1
|
Wu B, Shi J, Yu F, Wu Y, Tao X, Xuan T, Yang J, Wang X. Association of Cancer Antigen 125 with Long-Term Prognosis in Light-Chain Cardiorenal Amyloidosis. Cardiorenal Med 2022; 13:19-25. [PMID: 36215974 DOI: 10.1159/000527442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Light-chain (AL) cardiorenal amyloidosis has been characterized as type 5 cardiorenal syndrome with fluid overload and poor prognosis. Cancer antigen 125 (CA125) has the potential for its use in evaluating fluid load and prognosis for heart failure. However, less details for CA125 in AL cardiorenal amyloidosis have been reported. METHODS Sixty patients diagnosed with AL cardiorenal amyloidosis were enrolled in this retrospective study. Patients were divided into two groups according to the cutoff point of CA125 level (35 U/mL). Logistic regression was used to screen variables associated with CA125. Cox regression analyses were utilized to verify the prognostic potential of CA125. RESULTS The mean age was 61 ± 8 years, and 68% of the participants were male. Compared to patients with normal CA125 levels (≤35 U/mL), patients with high levels of CA125 (>35 U/mL) had a higher proportion of New York Heart Association class >II, pericardial effusion, and edema, as well as a lower level of albumin and left ventricular longitudinal strain (LVLS). Logistic regression showed age, albumin, and LVLS to be independently associated with CA125. Seventeen (28%) patients died during the follow-up. Multivariate model including CA125, estimated glomerular filtration rate, E/e', and left ventricular ejection fraction showed acceptable prognostic potential (C-index = 0.829, 95% CI: 0.749-0.909). CA125 remained an independent prognostic factor (HR = 1.018, 95% CI: 1.005-1.031, p = 0.008, per 10 U/mL increase) after adjusting for the remaining three variates and provided a significant incremental effect to the risk determined from them (C-index 0.829 vs. 0.784, p = 0.037). CONCLUSION Serum CA125 level was associated with long-term prognosis of AL cardiorenal amyloidosis.
Collapse
Affiliation(s)
- Bifeng Wu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangcong Yu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yakui Wu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinran Tao
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianming Xuan
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinxiu Yang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingxiang Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
2
|
Aquilani R, Maestri R, Dossena M, La Rovere MT, Buonocore D, Boschi F, Verri M. Altered Amino Acid Metabolism in Patients with Cardiorenal Syndrome Type 2: Is It a Problem for Protein and Exercise Prescriptions? Nutrients 2021; 13:nu13051632. [PMID: 34067952 PMCID: PMC8152258 DOI: 10.3390/nu13051632] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
The goal of this retrospective study was to document any alterations in plasma amino acids (AAs) in subjects with cardiorenal syndrome type 2 (CRS 2). We analyzed data from sixteen patients with CRS 2 and eight healthy subjects (control group, C), whose plasma arterial (A) and venous (V) AA concentrations had been measured. Compared to C, the group of CRS 2 patients showed significant reductions by more than 90% in A (p < 0.01) and V (p < 0.01) individual AAs, whereas negative A-V differences that indicated a net muscle AA release (muscle hypercatabolism) were found in 59% of CRS 2 patients (p < 0.03). No significant differences in plasma A and V AA concentrations nor in A-V differences were found between patients with mild kidney damage (N = 5; estimated glomerular filtration rate, eGFR ≥ 60 mL/min/1.73 m2) and patients with moderate-severe kidney damage (N = 11; eGFR < 60 mL/min/1.73 m2). Several plasma arterial AAs correlated with hemodynamic variables, but not with GFR. The study showed that patients with CRS 2 had very low concentrations of circulating AAs, independent of the degree of GFR damage.
Collapse
Affiliation(s)
- Roberto Aquilani
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, 27100 Pavia, Italy; (R.A.); (M.D.); (D.B.)
| | - Roberto Maestri
- Department of Biomedical Engineering of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy;
| | - Maurizia Dossena
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, 27100 Pavia, Italy; (R.A.); (M.D.); (D.B.)
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy;
| | - Daniela Buonocore
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, 27100 Pavia, Italy; (R.A.); (M.D.); (D.B.)
| | - Federica Boschi
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Manuela Verri
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, 27100 Pavia, Italy; (R.A.); (M.D.); (D.B.)
- Correspondence: ; Tel.: +39-0382-986423
| |
Collapse
|
3
|
Robles NR, Campillejo RD, Valladares J, de Vinuesa EG, Villa J, Gervasini G. Sacubitril-Valsartan Improves Anemia of Cardiorenal Syndrome (CRS). Cardiovasc Hematol Agents Med Chem 2021; 19:93-97. [PMID: 32370725 DOI: 10.2174/1871525718666200506095537] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIMS Anemia is a common complication of heart failure and Chronic Kidney Disease (CKD). Sacubitril-valsartan is a novel therapy for the treatment of chronic Heart Failure with a reduced Ejection Fraction (HFrEF). We have evaluated the short-term effects of sacubitril- valsartan on the anemia of CRS. METHODS The study group comprised 39 patients with HFrEF, who were followed-up for three months. The study is a retrospective analysis of clinical data. Data of 3 months' and baseline visits were recorded including plasmatic creatinine, glomerular filtration rate, cystatin C, kaliemia, haemoglobin, pro-BNP, and albuminuria. RESULTS In all, 34 patients ended the follow-up. Mean sacubitril-valsartan dosage at baseline was 101 ± 62 mg/day and 126 ± 59 mg/day at end. Mean hemoglobin increased from 12.2 ± 1.1 g/dl at baseline to 12.9 ± 1.0 g/dl (p = 0.001,). Prevalence of anemia was 64.7% (95%CI, 47.9-78.5%) at baseline and 38.4 (95%CI, 23.9-55.0%) after the follow-up (p = 0.016). Serum cystatin C levels decreased from 2.71 ± 1.0 to 2.48 ± 1.0 mg/l (p = 0.028). Serum K levels remained unchanged (baseline 4.94 ± 0.60, three months visit 4.94 ± 0.61 mmol/l, p = 0.998). CONCLUSION Sacubitril-valsartan improves anemia in CRS patients. An improvement in serum cystatin levels was observed. Few untoward effects were detected. These findings should be confirmed in wider clinical trials.
Collapse
Affiliation(s)
- Nicolás R Robles
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Rosa D Campillejo
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Julian Valladares
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Elena G de Vinuesa
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Juan Villa
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Division of Pharmacology, Medical School, University of Extremadura, Badajoz, Spain
| |
Collapse
|
4
|
Law JP, Price AM, Pickup L, Radhakrishnan A, Weston C, Jones AM, McGettrick HM, Chua W, Steeds RP, Fabritz L, Kirchhof P, Pavlovic D, Townend JN, Ferro CJ. Clinical Potential of Targeting Fibroblast Growth Factor-23 and αKlotho in the Treatment of Uremic Cardiomyopathy. J Am Heart Assoc 2020; 9:e016041. [PMID: 32212912 PMCID: PMC7428638 DOI: 10.1161/jaha.120.016041] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic kidney disease is highly prevalent, affecting 10% to 15% of the adult population worldwide and is associated with increased cardiovascular morbidity and mortality. As chronic kidney disease worsens, a unique cardiovascular phenotype develops characterized by heart muscle disease, increased arterial stiffness, atherosclerosis, and hypertension. Cardiovascular risk is multifaceted, but most cardiovascular deaths in patients with advanced chronic kidney disease are caused by heart failure and sudden cardiac death. While the exact drivers of these deaths are unknown, they are believed to be caused by uremic cardiomyopathy: a specific pattern of myocardial hypertrophy, fibrosis, with both diastolic and systolic dysfunction. Although the pathogenesis of uremic cardiomyopathy is likely to be multifactorial, accumulating evidence suggests increased production of fibroblast growth factor-23 and αKlotho deficiency as potential major drivers of cardiac remodeling in patients with uremic cardiomyopathy. In this article we review the increasing understanding of the physiology and clinical aspects of uremic cardiomyopathy and the rapidly increasing knowledge of the biology of both fibroblast growth factor-23 and αKlotho. Finally, we discuss how dissection of these pathological processes is aiding the development of therapeutic options, including small molecules and antibodies, directly aimed at improving the cardiovascular outcomes of patients with chronic kidney disease and end-stage renal disease.
Collapse
Affiliation(s)
- Jonathan P. Law
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of NephrologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Anna M. Price
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of NephrologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Luke Pickup
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
| | - Ashwin Radhakrishnan
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
| | - Chris Weston
- Institute of Immunology and ImmunotherapyUniversity of BirminghamUnited Kingdom
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamUnited Kingdom
| | - Alan M. Jones
- School of PharmacyUniversity of BirminghamUnited Kingdom
| | | | - Winnie Chua
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
| | - Richard P. Steeds
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of CardiologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Larissa Fabritz
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of CardiologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Paulus Kirchhof
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
| | - Davor Pavlovic
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
| | - Jonathan N. Townend
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of CardiologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Charles J. Ferro
- Birmingham Cardio‐Renal GroupUniversity Hospitals BirminghamUniversity of BirminghamUnited Kingdom
- Institute of Cardiovascular SciencesUniversity of BirminghamUnited Kingdom
- Department of NephrologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| |
Collapse
|
5
|
Wang Y, Liang Y, Zhao W, Fu G, Li Q, Min X, Guo Y. Circulating miRNA-21 as a diagnostic biomarker in elderly patients with type 2 cardiorenal syndrome. Sci Rep 2020; 10:4894. [PMID: 32184430 PMCID: PMC7078306 DOI: 10.1038/s41598-020-61836-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/04/2020] [Indexed: 12/30/2022] Open
Abstract
Circulating miRNAs have attracted attention as serum biomarkers for several diseases. In this study, we aimed to evaluate the diagnostic value of circulating miRNA-21 (miR-21) as a novel biomarker for elderly patients with type 2 cardiorenal syndrome (CRS-2). A total of 157 elderly patients with chronic heart failure (CHF) were recruited for the study. According to an estimated glomerular filtration rate (eGFR) cut-off of 60 ml/min/1.73 m2, 84 patients (53.5%) and 73 patients (46.5%) were assigned to the CRS group and the CHF group, respectively. Expression levels of serum miR-21 and biomarkers for CRS, such as kidney injury factor-1 (KIM-1), neutrophil gelatinase-related apolipoprotein (NGAL), cystatin C (Cys C), amino-terminal pro-B-type natriuretic peptide (NT-proBNP), N-acetyl-κ-D-glucosaminidase (NAG), and heart-type fatty acid-binding protein (H-FABP), were detected. Serum miR-21, KIM-1, NGAL, Cys C, NT-proBNP and H-FABP levels were significantly higher in the CRS group than in the CHF group (P < 0.01), whereas NAG expression was not significantly different between the two groups (P > 0.05). Cys C, H-FABP and eGFR correlated significantly with miR-21 expression, but correlations with miR-21 were not significant for NT-proBNP, NGAL, NAG and KIM-1. Moreover, multivariate logistic regression found that serum miR-21, increased serum Cys C, serum KIM-1, hyperlipidaemia and ejection fraction (EF) were independent influencing factors for CRS (P < 0.05). The AUC of miR-21 based on the receiver operating characteristic (ROC) curve was 0.749, with a sensitivity of 55.95% and a specificity of 84.93%. Furthermore, combining miR-21 with Cys C enhanced the AUC to 0.902, with a sensitivity of 88.1% and a specificity of 83.6% (P < 0.001). Our findings suggest that circulating miR-21 has medium diagnostic value in CRS-2. The combined assessment of miR-21 and Cys C has good clinical value in elderly patients with CRS-2.
Collapse
Affiliation(s)
- Yan Wang
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Liang
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Medical University, major in Cardiovascular Medicine, Shijiazhuang, Hebei, China
| | - WenJun Zhao
- Hebei Medical University, major in Cardiovascular Medicine, Shijiazhuang, Hebei, China
- Department of International Medical, the First Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - GuangPing Fu
- Hebei Key Laboratory of Forensic Medicine, Department of Forensic Medical, Hebei Medical University, Shijiazhuang, Hebei, China
| | - QingQuan Li
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - XuChen Min
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - YiFang Guo
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| |
Collapse
|
6
|
Abstract
Cardiorenal syndrome commonly refers to the collective dysfunction of heart and kidney resulting in a cascade of feedback mechanism causing damage to both the organs and is associated with adverse clinical outcomes. The pathophysiology of cardiorenal syndrome is complex, multifactorial, and dynamic. Improving the understanding of disease mechanisms will aid in developing targeted pharmacologic and nonpharmacologic therapies for the management of this syndrome. This article discusses the various mechanisms involved in the pathophysiology of the cardiorenal syndrome.
Collapse
Affiliation(s)
- Ujjala Kumar
- Division of Nephrology-Hypertension, University of California San Diego, 9500 Gilman Drive# 9111H, La Jolla, CA 92093-9111, USA
| | - Nicholas Wettersten
- Division of Cardiology, University of California San Diego, 9434 Medical Center Drive, La Jolla, CA 92037, USA
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, University of California San Diego, 9500 Gilman Drive# 9111H, La Jolla, CA 92093-9111, USA.
| |
Collapse
|
7
|
Yang CC, Chen YT, Chen CH, Li YC, Shao PL, Huang TH, Chen YL, Sun CK, Yip HK. The therapeutic impact of entresto on protecting against cardiorenal syndrome-associated renal damage in rats on high protein diet. Biomed Pharmacother 2019; 116:108954. [PMID: 31108352 DOI: 10.1016/j.biopha.2019.108954] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/09/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study tested the hypothesis that Entresto could safely and effectively preserve heart and kidney function in rats with cardiorenal syndrome (CRS) induced by 5/6 nephrectomy and intra-peritoneal doxorubicin administration (accumulated dosage up to 7.5 mg/kg) together with daily high-protein-diet (HPD). METHODS AND RESULTS Adult male Sprague-Dawley rats (n = 24) were equally categorized into Group 1 (sham-operated control + HPD), Group 2 (CRS + HPD) and Group 3 [CRS + HPD + Entresto (100 mg/kg/day orally) since Day 14 after CRS induction] and euthanized by Day 63 after CRS induction. By Day 63, circulatory BUN and creatinine levels and ratios of urine protein to creatinine were significantly higher in Group 2 than those in Groups 1 and 3, and significantly higher in Group 3 than in Group 1, whereas left-ventricular ejection fraction and kidney weight showed an opposite pattern among all groups (all p < 0.001). Microscopically, fibrosis area and intensity of oxidative stress (i.e., DCFDA stain) in kidney/heart tissues exhibited a pattern identical to that of creatinine level among all groups (all p < 0.0001). Kidney injury score and protein expressions of autophagy (i.e., beclin-1/Atg-5/protein ratio of LC3-BII/LC3-BI), fibrosis (Smad3/TGF-ß), apoptosis (mitochondrial-Bax/capase2/3/9), oxidative-stress (NOX-4/oxidized protein/xanthine-oxidase/catalase), membranous p47phox phosphorylation and mitochondrial-damage biomarker (cytosolic-cytochrome-C) were higher in Group 2 than those in Groups 1 and 3, and significantly higher in Group 3 than in Group 1, while protein expressions of anti-apoptosis (Bcl-2/Bcl-XL) and mitochondrial integrity (mitochondrial-cytochrome-C) markers displayed an opposite pattern among all groups in kidney tissues (all p < 0.0001). CONCLUSION Oral administration of entresto was safe and could offer protection against CRS-induced heart and kidney damage.
Collapse
Affiliation(s)
- Chih-Chao Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Yen-Ta Chen
- Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Chih-Hung Chen
- Divisions of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Pei-Lin Shao
- Department of Nursing, Asia University, Taichung, 41354, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan, ROC
| | - Then-Hung Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, Kaohsiung, 82445 Taiwan, ROC
| | - Hon-Kan Yip
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Department of Nursing, Asia University, Taichung, 41354, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC.
| |
Collapse
|
8
|
Zhang D, Li H, Chen H, Ma Q, Chen H, Xing Y, Zhao X. Combination of Amino-Terminal Pro- BNP , Estimated GFR , and High-Sensitivity CRP for Predicting Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients. J Am Heart Assoc 2018; 7:e009162. [PMID: 30371311 PMCID: PMC6404877 DOI: 10.1161/jaha.118.009162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/14/2018] [Indexed: 12/28/2022]
Abstract
Background Cardiorenal syndrome type 1 ( CRS 1) as a complication of acute myocardial infarction can lead to adverse outcomes, and a method for early detection is needed. This study investigated the individual and integrated effectiveness of amino-terminal pro-brain natriuretic peptide (Pro-BNP), estimated glomerular filtration rate (eGFR), and high-sensitivity C-reactive protein (CRP) as predictive factors for CRS 1 in patients with acute myocardial infarction. Methods and Results In a retrospective analysis of 2094 patients with acute myocardial infarction, risk factors for CRS 1 were analyzed by logistic regression. Receiver operating characteristic curves were constructed to determine the predictive ability of the biomarkers individually and in combination. Overall, 177 patients (8.45%) developed CRS 1 during hospitalization. On multivariable analysis, all 3 biomarkers were independent predictors of CRS 1 with odds radios and 95% confidence intervals for a 1-SD change of 1.792 (1.311-2.450) for log(amino-terminal pro-brain natriuretic peptide, 0.424 (0.310-0.576) for estimated glomerular filtration rate, and 1.429 (1.180-1.747) for high-sensitivity C-reactive peptide. After propensity score matching, the biomarkers individually and together significantly predicted CRS 1 with areas under the curve of 0.719 for amino-terminal pro-brain natriuretic peptide, 0.843 for estimated glomerular filtration rate, 0.656 for high-sensitivity C-reactive peptide, and 0.863 for the 3-marker panel (all P<0.001). Also, the integrated 3-marker panel performed better than the individual markers ( P<0.05). CRS 1 risk correlated with the number of biomarkers showing abnormal levels. Abnormal measurements for at least 2 biomarkers indicated a greater risk of CRS 1 (odds ratio 36.19, 95% confidence interval 8.534-153.455, P<0.001). Conclusions The combination of amino-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate, and high-sensitivity C-reactive peptide at presentation may assist in the prediction of CRS 1 and corresponding risk stratification in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- De‐Qiang Zhang
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hong‐Wei Li
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
- Department of CardiologyBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hai‐Ping Chen
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Qing Ma
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hui Chen
- Department of CardiologyBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Yun‐Li Xing
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Xue‐Qiao Zhao
- Clinical Atherosclerosis Research LaboratoryDivision of CardiologyUniversity of WashingtonSeattleWA
| |
Collapse
|
9
|
Bolotova EV, Yavlyanskaya VV, Dudnikova AV. [The relationship of vitamin D level with markers of cardiorenal syndrome in patients with chronic obstructive pulmonary disease.]. Adv Gerontol 2018; 31:191-196. [PMID: 30080325] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study was to examine the relationship of vitamin D levels with markers of cardiorenal syndrome in patients with COPD depending on the severity of bronchial obstruction.198 patients with COPD were divided into 2 groups depending on the severity of bronchial obstruction. A deficiency of vitamin D was significantly more prevalent in COPD patients with GFRcys <60 ml/min/1,73 m2 compared to patients with preserved renal function. A medium positive correlation of vitamin D levels with the severity of bronchial obstruction (r=0,419, p=0,001), medium negative correlation of vitamin D levels with exacerbation frequency (r=0,421, p=0,01) and CRP (r=0,301, p=0,02) were observed. Significant negative correlation of vitamin D levels with the magnitude of albuminuria (r=0,345, p=0,02) was also discovered. Significant lower relative frequency of hyperphosphatemia in patients with COPD 3, 4 severity (63,16 vs 78,69%, χ2=6,627, p<0,05), there was a positive correlation between the phosphorus level of the blood serum level of 25(ОН)D (r=+0,475, p=0,025).The level of vitamin D in some clinical situations can be considered as a promising biomarker of current cardiorenal continuum in patients with COPD, and its correction, as a possible way of slowing the progression of cardiovascular complications in such patients.
Collapse
Affiliation(s)
- E V Bolotova
- Kuban State Medical University, 4, Sedina str., Krasnodar, 350063, Russian Federation
| | - V V Yavlyanskaya
- Kuban State Medical University, 4, Sedina str., Krasnodar, 350063, Russian Federation
- Regional Clinical Hospital № 2, 6/2, Krasnyh partizan str., Krasnodar, 350012, Russian Federation;
| | - A V Dudnikova
- Regional Clinical Hospital № 2, 6/2, Krasnyh partizan str., Krasnodar, 350012, Russian Federation;
| |
Collapse
|
10
|
Virzì GM, de Cal M, Day S, Brocca A, Cruz DN, Castellani C, Cantaluppi V, Bolin C, Fedrigo M, Thiene G, Valente M, Angelini A, Vescovo G, Ronco C. Pro-Apoptotic Effects of Plasma from Patients with Cardiorenal Syndrome on Human Tubular Cells. Am J Nephrol 2015; 41:474-84. [PMID: 26228789 DOI: 10.1159/000438459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The pathophysiology of Cardiorenal Syndrome Type 1 (CRS1) is widely studied, although the mechanisms by which renal tubular epithelial cells (TECs) cease to proliferate and embark upon terminal differentiation, following the initial insult of heart failure (HF), remain a key target. This study seeks to provide insight into the pathophysiological pathways in CRS1; we evaluated in vitro the effects of CRS1 plasma on TECs. METHODS We enrolled 40 acute HF patients and 15 controls (CTR) without HF or acute kidney injury (AKI). Ten out of 40 HF patients exhibited AKI at the time of admission for HF or developed AKI during hospitalization and were classified as CRS1. In vitro, cell viability, DNA fragmentation and caspase-3 levels were investigated in TECs incubated with HF, CRS1, and CTR plasma. We assessed inflammatory cytokines and NGAL expression at the gene and protein levels. RESULTS We observed a marked pro-apoptotic activity and a significantly increased in vitro level of apoptosis in TECs incubated with plasma from CRS1 patients compared to HF and CTR (p < 0.01). In the CRS1 group, the mRNA expression of IL-6, IL-18 and NGAL resulted significantly higher in TECs incubated with CRS1 plasma compared with those incubated with plasma from HF and CTR (p < 0.01). IL-6, IL-18, NGAL, and RANTES levels were significantly higher in TECs supernatant incubated with CRS1 plasma compared with HF patients and CTR plasma (p < 0.01). CONCLUSION In vitro exposure to plasma from CRS1 patients altered the expression profile of TECs characterized by increases in proinflammatory mediators, release of tubular damage markers, and apoptosis.
Collapse
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Brocca A, Virzì GM, Pasqualin C, Pastori S, Marcante S, de Cal M, Ronco C. Cardiorenal syndrome type 5: in vitro cytotoxicity effects on renal tubular cells and inflammatory profile. Anal Cell Pathol (Amst) 2015; 2015:469461. [PMID: 26266085 PMCID: PMC4525149 DOI: 10.1155/2015/469461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/07/2015] [Accepted: 07/05/2015] [Indexed: 12/14/2022] Open
Abstract
Background. Cardiorenal Syndrome Type 5 (CRS Type 5) reflects concomitant cardiac and renal dysfunctions in the setting of a wide spectrum of systemic disorders. Our aim was to study in vitro effects of CRS Type 5 plasma on renal tubular cells (RTCs), in terms of cellular death and the characterization of inflammatory plasma profile in these patients. Material and Methods. We enrolled 11 CRS Type 5 patients from ICU and 16 healthy controls. Plasma from patients and controls was incubated with renal tubular cells (RTCs) and cell death was evaluated. Plasma cytokines were detected. Results. RTCs incubated with CRS Type 5 plasma showed significantly higher apoptosis and necrosis with respect to controls. Plasma cytokine profile of CRS Type 5 patients was significantly different from controls: we observed the production of pro- and anti-inflammatory mediators in these patients. Caspase-3, caspase-8, and caspase-9 were activated in cells treated with CRS Type 5 plasma compared to controls. Conclusions. Our results underline the cytotoxic effect of CRS Type 5 mediators on RTC viability, probably due to the activation of both intrinsic and extrinsic pathways of apoptosis and to the deregulation of cytokine release. The consequence may be the damage of distant organs which lead to the worsening of condition of patients.
Collapse
Affiliation(s)
- Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
- Department of Medicine DIMED, University of Padova Medical School, Via Giustiniani 2, 35100 Padova, Italy
- Laboratory of Experimental Hepatology, Department of Medicine, University of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Chiara Pasqualin
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
- Department of Information Engineering, University of Padua, Via Gradenigo 6, 35131 Padova, Italy
| | - Stefano Marcante
- Intensive Care Unit, San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy
| |
Collapse
|
12
|
Duan SY, Xing CY, Zhang B, Chen Y. Detection and evaluation of renal biomarkers in a swine model of acute myocardial infarction and reperfusion. Int J Clin Exp Pathol 2015; 8:8336-8347. [PMID: 26339403 PMCID: PMC4555731] [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] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/20/2015] [Indexed: 06/05/2023]
Abstract
The prevalence of type 1 cardiorenal syndrome (CRS) is increasing and strongly associated with long-term mortality. However, lack of reliable animal models and well-defined measures of renoprotection, made early diagnosis and therapy difficult. We previously successfully established the swine acute myocardial infarction (AMI) model of ischemia-reperfusion by blocking left anterior descending branch (LAD). Reperfusion was performed after 90-minute occlusion of the LAD. AMI was confirmed by ECG and left ventricular angiography (LVG). Then those 52 survived AMI reperfusion swine, including ventricular fibrillation-cardiac arrest after restoration of blood flow, were randomly divided into four groups (four/group) according to different interventions: resuscitation in room temperature, resuscitation with 500 ml saline in room temperature, resuscitation with 4°C 500 ml saline and normal control (with no intervention of resuscitation). Each group was further observed in four groups according to different time of resuscitation after ventricular arrhythmias: 1, 3, 5, 10-minute reperfusion after ventricular arrhythmias. Plasma and random urine were collected to evaluate renal function and test renal biomarkers of acute kidney injury (AKI). Our swine AMI model of ischemia-reperfusion provoked subclinical AKI with the elevation of the tubular damage biomarker, NGAL, IL-18 and L-FABP. Renal damage rapidly observed after hemodynamic instability, rather than observation after several hours as previously reported. The increasing rate of biological markers declined after interventions, however, its impact on the long-term prognosis remains to be further studied. These data show that elevation of tubular damage biomarkers without glomerular function loss may indicate appropriate timing for effective renoprotections like hypothermia resuscitation in type 1 CRS.
Collapse
Affiliation(s)
- Su-Yan Duan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)Jiangsu Province, China
| | - Chang-Ying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)Jiangsu Province, China
| | - Bo Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)Jiangsu Province, China
| | - Yan Chen
- Emergency Center, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital)Jiangsu Province, China
| |
Collapse
|
13
|
Lubas A, Ryczek R, Kade G, Niemczyk S. Renal perfusion index reflects cardiac systolic function in chronic cardio-renal syndrome. Med Sci Monit 2015; 21:1089-96. [PMID: 25881555 PMCID: PMC4412086 DOI: 10.12659/msm.892630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/14/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiac dysfunction can modify renal perfusion, which is crucial to maintain sufficient kidney tissue oxygenation. Renal cortex perfusion assessed by dynamic ultrasound method is related both to renal function and cardiac hemodynamics. The aim of the study was to test the hypothesis that Renal Perfusion Index (RPI) can more closely reflect cardiac hemodynamics and differentiate etiology of chronic cardio-renal syndrome. MATERIAL AND METHODS Twenty-four patients with hypertension and chronic kidney disease (CKD) at 2-4 stage (12 with hypertensive nephropathy and 12 with CKD prior to hypertension) were enrolled in the study. Blood tests, 24-h ABPM, echocardiography, and ultrasonography with estimation of Total renal Cortical Perfusion intensity and Renal Perfusion Index (RPI) were performed. RESULTS In the group of all patients, RPI correlated with left ventricular stoke volume (LVSV), and cardiac index, but not with markers of renal function. In multiple stepwise regression analysis CKD-EPI(Cys-Cr) (b=-0.360), LVSV (b=0.924) and MAP (b=0.376) together independently influenced RPI (R2=0.74; p<0.0001). RPI<0.567 allowed for the identification of patients with chronic cardio-renal syndrome with sensitivity of 41.7% and specificity of 83.3%. CONCLUSIONS Renal perfusion index relates more strongly to cardiac output than to renal function, and could be helpful in recognizing chronic cardio-renal syndrome. Applicability of RPI in diagnosing early abnormalities in the cardio-renal axis requires further investigation.
Collapse
Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Robert Ryczek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Kade
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
14
|
Peng DF, Tang SY, Hu YJ, Chen J, Peng X, Huang Q. Comparison of valsartan and benazepril when combined with atorvastatin in protecting patients with early cardio-renal syndrome (CRS). Eur Rev Med Pharmacol Sci 2015; 19:1264-1271. [PMID: 25912588] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aims to investigate the different protective effects of valsartan and benazepril when combined with atorvastatin in the cardio-renal functions of cardio-renal syndrome (CRS) patients. PATIENTS AND METHODS A total of 200 early CRS patients were enrolled in the present study, including 104 males and 96 females, with an average age of 62.2 ± 7.7 years. The same group of patients were set as the control group prior to treatment, and then randomly divided into two groups; the A group was treated with valsartan (80 mg/d) and atorvastatin (20 mg/d); the B group was treated with benazepril (10 mg/d) and atorvastatin (20 mg/d). The treatment period was 24 months. RESULTS The clinical efficacy and clinical events were observed and the following parameters of each patient were measured before and after treatment: 24h urine protein; creatinine clearance; serum brain natriuretic peptide (BNP); high sensitivity C-reactive protein (hsCRP); blood lipid level; liver function and ejection fraction (EF) value. Compared with the control group, the clinical symptoms of the treatment groups were improved with decreased blood lipid levels, significantly decreased serum BNP and hsCRP levels and significantly increased EF values and creatinine clearance rates (p < 0.01). The differences between the two treatment groups were not statistically significant. The number of patients that stopped treatment due to the development of a cough was significantly higher in the B group than the A group (p < 0.01). CONCLUSIONS When combined with atorvastatin, both valsartan and benazepril effectively improved the cardio-renal functions of early CRS patients. There was no significant difference between the two treatments however, valsartan appeared to be better tolerated by patients.
Collapse
Affiliation(s)
- D-F Peng
- Department of Vasculocardiology, Affiliated Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | | | | | | | | | | |
Collapse
|
15
|
Sato N. [Cardiorenal syndrome in ICU/CCU]. Nihon Jinzo Gakkai Shi 2015; 57:302-307. [PMID: 25939153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
16
|
Tang SY, Peng DF, Hu YJ, Chen J. Protective effects of valsartan and benazepril combined with atorvastatin on cardiorenal syndrome in rats. Eur Rev Med Pharmacol Sci 2015; 19:759-766. [PMID: 25807427] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the protective effects of valsartan (Val) and benazepril, (Ben) combined with atorvastatin (Ato), on cardiorenal syndrome (CRS) in rats. MATERIALS AND METHODS After establishing cardiorenal syndrome model, the rats were randomly divided into control, Ato, Ben+Ato and Val+Ato groups, which were treated with corresponding drugs. Before and 4 weeks after treatment, the serum creatinine (Scr), blood urea nitrogen (BUN), type-B natriuretic peptide (BNP), aldosterone (ALD), angiotensin (Ang) II, C-reactive protein (CRP), blood lipid and urine protein were determined. The left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), left ventricular end-diastolic pressure (LVEDP) as well as maximum rising and falling rates of left ventricular pressure (±dp/dtmax) were detected. The heart weight index was also determined. RESULTS 6, 3, 1 and 2 rats control, Ato, Ben+Ato and Val+Ato groups died, respectively. Compared with control group, the serum Cr, BUN, BNP, ALD, CRP and urinary protein levels in treatment groups significantly decreased, and the blood lipid level, LVDP, LVEDP and heart weight index significantly decreased, with increased LVSP. No statistically significant difference was observed among treatment groups. CONCLUSIONS Valsartan and benazepril, combined with atorvastatin, can have significant protective effects on cardiorenal functions of rats with CRS, with no significant difference between these two drugs.
Collapse
Affiliation(s)
- S-Y Tang
- Department of Cardiology, Affiliated Puai Hospital, Tongji Medical College, Wuhan, Hubei Province, China.
| | | | | | | |
Collapse
|
17
|
Buglioni A, Cannone V, Cataliotti A, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Dessì-Fulgheri P, Sarzani R, Burnett JC. Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease. Hypertension 2014; 65:45-53. [PMID: 25368032 DOI: 10.1161/hypertensionaha.114.03936] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to investigate the role of aldosterone as a mediator of disease and its relationship with the counter-regulatory natriuretic peptide (NP) system. We measured plasma aldosterone (n=1674; aged≥45 years old) in a random sample of the general population from Olmsted County, MN. In a multivariate logistic regression model, aldosterone analyzed as a continuous variable was associated with hypertension (odds ratio [OR]=1.75; 95% confidence interval [CI]=1.57-1.96; P<0.0001), obesity (OR=1.34; 95% CI=1.21-1.48; P<0.0001), chronic kidney disease (OR=1.39; 95% CI=1.22-1.60; P<0.0001), central obesity (OR=1.47; 95% CI=1.32-1.63; P<0.0001), metabolic syndrome (OR=1.41; 95% CI=1.26-1.58; P<0.0001), high triglycerides (OR=1.23; 95% CI=1.11-1.36; P<0.0001), concentric left ventricular hypertrophy (OR=1.22; 95% CI=1.09-1.38; P=0.0007), and atrial fibrillation (OR=1.24; 95% CI=1.01-1.53; P=0.04), after adjusting for age and sex. The associations with hypertension, central obesity, metabolic syndrome, triglycerides, and concentric left ventricular hypertrophy remained significant after further adjustment for body mass index, NPs, and renal function. Furthermore, aldosterone in the highest tertile correlated with lower NP levels and increased mortality. Importantly, most of these associations remained significant even after excluding subjects with aldosterone levels above the normal range. In conclusion, we report that aldosterone is associated with hypertension, chronic kidney disease, obesity, metabolic syndrome, concentric left ventricular hypertrophy, and lower NPs in the general community. Our data suggest that aldosterone, even within the normal range, may be a biomarker of cardiorenal and metabolic disease. Further studies are warranted to evaluate a therapeutic and preventive strategy to delay the onset and progression of disease, using mineralocorticoid antagonists or chronic NP administration in high-risk subjects identified by plasma aldosterone.
Collapse
Affiliation(s)
- Alessia Buglioni
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.).
| | - Valentina Cannone
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Alessandro Cataliotti
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Paolo Dessì-Fulgheri
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Riccardo Sarzani
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - John C Burnett
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| |
Collapse
|
18
|
Buglioni A, Burnett JC. Pathophysiology and the cardiorenal connection in heart failure. Circulating hormones: biomarkers or mediators. Clin Chim Acta 2014; 443:3-8. [PMID: 25445413 DOI: 10.1016/j.cca.2014.10.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/17/2014] [Accepted: 10/19/2014] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a syndrome characterized by a complex pathophysiology which involves multiple organ systems, with the kidney playing a major role. HF can present with reduced ejection fraction (EF), HFrEF, or with preserved EF (HFpEF). The interplay between diverse organ systems contributing to HF is mediated by the activation of counteracting neurohormonal pathways focused to re-establishing hemodynamic homeostasis. During early stages of HF, these biochemical signals, consisting mostly of hormones and neurotransmitters secreted by a variety of cell types, are compensatory and the patient is asymptomatic. However, with disease progression, the attempt to reverse or delay cardiac dysfunction is deleterious, leading to multi-organ congestion, fibrosis and decompensation and finally symptomatic HF. In conclusion, these neurohormonal pathways mediate the evolution of HF and have become a way to monitor HF. Specifically, these mediators have become important in the diagnosis and prognosis of this highly fatal cardiovascular disease. Finally, while these multiple neurohumoral factors serve as important HF biomarkers, they can also be targeted for more effective and curative HF treatments.
Collapse
Affiliation(s)
- Alessia Buglioni
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Medicine and Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Department of Medicine and Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Demikhova NV, Vlasenko EM, Rudenko TN, Smiianova OI, Kirichenko NN, Prikhod'ko OA. [Structural and functional changes of cell membranes in patients with renocardiac chronic syndrome]. Lik Sprava 2013:38-43. [PMID: 25095683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The 53 patients with chronic renocardiac syndrome, with hypertension in chronic kidney disease, were investigated. In the presence of chronic renal failure there is a decrease of cholesterol in the membrane, which is the basis for the violation liquid characteristics of cell membranes. Changes in the exchange of phospholipids and an increase in the exchange rate reflect increasing phosphatidylcholine lipid peroxidation, increasing in chronic renal failure. The degradation of cell membranes reflects a compensatory accumulation in these fractions of phosphatidylcholine, a major component of the outer layer of biomembranes. Regardless of the degree of renal dysfunction and clinical manifestations of the disease in the membranes of platelets accumulate lizoform phospholipids, indicating a strengthening of the processes of lipid peroxidation and accumulation of biologically active substances, which have membrane-destructive activity.
Collapse
|
20
|
Merz WM, Kübler K, Fimmers R, Willruth A, Stoffel-Wagner B, Gembruch U. Cardiorenal syndrome is present in human fetuses with severe, isolated urinary tract malformations. PLoS One 2013; 8:e63664. [PMID: 23717461 PMCID: PMC3661568 DOI: 10.1371/journal.pone.0063664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/20/2012] [Accepted: 04/07/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We analyzed the association between renal and cardiovascular parameters in fetuses with isolated severe urinary tract malformations. METHODS 39 fetuses at a mean gestational age of 23.6 weeks with nephropathies or urinary tract malformations and markedly impaired or absent renal function were prospectively examined. Fetal echocardiography was performed, and thicknesses of the interventricular septum, and left and right ventricular wall were measured. Blood flow velocity waveforms of the umbilical artery, middle cerebral artery, and ductus venosus were obtained by color Doppler ultrasound. Concentrations of circulating n-terminal pro-B-type natriuretic peptide (nt-proBNP), cystatin C, ß2-microglobulin, and hemoglobin were determined from fetal blood samples. RESULTS Malformations included 21 cases of obstructive uropathy, 10 fetuses with bilateral nephropathy, and 8 cases of bilateral renal agenesis. Marked biventricular myocardial hypertrophy was present in all cases. The ratio between measured and gestational age-adjusted normal values was 2.01 (interventricular septum), 1.85, and 1.78 (right and left ventricular wall, respectively). Compared to controls, levels of circulating nt-proBNP were significantly increased (median (IQR) 5035 ng/L (5936 ng/L) vs. 1874 ng/L (1092 ng/L); p<0.001). Cystatin C and ß2-microglobulin concentrations were elevated as follows (mean ± SD) 1.85±0.391 mg/L and 8.44±2.423 mg/L, respectively (normal range 1.66±0.202 mg/L and 4.25±0.734 mg/L, respectively). No correlation was detected between cardiovascular parameters and urinary tract morphology and function. Despite increased levels of nt-proBNP cardiovascular function was preserved, with normal fetal Doppler indices in 90.2% of cases. CONCLUSION Urinary tract malformations resulting in severe renal impairment are associated with biventricular myocardial hypertrophy and elevated concentrations of circulating nt-proBNP during fetal life. Cardiovascular findings do not correlate with kidney function or morphology.
Collapse
Affiliation(s)
- Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University of Bonn Medical School, Bonn, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Shi JB, Guo ZF, Zheng X, Wang ZB, Ma YJ. Circulating obestatin is increased in patients with cardiorenal syndrome and positively correlated with vasopressin. Peptides 2012; 38:377-80. [PMID: 23017530 DOI: 10.1016/j.peptides.2012.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 07/17/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 01/23/2023]
Abstract
Obestatin regulates fluid and electrolyte homeostasis mainly by opposing the action of vasopressin (AVP). We measured plasma concentration of obestatin and AVP in patients with cardiorenal syndrome (CRS). Plasma AVP and obestatin concentration were measured in 34 patients with type II CRS. The data were compared to that in 31 patients with chronic kidney disease (CKD), 41 patients with chronic heart failure (CHF) and 30 healthy subjects. Obestatin was significantly higher in the patients with CRS (355.8 ± 85.1 pg/ml) than that in the healthy controls (212.3 ± 37.9 pg/ml, P<0.01), the patients with CKD (246.7 ± 34.3 pg/ml, P<0.01) and the patients with CHF (258.4 ± 112.1 pg/ml, P<0.01). AVP was also significantly higher in the patients with CRS (65.1 ± 36.0 pg/ml) than that in the healthy controls (38.5 ± 20.1 pg/ml, P<0.01), the patients with CKD (50.4 ± 24.8 pg/ml, P<0.01) and the patients with CHF (54.6 ± 16.3 pg/ml, P<0.01). Plasma concentration of obestatin was positively correlated with AVP plasma concentration in the overall analysis that included subjects from all disease categories (r = 0.219, P<0.05), but not within the CRS group. Plasma obestatin and vasopressin were elevated in patients with CRS. Plasma obestatin concentration seemed to be positively correlated with plasma AVP.
Collapse
Affiliation(s)
- Jian-Bo Shi
- Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, China.
| | | | | | | | | |
Collapse
|
22
|
Virzi' GM, de Cal M, Cruz DN, Bolin C, Vescovo G, Ronco C. [Type 1 cardiorenal syndrome and its possible pathophysiological mechanisms]. G Ital Nefrol 2012; 29:690-698. [PMID: 23229667] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiorenal syndrome (CRS) type 1, consisting of acute cardiac events leading to acute kidney injury (AKI), is characterized by multiple factors and its pathophysiology is very complex. Given the circulating nature of many inflammatory mediators, it is tempting to examine the immune-mediated mechanism as a mediator of organ crosstalk. In this pilot study, we examined the possible role of immune-mediated mechanisms in the pathogenesis of this syndrome. We enrolled 12 patients with acute heart failure (AHF), 7 patients with type 1 CRS, and 5 healthy volunteers. EDTA plasma samples from the 3 groups were incubated with a monocyte cell line (U937) and cell apoptosis was subsequently evaluated by different methods. In addition, quantitative determination of TNF-alpha, IL-6 and IL-18 production in the supernatants was performed by ELISA. In U937 cells treated with type 1 CRS plasma, the results showed DNA ladder formation with different molecular weight fractions, suggesting the presence of apoptotic events. In fact, quantitative analysis of apoptosis and caspase-3 levels showed significantly higher apoptosis rates in cells incubated with plasma from patients with type 1 CRS (p<0.05). TNF-alpha levels in the supernatants were significantly elevated in both the AHF and type 1 CRS groups compared with control subjects (p<0.05). Furthermore, in patients with type 1 CRS the levels of the proinflammatory cytokines IL-6 and IL-18 were significantly higher than in AHF patients and the control group (p<0.05). This pilot study explores the premise of an immune-mediated process in the pathophysiology of type 1 CRS. These preliminary findings suggest the presence of defective regulation of apoptosis in patients with this syndrome and the involvement of an immune-mediated mechanism in its pathogenesis. Furthermore, inflammatory pathways seem to play a central role in organ crosstalk and may be fundamental to distant organ damage.
Collapse
Affiliation(s)
- Grazia Maria Virzi'
- Dipartimento di Nefrologia, International Renal Research Institute, Vicenza, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Jie KE, van der Putten K, Wesseling S, Joles JA, Bergevoet MW, Pepers-de Kort F, Doevendans PA, Yasui Y, Liu Q, Verhaar MC, Gaillard CA, Braam B. Short-term erythropoietin treatment does not substantially modulate monocyte transcriptomes of patients with combined heart and renal failure. PLoS One 2012; 7:e41339. [PMID: 22957013 PMCID: PMC3434212 DOI: 10.1371/journal.pone.0041339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/27/2011] [Accepted: 06/25/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Combined heart and renal failure is associated with high cardiovascular morbidity and mortality. Anti-oxidant and anti-inflammatory, non-hematopoietic effects of erythropoietin (EPO) treatment have been proposed. Monocytes may act as biosensors of the systemic environment. We hypothesized that monocyte transcriptomes of patients with cardiorenal syndrome (CRS) reflect the pathophysiology of the CRS and respond to short-term EPO treatment at a recommended dose for treatment of renal anemia. METHODS Patients with CRS and anemia (n = 18) included in the EPOCARES trial were matched to healthy controls (n = 12). Patients were randomized to receive 50 IU/kg/week EPO or not. RNA from CD14(+)-monocytes was subjected to genome wide expression analysis (Illumina) at baseline and 18 days (3 EPO injections) after enrolment. Transcriptomes from patients were compared to healthy controls and effect of EPO treatment was evaluated within patients. RESULTS In CRS patients, expression of 471 genes, including inflammation and oxidative stress related genes was different from healthy controls. Cluster analysis did not separate patients from healthy controls. The 6 patients with the highest hsCRP levels had more differentially expressed genes than the 6 patients with the lowest hsCRP levels. Analysis of the variation in log(2) ratios of all individual 18 patients indicated that 4 of the 18 patients were different from the controls, whereas the other 14 were quite similar. After short-term EPO treatment, every patient clustered to his or her own baseline transcriptome. Two week EPO administration only marginally affected expression profiles on average, however, individual gene responses were variable. CONCLUSIONS In stable, treated CRS patients with mild anemia, monocyte transcriptomes were modestly altered, and indicated imprints of inflammation and oxidative stress. EPO treatment with a fixed dose has hematopoietic effects, had no appreciable beneficial actions on monocyte transcription profiles, however, could also not be associated with undesirable transcriptional responses.
Collapse
Affiliation(s)
- Kim E. Jie
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karien van der Putten
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | - Sebastiaan Wesseling
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marloes W. Bergevoet
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yutaka Yasui
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Canada
| | - Qi Liu
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Canada
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo A. Gaillard
- Department of Internal Medicine, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
- Department of Nephrology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Branko Braam
- Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Canada
- Department of Physiology, University of Alberta, Edmonton, Canada
- * E-mail:
| |
Collapse
|
24
|
Hara K, Uchida T, Takebayashi K, Sakai Y, Inoue T, Inukai T, Takayanagi K, Aso Y. Determinants of serum high molecular weight (HMW) adiponectin levels in patients with coronary artery disease: associations with cardio-renal-anemia syndrome. Intern Med 2011; 50:2953-60. [PMID: 22185985 DOI: 10.2169/internalmedicine.50.5926] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 11/06/2022] Open
Abstract
OBJECTIVE A low serum adiponectin level is associated with a high incidence of coronary artery disease (CAD) in the healthy population. Paradoxically, serum adiponectin is elevated in patients with severe CAD or chronic heart failure. We investigated the determinants of serum high molecular weight (HMW) adiponectin in patients with CAD. PATIENTS AND METHODS We studied 228 consecutive patients with CAD confirmed by angiography. Anemia was defined as a hemoglobin of <13.0 g/dL in men and<12.0 g/dL in women. A high plasma B-type natriuretic-peptide (BNP) was defined as >100 pg/mL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min for more than 3 months. The patients with CAD were divided into eight groups according to the presence or absence of anemia, high BNP, and/or CKD. RESULTS In all 228 patients with CAD, serum HMW adiponectin correlated positively with age, high-density-lipoprotein cholesterol (HDL-C), and BNP, while this parameter showed negative correlations with body mass index, insulin resistance, triglycerides, eGFR, and hemoglobin. Multivariate analysis showed that HDL-C, BNP, gender, and age were independently associated with the HMW adiponectin. Serum HMW adiponectin was lower in CAD patients with than without metabolic syndrome. Serum HMW adiponectin and the HMW/total adiponectin ratio were highest in CAD patients who had anemia, high BNP, and CKD among the groups. CONCLUSION In patients with CAD, metabolic syndrome is associated with a lower serum HMW adiponectin, while the presence of anemia, high BNP, and CKD is associated with elevation of the serum HMW adiponectin.
Collapse
Affiliation(s)
- Kenji Hara
- Department of Internal Medicine, Koshigaya Hospital, Dokkyo Medical University, Japan
| | | | | | | | | | | | | | | |
Collapse
|