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Voorrips SN, Boorsma EM, Beusekamp JC, DE-Boer RA, Connelly MA, Dullaart RPF, VAN-DER-Meer P, VAN-Veldhuisen DJ, Voors AA, Damman K, Westenbrink BD. Longitudinal Changes in Circulating Ketone Body Levels in Patients With Acute Heart Failure: A Post Hoc Analysis of the EMPA-Response-AHF Trial. J Card Fail 2023; 29:33-41. [PMID: 36244653 DOI: 10.1016/j.cardfail.2022.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 05/12/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ketone bodies are endogenous fuels produced by the liver under conditions of metabolic or neurohormonal stress. Circulating ketone bodies are increased in patients with chronic heart failure (HF), yet little is known about the effect of acute HF on ketosis. We tested the hypothesis that ketogenesis is increased in patients with acute decompensated HF. METHODS AND RESULTS This was a post hoc analysis of 79 patients with acute HF included in the EMPA-RESPONSE-AHF trial, which compared sodium-dependent glucose-cotransporter protein 2 inhibitor treatment with empagliflozin for 30 days with placebo in patients with acute HF [NCT03200860]. Plasma concentrations of ketone bodies acetone, β-hydroxybutyrate, and acetoacetate were measured at baseline and 5 different timepoints. Changes in ketone bodies over time were monitored using repeated measures analysis of variance. In the total cohort, median total ketone body concentration was 251 µmol/L (interquartile range, 178-377 µmol/L) at baseline, which gradually decreased to 202 µmol/L (interquartile range, 156-240 µmol/L) at day 30 (P = .041). Acetone decreased from 60 µmol/L (interquartile range, 34-94 µmol/L) at baseline to 30 µmol/L (interquartile range, 21-42 µmol/L) ( P < .001), whereas β-hydroxybutyrate and acetoacetate remained stable over time. Higher acetone concentrations were correlated with higher N-terminal pro brain natriuretic peptide levels (r = 0.234; P = .039). Circulating ketone bodies did not differ between patients treated with empagliflozin or placebo throughout the study period. A higher acetone concentration at baseline was univariately associated with a greater risk of the composite end point, including in-hospital worsening HF, HF rehospitalizations, and all-cause mortality after 30 days. However, after adjustment for age and sex, acetone did not remain an independent predictor for the combined end point. CONCLUSIONS Circulating ketone body concentrations, and acetone in particular, were significantly higher during an episode of acute decompensated HF compared with after stabilization. Treatment with empagliflozin did not affect ketone body concentrations in patients with acute HF.
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Affiliation(s)
- S N Voorrips
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - E M Boorsma
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - J C Beusekamp
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - R A DE-Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands; Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina; and the
| | - R P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - P VAN-DER-Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - D J VAN-Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - A A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - K Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - B D Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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2
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De Brouwer R, Te Rijdt WP, Hoorntje ET, Karper JC, Westenbrink BD, Te Riele ASJM, Van Der Heijden JF, Amin A, Van Tintelen JP, Asselbergs FW, Wilde AAM, De Boer RA, Van Den Berg MP. The effect of eplerenone on the disease onset and progression of phospholamban cardiomyopathy in presymptomatic mutation carriers: results of the i-PHORECAST trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A pathogenic variant in the gene encoding phospholamban (PLN; p.Arg14del) may cause cardiomyopathy, the pathophysiologic hallmark of which is cardiac fibrosis that may cause malignant ventricular arrhythmias and severe heart failure. There is no evidence-based therapy to modify disease progression in presymptomatic pathogenic variant carriers. Eplerenone is a selective mineralocorticoid receptor antagonist with established antifibrotic properties, and may be a potentially interesting treatment in PLN p.Arg14del mutation carriers.
Purpose
To investigate if preventive therapy with eplerenone attenuates disease onset and progression in PLN cardiomyopathy.
Methods
84 presymptomatic PLN p.Arg14del mutation carriers (median age 39 [27–50] years, 44% males) were randomized 1:1 to receive eplerenone (50mg once daily) or no treatment, and endpoints were adjudicated in a blinded fashion (PROBE design). Baseline values were acquired including demographics, cardiac magnetic resonance imaging (CMR) parameters (ventricular volumes, systolic function, late gadolinium enhancement (LGE)), and electrocardiographic parameters (QRS voltages and ventricular ectopy per 24 hour). Subjects were re-evaluated every year and CMR was performed at baseline and after three years. The composite endpoint included LVEDV/RVEDV increase (>10%), LVEF/RVEF decrease (5%), newly developed LGE on CMR, increase in ventricular ectopy (>100% PVCs/24h if >1000 PVCs/24h), decrease in QRS voltage (>25%), non-sustained ventricular tachycardia, symptoms or arrhythmias necessitating treatment, and cardiovascular death.
Results
Two out of 84 subjects (2%) were lost to follow up. 49 out of 82 remaining subjects (60%) reached the composite end point, 25 (60%) in the control group, 24 (60%) in the treatment group (p=0.825). There was no significant difference between the groups when considering the individual end points, see Table 1. Baseline and follow up CMR was performed on 76 subjects, 39 in the control group, 37 in the treatment group. In total there were 10 (13%) cases of newly developed LGE, 6 (18%) in the control group, 4 (12%) in the treatment group (p=0.556), see Figure 1.
Conclusions
Eplerenone did not significantly attenuate disease onset and progression in presymptomatic PLN p.Arg14del mutation carriers. There was no significant difference in new incidence of LGE between the treatment and control groups.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was financially supported by the Netherlands Cardiovascular Research Initiative, an initiative supported by the Dutch Heart Foundation (The Hague, Netherlands).
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Affiliation(s)
- R De Brouwer
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - W P Te Rijdt
- Erasmus University Medical Centre, Department of Medical Genetics , Rotterdam , The Netherlands
| | - E T Hoorntje
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - J C Karper
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - B D Westenbrink
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - A S J M Te Riele
- University Medical Center Utrecht, Department of Cardiology , Utrecht , The Netherlands
| | - J F Van Der Heijden
- Haga Teaching Hospital, Department of Cardiology , The Hague , The Netherlands
| | - A Amin
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - J P Van Tintelen
- University Medical Center Utrecht, Department of Cardiology , Utrecht , The Netherlands
| | - F W Asselbergs
- University Medical Center Utrecht, Department of Cardiology , Utrecht , The Netherlands
| | - A A M Wilde
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - R A De Boer
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - M P Van Den Berg
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
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Hoes MF, Te Riele ASJM, Gladka MM, Westenbrink BD, van Hout GPJ, van den Hoogenhof MMG, Ghigo A, Bollini S, Purcell NH, Sohaib SMA, Kardys I, Kuster DWD. Young@Heart: empowering the next generation of cardiovascular researchers. Neth Heart J 2020; 28:25-30. [PMID: 32780328 PMCID: PMC7418282 DOI: 10.1007/s12471-020-01454-6] [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] [Indexed: 11/27/2022] Open
Abstract
In recognition of the increasing health burden of cardiovascular disease, the Dutch CardioVascular Alliance (DCVA) was founded with the ambition to lower the cardiovascular disease burden by 25% in 2030. To achieve this, the DCVA is a platform for all stakeholders in the cardiovascular field to align policies, agendas and research. An important goal of the DCVA is to guide and encourage young researchers at an early stage of their careers in order to help them overcome challenges and reach their full potential. Young@Heart is part of the DCVA that supports the young cardiovascular research community. This article illustrates the challenges and opportunities encountered by young cardiovascular researchers in the Netherlands and highlights Young@Heart’s vision to benefit from these opportunities and optimise collaborations to contribute to lowering the cardiovascular disease burden together as soon as possible.
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Affiliation(s)
- M F Hoes
- Young@Heart, the Dutch CardioVascular Alliance, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A S J M Te Riele
- Young@Heart, the Dutch CardioVascular Alliance, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M Gladka
- Young@Heart, the Dutch CardioVascular Alliance, Utrecht, The Netherlands
- Hubrecht Institute, Royal Netherlands Academy of Arts and Science, Utrecht, The Netherlands
- European Society of Cardiology, Scientists of Tomorrow, Biot, France
| | - B D Westenbrink
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G P J van Hout
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Junior Chamber Board of the Netherlands Society of Cardiology, Utrecht, The Netherlands
| | - M M G van den Hoogenhof
- Institute of Experimental Cardiology, University of Heidelberg, Heidelberg, Germany
- Partner Site Heidelberg/Mannheim, DZHK (German Center for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - A Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
- International Society of Heart Research, Durham, NC, USA
| | - S Bollini
- European Society of Cardiology, Scientists of Tomorrow, Biot, France
- Department of Experimental Medicine (DIMES), Regenerative Medicine Laboratory, University of Genova, Genova, Italy
| | - N H Purcell
- Basic Cardiovascular Sciences Early Career Committee, American Heart Association, Dallas, TX, USA
- Department of Pharmacology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - S M A Sohaib
- European Society of Cardiology Board Committee for Young Cardiovascular Professionals, Biot, France
- King George Hospital, Essex, UK
- St Bartholomew's Hospital, London, UK
| | - I Kardys
- Young@Heart, the Dutch CardioVascular Alliance, Utrecht, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D W D Kuster
- Young@Heart, the Dutch CardioVascular Alliance, Utrecht, The Netherlands.
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
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Westenbrink BD, Alings M, Connolly SJ, Eikelboom J, Ezekowitz MD, Oldgren J, Yang S, Pongue J, Yusuf S, Wallentin L, van Gilst WH. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial. J Thromb Haemost 2015; 13:699-707. [PMID: 25683276 DOI: 10.1111/jth.12874] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 07/21/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). OBJECTIVES To investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. PATIENTS AND METHODS We retrospectively analyzed the RE-LY trial database, which randomized 18 113 patients with AF and a risk of stroke to receive dabigatran or warfarin for a median follow-up of 2 years. Cox regression analysis was used to determine whether anemia predicted cardiovascular events and bleeding complications in these patients. RESULTS Anemia was present in 12% of the population at baseline, and the presence of anemia was associated with a higher risk of thromboembolic cardiovascular events, including the composite endpoint of all-cause mortality or myocardial infarction (adjusted hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.32-1.71) and the primary RE-LY outcome of stroke or systemic embolism (adjusted HR 1.41, 95% CI 1.12-1.78). Anemia was also associated with a higher risk of major bleeding complications (adjusted HR 2.14, 95% CI 1.87-2.46) and discontinuation of anticoagulants (adjusted HR 1.40, 95% CI 1.28-1.79). The association between anemia and outcome was similar irrespective of cardiovascular comorbidities, randomized treatment allocation, or prior use of warfarin. The incidence of events was lower in patients with transient anemia than in patients in whom anemia was sustained (adjusted HR 0.66, 95% CI 0.49-0.91). CONCLUSIONS Anemia is associated with an increased risk of thromboembolic events, bleeding complications and mortality in anticoagulated patients with AF. These findings suggest that patients with anemia should be monitored closely during all types of anticoagulant treatment.
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Affiliation(s)
- B D Westenbrink
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Westenbrink BD, Kleijn L, de Boer RA, Tijssen JG, Warnica WJ, Baillot R, Rouleau JL, van Gilst WH. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery: insights from the IMAGINE trial. Heart 2011; 97:1590-6. [DOI: 10.1136/heartjnl-2011-300118] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Schipper HS, Rutgers B, Huitema MG, Etuaful SN, Westenbrink BD, Limburg PC, Timens W, van der Werf TS. Systemic and local interferon-gamma production following Mycobacterium ulcerans infection. Clin Exp Immunol 2007; 150:451-9. [PMID: 17900302 PMCID: PMC2219368 DOI: 10.1111/j.1365-2249.2007.03506.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 10/19/2022] Open
Abstract
Buruli ulcer disease (BUD) is an emerging predominantly tropical disease caused by Mycobacterium ulcerans. The initial pre-ulcerative skin lesion often breaks down into an ulcer with undermined edges. Healing is common but may require considerable time, and scarring often results in functional limitations. Considerable evidence has now emerged that patients with early BUD cannot mount a sufficient protective T helper 1 (Th1) cell response to M. ulcerans, but uncertainty remains as to whether immune protection is restored over time. This study investigates the Th1 cell response of patients with various stages of BUD on mycobacterial antigens. We measured interferon (IFN)-gamma levels after ex vivo whole blood stimulation with tuberculin purified protein derivative (PPD), and compared the Th1 cell response of individuals with pre-ulcerative, ulcerative and healed BUD as well as healthy controls. Moreover, the systemic Th1 cell response was related to histopathological features in the various stages of surgically resected BUD lesions. We show that patients with ulcerative and healed BUD produce significantly higher IFN-gamma levels after mycobacterial ex vivo whole blood stimulation than healthy controls, and that patients with a granulomatous tissue response produce higher IFN-gamma levels than individuals without. We therefore suggest that the mounted Th1 cell response in ulcerative BUD patients might be related to their histopathological tissue response.
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Affiliation(s)
- H S Schipper
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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