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Dini FL, Cameli M, Stefanini A, Aboumarie HS, Lisi M, Lindqvist P, Henein MY. Echocardiography in the Assessment of Heart Failure Patients. Diagnostics (Basel) 2024; 14:2730. [PMID: 39682638 DOI: 10.3390/diagnostics14232730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 11/26/2024] [Accepted: 11/29/2024] [Indexed: 12/18/2024] Open
Abstract
Doppler echocardiography is the corner-stone of non-invasive investigation of patients with a clinical diagnosis of heart failure. It provides an accurate and quantitative assessment of cardiac structure and function. Furthermore, spectral Doppler measurement is an invaluable technique for estimating intracardiac pressures with their crucial value in the optimum management of heart failure patients, irrespective of ejection fraction. Speckle tracking echocardiography stretches the unique application of echocardiography to analyze the myocardial deformation function which has proved very accurate in detecting ischemia, dyssynchrony, subclinical dysfunction and also in estimating pulmonary capillary wedge pressures. The role of longitudinal myocardial left atrial deformation dynamics has recently emerged as a valuable tool for assessing left ventricular diastolic dysfunction in patients with cardiac diseases regardless of their ejection fraction. Finally, the extent of myocardial deformation has been shown to correlate with the severity of myocardial fibrosis, a common finding in patients with heart failure.
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Affiliation(s)
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Andrea Stefanini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Hatem Soliman Aboumarie
- Department of Anaesthetics, Critical Care and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
- School of Cardiovascular, Metabolic Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Matteo Lisi
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, 48121 Ravenna, Italy
| | - Per Lindqvist
- Department of Diagnostics and Intervention, Clinical Physiology, Umea University, 90585 Umea, Sweden
| | - Michael Y Henein
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Imperial College London, Du Cane Road, London W12 0NN, UK
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2
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Menezes CADS, de Oliveira ALG, Barbosa ICM, de Jesus ACP, Chaves AT, Rocha MODC. Galectin-3 (Gal-3) and the tissue inhibitor of matrix metalloproteinase (TIMP-2) as potential biomarkers for the clinical evolution of chronic Chagas cardiomyopathy. Acta Trop 2024; 252:107153. [PMID: 38373528 DOI: 10.1016/j.actatropica.2024.107153] [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: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Chronic Chagas cardiomyopathy (CCC) is responsible for the highest morbidity and worst prognosis in Chagas disease patients. However, predicting factors that correlate with disease progression, morbidity, and mortality is challenging. It is necessary to have simple, quantitative, and economical risk biomarkers that add value to conventional methods and assist in the diagnosis and prognosis of patients with CCC or in evolution. OBJECTIVES We evaluated molecules related to cardiac remodeling and fibrosis, such as MMP-2, MMP-9, TIMP-2, TIMP-1, PICP, CTXI, and Gal-3, and correlated these biomarkers with echocardiographic variables (LVDD, LVEF, and E/e' ratio). METHODS Blood samples from Chagasic patients without apparent cardiopathy (WAC), CCC patients, and healthy individuals were used to perform plasma molecule dosages using Luminex or ELISA. RESULTS MMP-2 and TIMP-2 presented higher levels in CCC; in these patients, the inhibitory role of TIMP-2 over MMP-2 was reinforced. The ratio of MMP-2/TIMP-2 in WAC patients showed a bias in favor of the gelatinase pathway. MMP-9 and TIMP-1 showed higher levels in Chagas patients compared to healthy subjects. PICP and CTXI are not associated with cardiac deterioration in Chagas disease. Increased levels of Gal-3 are associated with worse cardiac function in CCC. Receiver operating characteristic (ROC) curve analysis identified Gal-3 and TIMP-2 as putative biomarkers to discriminate WAC from cardiac patients. CONCLUSIONS Among the molecules evaluated, Gal-3 and TIMP-2 have the potential to be used as biomarkers of cardiac remodeling and progressive myocardial fibrosis in Chagas disease.
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Affiliation(s)
- Cristiane Alves da Silva Menezes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais CEP 31270-901, Brazil.
| | - Ana Laura Grossi de Oliveira
- Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Isabela Cristina Magalhães Barbosa
- Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Augusto César Parreiras de Jesus
- Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Thereza Chaves
- Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Manoel Otávio da Costa Rocha
- Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Agoston-Coldea L, Negru A. Myocardial fibrosis in right heart dysfunction. Adv Clin Chem 2024; 119:71-116. [PMID: 38514212 DOI: 10.1016/bs.acc.2024.02.005] [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] [Indexed: 03/23/2024]
Abstract
Cardiac fibrosis, associated with right heart dysfunction, results in significant morbidity and mortality. Stimulated by various cellular and humoral stimuli, cardiac fibroblasts, macrophages, CD4+ and CD8+ T cells, mast and endothelial cells promote fibrogenesis directly and indirectly by synthesizing numerous profibrotic factors. Several systems, including the transforming growth factor-beta and the renin-angiotensin system, produce type I and III collagen, fibronectin and α-smooth muscle actin, thus modifying the extracellular matrix. Although magnetic resonance imaging with gadolinium enhancement remains the gold standard, the use of circulating biomarkers represents an inexpensive and attractive means to facilitate detection and monitor cardiovascular fibrosis. This review explores the use of protein and nucleic acid (miRNAs) markers to better understand underlying pathophysiology as well as their role in the development of therapeutics to inhibit and potentially reverse cardiac fibrosis.
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Affiliation(s)
- Lucia Agoston-Coldea
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Andra Negru
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Gao L, Lin Y, Ji M, Wu W, Li H, Qian M, Zhang L, Xie M, Li Y. Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure. J Clin Med 2022; 11:6307. [DOI: 10.3390/jcm11216307] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.
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Nikolov A, Popovski N. Extracellular Matrix in Heart Disease: Focus on Circulating Collagen Type I and III Derived Peptides as Biomarkers of Myocardial Fibrosis and Their Potential in the Prognosis of Heart Failure: A Concise Review. Metabolites 2022; 12:297. [PMID: 35448484 PMCID: PMC9025448 DOI: 10.3390/metabo12040297] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/31/2022] Open
Abstract
Accumulating evidence indicates that two major proteins are responsible for the structural coherence of bounding cardiomyocytes. These biomolecules are known as myocardial fibrillar collagen type I (COL1) and type III (COL3). In addition, fibronectin, laminin, fibrillin, elastin, glycoproteins, and proteoglycans take part in the formation of cardiac extracellular matrix (ECM). In physiological conditions, collagen synthesis and degradation in human cardiac ECM are well-regulated processes, but they can be impaired in certain cardiovascular diseases, such as heart failure (HF). Myocardial remodeling is part of the central mechanism of HF and involves cardiomyocyte injury and cardiac fibrosis due to increased fibrillar collagen accumulation. COL1 and COL3 are predominantly involved in this process. Specific products identified as collagen-derived peptides are released in the circulation as a result of abnormal COL1 and COL3 turnover and myocardial remodeling in HF and can be detected in patients' sera. The role of these products in the pathogenesis of cardiac fibrosis and the possible clinical implications are the focus of numerous investigations. This paper reviews recent studies on COL1- and COL3-derived peptides in patients with HF. Their potential application as indicators of myocardial fibrosis and prognostic markers of HF is also highlighted.
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Affiliation(s)
- Asparuh Nikolov
- Cardiovascular Research Working Group, Division of Medicine, Institute for Scientific Research, Medical University-Pleven, 5800 Pleven, Bulgaria
| | - Nikola Popovski
- Clinic of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University Hospital Pleven, Medical University-Pleven, 5800 Pleven, Bulgaria
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Lisi M, Cameli M, Mandoli GE, Pastore MC, Righini FM, D'Ascenzi F, Focardi M, Rubboli A, Mondillo S, Henein MY. Detection of myocardial fibrosis by speckle-tracking echocardiography: from prediction to clinical applications. Heart Fail Rev 2022; 27:1857-1867. [PMID: 35043264 DOI: 10.1007/s10741-022-10214-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
Myocardial fibrosis (MF) represents the underlying pathologic condition of many cardiac disease, leading to cardiac dysfunction and heart failure (HF). Biopsy studies have shown the presence of MF in patients with decompensating HF despite apparently normal cardiac function. In fact, basic indices of left ventricular (LV) function, such as LV ejection fraction (EF), fail to recognize subtle LV dysfunction caused by MF. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is currently recognized as the gold standard imaging investigation for the detection of focal and diffuse cardiac chambers MF; however, its use is limited by its availability and the use of contrast agents, while echocardiography remains the first level cardiac imaging technique due to its low cost, portability and high accessibility. Advanced echocardiographic techniques, above all speckle-tracking echocardiography (STE), have demonstrated reliability for early detection of structural myocardial abnormalities and for the prediction of prognosis in acute and chronic HF. Myocardial strain of both ventricles and also left atrium has been shown to correlate with the degree of MF, providing useful prognostic information in several diseases, such as HF, cardiomyopathies and valvular heart disease. This paper aims to provide an overview of the pathophysiology of MF and the clinical application of STE for the prediction of left and right heart chambers MF in HF patients.
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Affiliation(s)
- Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Andrea Rubboli
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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Diagnostic biomarkers of dilated cardiomyopathy. Immunobiology 2021; 226:152153. [PMID: 34784575 DOI: 10.1016/j.imbio.2021.152153] [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: 08/29/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a condition involving dilation of cardiac chambers, which results in contraction impairment. Besides invasive and non-invasive diagnostic procedures, cardiac biomarkers are of great importance in both diagnosis and prognosis of the disease. These biomarkers are categorized into three groups based on their site; cardiomyocyte biomarkers, microenvironmental biomarkers and macroenvironmental biomarkers. AIMS In this review, an overview of characteristics, epidemiology, etiology and clinical manifestations of DCM is provided. In addition, the most important biomarkers, of all three categories, and their diagnostic and prognostic values are discussed. CONCLUSION Considering the association of DCM with conditions such as infections and autoimmunity, which are prevalent among the population, introducing efficient diagnostic tools is of high value for the early detection of DCM to prevent its severe complications. The three discussed classes of biomarkers are potential candidates for the detection of DCM. However, further studies are necessary in this regard.
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El Hajjar AH, Marrouche N. The need to refine selection criteria for catheter ablation in heart failure patients with atrial fibrillation. Europace 2021; 24:527-529. [PMID: 34524414 DOI: 10.1093/europace/euab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abdel Hadi El Hajjar
- Tulane University Heart and Vascular Institute, School of Medicine, New Orleans, LA, USA
| | - Nassir Marrouche
- Tulane University Heart and Vascular Institute, School of Medicine, New Orleans, LA, USA
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Wittig C, Szulcek R. Extracellular Matrix Protein Ratios in the Human Heart and Vessels: How to Distinguish Pathological From Physiological Changes? Front Physiol 2021; 12:708656. [PMID: 34421650 PMCID: PMC8371527 DOI: 10.3389/fphys.2021.708656] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/14/2021] [Indexed: 12/03/2022] Open
Abstract
Cardiovascular pathology is often accompanied by changes in relative content and/or ratios of structural extracellular matrix (ECM) proteins within the heart and elastic vessels. Three of these proteins, collagen-I, collagen-III, and elastin, make up the bulk of the ECM proteins in these tissues, forming a microenvironment that strongly dictates the tissue biomechanical properties and effectiveness of cardiac and vascular function. In this review, we aim to elucidate how the ratios of collagen-I to collagen-III and elastin to collagen are altered in cardiovascular diseases and the aged individuum. We elaborate on these major cardiovascular ECM proteins in terms of structure, tissue localization, turnover, and physiological function and address how their ratios change in aging, dilated cardiomyopathy, coronary artery disease with myocardial infarction, atrial fibrillation, aortic aneurysms, atherosclerosis, and hypertension. To the end of guiding in vitro modeling approaches, we focus our review on the human heart and aorta, discuss limitations in ECM protein quantification methodology, examine comparability between studies, and highlight potential in vitro applications. In summary, we found collagen-I relative concentration to increase or stay the same in cardiovascular disease, resulting in a tendency for increased collagen-I/collagen-III and decreased elastin/collagen ratios. These ratios were found to fall on a continuous scale with ranges defining distinct pathological states as well as a significant difference between the human heart and aortic ECM protein ratios.
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Affiliation(s)
- Corey Wittig
- Laboratory of in vitro Modeling Systems of Pulmonary Diseases, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Szulcek
- Laboratory of in vitro Modeling Systems of Pulmonary Diseases, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pichler G, Redon J, Martínez F, Solaz E, Calaforra O, Andrés MS, Lopez B, Díez J, Oberbauer R, Adlbrecht C, Karth GD, Maceira A. Cardiac magnetic resonance-derived fibrosis, strain and molecular biomarkers of fibrosis in hypertensive heart disease. J Hypertens 2020; 38:2036-2042. [PMID: 32890280 DOI: 10.1097/hjh.0000000000002504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS Myocardial fibrosis is a relevant component of hypertensive heart disease (HHD). Novel cardiovascular magnetic resonance (CMR) imaging techniques have shown potential in quantification of diffuse cardiac fibrosis, with T1 mapping, and estimating preclinical cardiac dysfunction, with strain analysis. Molecular biomarkers of fibrosis have been related with clinical outcomes and histologically proven myocardial fibrosis. The relationship between these CMR-imaging techniques and circulating biomarkers is not fully understood. METHODS AND RESULTS CMR was performed on a 3T scanner in 36 individuals with HHD. Extracellular volume fraction (ECV) and the partition coefficient were assessed using the T1 mapping technique shMOLLI. Longitudinal, circumferential and radial strain was assessed using CMR-Feature Tracking. Molecular biomarkers of collagen synthesis (PICP and PIIINP) and collagen degradation (CITP and MMP-1) were measured in blood using commercial kits. Correlation models showed a significant relationship of T1 mapping measures with left atrial diameter, LV mass, LV posterior wall thickness, LV end-diastolic volume and longitudinal strain. In fully adjusted regression models, ECV was associated with left atrial diameter (β=0.75, P = 0.005) and longitudinal strain (β = 0.43, P = 0.030); the partition coefficient was associated with LV posterior wall thickness (β = 0.53, P = 0.046). Strain measures were associated with cardiac geometry, and longitudinal strain was marginally associated with CITP. CONCLUSION In individuals with HHD, CMR-derived measures of myocardial fibrosis and function are related and might be useful tools for the identification and characterization of preclinical cardiac dysfunction and diffuse myocardial fibrosis. Molecular biomarkers of fibrosis were marginally associated with myocardial strain, but not with the extension of CMR-measured cardiac fibrosis.
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Affiliation(s)
- Gernot Pichler
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain
- Department of Cardiology, Heart Center Clinic Floridsdorf, Vienna, Austria
| | - Josep Redon
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain
- Department of Internal Medicine, Hospital Clínico de Valencia, University of Valencia, Valencia
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III
| | - Fernando Martínez
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain
- Department of Internal Medicine, Hospital Clínico de Valencia, University of Valencia, Valencia
| | - Elena Solaz
- Department of Internal Medicine, Hospital Clínico de Valencia, University of Valencia, Valencia
| | - Oscar Calaforra
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain
| | | | - Begoña Lopez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Georg Delle Karth
- Department of Cardiology, Heart Center Clinic Floridsdorf, Vienna, Austria
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Sohns C, Zintl K, Zhao Y, Dagher L, Andresen D, Siebels J, Wegscheider K, Sehner S, Boersma L, Merkely B, Pokushalov E, Sanders P, Schunkert H, Bänsch D, Mahnkopf C, Brachmann J, Marrouche NF. Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure: CASTLE-AF Trial. Circ Arrhythm Electrophysiol 2020; 13:e008461. [PMID: 32903044 DOI: 10.1161/circep.120.008461] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined. METHODS The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit. RESULTS In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; P<0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; P=0.006), all-cause mortality (HR, 0.54; P=0.019), and cardiovascular hospitalizations (HR, 0.66; P=0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; P<0.001; mortality: HR, 0.30; P=0.001). CONCLUSIONS Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient's heart failure symptoms.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany (C.S.)
| | - Konstantin Zintl
- Department of Cardiology, Klinikum Coburg, Germany (K.Z., C.M., J.B.)
| | - Yan Zhao
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
| | - Lilas Dagher
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
| | | | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (K.W., S.S.)
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (K.W., S.S.)
| | - Lucas Boersma
- Department of Cardiology, Antonius Ziekenhuis Nieuwegein, the Netherlands (L.B.)
| | - Béla Merkely
- Department of Cardiology, Semmelweis Medical University, Budapest, Hungary (B.M.)
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia (E.P.)
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (P.S.)
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Munich, Germany (H.S.)
| | - Dietmar Bänsch
- Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany (D.B.)
| | | | | | - Nassir F Marrouche
- Department of Cardiology, Tulane University School of Medicine, New Orleans, LA (Y.Z., L.D., N.F.M.)
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12
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Ureche C, Nedelcu AE, Sascău RA, Stătescu C, Kanbay M, Covic A. Role of collagen turnover biomarkers in the noninvasive assessment of myocardial fibrosis: an update. Biomark Med 2020; 14:1265-1275. [DOI: 10.2217/bmm-2020-0298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The pro-fibrotic milieu, as the result of the extracellular matrix remodeling, is a central feature in the pathophysiology of heart disease and contributes to its high morbidity and mortality. Fibrosis is a recognized risk factor for development of heart failure and arrythmias and is usually detected by cardiac magnetic resonance or endomyocardial biopsy. Collagen type I and type III are major components of the collagen network, and the assessment of their derived biomarkers could serve as estimate of the myocardial fibrotic content. This review summarizes data from numerous studies in which these biomarkers have proven their diagnostic and prognostic utility, setting the stage for further randomized clinical trials that might translate into early implementation of antifibrotic therapies.
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Affiliation(s)
- Carina Ureche
- ‘Grigore T. Popa’ University of Medicine & Pharmacy, Iaşi 700115, Romania
- Institute of Cardiovascular Disease ‘Prof. Dr. George IM Georgescu’, Iaşi 700503, Romania
| | | | - Radu A Sascău
- ‘Grigore T. Popa’ University of Medicine & Pharmacy, Iaşi 700115, Romania
- Institute of Cardiovascular Disease ‘Prof. Dr. George IM Georgescu’, Iaşi 700503, Romania
| | - Cristian Stătescu
- ‘Grigore T. Popa’ University of Medicine & Pharmacy, Iaşi 700115, Romania
- Institute of Cardiovascular Disease ‘Prof. Dr. George IM Georgescu’, Iaşi 700503, Romania
| | - Mehmet Kanbay
- Koc University School of Medicine, Istanbul 34010, Turkey
| | - Adrian Covic
- ‘Grigore T. Popa’ University of Medicine & Pharmacy, Iaşi 700115, Romania
- Nephrology Department, Dialysis & Renal Transplant Center, ‘Dr. C. I. Parhon’ University Hospital, Iaşi 700503, Romania
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13
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Zhuang B, Cui C, Sirajuddin A, He J, Wang X, Yue G, Duan X, Wang H, Arai AE, Zhao S, Lu M. Detection of Myocardial Fibrosis and Left Ventricular Dysfunction with Cardiac MRI in a Hypertensive Swine Model. Radiol Cardiothorac Imaging 2020; 2:e190214. [PMID: 32914091 DOI: 10.1148/ryct.2020190214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/11/2022]
Abstract
Purpose To quantitatively evaluate the dynamic changes of extracellular volume (ECV) and native T1 in hypertensive swine over time using histologic findings as standard of reference. Materials and Methods Eighteen hypertensive (hypertension group) and six healthy (control group) swine aged 6-12 months were studied. Both groups underwent cardiac MRI, including pre- and postcontrast T1 mapping and late gadolinium enhancement (LGE) imaging at three time points: baseline, 1 month, and 3 months after hypertensive model induction. The left ventricular function, strain, and strain rate were also calculated using the cine images. Animals were killed after the last MRI examination. Histopathologic examination of the heart was performed later. Analysis of the relationship between strain, ECV, and native T1 was carried out by Pearson correlation and linear regression models. Results The mean systolic and diastolic pressure increased from 111 mg Hg and 68 mm Hg to 160 mm Hg and 97 mm Hg, respectively, over 3 months during developing hypertension (P = .03, .02, respectively). There was no LGE detected at any of three imaging times. The ECV and native T1 value of myocardium in the hypertension group increased over 3 months (ECV, increased from 21.5% ± 4.4 to 27.3% ± 5.4; native T1, increased from a mean of 1056 msec ± 32 [standard deviation] to 1218 msec ± 66; all P < .001). The collagen volume fraction (CVF) was calculated and correlated with ECV (r = 0.63, P = .01) and native T1 (r = 0.80, P < .001). In addition, ECV was associated with longitudinal diastolic strain rate (r =-.34, P = .04). Native T1 was associated with radial strain (r = -0.62, P < .001) as well as circumferential strain (r = 0.57, P < .001). Conclusion Native T1 and ECV correlated significantly with the CVF, indicating that early myocardial interstitial fibrosis exists in hypertensive heart disease. As hypertension progresses, the values of ECV fraction and T1 native increase. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Baiyan Zhuang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Chen Cui
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Arlene Sirajuddin
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Jian He
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Xin Wang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Guangxin Yue
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Xuejing Duan
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Hongyue Wang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Andrew E Arai
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Shihua Zhao
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Minjie Lu
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
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Chuang TD, Ansari A, Yu C, Sakurai R, Harb A, Liu J, Khorram O, Rehan VK. Mechanism underlying increased cardiac extracellular matrix deposition in perinatal nicotine-exposed offspring. Am J Physiol Heart Circ Physiol 2020; 319:H651-H660. [PMID: 32795172 DOI: 10.1152/ajpheart.00021.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although increased predisposition to cardiac fibrosis and cardiac dysfunction has been demonstrated in the perinatally nicotine-exposed heart, the underlying mechanisms remain unclear. With the use of a well-established rat model and cultured primary neonatal rat cardiac fibroblasts, the effect of perinatal nicotine exposure on offspring heart extracellular matrix deposition and the likely underlying mechanisms were investigated. Perinatal nicotine exposure resulted in increased collagen type I (COL1A1) and III (COL3A1) deposition along with a decrease in miR-29 family and an increase in long noncoding RNA myocardial infarction-associated transcript (MIAT) levels in offspring heart. Nicotine treatment of isolated primary neonatal rat cardiac fibroblasts suggested that these effects were mediated via nicotinic acetylcholine receptors including α7 and the induced collagens accumulation was reversed by a gain-of function of miR-29 family. Knockdown of MIAT resulted in increased miR-29 family and decreased COL1A1 and COL3A1 levels, suggesting nicotine-mediated MIAT induction as the underlying mechanism for nicotine-induced collagen deposition. Luciferase reporter assay and RNA immunoprecipitation studies showed an intense physical interaction between MIAT, miR-29 family, and argonaute 2, corroborating the mechanistic link between perinatal nicotine exposure and increased extracellular matrix deposition. Overall, perinatal nicotine exposure resulted in lower miR-29 family levels in offspring heart, while it elevated cardiac MIAT and collagen type I and III levels. These findings provide mechanistic basis for cardiac dysfunction in perinatal nicotine-exposed offspring and offer multiple novel potential therapeutic targets.NEW & NOTEWORTHY Using an established rat model and cultured primary neonatal cardiac fibroblasts, we show that nicotine mediated MIAT induction as the underlying mechanism for the excessive cardiac collagen deposition. These observations provide mechanistic basis for the increased predisposition to cardiac dysfunction following perinatal cigarette/nicotine exposure and offer novel potential therapeutic targets.
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Affiliation(s)
- Tsai-Der Chuang
- Department of and Obstetrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Aamir Ansari
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Celia Yu
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Reiko Sakurai
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Amir Harb
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Jie Liu
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Omid Khorram
- Department of and Obstetrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - Virender K Rehan
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Torrance, California
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15
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Saeed S, Waje-Andreassen U, Nilsson PM. The association of the metabolic syndrome with target organ damage: focus on the heart, brain, and central arteries. Expert Rev Cardiovasc Ther 2020; 18:601-614. [PMID: 32757786 DOI: 10.1080/14779072.2020.1807327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The metabolic syndrome (MetS) is an adverse metabolic state composed of obesity, hyperglycemia/pre-diabetes, hypertension, and dyslipidemia. It substantially increases the risk of type 2 diabetes, cardiovascular disease (CVD) and mortality, and has a huge impact on public health. AREA COVERED The present review gives an update on the definition and prevalence of MetS, and its impact on cardiac structure and function as well as on the brain and central arteries. The association with CVD and mortality risk is discussed. Focus is mainly directed toward the subclinical target organ damage related to MetS. Data is also critically reviewed to provide evidence on the incremental prognostic value of overall MetS over its individual components. EXPERT COMMENTARY MetS is a clinical risk condition associated with subclinical and clinical CVD and mortality. Roughly, 30% of the world population suffer from MetS. As all components of the MetS are modifiable, optimal preventive and therapeutic measures should be initiated to improve CV risk control, particularly aggressively treating hypertension and hyperglycemia, and encouraging people to adopt healthy lifestyle as early as possible is of great importance.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital , Bergen, Norway
| | | | - Peter M Nilsson
- Department of Clinical Science, Lund University, Skåne University Hospital , Malmö, Sweden
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16
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Kaya Ü, Eren H, Öcal L, İnanır M, Balaban İ. Association between fragmented QRS complexes and left-ventricular dysfunction in anabolic androgenic steroid users. Acta Cardiol 2020; 75:244-253. [PMID: 31663816 DOI: 10.1080/00015385.2019.1682339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Anabolic androgen steroid (AS) use has adverse effects on left ventricular functions, such as fibrosis development. Fragmented QRS is an important marker of myocardial fibrosis, while speckle-tracking echocardiographyis a method used to show subclinical left ventricle dysfunction. In this study, we examined the the ability of fQRS + to detect left ventricle fibrosis by speckle tracking echocardiography (STE) in AS users.Methods: The study included a total of 181 healthy athletes. Athletes were divided into two groups as AS users (n = 89) and non-AS users (n = 92). Then, athletes using AS were divided into two groups as fQRS+ (n = 52) and fQRS- (n = 37). In both groups, the arithmetic mean of three images was used to obtain the left ventricle global longitudinal strain (LV-GLS). The E/SRe ratio was also calculated and analysed.Results: There were significant differences between the AS users and non-AS users in terms of, E/SRe (55.7 ± 17.9 vs 50.3 ± 14.8; p = 0.015), LV-GLS (23.1 ± 1.9 vs 24.0 ± 1.7; p = 0.001), and fQRS (18.5% vs 6%; p = 0.005). When subgroup analysis was performed, both LV-GLS and E/SRivr were found to be poor in the fQRS + group. When multiple linear regression analysis was performed, we determined fQRS as an independent predictor for LV-GLS and E/SRivr ratio.Conclusion: In conclusion, our study demonstrated that fQRS is a parameter that can beused to determine left ventricle subclinical systolic and diastolic dysfunction in AS users. It can be used for cessation of drug use, especially in long-term use.
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Affiliation(s)
- Ülker Kaya
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Hayati Eren
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet İnanır
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - İsmail Balaban
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
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17
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Liu W, Wang Z. Current Understanding of the Biomechanics of Ventricular Tissues in Heart Failure. Bioengineering (Basel) 2019; 7:E2. [PMID: 31861916 PMCID: PMC7175293 DOI: 10.3390/bioengineering7010002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022] Open
Abstract
Heart failure is the leading cause of death worldwide, and the most common cause of heart failure is ventricular dysfunction. It is well known that the ventricles are anisotropic and viscoelastic tissues and their mechanical properties change in diseased states. The tissue mechanical behavior is an important determinant of the function of ventricles. The aim of this paper is to review the current understanding of the biomechanics of ventricular tissues as well as the clinical significance. We present the common methods of the mechanical measurement of ventricles, the known ventricular mechanical properties including the viscoelasticity of the tissue, the existing computational models, and the clinical relevance of the ventricular mechanical properties. Lastly, we suggest some future research directions to elucidate the roles of the ventricular biomechanics in the ventricular dysfunction to inspire new therapies for heart failure patients.
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Affiliation(s)
- Wenqiang Liu
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
| | - Zhijie Wang
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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18
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Heart Failure Epidemiology in Patients With Diabetes Mellitus Without Coronary Heart Disease. J Card Fail 2019; 25:78-86. [DOI: 10.1016/j.cardfail.2018.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
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2D-Speckle tracking echocardiography contributes to early identification of impaired left ventricular myocardial function in children with chronic kidney disease. Cardiol Young 2018; 28:1404-1409. [PMID: 30152295 DOI: 10.1017/s1047951118001397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED IntroductionThe aim of this study is to determine early changes in cardiac function of children with chronic kidney disease by using 2D-speckle tracking echocardiography. METHOD The study included 38 children - 16 girls and 22 boys - diagnosed as having chronic kidney disease in the nephrology department with a glomerular filtration rate of <90 ml/minute/1.73 m2 for at least 3 months. A total of 37 - 15 girls and 22 boys - age- and sex-matched healthy children were included as the control group. 2D-Speckle tracking echocardiography was performed in all subjects. RESULTS The mean age was 13.45±2.8 years in patients and 12.89±3.07 years in controls. Systolic and diastolic blood pressures and left ventricular mass index were significantly higher in patients (p<0.05). The values of mitral e, mitral a, mitral e/a ratio, and mitral deceleration time were not different between the groups. Tricuspid annular plane systolic excursion values were lower in patients (p<0.01). Global strain values in apical long-axis 3-chamber and 2-chamber views were significantly lower in patients (p<0.05). Longitudinal, radial, and circumferential peak systolic strain values were lower in patients, but the difference was statistically significant in all segments of longitudinal view and basal segment of circumferential view (p<0.05). Radial and circumferential systolic strain rates were significantly lower in patients in all three segments (p<0.05). Moreover, early diastolic strain rate was significantly lower in longitudinal and radial apical segments and in all segments of circumferential measurements in patients. Besides, strain rate e/a ratio was significantly lower in all longitudinal segments of patients (p=0.01). CONCLUSION The study concluded that 2D-speckle tracking echocardiography method can determine cardiac involvement earlier than conventional echocardiography in children with chronic kidney disease having preserved ejection fraction.
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Heart failure with preserved ejection fraction: A systemic disease linked to multiple comorbidities, targeting new therapeutic options. Arch Cardiovasc Dis 2018; 111:766-781. [DOI: 10.1016/j.acvd.2018.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
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21
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Bayramoğlu A, Taşolar H, Kaya Y, Bektaş O, Kaya A, Yaman M, Günaydın ZY. Fragmented QRS complexes are associated with left ventricular dysfunction in patients with type-2 diabetes mellitus: a two-dimensional speckle tracking echocardiography study. Acta Cardiol 2018; 73:449-456. [PMID: 29216794 DOI: 10.1080/00015385.2017.1410350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Heart failure may develop independently of coronary artery disease in diabetes mellitus (DM) patients. Fragmented QRS (fQRS) is a marker of myocardial fibrosis or scar tissue and is related to an increase in cardiovascular adverse events. In this study, we examined the utility of speckle tracking echocardiography (STE) in assessing LV function in DM patients with fQRS. Methods and Results: The current study included 178 consecutive patients diagnosed with type-2 DM. The patients included were separated into two groups: those with (n = 50) and without (n = 128) fQRS. The two groups were compared by obtaining LV strain values with STE. Statistically significant differences were also identified between fQRS(-) and fQRS (+) groups with respect to Lv-GLS (p < .001), maxLAVI (p = .020), minLAVI (p < .001), E velocity (p < .001), Em velocity (0.002), E/Em ratio (<0.001) SRe (p < .001), SRe/SRa ratio (p < .001), SRivr (p < .001) and E/SRivr ratio (p < .001). In the multiple linear regression analysis, fQRS (β = -2.077, p = .002) and DM duration (β = -0.216, p = .021) were identified as independent predictors of Lv-GLS. However, fQRS (β = 4.557, p = .001) and minLAVI (β = -2.198, p = .031) were also found to be independent predictors of E/SRivr. We also performed multiple logistic regression analysis and identified Lv-GLS (β = -0.557, p = .001), minLAVI (β = -0.769, p = .001), E/Em ratio (β = 0.650, p = .001) and E/SRivr (β = 0.105, p = .001) as independent predictors of fQRS. Conclusıons: The results of this study revealed that subclinical LV dysfunction was more common in diabetic patients with fQRS. Therefore, determination of fQRS could be an indicator of the diabetic CMP in patients with DM.
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Affiliation(s)
- Adil Bayramoğlu
- Faculty of Medicine, Department of Cardiology, Ordu University , Ordu , Turkey
| | - Hakan Taşolar
- Department of Cardiology, Adiyaman University Training and Research Hospital , Adıyaman , Turkey
| | - Yasemin Kaya
- Faculty of Medicine, Depatment of Internal Medicine, Ordu University , Ordu , Turkey
| | - Osman Bektaş
- Faculty of Medicine, Department of Cardiology, Ordu University , Ordu , Turkey
| | - Ahmet Kaya
- Faculty of Medicine, Department of Cardiology, Ordu University , Ordu , Turkey
| | - Mehmet Yaman
- Faculty of Medicine, Department of Cardiology, Ordu University , Ordu , Turkey
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Sharif H, Ting S, Forsythe L, McGregor G, Banerjee P, O'Leary D, Ditor D, George K, Zehnder D, Oxborough D. Layer-specific systolic and diastolic strain in hypertensive patients with and without mild diastolic dysfunction. Echo Res Pract 2018; 5:41-49. [PMID: 29432196 PMCID: PMC5827572 DOI: 10.1530/erp-17-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/02/2018] [Indexed: 02/01/2023] Open
Abstract
This study sought to examine layer-specific longitudinal and circumferential systolic and diastolic strain, strain rate (SR) and diastolic time intervals in hypertensive patients with and without diastolic dysfunction. Fifty-eight treated hypertensive patients were assigned to normal diastolic function (NDF, N = 39) or mild diastolic dysfunction (DD, N = 19) group. Layer-specific systolic and diastolic longitudinal and circumferential strains and SR were assessed. Results showed no between-group difference in left ventricular mass index (DD: 92.1 ± 18.1 vs NDF: 88.4 ± 16.3; P = 0.44). Patients with DD had a proportional reduction in longitudinal strain across the myocardium (endocardial for DD -13 ± 4%; vs NDF -17 ± 3, P < 0.01; epicardial for DD -10 ± 3% vs NDF -13 ± 3%, P < 0.01; global for DD: -12 ± 3% vs NDF: -15 ± 3, P = 0.01), and longitudinal mechanical diastolic impairments as evidenced by reduced longitudinal strain rate of early diastole (DD 0.7 ± 0.2 L/s vs NDF 1.0 ± 0.3 L/s, P < 0.01) and absence of a transmural gradient in the duration of diastolic strain (DD endocardial: 547 ± 105 ms vs epicardial: 542 ± 113 ms, P = 0.24; NDF endocardial: 566 ± 86 ms vs epicardial: 553 ± 77 ms, P = 0.03). Patients with DD also demonstrate a longer duration of early circumferential diastolic strain (231 ± 71 ms vs 189 ± 58 ms, P = 0.02). In conclusion, hypertensive patients with mild DD demonstrate a proportional reduction in longitudinal strain across the myocardium, as well as longitudinal mechanical diastolic impairment, and prolonging duration of circumferential mechanical relaxation.
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Affiliation(s)
- Hisham Sharif
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
- Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Stephen Ting
- Division of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Division of Metabolic and Vascular Health, The University of Warwick, Coventry, UK
- Department of Acute Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Lynsey Forsythe
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Gordon McGregor
- Centre for Applied Biological and Exercise Sciences, Coventry University, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Deborah O'Leary
- Health Sciences, Brock University, St Catharines, Ontario, Canada
- Brock-Niagara Centre for Health and Well-Being, Brock University, St Catharines, Ontario, Canada
| | - David Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
- Brock-Niagara Centre for Health and Well-Being, Brock University, St Catharines, Ontario, Canada
| | - Keith George
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Daniel Zehnder
- Division of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Department of Acute Medicine, North Cumbria University Hospital NHS Trust, Carlisle, UK
| | - David Oxborough
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Nielsen SH, Mouton AJ, DeLeon-Pennell KY, Genovese F, Karsdal M, Lindsey ML. Understanding cardiac extracellular matrix remodeling to develop biomarkers of myocardial infarction outcomes. Matrix Biol 2017; 75-76:43-57. [PMID: 29247693 DOI: 10.1016/j.matbio.2017.12.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/02/2017] [Accepted: 12/08/2017] [Indexed: 01/08/2023]
Abstract
Cardiovascular Disease (CVD) is the most common cause of death in industrialized countries, and myocardial infarction (MI) is a major CVD with significant morbidity and mortality. Following MI, the left ventricle (LV) undergoes a wound healing response to ischemia that results in extracellular matrix (ECM) scar formation to replace necrotic myocytes. While ECM accumulation following MI is termed cardiac fibrosis, this is a generic term that does not differentiate between ECM accumulation that occurs in the infarct region to form a scar that is structurally necessary to preserve left ventricle (LV) wall integrity and ECM accumulation that increases LV wall stiffness to exacerbate dilation and stimulate the progression to heart failure. This review focuses on post-MI LV ECM remodeling, targeting the discussion on ECM biomarkers that could be useful for predicting MI outcomes.
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Affiliation(s)
- Signe Holm Nielsen
- Fibrosis Biology and Biomarkers, Nordic Bioscience, Herlev, Denmark; Disease Systems Immunology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Alan J Mouton
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kristine Y DeLeon-Pennell
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA; Research Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA
| | | | - Morten Karsdal
- Fibrosis Biology and Biomarkers, Nordic Bioscience, Herlev, Denmark
| | - Merry L Lindsey
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA; Research Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS, USA.
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Yoshihisa A, Sato Y, Yokokawa T, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Saitoh S, Takeishi Y. Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction. ESC Heart Fail 2017; 5:262-270. [PMID: 28967709 PMCID: PMC5880657 DOI: 10.1002/ehf2.12222] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/27/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects, including stiffness and/or congestion of multiple organs. Poor prognosis is expected in heart failure patients with liver stiffness, which has recently been assessed by non-alcoholic fatty liver disease fibrosis score (NFS; based on aspartate aminotransferase to alanine aminotransferase ratio, platelet counts, and albumin). We aimed to investigate the impact of NFS on prognosis of HFpEF patients, with consideration for the peripheral collagen markers such as procollagen type III peptide (PIIIP), type IV collagen 7S, and hyaluronic acid. METHODS AND RESULTS We performed a prospective observational study. Consecutive 492 hospitalized HFpEF patients were divided into four groups based on their NFS: first-fourth quartiles (n = 123). The fourth quartile group had the highest levels of PIIIP, type IV collagen 7S, hyaluronic acid, and B-type natriuretic peptide (P<0.001 each). In addition, there were significant positive correlations between PIIIP, type IV collagen 7S, hyaluronic acid, B-type natriuretic peptide, and NFS (P < 0.001 each). In the follow-up period (mean 1107 days), 93 deaths occurred. All-cause mortality increased in all four quartiles (8.1%, 12.2%, 23.6%, and 31.7%, P < 0.001). In the multivariable Cox proportional hazard analysis, NFS was an independent predictor of all-cause mortality in the HFpEF patients. CONCLUSIONS NFS, a novel indicator of liver fibrosis, correlates with circulating systemic markers of fibrosis and congestion and is associated with higher all-cause mortality in HFpEF patients. NFS can be calculated simply and may be a useful tool to assess liver stiffness and prognosis in HFpEF patients.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Yu Sato
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Takamasa Sato
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Satoshi Suzuki
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Shu‐ichi Saitoh
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular MedicineFukushima Medical University1 HikarigaokaFukushima960‐1295Japan
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25
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Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. J Hypertens 2017; 35:1727-1741. [DOI: 10.1097/hjh.0000000000001396] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Perrone-Filardi P, Coca A, Galderisi M, Paolillo S, Alpendurada F, de Simone G, Donal E, Kahan T, Mancia G, Redon J, Schmieder R, Williams B, Agabiti-Rosei E, Delgado V, Cosyns B, Lombardi M, Lancellotti P, Muraru D, Kauffmann P, Cardim N, Haugaa K, Hagendorff A. Non-invasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. Eur Heart J Cardiovasc Imaging 2017; 18:945-960. [DOI: 10.1093/ehjci/jex094] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Pasquale Perrone-Filardi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maurizio Galderisi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | | | - Francisco Alpendurada
- NIHR Cardiovascular BRU, Royal Brompton & Harefield NHS Trust, Imperial College London, London, UK
| | - Giovanni de Simone
- Hypertension Research Center (CIRIAPA), Federico II University of Naples, Naples, Italy
| | - Erwan Donal
- Cardiology & Cic-it 1414, CHU Rennes LTSI, Insert 1099, Université Rennes-1, Rennes, France
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Giuseppe Mancia
- IRCCS Istituto Auxologico Italiano e Istituto Clinico Universitario di Verano Brianza, Policlinico di Monza, Italy
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia and CIBERObn Carlos III Institute, Madrid, Spain
| | - Roland Schmieder
- University Hospital, Nephrology and Hypertension, Erlangen, Germany
| | - Bryan Williams
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, University College London, London, UK
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, Hypertension and Cardiovascular Risk Research Centre, University of Brescia, Spedali Civili, Brescia
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Täger T, Wiebalck C, Fröhlich H, Corletto A, Katus HA, Frankenstein L. Biological variation of extracellular matrix biomarkers in patients with stable chronic heart failure. Clin Res Cardiol 2017; 106:974-985. [PMID: 28779229 DOI: 10.1007/s00392-017-1147-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/31/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Extracellular matrix (ECM) biomarkers such as matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) are pathophysiological key, prognostic marker and therapeutic target in chronic heart failure (HF). Serial measurements of MMPs and TIMPs may be useful for guidance of these applications. However, interpretation of time-dependent changes requires knowledge about the biological variation of ECM biomarkers. METHODS We performed measurements of MMP-2, MMP-9, TIMP-1, and TIMP-4 in 50 patients with chronic HF who met rigid criteria for clinical stability at 3-h, 6-h, 1-week and 2-week time intervals. In addition, clinical and haemodynamic assessment was performed at baseline, at 1- and 2-week intervals. Haemodynamic variables were measured using inert gas rebreathing and impedance cardiography. Heart rhythm was monitored with external ECG event recorders throughout the complete study. Reference change values (RCVs) and minimal important differences (MIDs) were determined for MMP-2, MMP-9, TIMP-1, and TIMP-4. RESULTS Clinical and haemodynamic variables were stable over time. Depending on the time-interval, RCVs ranged between 4.9 and 11.7% for MMP-2, 26.4 and 56.7% for MMP-9, 10.8 and 30.7% for TIMP-1, and 16.0 and 47.4% for TIMP-4, respectively. The MIDs varied between 43.38 and 65.22 ng/ml for MMP-2, 28.71 and 40.96 ng/ml for MMP-9, 52.32 and 156.07 ng/ml for TIMP-1, and 293.92 and 798.04 pg/ml for TIMP-4, respectively. CONCLUSION The biological variation of ECM biomarkers differs with respect to individual biomarkers and time intervals. MMP-2 may be most suitable for serial biomarker measurements, as the biological variation is low irrespective of the time interval between measurements.
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Affiliation(s)
- Tobias Täger
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Clara Wiebalck
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anna Corletto
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Liu JH, Chen Y, Zhen Z, Ho LM, Tsang A, Yuen M, Lam K, Tse HF, Yiu KH. Relationship of biomarkers of extracellular matrix with myocardial function in Type 2 diabetes mellitus. Biomark Med 2017; 11:569-578. [PMID: 28685602 DOI: 10.2217/bmm-2017-0044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIM The study evaluated the relationship of extracellular matrix and renin angiotensin system with myocardial dysfunction in Type 2 diabetes mellitus. METHODS All patients underwent resting and exercise echocardiography, including conventional parameters, E/E' ratio, global longitudinal strain and diastolic function reserve index. Plasma matrix metalloproteinase-1, TIMP-1, amino-terminal propeptide of type I and type III procollagen and renin angiotensin system activity were measured. RESULTS As patients with diastolic dysfunction had a higher plasma level of TIMP-1 and propeptide of type III procollagen than those with no diastolic dysfunction. After multivariate adjustment, TIMP-1 associated with E/E' (both at rest and stress) and diastolic function reserve index. CONCLUSION TIMP-1 is independently associated with myocardial diastolic dysfunction in patients with Type 2 diabetes mellitus.
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Affiliation(s)
- Ju-Hua Liu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Yan Chen
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anita Tsang
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Michele Yuen
- Division of Endocrinology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Karen Lam
- Division of Endocrinology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Usefulness of Collagen Carboxy-Terminal Propeptide and Telopeptide to Predict Disturbances of Long-Term Mortality in Patients ≥60 Years With Heart Failure and Reduced Ejection Fraction. Am J Cardiol 2017; 119:2042-2048. [PMID: 28464988 DOI: 10.1016/j.amjcard.2017.03.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
Abstract
Disturbances of collagen metabolism may alter the myocardial collagen network and contribute to cardiac remodeling and prognosis in heart failure (HF). Collagen type I synthesis and degradation can be assessed indirectly by the circulating biomarkers carboxy-terminal propeptide (PICP) and carboxy-terminal telopeptide (CITP), respectively. We examined the associations between PICP and CITP and long-term mortality in patients with HF. The Optimizing Congestive Heart Failure Outpatient Clinic (OPTIMAL) project studied patients aged ≥60 years with New York Heart Association class II to IV and HF with reduced ejection fraction (EF) hospitalized with acute HF during 1996 to 1999. On entry, mean age was 75 years, blood pressure 134/80 mm Hg, EF 34%, brain natriuretic peptide 312 pg/ml; 55% had atrial fibrillation. Dates of mortality were collected from administrative databases and medical records up until 2008. Follow-up was 9 to 13 years in all 132 patients, and mean survival was 5.5 ± 4.0 years. Baseline PICP tended to be higher, CITP was higher, and the PICP:CITP ratio was lower in the 102 deceased, compared with the 30 patients alive. Multivariable Cox regression analyses including 2 established risk factor models performed for all-cause (n = 101) and cardiovascular mortality (n = 61) show PICP and CITP to be independent predictors for all-cause and cardiovascular mortality. In conclusion, disturbances of collagen type I metabolism have independent prognostic implications for long-term all-cause and cardiovascular mortality in patients with HF with reduced EF. The results suggest excessive degradation to be the predominant disturbance associated with untoward prognosis and adds information on possible target mechanisms for future therapy.
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30
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Ikonomidis I, Tzortzis S, Triantafyllidi H, Parissis J, Papadopoulos C, Venetsanou K, Trivilou P, Paraskevaidis I, Lekakis J. Association of impaired left ventricular twisting-untwisting with vascular dysfunction, neurohumoral activation and impaired exercise capacity in hypertensive heart disease. Eur J Heart Fail 2015; 17:1240-51. [PMID: 26443037 DOI: 10.1002/ejhf.403] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/25/2015] [Accepted: 08/19/2015] [Indexed: 01/10/2023] Open
Abstract
AIMS We investigated the association between left ventricular (LV) torsional deformation and vascular dysfunction, fibrosis, neurohumoral activation, and exercise capacity in patients with normal ejection fraction METHODS AND RESULTS In 320 newly-diagnosed untreated hypertensive patients and 160 controls, we measured: pulse wave velocity (PWV); coronary flow reserve (CFR) by Doppler echocardiography; global longitudinal strain and strain rate, peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw - UtwMVO ), at peak (%dpTw - UtwPEF ), and the end of early LV diastolic filling (%dpTw - UtwEDF ) by speckle tracking imaging; transforming growth factor (TGFb-1), metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloptoteinase-1(TIMP-1), markers of collagen synthesis, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Oxygen consumption (VO2 ), measured by means of cardiopulmonary exercise test, was assessed in a subset of 80 patients. The PWV, CFR, longitudinal strain and strain rate, %dpTw-UtwMVO , %dpTw-UtwPEF , and %dpTw-UtwEDF were impaired in hypertensive patients compared with controls. In multivariable analysis, CFR, PWV, LV mass, and systolic blood pressure were independent determinants of longitudinal strain, strain rate, and untwisting markers (P < 0.05). Increased TGFb-1 was related with increased collagen synthesis markers, TIMP-1 and MMP-9 and these biomarkers were associated with impaired longitudinal systolic strain rate, untwisting markers, CFR and PWV (P < 0.05). Delayed untwisting as assessed by reduced %dpTw - UtwEDF was related with increased NT-proBNP and reduced VO2 (P < 0.05). CONCLUSIONS Impaired LV untwisting is associated with increased arterial stiffness and coronary microcirculatory dysfunction, and is linked to reduced exercise capacity and neurohumoral activation in hypertensive heart disease. A fibrotic process may be the common link between vascular dysfunction and abnormal myocardial deformation.
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Affiliation(s)
- Ignatios Ikonomidis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Stavros Tzortzis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Helen Triantafyllidi
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - John Parissis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Costas Papadopoulos
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Kyriaki Venetsanou
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Paraskevi Trivilou
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - Ioannis Paraskevaidis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
| | - John Lekakis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Rimini 1, Haidari, Athens, 12462 Greece
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31
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The mechanism of reduced longitudinal left ventricular systolic function in hypertensive patients with normal ejection fraction. J Hypertens 2015; 33:1962-9; discussion 1969. [DOI: 10.1097/hjh.0000000000000624] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nogi S, Ito T, Kizawa S, Shimamoto S, Sohmiya K, Hoshiga M, Ishizaka N. Association between Left Ventricular Postsystolic Shortening and Diastolic Relaxation in Asymptomatic Patients with Systemic Hypertension. Echocardiography 2015; 33:216-22. [PMID: 26234318 DOI: 10.1111/echo.13022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Few data have existed on myocardial postsystolic shortening (PSS) accounting for left ventricular (LV) diastolic dysfunction in systemic hypertension. We examined this relationship, along with clinical and other cardiac parameters, in asymptomatic patients with hypertension. METHODS We analyzed 104 patients on pharmacological treatment for hypertension who had no signs or symptoms of heart failure for conventional and speckle tracking echocardiography. The sum of the postsystolic index for multiple LV segments (total PSI) and global longitudinal strain (GLS) was computed and used as measures for global PSS and myocardial systolic function, respectively. The tissue Doppler e' and the speckle tracking-derived global strain rate during early diastole (e'sr) were obtained as indicators of LV relaxation. The circumferential end-systolic stress was also determined noninvasively and substituted for a measure of myocardial afterload. RESULTS Main variables that correlated with the e' and e'sr were shown to be age, LV mass index, left atrial volume index, GLS, and the total PSI. Multivariate analysis including gender, circumferential end-systolic stress, and the use of calcium channel blockers as possible covariates revealed that age (β = -0.29, P = 0.002), total PSI (β = -0.26, P = 0.008), and LV mass index (β = -0.25, P = 0.017) were significant independent determinants of e' and that age (β = -0.34, P < 0.001) and GLS (β = -0.28, P = 0.006) were of e'sr. CONCLUSIONS Our findings indicate that while depending on the degree of GLS, PSS may affect diastolic relaxation in patients with asymptomatic, but treated, hypertensive patients.
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Affiliation(s)
- Shimpei Nogi
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shun Kizawa
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shinsaku Shimamoto
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Nobukazu Ishizaka
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
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RV Longitudinal Deformation Correlates With Myocardial Fibrosis in Patients With End-Stage Heart Failure. JACC Cardiovasc Imaging 2015; 8:514-522. [DOI: 10.1016/j.jcmg.2014.12.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/19/2022]
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Bielecka-Dabrowa A, Michalska-Kasiczak M, Gluba A, Ahmed A, Gerdts E, von Haehling S, Rysz J, Banach M. Biomarkers and echocardiographic predictors of myocardial dysfunction in patients with hypertension. Sci Rep 2015; 5:8916. [PMID: 25747153 PMCID: PMC5390083 DOI: 10.1038/srep08916] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/10/2015] [Indexed: 01/19/2023] Open
Abstract
The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography. Echocardiography at rest and during exercise, and selected biomarkers were assessed in control group, dyspnea group, and HF group. On exercise dyspnea patients had lower early diastolic (E') and systolic (S') mitral annular velocity (12.8 ± 1.0 vs 14.9 ± 3.0 cm/sec and 9.3 ± 2.0 vs 10.9 ± 2.0 cm/sec, respectively), and higher E/E' ratio compared to control group (6.7 ± 1.0 vs 5.9 ± 1.0) (p < 0.05 for all comparisons). The level of N-terminal propeptide of procollagen type III (PIIINP) was significantly higher in dyspnea group than in controls (p = 0.01). Control and dyspnea patients had lower levels of cardiotrophin-1, cystatin C, syndecan-4, and N terminal-probrain natriuretic peptide than HF patients (all p ≤ 0.01). In multivariate analysis PIIINP (unadjusted odds ratio [OR] = 8.2, 95% confidence interval [Cl] 1.7-40.6; p = 0.001; adjusted OR = 8.7; 95%CI: 1.5-48.3; p = 0.001) and E/E' ratio on exercise (unadjusted OR = 1.8, 95%CI: 0.8-4.0; p = 0.033; adjusted OR = 2.0; 95%CI: 0.8-4.8; p = 0.012) were the only factors significantly associated with the presence of dyspnea. PIIINP is the first early biomarker for the HF development in patients with HA and normal resting echocardiography. Exertional echocardiography may indicate patients with incipient HF with preserved ejection fraction.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Marta Michalska-Kasiczak
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Anna Gluba
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Norway
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
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35
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Reply to the letter “Androgens in cardiac fibrosis and other cardiovascular mechanisms”. Int J Cardiol 2015; 182:340-1. [DOI: 10.1016/j.ijcard.2014.12.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/28/2014] [Indexed: 11/20/2022]
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Chalikias GK, Tziakas DN. Biomarkers of the extracellular matrix and of collagen fragments. Clin Chim Acta 2015; 443:39-47. [DOI: 10.1016/j.cca.2014.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 06/15/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023]
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Kuruvilla S, Janardhanan R, Antkowiak P, Keeley EC, Adenaw N, Brooks J, Epstein FH, Kramer CM, Salerno M. Increased extracellular volume and altered mechanics are associated with LVH in hypertensive heart disease, not hypertension alone. JACC Cardiovasc Imaging 2015; 8:172-80. [PMID: 25577446 PMCID: PMC4418794 DOI: 10.1016/j.jcmg.2014.09.020] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The goal of this study was to assess the relationship among extracellular volume (ECV), native T1, and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH), hypertensive patients without LVH (HTN non-LVH), and normotensive controls. BACKGROUND Diffuse myocardial fibrosis in HTN LVH patients, as reflected by increased ECV and native T1, may be an underlying mechanism contributing to increased cardiovascular risk compared with HTN non-LVH subjects and controls. Furthermore, increased diffuse fibrosis in HTN LVH subjects may be associated with reduced peak systolic and early diastolic strain rate compared with the other 2 groups. METHODS T1 mapping was performed in 20 HTN LVH (mean age, 55 ± 11 years), 23 HTN non-LVH (mean age, 61 ± 12 years), and 22 control subjects (mean age, 54 ± 7 years) on a Siemens 1.5-T Avanto (Siemens Healthcare, Erlangen, Germany) using a previously validated modified look-locker inversion-recovery pulse sequence. T1 was measured pre-contrast and 10, 15, and 20 min after injection of 0.15 mmol/kg gadopentetate dimeglumine, and the mean ECV and native T1 were determined for each subject. Measurement of circumferential strain parameters were performed using cine displacement encoding with stimulated echoes. RESULTS HTN LVH subjects had higher native T1 compared with controls (p < 0.05). HTN LVH subjects had higher ECV compared with HTN non-LVH subjects and controls (p < 0.05). Peak systolic circumferential strain and early diastolic strain rates were reduced in HTN LVH subjects compared with HTN non-LVH subjects and controls (p < 0.05). Increased levels of ECV and native T1 were associated with reduced peak systolic and early diastolic circumferential strain rate across all subjects. CONCLUSIONS HTN LVH patients had higher ECV, longer native T1 and associated reduction in peak systolic circumferential strain, and early diastolic strain rate compared with HTN non-LVH and control subjects. Measurement of ECV and native T1 provide a noninvasive assessment of diffuse fibrosis in hypertensive heart disease.
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Affiliation(s)
- Sujith Kuruvilla
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Rajesh Janardhanan
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Patrick Antkowiak
- Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Ellen C Keeley
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Nebiyu Adenaw
- Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Jeremy Brooks
- Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Frederick H Epstein
- Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
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Krämer J, Niemann M, Störk S, Frantz S, Beer M, Ertl G, Wanner C, Weidemann F. Relation of burden of myocardial fibrosis to malignant ventricular arrhythmias and outcomes in Fabry disease. Am J Cardiol 2014; 114:895-900. [PMID: 25073565 DOI: 10.1016/j.amjcard.2014.06.019] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 12/13/2022]
Abstract
The aim of this study was to investigate the impact of myocardial fibrosis in Fabry disease. Seventy-three patients with genetically confirmed Fabry disease were followed for 4.8 ± 2.4 years. In accordance with current guidelines, 57 patients received enzyme replacement therapy (ERT) after study inclusion, whereas 16 did not. At baseline and latest possible follow-up, myocardial fibrosis was assessed noninvasively by cardiac magnetic resonance, and biomarkers of collagen metabolism were determined. Holter electrocardiography and clinical follow-up at yearly intervals were used to monitor malignant ventricular arrhythmias (MVAs; nonsustained and sustained ventricular tachycardia and sudden cardiac death). In total, 48 patients (66%) showed fibrosis assessed by late enhancement (LE) at baseline, and 4 patients developed new LE during follow-up, 2 of them despite ERT. The 2 patients receiving ERT (1.4 ± 1.9% vs 2.5 ± 2.6%, p <0.001) and the patients not receiving ERT (0.5 ± 0.8% vs 0.7 ± 1.0%, p = 0.035) showed a progression of LE during follow-up. None of the patients displayed reductions of LE during follow-up. Collagen biomarkers were elevated in patients with and without LE but did not correlate with LE amount. Thirteen LE-positive patients at the baseline examination had documented MVAs (including 5 sudden cardiac deaths), whereas none of the patients without LE had MVAs. The yearly increase in fibrosis was 0.9 ± 0.6% in patients with MVAs and 0.2 ± 0.3% in patients without MVAs (p <0.001). Logistic multivariate regression analysis revealed that the annual increase in fibrosis during follow-up was the only independent predictor of MVAs. In conclusion, myocardial fibrosis in Fabry disease is progressive, apparently not modified by ERT, and a crucial outcome determinant.
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Affiliation(s)
- Johannes Krämer
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Markus Niemann
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Meinrad Beer
- Institute of Radiology, University of Ulm, Ulm, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Department of Internal Medicine I, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
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RightVentricular Strain and Strain Rate in Patientswith Systemic Sclerosis Without Pulmonary Hypertension. ACTA ACUST UNITED AC 2014. [DOI: 10.5812/acvi.20735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yuan J, Chen S, Qiao S, Duan F, Zhang J, Wang H. Characteristics of myocardial postsystolic shortening in patients with symptomatic hypertrophic obstructive cardiomyopathy before and half a year after alcohol septal ablation assessed by speckle tracking echocardiography. PLoS One 2014; 9:e99014. [PMID: 24922531 PMCID: PMC4055631 DOI: 10.1371/journal.pone.0099014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/08/2014] [Indexed: 02/05/2023] Open
Abstract
Objectives Postsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on PSS in HOCM patients using speckle tracking imaging. Methods Conventional echocardiographic and PSS parameters were obtained in 18 healthy controls and 30 HOCM patients before and half a year after PTSMA. Results Compared with the healthy controls, the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. At 6 months after PTSMA, both the number of segments having PSS (10.5±2.8 vs. 13.2±2.6; P<0.001) and the average value of PSS (−1.24±0.57 vs. −1.55±0.56; P = 0.009) were significantly reduced. Moreover, the reductions in the average value of PSS correlated well with the reductions in the E-to-Ea ratio (r = 0.705, P<0.001). Conclusions Both the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. PTSMA has a favourable effect on PSS, which may partly account for the persistent improvement in LV diastolic function in HOCM patients after PTSMA.
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Affiliation(s)
- Jiansong Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
| | - Fujian Duan
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiafen Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Khan H, Kalogeropoulos AP, Zannad F, Marti CN, Wilson PWF, Georgiopoulou VV, Kanaya AM, Newman AB, Schelbert E, Harris TB, Kritchevsky S, Yancy C, Gheorghiade M, Fonarow GC, Butler J. Incident heart failure in relation to vascular disease: insights from the Health, Aging, and Body Composition Study. Eur J Heart Fail 2014; 16:526-34. [PMID: 24578142 DOI: 10.1002/ejhf.69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 01/09/2023] Open
Abstract
AIMS The contribution of heart failure (HF) unrelated to vascular disease to the overall HF burden in older adults is not well characterized. This was investigated in this study. METHODS AND RESULTS We assessed HF incidence and outcomes in 2895 participants of the Health ABC Study (age 74 ± 3 years, 48.4% men, 41.4% black) in relation to vascular disease (coronary, peripheral, or cerebrovascular disease) either present at baseline or developed prior to HF. During 11.4 years follow-up, 493 participants developed HF; 134 (27.2%) in participants without any prior vascular disease and 177 (36.8%) without coronary disease. Both baseline [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.9-2.8] and incident vascular disease (HR 4.3, 95% CI 3.6-5.2) were associated with HF. During a median follow-up of 2.1 years after HF onset, 67.5% participants died. Annual mortality after HF development was 21.3% in those with compared with 24.6% in those without vascular disease (HR 1.11, 95% CI 0.87-1.43; P = 0.399). There were 658 all-cause (436.3/1000 person-years) and 523 HF-related (346.4/1000 person-years) hospitalizations after HF development. There was no significant difference in hospitalizations between those with and without vascular disease [rate ratio (RR) 1.04, 95% CI 0.86-1.24 for all-cause, and RR 0.84 95% CI 0.69-1.02 for HF hospitalization]. HF with preserved EF was more common in participants without vascular disease (67.0% vs. 55.0%, P = 0.040). CONCLUSION A significant proportion of HF in older adults develops without prior vascular disease. Outcomes for these patients are poor compared with those with preceding vascular disease. These data suggest the need for more targeted HF prediction and prevention efforts.
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Affiliation(s)
- Hassan Khan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Ballo P, Nistri S, Cameli M, Papesso B, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. Association of Left Ventricular Longitudinal and Circumferential Systolic Dysfunction With Diastolic Function in Hypertension: A Nonlinear Analysis Focused on the Interplay With Left Ventricular Geometry. J Card Fail 2014; 20:110-20. [DOI: 10.1016/j.cardfail.2013.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/02/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
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Özkan B, Açar G, Alıcı G, Alizade E, Tabakcı MM, Sahin M, Yazıcıoğlu MV, Ozkok A, Tanboğa IH, Coşkun C, Esen AM. Decreased plasma adiponectin is associated with impaired left ventricular longitudinal systolic function in hypertensive patients: a two-dimensional speckle tracking study. Clin Exp Hypertens 2013; 36:46-51. [PMID: 23772851 DOI: 10.3109/10641963.2013.783053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The influence of plasma adiponectin levels on myocardial contractile function has not been fully examined. We aimed to investigate the relationship between three-directional systolic function and plasma adiponectin levels in asymptomatic hypertensive patients using two- dimensional speckle-tracking echocardiography. The study population consisted of 78 patients with hypertension and 40 healthy controls. Longitudinal strain was significantly reduced in all patients, including those without LV hypertrophy (p=0.009). In multiple-regression analysis, plasma adiponectin levels (β=-0.273, p=0.008) and LV mass index (β=0.458, p<0.001) independently correlated with LV longitudinal strain. Decreased plasma adiponectin concentrations were associated with the progression of LV hypertrophy with impaired LV longitudinal systolic function.
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Affiliation(s)
- Birol Özkan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital , Istanbul , Turkey
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Hare JL, Sharman JE, Leano R, Jenkins C, Wright L, Marwick TH. Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise. Am J Hypertens 2013; 26:691-9. [PMID: 23412930 DOI: 10.1093/ajh/hpt008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. METHODS In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. RESULTS Baseline 24-hour systolic BP (SBP) was 133 ± 10 mm Hg and peak-exercise SBP was 219 ± 16 mm Hg. Peak systolic strain (0.3 ± 3.6% vs. -0.1 ± 3.2, P = 0.56), E/em (-1.1 ± 2.3 vs. -0.6 ± 1.7, P = 0.30), VO(2max) (0.4 ± 4.9 vs. -0.9 ± 4.1 ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3 ± 2.4 vs. 0.8 ± 2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO(2max) (1.1 ± 5.6 vs. -2.4 ± 4.4 ml/kg/min, P < 0.05) and reduced exercise E/e(m) (-0.7 ± 2.7 vs. 1.9 ± 2.8, P < 0.05). CONCLUSIONS In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/e(m) but did not significantly alter exercise capacity or myocardial strain.
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Affiliation(s)
- James L Hare
- School of Medicine, The University of Queensland, Brisbane, Australia
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Cohen S, Gaddam S, Gemignani A, Wu WC, Sharma S, Choudhary G. Right Ventricular Function Relates to Functional Capacity in Men with Atrial Fibrillation and Preserved Left Ventricular Ejection Fraction. Echocardiography 2013; 30:542-50. [DOI: 10.1111/echo.12099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Hassager C, Søgaard P, Køber L. Relationship between Left Ventricular Longitudinal Deformation and Clinical Heart Failure during Admission for Acute Myocardial Infarction: A Two-Dimensional Speckle-Tracking Study. J Am Soc Echocardiogr 2012; 25:1280-9. [DOI: 10.1016/j.echo.2012.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Indexed: 11/15/2022]
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Phelan D, Watson C, Martos R, Collier P, Patle A, Donnelly S, Ledwidge M, Baugh J, McDonald K. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes. PLoS One 2012; 7:e49259. [PMID: 23152884 PMCID: PMC3495762 DOI: 10.1371/journal.pone.0049259] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/05/2012] [Indexed: 01/19/2023] Open
Abstract
In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g/m2, p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.
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Affiliation(s)
- Dermot Phelan
- Heart Failure Unit, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Chris Watson
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramon Martos
- Heart Failure Unit, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Anil Patle
- Heart Failure Unit, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Seamas Donnelly
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Mark Ledwidge
- Heart Failure Unit, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - John Baugh
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Ken McDonald
- Heart Failure Unit, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
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Green D, Kalra PR, Kalra PA. Echocardiographic abnormalities in dialysis patients with normal ejection fraction. Nephrol Dial Transplant 2012; 27:4256-9. [PMID: 22892125 DOI: 10.1093/ndt/gfs357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Darren Green
- Vascular Research Group, Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Sciences Centre, UK.
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Agrinier N, Thilly N, Boivin JM, Dousset B, Alla F, Zannad F. Prognostic value of serum PIIINP, MMP1 and TIMP1 levels in hypertensive patients: a community-based prospective cohort study. Fundam Clin Pharmacol 2012; 27:572-80. [DOI: 10.1111/j.1472-8206.2012.01053.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/04/2012] [Accepted: 06/01/2012] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Jean-Marc Boivin
- Departement of Cardiology; INSERM; CIC9501 and U961, CHU Nancy; Hypertension and Heart Failure Unit; CHU, Université de Lorraine; 54500; Vandœuvre les Nancy; France
| | | | | | - Faiez Zannad
- Departement of Cardiology; INSERM; CIC9501 and U961, CHU Nancy; Hypertension and Heart Failure Unit; CHU, Université de Lorraine; 54500; Vandœuvre les Nancy; France
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