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Solanki JD, Gadhavi BP, Makwana AH, Mehta HB, Shah CJ, Gokhale PA. Early Screening of Hypertension and Cardiac Dysautonomia in Each Hypertensive is Needed-inference from a Study of QTc Interval in Gujarat, India. Int J Prev Med 2018; 9:62. [PMID: 30123436 PMCID: PMC6071444 DOI: 10.4103/ijpvm.ijpvm_423_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/12/2017] [Indexed: 11/04/2022] Open
Abstract
Background Hypertension (HTN) is linked to cardiac dysautonomia that can end up as life-threatening arrhythmias. The same can be screened by simple electrocardiogram (ECG)-based QTc (QT corrected for heart rate) interval which indicates repolarization abnormality. We quantified QTc interval among treated hypertensives in comparison to controls, testing effect of age, gender, and blood pressure. Methods We conducted a cross-sectional study was done at a tertiary care teaching hospital of Gujarat, India, on 142 hypertensives on monotherapy (60 males, 82 females) and 72 age-, sex-, and time-matched normotensives. ECG was recorded with minimum 10 complexes of Lead II. QTc was derived from average of 10 values, using Bazett's formula. QTc > 0.43 s in male and > 0.45 s in female was considered abnormal. Results Hypertensives (mean age 40 and duration 5 years) had significantly higher QTc value than normotensives among males (0.42 vs. 0.40, P < 0.001), females (0.44 vs. 0.41, P < 0.001), and in total (0.43 vs. 0.41, P < 0.001) with 24% prevalence of ECG-based left ventricular hypertrophy. Hypertensives had odds ratio 1.63 in males (P = 0.15), 23.71 in females (P = 0.003), and 3.83 in total (P < 0.001) for prolonged QTc. QTc values were significantly affected by increasing age amongst hypertensives but not by duration of HTN or current blood pressure. Conclusions Our study showed a high prevalence of prolonged QTc, both qualitatively and quantitatively, in hypertensives on monotherapy with poor pressure control, associated with female gender and age but not duration or blood pressure. This underscores high risk of repolarization abnormality induced future event, suggesting QTc screening as primary prevention.
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Affiliation(s)
| | - Bhakti P Gadhavi
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Amit H Makwana
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Hemant B Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Chinmay J Shah
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Pradnya A Gokhale
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
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Yu R, Xiang Z, Zhou Y, Huang H, Zeng J. Overexpression of microRNA-26b attenuates angiotensin II-induced cardiac hypertrophy through inhibition of autophagic responses. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:9409-9417. [PMID: 31966813 PMCID: PMC6965924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/20/2017] [Indexed: 06/10/2023]
Abstract
Although microRNA-26b (miR-26b) has been previously identified as a regulator of cardiac hypertrophy, the specific mechanism remains elusive. Cardiac hypertrophy was induced by thoracic aortic constriction (TAC) in mice. Four weeks after surgery, the cardiac hypertrophy mice model was successfully established. In addition, a cell model of hypertrophy was also established based on angiotensin II (AngII)-induced neonatal mouse ventricular cardiomyocytes. We observed that miR-26b was markedly down-regulated in hypertrophic myocardium tissues and hypertrophic cultured cardiomyocytes, whereas administration of miR-26b mimics suppressed hypertrophic phenotype of cultured cardiomyocytes. Additionally, it was shown that overexpression of miR-26b attenuated autophagic responses in hypertrophic cardiomyocytes, which was confirmed by reducing Beclin-1 expression and the light chain 3(LC3)-II/LC3-I ratio. Taken together, our study provides substantial evidence that upregulation of miR-26b expression might be a potential effective therapeutic strategy to attenuate cardiac hypertrophy.
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Affiliation(s)
- Rong Yu
- Department of Geriatrics, Sichuan Provincial Academy of Medical Sciences, Sichuan Provincial People’ HospitalChengdu, China
| | - Zheng Xiang
- Department of Geriatrics, Sichuan Provincial Academy of Medical Sciences, Sichuan Provincial People’ HospitalChengdu, China
| | - Yongmei Zhou
- Department of Cardiology, Sichuan Provincial Academy of Medical Sciences, Sichuan Provincial People’ HospitalChengdu, China
| | - Hui Huang
- Department of Cardiology, Sichuan Provincial Academy of Medical Sciences, Sichuan Provincial People’ HospitalChengdu, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Provincial Academy of Medical Sciences, Sichuan Provincial People’ HospitalChengdu, China
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van Kesteren F, Wollersheim LW, Baan J, Nederveen AJ, Kaya A, Boekholdt SM, de Mol BA, van Ooij P, Planken RN. Four-dimensional flow MRI of stented versus stentless aortic valve bioprostheses. Eur Radiol 2017; 28:257-264. [PMID: 28710578 PMCID: PMC5717112 DOI: 10.1007/s00330-017-4953-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/27/2022]
Abstract
Objectives To evaluate aortic velocity, wall shear stress (WSS) and viscous energy loss (EL) of stented and stentless bioprostheses using 4D flow MRI 1 year after surgical aortic valve replacement. Methods For this cross-sectional study 28 patients with stented (n = 14) or stentless (n = 14) bioprosthesis underwent non-contrast-enhanced 4D-flow MRI at 1.5 T. Analyses included a comparison of velocity, WSS and EL in the ascending aorta during peak systole for both spatially averaged values and a comparison of local differences using per-voxel analysis. Results No significant differences were found in peak and mean velocity (stented vs. stentless: 2.45 m/s vs. 2.11 m/s; p = 0.09 and 0.60 m/s vs. 0.62 m/s; p = 0.89), WSS (0.60 Pa vs. 0.59 Pa; p = 0.55) and EL (10.17 mW vs. 7.82 mW; p = 0.10). Per-voxel analysis revealed significantly higher central lumen velocity, and lower outer lumen velocity, WSS and EL for stentless versus stented prostheses. Conclusion One year after aortic valve implantation with stented and stentless bioprostheses, velocity, WSS and EL were comparable when assessed for averaged values in the ascending aorta. However, the flow profile described with local analysis for stentless prosthesis is potentially favourable with a significantly higher central velocity profile and lower values for outer lumen velocity, WSS and EL. Key Points • Stentless bioprostheses can be implanted instead of stented aortic valve bioprostheses. • Haemodynamic performance of valve prosthesis can be assessed using 4D flow MRI. • Averaged ascending aorta PSV, WSS and EL are comparable 1 year post-implantation. • Centreline velocity is highest, WSS and EL is lowest for stentless prosthesis.
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Affiliation(s)
- Floortje van Kesteren
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens W Wollersheim
- Department of Cardiothoracic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Bas A de Mol
- Department of Cardiothoracic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Geraldino-Pardilla L, Russo C, Sokolove J, Robinson WH, Zartoshti A, Van Eyk J, Fert-Bober J, Lima J, Giles JT, Bathon JM. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:534-540. [PMID: 27994093 DOI: 10.1093/rheumatology/kew436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 01/27/2023] Open
Abstract
Objective High levels of ACPAs in RA are associated with more severe arthritis and worse prognosis. However, the role of ACPAs in mediating the increased risk of heart failure in RA remains undefined. We examined whether specific ACPAs were associated with subclinical left ventricular (LV) phenotypes that presage heart failure. Methods Sera from RA patients without clinical cardiovascular disease were assayed for specific ACPAs using a custom Bio-Plex bead assay, and their cross-sectional associations with cardiac magnetic resonance-derived LV measures were evaluated. High ACPA level was defined as ⩾ 75th percentile. Findings were assessed in a second independent RA cohort with an expanded panel of ACPAs and LV measures assessed by 3D-echocardiography. Results In cohort 1 (n = 76), higher levels of anti-citrullinated fibrinogen 41-60 and anti-citrullinated vimentin antibodies were associated with a 10 and 6% higher adjusted mean LV mass index (LVMI), respectively, compared with lower antibody levels (P < 0.05). In contrast, higher levels of anti-citrullinated biglycan 247-266 were associated with a 13% lower adjusted mean LVMI compared with lower levels (P < 0.001). In cohort 2 (n = 74), the association between ACPAs targeting citrullinated fibrinogen and citrullinated vimentin peptides or protein and LVMI was confirmed: higher anti-citrullinated fibrinogen 556-575 and anti-citrullinated vimentin 58-77 antibody levels were associated with a higher adjusted mean LVMI (19 and 15%, respectively; P < 0.05), but no association with biglycan was found. Conclusion Higher levels of antibodies targeting citrullinated fibrinogen and vimentin peptides or protein were associated with a higher mean LVMI in both RA cohorts, potentially implicating autoimmune targeting of citrullinated proteins in myocardial remodelling in RA.
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Affiliation(s)
| | - Cesare Russo
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY
| | - Jeremy Sokolove
- Department of Medicine, Stanford University School of Medicine, Stanford.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto
| | - William H Robinson
- Department of Medicine, Stanford University School of Medicine, Stanford.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto
| | - Afshin Zartoshti
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY
| | - Jenny Van Eyk
- The Heart Institute and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Justyna Fert-Bober
- The Heart Institute and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jon T Giles
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY
| | - Joan M Bathon
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY
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Tripepi G, Pannier B, D’Arrigo G, Mallamaci F, Zoccali C, London G. Reappraisal in two European cohorts of the prognostic power of left ventricular mass index in chronic kidney failure. Kidney Int 2017; 91:704-710. [DOI: 10.1016/j.kint.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 01/17/2023]
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Solanki JD, Gadhavi BP, Makwana AH, Mehta HB, Shah CJ, Gokhale PA. QTc interval in young Gujarati hypertensives: Effect of disease, antihypertensive monotherapy, and coexisting risk factors. J Pharmacol Pharmacother 2017; 7:165-170. [PMID: 28163537 PMCID: PMC5242029 DOI: 10.4103/0976-500x.195900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the effect of disease duration, treatment and risk factors on QTc interval among young hypertensives. MATERIALS AND METHODS A case-control study was conducted on 142 hypertensives (60 males, 82 females) taking calcium channel blocker (CCB) or angiotensin-converting enzyme inhibitor (ACEI) as monotherapy. After blood pressure measurement, we recorded lead II electrocardiograph with minimum ten waveforms. QTc was derived from average of ten values using Bazett's formula. QTc interval >0.43 s in male and >0.45 s in female was considered abnormal. RESULTS Cases had mean duration of hypertension 5 years, mean age of 40 years, and poor blood pressure control (systolic blood pressure >140 and diastolic blood pressure >90 mm of Hg). Newly diagnosed hypertensives had significantly higher QTc values than the matched known cases (0.44 vs. 0.42 s, P < 0.05). Known hypertensives did not differ significantly in QTc values by the duration of disease. CCB users showed small, insignificant disadvantage for abnormally prolonged QTc values than ACEI users. With coexisting diabetes, smoking, and positive family history of hypertension, there was odds risk of 7.69, 2.75, and 2.54, respectively for prolonged QTc. CONCLUSION Our study showed prolonged QTc in hypertensives more so in newly diagnosed, unaffected by duration or use of ACEI, or CCB but associated with modifiable risk factors. This underscores high risk of repolarization abnormality-induced future events, suggesting early screening of hypertension, strict blood pressure control, optimum use of QTc measurement, and preventive pharmacotherapy to reduce this aftermath.
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Affiliation(s)
| | - Bhakti P Gadhavi
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Amit H Makwana
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Hemant B Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Chinmay J Shah
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Pradnya A Gokhale
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
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Wu Y, Chen H, Li R, Wang X, Li H, Xin J, Liu Z, Wu S, Jiang W, Zhu L. Cucurbitacin-I induces hypertrophy in H9c2 cardiomyoblasts through activation of autophagy via MEK/ERK1/2 signaling pathway. Toxicol Lett 2016; 264:87-98. [DOI: 10.1016/j.toxlet.2016.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain. Eur J Radiol 2016; 86:163-168. [PMID: 28027742 DOI: 10.1016/j.ejrad.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/18/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. MATERIALS AND METHODS This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. RESULTS 225 subjects (age, 56.2±11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01-1.13permm) and LV mass (HR:1.05, 95%CI:1.00-1.10perg) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. CONCLUSION CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and obstructive coronary artery disease.
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Evaristi MF, Caubère C, Harmancey R, Desmoulin F, Peacock WF, Berry M, Turkieh A, Barutaut M, Galinier M, Dambrin C, Polidori C, Miceli C, Chamontin B, Koukoui F, Roncalli J, Massabuau P, Smih F, Rouet P. Increased mean aliphatic lipid chain length in left ventricular hypertrophy secondary to arterial hypertension: A cross-sectional study. Medicine (Baltimore) 2016; 95:e4965. [PMID: 27861330 PMCID: PMC5120887 DOI: 10.1097/md.0000000000004965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
About 77.9 million (1 in 4) American adults have high blood pressure. High blood pressure is the primary cause of left ventricular hypertrophy (LVH), which represents a strong predictor of future heart failure and cardiovascular mortality. Previous studies have shown an altered metabolic profile in hypertensive patients with LVH. The goal of this study was to identify blood metabolomic LVH biomarkers by H NMR to provide novel diagnostic tools for rapid LVH detection in populations of hypertensive individuals. This cross-sectional study included 48 hypertensive patients with LVH matched with 48 hypertensive patients with normal LV size, and 24 healthy controls. Two-dimensional targeted M-mode echocardiography was performed to measure left ventricular mass index. Partial least squares discriminant analysis was used for the multivariate analysis of the H NMR spectral data. From the H NMR-based metabolomic profiling, signals coming from methylene (-CH2-) and methyl (-CH3) moieties of aliphatic chains from plasma lipids were identified as discriminant variables. The -CH2-/-CH3 ratio, an indicator of the mean length of the aliphatic lipid chains, was significantly higher (P < 0.001) in the LVH group than in the hypertensive group without LVH and controls. Receiver operating characteristic curve showed that a cutoff of 2.34 provided a 52.08% sensitivity and 85.42% specificity for discriminating LVH (AUC = 0.703, P-value < 0.001). We propose the -CH2-/-CH3 ratio from plasma aliphatic lipid chains as a biomarker for the diagnosis of left ventricular remodeling in hypertension.
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Affiliation(s)
- Maria Francesca Evaristi
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- University of Camerino, Camerino, Italy
| | - Céline Caubère
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Romain Harmancey
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson, MS
| | - Franck Desmoulin
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | | | - Matthieu Berry
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Annie Turkieh
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Manon Barutaut
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | - Michel Galinier
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | - Camille Dambrin
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | | | | | | | - François Koukoui
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
| | | | - Pierre Massabuau
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Toulouse University Hospital, Toulouse
| | - Fatima Smih
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
- Spartacus-Biomed, Clermont le Fort, France
| | - Philippe Rouet
- UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse Cedex 4, France
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Sedmera D, Neckar J, Benes J, Pospisilova J, Petrak J, Sedlacek K, Melenovsky V. Changes in Myocardial Composition and Conduction Properties in Rat Heart Failure Model Induced by Chronic Volume Overload. Front Physiol 2016; 7:367. [PMID: 27610087 PMCID: PMC4997968 DOI: 10.3389/fphys.2016.00367] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Volume overload leads to development of eccentric cardiac hypertrophy and heart failure. In our previous report, we have shown myocyte hypertrophy with no fibrosis and decrease in gap junctional coupling via connexin43 in a rat model of aorto-caval fistula at 21 weeks. Here we set to analyze the electrophysiological and protein expression changes in the left ventricle and correlate them with phenotypic severity based upon ventricles to body weight ratio. ECG analysis showed increased amplitude and duration of the P wave, prolongation of PR and QRS interval, ST segment elevation and decreased T wave amplitude in the fistula group. Optical mapping showed a prolongation of action potential duration in the hypertrophied hearts. Minimal conduction velocity (CV) showed a bell-shaped curve, with a significant increase in the mild cases and there was a negative correlation of both minimal and maximal CV with heart to body weight ratio. Since the CV is influenced by gap junctional coupling as well as the autonomic nervous system, we measured the amounts of tyrosine hydroxylase (TH) and choline acetyl transferase (ChAT) as a proxy for sympathetic and parasympathetic innervation, respectively. At the protein level, we confirmed a significant decrease in total and phosphorylated connexin43 that was proportional to the level of hypertrophy, and similarly decreased levels of TH and ChAT. Even at a single time-point, severity of morphological phenotype correlates with progression of molecular and electrophysiological changes, with the most hypertrophied hearts showing the most severe changes that might be related to arrhythmogenesis.
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Affiliation(s)
- David Sedmera
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; First Faculty of Medicine, Institute of Anatomy, Charles University in PraguePrague, Czech Republic
| | - Jan Neckar
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; Institute of Clinical and Experimental MedicinePrague, Czech Republic
| | - Jiri Benes
- Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; First Faculty of Medicine, Institute of Anatomy, Charles University in PraguePrague, Czech Republic; Department of Radiology, First Faculty of Medicine, Charles University in PraguePrague, Czech Republic
| | - Jana Pospisilova
- First Faculty of Medicine, Institute of Pathological Physiology, Charles University in Prague Prague, Czech Republic
| | - Jiri Petrak
- First Faculty of Medicine, Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec Vestec, Czech Republic
| | - Kamil Sedlacek
- Institute of Clinical and Experimental Medicine Prague, Czech Republic
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Chugh SS, Uy-Evanado A. Improved Prediction of Sudden Cardiac Death Risk: Staying Within the Echocardiogram but Extending Beyond the Ejection Fraction. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005133. [PMID: 27496551 DOI: 10.1161/circimaging.116.005133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sumeet S Chugh
- From the The Heart Institute, Cedars-Sinai, Los Angeles, CA.
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Aro AL, Chugh SS. Clinical Diagnosis of Electrical Versus Anatomic Left Ventricular Hypertrophy: Prognostic and Therapeutic Implications. Circ Arrhythm Electrophysiol 2016; 9:e003629. [PMID: 27009417 DOI: 10.1161/circep.115.003629] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Aapo L Aro
- From the The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sumeet S Chugh
- From the The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Tereshchenko LG, Kim ED, Oehler A, Meoni LA, Ghafoori E, Rami T, Maly M, Kabir M, Hawkins L, Tomaselli GF, Lima JA, Jaar BG, Sozio SM, Estrella M, Kao WHL, Parekh RS. Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis. J Am Soc Nephrol 2016; 27:3413-3420. [PMID: 27129390 DOI: 10.1681/asn.2015080916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/30/2016] [Indexed: 01/19/2023] Open
Abstract
The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients on incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59% men, and 73% were black, with a mean±SD age of 55±13 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%±12.0% and a mean±SD left ventricular mass index of 66.6±22.3 g/m2.7 During 864.6 person-years of follow-up, 77 patients died; 35 died from cardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95% confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95% confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.
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Affiliation(s)
| | - Esther D Kim
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Oehler
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Lucy A Meoni
- Departments of Biostatistics and.,Department of Medicine, and.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | | | - Tejal Rami
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maggie Maly
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Joao A Lima
- Division of Cardiology, Department of Medicine
| | - Bernard G Jaar
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland.,Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Nephrology Center of Maryland, Baltimore, Maryland; and.,Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M Sozio
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Estrella
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - W H Linda Kao
- Department of Medicine, and.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland.,Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; .,Department of Medicine, and.,Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
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64
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Trivedi A, Knight BP. ICD Therapy for Primary Prevention in Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2016; 5:188-196. [PMID: 28116084 DOI: 10.15420/aer.2016:30:2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common and heterogeneous disorder that increases an individual's risk of sudden cardiac death (SCD). This review article discusses the relevant factors that are involved in the challenge of preventing SCD in patients with HCM. The epidemiology of SCD in patients is reviewed as well as the structural and genetic basis behind ventricular arrhythmias in HCM. The primary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy is the cornerstone of modern treatment for individuals at high risk of SCD. The focus here is on the current and emerging predictors of SCD as well as risk stratification recommendations from both North American and European guidelines. Issues related to ICD implantation, such as programming, complications and inappropriate therapies, are discussed. The emerging role of the fully subcutaneous ICD and the data regarding its implantation are reviewed.
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Affiliation(s)
- Amar Trivedi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
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65
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Wollersheim LW, Li WW, Bouma BJ, Repossini A, van der Meulen J, de Mol BA. Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review. Ann Thorac Surg 2015; 100:1496-504. [DOI: 10.1016/j.athoracsur.2015.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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66
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Kontaraki JE, Marketou ME, Parthenakis FI, Maragkoudakis S, Zacharis EA, Petousis S, Kochiadakis GE, Vardas PE. Hypertrophic and antihypertrophic microRNA levels in peripheral blood mononuclear cells and their relationship to left ventricular hypertrophy in patients with essential hypertension. ACTA ACUST UNITED AC 2015; 9:802-810. [PMID: 26358152 DOI: 10.1016/j.jash.2015.07.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022]
Abstract
MicroRNAs regulate several aspects of physiological and pathologic cardiac hypertrophy, and they represent promising therapeutic targets in cardiovascular disease. We assessed the expression levels of the microRNAs miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21, in 102 patients with essential hypertension and 30 healthy individuals. All patients underwent two-dimensional echocardiography. MicroRNA expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Hypertensive patients showed significantly lower miR-133a (5.06 ± 0.50 vs. 13.20 ± 2.15, P < .001) and miR-26b (6.76 ± 0.53 vs. 9.36 ± 1.40, P = .037) and higher miR-1 (25.99 ± 3.07 vs. 12.28 ± 2.06, P = .019), miR-208b (22.29 ± 2.96 vs. 8.73 ± 1.59, P = .016), miR-499 (10.06 ± 1.05 vs. 5.70 ± 0.91, P = .033), and miR-21 (2.75 ± 0.15 vs. 1.82 ± 0.20, P = .002) expression levels compared with healthy controls. In hypertensive patients, we observed significant negative correlations of miR-1 (r = -0.374, P < .001) and miR-133a (r = -0.431, P < .001) and significant positive correlations of miR-26b (r = 0.302, P = .002), miR-208b (r = 0.426, P < .001), miR-499 (r = 0.433, P < .001) and miR-21 (r = 0.498, P < .001) expression levels with left ventricular mass index. Our data reveal that miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21 show distinct expression profiles in hypertensive patients relative to healthy individuals and they are associated with clinical indices of left ventricular hypertrophy in hypertensive patients. Thus, they may be related to heart hypertrophy in hypertensive patients and are possibly candidate therapeutic targets in hypertensive heart disease.
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Affiliation(s)
- Joanna E Kontaraki
- Molecular Cardiology Laboratory, Department of Cardiology, School of Medicine, University of Crete, Heraklion, Greece.
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | | | | | - Stelios Petousis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
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67
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Singh S, Sethi A, Singh M, Khosla K, Grewal N, Khosla S. Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:640-650.e12. [PMID: 26160261 DOI: 10.1016/j.jash.2015.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/12/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher brachial-ankle PWVs. Presence of inter-limb BP difference may indicate higher global CV risk.
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Affiliation(s)
- Sukhchain Singh
- Department of Hospital Medicine, Ingalls Memorial Hospital, Harvey, IL, USA; Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA.
| | - Ankur Sethi
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA
| | - Mukesh Singh
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA
| | - Kavia Khosla
- Department of Science, Brown University, Providence, RI, USA
| | - Navsheen Grewal
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA; School of Public Health, University of Illinois, Chicago, IL, USA
| | - Sandeep Khosla
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA; Department of Cardiovascular Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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68
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Abstract
Left ventricular hypertrophy (LVH) poses an independent risk of increased morbidity and mortality, including atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death. The most common causes of LVH are hypertension and valvular heart disease. Electrocardiography and echocardiography are the first steps in the diagnosis and evaluation of therapy in patients with LVH. Cardiac MRI is the gold standard in diagnosis and assessment of response to therapy. Management of LVH should be based on etiology, evidence, and guideline adherence. Timely and optimal management of the underlying cause of LVH results in improvement (regression) of LVH and its related complications.
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69
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Laukkanen JA, Khan H, Kurl S, Willeit P, Karppi J, Ronkainen K, Di Angelantonio E. Left ventricular mass and the risk of sudden cardiac death: a population-based study. J Am Heart Assoc 2014; 3:e001285. [PMID: 25376188 PMCID: PMC4338721 DOI: 10.1161/jaha.114.001285] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Left ventricular (LV) mass ascertained using echocardiography may enhance risk stratification for sudden cardiac death. The objective of this study was to assess the association between left ventricular mass and the risk of sudden cardiac death in a population-based cohort and determine its incremental value beyond conventional risk predictors. METHODS AND RESULTS Assessment of LV mass was based on echocardiography in a sample of 905 middle-aged men representative of the general population (aged 42 to 61 years). During the follow-up period of 20 years, there were a total of 63 sudden cardiac deaths. In a comparison of the top versus the bottom quartile of LV mass adjusted by body surface area (>120 versus <89 g/m(2)), the multivariable adjusted hazard ratio was 2.57 (95% CI 1.24 to 5.31, P=0.010). Further adjustment for LV function only modestly attenuated the risk of sudden cardiac death among men with LV mass of >120 g/m(2) (hazard ratio 2.29, 95% CI 1.10 to 4.74, P=0.026). Addition of LV mass adjusted by body surface area to a conventional risk factor model for sudden cardiac death improved the integrated discrimination index by 0.033 (95% CI 0.009 to 0.057, P=0.007) and the category-free net reclassification index by 0.501 (95% CI 0.092 to 0.911, P=0.016). CONCLUSIONS Indexed LV mass by body surface area is an independent predictor of sudden cardiac death and may help improve the risk prediction of sudden cardiac death beyond conventional cardiovascular risk factors.
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Affiliation(s)
- Jari A. Laukkanen
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | | | - Sudhir Kurl
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Peter Willeit
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.D.A.)
| | - Jouni Karppi
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Kimmo Ronkainen
- Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland (J.A.L., S.K., J.K., K.R.)
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.D.A.)
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70
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Wu N, Zhao W, Ye K, Li Y, He M, Lu B, Hu R. Albuminuria is associated with left ventricular hypertrophy in patients with early diabetic kidney disease. Int J Endocrinol 2014; 2014:351945. [PMID: 25214836 PMCID: PMC4158151 DOI: 10.1155/2014/351945] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/19/2014] [Accepted: 08/06/2014] [Indexed: 01/20/2023] Open
Abstract
Aims. Left ventricular hypertrophy (LVH) and albuminuria are both markers for cardiovascular diseases (CVDs) in patients with type 2 diabetes mellitus (T2DM). We speculate that albuminuria in T2DM patients with early diabetic kidney disease (DKD) could predict LVH. Methods. 333 diabetic patients (219 non-DKD and 114 early DKD) were enrolled. The association between albuminuria and LVMI was examined using multivariate linear regression and logistic regression. Results. The rate of LVH was significantly higher in patients with early DKD versus those without DKD (57.0% versus 32.9%; P < 0.001). Multivariate linear regression analysis demonstrated that albuminuria status (no, micro-, and macroalbuminuria; P < 0.001), age (P < 0.001), systolic blood pressure (P = 0.0578), and the use of ACEI/ARB drug (P < 0.001) were independently associated with LVMI. The risks were substantially higher for LVH in the microalbuminuria group (odds ratio 2.473 (95% confidence interval 1.370-4.464)) and macroalbuminuria group (odds ratio 3.940 (95% confidence interval 1.553-9.993)) compared with that in non-DKD group. Concentric hypertrophy was the most common geometric pattern in patients with early DKD (36.0%), followed by eccentric hypertrophy (21.0%). Conclusions. Albuminuria is associated with higher LVMI and higher rate of LVH in patients with early phase DKD.
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Affiliation(s)
- Nan Wu
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Weiwei Zhao
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Kuanping Ye
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Yintao Li
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Min He
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Bin Lu
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Renming Hu
- The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
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71
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Fournier SB, Reger BL, Donley DA, Bonner DE, Warden BE, Gharib W, Failinger CF, Olfert MD, Frisbee JC, Olfert IM, Chantler PD. Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome. Exp Physiol 2014; 99:149-63. [PMID: 24036595 PMCID: PMC3947356 DOI: 10.1113/expphysiol.2013.075796] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.
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Affiliation(s)
- Sara B Fournier
- P. D. Chantler: West Virginia University, 1 Medical Center Drive, PO Box 9227, Morgantown, WV 26508, USA.
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Affiliation(s)
- Lawrence R. Krakoff
- From the Cardiovascular Center, Icahn School of Medicine at Mount Sinai, New York, NY
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