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Milyukov VE, Bryukhanov VA, Nguyen CC. [Morphofunctional Analysis of the Role of Epicardial Adipose Tissue in the Formation of the Obesity Paradox in Chronic Heart Failure]. KARDIOLOGIIA 2024; 64:72-80. [PMID: 38597765 DOI: 10.18087/cardio.2024.3.n2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 04/11/2024]
Abstract
Based on the available modern medical literature, the article summarizes data on the morpho-functional significance of epicardial adipose tissue (EAT) in health and heart failure, analyzes the likelihood and reliability of the formation of the obesity paradox, and also discusses its possible morpho-functional mechanisms. The authors reviewed and analyzed the consequences of the obesity paradox in the aspect of the normal EAT phenotype protectivity. The review proposed ways of further research in this direction aimed at a deep anatomical and physiological analysis and at determining the morpho-functional role of EAT in the adaptive mechanisms of myocardial trophic provision, which may be an important part of the pathogenetic connection between obesity and CHF and, therefore, can improve outcomes in such patients.
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Affiliation(s)
- V E Milyukov
- Pirogov Russian National Research Medical University
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Rouhi AD, Choudhury RA, Hoeltzel GD, Ghanem YK, Bababekov YJ, Suarez-Pierre A, Yule A, Vigneshwar NG, Williams NN, Dumon KR, Nydam TL. Ventricular Remodeling Following Metabolic and Bariatric Surgery Decreases Need for Heart Transplantation: A Predictive Model. Obes Surg 2024; 34:15-21. [PMID: 38017330 DOI: 10.1007/s11695-023-06948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE For patients with obesity and congestive heart failure (CHF) who require heart transplantation (HT), aggressive weight loss has been associated with ventricular remodeling, or subclinical alterations in left and right ventricular structure that affect systolic function. Many have suggested offering metabolic and bariatric surgery (MBS) for these patients. As such, we evaluated the role of MBS in HT for patients with obesity and CHF using predictive modelling techniques. MATERIALS AND METHODS Markov decision analysis was performed to simulate the life expectancy of 30,000 patients with concomitant obesity, CHF, and 30% ejection fraction (EF) who were deemed ineligible to be waitlisted for HT unless they achieved a BMI < 35 kg/m2. Life expectancy following diet and exercise (DE), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) was estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. RESULTS RYGB patients had lower rates of HT and received HT quicker when needed. Base case patients who underwent RYGB gained 2.2 additional mean years survival compared with patients who underwent SG and 10.3 additional mean years survival compared with DE. SG patients gained 6.2 mean years of life compared with DE. CONCLUSION In this simulation of 30,000 patients with obesity, CHF, and reduced EF, MBS was associated with improved survival by not only decreasing the need for transplantation due to improvements in EF, but also increasing access to HT when needed due to lower average BMI.
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Affiliation(s)
- Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Gerard D Hoeltzel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Yanik J Bababekov
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Alejandro Suarez-Pierre
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Arthur Yule
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Navin G Vigneshwar
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado Hospital, Aurora, CO, USA
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Salvino NFA, de Sousa LT, Abrahao FM, Spineti PPDM, Sales ALF, Neves de Albuquerque F, Bittencourt MI, de Moraes PCB, Esporcatte R, Mourilhe-Rocha R. Is the obesity paradox in outpatients with heart failure reduced ejection fraction real? Front Cardiovasc Med 2023; 10:1239722. [PMID: 38149266 PMCID: PMC10750383 DOI: 10.3389/fcvm.2023.1239722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Background The obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population. Methods We analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56-70), BMI 18.5-24.9 = 35.1%, 25-29.9 = 37.2%, 30-34.9 = 17.8%, 35-39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing. Results BMI 30-34.9 and BMI 18.5-24.9 had the best prognosis, BMI 25-29.9 had an average performance, and BMI -39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30-34.9 group had a better prognosis compared to the BMI 35-39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI. Conclusion In not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.
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Affiliation(s)
- Nathália Felix Araujo Salvino
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
| | | | - Fabio Maia Abrahao
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Luiza Ferreira Sales
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Castello Branco de Moraes
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
| | - Roberto Esporcatte
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Mourilhe-Rocha
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
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Tsai C, Dolan P, Moss N, Sandoval AF, Roldan J, Herron DM. Sleeve gastrectomy facilitates weight loss and permits cardiac transplantation in patients with severe obesity and a left ventricular assist device (LVAD). Surg Endosc 2023; 37:8655-8662. [PMID: 37495848 DOI: 10.1007/s00464-023-10264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Patients suffering from advanced heart failure may undergo left ventricular assist device (LVAD) placement as a bridge to cardiac transplantation. However, those with a BMI above 35 kg/m2 are generally not considered eligible for transplant due to their elevated cardiac risk. We review our experience with bariatric surgery in this high-risk population to assess its safety and efficacy in reducing BMI to permit cardiac transplantation. METHODS We retrospectively reviewed all patients on durable LVAD support who underwent sleeve gastrectomy (SG) at Mount Sinai Hospital between August 2018 and December 2022. Electronic medical records were reviewed to analyze patient demographics, surgical details, and outcomes regarding weight loss and heart transplantation. RESULTS We identified twelve LVAD patients who underwent SG. Three were performed laparoscopically and 9 via robotic approach. Four patients (33.3%) underwent an orthotopic heart transplant (OHTx). Half of these patients were female. For patients who underwent OHTx, mean age at LVAD placement was 41.0 (R30.6-52.2), at SG was 43.9 (R32.7-55.0) and at OHTx was 45.3 years (R33.3-56.8). Mean BMI increased from 38.8 at LVAD placement to 42.5 prior to SG. Mean time from SG to OHTx was 17.9 months (R6-7-27.5) during which BMI decreased to mean 32.8 at the time of OHTx. At most recent follow-up, mean BMI was 31.9. All patients were anticoagulated prior to surgery; one required return to the operating room on post-operative day 1 after SG for bleeding and one was re-admitted on post-operative day 7 for hematochezia treated conservatively. CONCLUSION SG is a safe and effective operation in patients with severe obesity and heart failure requiring an LVAD. 66.7% of our cohort achieved target BMI < 35 and 33.3% underwent heart transplantation. Longer term follow-up is needed to clarify full bridge-to-transplant rate and long-term survival outcomes.
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Affiliation(s)
- Catherine Tsai
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Patrick Dolan
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Noah Moss
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | | | - Julie Roldan
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | - Daniel M Herron
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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Dong Y, Gong Y, Han Y, Yu H, Zeng X, Chen Z, An R, Sun N, Chen Z, Yin X. Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study. Int J Obes (Lond) 2023; 47:848-854. [PMID: 37414876 DOI: 10.1038/s41366-023-01335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension are not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension. SUBJECTS/METHODS Our Data were drawn from the medical records of primary-care institutions in China. A total of 24,750 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight ( < 18.5 kg/m2), healthy weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2) and obesity ( ≥ 25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1-4%, stable (-1 to 1%), loss 1-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD. RESULTS After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR = 1.48, 95% CI: 1.19-1.85). Higher risks were seen in participants with loss ≥4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR = 1.33, 95% CI: 1.04-1.70; gain >4%: HR = 1.36, 95% CI: 1.04-1.77). CONCLUSION Obesity and weight change of loss ≥4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse cardiovascular outcomes for patients with hypertension.
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Affiliation(s)
- Yue Dong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yanping Han
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Hanbing Yu
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Xiaozhou Zeng
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Zimei Chen
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Rongrong An
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Na Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Zhenyuan Chen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
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Pathophysiology of obesity and its associated diseases. Acta Pharm Sin B 2023. [DOI: 10.1016/j.apsb.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Oh J, Cho Y, Kim DY. Analysis of Lateral Decubitus Position During Sleep in Patients With Obstructive Sleep Apnea Using WatchPAT Device. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2021.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background and Objectives: Measurement of sleep parameters in both supine and non-supine positions is important for the diagnosis of positional obstructive sleep apnea (OSA). However, the influence of right and left lateral decubitus positions (RLDP and LLDP, respectively) on sleep parameters is relatively unknown and has not been well investigated. This study was performed to verify the associations between sleep parameters and lateral decubitus sleep position.Methods: A retrospective study was performed on 38 patients who were diagnosed with OSA and underwent surgical interventions from January 2014 to December 2016. Preoperative sleep parameters were evaluated with WatchPAT, and patients who slept sufficiently in both RLDP and LLDP to accurately analyze sleep parameters were enrolled in the study. Basic clinical data including body mass index (BMI) and nasal endoscopic findings of patients were assessed.Results: The difference in peripheral arterial tonometry apnea-hypopnea index (pAHI) and PAT respiratory disturbance index (pRDI) between RLDP and LLDP showed no association with the side of deviated nasal septum. Patients with higher BMI showed higher pRDI in LLDP than RLDP (p=0.038). The difference in sleep position percentage between RLDP and LLDP was negatively correlated with the difference in pRDI (p=0.023).Conclusion: Higher BMI patients with OSA might benefit more from sleeping in RLDP than LLDP. Patients slept longer in the lateral decubitus position that produced lower pRDI. Not only supine and non-supine positions, but also RLDP and LLDP need to be evaluated in patients with OSA.
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de Ávila DX, Villacorta H, de Andrade Martins W, Mesquita ET. High-output Cardiac Failure: A Forgotten Phenotype in Clinical Practice. Curr Cardiol Rev 2022; 18:e050821195319. [PMID: 34353268 PMCID: PMC9241123 DOI: 10.2174/1573403x17666210805142010] [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: 12/07/2020] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The knowledge on High-Output Cardiac Failure (HOCF) has greatly improved in the last two decades. One of the advances was the identification of a new phenotype of HOCF, characterized by the absence of ventricular dilation, already associated with liver disease, Arteriovenous Fistulas (AVF), lung disease, myelodysplastic syndromes, and obesity. However, it has been noted that any aetiology can present with one of the two phenotypes, depending on the evolution. OBJECTIVE The study aims to describe, through an integrative review, the physiopathology and aetiologies of HOCF and to discuss phenotypes associated with this condition. METHODS Revisions, guidelines, case-controls, cohort studies and clinical studies were searched in MEDLINE and LILACS, using the connectives in the "cardiac output, high" database (MeSH Terms) OR "high cardiac output" (All Fields). DISCUSSION Two distinct phenotypes are currently described in the HOCF, regardless of the aetiology: 1) one with enlarged cardiac chambers; and 2) with normal heart chambers. The mechanisms related to HOCF are vasodilation, arteriovenous shunts that cause increased microvascular density, Reduced Systemic Vascular Resistance (RSVR), and high metabolism. These mechanisms lead to activation of the renin-angiotensin-aldosterone system, sodium and water retention, activation of neprilysin, of the sodium-glucose-2 transporter, which promote interstitial fibrosis, ventricular remodeling and a consequent increase in cardiac output >8L/min. CONCLUSION Many aetiologies of HOCF have been described, and some of them are potentially curable. Prompt recognition of this condition and proper treatment may lead to better outcomes.
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Affiliation(s)
- Diane Xavier de Ávila
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Amyloidosis Center, Complexo Hospitalar de Niterói - DASA, Rio de Janeiro, Brazil
| | - Humberto Villacorta
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Wolney de Andrade Martins
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Amyloidosis Center, Complexo Hospitalar de Niterói - DASA, Rio de Janeiro, Brazil
| | - Evandro Tinoco Mesquita
- Postgraduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Amyloidosis Center, Complexo Hospitalar de Niterói - DASA, Rio de Janeiro, Brazil
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Hansen AL, Søndergaard MM, Hlatky MA, Vittinghof E, Nah G, Stefanick ML, Manson JE, Farland LV, Wells GL, Mongraw-Chaffin M, Gunderson EP, Van Horn L, Wild RA, Liu B, Shadyab AH, Allison MA, Liu S, Eaton CB, Honigberg MC, Parikh NI. Adverse Pregnancy Outcomes and Incident Heart Failure in the Women's Health Initiative. JAMA Netw Open 2021; 4:e2138071. [PMID: 34882182 PMCID: PMC8662370 DOI: 10.1001/jamanetworkopen.2021.38071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Some prior evidence suggests that adverse pregnancy outcomes (APOs) may be associated with heart failure (HF). Identifying unique factors associated with the risk of HF and studying HF subtypes are important next steps. OBJECTIVE To investigate the association of APOs with incident HF overall and stratified by HF subtype (preserved vs reduced ejection fraction) among postmenopausal women in the Women's Health Initiative (WHI). DESIGN, SETTING, AND PARTICIPANTS In 2017, an APO history survey was administered in the WHI study, a large multiethnic cohort of postmenopausal women. The associations of 5 APOs (gestational diabetes, hypertensive disorders of pregnancy [HDP], low birth weight, high birth weight, and preterm delivery) with incident adjudicated HF were analyzed. In this cohort study, the association of each APO with HF was assessed using logistic regression models and with HF subtypes using multinomial regression, adjusting for age, sociodemographic characteristics, smoking, randomization status, reproductive history, and other APOs. Data analysis was performed from January 2020 to September 2021. EXPOSURES APOs (gestational diabetes, HDP, low birth weight, high birth weight, and preterm delivery). MAIN OUTCOMES AND MEASURES All confirmed cases of women hospitalized with HF and HF subtype were adjudicated by trained physicians using standardized methods. RESULTS Of 10 292 women (median [IQR] age, 60 [55-64] years), 3185 (31.0%) reported 1 or more APO and 336 (3.3%) had a diagnosis of HF. Women with a history of any APO had a higher prevalence of hypertension, diabetes, coronary heart disease, or smoking. Of the APOs studied, only HDP was significantly associated with HF with a fully adjusted odds ratio (OR) of 1.75 (95% CI, 1.22-2.50), and with HF with preserved ejection fraction in fully adjusted models (OR, 2.06; 95% CI, 1.29-3.27). In mediation analyses, hypertension explained 24% (95% CI, 12%-73%), coronary heart disease 23% (95% CI, 11%-68%), and body mass index 20% (95% CI, 10%-64%) of the association between HDP and HF. CONCLUSIONS AND RELEVANCE In this large cohort of postmenopausal women, HDP was independently associated with incident HF, particularly HF with preserved ejection fraction, and this association was mediated by subsequent hypertension, coronary heart disease, and obesity. These findings suggest that monitoring and modifying these factors early in women presenting with HDP may be associated with reduced long-term risk of HF.
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Affiliation(s)
| | | | - Mark A. Hlatky
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Eric Vittinghof
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco
| | - Gregory Nah
- Department of Medicine, Division of Cardiology, University of California, San Francisco
| | - Marcia L. Stefanick
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - JoAnn E. Manson
- Department of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie V. Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Morgana Mongraw-Chaffin
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Erica P. Gunderson
- Lifecourse Epidemiology of Diabetes and Heart Disease in Women and Youth Division of Research, Kaiser Permanente Northern California, Oakland
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert A. Wild
- Department of Biostatistics and Epidemiology, Oklahoma University Health Sciences Center, Oklahoma City
- Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City
| | - Buyun Liu
- Department of Epidemiology, University of Iowa, Iowa City
| | | | | | - Simin Liu
- Department of Epidemiology, Public Health Program, Brown University, Providence, Rhode Island
| | - Charles B. Eaton
- Alpert Medical School, Brown University, Pawtucket, Rhode Island
| | - Michael C. Honigberg
- Cardiology Division, Massachusetts General Hospital, Boston
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge
| | - Nisha I. Parikh
- Department of Medicine, Division of Cardiology, University of California, San Francisco
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Choudhury RA, Foster M, Hoeltzel G, Moore HB, Yaffe H, Yoeli D, Prins K, Ghincea C, Vigneshwar N, Dumon KR, Rame JE, Conzen KD, Pomposelli JJ, Pomfret EA, Nydam TL. Bariatric Surgery for Congestive Heart Failure Patients Improves Access to Transplantation and Long-term Survival. J Gastrointest Surg 2021; 25:926-931. [PMID: 32323251 DOI: 10.1007/s11605-020-04587-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/25/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Obese patients with congestive heart failure (CHF) are often denied access to heart transplantation until they obtain significant weight loss to achieve a certain BMI threshold, often less than 35 kg/m2. It is unknown whether the rapid weight loss associated with bariatric surgery leads to improved waitlist placement, and as such improved survival for morbidly obese patients with CHF. METHODS A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with CHF who were deemed ineligible to be waitlisted for heart transplantation unless they achieved a BMI less than 35 kg/m2. Life expectancy following medical weight management (MWM), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) was estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review. RESULTS RYGB improved survival compared with both SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 2.1 additional years of life compared with patient's who underwent SG and 7.4 additional years of life compared with MWM. SG patients gained 5.3 years of life compared with MWM. CONCLUSIONS When strict waitlist criteria were applied, bariatric surgery improved access to heart transplantation and thereby increased long-term survival compared with MWM. Morbidly obese CHF patients who anticipate need for heart transplantation should be encouraged to pursue surgical weight management strategies, necessitating discussion between bariatric surgeons, cardiologists, and cardiac surgeons for appropriate perioperative risk management.
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Affiliation(s)
- Rashikh A Choudhury
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA. .,, Denver, USA.
| | - M Foster
- Department of Medicine- Division of Cardiovascular Medicine, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - G Hoeltzel
- Department of General Surgery, Jefferson University Hospital, Philadelphia, PA, USA
| | - H B Moore
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - H Yaffe
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - D Yoeli
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - K Prins
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - C Ghincea
- Department of Surgery- Division of Cardiothoracic Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - N Vigneshwar
- Department of Surgery- Division of Cardiothoracic Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - K R Dumon
- Department of Surgery, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - J E Rame
- Department of Medicine- Division of Cardiovascular Medicine, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - K D Conzen
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - J J Pomposelli
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - E A Pomfret
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - T L Nydam
- Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA
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Mouton AJ, Flynn ER, Moak SP, Li X, da Silva AA, Wang Z, do Carmo JM, Hall ME, Hall JE. Interaction of Obesity and Hypertension on Cardiac Metabolic Remodeling and Survival Following Myocardial Infarction. J Am Heart Assoc 2021; 10:e018212. [PMID: 33666098 PMCID: PMC8174210 DOI: 10.1161/jaha.120.018212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Obesity and hypertension are risk factors for myocardial infarction (MI); however, their potential interactions on post‐MI outcomes are unclear. We examined interactions of obesity and hypertensionon post‐MI function, remodeling, metabolic changes, and recovery. Methods and Results Male and female C57BL/6J mice were provided standard chow or high‐fat/fructose diet for 8 weeks and then infused with angiotensin II for 2 weeks to induce hypertension. MI was then induced by surgical ligation of the left coronary artery for 7 days. Obesity alone did not cause cardiac injury or exacerbate hypertension‐induced cardiac dysfunction. After MI, however, obese‐normotensive mice had lower survival rates compared with chow‐fed mice (56% versus 89% males; 54% versus 75% females), which were further decreased by hypertension (29% males; and 35% females). Surviving obese‐normotensive males displayed less left ventricular dilation and pulmonary congestion compared with chow‐fed males after MI; hypertension reversed left ventricular dilation because of high‐fat/fructose diet and promoted significant pulmonary congestion compared with chow‐fed controls. Obese‐normotensive males displayed higher left ventricular α‐MHC (alpha‐myosin heavy chain) protein, phosphorylated Akt (protein kinase B) and AMPK (adenosine‐monophosphate activated kinase), PPAR‐γ (peroxisome proliferator activated receptor gamma), and plasma adiponectin levels after MI, indicating favorable contractile and metabolic changes. However, these favorable contractile and metabolic changes were attenuated by hypertension. Obese‐hypertensive males also had lower levels of collagen in the infarcted region, indicating decreased ability to promote an adaptive wound healing response to MI. Conclusions Obesity reduces post‐MI survival but is associated with improved post‐MI cardiac function and metabolism in surviving normotensive mice. When hypertension accompanies obesity, favorable metabolic pathways associated with obesity are attenuated and post‐MI cardiac function and remodeling are adversely impacted.
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Affiliation(s)
- Alan J Mouton
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Elizabeth R Flynn
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS
| | - Sydney P Moak
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS
| | - Xuan Li
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Alexandre A da Silva
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Zhen Wang
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Jussara M do Carmo
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Michael E Hall
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Department of Medicine University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - John E Hall
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
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12
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Hu J, Xu H, Zhu J, Zhang J, Li J, Chen L, Liu X, Qin G. Association between body mass index and risk of cardiovascular disease-specific mortality among adults with hypertension in Shanghai, China. Aging (Albany NY) 2021; 13:6866-6877. [PMID: 33621195 PMCID: PMC7993713 DOI: 10.18632/aging.202543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
The aim of our study was to examine the association between body mass index (BMI) and the risk of cardiovascular disease (CVD)-specific mortality among Chinese adults with hypertension by sex. This study included 212,394 adult hypertensive patients aged 20-85 years registered in the records of Minhang District during 2007-2018. Cox proportional hazards regression was performed to evaluate the association between BMI and CVD-specific mortality among Chinese adults with hypertension. There were 14,029 deaths over an average of 8.24 years (range, 0.19-11.96 years). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across BMI categories (< 18.5 kg/m2, 18.5-24.9 kg/m2 [reference group], 25.0-29.9 kg/m2, and ≥ 30 kg/m2) for CVD-specific mortality were 1.37 (1.22-1.53), 1.00 (reference), 0.95 (0.90-1.01), and 1.21 (1.04-1.40) in males, and 1.44 (1.31-1.59), 1.00 (reference), 0.96 (0.91-1.01), and 1.04 (0.92-1.17) in females. A U-shaped relationship was observed between BMI and CVD-specific mortality (overall association P< 0.001; non-linearity P< 0.001). This association was attenuated in old age. This study revealed a U-shaped relationship between BMI and CVD-specific mortality among hypertensive men and women. In older people, overweight and obesity are potential factors that reduce the risk of CVD death.
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Affiliation(s)
- Jing Hu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jinling Zhang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Jun Li
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Linli Chen
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Xiaohua Liu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Key Lab of Health Technology Assessment, National Health Commission of the People’s Republic of China, Fudan University, Shanghai, People’s Republic of China
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13
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Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese Patients: a Systematic Review and Meta-Analysis. Cardiol Rev 2020; 30:1-7. [PMID: 33165086 DOI: 10.1097/crd.0000000000000346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Class 2 obesity or greater (body mass index [BMI] >35 kg/m) is a relative contraindication for heart transplant due to its associated perioperative risks and mortality. Whether bariatric surgery can act as a potential bridging procedure to heart transplantation is unknown. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery on improving transplant candidacy in patients with end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed databases were searched up to September 2019 for studies that performed bariatric surgery on patients with severe obesity and ESHF. Outcomes of interest included incidence of patients listed for heart transplantation after bariatric surgery, proportion of patients that successfully received transplant, the change in BMI after bariatric surgery, and 30-day complications. Pooled estimates were calculated using a random effects meta-analysis of proportions. Eleven studies with 98 patients were included. Mean preoperative BMI was 44.9 (2.1) kg/m and BMI after surgery was 33.2 (2.3) kg/m with an absolute BMI reduction of 26.1%. After bariatric surgery, 71% (95% confidence interval [CI], 55%-86%) of patients with ESHF were listed for transplantation. The mean time from bariatric surgery to receiving a heart transplant was 14.9 (4.0) months. Of the listed patients, 57% (95% CI, 39-74%) successfully received heart transplant. The rate of 30-day mortality after bariatric surgery was 0%, and the 30-day major and minor complications after bariatric surgery was 28% (95% CI, 10%-49%). Bariatric surgery can facilitate sustained weight loss in obese patients with ESHF, improving heart transplant candidacy and the incidence of transplantation.
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14
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Effects of High-Fat Diet Induced Obesity and Fructooligosaccharide Supplementation on Cardiac Protein Expression. Nutrients 2020; 12:nu12113404. [PMID: 33167590 PMCID: PMC7694524 DOI: 10.3390/nu12113404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 01/12/2023] Open
Abstract
The mechanism by which high fat-diet induced obesity affects cardiac protein expression is unclear, and the extent to which this is modulated by prebiotic treatment is not known. These outcomes were assessed in rats initially fed a high-fat diet, then the top 40% weight gain group were randomly allocated to control (CON), high-fat (HF) and HF supplemented with fructooligosaccharide (32 g; HF-FOS) treatments for 12 weeks (n = 10/group). At sacrifice, left ventricles were either frozen or preserved in formalin. Serum was stored for glucose and insulin measurements. Protein spectra was obtained using an Orbitrap analyzer, processed with Sequest and fold changes assessed with Scaffold Q +. Treatment effects for body weights, glucose and insulin were assessed using one-way ANOVA, and the differential protein expression was assessed by a Mann-Whitney U test. The Database for Annotation, Visualization and Integrated Discovery and the Kyoto Encyclopedia of Genes and Genomes identified pathways containing overrepresented proteins. Hematoxylin and eosin sections were graded for hypertrophy and also quantified; differences were identified using Chi-square analyses and Mann-Whitney U tests. HF diet fed rats were significantly (p < 0.05) heavier than CON, and 23 proteins involved in mitochondrial function and lipid metabolism were differentially expressed between HF and CON. Between HF-FOS and HF, 117 proteins involved in contractility, lipid and carbohydrate metabolism were differentially expressed. HF cardiomyocytes were significantly (p < 0.05) more hypertrophic than CON. We conclude that high-fat feeding and FOS are associated with subcellular deviations in cardiac metabolism and contractility, which may influence myocardial function and alter the risk of cardiovascular disease.
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Van Aelst P, Deleus E, Van der Schueren B, Meyns B, Vandersmissen K, Lannoo M. Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device—Case Series and Review of Literature. Obes Surg 2020; 30:3628-3633. [DOI: 10.1007/s11695-020-04642-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Vandersmissen K, Jacobs S, Fresiello L, Gerits K, Roppe M, Van den Bossche K, Droogne W, Meyns B. Weight evolution after implantation of left ventricular assist device: Do we need to interfere? Int J Artif Organs 2020; 43:671-676. [PMID: 32089042 DOI: 10.1177/0391398820906554] [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: 11/15/2022]
Abstract
OBJECTIVES Weight change after left ventricular assist device implantation may influence outcomes and can affect transplant candidacy. We questioned if there is a systematic weight change after left ventricular assist device implantation and examined the evolution in functional capacity. METHODS A retrospective analysis of 84 patients who received a left ventricular assist device in Universitaire Ziekenhuizen Leuven between 2008 and 2016 was performed. Patients were divided into four groups based on their baseline body mass index, and we also examined weight evolution for patients presenting with new-onset heart failure versus those suffering from chronic heart failure. Body mass index was assessed at baseline, 6, 12, 18, and 24 months. To indicate the functional capacity, we analyzed the results of routine 6-Minute Walk Test performed at 6, 12, and 18 months. RESULTS During the first 6 months after surgery, the underweight patients evolved to normal weight and the body mass index of the obese patients reduced significantly. Afterward, all patients gained weight. The weight loss of the obese was not maintained over time. The weight of patients with normal weight and overweight evolved to overweight and obesity, respectively. No body mass index changes were demonstrated for patients presenting with new-onset heart failure, and the body mass index of patients suffering from chronic HF significantly increased. There was a significant improvement in functional capacity at 6 months, but this level remained unchanged at 12 and 18 months after surgery. CONCLUSION Although the initial 6 months evolve beneficial, all patients gain weight in the second year and do not further improve their exercise capacity.
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Affiliation(s)
| | - Steven Jacobs
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Libera Fresiello
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Kathleen Gerits
- Department of Endocrinology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marieke Roppe
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | | | - Walter Droogne
- Department of Cardiology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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17
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Liu Y, Xu XY, Shen Y, Ye CF, Hu N, Yao Q, Lv XZ, Long SL, Ren C, Lang YY, Liu YL. Ghrelin protects against obesity-induced myocardial injury by regulating the lncRNA H19/miR-29a/IGF-1 signalling axis. Exp Mol Pathol 2020; 114:104405. [PMID: 32084395 DOI: 10.1016/j.yexmp.2020.104405] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/10/2020] [Accepted: 02/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is associated with the impairment of cardiac fitness and consequent ventricular dysfunction and heart failure. Ghrelin has been largely documented to be cardioprotective against ischaemia/reperfusion injury. However, the role of ghrelin in obesity-induced myocardial injury is largely unknown. This study sought to determine the cardiac effect of ghrelin against obesity-induced injury and the underlying mechanisms. METHODS The effect of ghrelin was evaluated in a mouse model of obesity and a palmitic acid (PA)-treated cardiomyocyte cell line with or without ghrelin transfection. Gene and protein expression levels were determined by real-time PCR and western blot, respectively. Cell apoptosis was measured by flow cytometry analysis. RESULTS In the present study, we found that both a high-fat diet (HFD) and PA treatment caused myocardial injury by increasing apoptosis and the expression of inflammatory cytokines. Overexpression of ghrelin reversed the effects induced by HFD or PA treatment. Knockdown of lncRNA H19 or overexpression of miR-29a abrogated the cardioprotective effects of ghrelin against apoptosis and inflammation. We also found that IGF-1 was a target gene of miR-29a and that H19 regulated IGF-1 expression via miR-29a. Overexpression of IGF-1 partially reversed the apoptosis and inflammation promoting effects of miR-29a. CONCLUSIONS Our findings suggested that ghrelin protected against obesity-induced myocardial injury by regulating the H19/miR-29a/IGF-1 signalling axis, providing further evidence for the clinical application of ghrelin.
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Affiliation(s)
- Yang Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Xin-Yue Xu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yang Shen
- Molecular medicine laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chun-Feng Ye
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Na Hu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Qing Yao
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Xiu-Zi Lv
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Sheng-Lan Long
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Chao Ren
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China
| | - Yuan-Yuan Lang
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China.
| | - Yan-Ling Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, PR China.
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18
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Shudo Y, Cohen JE, Lingala B, He H, Woo YJ. Impact of Donor Obesity on Outcomes After Orthotopic Heart Transplantation. J Am Heart Assoc 2019; 7:e010253. [PMID: 30511896 PMCID: PMC6405563 DOI: 10.1161/jaha.118.010253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The impact of donor obesity on the outcome of orthotopic heart transplantation has not been studied. The aim of this study was to investigate the impact of donor obesity on the outcomes of adult orthotopic heart transplantation recipients. Methods and Results Data were obtained from the United Network for Organ Sharing database. All adult (age ≥18 years) patients undergoing orthotopic heart transplantation from 2000 through 2016 were included (n=31 920). We stratified the cohort by donor body mass index (BMI); 13 015 patients (40.8%) received a heart from a normal‐weight donor (BMI 18.5–24.9), 11 271 patients (35.3%) received a heart from an overweight donor (BMI 25.0–29.9), 4910 patients (15.4%) received a heart from an obese donor (BMI 30.0–34.9), and 2724 patients (8.5%) received a heart from an extremely obese donor (BMI ≥35). The cohort of obese donors was older, included a higher incidence of diabetes mellitus, and had a higher creatinine. Our data also showed that the recipients of obese donor grafts were older, had a higher BMI, creatinine, percentage of diabetes mellitus, and longer total waiting period. There was no significant difference detected in the survival likelihood (P=0.08) of patients based on a donor's BMI‐based categorized cohort. There were no significant differences found in the overall survival probability among 4 groups in the adjusted survival analyses (P=0.25). Conclusions This study demonstrated that patients receiving higher BMI donor hearts might not be subjected to an increased risk of death, at least during the short term after transplant, compared with those using the normal‐weight donors.
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Affiliation(s)
- Yasuhiro Shudo
- 1 Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Jeffrey E Cohen
- 1 Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Bharathi Lingala
- 1 Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Hao He
- 1 Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Y Joseph Woo
- 1 Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
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Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device. Obes Surg 2019; 29:1122-1129. [DOI: 10.1007/s11695-018-3570-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant. Surg Obes Relat Dis 2018; 14:1269-1273. [DOI: 10.1016/j.soard.2018.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/06/2023]
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21
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Comment on: Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant. Surg Obes Relat Dis 2018; 14:1274-1275. [PMID: 29983363 DOI: 10.1016/j.soard.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022]
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22
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Tuleta I, Eckstein N, Aurich F, Nickenig G, Schaefer C, Skowasch D, Schueler R. Reduced longitudinal cardiac strain in asthma patients. J Asthma 2018; 56:350-359. [PMID: 29668337 DOI: 10.1080/02770903.2018.1466311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE There is limited knowledge about the potential relationship between asthma and heart function. Aim of our present study was to examine if asthma may be associated with manifest or subclinical heart dysfunction. METHODS Seventy-two allergic mild-to-moderate and severe asthma patients and 20 matched controls were enrolled in the study. Depending on the anti-asthmatic therapy, four subgroups of asthma patients were created: patients under long-acting beta2-agonists (LABA) and inhaled cortisone without oral cortisone treatment with (1a) versus without (1b) additional omalizumab therapy; patients with LABA, inhaled cortisone and omalizumab treatment with (2a) versus without (2b) oral cortisone. Standard echocardiographic parameters as well as global longitudinal left and right ventricular strains as determined by ultrasound-based speckle-tracking method were evaluated. Furthermore, NT-pro-brain natriuretic peptide (NT-pro-BNP), immunoglobulin E (IgE), C-reactive protein (CRP), and blood count were assessed in asthma and control groups. RESULTS There were no relevant differences in standard echocardiographic measures between both asthma groups and the control collective. Longitudinal left ventricular strain values were reduced significantly in severe and mild-to-moderate asthma groups (-12.91 ± 0.84% and -13.92 ± 1.55%, respectively), whereas longitudinal right ventricular strain values were additionally relevantly decreased in severe asthma (-10.35 ± 1.04%) compared to the control (-16.55 ± 0.49% and -18.48 ± 1.90%, respectively). Cardiac strains were similar in subgroups 1a and 1b. In contrast, patients from subgroup 2a presented reduced heart strains and decreased lung function compared to those from 2b. CRP, IgE, and eosinophils were significantly increased in asthma versus control individuals. CONCLUSIONS Allergic asthma, especially severe asthma is associated with subclinical impaired left and right ventricular function as determined by speckle-tracking analysis.
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Affiliation(s)
- I Tuleta
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - N Eckstein
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - F Aurich
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - G Nickenig
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - C Schaefer
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - D Skowasch
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - R Schueler
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
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