastolic function under the presence of albuminuria distinctly improved after PA treatment. Conclusion The presence of concomitant albuminuria in patients with PA was associated with pronounced LV hypertrophy and compromised LV diastolic function. These alterations were reversible after treatment for PA. Plain language summary Cardiac Impact of Primary Aldosteronism and Albuminuria Primary aldosteronism and albuminuria has been, respectively, demonstrated to bring about left ventricular remodeling, but the aggregative effect was unknown. We constructed a prospective single-center cohort study in Taiwan. We proposed the presence of concomitant albuminuria was associated with left ventricular hypertrophy and compromised diastolic function. Intriguingly, management of primary aldosteronism was able to restore these alterations. Our study delineated the cardiorenal crosstalk in the setting of secondary hypertension and the role of albuminuria for left ventricular remodeling. Future interrogations toward the underlying pathophysiology as well as therapeutics will facilitate the improvement of holistic care for such population.
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Affiliation(s)
- Ting-Wei Kao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan
| | - Che-Wei Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei,Cardiovascular Center, National Taiwan University Hospital, National Taiwan University, Taipei,Department of Internal Medicine, National Taiwan University Cancer Center, Taipei
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei,Cardiovascular Center, National Taiwan University Hospital, National Taiwan University, Taipei,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Douliu
| | - Yi-Yao Chang
- Cardiovascular Medical Center, Cardiology Division, Far Eastern Memorial Hospital, New Taipei City,Graduate Institute of Medicine, Yuan Ze University, Taoyuan City
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei
| | - Yu-Wei Chiu
- Cardiovascular Medical Center, Cardiology Division, Far Eastern Memorial Hospital, New Taipei City,Department of Science and Engineering, Yuan Ze University, Taoyuan
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei,College of Medicine, National Taiwan University, Taipei,Cardiovascular Center, National Taiwan University Hospital, National Taiwan University, Taipei
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10
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Liao CW, Lin YT, Tsai CH, Chang YY, Chen ZW, Lu CC, Pan CT, Chang CC, Lee BC, Chiu YW, Huang WC, Huang KH, Lai TS, Hung CS, Wu VC, Wu XM, Lin YH. Mineralocorticoid receptor antagonist treatment improved arterial stiffness in patients with primary aldosteronism: a cohort study compared with adrenalectomy. Ther Adv Chronic Dis 2023; 14:20406223221143233. [PMID: 36687666 PMCID: PMC9846303 DOI: 10.1177/20406223221143233] [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: 06/04/2022] [Accepted: 11/17/2022] [Indexed: 01/18/2023] Open
Abstract
Background Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown. Objectives The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients. Design Prospective cohort study. Methods We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors. Results A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p < 0.001). There were no significant differences in post-treatment PWV (p = 0.173) and improvement in PWV (p = 0.579) between the adrenalectomy and MRA groups. The determinant factors for an improvement in PWV after treatment were hypertension duration, baseline PWV, and the decrease in BP. Conclusion The PA patients who received medical treatment with MRAs had a significant improvement in arterial stiffness. There was no significant difference in the improvement in arterial stiffness between the two treatment strategies.
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Affiliation(s)
- Che-Wei Liao
- Department of Internal Medicine, National
Taiwan University Cancer Center, Taipei
| | - Yen-Tin Lin
- Department of Internal Medicine, Taoyuan
General Hospital, Ministry of Health and Welfare, Taoyuan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National
Taiwan University Hospital and National Taiwan University College of
Medicine, Taipei
| | | | - Zheng-Wei Chen
- Department of Internal Medicine, National
Taiwan University Hospital Yunlin Branch, Douliu
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan
University Hospital and National Taiwan University College of Medicine,
Taipei
| | - Chien-Ting Pan
- Department of Internal Medicine, National
Taiwan University Hospital Yunlin Branch, Douliu
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan
University Hospital, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan
University Hospital, Taipei
| | - Yu-Wei Chiu
- Cardiology Division of Cardiovascular Medical
Center, Far Eastern Memorial Hospital, New Taipei City
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal
Medicine, Taipei Veterans General Hospital, Taipei
| | - Kuo-How Huang
- Department of Urology, National Taiwan
University Hospital and National Taiwan University College of Medicine,
Taipei
| | - Tai-Shuan Lai
- Department of Internal Medicine, National
Taiwan University Hospital and National Taiwan University College of
Medicine, Taipei
| | - Chi-Shen Hung
- Department of Internal Medicine, National
Taiwan University Hospital and National Taiwan University College of
Medicine, Taipei
| | - Vin-Cent Wu
- Department of Internal Medicine, National
Taiwan University Hospital and National Taiwan University College of
Medicine, Taipei
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11
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Chang YY, Lee BC, Chen ZW, Tsai CH, Chang CC, Liao CW, Pan CT, Peng KY, Chou CH, Lu CC, Wu VC, Hung CS, Lin YH. Cardiovascular and metabolic characters of KCNJ5 somatic mutations in primary aldosteronism. Front Endocrinol (Lausanne) 2023; 14:1061704. [PMID: 36950676 PMCID: PMC10025475 DOI: 10.3389/fendo.2023.1061704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Primary aldosteronism (PA) is the leading cause of curable endocrine hypertension, which is associated with a higher risk of cardiovascular and metabolic insults compared to essential hypertension. Aldosterone-producing adenoma (APA) is a major cause of PA, which can be treated with adrenalectomy. Somatic mutations are the main pathogenesis of aldosterone overproduction in APA, of which KCNJ5 somatic mutations are most common, especially in Asian countries. This article aimed to review the literature on the impacts of KCNJ5 somatic mutations on systemic organ damage. EVIDENCE ACQUISITION PubMed literature research using keywords combination, including "aldosterone-producing adenoma," "somatic mutations," "KCNJ5," "organ damage," "cardiovascular," "diastolic function," "metabolic syndrome," "autonomous cortisol secretion," etc. RESULTS APA patients with KCNJ5 somatic mutations are generally younger, female, have higher aldosterone levels, lower potassium levels, larger tumor size, and higher hypertension cure rate after adrenalectomy. This review focuses on the cardiovascular and metabolic aspects of KCNJ5 somatic mutations in APA patients, including left ventricular remodeling and diastolic function, abdominal aortic thickness and calcification, arterial stiffness, metabolic syndrome, abdominal adipose tissue, and correlation with autonomous cortisol secretion. Furthermore, we discuss modalities to differentiate the types of mutations before surgery. CONCLUSION KCNJ5 somatic mutations in patients with APA had higher left ventricular mass (LVM), more impaired diastolic function, thicker aortic wall, lower incidence of metabolic syndrome, and possibly a lower incidence of concurrent autonomous cortisol secretion, but better improvement in LVM, diastolic function, arterial stiffness, and aortic wall thickness after adrenalectomy compared to patients without KCNJ5 mutations.
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Affiliation(s)
- Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Kang-Yung Peng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yen-Hung Lin,
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12
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Lee CL, Chang YY, Wu YW. An Unusual Case of Marijuana-Induced Extensive ST-Elevation Myocardial Infarction in Different Territories. Acta Cardiol Sin 2022; 38:653-657. [PMID: 36176375 PMCID: PMC9479053 DOI: 10.6515/acs.202209_38(5).20220330e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/30/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Chien-Lin Lee
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Yi-Yao Chang
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City;
,
National Taiwan University College of Medicine Graduate Institute of Clinical Medicine, Taipei;
,
Center of General Education, Chihlee University of Technology
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City;
,
Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City;
,
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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13
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Tsai CH, Liao CW, Wu XM, Chen ZW, Pan CT, Chang YY, Lee BC, Shun CT, Wen WF, Chou CH, Wu VC, Hung CS, Lin YH. Autonomous cortisol secretion is associated with worse arterial stiffness and vascular fibrosis in primary aldosteronism: a cross-sectional study with follow-up data. Eur J Endocrinol 2022; 187:197-208. [PMID: 35551115 DOI: 10.1530/eje-21-1157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/14/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The presence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) is common and potentially associated with poor outcomes. The aim of this study was to investigate the association between ACS and vascular remodeling in PA patients. DESIGN AND METHODS We prospectively enrolled 436 PA patients from October 2006 to November 2019. ACS (defined as a cortisol level >1.8 μg/dL after a 1 mg dexamethasone suppression test) was detected in 23% of the PA patients. Propensity score matching (PSM) with age, sex, systolic and diastolic blood pressure was performed. The brachial-ankle pulse wave velocity (baPWV) was examined at baseline and 1 year after targeted treatment. Small arteries of periadrenal fat in 46 patients were stained with Picro Sirus red to quantify the severity of vascular fibrosis. RESULTS After PSM, the PA patients with ACS had a significantly higher prevalence of diabetes mellitus, higher plasma aldosterone concentration and higher aldosterone-to-renin ratio. The baseline mean baPWV was also significantly higher in the PA patients with ACS. After multivariable regression analysis, the presence of ACS was a significant predictor of worse baseline mean baPWV (β: 235.745, 95% CI: 59.602-411.888, P = 0.010). In addition, the PA patients with ACS had worse vascular fibrosis (fibrosis area: 25.6 ± 8.4%) compared to those without ACS (fibrosis area: 19.8 ± 7.7%, P = 0.020). After 1 year of PA treatment, baPWV significantly improved in both groups. CONCLUSION The presence of ACS in PA patients is associated with worse arterial stiffness and vascular remodeling.
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Affiliation(s)
- Cheng-Hsuan Tsai
- National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chien-Ting Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Forensic Medicine and Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Fen Wen
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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14
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Hsu JC, Khoi CS, Huang SH, Chang YY, Chen SL, Wu YW. EchoNavigator virtual marker and Agilis NxT steerable introducer facilitate transseptal transcatheter closure of mitral paravalvular leak. World J Clin Cases 2022; 10:4236-4241. [PMID: 35665107 PMCID: PMC9131240 DOI: 10.12998/wjcc.v10.i13.4236] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/20/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paravalvular leak (PVL), also known as paravalvular prosthetic regurgitation, is not a rare complication after surgical valve replacement, and it may cause varying degrees of heart failure. The transcatheter closure of PVL is technically demanding and challenging.
CASE SUMMARY A 68-year-old man presented with degenerative mitral regurgitation with heart failure, New York Heart Association functional class 3. He received bioprosthetic mitral valve replacement in December 2019. PVL was noted at the location of the aorto-mitral curtain in transesophageal echocardiography without signs of endocarditis or dehiscence of the bioprosthetic valve. Transseptal transcatheter closure of the mitral PVL was performed efficiently using the EchoNavigator virtual marker and Agilis NxT steerable introducer.
CONCLUSION This case highlights that the EchoNavigator virtual marker and Agilis NxT steerable introducer can facilitate transseptal transcatheter closure of mitral PVL by reducing the procedure time and contrast media.
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Affiliation(s)
- Jung-Cheng Hsu
- Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- General Education Center, Lunghwa University of Science and Technology, Taoyuan City 333026, Taiwan
| | - Chong-Sun Khoi
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
| | - Shan-Hui Huang
- Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
| | - Yi-Yao Chang
- Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
| | - Shu-Lu Chen
- Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
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Tsai CH, Wu XM, Liao CW, Chen ZW, Pan CT, Chang YY, Lee BC, Chiu YW, Lai TS, Wu VC, Hung CS, Lin YH. Diabetes mellitus is associated with worse baseline and less post-treatment recovery of arterial stiffness in patients with primary aldosteronism. Ther Adv Chronic Dis 2022; 13:20406223211066727. [PMID: 35070251 PMCID: PMC8771743 DOI: 10.1177/20406223211066727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/22/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Aldosterone excess in primary aldosteronism (PA) has been linked to insulin resistance, and diabetes mellitus has been associated with increased arterial stiffness and worse cardiovascular outcomes. However, the impact of diabetes on baseline and post-treatment arterial stiffness in patients with PA is unknown. Methods: This study prospectively enrolled 1071 PA patients, of whom 177 had diabetes and 894 did not. Clinical, biochemical, and brachial-ankle pulse wave velocity (baPWV) data were analyzed at baseline and 1 year after PA-specific treatment. After propensity score matching of age, sex, body mass index, systolic and diastolic blood pressure, hypertension duration, and number of antihypertensive medications, 144 patients with diabetes and 320 without diabetes were included for further analysis. Results: After propensity score matching, the baseline characteristics were balanced between the diabetes and nondiabetes groups except for fasting glucose, HbA1c, and lipid profiles. The patients with diabetes had significantly worse baseline baPWV compared with those without diabetes. After multivariable linear regression, the presence of diabetes mellitus remained a significant predictor of worse baseline mean baPWV (β: 46.3, 95% confidence interval: 2.9–89.7, p = 0.037). After 1 year of PA-specific treatment, only the nondiabetes group had significant recovery of mean baPWV (1661.8 ± 332.3 to 1565.0 ± 329.2 cm/s, p < 0.001; Δ = −96.8 ± 254.6 cm/s). In contrast, the diabetes group had less improvement (1771.2 ± 353.8 cm/s to 1742.0 ± 377.2 cm/s, p = 0.259; Δ = −29.2 ± 263.2 cm/s) even though the systolic and diastolic blood pressure significantly improved in both groups. Conclusion: The presence of diabetes mellitus in PA patients was associated with worse baseline and less post-treatment recovery of arterial stiffness.
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Affiliation(s)
- Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, National Taiwan University Hospital, Taipei
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan
| | - Che-Wei Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Cancer Center, Department of Medicine, National Taiwan University, Taipei
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin
| | - Chien-Ting Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin
| | - Yi-Yao Chang
- Cardiovascular Medical Center, Cardiology Division, Far Eastern Memorial Hospital, New Taipei City
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei
| | - Yu-Wei Chiu
- Cardiovascular Medical Center, Cardiology Division, Far Eastern Memorial Hospital, New Taipei City; Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei
| | - Chi-Shen Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100 Cardiovascular Center, National Taiwan University Hospital, Taipei
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Lee BC, Kang VJW, Pan CT, Huang JZ, Lin YL, Chang YY, Tsai CH, Chou CH, Chen ZW, Liao CW, Chiu YW, Wu VC, Hung CS, Chang CC, Lin YH. KCNJ5 Somatic Mutation Is Associated With Higher Aortic Wall Thickness and Less Calcification in Patients With Aldosterone-Producing Adenoma. Front Endocrinol (Lausanne) 2022; 13:830130. [PMID: 35311227 PMCID: PMC8924484 DOI: 10.3389/fendo.2022.830130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Primary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status. METHODS We enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed. RESULTS After propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P<0.001) than non-carriers. In multivariate analysis, KCNJ5 mutations were independently associated with AAC score (P=0.014) and aortic wall thickness (SMA level: P<0.001; IMA level: P=0.004). After adrenalectomy, mutation carriers had less aortic wall thickness progression than non-carriers (Δthickness SMA: -0.1 ± 0.8 mm vs. 0.9 ± 0.6 mm, P=0.024; IMA: -0.1 ± 0.6 mm vs. 0.8 ± 0.7 mm, P=0.04). CONCLUSION KCNJ5 mutation carriers had less calcification burden of the aorta, thickened aortic wall, and less wall thickness progression than non-carriers.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Victor Jing-Wei Kang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Pan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Li Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Chin-Chen Chang,
| | - Yen-Hung Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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Hung CS, Chang YY, Tsai CH, Liao CW, Peng SY, Lee BC, Pan CT, Wu XM, Chen ZW, Wu VC, Wan CH, Young MJ, Chou CH, Lin YH. Aldosterone suppresses cardiac mitochondria. Transl Res 2022; 239:58-70. [PMID: 34411778 DOI: 10.1016/j.trsl.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Elevated serum aldosterone promotes arterial hypertension, cardiac hypertrophy, and diastolic dysfunction. However, the effect of elevated aldosterone levels on cardiac mitochondria remains unclear. We used primary cultures of mouse cardiomyocytes to determine whether aldosterone has direct effects on cardiomyocyte mitochondria, and aldosterone-infused mice as a preclinical model to evaluate the impact of aldosterone in vivo. We show that aldosterone suppressed mtDNA copy number and SOD2 expression via the mineralocorticoid receptor (MR)-dependent regulation of NADPH oxidase 2 (NOX2) and generation of reactive oxygen species (ROS) in primary mouse cardiomyocytes. Aldosterone suppressed cardiac mitochondria adenosine triphosphate production, which was rescued by N-acetylcysteine. Aldosterone infusion for 4 weeks in mice suppressed the number of cardiac mitochondria, mtDNA copy number, and SOD2 protein expression. MR blockade by eplerenone or the administration of N-acetylcysteine prevented aldosterone-induced cardiac mitochondrial damage in vivo. Similarly, patients with primary aldosteronism had a lower plasma leukocyte mtDNA copy number. Plasma leukocyte mtDNA copy number was positively correlated with 24-hour urinary aldosterone level and left ventricular mass index. In conclusion, aldosterone suppresses cardiac mitochondria in vivo and directly via MR activation of ROS pathways.
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Affiliation(s)
- Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Yi-Yao Chang
- Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City , Taiwan (R.O.C.).
| | - Che-Wei Liao
- Department of Medicine, National Taiwan, University Cancer Center, Taipei, Taiwan (R.O.C.).
| | - Shih-Yuan Peng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (R.O.C.).
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, University College of Medicine, Taipei, Taoyuan City, Taiwan (R.O.C.).
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (R.O.C.).
| | - Vin-Cent Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
| | - Cho-Hua Wan
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan (R.O.C.).
| | - Morag J Young
- Baker Heart and Diabetes Institute, Prahran, Australia.
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan.
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.).
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Chen ZW, Pan CT, Tsai CH, Chang YY, Chang CC, Lee BC, Chiu YW, Huang WC, Lin YL, Wu VC, Hung CS, Liao CW, Lin YH. Heart-Ankle Pulse Wave Velocity Is Superior to Brachial-Ankle Pulse Wave Velocity in Detecting Aldosterone-Induced Arterial Stiffness. Biomedicines 2021; 9:biomedicines9101285. [PMID: 34680402 PMCID: PMC8533381 DOI: 10.3390/biomedicines9101285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
Primary aldosteronism (PA) is associated with higher arterial stiffness compared to essential hypertension (EH). However, few studies have compared different pulse wave velocity (PWV) parameters to detect aldosterone-induced arterial stiffness. In this study, we aimed to compare the sensitivity in detecting aldosterone-induced arterial stiffness between brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV). We prospectively enrolled 1006 PA patients and 983 EH patients. Detailed medical history, basic biochemistry data and two PWV measurements (baPWV and haPWV) were collected in both groups. We performed analysis on the original cohort and two propensity score matching (PSM) models (model 1 adjusted for age and sex; model 2 adjusted for age, sex, systolic and diastolic blood pressure). The DeLong test was used to compare areas under receiver operating characteristic curves (AUCs) between baPWV and haPWV to predict PA. In all models, the PA patients had significantly higher baPWV compared to the EH patients. The AUC of haPWV was greater than that of baPWV. In conclusion, haPWV seems to be a better PWV parameter than baPWV in detecting aldosterone-induced arterial stiffness.
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Affiliation(s)
- Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City 208, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; (Y.-Y.C.); (Y.-W.C.)
| | - Chin-Chen Chang
- Department of Medical Imaging, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei 100, Taiwan; (C.-C.C.); (B.-C.L.)
| | - Bo-Ching Lee
- Department of Medical Imaging, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei 100, Taiwan; (C.-C.C.); (B.-C.L.)
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; (Y.-Y.C.); (Y.-W.C.)
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
| | - Yu-Li Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City 220, Taiwan;
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Department of Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
- Correspondence: (C.-W.L.); (Y.-H.L.); Tel.: +886-2-23123456 (ext. 62152) (Y.-H.L.)
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Z.-W.C.); (C.-T.P.); (C.-H.T.); (V.-C.W.); (C.-S.H.)
- Correspondence: (C.-W.L.); (Y.-H.L.); Tel.: +886-2-23123456 (ext. 62152) (Y.-H.L.)
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Tsai CH, Pan CT, Chang YY, Peng SY, Lee PC, Liao CW, Shun CT, Li PT, Wu VC, Chou CH, Tsai IJ, Hung CS, Lin YH. Aldosterone Excess Induced Mitochondria Decrease and Dysfunction via Mineralocorticoid Receptor and Oxidative Stress In Vitro and In Vivo. Biomedicines 2021; 9:biomedicines9080946. [PMID: 34440149 PMCID: PMC8392669 DOI: 10.3390/biomedicines9080946] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Aldosterone excess plays a major role in the progression of cardiac dysfunction and remodeling in clinical diseases such as primary aldosteronism and heart failure. However, the effect of aldosterone excess on cardiac mitochondria is unclear. In this study, we investigated the effect of aldosterone excess on cardiac mitochondrial dysfunction and its mechanisms in vitro and in vivo. We used H9c2 cardiomyocytes to investigate the effect and mechanism of aldosterone excess on cardiac mitochondria, and further investigated them in an aldosterone-infused ICR mice model. The results of the cell study showed that aldosterone excess decreased mitochondrial DNA, COX IV and SOD2 protein expressions, and mitochondria ATP production. These effects were abolished or attenuated by treatment with a mineralocorticoid receptor (MR) antagonist and antioxidant. With regard to the signal transduction pathway, aldosterone suppressed cardiac mitochondria through an MR/MAPK/p38/reactive oxygen species pathway. In the mouse model, aldosterone infusion decreased the amount of cardiac mitochondrial DNA and COX IV protein, and the effects were also attenuated by treatment with an MR antagonist and antioxidant. In conclusion, aldosterone excess induced a decrease in mitochondria and mitochondrial dysfunction via MRs and oxidative stress in vitro and in vivo.
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Affiliation(s)
- Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-H.T.); (Y.-Y.C.)
- Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City 208, Taiwan
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
| | - Chien-Ting Pan
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-H.T.); (Y.-Y.C.)
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Shih-Yuan Peng
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
| | - Po-Chin Lee
- Department of Medical Imaging, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan;
| | - Che-Wei Liao
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
- Department of Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
| | - Chia-Tung Shun
- Department of Forensic Medicine and Pathology, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Po-Ting Li
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan;
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan;
| | - I-Jung Tsai
- Division of Nephrology, Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
- Correspondence: (I.-J.T.); (C.-S.H.); Tel.: +886-2-231-23456 (I.-J.T.); +886-2-23123456 (ext. 62152) (C.-S.H.); Fax: +886-2-23515811 (I.-J.T. & C.-S.H.)
| | - Chi-Sheng Hung
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
- Cardiovascular Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: (I.-J.T.); (C.-S.H.); Tel.: +886-2-231-23456 (I.-J.T.); +886-2-23123456 (ext. 62152) (C.-S.H.); Fax: +886-2-23515811 (I.-J.T. & C.-S.H.)
| | - Yen-Hung Lin
- Department of Internal Medicine, Division of Cardiology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan; (C.-T.P.); (S.-Y.P.); (C.-W.L.); (P.-T.L.); (Y.-H.L.)
- Cardiovascular Center, National Taiwan University Hospital, Taipei 100, Taiwan
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Abstract
In compromised bone conditions such as osteoporosis, developments of the implant surface are necessary to secure the stability of implants. This study investigated the effect of the surface porous titanium structure (PS) on the osseointegration of implants in osteoporotic bone. Bilateral ovariectomy (OVX) was performed in 4 female beagle dogs to induce osteoporosis for 32 wk. Success of induction was based on the evaluation of bone mineral density by Hounsfield units (HU) in computed tomography images. Posterior teeth in both mandibles were extracted 1 wk after OVX, and a total of 30 implants (15 implants in each group) were placed after 32 wk of osteoporosis induction. The control group implant underwent resorbable blast media (RBM) surface treatment, whereas the test group underwent RBM surface treatment in the coronal two-thirds and a PS added to the apical 3-mm portion. HU values in the mandibular trabecular bone, lumbar, and femoral head significantly decreased 32 wk after OVX, confirming osteoporotic condition after induction. Resonance frequency analysis and removal torque test showed comparable values between the 2 groups at 4 wk after implant placement. The surface topography of the implant after removal showed hard tissue integration at the PS in the test group. Bone-to-implant contact length was greater in the apical portion of the test group, although statistical significance was not found between the groups. Interthread bone area in the apical portion of the test group showed a significant increase compared to the control group (control: 0.059 ± 0.041 mm2, test: 0.121 ± 0.060 mm2, P = 0.028) with the histological feature of bone ingrowth at the PS. The findings of the study demonstrated that the surface PS could improve osteoconductivity in the osteoporotic trabecular bone by bone ingrowth at the pore space, thereby enhancing the osseointegration and stability of the implants.
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Affiliation(s)
- S Y Ko
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Republic of Korea
| | - J Y Hong
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - W Lee
- Advanced Process and Materials R&D Group, Korea Institute of Industrial Technology, Incheon, Republic of Korea
| | - Y Y Chang
- Department of Dentistry, Inha International Medical Center, Incheon, Republic of Korea
| | - K B Park
- MIR Dental Hospital and MegaGen, Daegu, Republic of Korea
| | - J H Yun
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Chan CK, Chang YY, Tsai YC, Chen ZW, Wu CY, Huang WC, Yen IW, Wu KH, Wu VC, Lin YH. Taiwan mini-frontier of primary aldosteronism: Updating treatment and comorbidities detection. J Formos Med Assoc 2021; 120:1811-1820. [PMID: 33906783 DOI: 10.1016/j.jfma.2021.03.032] [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: 10/01/2020] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to update the information on internationally acceptable standards and clinical practice recommendations for the management of patients with primary aldosteronism (PA). The Taiwan Society of Aldosteronism (TSA) Task Force acknowledged the novel issues of PA and reached a group consensus on PA in Taiwan by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. Unilateral adrenalectomy is the preferred treatment for patients with aldosterone-producing adenoma (APA). For medical treatment with mineralocorticoid receptor antagonists (MRAs), spironolactone is the first-line treatment, and eplerenone is a reasonable alternative in PA patients intolerant or contraindicated to spironolactone. The dose of MRAs can be titrated according to plasma renin activity (PRA). For screening PA-related comorbidities, we suggest albuminuria to predict a post-treatment decline in renal function, echocardiography as cardiac evaluation, bone mineral density scan for osteoporosis, and obstructive sleep apnea. In tissue and genetic surveys, we suggest immunohistochemical staining and somatic mutation screening for post-operative adrenal specimens in APA patients. With this consensus, we hope to update the information on PA for clinical physicians to facilitate better identification, management and treatment of patients with PA.
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Affiliation(s)
- Chieh-Kai Chan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin Chu County, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung University Hospital, Kaohsiung, Taiwan
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chun-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taichung General Veterans Hospital, Taichung, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Weng Yen
- Division of Metabolism & Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin Chu County, Taiwan
| | - Kuo-Hsin Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taiwan.
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- TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taiwan
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Tsai CH, Chen YL, Pan CT, Lin YT, Lee PC, Chiu YW, Liao CW, Chen ZW, Chang CC, Chang YY, Hung CS, Lin YH. New-Onset Atrial Fibrillation in Patients With Primary Aldosteronism Receiving Different Treatment Strategies: Systematic Review and Pooled Analysis of Three Studies. Front Endocrinol (Lausanne) 2021; 12:646933. [PMID: 34108934 PMCID: PMC8181760 DOI: 10.3389/fendo.2021.646933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/28/2020] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Primary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). However, the effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension. METHODS We performed the meta-analysis of the randomized or observational studies that investigated the incidence rate of NOAF in PA patients receiving MRA treatment versus PA patients receiving adrenalectomy from database inception until December 01, 2020 which were identified from PubMed, Embase, and Cochrane Library. RESULTS A total of 172 related studies were reviewed, of which three fulfilled the inclusion criteria, including a total of 2,705 PA patients. The results of meta-analysis demonstrated a higher incidence of NOAF among the PA patients receiving MRA treatment compared to the PA patients receiving adrenalectomy (pooled odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.76-4.57 in the random effects model, I2 = 0%). The pooled OR for the PA patients receiving MRA treatment compared to the patients with essential hypertension was 1.91 (95% CI: 1.11-3.28). The pooled OR for the PA patients receiving adrenalectomy compared to the patients with essential hypertension was 0.70 (95% CI: 0.28-1.79). CONCLUSION Compared to the essential hypertension patients and the PA patients receiving adrenalectomy, the patients with PA receiving MRA treatment had a higher risk of NOAF. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42021222022.
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Affiliation(s)
- Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Li Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yen-Tin Lin
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Po-Chin Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wei Chiu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Che-Wei Liao
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Yen-Hung Lin,
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Pan CT, Wu XM, Tsai CH, Chang YY, Chen ZW, Chang CC, Lee BC, Liao CW, Chen YL, Lin LC, Chang YR, Hung CS, Lin YH. Hemodynamic and Non-Hemodynamic Components of Cardiac Remodeling in Primary Aldosteronism. Front Endocrinol (Lausanne) 2021; 12:646097. [PMID: 33953695 PMCID: PMC8092478 DOI: 10.3389/fendo.2021.646097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/25/2020] [Accepted: 03/24/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Patients with primary aldosteronism (PA) have cardiac remodeling due to hemodynamic and non-hemodynamic causes. However, component analysis of cardiac remodeling and reversal in PA patients is lacking. We investigated components of cardiac remodeling and reversal after adrenalectomy in patients with aldosterone-producing adenoma (APA). METHODS This study prospectively enrolled 304 APA patients who received adrenalectomy and 271 with essential hypertension (EH). Clinical, biochemical and echocardiographic data were collected in both groups and 1 year after surgery in the APA patients. The hemodynamic and non-hemodynamic components of left ventricular (LV) remodeling were represented by predicted left ventricular mass index (LVMI) (pLVMI) and inappropriately excessive LVMI (ieLVMI, defined as LVMI-pLVMI). RESULTS After propensity score matching, 213 APA and 213 EH patients were selected. APA patients had higher hemodynamic (pLVMI) and non-hemodynamic (ieLVMI) components of LV remodeling than EH patients. In multivariate analysis, baseline pLVMI was correlated with systolic blood pressure (SBP) and serum potassium, whereas ieLVMI was correlated with log plasma aldosterone concentration but not blood pressure. Post-operative echocardiography was available in 207 patents and showed significant decreases in both pLVMI and ieLVMI after adrenalectomy. In multivariate analysis, ΔpLVMI was correlated with SBP, ΔSBP, and pre-operative pLVMI, whereas ΔieLVMI was correlated with Δlog aldosterone-to-renin ratio (ARR) and pre-operative ieLVMI. CONCLUSIONS This study concluded that extensive cardiac remodeling in APA patients occurs through hemodynamic and non-hemodynamic causes. Adrenalectomy can improve both hemodynamic and non-hemodynamic components of LV remodeling. Regressions of pLVMI and ieLVMI were correlated with decreases in blood pressure and ARR, respectively.
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Affiliation(s)
- Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, JinShan Branch, New Taipei, Taiwan
| | - Yi-Yao Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Center of General Education, Chihlee University of Technology, New Taipei City, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ya-Li Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ru Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yen-Hung Lin,
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Chang YY, Tsai CH, Peng SY, Chen ZW, Chang CC, Lee BC, Liao CW, Pan CT, Chen YL, Lin LC, Chang YR, Peng KY, Chou CH, Wu VC, Hung CS, Lin YH. KCNJ5 Somatic Mutations in Aldosterone-Producing Adenoma Are Associated With a Worse Baseline Status and Better Recovery of Left Ventricular Remodeling and Diastolic Function. Hypertension 2020; 77:114-125. [PMID: 33249859 DOI: 10.1161/hypertensionaha.120.15679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primary aldosteronism is the most common secondary endocrine form of hypertension and causes many cardiovascular injuries. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma. However, their impacts on left ventricular remodeling precluding the interference of age, sex, and blood pressure are still uncertain. We enrolled 184 aldosterone-producing adenoma patients who received adrenalectomy. Clinical, biochemical, and echocardiographic data were analyzed preoperatively and 1 year postoperatively. KCNJ5 gene sequencing of aldosterone-producing adenoma was performed. After propensity score matching for age, sex, body mass index, blood pressure, hypertension duration, and number of hypertensive medications, there were 60 patients in each group with and without KCNJ5 mutations. The mutation carriers had higher left ventricular mass index (LVMI) and inappropriately excessive LVMI (ieLVMI) and lower e' than the noncarriers. After adrenalectomy, the mutation carriers had greater decreases in LVMI and ieLVMI than the noncarriers. In addition, only mutation carriers had a significant decrease in E/e' after surgery. In multivariate analysis, baseline LVMI correlated with KCNJ5 mutations, the number of hypertensive medications, and systolic blood pressure. Baseline ieLVMI correlated with KCNJ5 mutations and the number of hypertensive medications. The regression of both LVMI and ieLVMI after surgery was mainly correlated with KCNJ5 mutations and changes in systolic blood pressure. Aldosterone-producing adenoma patients with KCNJ5 mutations had higher LVMI and ieLVMI and a greater regression of LVMI and ieLVMI after adrenalectomy than those without mutations. The patients with KCNJ5 mutations also benefited from adrenalectomy with regard to left ventricular diastolic function, whereas noncarriers did not.
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Affiliation(s)
- Yi-Yao Chang
- From the National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei (Y.-Y.C.).,Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan (Y.-Y.C.).,Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Center of General Education, Chihlee University of Technology, New Taipei City, Taiwan (Y.-Y.C.)
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Department of Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, JinShan Branch (C.-H.T.)
| | - Shih-Yuan Peng
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (Z.-W.C., C.-T.P.)
| | - Chin-Chen Chang
- Department of Medical Imaging (C.-C.C., B.-C.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging (C.-C.C., B.-C.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch (C.-W.L.)
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (Z.-W.C., C.-T.P.)
| | - Ya-Li Chen
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Lung-Chun Lin
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Yi-Ru Chang
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Kang-Yung Peng
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Chia-Hung Chou
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine (V.-C.W.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chi-Sheng Hung
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
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Wu YW, Yeh YT, Wu CC, Huang CL, Chang YY, Wu CC. Clinical Feasibility of Biofunctionalized Magnetic Nanoparticles for Detecting Multiple Cardiac Biomarkers in Emergency Chest Pain Patients. Acta Cardiol Sin 2020; 36:649-659. [PMID: 33235422 PMCID: PMC7677641 DOI: 10.6515/acs.202011_36(6).20200414a] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The rapid diagnosis of acute myocardial infarction (AMI) is a clinical and operational priority in emergency departments. Serial serum levels of cardiac biomarkers play a crucial role in the evaluation of patients presenting with acute chest pain, so that an accurate and rapidly responsive assay of cardiac biomarkers is vital for emergency departments. METHODS Immunomagnetic reduction (IMR) has been developed for rapid and on-site assays with a small sample volume. IMR kits for three biomarkers [myoglobin, creatine kinase-MB (CK-MB), and troponin-I] have been developed by MagQu Co., Ltd., Taiwan (US patent: US20190072563A1). In this study, we examined correlations between IMR signals and biomarker concentrations. The measurement threshold of the IMR kits, dynamic ranges, interference tests in vitro, and reagent stability were tested. Clinical cases were included with serial IMR measurements to determine the time course and peak of IMR-measured cardiac biomarkers after AMI. RESULTS The correlations between IMR signals and biomarker concentrations fitted well to logistic functions. The measurement thresholds of the IMR kits (1.03 × 10-8 ng/mL for myoglobin, 1.46 × 10-6 ng/mL for CK-MB, and 0.08 ng/mL for troponin-I) were much lower than the levels detected in the patients with AMI. There was no significant interference in vitro. The peak times of IMR-detected myoglobin, CK-MB, and troponin-I after AMI were 8.2 hours, 24.4 hours, and 24.7 hours, respectively. CONCLUSIONS IMR is an accurate and sensitive on-site rapid assay for multiple cardiac biomarkers in vitro, and may play a role in the early diagnosis of AMI. Clinical trials are needed.
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Affiliation(s)
- Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City;
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National Yang-Ming University School of Medicine;
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Department of Internal Medicine, Taoyuan General Hospital; Taoyuan
| | - Yen-Ting Yeh
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Chih-Cheng Wu
- National Yang-Ming University School of Medicine;
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National Taiwan University College of Medicine, Taipei;
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Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
| | - Chi-Lun Huang
- National Taiwan University College of Medicine, Taipei;
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Department of Internal Medicine, Taoyuan General Hospital; Taoyuan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City;
,
National Taiwan University College of Medicine, Taipei
| | - Chau-Chung Wu
- Department of Internal Medicine, National Taiwan University Hospital;
,
Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension. Increasing evidence has demonstrated an increased cardiovascular risk in patients with PA compared to those with essential hypertension (EH), including atrial fibrillation (AF), the most prevalent arrhythmia among adults that is associated with an elevated risk of subsequent cerebro-cardiovascular adverse events. The mechanisms of increased prevalence of AF in PA patients are complex. Excessive aldosterone production is regarded to be a key component in the pathogenesis of AF, in addition to arterial hypertension and electrolyte imbalance. In addition, several translational and clinical studies have reported that structural remodeling with atrial fibrosis and electrical remodeling with arrhythmogenicity induced by an excess of aldosterone also play major roles in AF genesis. Clinical studies from several registries and meta-analysis have reported an increased prevalence and risk of AF in PA patients compared to EH patients. Recent trials have further demonstrated a reduction in the risk of new-onset atrial fibrillation (NOAF) after adrenalectomy, while the results of medical treatment with mineralocorticoid receptor antagonists (MRAs) have been inconsistent. This review outlines the current evidence of the relationship between PA and AF, and highlights recent progress in the management of PA with regards to the development of AF.
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Affiliation(s)
- Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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27
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Pan CT, Liao CW, Tsai CH, Chen ZW, Chen L, Hung CS, Liu YC, Lin PC, Chang CC, Chang YY, Wu VC, Lin YH. Influence of Different Treatment Strategies on New-Onset Atrial Fibrillation Among Patients With Primary Aldosteronism: A Nationwide Longitudinal Cohort-Based Study. J Am Heart Assoc 2020; 9:e013699. [PMID: 32070205 PMCID: PMC7335564 DOI: 10.1161/jaha.119.013699] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Primary aldosteronism (PA) is associated with higher atrial fibrillation prevalence and other cardiovascular complications. However, the effect of target treatment to prevent new-onset atrial fibrillation (NOAF) remains unclear. This study investigated incidence of NOAF under different treatment strategies in patients with PA. Methods and Results We analyzed longitudinal data for patients with PA without atrial fibrillation history from 1997 to 2009 within the National Health Insurance Research Database in Taiwan. Patients with essential hypertension matched by propensity score were enrolled as controls. The primary outcome measurement was NOAF, and secondary outcome measurements were mortality, major cardiac and cardiac/cerebrovascular events, and a combined end point of NOAF and mortality. We identified 2202 patients with PA (534 adrenalectomy, 1668 mineralocorticoid receptor antagonist [MRA] therapy) and 8808 essential hypertension controls with mean follow-up of 4.4 years. In primary outcome measurement, patients with PA who underwent adrenalectomy had a lower incidence of NOAF (adjusted hazard ratio; 0.28, P=0.011) than controls. In contrast, the patients with PA who received MRA therapy had comparable risk of NOAF (adjusted hazard ratio, 1.20; P=0.224). In secondary outcome measurement, patients with PA who underwent adrenalectomy had a lower rate of mortality and combined end point of NOAF and mortality than controls. Patients with PA who received MRA therapy had a higher risk of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality than the essential hypertension controls. Conclusions Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF. However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy.
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Affiliation(s)
- Chien-Ting Pan
- Department of Internal Medicine National Taiwan University Hospital Yun-Lin Branch Yun-Lin Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine National Taiwan University Hospital Jin-Shan Branch New Taipei City Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine National Taiwan University Hospital Yun-Lin Branch Yun-Lin Taiwan
| | - Likwang Chen
- Institute of Population Health Sciences National Health Research Institutes Zhunan Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Yu-Chen Liu
- Department of Internal Medicine Far Eastern Poly Clinic Taipei Taiwan
| | - Po-Chih Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
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28
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Chang YY, Wang YG, Fan P, Wang JQ, Shu YQ, Li R, Zhong XN, Long L, Zhao ZH, Li CX, Qiu W. [Expression of HLA-DP in patients with neuromyelitis optica spectrum disorders]. Zhonghua Yi Xue Za Zhi 2019; 99:3574-3580. [PMID: 31826574 DOI: 10.3760/cma.j.issn.0376-2491.2019.45.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of HLA-DP gene expression on the susceptibility and disease status of neuromyelitis optica spectrum disorders (NMOSD). Methods: A total of 86 NMOSD patients (52 in acute phase and 34 in remission phase), 52 multiple sclerosis (MS) patients (20 in acute phase and 32 in remission phase) diagnosed in Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University and 29 healthy controls were enrolled prospectively. Genotyping of HLA-DP was performed. The expression levels of HLA-DP molecules in peripheral blood B cells and monocytes were measured by flow cytometry. The transcription levels of HLA-DPB1 mRNA in peripheral blood mononuclear cells (PBMC) were measured by real time-PCR. The results were compared among different groups Results: There was no statistically significant difference of the distributions of HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes and the frequencies of allele of HLA-DPB1*0501 among NMOSD, MS patients and healthy controls (P=0.96 and 0.71, respectively). The expression levels of HLA-DP on the surface of B cells in NMOSD patients, especially in remission phase patients, were significantly higher than those in healthy controls(212±328 and 374±394 vs 55±57, P=0.049 and 0.002, respectively). The expression levels of HLA-DP on the surface of monocytes in NMOSD patients in acute phase were significantly higher than those in healthy controls(158±175 vs 65±90, P=0.025). The transcription levels of PMBC HLA-DPB1 mRNA in acute phase and remission phase of NMOSD patients were significantly higher than those in healthy controls (3.0±1.4 and 2.9±1.3 vs 1.5±1.4, P=0.000 and 0.003, respectively). The expression levels of HLA-DP molecules on the surface of peripheral blood B cells and monocytes and the transcription levels of PMBC HLA-DPB1 mRNA in MS patients at the acute and remission stages were not significantly different from those in healthy controls. The expression levels of HLA-DP molecules on the surface of B cells in patients with HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes were statistically different (P=0.017). Conclusion: HLA-DP gene transcription and molecular expression levels in antigen presenting cells may affect the susceptibility and disease status of NMOSD patients, while HLA-DPB1*0501 allele may affect the transcription and molecular expression levels of HLA-DP gene in antigen presenting cells.
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Affiliation(s)
- Y Y Chang
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Y G Wang
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - P Fan
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - J Q Wang
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Y Q Shu
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - R Li
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - X N Zhong
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - L Long
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Z H Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450051, China
| | - C X Li
- School of Mathematics, Sun Yat-sen University, Guangzhou 510275, China
| | - W Qiu
- Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Liao CW, Chou CH, Wu XM, Chen ZW, Chen YH, Chang YY, Wu VC, Rose-John S, Hung CS, Lin YH. Interleukin-6 plays a critical role in aldosterone-induced macrophage recruitment and infiltration in the myocardium. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165627. [PMID: 31785407 DOI: 10.1016/j.bbadis.2019.165627] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/05/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022]
Abstract
Macrophages play an important role in aldosterone-induced myocardial fibrosis, in which the first key steps are macrophage recruitment and infiltration. We hypothesized that IL-6 may be a key mediator of aldosterone-induced macrophage recruitment and infiltration. To test this hypothesis, we designed cell studies with a human monocytic cell line THP-1 that with monocyte/macrophage functions to explore the signaling pathway of aldosterone-induced macrophage infiltration, and further investigated the phenomenon and consequent pathway in aldosterone-infused mice studies. The results showed that aldosterone induced the expression of IL-6 via mineralocorticoid receptors, and enhanced THP-1 cell migration and infiltration. Further experiments using a protease array and siRNA revealed that expressions of MMP-1 and MMP-9 were associated with aldosterone-induced macrophage infiltration. In addition, aldosterone-induced MMP-1 and MMP-9 expressions were mediated via cyclooxygenase-II and prostaglandin E2/EP-2 and EP-4 receptors. In aldosterone-infused mice, mRNA expressions of MMP-1, MMP-9 and COX-2 in peripheral blood monocytic cells were significantly increased. Moreover, the number of mouse macrophage-restricted F4/80 protein-positive cells in the myocardium was significantly higher in the aldosterone-infused mice compared with control mice. The increase in F4/80-positive cells in the myocardium was suppressed in the aldosterone-infused mice with the aldosterone antagonist eplerenone or anti-IL-6 antibody treatment. In conclusion, interleukin-6 played an important role in aldosterone-induced macrophage recruitment and infiltration in the myocardium.
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Affiliation(s)
- Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology and Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Rose-John
- Institute of Biochemistry, Kiel University, Olshausenstrasse 40, Kiel, Germany
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Chang YY, Liao CW, Tsai CH, Chen CW, Pan CT, Chen ZW, Chen YL, Lin LC, Chang YR, Wu VC, Wu KD, Hung CS, Lin YH. Left Ventricular Dysfunction in Patients With Primary Aldosteronism: A Propensity Score-Matching Follow-Up Study With Tissue Doppler Imaging. J Am Heart Assoc 2019; 8:e013263. [PMID: 31718437 PMCID: PMC6915298 DOI: 10.1161/jaha.119.013263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/20/2023]
Abstract
Background Primary aldosteronism is the most common cause of secondary hypertension and is associated with left ventricular hypertrophy. However, whether aldosterone excess is responsible for left ventricular (LV) diastolic dysfunction is unknown. Methods and Results We prospectively enrolled 129 patients with aldosterone‐producing adenoma and 120 patients with essential hypertension, and analyzed their clinical, biochemical, and echocardiographic data, including tissue Doppler images. The patients with aldosterone‐producing adenoma were reevaluated 1 year after adrenalectomy. After propensity score matching, there were 105 patients in each group. The patients with aldosterone‐producing adenoma had worse diastolic function than the patients with essential hypertension, as reflected by lower e′ (P<0.001) and higher E/e′ (P=0.003). Multivariate analysis showed that LV diastolic function was significantly correlated with age (P<0.001), sex (P<0.001), body mass index (P=0.002), systolic blood pressure (P=0.004), creatinine (P=0.008), and log‐transformed aldosterone‐renin ratio (P=0.003). After adrenalectomy, the patients with aldosterone‐producing adenoma had significant improvements in LV diastolic function as reflected by an increase in e′ (P=0.003) and decrease in E/e′ (P=0.002). The change in E/e′ was independently correlated with baseline E/e′ (P<0.001) and change in LV mass index (P=0.006). Conclusions The patients with primary aldosteronism had worse LV diastolic function than the patients with essential hypertension after propensity score matching, and this could be reversed after adrenalectomy, suggesting that aldosterone excess may induce LV diastolic dysfunction.
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Affiliation(s)
- Yi-Yao Chang
- Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan.,Cardiology Division of Cardiovascular Medical Center Far Eastern Memorial Hospital New Taipei City Taiwan.,Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan.,Center of General Education Chihlee University of Technology New Taipei City Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Ching-Way Chen
- Department of Internal Medicine National Taiwan University Hospital Yun-Lin Branch Yun-Lin Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Zheng-Wei Chen
- Department of Internal Medicine National Taiwan University Hospital Yun-Lin Branch Yun-Lin Taiwan
| | - Ya-Li Chen
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Yi-Ru Chang
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
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Liao MT, Liao CW, Tsai CH, Chang YY, Chen ZW, Pan CT, Lin LC, Wu VC, Kuo SF, Wu XM, Hung CS, Lin YH. U-shaped relationship between left ventricular mass index and estimated glomerular filtration rate in patients with primary aldosteronism. J Investig Med 2019; 68:371-377. [PMID: 31630138 DOI: 10.1136/jim-2019-001057] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 11/03/2022]
Abstract
Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=-0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=-0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m2, from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH.
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Affiliation(s)
- Min-Tsun Liao
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Che-Wei Liao
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Cheng-Hsuan Tsai
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Yao Chang
- Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Zheng-Wei Chen
- Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
| | - Chien-Ting Pan
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Fen Kuo
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Xue-Ming Wu
- Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Chi-Sheng Hung
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Chou CH, Hung CS, Liao CW, Wei LH, Chen CW, Shun CT, Wen WF, Wan CH, Wu XM, Chang YY, Wu VC, Wu KD, Lin YH. IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis. Cardiovasc Res 2019; 114:690-702. [PMID: 29360942 DOI: 10.1093/cvr/cvy013] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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] [Received: 03/03/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
Aims An excess of aldosterone results in cardiac remodelling and fibrosis. Interleukin-6 (IL-6) is a key mediator in the fibrotic process; however, the effect of aldosterone on the expression of IL-6 remains unclear. We investigated whether aldosterone induces the expression of IL-6 and thereby contributes to the fibrotic process. Methods and results In this clinical study, we prospectively enrolled 25 patients with primary aldosteronism (PA) and 26 patients with essential hypertension (EH). The PA patients had higher plasma IL-6 levels, left ventricular mass index, degree of myocardial fibrosis, and more impaired diastolic function than the EH patients. In addition, plasma IL-6 levels were positively correlated with 24-h urinary aldosterone and echocardiographic parameters. In cell studies, we investigated the possible molecular mechanism how aldosterone-induced IL-6 secretion and the further effects of collagen production. Aldosterone significantly induced IL-6 protein and mRNA production in human umbilical vein endothelial cells. Intracellular signalling occurred through the mineralocorticoid receptor/PI3K/Akt/NF-kB pathway. In cardiac fibroblasts, IL-6 trans-signalling played a critical role in aldosterone-induced IL-6-enhanced fibrosis-related factor expression. To further investigate the role of IL-6 trans-signalling in aldosterone-induced cardiac fibrosis, we measured the severity of myocardial fibrosis in aldosterone infusion mice models including an IL-6 chemical inhibitor and Sgp130 Knockin Transgenic Mice. Mice receiving recombinant soluble gp130 and Sgp130 Knockin Transgenic Mice prevented myocardial fibrosis and cardiac hypertrophy by aldosterone infusion. Conclusions IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis.
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Affiliation(s)
- Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, 100, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, 100, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital 300, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Lin-Hung Wei
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, 100, Taipei, Taiwan
| | - Ching-Way Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, 640, Douliu, Taiwan
| | - Chia-Tung Shun
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, 100, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital, 100, Taipei, Taiwan
| | - Wen-Fen Wen
- Department of Pathology, National Taiwan University Hospital, 100, Taipei, Taiwan
| | - Cho-Hua Wan
- Taiwan Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, 10617, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, 300, Taoyuan, Taiwan
| | - Yi-Yao Chang
- Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, 220, New Taipei City, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Hung CS, Wu XM, Chen CW, Chen YH, Wu VC, Liao CW, Chang YY, Yen RF, Lu CC, Su MYM, Liu KL, Chang CC, Liu LYD, Wu KD, Lin YH. The relationship among cardiac structure, dietary salt and aldosterone in patients with primary aldosteronism. Oncotarget 2017; 8:73187-73197. [PMID: 29069862 PMCID: PMC5641205 DOI: 10.18632/oncotarget.17505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/08/2016] [Accepted: 04/05/2017] [Indexed: 01/10/2023] Open
Abstract
Salt intake is highly associated with cardiac structure in patients with primary aldosteronism (PA). We investigated the association among dietary salt intake, aldosterone and left ventricular mass in patients with PA. We enrolled 158 patients with PA and 158 patients with essential hypertension. We measured 24-hour urinary sodium (UNa) and aldosterone (UAldo) level and echocardiography parameters. In patients with PA, the UAldo level was positively correlated with left ventricular mass index (LVMI; r=0.231, p=0.007). The UNa level was not linearly correlated with left ventricular structural parameters in patients with PA. To test if UNa has a non-linear relationship with LVMI among patients with PA, we categorized the participants according to the tertile of UNa (low, median, and high tertile). PA patients with medium tertile of UNa had significant lower LVMI than the other two groups (LVMI: 144.1 ± 42.9, 121.1 ± 33.4, and 136.7 ± 32.8 g/m2, from the lowest to the highest tertile of Una; analysis of variance p=0.006, post-hoc p <0.05). Multifactor analysis of variance confirmed this finding after adjustment for clinical parameters. Post-hoc analyses revealed that the high UNa tertile was associated with higher left ventricular end-diastolic volume compared with medium UNa tertile; while the low UNa tertile was associated with higher mean wall thickness compared with medium UNa tertile. The findings imply the reasons for increased LVMI may be different in patients with the highest and lowest UNa tertile. In conclusion, the medium tertile of 24-hour UNa is associated with lowest LVMI in patients with PA.
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Affiliation(s)
- Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Ching-Way Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ruh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Yuan M Su
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Yu Daisy Liu
- Department of Agronomy, Biometry Division, National Taiwan University, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YY, Wu YW, Lee JK, Lin YM, Lin YT, Kao HL, Hung CS, Lin HJ, Lin YH. Effects of 12 weeks of atorvastatin therapy on myocardial fibrosis and circulating fibrosis biomarkers in statin-naïve patients with hypertension with atherosclerosis. J Investig Med 2016; 64:1194-9. [DOI: 10.1136/jim-2016-000092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to assess the effects of 12 weeks of atorvastatin treatment on myocardial fibrosis in patients with hypertension with atherosclerosis. 15 statin-naïve participants (11 males; mean age 67±10 years) with atherosclerosis were given atorvastatin (40 mg/day) for 12 weeks and underwent echocardiography including ultrasonic tissue characterization by cyclic variation of integrated backscatter (CVIBS). Serum galectin-3 and fibrosis markers including aminoterminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase-2, metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) were also analyzed. After 12 weeks of atorvastatin (40 mg/day) treatment, serum total cholesterol and low-density lipoprotein cholesterol decreased significantly (204±31 to 140±24 mg/dL and 133±26 to 69±17 ng/mL, respectively, both p<0.001). In myocardial fibrosis analysis, CVIBS increased significantly (6.6±1.9 to 8.5±2.7 dB, p=0.024). In addition, the circulating fibrosis markers serum PIIINP and TIMP-1 decreased significantly (9.5±2.7 to 6.4±1.4 ng/mL, p=0.012 and 299±65 to 250±45 ng/mL, p=0.024, respectively). 12 weeks of medium dose atorvastatin treatment resulted in a significant reduction in myocardial fibrosis as evaluated by morphofunctional parameters and plasma markers of tissue fibrosis.Trial registration numberNTC00172419; results.
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Hung CS, Chou CH, Liao CW, Lin YT, Wu XM, Chang YY, Chen YH, Wu VC, Su MJ, Ho YL, Chen MF, Wu KD, Lin YH. Aldosterone Induces Tissue Inhibitor of Metalloproteinases-1 Expression and Further Contributes to Collagen Accumulation. Hypertension 2016; 67:1309-20. [DOI: 10.1161/hypertensionaha.115.06768] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
Aldosterone induces myocardial fibrosis. Tissue inhibitor of metalloproteinases-1 (TIMP-1) is a key factor of myocardial fibrosis. This study tested the hypothesis that aldosterone induces TIMP-1 expression and contributes to the fibrotic process. We prospectively enrolled 54 patients with primary aldosteronism, and measured plasma TIMP-1 and echocardiographic parameters. In the cell study, we investigated the possible molecular mechanism by which aldosterone induces TIMP-1 secretion and the effects on collagen accumulation. In the animal study, we measured serum TIMP-1 levels, cardiac TIMP-1 levels, and cardiac structure in an aldosterone infusion mouse model using implantation of aldosterone pellets. In patients with primary aldosteronism, plasma TIMP-1 was correlated with 24-hour urinary aldosterone, left ventricular mass, and impairment of left ventricular diastolic function. In human cardiac fibroblasts, TIMP-1 protein and mRNA expressions were significantly increased by aldosterone through the glucocorticoid receptor/PI3K/Akt/nuclear factor-κB pathway. TIMP-1 small-interfering RNA significantly reduced aldosterone-induced collagen accumulation, and aldosterone did not alter the levels of collagen1a1 or matrix metalloproteinase-1 mRNA. The aldosterone-induced TIMP-1 expression was inversely related to matrix metalloproteinase-1 activity. Furthermore, in the animal model, the serum and cardiac levels of TIMP-1 were significantly elevated in the mice that received aldosterone infusion. This elevation was blocked by RU-486 but not by eplerenone, suggesting that the effect was through glucocorticoid receptors. In a long-term aldosterone infusion model, serum TIMP-1 was associated with serum aldosterone level, cardiac structure, and fibrosis. In conclusion, aldosterone induced TIMP-1 expression in vivo and in vitro. This increased TIMP-1 expression resulted in enhanced collagen accumulation via the suppression of matrix metalloproteinase-1 activity.
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Affiliation(s)
- Chi-Sheng Hung
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Chia-Hung Chou
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Che-Wei Liao
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Yen-Tin Lin
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Xue-Ming Wu
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Yi-Yao Chang
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Ying-Hsien Chen
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Vin-Cent Wu
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Ming-Jai Su
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Yi-Lwun Ho
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Ming-Fong Chen
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Kwan-Dun Wu
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
| | - Yen-Hung Lin
- From the Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan (C.-S.H., Y.-H.C., Y.-L.H.); Departments of Internal Medicine (C.-S.H., V.-C.W., Y.-L.H., M.-F.C., K.-D.W., Y.-H.L.) and Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (C.-W.L., Y.-T.L.); Department of Internal Medicine, Taoyuan
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Liao CW, Lin YT, Wu XM, Chang YY, Hung CS, Wu VC, Wu KD, Lin YH. The relation among aldosterone, galectin-3, and myocardial fibrosis: a prospective clinical pilot follow-up study. J Investig Med 2016; 64:1109-13. [PMID: 27190071 DOI: 10.1136/jim-2015-000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Primary aldosteronism has been associated with myocardial fibrosis, and is the most common cause of secondary hypertension. We previously showed that aldosterone can induce the secretion of galectin-3. The aim of this study was to investigate the association between myocardial fibrosis and plasma galectin-3 level in patients with primary aldosteronism. We prospectively analyzed 11 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from December 2006 to October 2008, and 17 patients with essential hypertension as controls. Levels of plasma galectin-3 were determined in both groups, and both groups underwent echocardiography with cyclic variations of integrated backscatter (CVIBS) to characterize tissue initially and 1 year after surgery in the APA group. Diastolic blood pressure, concentration of plasma aldosterone and aldosterone-renin ratio were significantly higher, and serum potassium level and plasma renin activity significantly lower in the APA group compared to the controls. In addition, left ventricular mass index was significantly higher and CVIBS significantly lower in the APA group (7.3±2.0 vs 9.2±1.7 dB, p=0.015). Furthermore, the concentration of plasma galectin-3 was significantly higher in the APA group (2.1±0.9 vs 1.1±0.6 ng/mL, p=0.005) compared to the controls. CVIBS was correlated to plasma galectin-3 level. In the APA group, CVIBS increased significantly (7.3±2.0 to 9.2±2.4 dB, p=0.032) and plasma galectin-3 decreased (2.1±0.9 to 1.2±0.6, p=0.049) 1 year postadrenalectomy. The patients with APA had increased myocardial fibrosis, and this was associated with a higher plasma galectin-3 level. Both increased myocardial fibrosis and plasma galectin-3 level recovered at least partially after adrenalectomy. TRIAL REGISTRATION NUMBER 200611031R; Results.
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Affiliation(s)
- Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yen-Tin Lin
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chou CH, Chen YH, Hung CS, Chang YY, Tzeng YL, Wu XM, Wu VC, Tsai CT, Wu CK, Ho YL, Wu KD, Lin YH. Aldosterone Impairs Vascular Smooth Muscle Function: From Clinical to Bench Research. J Clin Endocrinol Metab 2015; 100:4339-47. [PMID: 26401591 DOI: 10.1210/jc.2015-2752] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Indexed: 02/13/2023]
Abstract
CONTEXT The effect of aldosterone on vascular smooth muscle cell function is still unclear. One method to measure vascular smooth muscle cell function is endothelial-independent vascular dilation, for which the key factor is sarcoplasmic reticulum calcium adenosine triphosphatase (SERCA). OBJECTIVE Our objective was to investigate the effect of aldosterone on vascular smooth muscle cell function and SERCA regulation. DESIGN We prospectively analyzed 35 patients with primary aldosteronism (PA; 32 patients with aldosterone-producing adenoma and three patients with idiopathic hyperaldosteronism) and 30 patients with essential hypertension (EH) who were enrolled as the control group. Flow and nitrate-mediated dilation were performed in both groups and 1 year after adrenalectomy in the patients with aldosterone-producing adenoma. In addition, we investigated the effect of aldosterone on SERCA regulation in human aortic smooth muscle cells. SETTING This study took place in an academic clinical research center. PARTICIPANTS Participants included 35 patients with PA and 30 patients with EH. INTERVENTIONS Adrenalectomy was undertaken in patients with aldosterone-producing adenoma. RESULTS The PA patients had significantly lower flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) values than the patients with EH (FMD: 13 ± 6 vs 16 ± 4; NMD: 16 ± 6 vs 19 ± 5; both P < .05). FMD/NMD were significantly correlated with log 24 hour-urine aldosterone (FMD: r = -0.287, P = .048; NMD: r = -0.402, P = .005) but not blood pressure. The impaired FMD and NMD values were significantly restored 1 year after adrenalectomy (FMD: 11 ± 4 to 19 ± 7; NMD: 15 ± 6 to 21 ± 6; both P < .01). Under confocal microscopy, aldosterone was shown to suppress the expression of SERCA2a of human aortic smooth muscle cells. Aldosterone significantly suppressed the expression of SERCA2a from 10(-8) M in mRNA and protein levels. This suppression was through down-regulation of mineralocorticoid receptor dependent mitochondrial transcription factors A and B2. CONCLUSIONS Aldosterone impairs vascular smooth muscle cell function and suppresses SERCA 2a expression.
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Affiliation(s)
- Chia-Hung Chou
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Ying-Hsien Chen
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Chi-Sheng Hung
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yi-Yao Chang
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yu-Lin Tzeng
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Xue-Ming Wu
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Vin-Cent Wu
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Chia-Ti Tsai
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Cho-Kai Wu
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yi-Lwun Ho
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Kwan-Dun Wu
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yen-Hung Lin
- Departments of Obstetrics and Gynecology (C.-H.C.) and Internal Medicine (Y.-H.C., C.-S.H., Y.-L.T., V.-C.W., C.-T.T., C.-K.W., Y.-L.H. K.-D.W., Y.-H.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center (Y.-Y.C.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; and Department of Internal Medicine (X.-M.W.), Taoyuan General Hospital, Taoyuan, Taiwan
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Liao MT, Wu XM, Chang CC, Liao CW, Chen YH, Lu CC, Lin YT, Chang YY, Hung CS, Lin LC, Lai CL, Lin LY, Wu VC, Ho YL, Wu KD, Lin YH. The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism. Int J Med Sci 2015; 12:369-77. [PMID: 26005371 PMCID: PMC4441061 DOI: 10.7150/ijms.10975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/20/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Glomerular hyperfiltration has been recently noticed as an important issue in primary aldosteronism (PA) patients. However, its effect on the cardiovascular system remains unknown. METHODS We prospectively analyzed 47 PA patients including 11 PA patients with estimated glomerular filtration rate (eGFR) > 130 ml/min per 1.73 m2 (group 1), and 36 PA patients with eGFR 90-110 ml/min per 1.73 m2 (group 2). Fourteen essential hypertension (EH) patients with eGFR 90-110 ml/min per 1.73 m2 were included as the control group (group 3). Echocardiography including left ventricular mass index (LVMI) measurement and tissue Doppler imaging (TDI) was performed. Predicted left ventricular mass (LVM) was calculated. Inappropriate LVM was defined as an excess of > 35% from the predicted value. RESULTS The value of LVMI decreased significantly in order from groups 1 to 3 (group 1>2>3). While group 2 had a significantly higher percentage of inappropriate LVM than group 3, the percentage of inappropriate LVM were comparable in groups 1 and 2. Group 1 had a higher mitral E velocity, E/A ratio than that of group 2. In the TDI study, the E/E' ratio also decreased significantly in order from groups 1 to 3 (group 1>2>3). Group 2 had lower E' than that of group 3, although the E' of group 1 and 2 were comparable. CONCLUSIONS Although PA patients with glomerular hyperfiltration were associated with higher LVMI, higher mitral E velocity, higher E/E' ratio, they had comparable E' with PA patients with normal GFR. This phenomenon may be explained by higher intravascular volume in this patient group.
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Affiliation(s)
- Min-Tsun Liao
- 1. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Xue-Ming Wu
- 2. Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Chin-Chen Chang
- 3. Department of Medical Image, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Che-Wei Liao
- 1. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ying-Hsien Chen
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Ching-Chu Lu
- 5. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Yen-Ting Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Yi-Yao Chang
- 6. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Sheng Hung
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Lung-Chun Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Chao-Lun Lai
- 1. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Lian-Yu Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Vin-Cent Wu
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Yi-Lwun Ho
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Kwan-Dun Wu
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
| | - Yen-Hung Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan
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Lin YH, Chou CH, Wu XM, Chang YY, Hung CS, Chen YH, Tzeng YL, Wu VC, Ho YL, Hsieh FJ, Wu KD. Aldosterone induced galectin-3 secretion in vitro and in vivo: from cells to humans. PLoS One 2014; 9:e95254. [PMID: 25180794 PMCID: PMC4152338 DOI: 10.1371/journal.pone.0095254] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 03/25/2014] [Indexed: 12/20/2022] Open
Abstract
Context Patients with primary aldosteronism are associated with increased myocardial fibrosis. Galectin-3 is one of the most important mediators between macrophage activation and myocardial fibrosis. Objective To investigate whether aldosterone induces galectin-3 secretion in vitro and in vivo. Methods and Results We investigated the possible molecular mechanism of aldosterone-induced galectin-3 secretion in macrophage cell lines (THP-1 and RAW 264.7 cells). Aldosterone induced galectin-3 secretion through mineralocorticoid receptors via the PI3K/Akt and NF-κB transcription signaling pathways. In addition, aldosterone-induced galectin-3 expression enhanced fibrosis-related factor expression in fibroblasts. We observed that galectin-3 mRNA from peripheral blood mononuclear cells and serum galectin-3 levels were both significantly increased in mice implanted with aldosterone pellets on days 7 and 14. We then conducted a prospective preliminary clinical study to investigate the association between aldosterone and galectin-3. Patients with aldosterone-producing adenoma had a significantly higher plasma galectin-3 level than patients with essential hypertension. One year after adrenalectomy, the plasma galectin-3 level had decreased significantly in the patients with aldosterone-producing adenoma. Conclusion This study demonstrated that aldosterone could induce galectin-3 secretion in vitro and in vivo.
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Affiliation(s)
- Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yi-Yao Chang
- Department of Cardiology, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Lin Tzeng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
| | - Fon-Jou Hsieh
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YY, Chen A, Chen YH, Hung CS, Wu VC, Wu XM, Lin YH, Ho YL, Wu KD. Hypokalemia correlated with arterial stiffness but not microvascular endothelial function in patients with primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2014; 16:353-9. [DOI: 10.1177/1470320314524996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Aaron Chen
- Woodhull Medical and Mental Hospital, Brooklyn, New York, USA
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YY, Lee HH, Hung CS, Wu XM, Lee JK, Wang SM, Liao MT, Chen YH, Wu VC, Wu KD, Lin YH. Association between urine aldosterone and diastolic function in patients with primary aldosteronism and essential hypertension. Clin Biochem 2014; 47:1329-32. [PMID: 24892901 DOI: 10.1016/j.clinbiochem.2014.05.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 04/18/2014] [Accepted: 05/25/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the association between aldosterone and cardiac diastolic dysfunction. DESIGN AND METHODS We prospectively enrolled 20 patients with primary aldosteronism (PA) and 22 patients with essential hypertension (EH). Plasma aldosterone concentration, plasma renin activity, and 24-h urine aldosterone level were measured. Echocardiography, including tissue Doppler image recordings, was performed. RESULTS PA patients had a significantly higher left ventricular (LV) mass index and worse LV diastolic function than those in EH patients. Among various measures of aldosterone, log-transformed 24-h urine aldosterone level had the most consistent correlation with diastolic function. CONCLUSIONS Aldosterone is strongly associated with LV diastolic dysfunction. Twenty-four hour urine aldosterone is a good indicator to evaluate the impact of aldosterone on LV diastolic function.
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Affiliation(s)
- Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiu-Hao Lee
- Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan; Institution of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Jen-Kuang Lee
- Department of Laboratory Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Chang YY, Chen A, Wu XM, Hsu TP, Liu LYD, Chen YH, Wu YW, Lin HJ, Hsu RB, Lee CM, Wang SS, Lo MT, Chen MF, Lin YH. Comparison the prognostic value of galectin-3 and serum markers of cardiac extracellular matrix turnover in patients with chronic systolic heart failure. Int J Med Sci 2014; 11:1098-106. [PMID: 25170292 PMCID: PMC4147635 DOI: 10.7150/ijms.8083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/31/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Galectin-3 (Gal-3) shows the ability of survival prediction in heart failure (HF) patients. However, Gal-3 is strongly associated with serum markers of cardiac extracellular matrix (ECM) turnover. The aim of this study is to compare the impact of Gal-3 and serum markers of cardiac ECM turnover on prognostic prediction of chronic systolic HF patients. METHODS Serum Gal-3, brain natriuretic peptide (BNP), extracellular matrix including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2, 9 (MMP-2, 9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were analyzed. Cox regression analysis was used for survival analysis. RESULTS A total of 105 (81 male) patients were enrolled. During 980±346 days follow-up, 17 patients died and 36 episodes of HF admission happened. Mortality of these patients was significantly associated with the log PIIINP (β= 15.380; P=0.042), log TIMP-1(β= 44.530; P=0.003), log MMP-2 (β= 554.336; P<0.001), log BNP (β= 28.273; P=0.034). Log Gal-3 (β= 7.484; P=0.066) is borderline associated with mortality. Mortality or first HF admission of these patients was significantly associated with the log TIMP-1(β= 16.496; P=0.006), log MMP-2 (β= 221.864; P<0.001), log BNP (β= 5.999; P=0.034). Log Gal-3 (β= 4.486; P=0.095) only showed borderline significance. In several models adjusting clinical parameters, log MMP-2 was significantly associated with clinical outcome. In contrast, log Gal-3 was not. CONCLUSION The prognostic strength of MMP-2 to clinical outcome prediction in HF patients is stronger than Gal-3.
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Affiliation(s)
- Yi-Yao Chang
- 1. Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Aaron Chen
- 2. Woodhull Medical and Mental Hospital, Brooklyn, New York, USA
| | - Xue-Ming Wu
- 3. Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Tse-Pin Hsu
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Yu Daisy Liu
- 6. Department of Agronomy, Biometry Division, National Taiwan University, Taipei, Taiwan
| | - Yenh-Hsein Chen
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Wen Wu
- 1. Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; ; 7. National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hung-Ju Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ron-Bin Hsu
- 5. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Ming Lee
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shoei-Shen Wang
- 5. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Men-Tzung Lo
- 8. Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Ming-Fong Chen
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- 4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YY, Lee HH, Hung CS, Wu XM, Lee JK, Wang SM, Liao MT, Chen YH, Wu VC, Lin YH, Wu KD. WITHDRAWN: Association between the levels of carboxy-terminal propeptide of type I procollagen and aldosterone in patients with primary aldosteronism and essential hypertension. Clin Biochem 2013:S0009-9120(13)00037-4. [PMID: 23376327 DOI: 10.1016/j.clinbiochem.2013.01.010] [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] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 01/16/2013] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Yi-Yao Chang
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiu-Hao Lee
- Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan; Institution of Occupational Medicine and Industrial Hygiene, National Taiwan, University College of Public Health, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xue-Ming Wu
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Jen-Kuang Lee
- Department of Laboratory Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shuo-Meng Wang
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin branch, Yun-Lin, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Wang YM, Chang Y, Chang YY, Cheng J, Li J, Wang T, Zhang QY, Liang DC, Sun B, Wang BM. Serotonin transporter gene promoter region polymorphisms and serotonin transporter expression in the colonic mucosa of irritable bowel syndrome patients. Neurogastroenterol Motil 2012; 24:560-5, e254-5. [PMID: 22435794 DOI: 10.1111/j.1365-2982.2012.01902.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 12/13/2022]
Abstract
BACKGROUND The role of serotonin transporter (SERT) gene polymorphism in irritable bowel syndrome (IBS) has been demonstrated. However, the expression of SERT mRNA and proteins in the colonic mucosa with different 5-HTT gene-linked polymorphic region (5-HTTLPR) genotypes remains unknown. We examined SERT mRNA and protein levels in colon biopsies from patients with different 5-HTTLPR genotypes and evaluated the links between the polymorphism and the expression levels. METHODS Two hundred and fifty-four patients with IBS and 120 healthy subjects were studied. DNA samples were extracted from peripheral blood and genotyped by polymerase chain reaction (PCR). SERT mRNA and protein levels were evaluated by quantitative real time PCR and western blotting. The promoter efficiency of the serotonin transporter promoter (SERT-P) was evaluated with luciferase reporter system. KEY RESULTS The frequency of the L/L genotype in C-IBS group was significantly higher than that in the control and D-IBS. However, the S/S genotype in D-IBS was significantly higher than that in C-IBS. The transcriptional efficiency of the L/L genotype was significantly higher than that in the L/S and S/S genotype. Patients with the L/L genotype demonstrated increased production of the SERT protein when compared with L/S and S/S patients. The l variant increased SERT promoter activity by 2.43-fold when compared with the s variant. CONCLUSIONS & INFERENCES Polymorphism in the promoter region of the SERT gene can influence the expression of SERT mRNA and the levels of the SERT protein in the colonic mucosa, thereby playing a key role in motility-related symptoms of IBS patients.
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Affiliation(s)
- Y M Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University Hospital, Tianjin, China
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Chang YY, Cronan JE. An Escherichia coli mutant deficient in pyruvate oxidase activity due to altered phospholipid activation of the enzyme. Proc Natl Acad Sci U S A 2010; 81:4348-52. [PMID: 16593486 PMCID: PMC345586 DOI: 10.1073/pnas.81.14.4348] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The pyruvate oxidase (pyruvate:ferricytochrome b(1) oxidoreductase, EC 1.2.2.2) of Escherichia coli is markedly activated by phospholipids in vitro. To test the physiological relevance of this activation, we isolated an E. coli mutant producing an oxidase that is deficient in activation by (and binding to) phospholipids. The mutant oxidase could be fully activated by a specific proteolytic cleavage, indicating that the catalytic site is normal. The mutant enzyme functions poorly in vivo, indicating that activation of the oxidase by phospholipids plays an important physiological role.
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Affiliation(s)
- Y Y Chang
- Department of Microbiology, University of Illinois, 131 Burrill Hall, 407 South Goodwin, Urbana, IL 61801
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Abstract
Lipopolysaccharide isolated from colicin E2-sensitive Escherichia coli and from "receptor-minus" mutants inhibits the activity of colicin E2. Lipid A and the polysaccharide fraction obtained by mild acid hydrolysis of lipopolysaccharide are inactive either alone or when tested in combination. Periodate oxidation of lipopolysaccharide destroys over 85% of its inhibition activity.
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Affiliation(s)
- Y Y Chang
- Department of Biochemistry, University of Illinois, Urbana, Illinois 61801
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Chang CC, Chang YY, Chang WN, Lee YC, Wang YL, Lui CC, Huang CW, Liu WL. Cognitive deficits in multiple system atrophy correlate with frontal atrophy and disease duration. Eur J Neurol 2009; 16:1144-50. [PMID: 19486137 DOI: 10.1111/j.1468-1331.2009.02661.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Dementia remains an exclusion criterion in diagnosing multiple system atrophy (MSA). This study aimed to determine the cognitive changes and brain atrophy patterns in the Parkinsonian (MSA-P) and cerebellar (MSA-C) variants of MSA. METHODS Voxel-based morphometry (VBM) of magnetic resonance imaging (MRI) and neuro-psychological tests were applied to 10 MSA-C and 13 MSA-P patients, and compared to 37 age-matched controls. Correlation analyses were performed between cognitive test results and morphometric data extracted from the VBM data. RESULTS In neuro-psychological testing, the 23 MSA patients scored lower in the Stroop interference test and took longer in the trail-making test as compared with the controls, whereas MSA-C performed worse than MSA-P in the memory scores, Stroop test, and time to complete the trail-making test. MSA, as a group, showed atrophy in the cerebellum, insular cortex, fusiform gyrus, inferior orbito-frontal gyrus, superior temporal gyrus, and caudate nucleus. Memory scores correlated well with pre-frontal lobe atrophy but not in the insular area. CONCLUSION In conclusion, although dementia is not a typical presenting feature of MSA and is regarded as a sub-cortical movement disorder, frontal atrophy, cognitive changes, and dementia are identifiable as MSA progresses.
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Affiliation(s)
- C C Chang
- Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Lan MY, Chang YY, Chen WH, Kao YF, Lin HS, Liu JS. Serotonin transporter gene promoter polymorphism is associated with body mass index and obesity in non-elderly stroke patients. J Endocrinol Invest 2009; 32:119-22. [PMID: 19411808 DOI: 10.1007/bf03345699] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND The serotonergic system is involved in the complex behavioral and physiological process in maintaining energy balance. Genetic factors regulating serotonergic function may have links with the development of obesity. AIM To investigate whether the 5-HTTLPR polymorphism of the serotonin transporter gene is associated with body mass index (BMI) and obesity in stroke patients. SUBJECTS AND METHODS The study included 376 patients (65.3+/-11.3 yr; male, 61.7%) with stroke. Associations between the 5-HTTLPR and BMI and obesity (BMI > or = 25 kg/m2) were examined in all subjects. In order to test age-dependent effects of the genetic variant, the association was also examined in the non-elderly subgroup (<65 yr) and the elderly subgroup (> or =65 yr) respectively. RESULTS For non-elderly subjects, the SS genotype was independently associated with increased BMI level (beta=1.84, p=0.037) and obesity (odds ratio 4.17, 95% CI 1.25-14.0, p=0.021) when the LL genotype was used as the reference. The association was not found for all patients or in the elderly subgroup. The LS genotype was not different from the LL genotype in BMI level or risk of obesity, either for all subjects or with regard to the non-elderly and elderly subgroups. CONCLUSIONS The SS genotype of 5-HTTLPR is an independent determinant of increased BMI level and obesity in non-elderly stroke patients but not in elderly patients. An age-dependent modification for the effect of the 5-HTTLPR on development of obesity is considered.
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Affiliation(s)
- M Y Lan
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niaosung, Taiwan
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Fang CT, Chang YY, Hsu HM, Twu SJ, Chen KT, Lin CC, Huang LYL, Chen MY, Hwang JS, Wang JD, Chuang CY. Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy. QJM 2007; 100:97-105. [PMID: 17277317 DOI: 10.1093/qjmed/hcl141] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited data are available on the life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy (HAART). AIM To provide such an estimate using a semi-parametric projection. DESIGN Statistical analysis. METHODS Follow-up data for patients newly diagnosed with HIV infection in Taiwan (HIV/AIDS Cohort) from 1 May 1997 to 30 April 2003 (n = 3351, only 1% are injecting drug users) were analysed using the Kaplan-Meier method. The survival function for an age- and gender-matched reference population was generated by the Monte Carlo method from the life-table of the general population. A constant excess hazard model was used to project long-term survival of HIV-infected patients, with linear extrapolation of a logit-transformed curve of survival ratio between HIV-infected patients and the reference population. RESULTS The 5-year survival rate was 58% in patients who had already developed AIDS at diagnosis (AIDS group), and 89% in those who had not (non-AIDS group). Extrapolation yielded an expected mean survival time of 10.6 years after diagnosis for the AIDS group, and 21.5 years after diagnosis for the non-AIDS group. DISCUSSION Our results support the expansion of HIV screening programs to minimize delay in diagnosis. With continuing advances in HAART, this estimate of survival in initially asymptomatic patients may be conservative. Their long life expectancy raises questions about what kind of preventive heath services should be offered. These should be addressed through further analysis of overall benefit and cost-effectiveness.
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Affiliation(s)
- C T Fang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei, Taiwan
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Abstract
In this study, as a promising technique for the treatment of both As(III) and As(V) at the same time in a single reactor, a column reactor containing both manganese-coated sand (MCS) and iron-coated sand (ICS), at different configuration of MCS and ICS, was used to treat wastewater contaminated with As(III). Prior to column experiments, batch experiments for the adsorption of As(V) by ICS were performed with variation of solution pH, ionic strength and types of background ions to investigate the effect of these parameters on the As(V) adsorption behaviour. As(V) adsorption onto ICS was quite similar with the variation of ionic strength by using NaNO3 as a background ion as well as in the presence of different types of background ions except phosphate. The adsorption curves shifted to the lower pH region with the increase of the initial arsenic concentration due to the finite number of adsorption sites on the ICS. For model prediction on the adsorption of As(V) onto ICS, the MINEQL program employing an inner-sphere complexation and a diffuse layer model was used. Model predictions generally agreed well with experimental results. From the column test, column system packed with equal ratio of MCS and ICS was identified as the best system due to a promising oxidation efficiency of As(III) to As(V) by MCS and adsorption of As(V) by both MCS and ICS.
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Affiliation(s)
- J K Yang
- Department of Environmental Engineering, Kwangwoon University, Seoul, Korea.
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