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Gumina S, Song HS, Kim H, Candela V. Arthroscopic evaluation of the rotator cuff vasculature: inferences into the pathogenesis of cuff tear and re-tear. Clin Shoulder Elb 2024; 27:203-211. [PMID: 38863404 DOI: 10.5397/cise.2024.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Little is known about alterations of the rotator cuff (RC) macroscopic vasculature associated with medical conditions and/or habits that predispose a person to diseases of the peripheral microcirculation. The high frequency of cuff tear and re-tear in patients with diabetes, hypercholesterolemia, uncontrolled arterial hypertension, or metabolic syndrome may be due to tissue hypovascularity. METHODS The macroscopic vasculature of both the articular and bursal sides of the posterosuperior RC was evaluated arthroscopically in 107 patients (mean age, 58.2 years) with no RC tear. Patients were divided into three groups according to medical comorbidities and lifestyle factors (group I, none; group II, smokers and/or drinkers and one comorbidity; and group III, two or more comorbidities). Pulsating vessels originating from both the myotendinous and osteotendinous junctions were assessed as "clearly evident," "poorly evident," or "not evident." RESULTS Groups I, II, and III comprised 36, 45, and 26 patients, respectively. Within the myotendinous junction, vessels were visualized in 22 group I patients (61%), 25 group II patients (55%), and 6 group III patients (23%) (P=0.007). Pulsating arterial vessels originating from the osteotendinous junction were seen in 42%, 36%, and 0% of patients, respectively (P<0.001). Within the bursal side of the RC, a dense anastomotic network was visualized (either clearly or poorly) in 94% (34), 80% (36), and 35% (9) of patients, respectively (P<0.001). CONCLUSIONS The macroscopic vasculature of the RC is influenced by pre-existing diseases and lifestyle factors, which may impair peripheral microcirculation. Level of evidence: III.
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Affiliation(s)
- Steafano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Hyun Seok Song
- Department of Orthopaedics Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopaedics Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
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2
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Screm G, Mondini L, Salton F, Confalonieri P, Trotta L, Barbieri M, Romallo A, Galantino A, Hughes M, Lerda S, Confalonieri M, Ruaro B. Vascular Endothelial Damage in COPD: Where Are We Now, Where Will We Go? Diagnostics (Basel) 2024; 14:950. [PMID: 38732364 PMCID: PMC11083092 DOI: 10.3390/diagnostics14090950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has higher rates among the general population, so early identification and prevention is the goal. The mechanisms of COPD development have not been completely established, although it has been demonstrated that endothelial dysfunction plays an important role. However, to date, the measurement of endothelial dysfunction is still invasive or not fully established. Nailfold video capillaroscopy (NVC) is a safe, non-invasive diagnostic tool that can be used to easily evaluate the microcirculation and can show any possible endothelial dysfunctions early on. The aim of this review is to evaluate if nailfold microcirculation abnormalities can reflect altered pulmonary vasculature and can predict the risk of cardiovascular comorbidities in COPD patients. METHODS A systematic literature search concerning COPD was performed in electronic databases (PUBMED, UpToDate, Google Scholar, ResearchGate), supplemented with manual research. We searched in these databases for articles published until March 2024. The following search words were searched in the databases in all possible combinations: chronic obstructive pulmonary disease (COPD), endothelial damage, vascular impairment, functional evaluation, capillaroscopy, video capillaroscopy, nailfold video capillaroscopy. Only manuscripts written in English were considered for this review. Papers were included only if they were able to define a relationship between COPD and endothelium dysfunction. RESULTS The search selected 10 articles, and among these, only three previous reviews were available. Retinal vessel imaging, flow-mediated dilation (FMD), and skin autofluorescence (AF) are reported as the most valuable methods for assessing endothelial dysfunction in COPD patients. CONCLUSIONS It has been assumed that decreased nitric oxide (NO) levels leads to microvascular damage in COPD patients. This finding allows us to assume NVC's potential effectiveness in COPD patients. However, this potential link is based on assumption; further investigations are needed to confirm this hypothesis.
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Affiliation(s)
- Gianluca Screm
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Antonio Romallo
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Alessandra Galantino
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milan, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
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Webb AJ. "Every beet you take": lowering systolic blood pressure and improving vascular function/exercise capacity via the dietary nitrate-nitrite-NO pathway in patients with COPD. Eur Respir J 2024; 63:2302238. [PMID: 38302179 DOI: 10.1183/13993003.02238-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Andrew J Webb
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Corrêa DI, de-Lima-Oliveira M, Nogueira RC, Carvalho-Pinto RM, Bor-Seng-Shu E, Panerai RB, Carvalho CRF, Salinet AS. Integrative assessment of cerebral blood regulation in COPD patients. Respir Physiol Neurobiol 2024; 319:104166. [PMID: 37758031 DOI: 10.1016/j.resp.2023.104166] [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: 05/18/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Cerebrovascular responses were compared between COPD and non-COPD participants. The association between COPD severity and cognitive function was also investigated. Cerebral blood velocity in the middle cerebral artery, blood pressure, and end-tidal CO2 were recorded at rest, followed by a brain activation paradigm, and an inhaled gas mixture (5% CO2) to assess cerebral autoregulation (CA), neurovascular coupling (NVC) and cerebrovascular reactivity to carbon dioxide (CVRCO2), respectively. Pulmonary function, blood gas analysis (COPD) and cognitive function (MoCA test) were also performed. No difference in baseline (systemic and cerebral parameters) and CA was found between 20 severe COPD and 21 non-COPD. Reduced NVC and CVRCO2 test were found in the COPD group. Lower pulmonary function was positively correlated with CA, NVC and CVRCO2 in COPD patients. Cognitive impairment (MoCA<26) was associated with lower NVC responses (COPD and non-COPD) and lower pulmonary function (COPD). Both mechanisms, CVRCO2 and NVC, were lower in COPD patients. Moreover, disease severity and cognitive impaired were associated with worse cerebrovascular regulation.
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Affiliation(s)
- Daniel I Corrêa
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Marcelo de-Lima-Oliveira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Ricardo C Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Regina M Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, Brazil
| | - Angela Sm Salinet
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
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Abagnale L, Candia C, Motta A, Galloway B, Ambrosino P, Molino A, Maniscalco M. Flow-mediated dilation as a marker of endothelial dysfunction in pulmonary diseases: A narrative review. Respir Med Res 2023; 84:101049. [PMID: 37826872 DOI: 10.1016/j.resmer.2023.101049] [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: 04/17/2023] [Revised: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 10/14/2023]
Abstract
The endothelium is an active and crucial component of vessels and produces several key regulatory factors for the homeostasis of the entire organism. Endothelial function can be investigated invasively or non-invasively, both in the coronary and peripheral circulation. A widely accepted method for the assessment of endothelial function is measurement of flow-mediated dilation (FMD), which evaluates the vascular response to changes in blood flow. In this current review, we describe FMD applications in the clinical setting of different respiratory diseases: acute SARS-COV2 infection, pulmonary embolism; post-acute SARS-COV2 infection, Chronic Obstructive Pulmonary Disease, Obstructive Sleep Apneas Syndrome, Pulmonary Hypertension, Interstitial Lung Diseases. Emerging evidence shows that FMD might be an effective tool to assess the cardiovascular risk in patients suffering from the undermentioned respiratory diseases as well as an independent predictive factor of disease severity and/or recovery.
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Affiliation(s)
- Lucia Abagnale
- Department of Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudio Candia
- Department of Medicine and Surgery, Federico II University, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Naples, Italy
| | - Brurya Galloway
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, Telese Terme, Italy
| | - Antonio Molino
- Department of Medicine and Surgery, Federico II University, Naples, Italy
| | - Mauro Maniscalco
- Department of Medicine and Surgery, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy.
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Ambrosino P, Marcuccio G, Lombardi C, D’Anna SE, Sanduzzi Zamparelli S, Mancusi C, Spedicato GA, Motta A, Maniscalco M. Cardiovascular Risk Associated with Alpha-1 Antitrypsin Deficiency (AATD) Genotypes: A Meta-Analysis with Meta-Regressions. J Clin Med 2023; 12:6490. [PMID: 37892629 PMCID: PMC10607733 DOI: 10.3390/jcm12206490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) can result in severe liver and respiratory disorders. The uninhibited elastase activity on the elastic tissue of arterial walls suggests that AATD may also impact vascular health. Thus, we performed a meta-analysis of the studies evaluating cardiovascular risk in individuals with AATD and non-AATD controls. METHODS A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Differences between cases and controls were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). The protocol was registered on PROSPERO under the identification number CRD42023429756. RESULTS The analysis of eight studies showed that, with a prevented fraction of disease of 15.0% and a corresponding OR of 0.779 (95%CI: 0.665-0.912; p = 0.002), a total of 24,428 individuals with AATD exhibited a significantly lower risk of ischemic heart disease compared to 534,654 non-AATD controls. Accordingly, given a prevented fraction of disease of 19.5%, a lower risk of acute myocardial infarction was documented when analyzing four studies on 21,741 cases and 513,733 controls (OR: 0.774; 95%CI: 0.599-0.999; p = 0.049). Sensitivity and subgroup analyses substantially confirmed results. Meta-regression models suggested that these findings were not influenced by AATD genotypes or prevalence of chronic obstructive pulmonary disease (COPD) among cases and controls, while higher differences in the prevalence of male sex (Z-score: 3.40; p < 0.001), hypertension (Z-score: 2.31; p = 0.021), and diabetes (Z-score: 4.25; p < 0.001) were associated with a lower effect size. CONCLUSIONS Individuals with AATD may exhibit a reduced risk of ischemic heart disease, even in the presence of mild deficiency of the serine protease inhibitor. Although caution is warranted due to the observational nature of the data, future pharmacological and rehabilitation strategies should also take this controversial relationship into account.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | - Carmen Lombardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
| | | | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
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7
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Ambrosino P, Di Minno MND, D'Anna SE, Formisano R, Pappone N, Mancusi C, Molino A, Motta A, Maniscalco M. Pulmonary rehabilitation and endothelial function in patients with chronic obstructive pulmonary disease: A prospective cohort study. Eur J Intern Med 2023; 116:96-105. [PMID: 37349204 DOI: 10.1016/j.ejim.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, thereby leading to increased cardiovascular risk. In the present study, we evaluated the changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of severe COPD patients undergoing pulmonary rehabilitation. METHODS Consecutive COPD patients referred to our Pulmonary Rehabilitation Unit were screened for inclusion. All study procedures were performed at hospital admission and discharge. RESULTS Of 78 patients screened for eligibility, a total of 40 participants (67.5% males, median age 72.5 years) were included. After pulmonary rehabilitation, a significant improvement in functional parameters, exercise capacity, and measures of disability and quality of life were documented. FMD changed from 3.25% (IQR: 2.31-4.26) to 4.95% (IQR: 3.57-6.02), corresponding to a 52.3% increase of its median value (P < 0.001). Significantly lower changes in FMD were documented in COPD patients with hypercholesterolemia as compared to those without (+0.33% ± 1.61 vs. +1.62% ± 1.59, P = 0.037). Changes in FMD (ΔFMD) were positively associated with changes in forced expiratory volume in 1 s (FEV1), when expressed both as absolute values (ΔFEV1) (r = 0.503, P = 0.002) and as percentages of predicted values (ΔFEV1%) (r = 0.608; P < 0.001). In multiple linear regressions, after adjusting for major cardiovascular risk factors, ΔFEV1 (β=0.342; P = 0.049) and ΔFEV1% (β=0.480; P = 0.015) were both confirmed as independent predictors of ΔFMD. CONCLUSIONS Results of our study suggest that endothelial function may improve in COPD after pulmonary rehabilitation. The potential beneficial effect in terms of cardiovascular risk prevention should be evaluated in ad hoc designed studies.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, Italy
| | | | - Silvestro Ennio D'Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Italy
| | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Telese Terme Institute, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy.
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Desplanche E, Grillet PE, Wynands Q, Bideaux P, Alburquerque L, Charrabi A, Bourdin A, Cazorla O, Gouzi F, Virsolvy A. Elevated Blood Pressure Occurs without Endothelial Dysfunction in a Rat Model of Pulmonary Emphysema. Int J Mol Sci 2023; 24:12609. [PMID: 37628790 PMCID: PMC10454081 DOI: 10.3390/ijms241612609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease involving airway closure and parenchyma destruction (emphysema). Cardiovascular diseases are the main causes of morbi-mortality in COPD and, in particular, hypertension and heart failure with preserved ejection fraction (HFpEF). However, no mechanistic link has currently been established between the onset of COPD, elevated blood pressure (BP) and systemic vascular impairment (endothelial dysfunction). Thus, we aimed to characterize BP and vascular function and remodeling in a rat model of exacerbated emphysema focusing on the role of sympathetic hyperactivity. Emphysema was induced in male Wistar rats by four weekly pulmonary instillations of elastase (4UI) and exacerbation by a single dose of lipopolysaccharides (LPS). Five weeks following the last instillation, in vivo and ex vivo cardiac and vascular functions were investigated. Exacerbated emphysema induced cardiac dysfunction (HFpEF) and a BP increase in this COPD model. We observed vasomotor changes and hypotrophic remodeling of the aorta without endothelial dysfunction. Indeed, changes in contractile and vasorelaxant properties, though endothelium-dependent, were pro-relaxant and NO-independent. A β1-receptor antagonist (bisoprolol) prevented HFpEF and vascular adaptations, while the effect on BP increase was partial. Endothelial dysfunction would not trigger hypertension and HFpEF in COPD. Vascular changes appeared as an adaptation to the increased BP. The preventing effect of bisoprolol revealed a pivotal role of sympathetic hyperactivation in BP elevation. The mechanistic link between HFpEF, cardiac sympathetic activation and BP deserves further studies in this exacerbated-emphysema model, as well as in COPD patients.
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Affiliation(s)
- Elodie Desplanche
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Pierre-Edouard Grillet
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Quentin Wynands
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Patrice Bideaux
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Laurie Alburquerque
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Azzouz Charrabi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Arnaud Bourdin
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Olivier Cazorla
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Fares Gouzi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Anne Virsolvy
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
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9
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Lee JS, Bae BJ, Bae HW, Choi W, Kim CY, Lee SY. Alterations of Macular Structure in Non-Glaucomatous Subjects With Obstructive Pulmonary Function. Invest Ophthalmol Vis Sci 2023; 64:24. [PMID: 37589982 PMCID: PMC10440609 DOI: 10.1167/iovs.64.11.24] [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: 03/15/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The purpose of this study was to identify possible associations between obstructive pulmonary function and macular structure parameters on optical coherence tomography (OCT) and angiography in subjects without glaucomatous optic neuropathy. Methods A total of 70 patients were prospectively enrolled from June to December 2021 as a part of All About Life Yongin-Pulmonary/Psychiatry, Rehabilitation, Eye (AALY PRE) cohort in Yongin Severance Hospital. Patients underwent intraocular pressure (IOP), visual acuity measurements, cirrus OCT, OCT angiography, and pulmonary function testing (PFT) on the same day. Subjects with glaucomatous optic nerve damage were excluded. Those whose first second of forced expiration (FEV1) to forced vital capacity (FVC) ratio was below 70% were diagnosed with obstructive pulmonary function. Vessel densities (VDs) of retinal superficial vascular plexus were compared. Results Patients with obstructive function (n = 30) were significantly older than those with normal pulmonary function (n = 40, P < 0.001). After adjusting for age, IOP, and average ganglion cell-inner plexiform layer (GCIPL) thickness, macular VD was significantly decreased in all sectors except for the nasal sector in subjects with obstructive pulmonary function in comparison to those with normal function (P = 0.006). Multivariate regression analysis demonstrated that macular VD was linearly associated with FEV1/FVC (β = 0.102, P = 0.031). In subjects with obstructive function, the severity of pulmonary obstruction, FEV1, was linearly associated with GCIPLT (β = 0.302, P = 0.017). Conclusions Obstructive pulmonary function is associated with reduced macular VD in subjects without glaucoma. Among subjects with obstructive pulmonary function, the severity of pulmonary obstruction is associated with GCIPL thickness in the macular region. Further studies are needed on the relationship between pulmonary function and macular disease.
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Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Jin Bae
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Hyoung Won Bae
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wungrak Choi
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Yeop Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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10
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Ambrosino P, Marcuccio G, Formisano R, Marcuccio L, Filosa R, Maniscalco M. Cardiac and Pulmonary Rehabilitation: Two Underutilized Approaches with Some Unexpected Benefits. J Clin Med 2023; 12:2847. [PMID: 37109184 PMCID: PMC10146392 DOI: 10.3390/jcm12082847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Although still underutilized [...].
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Affiliation(s)
- Pasquale Ambrosino
- Directorate of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy
| | - Giuseppina Marcuccio
- Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy; (G.M.); (R.F.)
| | - Roberto Formisano
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy;
| | - Laura Marcuccio
- Neurological Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy;
| | - Rosanna Filosa
- Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy; (G.M.); (R.F.)
- Department of Science and Technology, University of Sannio, 82100 Benevento, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, 82037 Telese Terme, Italy; (G.M.); (R.F.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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11
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Vaes AW, De Boever P, Franssen FME, Uszko-Lencer NHMK, Vanfleteren LEGW, Spruit MA. Endothelial function in patients with COPD: an updated systematic review of studies using flow-mediated dilatation. Expert Rev Respir Med 2023; 17:53-69. [PMID: 36731860 DOI: 10.1080/17476348.2023.2176845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be involved in cardiovascular disease pathogenesis, and multiple studies report endothelial dysfunction in COPD. This article summarized the current knowledge on endothelial function in COPD patients. AREAS COVERED Databases were screened until November 2022 for studies using ultrasound-based flow-mediated dilation in patients with stable COPD. Pooled effect sizes were calculated using random effects model. Meta-regression analyses assessed the effects of demographic and clinical variables. EXPERT OPINION 34 studies were identified (1365 COPD patients; 617 controls). Pooled analysis demonstrated an impaired endothelial-dependent (-2.33%; 95%CI -3.30/-1.35; p < 0.001) and endothelial-independent dilation (-3.11%; 95%CI -5.14/-1.08; p = 0.003) in COPD patients when compared to non-COPD controls. Meta-regression identified that higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function. Studies evaluating the effects of pharmacological and non-pharmacological interventions on endothelial function in COPD patients demonstrated conflicting results.
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Affiliation(s)
- Anouk W Vaes
- Department of Research and Development, Ciro, Horn, Netherlands
| | - Patrick De Boever
- Center of Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nicole H M K Uszko-Lencer
- Department of Research and Development, Ciro, Horn, Netherlands.,Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lowie E G W Vanfleteren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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12
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Ambrosino P, Sanduzzi Zamparelli S, Mosella M, Formisano R, Molino A, Spedicato GA, Papa A, Motta A, Di Minno MND, Maniscalco M. Clinical assessment of endothelial function in convalescent COVID-19 patients: a meta-analysis with meta-regressions. Ann Med 2022; 54:3234-3249. [PMID: 36382632 PMCID: PMC9673781 DOI: 10.1080/07853890.2022.2136403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endothelial dysfunction has been proposed to play a key role in the pathogenesis of coronavirus disease 2019 (COVID-19) and its post-acute sequelae. Flow-mediated dilation (FMD) is recognized as an accurate clinical method to assess endothelial function. Thus, we performed a meta-analysis of the studies evaluating FMD in convalescent COVID-19 patients and controls with no history of COVID-19. METHODS A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using the random effects method, differences between cases and controls were expressed as mean difference (MD) with 95% confidence intervals (95% CI). The protocol was registered on PROSPERO with reference number CRD42021289684. RESULTS Twelve studies were included in the final analysis. A total of 644 convalescent COVID-19 patients showed significantly lower FMD values as compared to 662 controls (MD: -2.31%; 95% CI: -3.19, -1.44; p < 0.0001). Similar results were obtained in the sensitivity analysis of the studies that involved participants in either group with no cardiovascular risk factors or history of coronary artery disease (MD: -1.73%; 95% CI: -3.04, -0.41; p = 0.010). Interestingly, when considering studies separately based on enrolment within or after 3 months of symptom onset, results were further confirmed in both short- (MD: -2.20%; 95% CI: -3.35, -1.05; p < 0.0001) and long-term follow-up (MD: -2.53%; 95% CI: -4.19, -0.86; p = 0.003). Meta-regression models showed that an increasing prevalence of post-acute sequelae of COVID-19 was linked to a higher difference in FMD between cases and controls (Z-score: -2.09; p = 0.037). CONCLUSIONS Impaired endothelial function can be documented in convalescent COVID-19 patients, especially when residual clinical manifestations persist. Targeting endothelial dysfunction through pharmacological and rehabilitation strategies may represent an attractive therapeutic option.Key messagesThe mechanisms underlying the post-acute sequelae of coronavirus disease 2019 (COVID-19) have not been fully elucidated.Impaired endothelial function can be documented in convalescent COVID-19 patients for up to 1 year after infection, especially when residual clinical manifestations persist.Targeting endothelial dysfunction may represent an attractive therapeutic option in the post-acute phase of COVID-19.
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Affiliation(s)
- Pasquale Ambrosino
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Marco Mosella
- Neurological Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Roberto Formisano
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Antimo Papa
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | | | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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13
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Ambrosino P, Fuschillo S, Accardo M, Mosella M, Molino A, Spedicato GA, Motta A, Maniscalco M. Fractional Exhaled Nitric Oxide (FeNO) in Patients with Stable Chronic Obstructive Pulmonary Disease: Short-Term Variability and Potential Clinical Implications. J Pers Med 2022; 12:1906. [PMID: 36422082 PMCID: PMC9699194 DOI: 10.3390/jpm12111906] [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: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The use of fractional exhaled nitric oxide (FeNO) has been proposed for identifying and monitoring eosinophilic airway inflammation in chronic obstructive pulmonary disease (COPD). To explore the clinical utility of FeNO in COPD, we aimed to assess its short-term variability in a clinically stable COPD cohort. METHODS Consecutive COPD patients, formerly smokers, underwent FeNO assessment at the baseline and six time-points through serial sampling spaced 3 days apart. RESULTS A total of 41 patients (mean age 72.9, 87.8% males) showed a median baseline value of FeNO of 11.7 (8.0-16.8) ppb. A weak linear relationship was documented between baseline FeNO values and both eosinophil counts (r = 0.341, p = 0.029) and the percentage of eosinophils (r = 0.331, p = 0.034), confirmed in multiple linear regressions after adjusting for steroid use. The overall individual variability of FeNO between time-points was 3.90 (2.53-7.29) ppb, with no significant difference in the distribution of FeNO values measured at different time-points (p = 0.204). A total of 28 (68.3%) patients exhibited FeNO always below the 25 ppb cut-off at all determinations, while the remining 13 (31.7%) had at least one value above the established limit. Interestingly, none of these 13 participants had FeNO stably above 25 ppb, all showing at least one normal value during serial sampling. Compared to these patients with more fluctuating values, the 28 with stably normal FeNO only exhibited a significantly higher body weight (80.0 ± 18.2 kg vs. 69.0 ± 8.8 kg, p = 0.013) and body mass index (29.7 ± 6.5 kg/m2 vs. 25.9 ± 3.7 kg/m2, p = 0.026), confirmed in multiple logistic regressions after adjusting for major potential confounders. CONCLUSIONS A certain degree of FeNO variability, apparently unrelated to eosinophil counts but somehow influenced by body weight, must be considered in COPD patients. Further studies are needed to clarify whether this biomarker may be effectively used to plan more personalized pharmacological and rehabilitation strategies in this clinical setting.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Salvatore Fuschillo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Mariasofia Accardo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Marco Mosella
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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14
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Li XF, Wan CQ, Mao YM. Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease. Front Med (Lausanne) 2022; 9:979959. [PMID: 36405582 PMCID: PMC9672343 DOI: 10.3389/fmed.2022.979959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/05/2022] [Indexed: 09/19/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent airflow limitation, and is associated with abnormal inflammatory responses in the lungs to cigarette smoke and toxic and harmful gases. Due to the existence of common risk factors, COPD is prone to multiple complications, among which cardiovascular disease (CVD) is the most common. It is currently established that cardiovascular comorbidities increase the risk of exacerbations and mortality from COPD. COPD is also an independent risk factor for CVD, and its specific mechanism is still unclear, which may be related to chronic systemic inflammation, oxidative stress, and vascular dysfunction. There is evidence that chronic inflammation of the airways can lead to destruction of the lung parenchyma and decreased lung function. Inflammatory cells in the airways also generate reactive oxygen species in the lungs, and reactive oxygen species further promote lung inflammation through signal transduction and other pathways. Inflammatory mediators circulate from the lungs to the whole body, causing intravascular dysfunction, promoting the formation and rupture of atherosclerotic plaques, and ultimately leading to the occurrence and development of CVD. This article reviews the pathophysiological mechanisms of COPD complicated by CVD and the effects of common cardiovascular drugs on COPD.
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Affiliation(s)
- Xiao-Fang Li
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
| | - Cheng-Quan Wan
- Department of Neonatology, Luoyang Maternal and Child Health Hospital,, Luoyang, Henan, China
| | - Yi-Min Mao
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
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15
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Is It All about Endothelial Dysfunction? Focusing on the Alteration in Endothelial Integrity as a Key Determinant of Different Pathological Mechanisms. Biomedicines 2022; 10:biomedicines10112757. [PMID: 36359277 PMCID: PMC9687329 DOI: 10.3390/biomedicines10112757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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16
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Ambrosino P, Bachetti T, D’Anna SE, Galloway B, Bianco A, D’Agnano V, Papa A, Motta A, Perrotta F, Maniscalco M. Mechanisms and Clinical Implications of Endothelial Dysfunction in Arterial Hypertension. J Cardiovasc Dev Dis 2022; 9:jcdd9050136. [PMID: 35621847 PMCID: PMC9146906 DOI: 10.3390/jcdd9050136] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
The endothelium is composed of a monolayer of endothelial cells, lining the interior surface of blood and lymphatic vessels. Endothelial cells display important homeostatic functions, since they are able to respond to humoral and hemodynamic stimuli. Thus, endothelial dysfunction has been proposed as a key and early pathogenic mechanism in many clinical conditions. Given the relevant repercussions on cardiovascular risk, the complex interplay between endothelial dysfunction and systemic arterial hypertension has been a matter of study in recent years. Numerous articles have been published on this issue, all of which contribute to providing an interesting insight into the molecular mechanisms of endothelial dysfunction in arterial hypertension and its role as a biomarker of inflammation, oxidative stress, and vascular disease. The prognostic and therapeutic implications of endothelial dysfunction have also been analyzed in this clinical setting, with interesting new findings and potential applications in clinical practice and future research. The aim of this review is to summarize the pathophysiology of the relationship between endothelial dysfunction and systemic arterial hypertension, with a focus on the personalized pharmacological and rehabilitation strategies targeting endothelial dysfunction while treating hypertension and cardiovascular comorbidities.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
- Correspondence: (P.A.); (M.M.)
| | - Tiziana Bachetti
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction, 27100 Pavia, Italy;
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Brurya Galloway
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.G.); (A.B.); (V.D.); (F.P.)
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.G.); (A.B.); (V.D.); (F.P.)
| | - Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.G.); (A.B.); (V.D.); (F.P.)
| | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy;
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.G.); (A.B.); (V.D.); (F.P.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
- Correspondence: (P.A.); (M.M.)
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17
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Ambrosino P, Parrella P, Formisano R, Perrotta G, D’Anna SE, Mosella M, Papa A, Maniscalco M. Cardiopulmonary Exercise Performance and Endothelial Function in Convalescent COVID-19 Patients. J Clin Med 2022; 11:jcm11051452. [PMID: 35268542 PMCID: PMC8911200 DOI: 10.3390/jcm11051452] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Endothelial dysfunction has been proposed as the common pathogenic background of most manifestations of coronavirus disease 2019 (COVID-19). Among these, some authors also reported an impaired exercise response during cardiopulmonary exercise testing (CPET). We aimed to explore the potential association between endothelial dysfunction and the reduced CPET performance in COVID-19 survivors. Methods: 36 consecutive COVID-19 survivors underwent symptom-limited incremental CPET and assessment of endothelium-dependent flow-mediate dilation (FMD) according to standardized protocols. Results: A significantly higher FMD was documented in patients with a preserved, as compared to those with a reduced, exercise capacity (4.11% ± 2.08 vs. 2.54% ± 1.85, p = 0.048), confirmed in a multivariate analysis (β = 0.899, p = 0.038). In the overall study population, FMD values showed a significant Pearson’s correlation with two primary CPET parameters, namely ventilation/carbon dioxide production (VE/VCO2) slope (r = −0.371, p = 0.026) and end-tidal carbon dioxide tension (PETCO2) at peak (r = 0.439, p = 0.007). In multiple linear regressions, FMD was the only independent predictor of VE/VCO2 slope (β = −1.308, p = 0.029) and peak PETCO2 values (β = 0.779, p = 0.021). Accordingly, when stratifying our study population based on their ventilatory efficiency, patients with a ventilatory class III-IV (VE/VCO2 slope ≥ 36) exhibited significantly lower FMD values as compared to those with a ventilatory class I-II. Conclusions: The alteration of endothelial barrier properties in systemic and pulmonary circulation may represent a key pathogenic mechanism of the reduced CPET performance in COVID-19 survivors. Personalized pharmacological and rehabilitation strategies targeting endothelial function may represent an attractive therapeutic option.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (G.P.); (A.P.)
- Correspondence: (P.A.); (M.M.)
| | - Paolo Parrella
- Ospedale Sacro Cuore di Gesù Fatebenefratelli, 82100 Benevento, Italy;
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (G.P.); (A.P.)
| | - Giovanni Perrotta
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (G.P.); (A.P.)
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (S.E.D.); (M.M.)
| | - Marco Mosella
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (S.E.D.); (M.M.)
| | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (G.P.); (A.P.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (S.E.D.); (M.M.)
- Correspondence: (P.A.); (M.M.)
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18
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Ambrosino P, Grassi G, Maniscalco M. Endothelial Dysfunction: From a Pathophysiological Mechanism to a Potential Therapeutic Target. Biomedicines 2021; 10:78. [PMID: 35052760 PMCID: PMC8773018 DOI: 10.3390/biomedicines10010078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/17/2022] Open
Abstract
The endothelium is considered the largest organ of the body, composed of a monolayer of endothelial cells (ECs) lining the interior surface of blood and lymphatic vessels [...].
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Benevento, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medical Sciences, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Benevento, Italy
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19
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Ambrosino P, Papa A, Buonauro A, Mosella M, Calcaterra I, Spedicato GA, Maniscalco M, Di Minno MND. Clinical assessment of endothelial function in heart failure with preserved ejection fraction: A meta-analysis with meta-regressions. Eur J Clin Invest 2021; 51:e13552. [PMID: 33749828 DOI: 10.1111/eci.13552] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endothelial dysfunction is a key mechanism in the development of cardiac remodelling and diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Flow-mediated (FMD) and nitrate-mediated dilation (NMD) are noninvasive methods to assess endothelial function. We performed a meta-analysis evaluating the impact of HFpEF on FMD and NMD. METHODS PubMed, Web of Science, Scopus and EMBASE databases were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Differences were expressed as mean difference (MD) with 95% confidence intervals (95%CI). The random effects method was used. RESULTS A total of seven studies were included in the final analysis, 7 with data on FMD (326 HFpEF patients and 417 controls) and 3 on NMD (185 HFpEF patients and 271 controls). Compared to controls, HFpEF patients showed significantly lower FMD (MD: -1.929; 95%CI: -2.770, -1.088; P < .0001) and NMD values (MD: -2.795; 95%CI: -3.876, -1.715; P < .0001). Sensitivity analyses substantially confirmed results. Meta-regression models showed that increasing differences in E/A ratio (Z-score: -2.002; P = .045), E/E' ratio (Z-score: -2.181; P = .029) and left atrial diameter (Z-score: -1.951; P = .050) were linked to higher differences in FMD values between cases and controls. CONCLUSIONS Impaired endothelial function can be documented in HFpEF, with the possibility of a direct association between the severity of diastolic and endothelial dysfunction. Targeting endothelial dysfunction through pharmacological and rehabilitation strategies may represent an attractive therapeutic option.
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Affiliation(s)
| | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Marco Mosella
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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20
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Pereira-Neto EA, Lewthwaite H, Boyle T, Johnston K, Bennett H, Williams MT. Effects of exercise training with blood flow restriction on vascular function in adults: a systematic review and meta-analysis. PeerJ 2021; 9:e11554. [PMID: 34277146 PMCID: PMC8272459 DOI: 10.7717/peerj.11554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background Blood flow restricted exercise (BFRE) improves physical fitness, with theorized positive effects on vascular function. This systematic review and meta-analysis aimed to report (1) the effects of BFRE on vascular function in adults with or without chronic health conditions, and (2) adverse events and adherence reported for BFRE. Methodology Five electronic databases were searched by two researchers independently to identify studies reporting vascular outcomes following BFRE in adults with and without chronic conditions. When sufficient data were provided, meta-analysis and exploratory meta-regression were performed. Results Twenty-six studies were included in the review (total participants n = 472; n = 41 older adults with chronic conditions). Meta-analysis (k = 9 studies) indicated that compared to exercise without blood flow restriction, resistance training with blood flow restriction resulted in significantly greater effects on endothelial function (SMD 0.76; 95% CI [0.36–1.14]). No significant differences were estimated for changes in vascular structure (SMD −0.24; 95% CI [−1.08 to 0.59]). In exploratory meta-regression analyses, several experimental protocol factors (design, exercise modality, exercised limbs, intervention length and number of sets per exercise) were significantly associated with the effect size for endothelial function outcomes. Adverse events in BFRE studies were rarely reported. Conclusion There is limited evidence, predominantly available in healthy young adults, on the effect of BFRE on vascular function. Signals pointing to effect of specific dynamic resistance exercise protocols with blood flow restriction (≥4 weeks with exercises for the upper and lower limbs) on endothelial function warrant further investigation.
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Affiliation(s)
- Elisio A Pereira-Neto
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hayley Lewthwaite
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Terry Boyle
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie Johnston
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Theodorakopoulou MP, Alexandrou ME, Bakaloudi DR, Pitsiou G, Stanopoulos I, Kontakiotis T, Boutou AK. Endothelial dysfunction in COPD: a systematic review and meta-analysis of studies using different functional assessment methods. ERJ Open Res 2021; 7:00983-2020. [PMID: 34195258 PMCID: PMC8236757 DOI: 10.1183/23120541.00983-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/09/2021] [Indexed: 01/18/2023] Open
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be one of the pathogenetic mechanisms involved. This is a systematic review and meta-analysis of studies using any available functional method to examine differences in endothelial function between patients with COPD and individuals without COPD (controls). Methods Literature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. The Newcastle–Ottawa scale was applied to evaluate the quality of retrieved studies. Subgroup analyses were performed to explore heterogeneity across the studies. Funnel plots were constructed to evaluate publication bias. Results Of the 21 reports initially identified, 19 studies with a total of 968 participants were included in the final meta-analysis. A significantly impaired response in endothelium-dependent (weighted mean between-group difference (WMD) −2.59, 95% CI −3.75 to −1.42) and -independent vasodilation (WMD −3.13, 95% CI −5.18 to −1.09) was observed in patients with COPD compared to controls. When pooling all studies together, regardless of the technique used for assessment of vascular reactivity, pronounced endothelial dysfunction was observed in COPD compared to controls (standardised mean difference (SMD) −1.19, 95% CI −1.69 to −0.68). Subgroup analysis showed that the difference was larger when patients with COPD were compared with nonsmoking controls (SMD −1.75, 95% CI −2.58 to −0.92). Sensitivity analyses confirmed the results. Conclusions Patients with COPD have significantly impaired endothelial function compared to controls without COPD. Future studies should delineate the importance of endothelial dysfunction towards development of cardiovascular disease in COPD. COPD is significantly associated with endothelial dysfunction of both conduit vessels and microvasculature. This association is further strengthened when patients with COPD are compared to nonsmoking controls.https://bit.ly/2NlWLFN
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Affiliation(s)
| | - Maria Eleni Alexandrou
- Dept of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgia Pitsiou
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Dept of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Dept of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Dept of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation. Biomedicines 2021; 9:biomedicines9060614. [PMID: 34071308 PMCID: PMC8226503 DOI: 10.3390/biomedicines9060614] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients.
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Theodorakopoulou MP, Bakaloudi DR, Alexandrou ME, Papakosta D, Pataka A, Kioumis I, Boutou AK. Endothelial Dysfunction during Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. COPD 2021; 18:246-253. [PMID: 33779450 DOI: 10.1080/15412555.2021.1900094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by high cardiovascular risk, which is further amplified during acute COPD exacerbations (AECOPD). Endothelial dysfunction has been previously suggested as one of the potential pathogenetic mechanisms. In order to study the effects of AECOPD on endothelial function assessed by available functional methods, we performed a literature search involving Pubmed and Scopus databases. Eligible studies were those that included adult patients with COPD and evaluated endothelial damage via semi-invasive or noninvasive functional methods, during AECOPD and after recovery or in stable condition. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Endothelial function was significantly impaired during AECOPD compared to recovery/stable condition (SMD: -0.87, 95%CI [-1.19, -0.55]). Patients during AECOPD presented a significantly worse response in endothelium-dependent (flow-mediated dilatation WMD: -2.59, 95%CI [-3.75, -1.42]) and independent vasodilation (nitroglycerine-mediated dilatation WMD: -3.13, 95%CI [-5.18, -1.09]) compared to recovery. Sensitivity analyses confirmed the above results. In conclusion, endothelium-dependent and independent vasodilation is worse during AECOPD compared to the stable condition. Endothelial dysfunction could play a role in the high cardiovascular risk during AECOPD.
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Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia Pataka
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
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Kohlbrenner D, Clarenbach CF, Thiel S, Roeder M, Kohler M, Sievi NA. A few more steps lead to improvements in endothelial function in severe and very severe COPD. Respir Med 2020; 176:106246. [PMID: 33248361 DOI: 10.1016/j.rmed.2020.106246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiovascular disease is among the most prevalent concomitant chronic diseases in COPD. Physical activity (PA) modifies endothelial function and is commonly impaired in COPD. However, studies directly investigating the effects of increased PA on endothelial function in COPD are lacking. We investigated the effect of changes in PA on endothelial function in patients with severe to very severe COPD. Furthermore, we determined which variables modify this effect. MATERIALS AND METHODS This is a secondary outcome analysis from a randomised controlled trial investigating the effects of combined PA counselling and pedometer-based feedback in COPD. We analysed the change in PA based on three visits during one year. We measured PA using a validated triaxial accelerometer, and endothelial function using flow-mediated dilation. RESULTS Data was analysed from 54 patients, which provided 101 change scores. Multiple regression modelling, including adjustment for baseline step count, showed strong evidence for an association between changes in flow-mediated dilation and changes in PA (p < 0.001). The analysis of several effect modificators showed no evidence of any influence on the interaction between PA and endothelial function: smoking status (p = 0.766), severity of airflow obstruction (p = 0.838), exacerbation frequency (p = 0.227), lung diffusion capacity of carbon monoxide % pred. (p = 0.735). CONCLUSION We found strong evidence that increasing steps per day ameliorates the heavily impaired endothelial function in patients with severe and very severe COPD. Further studies should examine which factors influence this relationship in a positive or negative manner.
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Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
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25
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Cheng YC, Lu CN, Hu WL, Hsu CY, Su YC, Hung YC. Decreased stroke risk with combined traditional Chinese and western medicine in patients with ischemic heart disease: A real-world evidence. Medicine (Baltimore) 2020; 99:e22654. [PMID: 33080705 PMCID: PMC7571976 DOI: 10.1097/md.0000000000022654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Both ischemic heart disease (IHD) and stroke are major causes of death worldwide. We investigated the effects of combined Traditional Chinese medicine (TCM) and western medicine (WM) on stroke risk in IHD patients.Taiwanese patients with IHD were enrolled in the TCM study during their outpatient visit. Stroke events after TCM or non-TCM treatment were examined. Chi-square tests and Student t-tests were used to examine differences between patients using and not using TCM. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs). Sex, age, and comorbidities were included in a multivariable Cox model to estimate the adjusted HR (aHR). The survival probability and the probability free of stroke were calculated by the Kaplan-Meier method.There were 733 IHD patients using TCM and 733 using non-TCM treatment, with the same proportion of sex and age within each cohort. Using single Chinese herb such as Dan Shen, San Qi, or Chuan Xiong would have lower stroke events and lower aHR than non-TCM in IHD patients. There was 0.3-fold lower stroke risk in IHD patients with combination TCM and non-TCM treatment (95% CI = 0.11-0.84, P = .02). Moreover, the survival rate was higher (P < .001) and the incidence of hemorrhagic stroke was significantly lower (P = .04) in IHD patients with TCM treatment.IHD patients using combined TCM and WM had a higher survival rate and lower risk of new onset stroke, especially hemorrhagic stroke than those who did not use TCM treatment.
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Affiliation(s)
- Yu-Chen Cheng
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Nan Lu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- Fooyin University College of Nursing
- Kaohsiung Medical University College of Medicine, Kaohsiung
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University
| | - Yuan-Chih Su
- Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Merlo C, Bernardi E, Bellotti F, Pomidori L, Cogo A. Supervised exercise training improves endothelial function in COPD patients: a method to reduce cardiovascular risk? ERJ Open Res 2020; 6:00304-2019. [PMID: 32714965 PMCID: PMC7369457 DOI: 10.1183/23120541.00304-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular diseases, particularly coronary artery disease (CAD) [1]. Endothelial dysfunction is a marker of cardiovascular risk [2]; a validated and standardised method to assess endothelial function is flow-mediated dilation (FMD) [3]. Supervised exercise training is key to health improvement in chronic obstructive pulmonary disease patientshttps://bit.ly/2AdfKvb
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Affiliation(s)
- Carlotta Merlo
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
| | - Eva Bernardi
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
| | - Federico Bellotti
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
| | - Luca Pomidori
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
| | - Annalisa Cogo
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
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27
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Scherr A, Schumann DM, Karakioulaki M, Franchetti L, Strobel W, Zellweger M, Tamm M, Stolz D. Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease. Respir Res 2020; 21:90. [PMID: 32312273 PMCID: PMC7168975 DOI: 10.1186/s12931-020-01345-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
Background Local airway inflammation may cause systemic changes which result in endothelial dysfunction. Only a few studies have used reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with chronic obstructive pulmonary disease (COPD) in order to measure their endothelial dysfunction. Objective To determine the efficacy of endothelial dysfunction, measured by RH-PAT, in assessing disease severity and systemic burden in a cohort of COPD patients. Methods In this prospective, monocentric study, 157 patients with moderate to very severe COPD (GOLD class II-IV) were examined for endothelial dysfunction using RH-PAT (Itamar medical Ltd., Caesarea, Israel). In a nested-cohort, examination was repeated at exacerbation. The association between reactive hyperemia index (RHI), augmentation index (AI) and disease severity and outcome parameters was analysed. Results 57% of the COPD patients had a dysfunctional endothelium and the median (IQR) RHI was 1.42 (1.27–1.53). Exacerbation of COPD was not associated with a significant change in RHI (p = 0.625) or ΑΙ (p = 0.530). None of the diagnostic or clinical outcomes of COPD was associated with RHI or arterial stiffness. Conclusion Endothelial dysfunction is common in COPD. However, it does not seem to be a predictor neither of disease severity, nor of outcome and does not change during exacerbations of the disease.
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Affiliation(s)
- Andreas Scherr
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Meropi Karakioulaki
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Léo Franchetti
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Werner Strobel
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Zellweger
- Clinic of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Tamm
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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28
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Hancox RJ, Thomas L, Williams MJA, Sears MR. Associations between lung and endothelial function in early middle age. Respirology 2019; 25:89-96. [PMID: 30985946 DOI: 10.1111/resp.13556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/14/2019] [Accepted: 03/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic lung disease is associated with impaired endothelial function and this may be a risk factor for poor cardiovascular health. It is unknown if there is an association between lung and endothelial function in the general population. We investigated associations between lung and endothelial function in a population-based cohort of 38-year-old men and women. METHODS Systemic endothelial function was measured using peripheral arterial tonometry to calculate the Framingham reactive hyperaemia index. Lung function was assessed using spirometry, plethysmographic lung volumes, airway conductance and gas transfer. Associations between lung and endothelial function were assessed with and without adjustment for potential confounding factors using regression analyses. RESULTS Sex modified the association between lung and endothelial function. Among women, lower values of pre- and post-bronchodilator spirometry, total lung capacity and functional residual capacity (FRC) were associated with worse endothelial function (P < 0.05). These associations persisted after adjustment for smoking, asthma diagnoses, fitness and body mass index. Associations were weaker among men: only FRC, airway conductance and post-bronchodilator forced expiratory volume in 1 s (FEV1 )/forced vital capacity (FVC) ratios were associated with endothelial function. Endothelial function was not associated with gas transfer in either sex. CONCLUSION Lower lung volumes and airflow obstruction are associated with endothelial dysfunction among women. There is weaker evidence for an association between airway and endothelial function in men. These findings may partly explain the increased risk of cardiovascular disease among people with poor lung function, but suggest that there are sex differences in this association.
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Affiliation(s)
- Robert J Hancox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lathan Thomas
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Malcolm R Sears
- Firestone Institute for Respiratory Health, Michael de Groote School of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada
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Grigoryeva NY, Maiorova МV, Korolyova ME, Samolyuk MO. Сomorbidity and polymorbidity of the patient with chronic obstructive pulmonary disease and cardiovascular diseases. TERAPEVT ARKH 2019; 91:44-47. [PMID: 31090370 DOI: 10.26442/00403660.2019.01.000027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM the study of comorbid status and characteristics of clinical course of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS We conducted a retrospective analysis of case histories of 958 IHD patients aged 32 to 93 years (mean age of 60.8±10.2 years), including men - 525 (54.8%), women - 433 (45.2%) who were treated in the cardiology Department of city clinical hospital №5 of Nizhny Novgorod. Related COPD was diagnosed in 251 patients (26.3%). We compared two groups patients: with IHD and COPD, and the second - persons suffering from only IHD (without COPD). RESULTS Myocardial infarction was transferred by 62.2% of patients in Group 1, which is 16.3% more than in Group 2 (p<0.05). Arterial hypertension in patients with COPD was 13.6% more frequent than in patients without COPD (p<0.05), and 6.4% more often (p<0.05), with comorbid pathology there was a chronic and paroxysmal forms of atrial fibrillation. In patients with IHD in combination with COPD it is 21.5% more often (p<0.05) than in IHD without COPD, there was shortness of breath and 32.1% more often (p<0.05) of the heartbeat. In patients with IHD with COPD, a higher level of was C-reactive protein detected (p<0.05) and more pronounced violations of the lipid profile (p<0.05). CONCLUSION COPD makes a significant contribution to the development of the cardiovascular continuum, modifying its course. A modern patient with COPD is a high-risk patient with severe cardiovascular comorbidity and various polymorbidity.
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Affiliation(s)
- N Yu Grigoryeva
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Department of faculty and outpatient therapy, Nizhny Novgorod, Russia.,City Clinical Hospital №5, Nizhny Novgorod, Russia
| | - М V Maiorova
- City Clinical Hospital №5, Nizhny Novgorod, Russia
| | - M E Korolyova
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Department of faculty and outpatient therapy, Nizhny Novgorod, Russia
| | - M O Samolyuk
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Department of faculty and outpatient therapy, Nizhny Novgorod, Russia
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Böcskei RM, Benczúr B, Losonczy G, Illyés M, Cziráki A, Müller V, Bohács A, Bikov A. Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD. Lung 2019; 197:189-197. [PMID: 30820636 PMCID: PMC6486892 DOI: 10.1007/s00408-019-00211-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
Introduction Soluble urokinase-type plasminogen activator receptor (suPAR) is upregulated by inflammation and plays a role in the pathogenesis of atherosclerosis. Chronic obstructive pulmonary disease (COPD) is associated with enhanced systemic inflammation and increased risk for atherosclerosis, however, studies analysing the circulating suPAR levels in COPD are contradictory. The aim of the study was to investigate plasma suPAR concentrations together with markers of arterial stiffness in COPD. Materials and Methods Twenty-four patients with COPD and 18 non-COPD, control subjects participated in the study. Plasma suPAR was measured, together with lung volumes, symptom burden, exacerbation history, markers of arterial stiffness and soluble inflammatory biomarkers, such as endothelin-1, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6). Results Plasma suPAR levels were higher in COPD (2.84 ± 0.67 ng/ml vs. 2.41 ± 0.57 ng/ml, p = 0.03) and were related to lung function measured with FEV1 (r = − 0.65, p < 0.01) and symptom burden determined with the modified Medical Research Council questionnaire (r = 0.55, p < 0.05). Plasma suPAR concentrations correlated with various measures of arterial stiffness in all subjects, but only with ejection duration in COPD (r = − 0.44, p = 0.03). Conclusions Plasma suPAR levels are elevated in COPD and relate to arterial stiffness. Our results suggest that suPAR may be a potential link between COPD and atherosclerosis.
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Affiliation(s)
- Renáta M Böcskei
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary.
| | - Béla Benczúr
- 1st Dept of Internal Medicine (Cardiology/Nephrology), Balassa Janos County Hospital, Béri Balogh Ádám Street 5-7, Szekszárd, 7100, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - Miklós Illyés
- Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság Street 13, Pecs, 7624, Hungary
| | - Attila Cziráki
- Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság Street 13, Pecs, 7624, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - Anikó Bohács
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
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Zhao H, Zhao Y, Li X, Xu L, Jiang F, Hou W, Dong L, Cao J. Effects of Antioxidant Tempol on Systematic Inflammation and Endothelial Apoptosis in Emphysematous Rats Exposed to Intermittent Hypoxia. Yonsei Med J 2018; 59:1079-1087. [PMID: 30328323 PMCID: PMC6192890 DOI: 10.3349/ymj.2018.59.9.1079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Obstructive sleep apnea and chronic obstructive pulmonary disease are independent risk factors of cardiovascular disease (CVD), and their coexistence is known as overlap syndrome (OS). Endothelial dysfunction is the initial stage of CVD; however, underlying mechanisms linking OS and CVD are not well understood. The aim of this study was to explore whether OS can lead to more severe inflammation and endothelial apoptosis by promoting endothelial dysfunction, and to assess the intervention effects of antioxidant tempol. MATERIALS AND METHODS Male Wistar rats (n=66) were exposed to normal oxygen [normal control (NC) group], intermittent hypoxia (IH group), cigarette smoke (CH group), as well as cigarette smoke and IH (OS group). Tempol intervention was assessed in OS group treated with tempol (OST group) or NaCl (OSN group). After an 8-week challenge, lung tissues, serum, and fresh blood were harvested for analysis of endothelial markers and apoptosis. RESULTS The levels of intracellular adhesion molecule-1, vascular cellular adhesion molecule-1, and apoptosis in circulating epithelial cells were the highest in OS group and the lowest in NC group. These levels were all greater in IH group than in CH group, and were lower in OST group than in OS and OSN groups (all p<0.001). CONCLUSION Synergistic effects of IH with cigarette smoke-induced emphysema produce a greater inflammatory status and endothelial apoptosis. OS-related inflammation and endothelial cell apoptosis may play important roles in promoting cardiovascular dysfunction, and antioxidant tempol could achieve a partial protective effect.
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Affiliation(s)
- Haiyan Zhao
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Yaping Zhao
- Respiratory Department of Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xin Li
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Leiqian Xu
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Fangxin Jiang
- Department of Life Sciences, State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin, China
| | - Wanju Hou
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Lixia Dong
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China.
| | - Jie Cao
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China.
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Bernardi E, Merlo C, Cogo A. Endothelial Function in COPD Is in an Intermediate Position Between Healthy Subjects and Coronary Artery Disease Patients and Is Related to Physical Activity. Lung 2018; 196:669-672. [PMID: 30284026 DOI: 10.1007/s00408-018-0168-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of ischemic heart disease. Endothelial dysfunction may play a role in the onset of cardiovascular event. Previous studies showed an impaired endothelial function (measured by flow-mediated dilation, FMD) in COPD patients compared to healthy subjects. To the best of our knowledge no study has compared FMD in COPD and in cardiac (coronary artery disease, CAD) patients. We aimed to assess FMD in healthy subjects, COPD, CAD, and COPD + CAD. The main result is that FMD in COPD is reduced and is in an intermediate position between healthy subjects and CAD or COPD + CAD; this impairment can contribute to explain the higher prevalence of cardiovascular disease in COPD. The only determinant independently associated with FMD in all subjects is the physical activity level, irrespective of the traditional risk factors (i.e., smoke, dyslipidemia, hypertension).
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Affiliation(s)
- Eva Bernardi
- Biomedical Sport Studies Center, University of Ferrara, via Gramicia, 35, 44100, Ferrara, Italy.
| | - Carlotta Merlo
- Biomedical Sport Studies Center, University of Ferrara, via Gramicia, 35, 44100, Ferrara, Italy
| | - Annalisa Cogo
- Biomedical Sport Studies Center, University of Ferrara, via Gramicia, 35, 44100, Ferrara, Italy
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Rydell A, Janson C, Lisspers K, Ställberg B, Nowak C, Carlsson AC, Feldreich T, Iggman D, Lind L, Ärnlöv J. Endothelial dysfunction is associated with impaired lung function in two independent community cohorts. Respir Med 2018; 143:123-128. [PMID: 30261983 DOI: 10.1016/j.rmed.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Prior studies investigating the association between endothelial dysfunction and impaired lung function have been small and inconsistent. The primary aim was to investigate the association between endothelial function and lung function in two community-based cohorts. METHODS We used a discovery/replication approach to study the association between endothelial function and lung function in the Prospective investigation of Obesity, Energy and Metabolism (POEM, discovery cohort, n = 490, mean age 50.3 ± 0.2 years) and the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS, replication cohort, n = 892, mean age 70.2 ± 0.15 years). Spirometry and three different measures of endothelial function were performed including both the invasive forearm technique (endothelium-dependent and endothelium-independent vasodilation [EDV and EIDV, respectively] and noninvasive flow mediated dilation [FMD]). RESULTS An age and sex adjusted association between lower EDV and lower FEV1 was found in POEM and replicated in PIVUS. After merging the two cohorts, 1 standard deviation decrease in EDV was associated with 1.57% lower FEV1 after additional adjustment for smoking status, body mass index, exercise level, and C-reactive protein (95% confidence intervals 0.63-2.51, p = 0.001). The association was slightly lower albeit still statistically significant after excluding participants without cardiovascular disease and chronic respiratory disease and appeared stronger among previous/current smokers vs. non-smokers and in men vs. women (p for interaction = 0.2 and 0.02 respectively). CONCLUSIONS Our findings suggest that even individuals with sub-clinical impairments of lung function in the community have concomitant endothelial dysfunction.
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Affiliation(s)
- Andreas Rydell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Dalarna County Council, Norslund-Svärdsjö Primary Health Care Center, Falun, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Christoph Nowak
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Tobias Feldreich
- School of Health and Social Sciences, Dalarna University, Falun, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - David Iggman
- Dalarna County Council, Norslund-Svärdsjö Primary Health Care Center, Falun, Sweden; Unit for Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Dalarna County Council, Norslund-Svärdsjö Primary Health Care Center, Falun, Sweden; School of Health and Social Sciences, Dalarna University, Falun, Sweden.
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34
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Raparelli V, Pastori D, Pignataro SF, Vestri AR, Pignatelli P, Cangemi R, Proietti M, Davì G, Hiatt WR, Lip GYH, Corazza GR, Perticone F, Violi F, Basili S. Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study. Intern Emerg Med 2018; 13:651-660. [PMID: 29582316 DOI: 10.1007/s11739-018-1835-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, patients with COPD (9%) are more commonly male, elderly and at higher thromboembolic risk. During a median 36.0 months follow-up, 186 patients experienced MACE: vascular death (n = 72), MI (n = 57), stroke/TIA (n = 57). All major outcomes (including stroke/TIA, MI, vascular death, and all-cause death) are centrally adjudicated. Kaplan-Meier curves show that NVAF patients with COPD are at higher risk for MACE (p < 0.001), CV death (p < 0.001) and all-cause death (p < 0.001). On Cox proportional hazard analysis, COPD is an independent predictor of MACE (Hazard ratio [HR] 1.77, 95% Confidence Intervals [CI] 1.20-2.61; p = 0.004), CV death (HR 2.73, 95% CI 1.76-4.23; p < 0.0001) and all-cause death (HR 2.16, 95% CI 1.48-3.16; p < 0.0001). COPD is an independent predictor of MACE, CV death and all-cause death during a long-term follow-up of NVAF patients.
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Affiliation(s)
- Valeria Raparelli
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Daniele Pastori
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Serena Francesca Pignataro
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Anna Rita Vestri
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Cangemi
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Proietti
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Giovanni Davì
- Department of Medicine and Aging, University of Chieti "G. d'Annunzio, Chieti, Italy
| | - William Robert Hiatt
- Division of Cardiology, University of Colorado School of Medicine and CPC Clinical Research, Aurora, CO, USA
| | - Gregory Yoke Hong Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gino Roberto Corazza
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Violi
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties, Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Zelt JT, Jones JH, Hirai DM, King TJ, Berton DC, Pyke KE, O'Donnell DE, Neder JA. Systemic vascular dysfunction is associated with emphysema burden in mild COPD. Respir Med 2018; 136:29-36. [PMID: 29501244 DOI: 10.1016/j.rmed.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiovascular diseases play a major role in morbidity and mortality in the earlier stages of COPD. We hypothesized that systemic vascular dysfunction would be present even in patients who are currently considered at "low-risk" for negative cardiovascular outcomes, i.e., those with largely preserved FEV1, few exacerbations and only mild burden of respiratory symptoms (GOLD spirometric grade 1, clinical group A). METHODS 16 patients (FEV1 = 86 ± 13%) and 16 age- and gender-matched controls underwent measurements of: a) central arterial stiffness by pulse wave velocity, b) brachial flow-mediated dilation and c) forearm muscle oxygenation by near-infrared spectroscopy. Computed tomography quantified emphysema (% of low attenuation areas (LAA)) and airway disease. RESULTS Patients and controls were well matched for key clinical variables including co-morbidities burden. Thirteen patients presented with more than 5% LAA: emphysema extension was negatively related to transfer factor for carbon monoxide (TLCO) (r = -0.63; p = .01). Compared to controls, patients had higher central arterial stiffness, lower normalized (to shear stress) flow-mediated dilation, delayed time to peak flow-mediated dilation and poorer muscle oxygenation (p < .05). TLCO and emphysema, but not airway disease, were significantly related to each of these functional abnormalities (r values ranging from 0.51 to 0.66; p < .05). CONCLUSION Systemic vascular dysfunction is present in the earlier stages of COPD, particularly in patients with greater emphysema burden and low TLCO. Regardless FEV1, patients showing those structural and functional abnormalities might be at higher risk of negative events thereby deserving closer follow-up for early detection of cardiovascular disease.
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Affiliation(s)
- Joel T Zelt
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Joshua H Jones
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Daniel M Hirai
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Trevor J King
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Danilo C Berton
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada; Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kyra E Pyke
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada.
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