1
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Catestatin as a Biomarker of Cardiovascular Diseases: A Clinical Perspective. Biomedicines 2021; 9:biomedicines9121757. [PMID: 34944578 PMCID: PMC8698910 DOI: 10.3390/biomedicines9121757] [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: 11/03/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Accounting for almost one-third of the global mortality, cardiovascular diseases (CVDs) represent a major global health issue. Emerging data suggest that most of the well-established mechanistic explanations regarding the cardiovascular pathophysiology are flawed, and cannot fully explain the progression and long-term effects of these diseases. On the other hand, dysregulation of the sympathetic nervous system (SNS) has emerged as an important player in the pathophysiology of CVDs. Even though upregulated SNS activity is an essential compensatory response to various stress conditions, in the long term, it becomes a major contributor to both cardiac dysfunction and vascular damage. Despite the fact that the importance of SNS hyperactivity in the setting of CVDs has been well-appreciated, its exact quantification and clinical application in either diagnostics or therapy of CVDs is still out of reach. Nevertheless, in recent years a number of novel laboratory biomarkers implicated in the pathophysiology of SNS activation have been explored. Specifically, in this review, we aimed to discuss the role of catestatin, a potent physiological inhibitor of catecholamine spillover that offers cardioprotective effects. Limited data indicate that catestatin could also be a reliable indirect marker of SNS activity and it is likely that high CST levels reflect advanced CV disease burden. Consequently, large-scale studies are required to validate these observations in the upcoming future.
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2
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Miller WL, Sorimachi H, Grill DE, Fischer K, Borlaug BA. Contributions of cardiac dysfunction and volume status to central haemodynamics in chronic heart failure. Eur J Heart Fail 2021; 23:1097-1105. [PMID: 33565251 DOI: 10.1002/ejhf.2121] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Elevated cardiac filling pressures producing clinical congestion in heart failure (HF) patients may be secondary to intravascular volume expansion or abnormalities in cardiac diastolic properties. The objective of this study was to assess the extent to which measures of myocardial function and intravascular volume correlate with haemodynamic abnormalities in chronic HF. METHODS AND RESULTS Subjects underwent invasive haemodynamic assessment, measurement of total blood volume (TBV) using radiolabel indicator-dilution methodology, and echocardiography to evaluate cardiac structure and function. Patients were divided into those with hypervolaemia (defined as TBV > +8% above referenced normal volume) and normal volume ('euvolaemia') (TBV ≤ + 8%). Of 66 patients, 39 (59%) were hypervolaemic and 27 (41%) normal TBV. Central venous pressure (CVP, P = 0.01) and pulmonary capillary wedge pressure (PCWP, P < 0.001) were higher in hypervolaemic compared with euvolaemic patients; however, 15% of hypervolaemic patients displayed normal pressures. Of euvolaemic patients, 70% displayed elevated CVP and 63% elevated PCWP. PCWP was moderately correlated with TBV (r = 0.42), left ventricular diastolic function (e' velocity, r = -0.44), and left atrial strain (r = -0.47). In multivariable regression TBV, left ventricular e', and left atrial strain were independently associated with PCWP (all P < 0.05). CONCLUSIONS While hypervolaemic patients displayed elevations in filling pressures, a substantial proportion (15%) had normal pressures, and of all subjects with elevated filling pressures nearly one third had normal TBVs. Importantly, of patients with normal volumes, a majority (>60%) display elevated filling pressures. Combined analysis of volume, pressure, and cardiac function may be helpful to guide comprehensive assessments of HF status.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Diane E Grill
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Karen Fischer
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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3
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Fudim M, Sobotka PA, Dunlap ME. Extracardiac Abnormalities of Preload Reserve: Mechanisms Underlying Exercise Limitation in Heart Failure with Preserved Ejection Fraction, Autonomic Dysfunction, and Liver Disease. Circ Heart Fail 2021; 14:e007308. [PMID: 33464948 DOI: 10.1161/circheartfailure.120.007308] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While many of the cardiac limitations to exercise performance are now well-characterized, extracardiac limitations to exercise performance have been less well recognized but are nevertheless important. We propose that abnormalities of cardiac preload reserve represents an under-recognized but common cause of exercise limitations. We further propose that mechanistic links exist between conditions as seemingly disparate as heart failure with preserved ejection fraction, nonalcoholic fatty liver disease, and pelvic venous compression/obstruction syndromes (eg, May-Thurner). We conclude that extracardiac abnormalities of preload reserve serve as a major pathophysiologic mechanism underlying these and other disease states.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (M.F.). Duke Clinical Research Institute, Durham, NC (M.F.)
| | - Paul A Sobotka
- Affiliated Faculty, Department of Medicine, Division of Cardiology, The Ohio State University, Columbus (P.A.S.)
| | - Mark E Dunlap
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.)
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4
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Sokolska JM, Sokolski M, Zymliński R, Biegus J, Siwołowski P, Nawrocka-Millward S, Swoboda K, Gajewski P, Jankowska EA, Banasiak W, Ponikowski P. Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes. ESC Heart Fail 2020; 7:3830-3840. [PMID: 32909684 PMCID: PMC7754722 DOI: 10.1002/ehf2.12973] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes. Methods and results We investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma‐glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N‐terminal pro‐B‐type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co‐morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [−22 (−45 to −4) vs. −2 (−13 to 2) vs. −10 (−25 to 0) mmHg] and heart rate [−16 (−35 to −1.5) vs. −1 (−10 to 5) vs. −7 (−20 to 0) b.p.m.] with the lowest weight change [−1.0 (−1.0 to 0) vs. −2.9 (−3.8 to −0.9) vs. −2.0 (−3.0 to −1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short‐term and long‐term outcomes with favourable results in Group A. Group A experienced less frequent in‐hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5–8) vs. 7 (5–11) vs. 7 (6–11) days], and had lower 1 year all‐cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all‐cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06–6.79); P = 0.04]. Conclusions Patterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF.
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Affiliation(s)
- Justyna Maria Sokolska
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Robert Zymliński
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Paweł Siwołowski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | | | - Katarzyna Swoboda
- Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | - Piotr Gajewski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Ewa Anita Jankowska
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Waldemar Banasiak
- Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
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5
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Borovac JA, D'Amario D, Bozic J, Glavas D. Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers. World J Cardiol 2020; 12:373-408. [PMID: 32879702 PMCID: PMC7439452 DOI: 10.4330/wjc.v12.i8.373] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/19/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues. The sympathetic nervous system (SNS) is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes, circulating and neuronal catecholamine spillover, attenuated parasympathetic response, and augmented sympathetic outflow to the heart, kidneys and skeletal muscles. When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis, maladaptive ventricular and vascular remodeling, arrhythmogenesis, and poor prognosis in patients with HF. These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities. Therefore, this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF. Finally, special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.
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Affiliation(s)
- Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome 00168, Italy
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Duska Glavas
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
- Clinic for Cardiovascular Diseases, University Hospital of Split, Split 21000, Croatia
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6
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Nijst P, Martens P, Verbrugge FH, Dupont M, Tang WHW, Mullens W. Cardiovascular Volume Reserve in Patients with Heart Failure and Reduced Ejection Fraction. J Cardiovasc Transl Res 2020; 13:519-527. [DOI: 10.1007/s12265-020-09973-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022]
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7
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Activation of bradykinin-sensitive pericardial afferents increases systemic venous tone in conscious rats. Auton Neurosci 2020; 223:102624. [PMID: 31901785 DOI: 10.1016/j.autneu.2019.102624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/22/2022]
Abstract
Our understanding of reflex regulation of veins lags behind that of the arterial system. While the cardiac sympathetic afferent reflex (CSAR) exerts control over sympathetic outflow, its effect on venous tone is not known. We tested the hypothesis that activation of pericardial bradykinin sensitive afferents elicits systemic venoconstriction. Male and female Sprague Dawley rats were chronically instrumented for measurement of arterial pressure and mean circulatory filling pressure, an index of venous tone, and with an indwelling pericardial catheter. Mean arterial pressure, heart rate and mean circulatory filling pressure responses were assessed in conscious rats in response to graded pericardial injections of bradykinin (1.5-20 μg/kg) before and after ganglionic blockade, and to intravenous norepinephrine (0.05-0.8 μg/kg). Bradykinin B2 receptor was assessed by Western blot. Pericardial bradykinin injections caused graded increases in mean arterial pressure, heart rate and mean circulatory filling pressure. These responses were markedly attenuated after autonomic blockade. The increments in mean circulatory filling pressure were attenuated in female rats. There were no differences in the venoconstrictor responses to norepinephrine or ventricular bradykinin receptor expression between male and females. We interpret these findings to indicate that activation of bradykinin sensitive pericardial afferents elicits a sexually dimorphic, autonomically mediated systemic venoconstrictor response. Differences in venous smooth muscle responses to norepinephrine or ventricular bradykinin receptor expression do not account for the sexual dimorphism. We conclude that systemic venoconstriction contributes to the overall hemodynamic response to activation of the cardiac sympathetic afferent reflex and that this effect is sexually dimorphic.
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8
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Gronda E, Vanoli E, Zorzi A, Corrado D. CardioMEMS, the real progress in heart failure home monitoring. Heart Fail Rev 2019; 25:93-98. [DOI: 10.1007/s10741-019-09840-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Affiliation(s)
- Steven D Anisman
- SVMC Cardiology, Dartmouth Hitchcock Department of Cardiovascular Medicine, Bennington, VT, USA
| | - Stephen B Erickson
- Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN, USA
| | - Nancy E Morden
- The Dartmouth Institute for Health Policy & Clinical Practice, The Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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10
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Fujita T, Inomata T, Yazaki M, Iida Y, Kaida T, Ikeda Y, Nabeta T, Ishii S, Maekawa E, Yanagisawa T, Koitabashi T, Takeuchi I, Ako J. Hemodilution after Initial Treatment in Patients with Acute Decompensated Heart Failure. Int Heart J 2018; 59:573-579. [DOI: 10.1536/ihj.17-307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Toyoji Kaida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ichiro Takeuchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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11
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Horiuchi Y, Tanimoto S, Latif AHMM, Urayama KY, Aoki J, Yahagi K, Okuno T, Sato Y, Tanaka T, Koseki K, Komiyama K, Nakajima H, Hara K, Tanabe K. Identifying novel phenotypes of acute heart failure using cluster analysis of clinical variables. Int J Cardiol 2018; 262:57-63. [PMID: 29622508 DOI: 10.1016/j.ijcard.2018.03.098] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute heart failure (AHF) is a heterogeneous disease caused by various cardiovascular (CV) pathophysiology and multiple non-CV comorbidities. We aimed to identify clinically important subgroups to improve our understanding of the pathophysiology of AHF and inform clinical decision-making. METHODS We evaluated detailed clinical data of 345 consecutive AHF patients using non-hierarchical cluster analysis of 77 variables, including age, sex, HF etiology, comorbidities, physical findings, laboratory data, electrocardiogram, echocardiogram and treatment during hospitalization. Cox proportional hazards regression analysis was performed to estimate the association between the clusters and clinical outcomes. RESULTS Three clusters were identified. Cluster 1 (n=108) represented "vascular failure". This cluster had the highest average systolic blood pressure at admission and lung congestion with type 2 respiratory failure. Cluster 2 (n=89) represented "cardiac and renal failure". They had the lowest ejection fraction (EF) and worst renal function. Cluster 3 (n=148) comprised mostly older patients and had the highest prevalence of atrial fibrillation and preserved EF. Death or HF hospitalization within 12-month occurred in 23% of Cluster 1, 36% of Cluster 2 and 36% of Cluster 3 (p=0.034). Compared with Cluster 1, risk of death or HF hospitalization was 1.74 (95% CI, 1.03-2.95, p=0.037) for Cluster 2 and 1.82 (95% CI, 1.13-2.93, p=0.014) for Cluster 3. CONCLUSIONS Cluster analysis may be effective in producing clinically relevant categories of AHF, and may suggest underlying pathophysiology and potential utility in predicting clinical outcomes.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
| | - Shuzou Tanimoto
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - A H M Mahbub Latif
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan; Institute of Statistical Research and Training, University of Dhaka, Dhaka 1000, Bangladesh
| | - Kevin Y Urayama
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan; Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Taishi Okuno
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yu Sato
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tetsu Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Keita Koseki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroyoshi Nakajima
- Division of General Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuhiro Hara
- Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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12
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University Hospital, Durham, NC
| | - Adrian F Hernandez
- Division of Cardiology, Department of Internal Medicine, Duke University Hospital, Durham, NC
- Duke Cardiovascular Research Institute, Durham, NC
| | - G Michael Felker
- Division of Cardiology, Department of Internal Medicine, Duke University Hospital, Durham, NC
- Duke Cardiovascular Research Institute, Durham, NC
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13
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Falls R, Seman M, Braat S, Sortino J, Allen JD, Neil CJ. Inorganic nitrate as a treatment for acute heart failure: a protocol for a single center, randomized, double-blind, placebo-controlled pilot and feasibility study. J Transl Med 2017; 15:172. [PMID: 28789663 PMCID: PMC5549289 DOI: 10.1186/s12967-017-1271-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 07/24/2017] [Indexed: 01/07/2023] Open
Abstract
Background Acute heart failure (AHF) is a frequent reason for hospitalization worldwide and effective treatment options are limited. It is known that AHF is a condition characterized by impaired vasorelaxation, together with reduced nitric oxide (NO) bioavailability, an endogenous vasodilatory compound. Supplementation of inorganic sodium nitrate (NaNO3) is an indirect dietary source of NO, through bioconversion. It is proposed that oral sodium nitrate will favorably affect levels of circulating NO precursors (nitrate and nitrite) in AHF patients, resulting in reduced systemic vascular resistance, without significant hypotension. Methods and outcomes We propose a single center, randomized, double-blind, placebo-controlled pilot trial, evaluating the feasibility of sodium nitrate as a treatment for AHF. The primary hypothesis that sodium nitrate treatment will result in increased systemic levels of nitric oxide pre-cursors (nitrate and nitrite) in plasma, in parallel with improved vasorelaxation, as assessed by non-invasively derived systemic vascular resistance index. Additional surrogate measures relevant to the known pathophysiology of AHF will be obtained in order to assess clinical effect on dyspnea and renal function. Discussion The results of this study will provide evidence of the feasibility of this novel approach and will be of interest to the heart failure community. This trial may inform a larger study.
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Affiliation(s)
- Roman Falls
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Michael Seman
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Sabine Braat
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Melbourne School of Population and Global Health and Melbourne Clinical and Translational Sciences Platform (MCATS), Parkville, Australia
| | - Joshua Sortino
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia
| | - Jason D Allen
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Melbourne, Australia
| | - Christopher J Neil
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia. .,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. .,Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Melbourne, Australia. .,Western Health Cardiology, Footscray Hospital, Gordon St, Locked Bag 2, Footscray, VIC, 3011, Australia.
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14
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio
- Center for Clinical Genomics, Cleveland Clinic, Cleveland, Ohio
| | - Mark E. Dunlap
- Heart & Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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15
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MacIver DH, Adeniran I, MacIver IR, Revell A, Zhang H. Physiological mechanisms of pulmonary hypertension. Am Heart J 2016; 180:1-11. [PMID: 27659877 DOI: 10.1016/j.ahj.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/05/2016] [Indexed: 12/25/2022]
Abstract
Pulmonary hypertension is usually related to obstruction of pulmonary blood flow at the level of the pulmonary arteries (eg, pulmonary embolus), pulmonary arterioles (idiopathic pulmonary hypertension), pulmonary veins (pulmonary venoocclusive disease) or mitral valve (mitral stenosis and regurgitation). Pulmonary hypertension is also observed in heart failure due to left ventricle myocardial diseases regardless of the ejection fraction. Pulmonary hypertension is often regarded as a passive response to the obstruction to pulmonary flow. We review established fluid dynamics and physiology and discuss the mechanisms underlying pulmonary hypertension. The important role that the right ventricle plays in the development and maintenance of pulmonary hypertension is discussed. We use principles of thermodynamics and discuss a potential common mechanism for a number of disease states, including pulmonary edema, through adding pressure energy to the pulmonary circulation.
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Affiliation(s)
- David H MacIver
- Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, United Kingdom; Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton, United Kingdom; Medical Education, University of Bristol, Senate House, Tyndall Avenue, Bristol, United Kingdom.
| | - Ismail Adeniran
- Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, United Kingdom
| | - Iain R MacIver
- Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, United Kingdom
| | - Alistair Revell
- Modelling & Simulation Centre, School of Mechanical, Aerospace & Civil Engineering, University of Manchester, United Kingdom
| | - Henggui Zhang
- Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, United Kingdom
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16
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Abstract
It has been known for many decades that multiple abnormalities of the autonomic nervous system (ANS) are present in heart failure (HF). Moreover, many of the effective therapies currently used to treat HF have either direct or indirect effects on the ANS. While therapies that block over-activity of the sympathetic nervous system are now standard of care, much less well studied are therapies aimed at augmenting the parasympathetic nervous system. This review will cover recent and ongoing investigations targeting modulation of the ANS, especially highlighting new and ongoing studies directed toward augmenting parasympathetic mechanisms.
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Affiliation(s)
- Mark E Dunlap
- MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
| | - Anju Bhardwaj
- MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Paul J Hauptman
- Saint Louis University School of Medicine, St. Louis, MO, USA
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Seitz BM, Krieger-Burke T, Fink GD, Watts SW. Serial Measurements of Splanchnic Vein Diameters in Rats Using High-Frequency Ultrasound. Front Pharmacol 2016; 7:116. [PMID: 27199758 PMCID: PMC4853411 DOI: 10.3389/fphar.2016.00116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/18/2016] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to investigate serial ultrasound imaging in rats as a fully non-invasive method to (1) quantify the diameters of splanchnic veins in real time as an indirect surrogate for the capacitance function of those veins, and (2) assess the effects of drugs on venous dimensions. A 21 MHz probe was used on anesthetized male Sprague–Dawley rats to collect images containing the portal vein (PV), superior mesenteric vein (SMV), abdominal inferior vena cava (IVC), and splenic vein (SpV; used as a landmark in timed studies) and the abdominal aorta (AA). Stable landmarks were established that allowed reproducible quantification of cross-sectional diameters within an animal. The average diameters of vessels measured every 5 min over 45 min remained within 0.75 ± 0.15% (PV), 0.2 ± 0.09% (SMV), 0.5 ± 0.12% (IVC), and 0.38 ± 0.06% (AA) of baseline (PV: 2.0 ± 0.12 mm; SMV: 1.7 ± 0.04 mm; IVC: 3.2 ± 0.1 mm; AA: 2.3 ± 0.14 mm). The maximal effects of the vasodilator sodium nitroprusside (SNP; 2 mg/kg, i.v. bolus) on venous diameters were determined 5 min post SNP bolus; the diameters of all noted veins were significantly increased by SNP, while mean arterial pressure (MAP) decreased 29 ± 4 mmHg. By contrast, administration of the venoconstrictor sarafotoxin (S6c; 5 ng/kg, i.v. bolus) significantly decreased PV and SpV, but not IVC, SMV, or AA, diameters 5 min post S6c bolus; MAP increased by 6 ± 2 mmHg. In order to determine if resting splanchnic vein diameters were stable over much longer periods of time, vessel diameters were measured every 2 weeks for 8 weeks. Measurements were found to be highly reproducible within animals over this time period. Finally, to evaluate the utility of vein imaging in a chronic condition, images were acquired from 4-week deoxycorticosterone acetate salt (DOCA-salt) hypertensive and normotensive (SHAM) control rats. All vessel diameters increased from baseline while MAP increased (67 ± 4 mmHg) in DOCA-salt rats compared to SHAM at 4 weeks after pellet implantation. Vessel diameters remained unchanged in SHAM animals. Together, these results support serial ultrasound imaging as a non-invasive, reliable technique able to measure acute and chronic changes in the diameter of splanchnic veins in intact rats.
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Affiliation(s)
- Bridget M Seitz
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing MI, USA
| | | | - Gregory D Fink
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing MI, USA
| | - Stephanie W Watts
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing MI, USA
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Yu A, Zhang J, Liu H, Liu B, Meng L. Identification of nondiabetic heart failure-associated genes by bioinformatics approaches in patients with dilated ischemic cardiomyopathy. Exp Ther Med 2016; 11:2602-2608. [PMID: 27284354 DOI: 10.3892/etm.2016.3252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/03/2016] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a common pathological condition affecting 4% of the worldwide population. However, approaches for predicting or treating nondiabetic HF (ND-HF) progression are insufficient. In the current study, the gene expression profile GSE26887 was analyzed, which contained samples from 5 healthy controls, 7 diabetes mellitus-HF patients and 12 ND-HF patients with dilated ischemic cardiomyopathy. The dataset of 5 healthy controls and 12 ND-HF patients was normalized with robust multichip average analysis and the differentially expressed genes (DEGs) were screened by unequal variance t-test and multiple-testing correction. In addition, the protein-protein interaction (PPI) network of the upregulated and downregulated genes was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database and the Cytoscape software platform. Subsequently, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. A total of 122 upregulated and 133 downregulated genes were detected. The most significantly up- and downregulated genes were EIF1AY and SERPINE1, respectively. In addition, 38 and 77 nodes were obtained in the up- and downregulated PPI network. DEGs that owned the highest connectivity degree were USP9Y and UTY in the upregulated network, and CD44 in the downregulated networks, respectively. NPPA and SERPINE1 were also found to be hub genes in the PPI network. Several GO terms and pathways that were enriched by DEGs were identified, and the most significantly enriched KEGG pathways were drug metabolism and extracellular matrix-receptor interaction. In conclusion, the two DEGs, NPPA and SERPINE1, may be important in the pathogenesis of HF and may be used for the diagnosis and treatment of HF.
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Affiliation(s)
- Anzhong Yu
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
| | - Jingyao Zhang
- Department of Blood Purification, Jinan Infectious Disease Hospital, Jinan, Shandong 250021, P.R. China
| | - Haiyan Liu
- Department of Internal Medicine, Jinan Minzu Hospital, Jinan, Shandong 250014, P.R. China
| | - Bing Liu
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
| | - Lingdong Meng
- Department of Cardiology, Jinan No. 4 People's Hospital, Jinan, Shandong 250031, P.R. China
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Abstract
OPINION STATEMENT Despite major advances that have led to effective therapeutic modalities for the treatment of heart failure (HF), this syndrome has continued to be a staggering health problem associated with significant mortality and morbidity. The increasing number of hospital admissions and readmissions related to acute HF continues to pose a fiscal challenge leading to constant interest in development of novel approaches. These point to multiple areas of unmet needs especially in acute HF, thus, necessitating further efforts to develop novel strategies for prevention and treatment of acute HF. One area of continuing focus is targeting the role of autonomic imbalance associated with the development of HF. Autonomic dysregulation, manifested by increased sympathetic drive and reduced parasympathetic activity, has been recognized as a mediator of increased mortality and morbidity in HF and myocardial infarction. Furthermore, vagal withdrawal has been shown to precede acute decompensation, though whether this represents cause or effect is unknown. This review discusses the potential role of autonomic dysregulation as a therapeutic modality for patients with acute decompensated HF.
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Ponikowski P, Jankowska EA. Patogenia y presentación clínica de la insuficiencia cardiaca aguda. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ponikowski P, Jankowska EA. Pathogenesis and clinical presentation of acute heart failure. ACTA ACUST UNITED AC 2015; 68:331-7. [PMID: 25743769 DOI: 10.1016/j.rec.2015.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/13/2015] [Indexed: 12/11/2022]
Abstract
Acute heart failure constitutes a heterogeneous clinical syndrome, whose pathophysiology is complex and not completely understood. Given the diversity of clinical presentations, several different pathophysiological mechanisms along with factors triggering circulatory decompensation are involved. This article discusses the available evidence on the pathophysiological phenomena attributed or/and associated with episodes of acute heart failure and describes different clinical profiles, which, from a clinical perspective, constitute a key element for therapeutic decision-making.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
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Mabote T, Wong K, Cleland JGF. The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure. Expert Rev Cardiovasc Ther 2014; 12:923-8. [PMID: 25026973 DOI: 10.1586/14779072.2014.935339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Monitoring a patient's hemodynamic status may be a revolutionary way to aid a 'health maintenance' strategy in which the physician strives to therapeutically keep the patient in an ideal hemodynamic range. Currently, home telemonitoring employs a 'crisis-prevention' approach. This strategy is still based on easily acquired measures such as heart rate, weight and blood pressure--measurements that are useful to help implement guideline-directed therapy but provide little information about impending decompensation or the risk of hospitalisation. Current systems provide limited information to personalize and adapt medication therapy for heart failure. Several innovative technologies that can remotely monitor estimates of cardiovascular hemodynamics, such as cardiac index, systemic vascular resistance, augmentation index and added heart sounds may enable earlier detection of heart failure decompensation. This editorial presents an overview of the innovative technologies that are available for non-invasive hemodynamic monitoring and maybe adapted for home telemonitoring for chronic heart failure.
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Affiliation(s)
- Thato Mabote
- Department of Academic Cardiology, Hull York Medical School, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
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