1
|
Bermudez C, Kerley CI, Ramadass K, Farber-Eger EH, Lin YC, Kang H, Taylor WD, Wells QS, Landman BA. Volumetric brain MRI signatures of heart failure with preserved ejection fraction in the setting of dementia. Magn Reson Imaging 2024; 109:49-55. [PMID: 38430976 DOI: 10.1016/j.mri.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an important, emerging risk factor for dementia, but it is not clear whether HFpEF contributes to a specific pattern of neuroanatomical changes in dementia. A major challenge to studying this is the relative paucity of datasets of patients with dementia, with/without HFpEF, and relevant neuroimaging. We sought to demonstrate the feasibility of using modern data mining tools to create and analyze clinical imaging datasets and identify the neuroanatomical signature of HFpEF-associated dementia. We leveraged the bioinformatics tools at Vanderbilt University Medical Center to identify patients with a diagnosis of dementia with and without comorbid HFpEF using the electronic health record. We identified high resolution, clinically-acquired neuroimaging data on 30 dementia patients with HFpEF (age 76.9 ± 8.12 years, 61% female) as well as 301 age- and sex-matched patients with dementia but without HFpEF to serve as comparators (age 76.2 ± 8.52 years, 60% female). We used automated image processing pipelines to parcellate the brain into 132 structures and quantify their volume. We found six regions with significant atrophy associated with HFpEF: accumbens area, amygdala, posterior insula, anterior orbital gyrus, angular gyrus, and cerebellar white matter. There were no regions with atrophy inversely associated with HFpEF. Patients with dementia and HFpEF have a distinct neuroimaging signature compared to patients with dementia only. Five of the six regions identified in are in the temporo-parietal region of the brain. Future studies should investigate mechanisms of injury associated with cerebrovascular disease leading to subsequent brain atrophy.
Collapse
Affiliation(s)
- Camilo Bermudez
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Cailey I Kerley
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Eric H Farber-Eger
- Department of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ya-Chen Lin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren D Taylor
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bennett A Landman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA; Department of Computer Science, Vanderbilt University, Nashville, TN, USA; Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
2
|
Traub J, Schließer M, Morbach C, Frantz S, Pham M, Störk S, Stoll G, Frey A, Neugebauer H. Internal carotid artery blood flow and pulsatility index in cognitively impaired people with chronic heart failure. ESC Heart Fail 2023; 10:3203-3208. [PMID: 37401264 PMCID: PMC10567624 DOI: 10.1002/ehf2.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
AIMS Mild cognitive impairment and dementia are common and serious co-morbidities in people with chronic heart failure (HF) as they increase hospitalization rates, mortality and health care costs. Upon other factors, dysregulated cerebral perfusion might contribute to brain pathology. We aimed to evaluate the association of non-invasively measured blood flow (BF) and pulsatility index (PI) of the internal carotid artery (ICA) with (i) chronic HF parameters, (ii) brain morphologic measures and (iii) cognitive impairment. METHODS AND RESULTS This post-hoc analysis of the observational, prospective Cognition.Matters-HF study included 107 chronic HF patients without atrial fibrillation or carotid artery stenosis (aged 63 ± 10 years; 19% women). Using extracranial sonography, we measured ICA-BF and ICA-PI 1.5 cm distal of the carotid bifurcation. Brain magnetic resonance imaging was performed on a 3-Tesla scanner to quantify cerebral atrophy, hippocampal atrophy and white matter hyperintensities. Extensive neuropsychological testing tested the cognitive domains intensity of attention, visual/verbal memory and executive function (including its subdomains selectivity of attention, visual/verbal fluency and working memory) using a comprehensive test battery. (i) Neither ICA-BF (median 630 (quartiles 570, 700) mL/min) nor ICA-PI (1.05 (0.96. 1.23)) related to left ventricular ejection fraction, left atrial volume index or NT-proBNP. (ii) Higher ICA-PI (r = 0.25; P = 0.011), but not ICA-BF (r = 0.08; P = 0.409), associated with increased volume of white matter hyperintensities beyond ageing, while neither ICA-PI nor ICA-BF related to cerebral or hippocampal atrophy indices. (iii) ICA-BF, but not ICA-PI, positively correlated with age-adjusted T-scores of executive function (r = 0.38; P < 0.001) and its subdomains working memory (r = 0.32; P < 0.001) and visual/verbal fluency (r = 0.32; P < 0.001). In a multivariate linear model of executive function, only ICA-BF (T = 3.79; P < 0.001), but not HF or magnetic resonance imaging parameters, remained a significant correlate of executive function. CONCLUSIONS ICA-BF and ICA-PI, measured in broadly available extracranial sonography, independently related to measures of functional and structural brain changes in people with chronic HF, respectively. Due to limitations of this cross-sectional approach without a healthy control group, larger controlled longitudinal studies are needed to further elucidate the role of ICA-BF dysregulation and its implication for clinical care in this vulnerable cohort.
Collapse
Affiliation(s)
- Jan Traub
- Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Interdisciplinary Center for Clinical ResearchUniversity Hospital WürzburgWürzburgGermany
| | - Mira Schließer
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Caroline Morbach
- Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
| | - Stefan Frantz
- Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
| | - Mirko Pham
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Department of NeuroradiologyUniversity Hospital WürzburgWürzburgGermany
| | - Stefan Störk
- Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
| | - Guido Stoll
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Anna Frey
- Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
- Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
| | | |
Collapse
|
3
|
Hu WS, Lin CL. Angiotensin Receptor-neprilysin Inhibitor Versus Renin-angiotensin System Inhibitor for Dementia Risk in Patients With Heart Failure. J Cardiovasc Pharmacol 2023; 82:229-234. [PMID: 37405835 DOI: 10.1097/fjc.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
ABSTRACT The authors report the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus renin-angiotensin system inhibitor (RASI) on the management and outcomes in dementia among heart failure (HF) patients as obtained from the real-life nationwide registry. In this study, HF patients between January 1, 2017 and December 31, 2019 were divided into 2 groups, including subjects receiving RASI and ARNI. The incidence rate of dementia was calculated with the unit of 1000 person-years. Cox proportional hazard model was applied for the examination of the hazard ratio, and also presented with 95% confidence interval. Between 2017 and 2019, RASI and ARNI cohorts contain 18,154 subjects. After adjusting with age, sex, comorbidities, and medications, ARNI cohort had a lower risk of dementia (adjusted hazard ratio = 0.83; 95% confidence interval = 0.72, 0.95) than RASI cohort. The authors concluded that use of ARNI was associated with a lower risk of new-onset dementia in patients with HF.
Collapse
Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; and
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
4
|
Luciani M, Montalbano M, Troncone L, Bacchin C, Uchida K, Daniele G, Jacobs Wolf B, Butler HM, Kiel J, Berto S, Gensemer C, Moore K, Morningstar J, Diteepeng T, Albayram O, Abisambra JF, Norris RA, Di Salvo TG, Prosser B, Kayed R, del Monte F. Big tau aggregation disrupts microtubule tyrosination and causes myocardial diastolic dysfunction: from discovery to therapy. Eur Heart J 2023; 44:1560-1570. [PMID: 37122097 PMCID: PMC10324644 DOI: 10.1093/eurheartj/ehad205] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Amyloid plaques and neurofibrillary tangles, the molecular lesions that characterize Alzheimer's disease (AD) and other forms of dementia, are emerging as determinants of proteinopathies 'beyond the brain'. This study aims to establish tau's putative pathophysiological mechanistic roles and potential future therapeutic targeting of tau in heart failure (HF). METHODS AND RESULTS A mouse model of tauopathy and human myocardial and brain tissue from patients with HF, AD, and controls was employed in this study. Tau protein expression was examined together with its distribution, and in vitro tau-related pathophysiological mechanisms were identified using a variety of biochemical, imaging, and functional approaches. A novel tau-targeting immunotherapy was tested to explore tau-targeted therapeutic potential in HF. Tau is expressed in normal and diseased human hearts, in contradistinction to the current oft-cited observation that tau is expressed specifically in the brain. Notably, the main cardiac isoform is high-molecular-weight (HMW) tau (also known as big tau), and hyperphosphorylated tau segregates in aggregates in HF and AD hearts. As previously described for amyloid-beta, the tauopathy phenotype in human myocardium is of diastolic dysfunction. Perturbation in the tubulin code, specifically a loss of tyrosinated microtubules, emerged as a potential mechanism of myocardial tauopathy. Monoclonal anti-tau antibody therapy improved myocardial function and clearance of toxic aggregates in mice, supporting tau as a potential target for novel HF immunotherapy. CONCLUSION The study presents new mechanistic evidence and potential treatment for the brain-heart tauopathy axis in myocardial and brain degenerative diseases and ageing.
Collapse
Affiliation(s)
- Marco Luciani
- Center for Translational and Experimental Cardiology, University of Zurich, Rämistrasse 100 8091 Zurich, Switzerland
| | - Mauro Montalbano
- Department of Neurology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1045 USA
| | - Luca Troncone
- Cardiovascular Research Center, Mass General Research Institute, Mass General Brigham, 149 13th St., Boston, MA 02129, USA
| | - Camilla Bacchin
- Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 2942, USA
| | - Keita Uchida
- Department of Physiology, University of Pennsylvania, 415 Curie Blvd., Philadelphia, PA 19104, USA
| | - Gianlorenzo Daniele
- Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 2942, USA
| | - Bethany Jacobs Wolf
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St., Charleston, SC 2942, USA
| | - Helen M Butler
- Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 2942, USA
| | - Justin Kiel
- Department of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC 29425, USA
| | - Stefano Berto
- Department of Neuroscience Medical, University of South Carolina, 68 President St., Charleston, SC 29425, USA
| | - Cortney Gensemer
- Department of Medicine, Medical University of South Carolina, 173 Ashley Ave., Charleston, SC 29425, USA
| | - Kelsey Moore
- Department of Medicine, Medical University of South Carolina, 173 Ashley Ave., Charleston, SC 29425, USA
| | - Jordan Morningstar
- Department of Medicine, Medical University of South Carolina, 173 Ashley Ave., Charleston, SC 29425, USA
| | - Thamonwan Diteepeng
- Center for Translational and Experimental Cardiology, University of Zurich, Rämistrasse 100 8091 Zurich, Switzerland
| | - Onder Albayram
- Department of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC 29425, USA
| | - José F Abisambra
- Department of Neuroscience, University of Florida Health, 1275 Center Drive, Gainesville, FL 32610, USA
| | - Russell A Norris
- Department of Medicine, Medical University of South Carolina, 173 Ashley Ave., Charleston, SC 29425, USA
| | - Thomas G Di Salvo
- Department of Medicine, Medical University of South Carolina, 30 Courtenay Drive, Charleston, SC 29425, USA
| | - Benjamin Prosser
- Department of Physiology, University of Pennsylvania, 415 Curie Blvd., Philadelphia, PA 19104, USA
| | - Rakez Kayed
- Department of Neurology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1045 USA
| | - Federica del Monte
- Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 2942, USA
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, Bologna 40054, Italy
- Massachusetts General Hospital, Harvard Medical School, Mass General Brigham, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
5
|
Ren QW, Katherine Teng TH, Tse YK, Tay WT, Li HL, Tromp J, Yu SY, Hung D, Wu MZ, Chen C, Yuk Yuen JK, Huang JY, Ouwerkerk W, Li XL, Teramoto K, Chandramouli C, Tse HF, Lam CSP, Yiu KH. Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure: A Population-Based Cohort Study. JACC. ASIA 2023; 3:108-119. [PMID: 36873768 PMCID: PMC9982209 DOI: 10.1016/j.jacasi.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/05/2023]
Abstract
Background Heart failure (HF) may increase the risk of dementia via shared risk factors. Objectives The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. Methods The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate. Results Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51; P < 0.001). Conclusions New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.
Collapse
Affiliation(s)
- Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | - Hang-Long Li
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jia-Yi Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| |
Collapse
|
6
|
Yang Z, Tian R, Zhang XJ, Cai J, She ZG, Li H. Effects of treatment of non-alcoholic fatty liver disease on heart failure with preserved ejection fraction. Front Cardiovasc Med 2023; 9:1120085. [PMID: 36712249 PMCID: PMC9877359 DOI: 10.3389/fcvm.2022.1120085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
In the past few decades, non-alcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) have become the most common chronic liver disease and the main form of heart failure (HF), respectively. NAFLD is closely associated with HFpEF by sharing common risk factors and/or by boosting systemic inflammation, releasing other secretory factors, and having an expansion of epicardial adipose tissue (EAT). Therefore, the treatments of NAFLD may also affect the development and prognosis of HFpEF. However, no specific drugs for NAFLD have been approved by the Food and Drug Administration (FDA) and some non-specific treatments for NAFLD are applied in the clinic. Currently, the treatments of NAFLD can be divided into non-pharmacological and pharmacological treatments. Non-pharmacological treatments mainly include dietary intervention, weight loss by exercise, caloric restriction, and bariatric surgery. Pharmacological treatments mainly include administering statins, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and metformin. This review will mainly focus on analyzing how these treatments may affect the development and prognosis of HFpEF.
Collapse
Affiliation(s)
- Zifeng Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Ruifeng Tian
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China,School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China,Institute of Model Animal, Wuhan University, Wuhan, China,*Correspondence: Zhi-Gang She,
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China,Institute of Model Animal, Wuhan University, Wuhan, China,School of Basic Medical Sciences, Wuhan University, Wuhan, China,Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, Ganzhou, China,Hongliang Li,
| |
Collapse
|
7
|
Arega Y, Shao Y. Heart failure and late-onset Alzheimer's disease: A Mendelian randomization study. Front Genet 2022; 13:1015674. [PMID: 36523758 PMCID: PMC9745072 DOI: 10.3389/fgene.2022.1015674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
Some observational studies suggested that heart failure (HF) is associated with increased risk of late-onset Alzheimer's disease (AD). On the other hand, a recently published Two-Sample Mendelian Randomization (2SMR) study was reported as inconclusive but the estimated odds ratios (ORs) were less than one indicating a potential causal association between genetically predicted HF and lowered risk of AD. Both HF and AD are quite common among elderly persons and frequently occur together resulting in a series of severe medical challenges and increased financial burden on healthcare. It is of great medical and financial interest to further investigate the statistical significance of the potential causal associations between genetically predicted HF and lowered risk of AD using large independent cohorts. To fill this important knowledge gap, the present study used the 2SMR method based on summary data from a recently published large genome-wide association study (GWAS) for AD on subjects with European ancestry. The 2SMR analysis provided statistically significant evidence of an association with ORs less than one between genetically predicted HF and late-onset AD (Inverse Variance Weighted, OR = 0.752, p = 0.004; MR Egger, OR = 0.546, p = 0.100; Weighted Median, OR = 0.757, p = 0.014). Further investigations of the significant associations between HF and late-onset AD, including specific genes related to the potential protective effect of HF-related medications on cognitive decline, are warranted.
Collapse
Affiliation(s)
- Yibeltal Arega
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | | |
Collapse
|
8
|
Investigating causal relations between heart failure and Alzheimer's disease: A two-sample Mendelian randomization study. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Augmented risk of dementia in hypertrophic cardiomyopathy: A propensity score matching analysis using the nationwide cohort. PLoS One 2022; 17:e0269911. [PMID: 35709174 PMCID: PMC9202937 DOI: 10.1371/journal.pone.0269911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Dementia is a big medical and socioeconomic problem on aging society, and cardiac diseases have already shown a significant contribution to developing dementia. However, the risk of dementia related to hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, has never been evaluated. Methods In a large-scale longitudinal cohort using National Health Insurance database, 4,645 subjects with HCM aged ≥50 years between 2010 and 2016 were collected and matched with 13,935 controls, based on propensity scores (1:3). We investigated the incidence and risk of dementia, Alzheimer’s disease (AD), and vascular dementia (VaD) between groups. Results During follow-up (median 3.9 years after 1-year lag), incident dementia occurred in 739 subjects (4.0%): 78.2% for AD and 13.0% for VaD. The incidence of dementia, AD, and VaD were 23.0, 18.0, and 2.9/1,000 person-years, respectively, and was generally more prevalent in HCM. HCM group had a 50% increased risk of dementia, particularly AD, whereas there was no difference in the risk of VaD. The impact of HCM on AD (HR 1.52, 95% CI 1.26–1.84, p<0.001) was comparable with that of diabetes mellitus and smoking. Increased risk of AD in relation to HCM was consistent in various subgroups including younger healthier population. Conclusions This is the first to demonstrate the increased risk of dementia, mainly AD rather than VaD, in subjects with HCM. Early surveillance and active prevention for cognitive impairment could help for a better quality of life in an era that HCM is considered a chronic manageable disease with low mortality.
Collapse
|
10
|
Marshall RA, Luchkanych AMS, Morton JS, Boyes NG, Zhai A, Marciniuk DD, Mei Y, Allison EY, Shoemaker JK, Al-Khazraji BK, Allen MD, Tomczak CR, Olver TD. Cerebral haemodynamics during arrhythmia in health, ischaemic heart disease and heart failure with reduced ejection fraction, and in a preclinical swine model. J Physiol 2022; 600:2311-2325. [PMID: 35389526 DOI: 10.1113/jp283112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 12/29/2022] Open
Abstract
Ventricular arrhythmias are associated with neurological impairment and could represent a source of cerebral hypoperfusion. In the present study, data from healthy individuals (n = 11), patients with ischaemic heart disease (IHD; ejection fraction >40%; n = 9) and patients with heart failure with reduced ejection fraction (HFrEF; EF = 31 (5)%, n = 11), as well as data from swine surgeries, where spontaneous ventricular arrhythmias were observed during cerebrovascular examination (transcranial Doppler ultrasound in humans and laser Doppler in swine) were analysed retrospectively to investigate the effect of arrhythmia on cerebral microvascular haemodynamics. A subset of participants also completed the Montreal Cognitive Assessment (MoCA). Middle cerebral artery mean blood velocity (MCAVmean ) decreased during premature ventricular contraction (PVC) in all groups, and data from swine indicate PVCs reduced cerebral microvascular perfusion. Overall MCAVmean was decreased in the HFrEF vs. control group. Further, %∆MCAVmean /%∆mean arterial pressure during the PVC was greater in the HFrEF vs. control group and was correlated with decreased MoCA scores. Subanalysis of HFrEF data revealed that during bigeminy MCAVmean decreased owing to reductions during irregular beats only. During non-sustained ventricular tachycardia, MCAVmean decreased but recovered above baseline upon return to sinus rhythm. Also, haemodynamic perturbations during and following the PVC were greater in the brachial artery vs. the MCA. Therefore, ventricular arrhythmias decreased indices of cerebral perfusion irrespective of IHD or HFrEF. The relative magnitude of arrhythmia-induced haemodynamic perturbations appears to be population specific and arrhythmia type and organ dependent. The cumulative burden of arrhythmia-induced deficits may exacerbate existing cerebral hypoperfusion in HFrEF and contribute to neurological abnormalities in this population. KEY POINTS: Irregular heartbeats are often considered benign in isolation, but individuals who experience them frequently have a higher prevalence of cerebrovascular and/or cognitive associated disorders. How irregular heartbeats affect blood pressure and cerebral haemodynamics in healthy and cardiovascular disease patients, those with and without reduced ejection fraction, remains unknown. Here it was found that in the absence of symptoms associated with irregular heartbeats, such as dizziness or hypotension, single, multiple non-sustained and sustained irregular heartbeats influence cerebral haemodynamics in a population-specific, arrhythmia-type and organ-dependent manner. Relative deficits in the index of cerebral blood flow normalized to relative deficits in blood pressure were greatest in patients with heart failure with reduced ejection and inversely related with cognitive performance. Chronic arrhythmias may exacerbate existing cerebral hypoperfusion in heart failure with reduced ejection fraction, thereby providing a mechanistic link between otherwise benign irregular heartbeats and cognitive dysfunction, independent of embolism.
Collapse
Affiliation(s)
- Rory A Marshall
- Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam M S Luchkanych
- Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jude S Morton
- Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Natasha G Boyes
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander Zhai
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Darcy D Marciniuk
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yixue Mei
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Elric Y Allison
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Baraa K Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Matti D Allen
- Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - T Dylan Olver
- Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
11
|
Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
Collapse
Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Beattie JM, Higginson IJ, McDonagh TA, Gao W. Implementation of the Mental Capacity Act: a national observational study comparing resultant trends in place of death for older heart failure decedents with or without comorbid dementia. BMC Med 2022; 20:30. [PMID: 35057803 PMCID: PMC9901524 DOI: 10.1186/s12916-021-02210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure (HF) is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. We compared trends in place of death (PoD) of HF patients with/without comorbid dementia around the implementation period of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency. METHODS Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with HF as the underlying cause of death, with/without a mention of comorbid dementia. We used modified Poisson regression with robust error variance to determine the prevalence ratio (PR) of the outcome in dying at home, in care homes or hospices compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban/rural settings. RESULTS One hundred twenty thousand sixty-eight HF-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence proportion of dementia was 6.8%, the trend significantly increasing from 5.6 to 8.0% pre- and post-MCA (Cochran-Armitage trend test p < 0.0001). Dementia was coded as unspecified (78.2%), Alzheimer's disease (13.5%) and vascular (8.3%). Demented decedents were commonly older, female, and with more comorbidities. Pre-MCA, PoD for non-demented HF patients was hospital 68.2%, care homes 20.2% and 10.7% dying at home. Corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, 62.5% and 17.2%, respectively; PR: 1.026 [95%CI: 1.024-1.029]. While home deaths also rose to 10.0% for those with dementia, with hospital deaths increasing to 50.4%, this trend was insignificant, PR: 1.001 [0.988-1.015]. Care home deaths reduced for all, with/without dementia, PR: 0.959 [0.949-0.969] and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups with no appreciable change over the study period. CONCLUSIONS Our analyses suggest the MCA did not materially affect the PoD of HF decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.
Collapse
Affiliation(s)
- James M Beattie
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.
| |
Collapse
|
13
|
Roderburg C, Loosen SH, Jördens MS, Konrad M, Luedde T, Kostev K, Luedde M. Heart failure and dementia: a comparative analysis with different types of cancer. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab003. [PMID: 35919092 PMCID: PMC9242070 DOI: 10.1093/ehjopen/oeab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022]
Abstract
Aims The prognosis and quality of life of patients with heart failure (HF) is determined by comorbidities, with dementia/cognitive decline believed to have a significant impact in this regard. This study compares the incidence of dementia in patients with HF with that in patients with common cancers in a large collective of outpatients. Methods and results This retrospective cohort study assessed the incidence of dementia/cognitive decline [International Classification of Diseases, 10th revision (ICD-10): I50] in a cohort of patients ≥65 years diagnosed with HF (ICD-10: I50), breast cancer (ICD-10: C50), prostate cancer (ICD-10: C61), or digestive organ cancer (ICD-10: C15-C26) in 1274 German general practices between January 2000 and December 2018. Multivariable Cox regression models were used to study the association between HF and dementia compared to each of three cancer cohorts. We included 72 259 patients with HF, 10 310 patients with breast cancer, 12 477 patients with prostate cancer, and 12 136 patients with digestive organ cancer. A total of 27.8% of patients with HF were diagnosed with dementia during the 10-year observation period compared to 16.2% of patients with breast cancer, 18.6% of patients with digestive organ cancer, and 16.1% of patients with prostate cancer. Patients with HF were significantly more likely to develop dementia within 10 years after diagnosis than patients with breast cancer [hazard ratio (HR): 1.36 (95% confidence interval 1.28–1.45, P < 0.001], prostate cancer [HR 1.38 (1.130–1.47), P < 0.001], or gastrointestinal tumours [HR 1.31 (1.24–1.39), P < 0.001]. Conclusions Our study demonstrates the significance of dementia in patients with HF, in whom the condition is much more prevalent than in patients with cancer.
Collapse
Affiliation(s)
- Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Markus S Jördens
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Marcel Konrad
- Health and Social, FOM University of Applied Sciences for Economics and Management Frankfurt , Franklinstr. 52, 60486 Frankfurt a.M., Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Karel Kostev
- Epidemiology, IQVIA Germany , Unterschweinstiege 2-14, 60549 Frankfurt a. M., Germany
| | - Mark Luedde
- Christian-Albrechts-University of Kiel , Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- KGP Bremerhaven , Postbrookstr. 105, Bremerhaven 27574, Germany
| |
Collapse
|
14
|
Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
Collapse
Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| |
Collapse
|
15
|
Wu H, Le Couteur DG, Hilmer SN. Mortality trends of stroke and dementia: Changing landscapes and new challenges. J Am Geriatr Soc 2021; 69:2888-2898. [PMID: 34133024 DOI: 10.1111/jgs.17322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/IMPORTANCE Stroke and dementia are important causes of death in the United States and may be interrelated as competing risks for mortality. No previous studies have simultaneously compared age- and sex-specific mortality trends between stroke and subtypes of dementia at a population level. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing stroke and dementia in the United States. OBJECTIVES To examine nationwide trends in mortality from stroke and subtypes of dementia in the United States by age group and sex. DESIGN Population-based cross-sectional study. SETTING U.S. mortality data from 2007 to 2016. PARTICIPANTS All U.S. residents whose primary cause of death was stroke, Alzheimer's disease, vascular dementia, or Lewy body dementia. MEASUREMENTS Age-adjusted mortality, mortality trends among men and women were analyzed separately using joinpoint regression. RESULTS From 2007 to 2016, age-adjusted stroke mortality fell by 21.6%. Age-adjusted mortality (per 1,000,000) for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by 1.2-fold, 2-fold, and 3-fold, respectively. Annual age-adjusted stroke mortality decreased by an average rate of 2.67% per year, while annual age-adjusted mortality for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by an average rate of 2.06%, 4.90%, and 12.13% per year, respectively. Mortality from stroke and dementia increased with age. Greater reductions in stroke mortality and greater increases in dementia mortality were seen in women than men; and in older than younger (<65 years) people. CONCLUSIONS There has been a striking rising trend in dementia mortality coincident with a reduction in stroke mortality in the United States. There are persistent age and sex disparities in stroke and dementia mortality trends. Our findings support the pathophysiological relationship between stroke and dementia, and have important implications for future research, healthcare planning, and provision.
Collapse
Affiliation(s)
- Harry Wu
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute (AAAI), Centre for Education and Research on Ageing (CERA) and ANZAC Research Institute, Concord Hospital, Concord, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Baranowski BJ, Allen MD, Nyarko JN, Rector RS, Padilla J, Mousseau DD, Rau CD, Wang Y, Laughlin MH, Emter CA, MacPherson RE, Olver TD. Cerebrovascular insufficiency and amyloidogenic signaling in Ossabaw swine with cardiometabolic heart failure. JCI Insight 2021; 6:143141. [PMID: 34027891 PMCID: PMC8262360 DOI: 10.1172/jci.insight.143141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
Individuals with heart failure (HF) frequently present with comorbidities, including obesity, insulin resistance, hypertension, and dyslipidemia. Many patients with HF experience cardiogenic dementia, yet the pathophysiology of this disease remains poorly understood. Using a swine model of cardiometabolic HF (Western diet+aortic banding; WD-AB), we tested the hypothesis that WD-AB would promote a multidementia phenotype involving cerebrovascular dysfunction alongside evidence of Alzheimer’s disease (AD) pathology. The results provide evidence of cerebrovascular insufficiency coupled with neuroinflammation and amyloidosis in swine with experimental cardiometabolic HF. Although cardiac ejection fraction was normal, indices of arterial compliance and cerebral blood flow were reduced, and cerebrovascular regulation was impaired in the WD-AB group. Cerebrovascular dysfunction occurred concomitantly with increased MAPK signaling and amyloidogenic processing (i.e., increased APP, BACE1, CTF, and Aβ40 in the prefrontal cortex and hippocampus) in the WD-AB group. Transcriptomic profiles of the stellate ganglia revealed the WD-AB group displayed an enrichment of gene networks associated with MAPK/ERK signaling, AD, frontotemporal dementia, and a number of behavioral phenotypes implicated in cognitive impairment. These provide potentially novel evidence from a swine model that cerebrovascular and neuronal pathologies likely both contribute to the dementia profile in a setting of cardiometabolic HF.
Collapse
Affiliation(s)
- Bradley J Baranowski
- Department of Health Sciences and.,Centre for Neuroscience, Brock University, St. Catharines, Ontario, Canada
| | - Matti D Allen
- Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer Nk Nyarko
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, USA
| | - Darrell D Mousseau
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christoph D Rau
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yibin Wang
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - M Harold Laughlin
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Craig A Emter
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Rebecca Ek MacPherson
- Department of Health Sciences and.,Centre for Neuroscience, Brock University, St. Catharines, Ontario, Canada
| | - T Dylan Olver
- Department of Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
17
|
Broulikova HM, Arltova M, Kuklova M, Formanek T, Cermakova P. Hospitalizations and Mortality of Individuals with Dementia: Evidence from Czech National Registers. J Alzheimers Dis 2021; 75:1017-1027. [PMID: 32390620 PMCID: PMC7369115 DOI: 10.3233/jad-191117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Facing an increasing prevalence of dementia, the Czech Republic is developing a new nationwide strategy for the management and prevention of dementia. Lack of evidence about characteristics of individuals with dementia in the country is a major obstacle. OBJECTIVE The study aimed to 1) characterize individuals with dementia, 2) compare their mortality with the general population, and 3) analyze differences in survival between different dementia disorders. METHODS The study capitalizes on two nationwide registers in the Czech Republic, from which information about individuals who were hospitalized with dementia or died from it between 1994 and 2014 was retrieved. Standardized intensity of hospitalizations was calculated for each year, mortality was studied using standardized mortality ratio, life-tables, Kaplan-Mayer curves, and Cox proportional hazard models. RESULTS Standardized intensity of hospitalizations for dementia increased more than 3 times from 1994 to 2014. Standardized mortality ratio was 3.03 (95% confidence interval 2.97-3.08). One-year survival rate was 45% and five-year survival rate 16%. Vascular dementia was the most common type of dementia disorders and was associated with higher hazard of death than Alzheimer's disease, even after adjusting for sociodemographic and clinical covariates (hazard ratio 1.04; 95% confidence interval 1.02-1.05). CONCLUSION The study provides estimates on demographic characteristics and mortality of the Czech hospitalized dementia population, which have not been so far available and which are unique also in the context of the entire region of Central and Eastern Europe.
Collapse
Affiliation(s)
- Hana Marie Broulikova
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | - Marketa Arltova
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Marie Kuklova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomas Formanek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| |
Collapse
|
18
|
Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rich MW. Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210006. [PMID: 33954261 PMCID: PMC8096199 DOI: 10.20900/jpbs.20210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart failure (HF) is a common cause of hospitalization and mortality in older adults. HF is almost always embedded within a larger pattern of multimorbidity, yet many studies exclude patients with complex psychiatric and medical comorbidities or cognitive impairment. This has left significant gaps in research on the problems and treatment of patients with HF. In addition, HF is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities that may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. The syndemics framework has yielded important insights into other disorders such as HIV/AIDS, but it has not been applied to the complex psychosocial problems of patients with HF. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims are: (1) to determine the coprevalence of psychiatric and medical comorbidities in patients with HF (n = 535); (2) to determine whether coprevalent comorbidities have synergistic effects on readmissions, mortality, self-care, and global health; (3) to identify vulnerable subpopulations of patients with HF who have high coprevalences of syndemic comorbidities; (4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes in vulnerable subgroups of patients with HF; and (5) to determine the effects of multimorbidity on readmissions, mortality, self-care, and global health.
Collapse
Affiliation(s)
- Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Judith A. Skala
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Robert M. Carney
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Brian C. Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Michael W. Rich
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
| |
Collapse
|
19
|
D'Elia E, Stamerra CA, Vecchi A, Duino V, Grosu A, Abete R, Baio P, Gori M, Gavazzi A, Ferri C, Senni M. Association between sleep disordered breathing, neurocognitive impairment and diastolic function in acute heart failure patients: an insight after the vulnerable phase of the hospitalization. Intern Emerg Med 2021; 16:369-377. [PMID: 32557094 DOI: 10.1007/s11739-020-02397-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Sleep disordered breathing (SDB) and neurocognitive impairment (NI) are a typical feature of HF (heart failure), especially with preserved ejection fraction (HFpEF). So far, very few data exist regarding changes in the severity of SDB, the degree of NI, and the diastolic function in acute HF (AHF) patients and during follow up. In a population of 24 AHF patients (12 with reduced ejection fraction-HFrEF- and 12 HFpEF) with SDB a complete echocardiogram, a set of NI tests, and a polysomnography were performed in the acute phase and after 90 days. A control group of 12 non-HF patients hospitalized for other cardiovascular causes was considered. At baseline, SDB were present both in HFpEF and HFrEF, and a consistent reduction of apneic events was observed at follow up. Improvements in diastolic and right ventricular function were documented at three months compared to baseline, both in HFpEF and in HFrEF. Compared to HFrEF patients and controls, HFpEF patients showed lower NI scores at baseline tests, but a more significant improvement at three months follow-up. In AHF patients with SDB the achievement of a better compensation could lead to important beneficial effect not only on echocardiographic variables and nocturnal respiratory profile, but also on NI, especially in HFpEF.
Collapse
Affiliation(s)
- Emilia D'Elia
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy.
| | - Cosimo Andrea Stamerra
- Department of Life, 2 Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Vecchi
- Cardiovascular Department, Hospital Galmarini, ASST Settelaghi, Tredate, Italy
| | - Vincenzo Duino
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Raffaele Abete
- Policlinico Di Monza, Monza, Italy
- Pavia University, Pavia, Italy
| | - Pierangelo Baio
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | | | - Claudio Ferri
- Department of Life, 2 Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| |
Collapse
|
20
|
Islam MR, Lbik D, Sakib MS, Maximilian Hofmann R, Berulava T, Jiménez Mausbach M, Cha J, Goldberg M, Vakhtang E, Schiffmann C, Zieseniss A, Katschinski DM, Sananbenesi F, Toischer K, Fischer A. Epigenetic gene expression links heart failure to memory impairment. EMBO Mol Med 2021; 13:e11900. [PMID: 33471428 PMCID: PMC7933944 DOI: 10.15252/emmm.201911900] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
In current clinical practice, care of diseased patients is often restricted to separated disciplines. However, such an organ-centered approach is not always suitable. For example, cognitive dysfunction is a severe burden in heart failure patients. Moreover, these patients have an increased risk for age-associated dementias. The underlying molecular mechanisms are presently unknown, and thus, corresponding therapeutic strategies to improve cognition in heart failure patients are missing. Using mice as model organisms, we show that heart failure leads to specific changes in hippocampal gene expression, a brain region intimately linked to cognition. These changes reflect increased cellular stress pathways which eventually lead to loss of neuronal euchromatin and reduced expression of a hippocampal gene cluster essential for cognition. Consequently, mice suffering from heart failure exhibit impaired memory function. These pathological changes are ameliorated via the administration of a drug that promotes neuronal euchromatin formation. Our study provides first insight to the molecular processes by which heart failure contributes to neuronal dysfunction and point to novel therapeutic avenues to treat cognitive defects in heart failure patients.
Collapse
Affiliation(s)
- Md Rezaul Islam
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Dawid Lbik
- Clinic of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany
| | - M Sadman Sakib
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | | | - Tea Berulava
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Martí Jiménez Mausbach
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Julia Cha
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Maria Goldberg
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Elerdashvili Vakhtang
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Christian Schiffmann
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Anke Zieseniss
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany.,Institute for Cardiovascular Physiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - Dörthe Magdalena Katschinski
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany.,Institute for Cardiovascular Physiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - Farahnaz Sananbenesi
- Genome Dynamics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Karl Toischer
- Clinic of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andre Fischer
- Department for Systems Medicine and Epigenetics, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| |
Collapse
|
21
|
Stepien K, Furczynska P, Zalewska M, Nowak K, Wlodarczyk A, Owsianka I, Skorek P, Zalewski J, Nessler J. Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes. Minerva Cardiol Angiol 2020; 69:251-260. [PMID: 32643895 DOI: 10.23736/s2724-5683.20.05157-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recently heart failure (HF) has been found to be a new dementia risk factor; nevertheless, their relations in patients following HF decompensation remain unknown. We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. METHODS One hundred forty-two patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. RESULTS SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=-0.29, P<0.001), peripheral arterial disease (PAD) (β=-0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs. 28.6%, P=0.042) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI: 1.23-4.01, P=0.007). CONCLUSIONS In patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not related with patients' compliance but irrespective of the stroke/TIA history it was associated with the increased risk of HF rehospitalization.
Collapse
Affiliation(s)
- Konrad Stepien
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland -
| | - Patrycja Furczynska
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Zalewska
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Aleksandra Wlodarczyk
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Izabella Owsianka
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Pawel Skorek
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jaroslaw Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW This review summarizes the evidence for the established vascular/hypoperfusion model and explores the new hypothesis that configures the heart/brain axis as an organ system where similar pathogenic mechanisms exploit physiological and pathological changes. RECENT FINDINGS Although associated by common risk factors, similar epidemiological stratification and common triggers (including inflammation, oxidative stress, and hypoxia), heart failure and Alzheimer's disease have been, for long time, viewed as pathogenically separate illnesses. The silos began to be broken down with the awareness that vascular dysfunction, and loss of cardiac perfusion pump power, trigger biochemical changes, contributing to the typical hallmark of Alzheimer's disease (AD)-the accumulation of Aβ plaques and hyperphosphorylated Tau tangles. Compromised blood flow to the brain becomes the paradigm for the "heart-to-head" connection. Compelling evidence of common genetic variants, biochemical characteristics, and the accumulation of Aβ outside the brain suggests a common pathogenesis for heart failure (HF) and AD. These new findings represent just the beginning of the understanding the complex connection between AD and HF requiring further studies and interdisciplinary approaches. Altogether, the current evidence briefly summarized in this review, highlight a closer and complex relationship between heart failure and Alzheimer's that goes beyond the vascular/perfusion hypothesis. Genetic and biochemical evidence begin to suggest common pathogenic mechanisms between the two diseases involving a systemic defect in the folding of protein or a seeding at distance of the misfolded proteins from one organ to the other.
Collapse
|
23
|
Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum. Int J Cardiol 2020; 298:59-65. [DOI: 10.1016/j.ijcard.2019.08.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/11/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
|
24
|
Yang T, Lu Z, Wang L, Zhao Y, Nie B, Xu Q, Han X, Li T, Zhao J, Cheng W, Wang B, Wu A, Zhu H, Meng W, Shang H, Zhao M. Dynamic Changes in Brain Glucose Metabolism and Neuronal Structure in Rats with Heart Failure. Neuroscience 2020; 424:34-44. [DOI: 10.1016/j.neuroscience.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
|
25
|
Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
Collapse
Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| |
Collapse
|
26
|
Hayward GC, LeBlanc PJ, Emter CA, Nyarko JNK, Mousseau DD, MacPherson REK, Olver TD. Female Sex Hormones and Cardiac Pressure Overload Independently Contribute to the Cardiogenic Dementia Profile in Yucatan Miniature Swine. Front Cardiovasc Med 2019; 6:129. [PMID: 31552273 PMCID: PMC6746895 DOI: 10.3389/fcvm.2019.00129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/19/2019] [Indexed: 01/29/2023] Open
Abstract
Post-menopausal women with heart failure (HF) frequently exhibit cardiogenic dementia. Using a pre-clinical swine model of post-menopausal HF, we recently demonstrated that experimental menopause (ovariectomy; OVX) and HF (6-month cardiac pressure overload/aortic banding; AB) independently altered cerebral vasomotor control and together impaired cognitive function. The purpose of this study was to examine the prefrontal cortex and hippocampus tissues from these animals to assess whether OVX and HF are associated with neurologic alterations that may contribute to cardiogenic dementia. We hypothesized that OVX and HF would independently alter neuronal cell signaling in swine with post-menopausal cardiogenic dementia. Immunoblot analyses revealed OVX was associated with reduced estrogen receptor-α in both brain regions and HF tended to exacerbate OVX-induced deficits in the hippocampus. Further, OVX was associated with a reduction in the ratio of phosphorylated:total Akt and ERK in the hippocampus as well as decreased total Akt and synaptophysin in the prefrontal cortex. In contrast, HF was associated with a trend toward reduced phosphorylated:total ERK in the prefrontal cortex. In addition, HF was associated with decreased β-amyloid (1-38) in the prefrontal cortex and increased β-amyloid (1-38) in the hippocampus. Regional brain lipid analysis revealed OVX tended to increase total, saturated, and monounsaturated fatty acid content in the prefrontal cortex, with the greatest magnitude of change occurring in the AB-OVX group. The data from this study suggest that OVX and HF are independently associated with regional-specific neurologic changes in the brain that contribute to the cardiogenic dementia profile in this model. This pre-clinical swine model may be a useful tool for better understanding post-menopausal cardiogenic dementia pathology and developing novel therapies.
Collapse
Affiliation(s)
- Grant C. Hayward
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
- Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
| | - Paul J. LeBlanc
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
- Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - Craig A. Emter
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States
| | - Jennifer N. K. Nyarko
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Darrell D. Mousseau
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rebecca E. K. MacPherson
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
- Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
| | - T. Dylan Olver
- Department of Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
27
|
Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
Collapse
Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
28
|
Olver TD, Edwards JC, Jurrissen TJ, Veteto AB, Jones JL, Gao C, Rau C, Warren CM, Klutho PJ, Alex L, Ferreira-Nichols SC, Ivey JR, Thorne PK, McDonald KS, Krenz M, Baines CP, Solaro RJ, Wang Y, Ford DA, Domeier TL, Padilla J, Rector RS, Emter CA. Western Diet-Fed, Aortic-Banded Ossabaw Swine: A Preclinical Model of Cardio-Metabolic Heart Failure. JACC Basic Transl Sci 2019; 4:404-421. [PMID: 31312763 PMCID: PMC6610000 DOI: 10.1016/j.jacbts.2019.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The development of new treatments for heart failure lack animal models that encompass the increasingly heterogeneous disease profile of this patient population. This report provides evidence supporting the hypothesis that Western Diet-fed, aortic-banded Ossabaw swine display an integrated physiological, morphological, and genetic phenotype evocative of cardio-metabolic heart failure. This new preclinical animal model displays a distinctive constellation of findings that are conceivably useful to extending the understanding of how pre-existing cardio-metabolic syndrome can contribute to developing HF.
Collapse
Key Words
- AB, aortic-banded
- CON, control
- EDPVR, end-diastolic pressure−volume relationship
- EF, ejection fraction
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IL1RL1, interleukin 1 receptor-like 1
- LV, left ventricle
- NF, nuclear factor
- PTX3, pentraxin-3
- WD, Western Diet
- cardio-metabolic disease
- heart failure
- integrative pathophysiology
- preclinical model of cardiovascular disease
Collapse
Affiliation(s)
- T. Dylan Olver
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Jenna C. Edwards
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Thomas J. Jurrissen
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Adam B. Veteto
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - John L. Jones
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Chen Gao
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Christoph Rau
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Chad M. Warren
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, Illinois
| | - Paula J. Klutho
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Linda Alex
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | | | - Jan R. Ivey
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Pamela K. Thorne
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Kerry S. McDonald
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Maike Krenz
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Christopher P. Baines
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - R. John Solaro
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, Illinois
| | - Yibin Wang
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David A. Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University- School of Medicine, St. Louis, Missouri
| | - Timothy L. Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
- Department of Child Health, University of Missouri-Columbia, Columbia, Missouri
| | - R. Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
- Department of Medicine – University of Missouri-Columbia, Columbia, Missouri
- Research Service, Harry S Truman Memorial VA Hospital, University of Missouri-Columbia, Columbia, Missouri
| | - Craig A. Emter
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| |
Collapse
|
29
|
Park S, Jeon SM, Jung SY, Hwang J, Kwon JW. Effect of late-life weight change on dementia incidence: a 10-year cohort study using claim data in Korea. BMJ Open 2019; 9:e021739. [PMID: 31110079 PMCID: PMC6530413 DOI: 10.1136/bmjopen-2018-021739] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The association between body mass index (BMI) in late-life and dementia risk remains unclear. We investigated the association between BMI changes over a 2-year period and dementia in an elderly Korean population. METHODS We examined 67 219 participants aged 60-79 years who underwent BMI measurement in 2002/2003 and 2004/2005 as part of the National Health Insurance Service-Health Screening Cohort. Baseline characteristics including BMI, socioeconomic status and cardiometabolic risk factors were measured at baseline (2002/2003). The difference between BMI at baseline and at the next health screening (2004/2005) was used to calculate the BMI change. After 2 years, the incidence of dementia was monitored for a mean 5.3 years from 2008 to 2013. Multivariate HRs for dementia incidence were estimated on the basis of baseline BMI and its changes after adjusting for various other risk factors. A subgroup analysis was conducted to determine the effects of baseline BMI and BMI changes. RESULTS We demonstrated a significant association between late-life BMI changes and dementia in both sexes (men: >-10% HR=1.26, 95% CI 1.08 to 1.46, >+10% HR=1.25, 95% CI 1.08 to 1.45; women: >-10% HR=1.15, 95% CI 1.03 to 1.29, >+10% HR=1.17, 95% CI 1.05 to 1.31). However, the baseline BMI was not associated with dementia, except in underweight men. After stratification based on the baseline BMI, the BMI increase over 2 years was associated with dementia in men with a BMI of <25 kg/m2 and women with a BMI of 18.5-25 kg/m2, but not in the obese subgroup in either sex. However, BMI decrease was associated with dementia in those with a BMI of ≥18.5 kg/m2, but not in the underweight subgroup in either sex. CONCLUSION Both weight gain and weight loss may be significant risk factors associated with dementia. Continuous weight control and careful monitoring of weight changes are necessary to prevent dementia development.
Collapse
Affiliation(s)
- Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Soo-Min Jeon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jinseub Hwang
- Division of Mathematics and Big Data Science, Daegu University, Gyeongsan, Republic of Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
30
|
Hu WS, Lin CL. Comparison of CHA 2DS 2-VASc and AHEAD scores for the prediction of incident dementia in patients hospitalized for heart failure: a nationwide cohort study. Intern Emerg Med 2019; 14:395-402. [PMID: 30306322 DOI: 10.1007/s11739-018-1961-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/26/2018] [Indexed: 01/03/2023]
Abstract
This study explores the use of the CHA2DS2-VASc and the AHEAD scores to predict incident dementia in patients with heart failure (HF) who need hospitalization. We used a large national database to study 387,595 adult patients hospitalized for HF from Taiwan. This registration cohort was followed to document the cumulative incidence of dementia. The area under the curve of receiver operating characteristics (AUROC) was used to evaluate the discriminative ability of CHA2DS2-VASc and AHEAD scores in predicting dementia, whereas the DeLong test was used to examine the difference between the predictive capacity. A higher CHA2DS2-VASc and AHEAD scores appear to be more strongly associated with a higher incidence of dementia. The AUROC for CHA2DS2-VASc score in predicting dementia (0.61, 95% CI = 0.60-0.61) is significantly higher than the AHEAD score (0.55, 95% CI = 0.54-0.55) (DeLong test p < 0.001). A significantly higher ability, by AUROC, of CHA2DS2-VASc score to predict new-onset dementia in patients hospitalized for HF is found.
Collapse
Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
| |
Collapse
|
31
|
Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20:1505-1535. [DOI: 10.1002/ejhf.1236] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Marco Metra
- Cardiology; University of Brescia; Brescia Italy
| | - Lars H. Lund
- Department of Medicine, Unit of Cardiology; Karolinska Institute; Stockholm Sweden
| | - Davor Milicic
- Department for Cardiovascular Diseases; University Hospital Center Zagreb, University of Zagreb; Zagreb Croatia
| | | | | | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Steven Tsui
- Transplant Unit; Royal Papworth Hospital; Cambridge UK
| | - Eduardo Barge-Caballero
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Nicolaas De Jonge
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center; Niguarda Hospital; Milan Italy
| | - Righab Hamdan
- Department of Cardiology; Beirut Cardiac Institute; Beirut Lebanon
| | - Tal Hasin
- Jesselson Integrated Heart Center; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin Hülsmann
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Aggeliki Gkouziouta
- Heart Failure and Transplant Unit; Onassis Cardiac Surgery Centre; Athens Greece
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; University of Heidelberg; Heidelberg Germany
| | - Arsen D. Ristic
- Department of Cardiology of the Clinical Center of Serbia; Belgrade University School of Medicine; Belgrade Serbia
| | | | | | - Petar Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center; Belgrade Serbia
| | - Frank Ruschitzka
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| |
Collapse
|
32
|
Cermakova P, Nelson M, Secnik J, Garcia-Ptacek S, Johnell K, Fastbom J, Kilander L, Winblad B, Eriksdotter M, Religa D. Living Alone with Alzheimer's Disease: Data from SveDem, the Swedish Dementia Registry. J Alzheimers Dis 2018; 58:1265-1272. [PMID: 28550260 PMCID: PMC5523910 DOI: 10.3233/jad-170102] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Many people with Alzheimer’s disease (AD) live alone in their own homes. There is a lack of knowledge about whether these individuals receive the same quality of diagnostics and treatment for AD as patients who are cohabiting. Objectives: To investigate the diagnostic work-up and treatment of community-dwelling AD patients who live alone. Methods: We performed a cross-sectional cohort study based on data from the Swedish Dementia Registry (SveDem). We studied patients diagnosed with AD between 2007 and 2015 (n = 26,163). Information about drugs and comorbidities was acquired from the Swedish Prescribed Drug Register and the Swedish Patient Register. Results: 11,878 (46%) patients lived alone, primarily older women. After adjusting for confounders, living alone was inversely associated with receiving computed tomography (OR 0.90; 95% CI 0.82–0.99), magnetic resonance imaging (OR 0.91; 95% CI 0.83–0.99), and lumbar puncture (OR 0.86; 95% CI 0.80–0.92). Living alone was also negatively associated with the use of cholinesterase inhibitors (OR 0.81; 95% CI 0.76; 0.87), memantine (OR 0.77; 95% CI 0.72; 0.83), and cardiovascular medication (OR 0.92; 0.86; 0.99). On the other hand, living alone was positively associated with the use of antidepressants (OR 1.15; 95% CI 1.08; 1.22), antipsychotics (OR 1.41; 95% CI 1.25; 1.58), and hypnotics and sedatives (OR 1.09; 95% CI 1.02; 1.17). Conclusions: Solitary living AD patients do not receive the same extent of care as those who are cohabiting.
Collapse
Affiliation(s)
- Pavla Cermakova
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,National Instituteof Mental Health, Klecany, Czech Republic
| | - Maja Nelson
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Juraj Secnik
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences andSociety, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.,Södersjukhuset, Department of Internal Medicine, Neurology, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lena Kilander
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences andSociety, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
33
|
Adamski MG, Sternak M, Mohaissen T, Kaczor D, Wierońska JM, Malinowska M, Czaban I, Byk K, Lyngsø KS, Przyborowski K, Hansen PBL, Wilczyński G, Chlopicki S. Vascular Cognitive Impairment Linked to Brain Endothelium Inflammation in Early Stages of Heart Failure in Mice. J Am Heart Assoc 2018; 7:e007694. [PMID: 29581224 PMCID: PMC5907583 DOI: 10.1161/jaha.117.007694] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although advanced heart failure (HF) is a clinically documented risk factor for vascular cognitive impairment, the occurrence and pathomechanisms of vascular cognitive impairment in early stages of HF are equivocal. Here, we characterize vascular cognitive impairment in the early stages of HF development and assess whether cerebral hypoperfusion or prothrombotic conditions are involved. METHODS AND RESULTS Tgαq*44 mice with slowly developing isolated HF triggered by cardiomyocyte-specific overexpression of G-αq*44 protein were studied before the end-stage HF, at the ages of 3, 6, and 10 months: before left ventricle dysfunction; at the stage of early left ventricle diastolic dysfunction (with preserved ejection fraction); and left ventricle diastolic/systolic dysfunction, respectively. In 6- to 10-month-old but not in 3-month-old Tgαq*44 mice, behavioral and cognitive impairment was identified with compromised blood-brain barrier permeability, most significantly in brain cortex, that was associated with myelin sheet loss and changes in astrocytes and microglia. Brain endothelial cells displayed increased E-selectin immunoreactivity, which was accompanied by increased amyloid-β1-42 accumulation in piriform cortex and increased cortical oxidative stress (8-OHdG immunoreactivity). Resting cerebral blood flow measured by magnetic resonance imaging in vivo was preserved, but ex vivo NO-dependent cortical arteriole flow regulation was impaired. Platelet hyperreactivity was present in 3- to 10-month-old Tgαq*44 mice, but it was not associated with increased platelet-dependent thrombogenicity. CONCLUSIONS We report for the first time that vascular cognitive impairment is already present in the early stage of HF development, even before left ventricle systolic dysfunction. The underlying pathomechanism, independent of brain hypoperfusion, involves preceding platelet hyperreactivity and brain endothelium inflammatory activation.
Collapse
MESH Headings
- Amyloid beta-Peptides/metabolism
- Animals
- Behavior, Animal
- Blood Platelets/metabolism
- Blood-Brain Barrier/metabolism
- Blood-Brain Barrier/physiopathology
- Brain/blood supply
- Capillary Permeability
- Cerebral Arteries/metabolism
- Cerebral Arteries/physiopathology
- Cerebrovascular Circulation
- Cognition
- Cognition Disorders/etiology
- Cognition Disorders/metabolism
- Cognition Disorders/physiopathology
- Cognition Disorders/psychology
- Dementia, Vascular/etiology
- Dementia, Vascular/metabolism
- Dementia, Vascular/physiopathology
- Dementia, Vascular/psychology
- Disease Models, Animal
- Disease Progression
- Encephalitis/etiology
- Encephalitis/metabolism
- Encephalitis/pathology
- Encephalitis/physiopathology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- GTP-Binding Protein alpha Subunits, Gq-G11/genetics
- Genetic Predisposition to Disease
- Heart Failure/complications
- Heart Failure/genetics
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Mice, Transgenic
- Myocytes, Cardiac/metabolism
- Peptide Fragments/metabolism
- Phenotype
- Time Factors
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
Collapse
Affiliation(s)
- Mateusz G Adamski
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Magdalena Sternak
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Tasnim Mohaissen
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Dawid Kaczor
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | | | - Monika Malinowska
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Iwona Czaban
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Katarzyna Byk
- Institute of Nuclear Physics, Polish Academy of Sciences, Warsaw, Poland
| | | | - Kamil Przyborowski
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Pernille B L Hansen
- University of Southern Denmark, Odense, Denmark
- Cardiovascular and Metabolic Disease, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Grzegorz Wilczyński
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Stefan Chlopicki
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
- Chair of Pharmacology, Jagiellonian University, Medical College, Kraków, Poland
| |
Collapse
|
34
|
|
35
|
Wolters FJ, Segufa RA, Darweesh SK, Bos D, Ikram MA, Sabayan B, Hofman A, Sedaghat S. Coronary heart disease, heart failure, and the risk of dementia: A systematic review and meta‐analysis. Alzheimers Dement 2018; 14:1493-1504. [DOI: 10.1016/j.jalz.2018.01.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/05/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Frank J. Wolters
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
- Department of NeurologyErasmus Medical CentreRotterdamThe Netherlands
| | - Reffat A. Segufa
- Department of Gerontology and GeriatricsLeiden University Medical CentreLeidenThe Netherlands
| | - Sirwan K.L. Darweesh
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
- Department of NeurologyErasmus Medical CentreRotterdamThe Netherlands
| | - Daniel Bos
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus Medical CentreRotterdamThe Netherlands
| | - Mohammad Arfan Ikram
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
- Department of NeurologyErasmus Medical CentreRotterdamThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus Medical CentreRotterdamThe Netherlands
| | - Behnam Sabayan
- Department of Gerontology and GeriatricsLeiden University Medical CentreLeidenThe Netherlands
- Department of NeurologyFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Albert Hofman
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
| | - Sanaz Sedaghat
- Department of EpidemiologyErasmus Medical CentreRotterdamThe Netherlands
| |
Collapse
|
36
|
Abstract
Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.
Collapse
|
37
|
Doehner W, Ural D, Haeusler KG, Čelutkienė J, Bestetti R, Cavusoglu Y, Peña-Duque MA, Glavas D, Iacoviello M, Laufs U, Alvear RM, Mbakwem A, Piepoli MF, Rosen SD, Tsivgoulis G, Vitale C, Yilmaz MB, Anker SD, Filippatos G, Seferovic P, Coats AJS, Ruschitzka F. Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. Eur J Heart Fail 2017; 20:199-215. [PMID: 29280256 DOI: 10.1002/ejhf.1100] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.
Collapse
Affiliation(s)
- Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany
| | - Dilek Ural
- Department of Cardiology, Koc University School of Medicine, Istanbul, Turkey
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Centre of Cardiology, Vilnius University, Lithuania
| | - Reinaldo Bestetti
- Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Yuksel Cavusoglu
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Duska Glavas
- Cardiology Department, University Hospital Split, Croatia
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Amam Mbakwem
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Stuart D Rosen
- Ealing and Royal Brompton Hospitals and NHLI, Imperial College, London, UK
| | | | - Cristiana Vitale
- Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy
| | - M Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine Cumhuriyet University, Sivas, Turkey
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité - Universitätsmedizin Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Gerasimos Filippatos
- Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Petar Seferovic
- University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
38
|
Cermakova P, Muller M, Armstrong AC, Religa D, Bryan RN, Lima JAC, Launer LJ. Subclinical Cardiac Dysfunction and Brain Health in Midlife: CARDIA (Coronary Artery Risk Development in Young Adults) Brain Magnetic Resonance Imaging Substudy. J Am Heart Assoc 2017; 6:JAHA.117.006750. [PMID: 29246962 PMCID: PMC5779005 DOI: 10.1161/jaha.117.006750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We investigated whether cardiac parameters in young adulthood are associated with indicators of brain health in midlife. Methods and Results This study includes 648 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study (52% women, 38% black). We studied associations of cardiac parameters assessed by echocardiography (left ventricular ejection fraction, left atrial volume, and left ventricular mass) in young adulthood (mean age: 30 years) with brain measures obtained by magnetic resonance imaging (total brain, gray and white matter volume, white matter integrity, abnormal white matter) in midlife (mean age: 50 years). In 406 individuals with complete measurements, higher left atrial volume was associated with lower white matter fractional anisotropy, independent of traditional cardiovascular risk factors (β=−0.002; P <0.02). The association was strongest in black participants and in men. Conclusions Higher left atrial volume in early adulthood is associated with impairment of white matter integrity in midlife. Interventions to improve cardiac function in young adults may benefit brain health and should be targeted in particular at black men.
Collapse
Affiliation(s)
- Pavla Cermakova
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,National Institute of Mental Health, Klecany, Czech Republic
| | - Majon Muller
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD.,Department of Internal Medicine-Section Geriatric Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Anderson C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.,University of Sao Francisco Valley, Petrolina, Brasil
| | - Dorota Religa
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD
| |
Collapse
|
39
|
van der Velpen IF, Yancy CW, Sorond FA, Sabayan B. Impaired Cardiac Function and Cognitive Brain Aging. Can J Cardiol 2017; 33:1587-1596. [DOI: 10.1016/j.cjca.2017.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022] Open
|
40
|
Olver TD, Hiemstra JA, Edwards JC, Schachtman TR, Heesch CM, Fadel PJ, Laughlin MH, Emter CA. Loss of Female Sex Hormones Exacerbates Cerebrovascular and Cognitive Dysfunction in Aortic Banded Miniswine Through a Neuropeptide Y-Ca 2+-Activated Potassium Channel-Nitric Oxide Mediated Mechanism. J Am Heart Assoc 2017; 6:JAHA.117.007409. [PMID: 29089345 PMCID: PMC5721796 DOI: 10.1161/jaha.117.007409] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Postmenopausal women represent the largest cohort of patients with heart failure with preserved ejection fraction, and vascular dementia represents the most common form of dementia in patients with heart failure with preserved ejection fraction. Therefore, we tested the hypotheses that the combination of cardiac pressure overload (aortic banding [AB]) and the loss of female sex hormones (ovariectomy [OVX]) impairs cerebrovascular control and spatial memory. Methods and Results Female Yucatan miniswine were separated into 4 groups (n=7 per group): (1) control, (2) AB, (3) OVX, and (4) AB‐OVX. Pigs underwent OVX and AB at 7 and 8 months of age, respectively. At 14 months, cerebral blood flow velocity and spatial memory (spatial hole‐board task) were lower in the OVX groups (P<0.05), with significant impairments in the AB‐OVX group (P<0.05). Resting carotid artery β stiffness and vascular resistance during central hypovolemia were increased in the AB‐OVX group (P<0.05), and blood flow recovery after central hypovolemia was reduced in both OVX groups (P<0.05). Isolated pial artery (pressure myography) vasoconstriction to neuropeptide Y was greatest in the AB‐OVX group (P<0.05), and vasodilation to the Ca2+‐activated potassium channel α‐subunit agonist NS‐1619 was impaired in both AB groups (P<0.05). The ratio of phosphorylated endothelial nitric oxide synthase:total endothelial nitric oxide synthase was depressed and Ca2+‐activated potassium channel α‐subunit protein was increased in AB groups (P<0.05). Conclusions Mechanistically, impaired cerebral blood flow control in experimental heart failure may be the result of heightened neuropeptide Y–induced vasoconstriction along with reduced vasodilation associated with decreased Ca2+‐activated potassium channel function and impaired nitric oxide signaling, the effects of which are exacerbated in the absence of female sex hormones.
Collapse
Affiliation(s)
- T Dylan Olver
- Department of Biomedical Sciences, University of Missouri, Columbia, MO
| | | | - Jenna C Edwards
- Department of Biomedical Sciences, University of Missouri, Columbia, MO
| | - Todd R Schachtman
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Cheryl M Heesch
- Department of Biomedical Sciences, University of Missouri, Columbia, MO.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO
| | - Paul J Fadel
- College of Nursing and Health Innovation, University of Texas at Arlington, TX
| | - M Harold Laughlin
- Department of Biomedical Sciences, University of Missouri, Columbia, MO.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO.,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO
| | - Craig A Emter
- Department of Biomedical Sciences, University of Missouri, Columbia, MO
| |
Collapse
|
41
|
Jin WS, Bu XL, Wang YR, Li L, Li WW, Liu YH, Zhu C, Yao XQ, Chen Y, Gao CY, Zhang T, Zhou HD, Zeng F, Wang YJ. Reduced Cardiovascular Functions in Patients with Alzheimer’s Disease. J Alzheimers Dis 2017; 58:919-925. [DOI: 10.3233/jad-170088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
42
|
Roy B, Woo MA, Wang DJJ, Fonarow GC, Harper RM, Kumar R. Reduced regional cerebral blood flow in patients with heart failure. Eur J Heart Fail 2017; 19:1294-1302. [PMID: 28560737 DOI: 10.1002/ejhf.874] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/13/2017] [Accepted: 04/04/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS Heart failure (HF) patients show significant lateralized neural injury, accompanied by autonomic, mood and cognitive deficits. Both gray and white matter damage occurs and probably develops from altered cerebral blood flow (CBF), a consequence of impaired cardiac output. However, the distribution of regional CBF changes in HF patients is unknown, but is an issue in determining mechanisms of neural injury. Our aim was to compare regional CBF changes in HF with CBF in control subjects using non-invasive pseudo-continuous arterial spin labelling (ASL) procedures. METHODS AND RESULTS We collected pseudo-continuous ASL data from 19 HF patients [mean age 55.5 ± 9.1 years; mean body mass index 27.7 ± 5.3 kg/m2 ; 13 male) and 29 control subjects (mean age 51.4 ± 5.3 years; mean body mass index 25.7 ± 3.6 kg/m2 ; 18 male), using a 3.0-Tesla magnetic resonance imaging (MRI) scanner. Whole-brain CBF maps were calculated, normalized to a common space, smoothed and compared between groups using ANCOVA (covariates; age, gender and gray matter volume). Reduced CBF appeared in multiple sites in HF patients in comparison with controls, with principally lateralized lower flow in temporal, parietal and occipital regions. Areas with decreased CBF included the bilateral prefrontal, frontal, temporal and occipital cortex, thalamus, cerebellum, corona radiate, corpus callosum, hippocampus and amygdala. CONCLUSIONS Heart failure patients showed lower, and largely lateralized, CBF in multiple autonomic, mood and cognitive regulatory sites. The reduced CBF is likely to contribute to the lateralized brain injury, leading to the autonomic and neuropsychological deficits found in the condition.
Collapse
Affiliation(s)
- Bhaswati Roy
- School of Nursing, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mary A Woo
- School of Nursing, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Danny J J Wang
- Departments of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ronald M Harper
- Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Rajesh Kumar
- Brain Research Institute, UCLA, Los Angeles, CA, USA.,Anaesthesiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Radiological Sciences and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Bioengineering, and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| |
Collapse
|
43
|
Doubal FN, Ali M, Batty GD, Charidimou A, Eriksdotter M, Hofmann-Apitius M, Kim YH, Levine DA, Mead G, Mucke HAM, Ritchie CW, Roberts CJ, Russ TC, Stewart R, Whiteley W, Quinn TJ. Big data and data repurposing - using existing data to answer new questions in vascular dementia research. BMC Neurol 2017; 17:72. [PMID: 28412946 PMCID: PMC5392951 DOI: 10.1186/s12883-017-0841-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/14/2017] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Traditional approaches to clinical research have, as yet, failed to provide effective treatments for vascular dementia (VaD). Novel approaches to collation and synthesis of data may allow for time and cost efficient hypothesis generating and testing. These approaches may have particular utility in helping us understand and treat a complex condition such as VaD. METHODS We present an overview of new uses for existing data to progress VaD research. The overview is the result of consultation with various stakeholders, focused literature review and learning from the group's experience of successful approaches to data repurposing. In particular, we benefitted from the expert discussion and input of delegates at the 9th International Congress on Vascular Dementia (Ljubljana, 16-18th October 2015). RESULTS We agreed on key areas that could be of relevance to VaD research: systematic review of existing studies; individual patient level analyses of existing trials and cohorts and linking electronic health record data to other datasets. We illustrated each theme with a case-study of an existing project that has utilised this approach. CONCLUSIONS There are many opportunities for the VaD research community to make better use of existing data. The volume of potentially available data is increasing and the opportunities for using these resources to progress the VaD research agenda are exciting. Of course, these approaches come with inherent limitations and biases, as bigger datasets are not necessarily better datasets and maintaining rigour and critical analysis will be key to optimising data use.
Collapse
Affiliation(s)
- Fergus N. Doubal
- Stroke Association Garfield Weston Foundation Clinical Senior Lecturer, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Myzoon Ali
- VISTA and VICCTA Coordinator, Institutes of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - G. David Batty
- Reader in Epidemiology, Department of Epidemiology & Public Health, University College London, London, UK
| | - Andreas Charidimou
- J Philip Kistler Stroke Research Centre, Department of neurology, Massachusetts General Hospital Stroke Research Centre, Harvard medical School, Boston, MA USA
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and department of Geriatric Medicine, Karolinska university hospital, Stockholm, Sweden
| | - Martin Hofmann-Apitius
- Chair and Head of Department, Fraunhofer Institute for Algorithms and Scientific Computing, Schloss Birlinghoven, Sankt Augustin, Germany
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Centre for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deborah A. Levine
- Department of Internal Medicine, University of Michigan and the VA Ann Arbor Healthcare System, Ann Arbor, MI USA
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Craig W. Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Charlotte J. Roberts
- ICHOM International Consortium for Health Outcomes Measurement, Hamilton House, Mabledon Place, London, WC1H 9BB UK
| | - Tom C. Russ
- Marjorie MacBeath Intermediate Clinical Fellow, Alzheimer Scotland Dementia Research Centre, & Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Robert Stewart
- King’s College London (Institute of Psychiatry, Psychology and Neuroscience), South London and Maudsley NHS Foundation Trust, London, UK
| | - William Whiteley
- MRC Clinician Scientist and Honorary Consultant Neurologist, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
44
|
Adelborg K, Horváth-Puhó E, Ording A, Pedersen L, Sørensen HT, Henderson VW. Heart failure and risk of dementia: a Danish nationwide population-based cohort study. Eur J Heart Fail 2017; 19:253-260. [PMID: 27612177 PMCID: PMC5522185 DOI: 10.1002/ejhf.631] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 11/08/2022] Open
Abstract
AIMS The association between heart failure and dementia remains unclear. We assessed the risk of dementia among patients with heart failure and members of a general population comparison cohort. METHODS AND RESULTS Individual-level data from Danish medical registries were linked in this nationwide population-based cohort study comparing patients with a first-time hospitalization for heart failure between 1980 and 2012 and a year of birth-, sex-, and calendar year-matched comparison cohort from the general population. Stratified Cox regression analysis was used to compute 1-35-year hazard ratios (HRs) for the risk of all-cause dementia and, secondarily, Alzheimer's disease, vascular dementia, and other dementias. Analyses included 324 418 heart failure patients and 1 622 079 individuals from the general population (median age 77 years, 52% male). Compared with the general population cohort, risk of all-cause dementia was increased among heart failure patients [adjusted HR 1.21, 95% confidence interval (CI) 1.18-1.24]. The associations were stronger in men and in heart failure patients under age 70. Heart failure patients had higher risks of vascular dementia (adjusted HR 1.49, 95% CI 1.40-1.59) and other dementias (adjusted HR 1.30, 95% CI 1.26-1.34) than members of the general population cohort. Heart failure was not associated with Alzheimer's disease (adjusted HR 1.00, 95% CI 0.96-1.04). CONCLUSION Heart failure was associated with an increased risk of all-cause dementia. Heart failure may represent a risk factor for dementia, but not necessarily for Alzheimer's disease.
Collapse
Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Anne Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| |
Collapse
|
45
|
Cvetinovic N, Loncar G, Farkas J. Heart failure management in the elderly - a public health challenge. Wien Klin Wochenschr 2016; 128:466-473. [PMID: 27900534 DOI: 10.1007/s00508-016-1138-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/09/2016] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) is a rapidly growing public health problem and the leading cause of morbidity, mortality, and hospitalization in populations > 65 years. The elderly HF patients have an increased prevalence of HF with preserved ejection fraction and comorbidities, may present with atypical symptoms and signs, have a higher risk for adverse drug reactions, and worse prognosis as compared with younger patients. Moreover, there is a lack of evidence-based therapies for this population because they are underrepresented in the clinical trials. The elderly are less likely to be evaluated by a cardiologist and to be treated in accordance with recommendations of the current HF guidelines. Although the treatment is improving, it is still suboptimal; therefore, HF in elderly patients requires mobilization of public health services and improvement of treatment strategies.
Collapse
Affiliation(s)
- Natasa Cvetinovic
- Cardiology Department, Clinical Hospital Center Zvezdara, Belgrade, Serbia
| | - Goran Loncar
- Cardiology Department, Clinical Hospital Center Zvezdara, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia.
| |
Collapse
|
46
|
Garcia‐Ptacek S, Kåreholt I, Cermakova P, Rizzuto D, Religa D, Eriksdotter M. Causes of Death According to Death Certificates in Individuals with Dementia: A Cohort from the Swedish Dementia Registry. J Am Geriatr Soc 2016; 64:e137-e142. [DOI: 10.1111/jgs.14421] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Garcia‐Ptacek
- Division of Clinical Geriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska InstitutetStockholm Sweden
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
| | - Ingemar Kåreholt
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm UniversityStockholm Sweden
- Institute of Gerontology School of Health and Welfare Jönköping University Jönköping Sweden
| | - Pavla Cermakova
- Division of Neurogeriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden
- International Clinical Research Center and St. Anne's University Hospital Brno Czech Republic
| | - Debora Rizzuto
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm UniversityStockholm Sweden
| | - Dorota Religa
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
- Division of Neurogeriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Mossakowski Medical Research Centre Polish Academy of Sciences Warsaw Poland
| | - Maria Eriksdotter
- Division of Clinical Geriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska InstitutetStockholm Sweden
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
47
|
Metra M, Carubelli V, Ravera A, Stewart Coats AJ. Heart failure 2016: still more questions than answers. Int J Cardiol 2016; 227:766-777. [PMID: 27838123 DOI: 10.1016/j.ijcard.2016.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Heart failure has reached epidemic proportions given the ageing of populations and is associated with high mortality and re-hospitalization rates. This article reviews and summarizes recent advances in the diagnosis, assessment and treatment of the patients with heart failure. Data are discussed based also on the most recent guidelines indications. Open issues and unmet needs are highlighted.
Collapse
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Alice Ravera
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | | |
Collapse
|
48
|
|
49
|
Metra M. June 2015 at a glance. Eur J Heart Fail 2015; 17:535. [DOI: 10.1002/ejhf.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| |
Collapse
|