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DeFilippis EM, Sweigart B, Khush KK, Shah P, Agbor-Enoh S, Valantine HA, Vest AR. Sex-specific patterns of donor-derived cell-free DNA in heart transplant rejection: An analysis from the Genomic Research Alliance for Transplantation (GRAfT). J Heart Lung Transplant 2024; 43:1135-1141. [PMID: 38460620 PMCID: PMC11144097 DOI: 10.1016/j.healun.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/22/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Noninvasive methods for surveillance of acute rejection are increasingly used in heart transplantation (HT), including donor-derived cell-free DNA (dd-cfDNA). As other cardiac biomarkers differ by sex, we hypothesized that there may be sex-specific differences in the performance of dd-cfDNA for the detection of acute rejection. The purpose of the current study was to examine patterns of dd-cfDNA seen in quiescence and acute rejection in male and female transplant recipients. METHODS Patients enrolled in the Genomic Research Alliance for Transplantation who were ≥18 years at the time of HT were included. Rejection was defined by endomyocardial biopsy with acute cellular rejection (ACR) grade ≥2R and/or antibody-mediated rejection ≥ pAMR 1. dd-cfDNA was quantitated using shotgun sequencing. Median dd-cfDNA levels were compared between sexes during quiescence and rejection. The performance of dd-cfDNA by sex was assessed using area under the receiver operator characteristic (AUROC) curve. Allograft injury was defined as dd-cfDNA ≥0.25%. RESULTS One hundred fifty-one unique patients (49 female, 32%) were included in the analysis with 1,119 available dd-cfDNA measurements. Baseline characteristics including demographics and comorbidities were not significantly different between sexes. During quiescence, there were no significant sex differences in median dd-cfDNA level (0.04% [IQR 0.00, 0.16] in females vs 0.03% [IQR 0.00, 0.12] in males, p = 0.22). There were no significant sex differences in median dd-cfDNA for ACR (0.33% [0.21, 0.36] in females vs 0.32% [0.21, 1.10] in males, p = 0.57). Overall, median dd-cfDNA levels were higher in antibody-mediated rejection (AMR) than ACR but did not significantly differ by sex (0.50% [IQR 0.18, 0.82] in females vs 0.63% [IQR 0.32, 1.95] in males, p = 0.51). Elevated dd-cfDNA detected ACR/AMR with an AUROC of 0.83 in females and 0.89 in males, p-value for comparison = 0.16. CONCLUSIONS There were no significant sex differences in dd-cfDNA levels during quiescence and rejection. Performance characteristics were similar, suggesting similar diagnostic thresholds can be used in men and women for rejection surveillance.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Sweigart
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Palak Shah
- Heart Failure, Mechanical Circulatory Support and Transplant, Inova Schar Heart and Vascular, Falls Church, Virginia
| | - Sean Agbor-Enoh
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah A Valantine
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
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2
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Alcaide P, Kallikourdis M, Emig R, Prabhu SD. Myocardial Inflammation in Heart Failure With Reduced and Preserved Ejection Fraction. Circ Res 2024; 134:1752-1766. [PMID: 38843295 PMCID: PMC11160997 DOI: 10.1161/circresaha.124.323659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Heart failure (HF) is characterized by a progressive decline in cardiac function and represents one of the largest health burdens worldwide. Clinically, 2 major types of HF are distinguished based on the left ventricular ejection fraction (EF): HF with reduced EF and HF with preserved EF. While both types share several risk factors and features of adverse cardiac remodeling, unique hallmarks beyond ejection fraction that distinguish these etiologies also exist. These differences may explain the fact that approved therapies for HF with reduced EF are largely ineffective in patients suffering from HF with preserved EF. Improving our understanding of the distinct cellular and molecular mechanisms is crucial for the development of better treatment strategies. This article reviews the knowledge of the immunologic mechanisms underlying HF with reduced and preserved EF and discusses how the different immune profiles elicited may identify attractive therapeutic targets for these conditions. We review the literature on the reported mechanisms of adverse cardiac remodeling in HF with reduced and preserved EF, as well as the immune mechanisms involved. We discuss how the knowledge gained from preclinical models of the complex syndrome of HF as well as from clinical data obtained from patients may translate to a better understanding of HF and result in specific treatments for these conditions in humans.
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Affiliation(s)
- Pilar Alcaide
- Department of Immunology, Tufts University School of Medicine, Boston MA
| | - Marinos Kallikourdis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy and Adaptive Immunity Laboratory, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Ramona Emig
- Department of Immunology, Tufts University School of Medicine, Boston MA
| | - Sumanth D. Prabhu
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
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3
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Rosano GMC, Stolfo D, Anderson L, Abdelhamid M, Adamo M, Bauersachs J, Bayes-Genis A, Böhm M, Chioncel O, Filippatos G, Hill L, Lainscak M, Lambrinou E, Maas AHEM, Massouh AR, Moura B, Petrie MC, Rakisheva A, Ray R, Savarese G, Skouri H, Van Linthout S, Vitale C, Volterrani M, Metra M, Coats AJS. Differences in presentation, diagnosis and management of heart failure in women. A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024. [PMID: 38783694 DOI: 10.1002/ejhf.3284] [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: 02/05/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Despite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex-specific conditions in the predisposition to HF has gained progressive interest in the HF community. Under-recruitment of women in large randomized clinical trials has continued in the more recent studies despite epidemiological data no longer reporting any substantial difference in the lifetime risk and prognosis between sexes. Target dose of medications and criteria for device eligibility are derived from studies with a large predominance of men, whereas specific information in women is lacking. The present scientific statement encompasses the whole scenario of available evidence on sex-disparities in HF and aims to define the most challenging and urgent residual gaps in the evidence for the scientific and clinical HF communities.
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Affiliation(s)
- Giuseppe M C Rosano
- Chair of Pharmacology, Department of Human Sciences and Promotion of Quality of Life, San Raffaele University of Rome, Rome, Italy
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Anderson
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Marianna Adamo
- ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Poujol, CIBERCV, Badalona, Spain
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Gerasimos Filippatos
- National & Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Chaidari, Greece
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Rakičan, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela R Massouh
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Amina Rakisheva
- City Cardiological Center, Almaty Kazakhstan Qonaev city hospital, Almaty Region, Kazakhstan
| | - Robin Ray
- Department of Cardiology, St George's Hospital, London, UK
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hadi Skouri
- Division of Cardiology, Sheikh Shakhbout Medical city, Abu Dhabi, UAE
| | - Sophie Van Linthout
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | | | - Maurizio Volterrani
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardio-Pulmonary Department, IRCCS San Raffaele, Rome, Italy
| | - Marco Metra
- ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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4
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Nan Tie E, Wolsk E, Nanayakkara S, Vizi D, Mariani J, Moller JE, Hassager C, Gustafsson F, Kaye DM. Hyperlactataemia is a marker of reduced exercise capacity in heart failure with preserved ejection fraction. ESC Heart Fail 2024. [PMID: 38698563 DOI: 10.1002/ehf2.14794] [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: 06/08/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 05/05/2024] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is associated with an array of central and peripheral haemodynamic and metabolic changes. The exact pathogenesis of exercise limitation in HFpEF remains uncertain. Our aim was to compare lactate accumulation and central haemodynamic responses to exercise in patients with HFpEF, non-cardiac dyspnoea (NCD), and healthy volunteers. METHODS AND RESULTS Right heart catheterization with mixed venous blood gas and lactate measurements was performed at rest and during symptom-limited supine exercise. Multivariable analyses were conducted to determine the relationship between haemodynamic and biochemical parameters and their association with exercise capacity. Of 362 subjects, 198 (55%) had HFpEF, 103 (28%) had NCD, and 61 (17%) were healthy volunteers. This included 139 (70%) females with HFpEF, 77 (75%) in NCD (P = 0.41 HFpEF vs. NCD), and 31 (51%) in healthy volunteers (P < 0.001 HFpEF vs. volunteers). The median age was 71 (65, 75) years in HFpEF, 66 (57, 72) years in NCD, and 49 (38, 65) years in healthy volunteers (HFpEF vs. NCD or volunteer, both P < 0.001). Peak workload was lower in HFpEF compared with healthy volunteers [52 W (interquartile range 31-73), 150 W (125-175), P < 0.001], but not NCD [53 W (33, 75), P = 0.85]. Exercise lactate indexed to workload was higher in HFpEF at 0.08 mmol/L/W (0.05-0.11), 0.06 mmol/L/W (0.05-0.08; P = 0.016) in NCD, and 0.04 mmol/L/W (0.03-0.05; P < 0.001) in volunteers. Exercise cardiac index was 4.5 L/min/m2 (3.7-5.5) in HFpEF, 5.2 L/min/m2 (4.3-6.2; P < 0.001) in NCD, and 9.1 L/min/m2 (8.0-9.9; P < 0.001) in volunteers. Oxygen delivery in HFpEF was lower at 1553 mL/min (1175-1986) vs. 1758 mL/min (1361-2282; P = 0.024) in NCD and 3117 mL/min (2667-3502; P < 0.001) in the volunteer group during exercise. Predictors of higher exercise lactate levels in HFpEF following adjustment included female sex and chronic kidney disease (both P < 0.001). CONCLUSIONS HFpEF is associated with reduced exercise capacity secondary to both central and peripheral factors that alter oxygen utilization. This results in hyperlactataemia. In HFpEF, plasma lactate responses to exercise may be a marker of haemodynamic and cardiometabolic derangements and represent an important target for future potential therapies.
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Affiliation(s)
- Emilia Nan Tie
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Emil Wolsk
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Donna Vizi
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Justin Mariani
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Jacob Eifer Moller
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Monash University, Melbourne, Australia
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5
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Losi MA, Bossone E, Piccolo R, Canciello G, Pacella D, Crisci G, Carbone A, Ferrara F, Izzo R, Esposito G, Cittadini A. Exploring the physiologic variations and related determinants of left ventricular diastolic function among 381 healthy Caucasian adults by the 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging guidelines. Eur J Prev Cardiol 2024; 31:e42-e44. [PMID: 37681345 DOI: 10.1093/eurjpc/zwad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Eduardo Bossone
- Department of Public Health, University Federico II, Ed. 18, I piano, Via Sergio Pansini 5, Naples 80131, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II, Ed. 18, I piano, Via Sergio Pansini 5, Naples 80131, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, via Pansini 5, Naples 80131, Italy
| | - Andreina Carbone
- Unit of Cardiology, University of Campania Luigi Vanvitelli, piazza Luigi Miraglia, Naples 80138, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, Via San Leonardo, Salerno 84131, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, via Pansini 5, Naples 80131, Italy
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6
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Smereka Y, Ezekowitz JA. HFpEF and sex: understanding the role of sex differences. Can J Physiol Pharmacol 2024. [PMID: 38447124 DOI: 10.1139/cjpp-2023-0403] [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: 03/08/2024]
Abstract
Heart failure is a complex clinical syndrome with many etiological factors and complex pathophysiology affecting millions worldwide. Males and females can have distinct clinical presentation and prognosis, and there is an emerging understanding of the factors that highlight the similarities and differences to synthesize and present available data for sex-specific differences in heart failure with preserved ejection fraction (HFpEF). While the majority of data demonstrate more similarities than differences between females and males in terms of heart failure, there are key differences. Data showed that females have a higher risk of developing HFpEF, but a lower risk of mortality and hospitalization. This can be conditioned by different profiles of comorbidities, postmenopausal changes in sex hormone levels, higher levels of inflammation and chronic microvascular dysfunction in females. These factors, combined with different left ventricular dimensions and function, which are more pronounced with age, lead to a higher prevalence of LV diastolic dysfunction at rest and exercise. As a result, females have lower exercise capacity and quality of life when compared to males. Females also have different activities of systems responsible for drug transformation, leading to different efficacy of drugs as well as higher risk of adverse drug reactions. These data prove the necessity for creating sex-specific risk stratification scales and treatment plans.
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Affiliation(s)
- Yuliia Smereka
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Edmonton, AB, Canada
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7
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Kawai A, Nagatomo Y, Yukino-Iwashita M, Nakazawa R, Yumita Y, Taruoka A, Takefuji A, Yasuda R, Toya T, Ikegami Y, Masaki N, Adachi T. Sex Differences in Cardiac and Clinical Phenotypes and Their Relation to Outcomes in Patients with Heart Failure. J Pers Med 2024; 14:201. [PMID: 38392634 PMCID: PMC10890585 DOI: 10.3390/jpm14020201] [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: 12/29/2023] [Revised: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
Biological sex is one of the major factors characterizing the heart failure (HF) patient phenotype. Understanding sex-related differences in HF is crucial to implement personalized care for HF patients with various phenotypes. There are sex differences in left ventricular (LV) remodeling patterns in the HF setting, namely, more likely concentric remodeling and diastolic dysfunction in women and eccentric remodeling and systolic dysfunction in men. Recently supra-normal EF (snLVEF) has been recognized as a risk of worse outcome. This pathology might be more relevant in female patients. The possible mechanism may be through coronary microvascular dysfunction and sympathetic nerve overactivation from the findings of previous studies. Further, estrogen deficit might play a significant role in this pathophysiology. The sex difference in body composition may also be related to the difference in LV remodeling and outcome. Lower implementation in guideline-directed medical therapy (GDMT) in female HFrEF patients might also be one of the factors related to sex differences in relation to outcomes. In this review, we will discuss the sex differences in cardiac and clinical phenotypes and their relation to outcomes in HF patients and further discuss how to provide appropriate treatment strategies for female patients.
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Affiliation(s)
- Akane Kawai
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | | | - Ryota Nakazawa
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yusuke Yumita
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Akira Taruoka
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Asako Takefuji
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Risako Yasuda
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
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8
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Spacht WA, Lau ES. A disease of her own? Unique features of heart failure in women. Climacteric 2024; 27:32-40. [PMID: 37768321 PMCID: PMC10843094 DOI: 10.1080/13697137.2023.2256673] [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: 05/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
Heart failure (HF) is a significant and growing public health challenge for women. Compared with men, women tend to develop HF later in life and are more likely to experience HF with preserved ejection fraction. There are also significant sex differences in outcomes, with women reporting lower quality of life but overall better survival versus men. In this review, we summarize sex differences in traditional HF risk factors, such as hypertension, diabetes, obesity and coronary artery disease, as well as female-specific HF risk factors including menopause, pregnancy and adverse pregnancy outcomes, and breast cancer therapy. While our understanding of the sex-specific efficacy of HF therapy remains limited by the underrepresentation of women in major clinical trials, there is a suggestion of preferential benefit of specific agents for women. Further work is required to better understand the pathophysiology of HF in women uniquely and to increase representation of women in clinical trials.
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Affiliation(s)
| | - Emily S. Lau
- Cardiovascular Research Center and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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9
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Crosier R, Lopez Laporte MA, Unni RR, Coutinho T. Female-Specific Considerations in Aortic Health and Disease. CJC Open 2024; 6:391-406. [PMID: 38487044 PMCID: PMC10935703 DOI: 10.1016/j.cjco.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
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Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Rudy R. Unni
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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10
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Samim D, Dernektsi C, Brugger N, Reineke D, Praz F. Contemporary Approach to Tricuspid Regurgitation: Knowns, Unknowns, and Future Challenges. Can J Cardiol 2024; 40:185-200. [PMID: 38052301 DOI: 10.1016/j.cjca.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Severe tricuspid regurgitation (TR) worsens heart failure and is associated with impaired survival. In daily clinical practice, patients are referred late, and tricuspid valve interventions (surgical or transcatheter) are underutilised, which may lead to irreversible right ventricular damage and increases risk. This article addresses the appropriate timing and modality for an intervention (surgical or transcatheter), and its potential benefits on clinical outcomes. Ongoing randomised controlled trials will provide further insights into the efficacy of transcatheter valve interventions compared with medical treatment.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Chrisoula Dernektsi
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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11
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Golino M, Morello M, Marazzato J, Blasi F, Chierchia V, Oliva CA, Zappa M, Ageno W, Passi A, Angeli F, De Ponti R. Sex-related differences in non-ischemic myocardial injury in the emergency department: A real-world perspective. Int J Cardiol 2024; 395:131394. [PMID: 37748523 DOI: 10.1016/j.ijcard.2023.131394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Myocardial injury is associated with adverse outcomes. No data are reported about sex differences in incidence and factors associated with myocardial injury in an emergency department (ED) setting from a real-world perspective. We aimed to assess whether sex plays a major role in the diagnosis of myocardial injury in the ED. METHODS In this subanalysis of a retrospective study, patients presenting at the ED with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis were compared. RESULTS 31,383 patients were admitted to the ED, 4660 had one hs-cTnT value, and 3937 were enrolled: 1943 females (49.4%) and 1994 males (50.6%). The diagnosis of myocardial injury was higher among men (36.8% vs. 32.9%, p < 0.01). Male sex was independently associated with myocardial injury. An older age, an elevated NT-proB-type Natriuretic Peptide and a lower estimated glomerular filtrate rate were independently associated with myocardial injury in both sexes. CONCLUSIONS In the ED, from a real-world perspective, myocardial injury occurred more frequently in males, and it was associated with older age and the presence of cardiac, lung, and kidney disease but not higher hs-cTnT values.
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Affiliation(s)
- Michele Golino
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Matteo Morello
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Valentina Chierchia
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Carlo-Agostino Oliva
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Alberto Passi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy; Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
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Abubakar M, Saleem A, Hajjaj M, Faiz H, Pragya A, Jamil R, Salim SS, Lateef IK, Singla D, Ramar R, Damara I, Shahid L. Sex-specific differences in risk factors, comorbidities, diagnostic challenges, optimal management, and prognostic outcomes of heart failure with preserved ejection fraction: A comprehensive literature review. Heart Fail Rev 2024; 29:235-256. [PMID: 37996694 DOI: 10.1007/s10741-023-10369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Due to hormonal variations, heart failure with preserved ejection fraction (HFpEF) remains prevalent in women and affects almost half of the heart failure (HF) patients. Given the yearly death rate of 10-30% and the unavailability of medications targeting HFpEF, the need arises for a better understanding of the fundamental mechanisms of this syndrome. This comprehensive review explores sex-specific differences in traditional risk factors; female-specific factors that may impact HFpEF development and response to therapy, including variations in hormone levels that may occur pre- and post-menopausal or during pregnancy; and disparities in comorbidities, clinical presentation, and diagnostic challenges. Lastly, the review addresses prognostic outcomes, noting that women with HFpEF have a poor quality of life but a higher survival rate. It also discusses novel biomarkers and precision medicine, emphasizing their potential to improve early detection and personalized treatment.
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Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Ameer-Ud-Din Medical College, Lahore General Hospital, 6 Birdwood Road, Jinnah Town, Lahore, Punjab, 54000, Pakistan.
| | - Ayesha Saleem
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Mohsin Hajjaj
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Haseeb Faiz
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Aastha Pragya
- Department of Internal Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Rosheen Jamil
- Department of Internal Medicine, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Siffat Saima Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
| | | | - Deepak Singla
- Department of Internal Medicine, Government Medical College, Patiala, Punjab, India
| | - Rajasekar Ramar
- Department of Internal Medicine, Rajah Muthiah Medical College, Chidambaram, Tamil Nadu, India
| | - Ivan Damara
- Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laraib Shahid
- Department of Dermatology, Lahore General Hospital, Lahore, Punjab, Pakistan
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13
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Crosier R, Coutinho T. Heart Failure With Preserved Ejection Fraction in Females: An Arterial Disease. Can J Cardiol 2023; 39:1642-1645. [PMID: 37423506 DOI: 10.1016/j.cjca.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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14
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Mills RM. Heart Failure With Preserved Ejection Fraction in Women: A Less "Cardio" and More "Vascular" Disease? Am J Cardiol 2023; 205:512-513. [PMID: 37679193 DOI: 10.1016/j.amjcard.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
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15
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Crosier R, Paquin A, Zhu T, Beanlands RS, Mielniczuk L, de Kemp RA, Coutinho T. Sex Differences in Systemic and Coronary Arterial Hemodynamics in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2023; 205:87-93. [PMID: 37595413 DOI: 10.1016/j.amjcard.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 08/20/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) predominantly affects females. Systemic and coronary arterial abnormalities are present in HFpEF and may contribute to HFpEF in females. We performed a cross-sectional study of 32 participants with HFpEF and 26 controls. Arterial hemodynamics were noninvasively assessed by combining arterial tonometry with echocardiography. Coronary microvascular function was assessed by rubidium-82 positron emission tomography as the myocardial flow reserve. Coronary vascular resistance (CVR) at rest and vasodilator stress were calculated using positron emission tomography. CVR reserve was calculated as stress - rest CVR. Multivariable linear regression assessed the associations of female sex with arterial hemodynamics in participants with and without HF, and the association of HF with arterial hemodynamics within each sex stratum. Demographics and left ventricular systolic and diastolic function were similar between males and females. Among those with HFpEF, females had a higher steady and pulsatile arterial load and more impaired (less negative) CVR reserve than males. Conversely, in controls, females had similar hemodynamics to males. We then divided the sample based on sex. Femaleswith HFpEF had a higher pulsatile arterial load and higher stress CVR than control females. Among males, arterial hemodynamics were similar, regardless of HFpEF status. The measures of early pulsatile arterial load were independently associated with higher E/e' and lower myocardial flow reserve in females only. In conclusion, despite similar left ventricular function between sexes, older females with HFpEF are characterized by additional systemic and coronary arterial hemodynamic abnormalities compared with males with HFpEF and similarly aged females without HFpEF.
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Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Amélie Paquin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tina Zhu
- APEX Cardiology, Kingston, Ontario, Canada
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa Mielniczuk
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert A de Kemp
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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16
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Sciatti E, Coccia MG, Magnano R, Aakash G, Limonta R, Diep B, Balestrieri G, D'Isa S, Abramov D, Parwani P, D'Elia E. Heart Failure Preserved Ejection Fraction in Women: Insights Learned from Imaging. Heart Fail Clin 2023; 19:461-473. [PMID: 37714587 DOI: 10.1016/j.hfc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
While the prevalence of heart failure, in general, is similar in men and women, women experience a higher rate of HFpEF compared to HFrEF. Cardiovascular risk factors, parity, estrogen levels, cardiac physiology, and altered response to the immune system may be at the root of this difference. Studies have found that in response to increasing age and hypertension, women experience more concentric left ventricle remodeling, more ventricular and arterial stiffness, and less ventricular dilation compared to men, which predisposes women to developing more diastolic dysfunction. A multi-modality imaging approach is recommended to identify patients with HFpEF. Particularly, appreciation of sex-based differences as described in this review is important in optimizing the evaluation and care of women with HFpEF.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Gupta Aakash
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Raul Limonta
- School of Medicine and Surgery, Milano Bicocca University, Milano, Italy
| | - Brian Diep
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Salvatore D'Isa
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Emilia D'Elia
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy.
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17
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Begrambekova YL, Mareev YV, Mareev VY, Orlova YA, Kobalava ZD, Karapetyan LV, Galochkin SA, Kazakhmedov ER, Lapshin AA, Garganeeva AA, Kuzheleva EA, Efremushkina AA, Kiseleva EV, Barbarash OL, Pecherina TB, Galyavich AS, Galeeva ZM, Baleeva LV, Koziolova NA, Veclich AS, Duplyakov DV, Maksimova MN, Yakushin SS, Smirnova EA, Sedykh EV, Shaposhnik II, Makarova NA, Zemlyanukhina AA, Skibitsky VV, Fendrikova AV, Skibitsky AV, Spiropoulos NA, Seredenina EM, Eruslanova KA, Kotovskaya YV, Tkacheva ON, Fedin MA. Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)» study. KARDIOLOGIIA 2023; 63:3-13. [PMID: 37815134 DOI: 10.18087/cardio.2023.9.n2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/27/2023] [Indexed: 10/11/2023]
Abstract
Aim To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.
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Affiliation(s)
| | - Yu V Mareev
- National Medical Research Center for Therapy and Preventive Medicine
| | - V Yu Mareev
- Lomonosov Medical Research and Educational Center
| | - Ya A Orlova
- Lomonosov Medical Research and Educational Center
| | - Zh D Kobalava
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - L V Karapetyan
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - S A Galochkin
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - E R Kazakhmedov
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - A A Lapshin
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - A A Garganeeva
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - E A Kuzheleva
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - A A Efremushkina
- Altai State Medical University; Altai Territorial Cardiological Dispensary
| | | | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T B Pecherina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | | | | | | | | | - D V Duplyakov
- Research Institute of Cardiology, Samara State Medical University; Polyakov Samara Regional Clinical Cardiological Dispensary
| | - M N Maksimova
- Polyakov Samara Regional Clinical Cardiological Dispensary
| | - S S Yakushin
- Pavlov Ryazan State Medical University; Ryazan Regional Clinical Cardiological Dispensary
| | - E A Smirnova
- Ryazan Regional Clinical Cardiological Dispensary
| | - E V Sedykh
- Pavlov Ryazan State Medical University; Ryazan Regional Clinical Cardiological Dispensary
| | | | | | | | | | | | | | | | | | | | | | - O N Tkacheva
- Russian Gerontological Research and Clinical Center
| | - M A Fedin
- Russian Gerontological Research and Clinical Center; Pirogov Russian National Research Medical University
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18
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Sless RT, Wright SP, Bentley RF, Valle FH, Mak S. Sex differences in pulmonary and systemic vascular function at rest and during exercise in healthy middle-aged adults. J Hum Hypertens 2023; 37:746-752. [PMID: 36997720 DOI: 10.1038/s41371-023-00822-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/26/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
Our aim was to conduct a sex-disaggregated analysis of pulmonary and systemic vascular function in healthy individuals both at rest and during submaximal exercise. Healthy individuals underwent right-heart catheterization at rest and during submaximal cycling. Hemodynamic data were collected in a control state and with moderate exercise. Pulmonary and systemic vascular variables including: compliance, resistance, and elastance were calculated, indexed to body surface area (BSA), adjusted for age and compared between male and female sex. Thirty-six individuals (18M/18F; 54 ± 7 vs. 58 ± 6 years, p = 0.04) were included. When adjusted for age and indexed to BSA, total pulmonary resistance (TPulmR) (516 ± 73 vs. 424 ± 118 WU m-2, p = 0.03) and pulmonary arterial elastance (PEa) (0.41 ± 0.1 vs. 0.32 ± 0.1 mmHg ml-1 m2, p = 0.03) were higher in females vs. males. Both pulmonary (Cpa) and systemic compliance (Csa) were lower in females vs. males however lost significance with adjustment for age. Systemic arterial elastance (SEa) was higher in females (1.65 ± 0.29 vs. 1.31 ± 0.24 mmHg ml-1, p = 0.05). Secondary analyses demonstrated significant correlations between age and PVR (r = 0.33, p = 0.05), TPulmR (r = 0.35, p = 0.04), Cpa (r = -0.48, p < 0.01), and PEa (r = 0.37, p = 0.03). During exercise, there were greater increases in TPulmR (p = 0.02) and PEa (p = 0.01) in females vs. males. In conclusion, TPulmR and PEa are significantly higher at rest and exercise in females vs. males. Cpa and Csa were lower in females, however this may have been confounded by age. Our results are consistent with the notion that indices of pulmonary and systemic vascular load are higher, related to both older age and female sex, independent of heart failure.
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Affiliation(s)
- Ryan T Sless
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephen P Wright
- School of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Robert F Bentley
- Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Susanna Mak
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Cardiology, Mt. Sinai Hospital, Toronto, ON, Canada.
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19
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Vasan SK, Alex AG, Roy A, Gowri M, Sinha S, Suresh J, Philip RS, Kochumon J, Jaiswal N, Arulappan G, Ramakrishnan L, Sachdev HS, Tandon N, Thomas N, Jebasingh F, Osmond C, Karpe F, Bhargava SK, Antonisamy B, Prabhakaran D, Fall CH, Thomson VS. Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study. Front Cardiovasc Med 2023; 10:1055454. [PMID: 37522075 PMCID: PMC10372793 DOI: 10.3389/fcvm.2023.1055454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. Methods The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Results Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Conclusions Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. ISRCTN registration number 13432279.
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Affiliation(s)
- Senthil K. Vasan
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Sikha Sinha
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Jenifer Suresh
- Department of Cardiology, Christian Medical College, Vellore, India
| | | | | | | | | | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Felix Jebasingh
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H.D. Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
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Zhazykbayeva S, Hassoun R, Herwig M, Budde H, Kovács Á, Mannherz HG, El-Battrawy I, Tóth A, Schmidt WE, Mügge A, Hamdani N. Oxidative stress and inflammation distinctly drive molecular mechanisms of diastolic dysfunction and remodeling in female and male heart failure with preserved ejection fraction rats. Front Cardiovasc Med 2023; 10:1157398. [PMID: 37363100 PMCID: PMC10285478 DOI: 10.3389/fcvm.2023.1157398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex cardiovascular insufficiency syndrome presenting with an ejection fraction (EF) of greater than 50% along with different proinflammatory and metabolic co-morbidities. Despite previous work provided key insights into our understanding of HFpEF, effective treatments are still limited. In the current study we attempted to unravel the molecular basis of sex-dependent differences in HFpEF pathology. We analyzed left ventricular samples from 1-year-old female and male transgenic (TG) rats homozygous for the rat Ren-2 renin gene (mRen2) characterized with hypertension and diastolic dysfunction and compared it to age-matched female and male wild type rats (WT) served as control. Cardiomyocytes from female and male TG rats exhibited an elevated titin-based stiffness (Fpassive), which was corrected to control level upon treatment with reduced glutathione indicating titin oxidation. This was accompanied with high levels of oxidative stress in TG rats with more prominent effects in female group. In vitro supplementation with heat shock proteins (HSPs) reversed the elevated Fpassive indicating restoration of their cytoprotective function. Furthermore, the TG group exhibited high levels of proinflammatory cytokines with significant alterations in apoptotic and autophagy pathways in both sexes. Distinct alterations in the expression of several proteins between both sexes suggest their differential impact on disease development and necessitate distinct treatment options. Hence, our data suggested that oxidative stress and inflammation distinctly drive diastolic dysfunction and remodeling in female and male rats with HFpEF and that the sex-dependent mechanisms contribute to HF pathology.
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Affiliation(s)
- Saltanat Zhazykbayeva
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Roua Hassoun
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Melissa Herwig
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Heidi Budde
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Árpád Kovács
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Hans Georg Mannherz
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Anatomy and Molecular Embryology, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, UK RUB, Ruhr University of Bochum, Bochum, Germany
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Research Centre for Molecular Medicine, University of Debrecen, Debrecen, Hungary
| | - Wolfgang E. Schmidt
- Department of Medicine I, St. Josef Hospital, UK RUB, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Mügge
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, UK RUB, Ruhr University of Bochum, Bochum, Germany
| | - Nazha Hamdani
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
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21
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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22
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Affiliation(s)
- Rebecca T Hahn
- From the Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
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23
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Churchill TW, Yucel E, Bernard S, Namasivayam M, Nagata Y, Lau ES, Deferm S, He W, Danik JS, Sanborn DY, Picard MH, Levine RA, Hung J, Bertrand PB. Sex Differences in Extensive Mitral Annular Calcification With Associated Mitral Valve Dysfunction. Am J Cardiol 2023; 193:83-90. [PMID: 36881941 PMCID: PMC10066827 DOI: 10.1016/j.amjcard.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
Mitral annular calcification (MAC)-related mitral valve (MV) dysfunction is an increasingly recognized entity, which confers a high burden of morbidity and mortality. Although more common among women, there is a paucity of data regarding how the phenotype of MAC and the associated adverse clinical implications may differ between women and men. A total of 3,524 patients with extensive MAC and significant MAC-related MV dysfunction (i.e., transmitral gradient ≥3 mm Hg) were retrospectively analyzed from a large institutional database, with the goal of defining gender differences in clinical and echocardiographic characteristics and the prognostic importance of MAC-related MV dysfunction. We stratified patients into low- (3 to 5 mm Hg), moderate- (5 to 10 mm Hg), and high- (≥10 mm Hg) gradient groups and analyzed the gender differences in phenotype and outcome. The primary outcome was all-cause mortality, assessed using adjusted Cox regression models. Women represented the majority (67%) of subjects, were older (79.3 ± 10.4 vs 75.5 ± 10.9 years, p <0.001) and had a lower burden of cardiovascular co-morbidities than men. Women had higher transmitral gradients (5.7 ± 2.7 vs 5.3 ± 2.6 mm Hg, p <0.001), more concentric hypertrophy (49% vs 33%), and more mitral regurgitation. The median survival was 3.4 years (95% confidence interval 3.0 to 3.6) among women and 3.0 years (95% confidence interval 2.6 to 4.5) among men. The adjusted survival was worse among men, and the prognostic impact of the transmitral gradient did not differ overall by gender. In conclusion, we describe important gender differences among patients with MAC-related MV dysfunction and show worse adjusted survival among men; although, the adverse prognostic impact of the transmitral gradient was similar between men and women.
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Affiliation(s)
- Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Evin Yucel
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Bernard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, New York University School of Medicine, New York University, New York, New York
| | - Mayooran Namasivayam
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Victor Chang Cardiac Research Institute, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Yasufumi Nagata
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sebastien Deferm
- Department of Cardiology, Mainz University Hospital, Mainz Germany
| | - Wei He
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline S Danik
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danita Y Sanborn
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philippe B Bertrand
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Ziekenhuis Oost-Limburg, Genk, Belgium
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24
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van Ommen AMLN, Canto ED, Cramer MJ, Rutten FH, Onland-Moret NC, Ruijter HMD. Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions. BMC Med 2022; 20:496. [PMID: 36575484 PMCID: PMC9795723 DOI: 10.1186/s12916-022-02650-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022] Open
Abstract
Diastolic dysfunction of the left ventricle (LVDD) is equally common in elderly women and men. LVDD is a condition that can remain latent for a long time but is also held responsible for elevated left ventricular filling pressures and high pulmonary pressures that may result in (exercise-induced) shortness of breath. This symptom is the hallmark of heart failure with preserved ejection fraction (HFpEF) which is predominantly found in women as compared to men within the HF spectrum. Given the mechanistic role of LVDD in the development of HFpEF, we review risk factors and mechanisms that may be responsible for this sex-specific progression of LVDD towards HFpEF from an epidemiological point-of-view and propose future research directions.
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Affiliation(s)
- A M L N van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - E Dal Canto
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - F H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - H M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
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25
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Ye F, Nelson MB, Bertoni AG, Ditzenberger GL, Duncan P, Mentz RJ, Reeves G, Whellan D, Chen H, Upadhya B, Kitzman DW, Pastva AM. Severity of functional impairments by race and sex in older patients hospitalized with acute decompensated heart failure. J Am Geriatr Soc 2022; 70:3447-3457. [PMID: 36527410 PMCID: PMC9759671 DOI: 10.1111/jgs.18006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older patients hospitalized with acute decompensated heart failure (ADHF) have marked functional impairments, which may contribute to their delayed and incomplete recovery and persistently poor outcomes. However, whether impairment severity differs by race and sex is unknown. METHODS REHAB-HF trial participants (≥60 years) were assessed just before discharge home from ADHF hospitalization. Physical function [Short Physical Performance Battery; 6-min walk distance (6MWD)], frailty (Fried criteria), cognition [Montreal Cognitive Assessment (MoCA)], quality-of-life [Kansas City Cardiomyopathy Questionnaire, Short-Form-12, EuroQol-5D-5L], and depression [Geriatric Depression Scale (GDS)] were examined by race and sex. RESULTS This prespecified subgroup cross-sectional analysis included 337 older adults (52% female, 50% Black). Black participants were on average younger than White participants (70.3 ± 7.2 vs. 74.7 ± 8.3 years). After age, body mass index, ejection fraction, comorbidity, and education adjustment, and impairments were similarly common and severe across groups except: Black male and Black and White female participants had more severely impaired walking function compared with White male participants [6MWD (m) 187 ± 12, 168 ± 9170 ± 11 vs. 239 ± 9, p < 0.001]; gait speed (m/s) (0.61 ± 0.03, 0.56 ± 0.02, 0.55 ± 0.02 vs. 0.69 ± 0.02, p < 0.001); White female participants had the highest frailty prevalence (72% vs. 47%-51%, p = 0.007); and Black participants had lower MoCA scores compared with White participants (20.9 ± 4.5 vs. 22.8 ± 3.9, p < 0.001). Depressive symptoms were common overall (43% GDS ≥5), yet underrecognized clinically (18%), especially in Black male participants compared with White male participants (7% vs. 20%). CONCLUSION Among older patients hospitalized for ADHF, frailty and functional impairments with high potential to jeopardize patient HF self-management, safety, and independence were common and severe across all race and sex groups. Impairment severity was often worse in Black participant and female participant groups. Formal screening across frailty and functional domains may identify those who may require greater support and more tailored care to reduce the risk of adverse events and excess hospitalizations and death.
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Affiliation(s)
- Fan Ye
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - M. Benjamin Nelson
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Grace L. Ditzenberger
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pamela Duncan
- Departments of Neurology, Sticht Center on Aging, Gerontology, and Geriatric Medicine (P.W.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert J. Mentz
- Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gordon Reeves
- Novant Health Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - David Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bharathi Upadhya
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, North Carolina, USA
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26
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Kaur G, Lau E. Sex differences in heart failure with preserved ejection fraction: From traditional risk factors to sex-specific risk factors. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221140209. [PMID: 36448661 PMCID: PMC9720805 DOI: 10.1177/17455057221140209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Heart failure with preserved ejection fraction has a higher prevalence in women versus men. There are several proposed mechanisms to explain this sex discrepancy including differences in cardiovascular adaptation to comorbidities and potential underlying etiologic mechanisms. In this review, we summarize sex differences in traditional risk factors, such as obesity, diabetes, hypertension, and coronary artery disease, which contribute to the development of heart failure with preserved ejection fraction in women. Furthermore, we explore female-specific risk factors, such as sex hormones, adverse pregnancy outcomes, and other reproductive factors, which may explain the predominance of heart failure with preserved ejection fraction in women. Beyond sex differences in risk factors, there are also significant sex differences in outcomes with women reporting lower quality of life but overall better survival versus men. Finally, while treatment options for patients with heart failure with preserved ejection fraction are still limited, sex differences have also been reported for the available therapies, with suggestion of preferential benefit of specific heart failure with preserved ejection fraction therapies in women. Further work is required to better understand sex differences in heart failure with preserved ejection fraction, including deeper understanding of pathophysiological mechanisms, derivation of more accurate risk stratification models, and increased representation of women in clinical trials.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA,Emily Lau, Division of Cardiology, Massachusetts General Hospital, 185 Cambridge Street, CPZN #3206, Boston, MA 02114, USA.
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27
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Butler J, Filippatos G, Siddiqi TJ, Ferreira JP, Brueckmann M, Bocchi E, Böhm M, Chopra VK, Giannetti N, Iwata T, Januzzi JL, Kaul S, Piña IL, Ponikowski P, Rauch-Kröhnert U, Shah SJ, Senni M, Sumin M, Verma S, Zhang J, Pocock SJ, Zannad F, Packer M, Anker SD. Effects of Empagliflozin in Women and Men With Heart Failure and Preserved Ejection Fraction. Circulation 2022; 146:1046-1055. [PMID: 36098051 PMCID: PMC9528945 DOI: 10.1161/circulationaha.122.059755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Women and men with heart failure (HF) and preserved ejection fraction may differ in their clinical characteristics and their response to therapy. The aim of this study was to evaluate the influence of sex on the effects of empagliflozin in patients with HF and preserved ejection fraction enrolled in the EMPEROR-Preserved trial (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction). METHODS The effects of empagliflozin on the primary outcome of cardiovascular death or hospitalization for HF and on secondary outcomes (including total HF hospitalization, cardiovascular and all-cause mortality, and Kansas City Cardiomyopathy Questionnaire scores) were compared in women and men in the overall cohort and in subgroups defined by left ventricular ejection fraction (41%-49%, 50%-59%, and ≥60%). The effects of empagliflozin on physiological measures, including changes in systolic blood pressure, uric acid, hemoglobin, body weight, and natriuretic peptide levels, were also assessed. RESULTS Of the 5988 patients randomized, 2676 (44.7%) were women. In the placebo arm, women tended to have lower risk for adverse outcomes, including a lower risk of all-cause mortality (hazard ratio, 0.69 [95% CI, 0.56, 0.84]). Compared with placebo, empagliflozin reduced the risk of cardiovascular death or hospitalization for HF to a similar degree in both sexes (hazard ratio, 0.81 [95% CI, 0.69, 0.96] for men; and hazard ratio, 0.75 [95% CI, 0.61, 0.92] for women; Pinteraction=0.54). Sex did not modify the relationship between empagliflozin and outcomes across ejection fraction groups. Similar results were seen for secondary outcomes and physiological measures. Compared with placebo, empagliflozin improved the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score to a similar extent in both sexes (1.38 for men versus 1.63 for women at 52 weeks; Pinteraction=0.77); the results were similar for Kansas City Cardiomyopathy Questionnaire overall summary score and total summary score. CONCLUSIONS Empagliflozin produced similar benefits on outcomes and health status in women and men with HF and preserved ejection fraction. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03057951.
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Affiliation(s)
- Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson (J.B., T.J.S.).,Baylor Scott and White Research Institute, Dallas, TX (J.B)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Greece (G.F.)
| | - Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi School of Medicine, Jackson (J.B., T.J.S.)
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques, Nancy, France (J.P.F., F.Z.).,Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (J.P.F., F.Z.).,Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal (J.P.F.)
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Ingelheim, Germany, and First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany (M. Brueckmann)
| | - Edimar Bocchi
- Heart Failure Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (E.B.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (M. Böhm)
| | - Vijay K. Chopra
- Max Superspeciality Hospital, Saket, New Delhi, India (V.K.C.)
| | - Nadia Giannetti
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (N.G.)
| | - Tomoko Iwata
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany (T.I.)
| | - James L. Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston (J.L.J.)
| | - Sanjay Kaul
- Cedars-Sinai Medical Center, Los Angeles, CA (S.K.)
| | | | | | - Ursula Rauch-Kröhnert
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin, Germany (U.R.-K.).,German Centre for Cardiovascular Research partner site Berlin (U.R.-K.)
| | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Michele Senni
- Cardiovascular Department, Cardiology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy (M. Senni)
| | - Mikhail Sumin
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (M. Sumin)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, ON, Canada (S.V.)
| | - Jian Zhang
- Fuwai Hospital Chinese Academic of Medical Science, Beijing, China (J.Z.)
| | - Stuart J. Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK (S.J.P.)
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques, Nancy, France (J.P.F., F.Z.).,Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (J.P.F., F.Z.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.).,Imperial College, London, UK (M.P.)
| | - Stefan D. Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, Germany (S.D.A.).,German Centre for Cardiovascular Research partner site Berlin (S.D.A.).,Charité Universitätsmedizin Berlin, Germany (S.D.A.)
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28
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Shuaishuai D, Jingyi L, Zhiqiang Z, Guanwei F. Sex differences and related estrogenic effects in heart failure with preserved ejection fraction. Heart Fail Rev 2022:10.1007/s10741-022-10274-2. [PMID: 36190606 DOI: 10.1007/s10741-022-10274-2] [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] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an essential subtype of heart failure accounting for 40% of the total. However, the related pathological mechanism and drug therapy research have been stagnant for a long time. The direct cause of this dilemma is the heterogeneity of HFpEF. And some researchers believe that there is no common pathway to reach the origin of HFpEF; others argue that there is an unidentified unified pathophysiological process hidden beneath the ice surface. Aside from the debate, a series of clinical studies have shown that hypertension and obesity play a fundamental role in the pathogenesis of HFpEF. These results imply that there may be two parallel pathological processes interweaved in one disease, manifested as multiple coexistent pathological phenomena, like a shadow. Meanwhile, the prevalence of HFpEF in women is higher than in men in any given age group, especially prominent in elderly patients. These pathological processes and epidemiological data reflect gender differences, reminding us to shift our attention to estrogen. This article will review the parallel pathogenesis of HFpEF, and also introduce sex differences and the potential effect of estrogen in this condition below.
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Affiliation(s)
- Deng Shuaishuai
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Acupuncture and Moxibustion, Tianjin, China
| | - Lin Jingyi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Acupuncture and Moxibustion, Tianjin, China
| | - Zhao Zhiqiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Acupuncture and Moxibustion, Tianjin, China
| | - Fan Guanwei
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China. .,National Clinical Research Center for Chinese Acupuncture and Moxibustion, Tianjin, China.
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29
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Eaton DM, Berretta RM, Lynch JE, Travers JG, Pfeiffer RD, Hulke ML, Zhao H, Hobby ARH, Schena G, Johnson JP, Wallner M, Lau E, Lam MPY, Woulfe KC, Tucker NR, McKinsey TA, Wolfson MR, Houser SR. Sex-specific responses to slow progressive pressure overload in a large animal model of HFpEF. Am J Physiol Heart Circ Physiol 2022; 323:H797-H817. [PMID: 36053749 PMCID: PMC9550571 DOI: 10.1152/ajpheart.00374.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
Approximately 50% of all heart failure (HF) diagnoses can be classified as HF with preserved ejection fraction (HFpEF). HFpEF is more prevalent in females compared with males, but the underlying mechanisms are unknown. We previously showed that pressure overload (PO) in male felines induces a cardiopulmonary phenotype with essential features of human HFpEF. The goal of this study was to determine if slow progressive PO induces distinct cardiopulmonary phenotypes in females and males in the absence of other pathological stressors. Female and male felines underwent aortic constriction (banding) or sham surgery after baseline echocardiography, pulmonary function testing, and blood sampling. These assessments were repeated at 2 and 4 mo postsurgery to document the effects of slow progressive pressure overload. At 4 mo, invasive hemodynamic studies were also performed. Left ventricle (LV) tissue was collected for histology, myofibril mechanics, extracellular matrix (ECM) mass spectrometry, and single-nucleus RNA sequencing (snRNAseq). The induced pressure overload (PO) was not different between sexes. PO also induced comparable changes in LV wall thickness and myocyte cross-sectional area in both sexes. Both sexes had preserved ejection fraction, but males had a slightly more robust phenotype in hemodynamic and pulmonary parameters. There was no difference in LV fibrosis and ECM composition between banded male and female animals. LV snRNAseq revealed changes in gene programs of individual cell types unique to males and females after PO. Based on these results, both sexes develop cardiopulmonary dysfunction but the phenotype is somewhat less advanced in females.NEW & NOTEWORTHY We performed a comprehensive assessment to evaluate the effects of slow progressive pressure overload on cardiopulmonary function in a large animal model of heart failure with preserved ejection fraction (HFpEF) in males and females. Functional and structural assessments were performed at the organ, tissue, cellular, protein, and transcriptional levels. This is the first study to compare snRNAseq and ECM mass spectrometry of HFpEF myocardium from males and females. The results broaden our understanding of the pathophysiological response of both sexes to pressure overload. Both sexes developed a robust cardiopulmonary phenotype, but the phenotype was equal or a bit less robust in females.
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Affiliation(s)
- Deborah M Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Remus M Berretta
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jacqueline E Lynch
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Physiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Joshua G Travers
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alexander R H Hobby
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Giana Schena
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jaslyn P Johnson
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Markus Wallner
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Edward Lau
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maggie P Y Lam
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathleen C Woulfe
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nathan R Tucker
- Masonic Medical Research Institute, Utica, New York
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Boston, Massachusetts
| | - Timothy A McKinsey
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marla R Wolfson
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Physiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Steven R Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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Baratto C, Caravita S, Soranna D, Dewachter C, Bondue A, Zambon A, Badano LP, Parati G, Vachiéry J. Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail 2022; 9:3079-3091. [PMID: 35748109 PMCID: PMC9715813 DOI: 10.1002/ehf2.13979] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects. METHODS AND RESULTS We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty-seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29-31] vs. 16 [15-17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I2 = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20-4.28] vs. 0.95 [0.30-1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007). CONCLUSIONS Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice.
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Affiliation(s)
- Claudia Baratto
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico Italiano IRCCS, Ospedale San LucaMilanItaly
- Department of CardiologyHopital Universitaire de Bruxelles, Hôpital Académique Erasme808 Route de Lennik1070BruxellesBelgium
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico Italiano IRCCS, Ospedale San LucaMilanItaly
- Department of Management, Information and Production EngineeringUniversity of BergamoDalmineItaly
| | - Davide Soranna
- Biostatistics UnitIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Céline Dewachter
- Department of CardiologyHopital Universitaire de Bruxelles, Hôpital Académique Erasme808 Route de Lennik1070BruxellesBelgium
| | - Antoine Bondue
- Department of CardiologyHopital Universitaire de Bruxelles, Hôpital Académique Erasme808 Route de Lennik1070BruxellesBelgium
| | - Antonella Zambon
- Biostatistics UnitIRCCS Istituto Auxologico ItalianoMilanItaly
- Department of Statistic and Quantitative MethodsUniversity of Milano‐BicoccaMilanItaly
| | - Luigi P. Badano
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico Italiano IRCCS, Ospedale San LucaMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico Italiano IRCCS, Ospedale San LucaMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Jean‐Luc Vachiéry
- Department of CardiologyHopital Universitaire de Bruxelles, Hôpital Académique Erasme808 Route de Lennik1070BruxellesBelgium
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31
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Andersen MJ, Wolsk E, Bakkestrøm R, Christensen N, Carter-Storch R, Omar M, Dahl JS, Frederiksen PH, Borlaug B, Gustafsson F, Hassager C, Moller JE. Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction. Heart 2022; 108:1895-1903. [PMID: 36356959 PMCID: PMC9664118 DOI: 10.1136/heartjnl-2022-321204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Haemodynamic exercise testing is important for evaluating patients with dyspnoea on exertion and preserved ejection fraction. Despite very different pathologies, patients with pressure (aortic stenosis (AS)) and volume (mitral regurgitation (MR)) overload and diastolic dysfunction after recent acute myocardial infarction (AMI) reach similar filling pressure levels with exercise. The pressure–flow relationships (the association between change in cardiac output (∆CO) and change in pulmonary arterial wedge pressure (∆PAWP) may provide insight into haemodynamic adaptation to exercise in these groups. Methods and results One hundred sixty-eight subjects aged >50 years with a left ventricular ejection fraction of ≥50% underwent invasive exercise testing. They were enrolled in four different studies: AS (40 patients), AMI (52 patients), MR (43 patients) and 33 healthy subjects. Haemodynamic data were measured at rest, at 25 W, 75 W and at peak exercise. In all groups, PAWP increased with exercise. The greatest increase was observed in patients with AMI (from 12.7±3.9 mm Hg to 33.1±8.2 mm Hg, p<0.0001) and patients with AS (from 11.8±3.9 mm Hg to 31.4±6.1 mm Hg, p<0.0001), and the smallest was observed in healthy subjects (from 8.3±2.4 mm Hg to 21.1±7.5 mm Hg, p<0.0001). In all groups, the relative pressure increase was greatest at the beginning of the exercise. CO increased most in healthy patients (from 5.3±1.1 to 16.0±3.0 L/min, p<0.0001) and least in patients with AS (from 5.3±1.2 L/min to 12.4±2.6 L/min, p<0.0001). The pressure–flow relationships (∆PAWP/∆CO) and differed among groups (p=0.02). In all groups, the pressure–flow relationship was steepest in the initial phase of the exercise test. The AMI and AS groups (2.3±1.2 mm Hg/L/min and 3.0±1.3 mm Hg/L/min, AMI and AS, respectively) had the largest overall pressure–flow relationship; the healthy group had the smallest initially and at peak exercise (1.3±1.1 mm Hg/L/min) followed by MR group (1.9±1.4 mm Hg/L/min). Conclusion The pressure–flow relationship was steepest in the initial phase of the exercise test in all groups. The pressure–flow relationship differs between groups. Trial registration numbers NCT01974557, NCT01046838, NCT02961647 and NCT02395107.
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Affiliation(s)
- Mads J Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil Wolsk
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Rine Bakkestrøm
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Barry Borlaug
- Department of Cardiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Jacob E Moller
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Ma Y, Shi Y, Ma W, Yang D, Hu Z, Wang M, Cao X, Zhang C, Luo X, He S, Zhang M, Duan Y, Cai H. A prospective study on sex differences in functional capacity, quality of life and prognosis in patients with heart failure. Medicine (Baltimore) 2022; 101:e29795. [PMID: 35777016 PMCID: PMC9239662 DOI: 10.1097/md.0000000000029795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Due to the lack of evidence and inconsistency of sex differences in Heart failure (HF) in the Chinese population, this study aimed to compare sex differences in functional capacity and quality of life (QoL) between women and men after standard HF medications therapies, and analyze whether sex differences were associated with the composite endpoints of all-cause mortality or HF-related hospitalization and cardiac event-free survival rate in Chinese patients with HF. METHODS This was a 1-year longitudinal study. Participants included patients with HF from March 2017 to December 2018. At baseline and followed up at 1, 6, and 12 months later, functional capacity was assessed by 6-minute walk testing (6MWT), QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQoL five dimensions (EQ-5D). The Cox proportional hazards model and Kaplan-Meier curves were used to determine sex differences in subsequent outcomes. The Cox proportional hazards model was used to identify the risk factors for composite endpoints. Kaplan-Meier curves were used to compare survival. RESULTS All patients were assigned to either men group (n = 94) or women group (n = 60). Longitudinal follow-ups showed a continuously increasing in 6MWT, Kansas City Cardiomyopathy Questionnaire overall score, EQ-5D visual analogue scale, and EQ-5D Index score in both groups (all P < 0.001); however, women reported a lower level of all parameters at the 1, 6, and 12 months follow-ups (all P < 0.05). In addition, women had a higher risk of all-cause mortality or HF-related hospitalization and a lower cardiac event-free survival rate than men (log-rank test, P = 0.027). CONCLUSION Women reported worse functional capacity, QoL, and prognosis than men in a sample of Chinese patients with HF. Our findings highlight the importance of paying attention to sex differences in HF.
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Affiliation(s)
- Yiming Ma
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yunke Shi
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wenfang Ma
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Dan Yang
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhao Hu
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Mingqiang Wang
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xingyu Cao
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chaoyue Zhang
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiang Luo
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shulin He
- Cardiology Department, People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, China
| | - Min Zhang
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yong Duan
- Yunnan Key Laboratory of Laboratory Medicine, Yunnan Institute of Experimental Diagnosis, Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Hongyan Cai, Cardiology Department, the First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming 650032, China (e-mail: )
| | - Hongyan Cai
- Cardiology Department, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Hongyan Cai, Cardiology Department, the First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming 650032, China (e-mail: )
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Argirò A, Ho C, Day SM, van der Velden J, Cerbai E, Saberi S, Tardiff JC, Lakdawala NK, Olivotto I. Sex-Related Differences in Genetic Cardiomyopathies. J Am Heart Assoc 2022; 11:e024947. [PMID: 35470690 PMCID: PMC9238595 DOI: 10.1161/jaha.121.024947] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiomyopathies are a heterogeneous collection of diseases that have in common primary functional and structural abnormalities of the heart muscle, often genetically determined. The most effective categorization of cardiomyopathies is based on the presenting phenotype, with hypertrophic, dilated, arrhythmogenic, and restrictive cardiomyopathy as the prototypes. Sex modulates the prevalence, morpho-functional manifestations and clinical course of cardiomyopathies. Aspects as diverse as ion channel expression and left ventricular remodeling differ in male and female patients with myocardial disease, although the reasons for this are poorly understood. Moreover, clinical differences may also result from complex societal/environmental discrepancies between sexes that may disadvantage women. This review provides a state-of-the-art appraisal of the influence of sex on cardiomyopathies, highlighting the many gaps in knowledge and open research questions.
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Affiliation(s)
- Alessia Argirò
- Cardiomyopathy UnitCareggi University HospitalFlorenceItaly
- Department of Experimental and Clinical MedicineUniversity of FlorenceItaly
- Division of General CardiologyCareggi University HospitalFlorenceItaly
| | - Carolyn Ho
- Cardiovascular DivisionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
| | - Sharlene M. Day
- Division of Cardiovascular MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Jolanda van der Velden
- Department of PhysiologyAmsterdam Cardiovascular SciencesAmsterdam University Medical CenterVrije UniversiteitAmsterdamNetherlands
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child HealthUniversity of FlorenceItaly
| | - Sara Saberi
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganMichigan MedicineAnn ArborMI
| | - Jil C. Tardiff
- Department of Biomedical EngineeringThe University of ArizonaTucsonAZ
| | - Neal K. Lakdawala
- Cardiovascular DivisionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
| | - Iacopo Olivotto
- Cardiomyopathy UnitCareggi University HospitalFlorenceItaly
- Department of Experimental and Clinical MedicineUniversity of FlorenceItaly
- Division of General CardiologyCareggi University HospitalFlorenceItaly
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Phang RJ, Ritchie RH, Hausenloy DJ, Lees JG, Lim SY. Cellular interplay between cardiomyocytes and non-myocytes in diabetic cardiomyopathy. Cardiovasc Res 2022; 119:668-690. [PMID: 35388880 PMCID: PMC10153440 DOI: 10.1093/cvr/cvac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with Type 2 diabetes mellitus (T2DM) frequently exhibit a distinctive cardiac phenotype known as diabetic cardiomyopathy. Cardiac complications associated with T2DM include cardiac inflammation, hypertrophy, fibrosis and diastolic dysfunction in the early stages of the disease, which can progress to systolic dysfunction and heart failure. Effective therapeutic options for diabetic cardiomyopathy are limited and often have conflicting results. The lack of effective treatments for diabetic cardiomyopathy is due in part, to our poor understanding of the disease development and progression, as well as a lack of robust and valid preclinical human models that can accurately recapitulate the pathophysiology of the human heart. In addition to cardiomyocytes, the heart contains a heterogeneous population of non-myocytes including fibroblasts, vascular cells, autonomic neurons and immune cells. These cardiac non-myocytes play important roles in cardiac homeostasis and disease, yet the effect of hyperglycaemia and hyperlipidaemia on these cell types are often overlooked in preclinical models of diabetic cardiomyopathy. The advent of human induced pluripotent stem cells provides a new paradigm in which to model diabetic cardiomyopathy as they can be differentiated into all cell types in the human heart. This review will discuss the roles of cardiac non-myocytes and their dynamic intercellular interactions in the pathogenesis of diabetic cardiomyopathy. We will also discuss the use of sodium-glucose cotransporter 2 inhibitors as a therapy for diabetic cardiomyopathy and their known impacts on non-myocytes. These developments will no doubt facilitate the discovery of novel treatment targets for preventing the onset and progression of diabetic cardiomyopathy.
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Affiliation(s)
- Ren Jie Phang
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia.,Departments of Surgery and Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Rebecca H Ritchie
- School of Biosciences, Parkville, Victoria 3010, Australia.,Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, Victoria 3052, Australia.,Department of Pharmacology, Monash University, Clayton, Victoria 3800, Australia
| | - Derek J Hausenloy
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,The Hatter Cardiovascular Institute, University College London, London, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Jarmon G Lees
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia.,Departments of Surgery and Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Shiang Y Lim
- O'Brien Institute Department, St Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia.,Departments of Surgery and Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
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35
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Stokar J, Gurt I, Cohen-Kfir E, Yakubovsky O, Hallak N, Benyamini H, Lishinsky N, Offir N, Tam J, Dresner-Pollak R. Hepatic Adropin is Regulated by Estrogen and Contributes to Adverse Metabolic Phenotypes in Ovariectomized Mice. Mol Metab 2022; 60:101482. [PMID: 35364299 PMCID: PMC9044006 DOI: 10.1016/j.molmet.2022.101482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Menopause is associated with visceral adiposity, hepatic steatosis and increased risk for cardiovascular disease. As estrogen replacement therapy is not suitable for all postmenopausal women, a need for alternative therapeutics and biomarkers has emerged. Methods 9-week-old C57BL/6 J female mice were subjected to ovariectomy (OVX) or SHAM surgery (n = 10 per group), fed a standard diet and sacrificed 6- & 12 weeks post-surgery. Results Increased weight gain, hepatic triglyceride content and changes in hepatic gene expression of Cyp17a1, Rgs16, Fitm1 as well as Il18, Rares2, Retn, Rbp4 in mesenteric visceral adipose tissue (VAT) were observed in OVX vs. SHAM. Liver RNA-sequencing 6-weeks post-surgery revealed changes in genes and microRNAs involved in fat metabolism in OVX vs. SHAM mice. Energy Homeostasis Associated gene (Enho) coding for the hepatokine adropin was significantly reduced in OVX mice livers and strongly inversely correlated with weight gain (r = −0.7 p < 0.001) and liver triglyceride content (r = −0.4, p = 0.04), with a similar trend for serum adropin. In vitro, Enho expression was tripled by 17β-estradiol in BNL 1 ME liver cells with increased adropin in supernatant. Analysis of open-access datasets revealed increased hepatic Enho expression in estrogen treated OVX mice and estrogen dependent ERα binding to Enho. Treatment of 5-month-old OVX mice with Adropin (i.p. 450 nmol/kg/twice daily, n = 4,5 per group) for 6-weeks reversed adverse adipokine gene expression signature in VAT, with a trended increase in lean body mass and decreased liver TG content with upregulation of Rgs16. Conclusions OVX is sufficient to induce deranged metabolism in adult female mice. Hepatic adropin is regulated by estrogen, negatively correlated with adverse OVX-induced metabolic phenotypes, which were partially reversed with adropin treatment. Adropin should be further explored as a potential therapeutic target and biomarker for menopause-related metabolic derangement. OVX increased body weight, liver fat & adverse visceral fat adipokine signature. OVX altered liver transcriptome & miRNA profile including fat metabolism pathways. Enho was downregulated by OVX & inversely correlated with weight gain & liver fat. Hepatic adropin expression was upregulated by estrogen in-vitro & in-vivo. Adropin treatment partially reversed OVX induced adverse metabolic phenotypes.
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36
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DeFilippis EM, Beale A, Martin T, Agarwal A, Elkayam U, Lam CSP, Hsich E. Heart Failure Subtypes and Cardiomyopathies in Women. Circ Res 2022; 130:436-454. [PMID: 35175847 PMCID: PMC10361647 DOI: 10.1161/circresaha.121.319900] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.
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Affiliation(s)
| | - Anna Beale
- Department of Cardiology, Alfred Hospital, Melbourne, Australia (A.B.)
| | - Trejeeve Martin
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
| | - Anubha Agarwal
- Northwestern University Feinberg School of Medicine (A.A.)
| | - Uri Elkayam
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California (U.E.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
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37
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Zhou D, Liu X, Lo K, Huang Y, Feng Y. The effect of total cholesterol/high-density lipoprotein cholesterol ratio on mortality risk in the general population. Front Endocrinol (Lausanne) 2022; 13:1012383. [PMID: 36589799 PMCID: PMC9797665 DOI: 10.3389/fendo.2022.1012383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The relationship between the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and all-cause and cardiovascular mortality has not been elucidated. Herein, we intend to probe the effect of the TC/HDL-C ratio on all-cause and cardiovascular mortality in the general population. METHODS From the 1999-2014 National Health and Nutrition Examination Surveys (NHANES), a total of 32,405 health participants aged ≥18 years were included. The TC/HDL-C levels were divided into five groups: Q1: <2.86, Q2: 2.86-3.46, Q3: 3.46-4.12, Q4: 4.12-5.07, Q5: >5.07. Multivariate Cox regression models were used to explore the relationship between the TC/HDL-C ratio and cardiovascular and all-cause mortality. Two-piecewise linear regression models and restricted cubic spline regression were used to explore nonlinear and irregularly shaped relationships. Kaplan-Meier survival curve and subgroup analyses were conducted. RESULTS The population comprised 15,675 men and 16,730 women with a mean age of 43 years. During a median follow-up of 98 months (8.1 years), 2,859 mortality cases were recorded. The TC/HDL-C ratio and all-cause mortality showed a nonlinear association after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause mortality were particularly positively related to the level of TC/HDL-C ratio in the higher range >5.07 and in the lower range <2.86 (HR 1.26; 95% CI 1.10, 1.45; HR 1.18; 95% CI 1.00, 1.38, respectively), although the HRs of cardiovascular disease mortality showed no difference among the five groups. In the two-piecewise linear regression model, a TC/HDL-C ratio range of ≥4.22 was positively correlated with cardiovascular mortality (HR 1.13; 95% CI 1.02, 1.25). In the subgroup analysis, a nonlinear association between TC/HDL-C and all-cause mortality was found in those aged <65 years, men, and the no lipid drug treatment population. CONCLUSION A nonlinear association between the TC/HDL-C ratio and all-cause mortality was found, indicating that a too-low or too-high TC/HDL-C ratio might increase all-cause mortality. However, for cardiovascular mortality, it does not seem so. The cutoff value was 4.22. The individuals had higher cardiovascular mortality with a TC/HDL-C ratio >4.22.
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Affiliation(s)
- Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaocong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, United States
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Yingqing Feng,
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Under-Enrollment of Obese Heart Failure with Preserved Ejection Fraction Patients in Major HFpEF Clinical Trials. J Card Fail 2021; 28:723-731. [PMID: 34933099 DOI: 10.1016/j.cardfail.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Therapy for heart failure with preserved ejection fraction (HFpEF) remains an unmet need with lack of consensus definition of HFpEF for inclusion into clinical trials. We evaluated for whether hemodynamically characterized patients from a HFpEF referral center met inclusion criteria for 4 major HFpEF trials. METHODS Patients were assessed for theoretical inclusion into four major clinical trials (I-PRESERVE, RELAX, TOPCAT, and PARAGON-HF). Clinical, echocardiographic, hemodynamic characteristics, and cardiovascular outcomes were compared between patients who met inclusion criteria versus those who did not for each trial. RESULTS Of 131 HFpEF patients, 23% of patients met enrollment criteria for I-PRESERVE, 38% for RELAX, 18% for TOPCAT, and 13% for PARAGON-HF. The top criteria that excluded patients included low natriuretic peptide level, obesity, uncontrolled hypertension, young age, and low hemoglobin. There was no difference in probability of HF hospitalization or death in patients included or excluded into each clinical trial. CONCLUSION In a cohort with hemodynamic evidence of HFpEF, a low proportion of patients met inclusion criteria for major HFpEF clinical trials, with no difference in outcomes in patients who did or did not meet inclusion criteria. Given the lack of proven therapies in HFpEF, consideration should be given to modifying criteria to represent contemporary HFpEF patients in future clinical trials.
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Kaye DM, Wolsk E, Nanayakkara S, Mariani J, Hassager C, Gustafsson F, Moller JE, Sunagawa K, Burkhoff D. Comprehensive Physiological Modeling Provides Novel Insights Into Heart Failure With Preserved Ejection Fraction Physiology. J Am Heart Assoc 2021; 10:e021584. [PMID: 34569288 PMCID: PMC8649144 DOI: 10.1161/jaha.121.021584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Although a rapid rise in left atrial pressure during exertion is considered pathognomonic of heart failure with preserved ejection fraction (HFpEF), the fundamental circulatory determinants of this response are not clear, impacting upon the development of more effective therapies. We aimed to comprehensively describe the circulatory mechanics of patients with HFpEF at rest and during exercise in comparison with controls. Methods and Results We performed simultaneous right‐heart catheterization and echocardiography at rest and during exercise in 22 healthy control volunteers and 60 patients with confirmed HFpEF. Using detailed individual patient‐level hemodynamic and left ventricular ejection fraction data we performed computer simulations to evaluate the circulatory parameters including the estimated stressed blood volumethat contribute to the resting and exercise pulmonary capillary pressure. At rest and during exercise, left ventricular stiffness (V30, the end‐diastolic pressure–volume relationship at a filling pressure of 30 mm Hg), left ventricular elastance, and arterial elastance were all significantly greater in HFpEF than in controls. Stressed blood volume was significantly greater in HFpEF (26.9±5.4 versus 20.2±4.7 mL/kg, P<0.001), becoming even more pronounced during exercise (40.9±3.7 versus 27.5±7.0 mL per 70 kg, P<0.001). During exercise, the magnitude of the change in stressed blood volume (r=0.67, P<0.001) and left ventricular stiffness (r=−0.44, P<0.001) were key determinants of the rise in pulmonary capillary wedge pressure. Further detailed modeling studies showed that the hemodynamic response to exercise results from a complex non‐linear interaction between circulatory parameters. Conclusions The circulatory determinants of HFpEF physiology are complex. We identified stressed blood volume at rest and during exercise is a novel, key factor, therebyrepresenting an important potential therapeutic target.
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Affiliation(s)
- David M Kaye
- Department of Cardiology Alfred Hospital Melbourne Australia.,Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Medicine Monash University Melbourne Australia
| | - Emil Wolsk
- Department of Cardiology Herlev-Gentofte Hospital Copenhagen Denmark
| | - Shane Nanayakkara
- Department of Cardiology Alfred Hospital Melbourne Australia.,Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Medicine Monash University Melbourne Australia
| | - Justin Mariani
- Department of Cardiology Alfred Hospital Melbourne Australia.,Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Medicine Monash University Melbourne Australia
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet University of Copenhagen Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet University of Copenhagen Denmark
| | - Jacob E Moller
- Department of Cardiology, Rigshospitalet University of Copenhagen Denmark.,Department of Cardiology Odense University Hospital Denmark
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine Kyushu University School of Medicine Fukuoka Japan
| | - Daniel Burkhoff
- Department of Medicine Columbia University Medical School New York NY
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40
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Sun J, Tai S, Guo Y, Tang L, Yang H, Li X, Xing Z, Fu L, Zhou S. Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Post-hoc Analysis From TOPCAT. Front Cardiovasc Med 2021; 8:721850. [PMID: 34671652 PMCID: PMC8520937 DOI: 10.3389/fcvm.2021.721850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Although the impact of sex on patient outcomes for heart failure (HF) with preserved ejection fraction (HFpEF) has been reported, it is still unclear whether this impact is applicable for elderly patients with HFpEF. This study was conducted as a secondary analysis from a large randomized controlled trial-The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT)-to evaluate the impact of sex differences on the baseline characteristics and outcomes of HFpEF patients who were older than 70 years. Methods: Baseline characteristic of elderly patients were compared between men and women. Primary outcomes were cardiovascular (CV) mortality and HF-related hospitalization, whereas secondary outcomes were all-cause mortality and all-cause hospitalization. Cox regression models were used to determine the effect of sex differences on patient outcomes. Results: A total of 1,619 patients were included in the study: 898 (55.5%) women and 721 (44.5%) men. Age was similar between women and men. Women had fewer comorbidities but worse cardiac function than men. The rate of primary outcomes was lower in women than in men (18.4 vs. 27.5%; p < 0.001), including rate of CV mortality (8.9 vs. 14.8%; p < 0.001) and HF-related hospitalization (13.4 vs. 18.2%; p = 0.008). All-cause mortality was also lower in women than in men (15.6 vs. 25.4%; p < 0.001). After adjustment for baseline characteristics, Cox regression analysis showed that female sex was a protective factor for CV mortality [hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.40-0.73], HF-related hospitalization (HR: 0.71; 95% CI: 0.55-0.93), and all-cause mortality (HR: 0.59; 95% CI: 0.47-0.75). Although spironolactone significantly reduced the rate of all-cause mortality in women even after adjusting for baseline characteristics (HR: 0.68; 95% CI: 0.48-0.96; p = 0.028), no significant multivariate association was noted between sex and treatment effects (p = 0.190). Conclusion: Among elderly patients with HFpEF, women had worse cardiac function but better survival and lower HF-related hospitalization rate than men. Clinical Trial Registration: NCT00094302 (TOPCAT). Registered October 15, 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302.
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Affiliation(s)
- Jiaxing Sun
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Tai
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Guo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liang Tang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xuping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
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Pandey A, Shah SJ, Butler J, Kellogg DL, Lewis GD, Forman DE, Mentz RJ, Borlaug BA, Simon MA, Chirinos JA, Fielding RA, Volpi E, Molina AJA, Haykowsky MJ, Sam F, Goodpaster BH, Bertoni AG, Justice JN, White JP, Ding J, Hummel SL, LeBrasseur NK, Taffet GE, Pipinos II, Kitzman D. Exercise Intolerance in Older Adults With Heart Failure With Preserved Ejection Fraction: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1166-1187. [PMID: 34503685 PMCID: PMC8525886 DOI: 10.1016/j.jacc.2021.07.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
Exercise intolerance (EI) is the primary manifestation of chronic heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure among older individuals. The recent recognition that HFpEF is likely a systemic, multiorgan disorder that shares characteristics with other common, difficult-to-treat, aging-related disorders suggests that novel insights may be gained from combining knowledge and concepts from aging and cardiovascular disease disciplines. This state-of-the-art review is based on the outcomes of a National Institute of Aging-sponsored working group meeting on aging and EI in HFpEF. We discuss aging-related and extracardiac contributors to EI in HFpEF and provide the rationale for a transdisciplinary, "gero-centric" approach to advance our understanding of EI in HFpEF and identify promising new therapeutic targets. We also provide a framework for prioritizing future research, including developing a uniform, comprehensive approach to phenotypic characterization of HFpEF, elucidating key geroscience targets for treatment, and conducting proof-of-concept trials to modify these targets.
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Affiliation(s)
- Ambarish Pandey
- University of Texas Southwestern Medical Center, Dallas, Texas, USA. https://twitter.com/ambarish4786
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dean L Kellogg
- University of Texas Health Science Center and GRECC, South Texas Veterans Affairs Health System, San Antonio, Texas, USA
| | | | - Daniel E Forman
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Robert J Mentz
- Duke Clinical Research Center, Durham, North Carolina, USA
| | | | - Marc A Simon
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | | | | | - Elena Volpi
- University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | | | - Flora Sam
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bret H Goodpaster
- Advent Health Translational Research Institute, Orlando, Florida, USA
| | - Alain G Bertoni
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jamie N Justice
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jingzhone Ding
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Scott L Hummel
- University of Michigan and the VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | | | | | | | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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42
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Seeland U, Nemcsik J, Lønnebakken MT, Kublickiene K, Schluchter H, Park C, Pucci G, Mozos I, Bruno RM. Sex and Gender Aspects in Vascular Ageing - Focus on Epidemiology, Pathophysiology, and Outcomes. Heart Lung Circ 2021; 30:1637-1646. [PMID: 34452844 DOI: 10.1016/j.hlc.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022]
Abstract
Sex and gender are important modifiers of cardiovascular system physiology, pathophysiology, and disease development. The atherosclerosis process, together with the progressive loss of arterial elasticity with age, is a major factor influencing the development of overt cardiovascular, renal, and cerebrovascular disease. While differences between women and men in epidemiology and pathophysiology of vascular ageing are increasingly reported, sex-disaggregated data are still scarcely available for prospective studies. A better knowledge of sex differences in physiological ageing as well as in disease-related changes in vascular ageing trajectories is crucial to avoid misdiagnosis and mistreatment. This review presents key concepts and knowledge gaps identified in vascular ageing due to gonadal function, vascular physiology, pathophysiology, psychosocial factors, pregnancy, and prognostic relevance. Gender roles determine the effectiveness of any cardiovascular preventive strategy and acceptance for non-invasive or invasive diagnostics and therapeutics. Gender differences in health behaviour, also due to sociocultural norms conditioned by society, contribute to behaviours that may lead to premature arterial vascular ageing. These include differences in risk behaviours like smoking, diet, exercise, and in stress, but also conditions such as housing, noise pollution, poverty, disability, and any kind of stigmatisation. The VascAgeNet Gender Expert Group aims to advance the use of non-invasive vascular ageing measures in routine clinical settings by providing facts to fill in the gaps concerning sex and gender differences at each step of this process, and to search for solutions.
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Affiliation(s)
- Ute Seeland
- Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - János Nemcsik
- Semmelweis University, Department of Family Medicine and Health Service of Zuglo (ZESZ), Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Karolina Kublickiene
- Institution for Clinical Science, Intervention & Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Schluchter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital - Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ioana Mozos
- Department of Functional Sciences - Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Rosa-Maria Bruno
- University of Paris and Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital and Cardiovascular Research Center - PARCC INSERM, Paris, France
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43
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Sethares KA, Chin E. Age and gender differences in physical heart failure symptom clusters. Heart Lung 2021; 50:832-837. [PMID: 34311226 DOI: 10.1016/j.hrtlng.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gender differences exist in structure and function of the heart resulting in HF symptom variation. Previous HF symptom cluster research described symptom clusters that were linked to functional status, mortality, quality of life and rehospitalization. Age and gender differences between cluster groups were described in one study. OBJECTIVES Identify physical HF symptom clusters and explore age and gender differences between clusters. METHODS Secondary analysis study of adults with HF. Cluster analysis was conducted using hierarchical agglomerative clustering techniques. A pictorial dendrogram output displays clusters. RESULTS Three symptom clusters were identified in this sample of 133 older HF patients that differed by gender (p = 0.04), age (p = 0.00) and beta blocker use (p = 0.01). Symptom clusters were consistent with worsening HF, acute HF and chronic HF. CONCLUSION Symptom clusters differ by age and gender. Education should be directed at increasing patient awareness of their individual symptom clusters.
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Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States.
| | - Elizabeth Chin
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States
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44
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Beale AL, O'Donnell JA, Nakai ME, Nanayakkara S, Vizi D, Carter K, Dean E, Ribeiro RV, Yiallourou S, Carrington MJ, Marques FZ, Kaye DM. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e020654. [PMID: 34212778 PMCID: PMC8403331 DOI: 10.1161/jaha.120.020654] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Risk factors for heart failure with preserved ejection fraction (HFpEF) include hypertension, age, sex, and obesity. Emerging evidence suggests that the gut microbiota independently contributes to each one of these risk factors, potentially mediated via gut microbial‐derived metabolites such as short‐chain fatty acids. In this study, we determined whether the gut microbiota were associated with HFpEF and its risk factors. Methods and Results We recruited 26 patients with HFpEF and 67 control participants from 2 independent communities. Patients with HFpEF were diagnosed by exercise right heart catheterization. We assessed the gut microbiome by bacterial 16S rRNA sequencing and food intake by the food frequency questionnaire. There was a significant difference in α‐diversity (eg, number of microbes) and β‐diversity (eg, type and abundance of microbes) between both cohorts of controls and patients with HFpEF (P=0.001). We did not find an association between β‐diversity and specific demographic or hemodynamic parameters or risk factors for HFpEF. The Firmicutes to Bacteroidetes ratio, a commonly used marker of gut dysbiosis, was lower, but not significantly so (P=0.093), in the patients with HFpEF. Compared with controls, the gut microbiome of patients with HFpEF was depleted of bacteria that are short‐chain fatty acid producers. Consistent with this, participants with HFpEF consumed less dietary fiber (17.6±7.7 versus 23.2±8.8 g/day; P=0.016). Conclusions We demonstrate key changes in the gut microbiota in patients with HFpEF, including the depletion of bacteria that generate metabolites known to be important for cardiovascular homeostasis. Further studies are required to validate the role of these gut microbiota and metabolites in the pathophysiology of HFpEF.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Joanne A O'Donnell
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Michael E Nakai
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Shane Nanayakkara
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia
| | - Donna Vizi
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Kaye Carter
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Eliza Dean
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Rosilene V Ribeiro
- School of Life and Environmental Sciences, Charles Perkins Centre University of Sydney Australia
| | - Stephanie Yiallourou
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Francine Z Marques
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - David M Kaye
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
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Horodinschi RN, Diaconu CC. Comorbidities Associated with One-Year Mortality in Patients with Atrial Fibrillation and Heart Failure. Healthcare (Basel) 2021; 9:830. [PMID: 34356208 PMCID: PMC8303755 DOI: 10.3390/healthcare9070830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). METHODS We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). RESULTS The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45-3.83), coronary artery disease (OR 1.67, 95% CI 1.06-2.62), and diabetes (OR 1.66, 95% CI 1.05-2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36-4.39). CONCLUSIONS One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.
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Affiliation(s)
- Ruxandra Nicoleta Horodinschi
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
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46
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Espersen C, Campbell RT, Claggett B, Lewis EF, Groarke JD, Docherty KF, Lee MM, Lindner M, Biering‐Sørensen T, Solomon SD, McMurray JJ, Platz E. Sex differences in congestive markers in patients hospitalized for acute heart failure. ESC Heart Fail 2021; 8:1784-1795. [PMID: 33709520 PMCID: PMC8120385 DOI: 10.1002/ehf2.13300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 01/06/2023] Open
Abstract
AIMS We sought to examine sex differences in congestion in patients hospitalized for acute heart failure (AHF). Understanding congestive patterns in women and men with AHF may provide insights into sex differences in the presentation and prognosis of AHF patients. METHODS AND RESULTS In a prospective, two-site study in adults hospitalized for AHF, four-zone lung ultrasound (LUS) was performed at the time of echocardiography at baseline (LUS1) and, in a subset, pre-discharge (LUS2). B-lines on LUS and echocardiographic images were analysed offline, blinded to clinical information and outcomes. Among 349 patients with LUS1 data (median age 74, 59% male, and 87% White), women had higher left ventricular ejection fraction (mean 43% vs. 36%, P < 0.001), higher tricuspid annular plane systolic excursion (mean 17 vs. 15 mm, P = 0.021), and higher measures of filling pressures (median E/e' 20 vs. 16, P < 0.001). B-line number on LUS1 (median 6 vs. 6, P = 0.69) and admission N-terminal pro-B-type natriuretic peptide levels (median 3932 vs. 3483 pg/mL, P = 0.77) were similar in women and men. In 121 patients with both LUS1 and LUS2 data, there was a similar and significant decrease in B-lines from baseline to discharge in both women and men. The risk of the composite 90 day outcome increased with higher B-line number on four-zone LUS2: unadjusted hazard ratio for each B-line tertile was 1.86 (95% confidence interval 1.08-3.20, P = 0.025) in women and 1.65 (95% confidence interval 1.03-2.64, P = 0.037) in men (interaction P = 0.72). CONCLUSIONS Among patients with AHF, echocardiographic markers differed between women and men at baseline, whereas B-line number on LUS did not. The dynamic changes in B-lines during a hospitalization for AHF were similar in women and men.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Division/Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMAUSA
| | - Ross T. Campbell
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Brian Claggett
- The Division of Cardiovascular MedicineStanford University Medical CenterCAUSA
| | - Eldrin F. Lewis
- The Division of Cardiovascular MedicineStanford University Medical CenterCAUSA
| | - John D. Groarke
- The Division of Cardiovascular MedicineStanford University Medical CenterCAUSA
| | - Kieran F. Docherty
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Matthew M.Y. Lee
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Moritz Lindner
- Cardiovascular Division/Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMAUSA
| | - Tor Biering‐Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Scott D. Solomon
- Cardiovascular Division/Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMAUSA
| | - John J.V. McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Elke Platz
- Cardiovascular Division/Department of Emergency MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMAUSA
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47
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Fourny N, Beauloye C, Bernard M, Horman S, Desrois M, Bertrand L. Sex Differences of the Diabetic Heart. Front Physiol 2021; 12:661297. [PMID: 34122133 PMCID: PMC8192974 DOI: 10.3389/fphys.2021.661297] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Type 2 diabetes is a chronic disease associated with micro- and macro-vascular complications, including myocardial ischemia, and also with a specific and intrinsic cardiac dysfunction called diabetic cardiomyopathy (DCM). Both clinical and animal studies demonstrate significant sex differences in prevalence, pathophysiology, and outcomes of cardiovascular diseases (CVDs), including those associated with diabetes. The increased risk of CVDs with diabetes is higher in women compared to men with 50% higher risk of coronary artery diseases and increased mortality when exposed to acute myocardial infarction. Clinical studies also reveal a sexual dimorphism in the incidence and outcomes of DCM. Based on these clinical findings, growing experimental research was initiated to understand the impact of sex on CVDs associated with diabetes and to identify the molecular mechanisms involved. Endothelial dysfunction, atherosclerosis, coagulation, and fibrosis are mechanisms found to be sex-differentially modulated in the diabetic cardiovascular system. Recently, impairment of energy metabolism also emerged as a determinant of multiple CVDs associated with diabetes. Therefore, future studies should thoroughly analyze the sex-specific metabolic determinants to propose new therapeutic targets. With current medicine tending toward more personalized care of patients, we finally propose to discuss the importance of sex as determinant in the treatment of diabetes-associated cardiac diseases to promote a more systemic inclusion of both males and females in clinical and preclinical studies.
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Affiliation(s)
- Natacha Fourny
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Sandrine Horman
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | | | - Luc Bertrand
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Bhargava A, Arnold AP, Bangasser DA, Denton KM, Gupta A, Hilliard Krause LM, Mayer EA, McCarthy M, Miller WL, Raznahan A, Verma R. Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement. Endocr Rev 2021; 42:219-258. [PMID: 33704446 PMCID: PMC8348944 DOI: 10.1210/endrev/bnaa034] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 02/08/2023]
Abstract
In May 2014, the National Institutes of Health (NIH) stated its intent to "require applicants to consider sex as a biological variable (SABV) in the design and analysis of NIH-funded research involving animals and cells." Since then, proposed research plans that include animals routinely state that both sexes/genders will be used; however, in many instances, researchers and reviewers are at a loss about the issue of sex differences. Moreover, the terms sex and gender are used interchangeably by many researchers, further complicating the issue. In addition, the sex or gender of the researcher might influence study outcomes, especially those concerning behavioral studies, in both animals and humans. The act of observation may change the outcome (the "observer effect") and any experimental manipulation, no matter how well-controlled, is subject to it. This is nowhere more applicable than in physiology and behavior. The sex of established cultured cell lines is another issue, in addition to aneuploidy; chromosomal numbers can change as cells are passaged. Additionally, culture medium contains steroids, growth hormone, and insulin that might influence expression of various genes. These issues often are not taken into account, determined, or even considered. Issues pertaining to the "sex" of cultured cells are beyond the scope of this Statement. However, we will discuss the factors that influence sex and gender in both basic research (that using animal models) and clinical research (that involving human subjects), as well as in some areas of science where sex differences are routinely studied. Sex differences in baseline physiology and associated mechanisms form the foundation for understanding sex differences in diseases pathology, treatments, and outcomes. The purpose of this Statement is to highlight lessons learned, caveats, and what to consider when evaluating data pertaining to sex differences, using 3 areas of research as examples; it is not intended to serve as a guideline for research design.
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Affiliation(s)
- Aditi Bhargava
- Center for Reproductive Sciences, San Francisco, CA, USA
- Department of Obstetrics and Gynecology, University of California, San Francisco, CA, USA
| | - Arthur P Arnold
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debra A Bangasser
- Department of Psychology and Neuroscience Program, Temple University, Philadelphia, PA, USA
| | - Kate M Denton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lucinda M Hilliard Krause
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, CA, USA
| | - Margaret McCarthy
- Department of Pharmacology and Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Walter L Miller
- Center for Reproductive Sciences, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Armin Raznahan
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institutes of Mental Health, Intramural Research Program, Bethesda, MD, USA
| | - Ragini Verma
- Diffusion and Connectomics In Precision Healthcare Research (DiCIPHR) lab, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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49
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Cai A, Zhou D, Liu L, Zhou Y, Tang S, Feng Y. Age-related alterations in cardiac and arterial structure and function in hypertensive women and men. J Clin Hypertens (Greenwich) 2021; 23:1322-1334. [PMID: 33960629 PMCID: PMC8678835 DOI: 10.1111/jch.14262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 01/21/2023]
Abstract
The study was to compare age‐related alterations in cardiac and arterial structure and function by sex and to explore the impacts of achieved systolic blood pressure (SBP; <130 mm Hg vs. <140 mm Hg) level on age‐related alterations in cardiac and arterial structure and function in hypertensive women and men. Community hypertensive individuals without cardiovascular disease who had echocardiographic examination were included. Age‐related alterations in cardiac and arterial structure and function were compared by sex, and interplay between age and sex was analyzed according to achieved SBP level. The mean age of the cohort was 66.5 years, and women accounted for 62% (n = 602) of the cohort (n = 971). Compared to men, women had worse left ventricular (LV) diastolic function and greater LV and arterial stiffness. After adjusting for covariates, the magnitude of the associations between age with septal E/e′ ratio, septal S′ velocity, effective arterial elastance (Ea) and LV end‐diastolic elastance (Eed) were greater in women. Sex differences in the magnitude of association between age with these four indices varied according to achieved SBP level. When achieved SBP <130 mm Hg, the magnitude of the associations between age with septal E/e′ ratio, septal S′ velocity, Ea and Eed did not differ by sex. Since age and sex are non‐modifiable, achieving SBP target, especially at a lower level, might be beneficial to attenuate sex differences in age‐related alterations in cardiac and arterial structure and function.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dan Zhou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Songtao Tang
- Community Health Center of the Liaobu County, Dongguan, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
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50
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Ying W, Sharma K, Yanek LR, Vaidya D, Schär M, Markl M, Subramanya V, Soleimani S, Ouyang P, Michos ED, Shah SJ, Hays AG. Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction. ESC Heart Fail 2021; 8:2535-2545. [PMID: 33939300 PMCID: PMC8318398 DOI: 10.1002/ehf2.13382] [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: 12/10/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Aims Visceral adipose tissue (AT) promotes inflammation and may be associated with disease progression in heart failure with preserved ejection fraction (HFpEF). We characterized regional AT distribution in HFpEF patients and controls and analysed associations with co‐morbidities and exercise tolerance. Methods and results Magnetic resonance imaging was performed to quantify epicardial, liver, abdominal, and thigh skeletal muscle AT. We assessed New York Heart Association (NYHA) class, 6 min walk distance, and global well‐being score. Multivariable linear regression models adjusting for body surface area were used. We studied 55 HFpEF patients (41 women, mean age 67 ± 11 years) and 33 controls (21 women, mean age 57 ± 10 years). Epicardial AT (median [interquartile range] 4.6 [2.0] vs. 3.2 [1.4] mm, P < 0.001), thigh intermuscular fat (11.0 [11.5] vs. 5.0 [2.7] cm2, P < 0.001) and liver fat fraction (6.4% [6.1] vs. 4.1% [5.5], P = 0.001) were higher in HFpEF patients than controls. Women with HFpEF had higher abdominal and thigh subcutaneous AT than men. Greater thigh intermuscular fat was associated with higher blood pressure (β [SE] 0.73 [0.17], P < 0.001) and diabetes (odds ratio [95% confidence interval] 1.2 [1.0–1.5], P = 0.03). Greater thigh intramuscular fat was associated with both worse NYHA class (β [SE] 2.7 [1.0], P = 0.01) and shorter 6 min walk distance (β [SE] −4.1 [1.9], P = 0.03), and greater epicardial AT (β [SE] −0.2 [0.1], P < 0.001) and liver fat fraction (β [SE] −0.4 [0.2], P = 0.04) were associated with lower global well‐being score. Conclusions Heart failure with preserved ejection fraction patients have increased epicardial, liver, and skeletal muscle fat compared with controls out of proportion to their increased body size, and adiposity was associated with worse NYHA class and exercise tolerance in HFpEF. These results provide the basis for further investigation into the effect of interventions to reduce regional AT distribution in relation to HFpEF symptoms and pathophysiology.
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Affiliation(s)
- Wendy Ying
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Kavita Sharma
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Lisa R Yanek
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Dhananjay Vaidya
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schär
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Michael Markl
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Sahar Soleimani
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Pamela Ouyang
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Erin D Michos
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison G Hays
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
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