1
|
Li L, Niemann B, Knapp F, Werner S, Mühlfeld C, Schneider JP, Jurida LM, Molenda N, Schmitz ML, Yin X, Mayr M, Schulz R, Kracht M, Rohrbach S. Comparison of the stage-dependent mitochondrial changes in response to pressure overload between the diseased right and left ventricle in the rat. Basic Res Cardiol 2024:10.1007/s00395-024-01051-3. [PMID: 38758338 DOI: 10.1007/s00395-024-01051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
The right ventricle (RV) differs developmentally, anatomically and functionally from the left ventricle (LV). Therefore, characteristics of LV adaptation to chronic pressure overload cannot easily be extrapolated to the RV. Mitochondrial abnormalities are considered a crucial contributor in heart failure (HF), but have never been compared directly between RV and LV tissues and cardiomyocytes. To identify ventricle-specific mitochondrial molecular and functional signatures, we established rat models with two slowly developing disease stages (compensated and decompensated) in response to pulmonary artery banding (PAB) or ascending aortic banding (AOB). Genome-wide transcriptomic and proteomic analyses were used to identify differentially expressed mitochondrial genes and proteins and were accompanied by a detailed characterization of mitochondrial function and morphology. Two clearly distinguishable disease stages, which culminated in a comparable systolic impairment of the respective ventricle, were observed. Mitochondrial respiration was similarly impaired at the decompensated stage, while respiratory chain activity or mitochondrial biogenesis were more severely deteriorated in the failing LV. Bioinformatics analyses of the RNA-seq. and proteomic data sets identified specifically deregulated mitochondrial components and pathways. Although the top regulated mitochondrial genes and proteins differed between the RV and LV, the overall changes in tissue and cardiomyocyte gene expression were highly similar. In conclusion, mitochondrial dysfuntion contributes to disease progression in right and left heart failure. Ventricle-specific differences in mitochondrial gene and protein expression are mostly related to the extent of observed changes, suggesting that despite developmental, anatomical and functional differences mitochondrial adaptations to chronic pressure overload are comparable in both ventricles.
Collapse
Affiliation(s)
- Ling Li
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392, Giessen, Germany
| | - Bernd Niemann
- Department of Cardiac and Vascular Surgery, Justus Liebig University Giessen, Rudolf-Buchheim-Street. 8, 35392, Giessen, Germany
| | - Fabienne Knapp
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392, Giessen, Germany
| | - Sebastian Werner
- Rudolf Buchheim Institute of Pharmacology, Justus Liebig University Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Christian Mühlfeld
- Hannover Medical School, Institute of Functional and Applied Anatomy, Carl-Neuberg-Street. 1, 30625, Hannover, Germany
| | - Jan Philipp Schneider
- Hannover Medical School, Institute of Functional and Applied Anatomy, Carl-Neuberg-Street. 1, 30625, Hannover, Germany
| | - Liane M Jurida
- Rudolf Buchheim Institute of Pharmacology, Justus Liebig University Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Nicole Molenda
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392, Giessen, Germany
| | - M Lienhard Schmitz
- Institute of Biochemistry, Justus Liebig University Giessen, Friedrichstr. 24, 35392, Giessen, Germany
| | - Xiaoke Yin
- School of Cardiovascular and Metabolic Medicine and Science, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Manuel Mayr
- School of Cardiovascular and Metabolic Medicine and Science, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Rainer Schulz
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392, Giessen, Germany
| | - Michael Kracht
- Rudolf Buchheim Institute of Pharmacology, Justus Liebig University Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Susanne Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392, Giessen, Germany.
| |
Collapse
|
2
|
Chaix MA, Dore A, Mondésert B, Mongeon FP, Roy V, Desrosiers-Gagnon C, Guertin MC, White M, Ibrahim R, O’Meara E, Rouleau JL, Khairy P. Angiotensin receptor-neprilysin inhibitor vs. placebo in congenital systemic right ventricular heart failure: the PARACYS-RV trial. Eur Heart J 2024; 45:1481-1483. [PMID: 38445853 PMCID: PMC11032706 DOI: 10.1093/eurheartj/ehad890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Véronique Roy
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Charles Desrosiers-Gagnon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal H1T 1C8, QC, Canada
| | - Michel White
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
| | - Eileen O’Meara
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Lucien Rouleau
- Heart failure clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger St.E., Montreal H1T 1C8, QC, Canada
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal H1T 1C8, QC, Canada
| |
Collapse
|
3
|
Goldstein SA, Krasuski RA. Complex Congenital Heart Disease in the Adult. Annu Rev Med 2024; 75:493-512. [PMID: 38285514 DOI: 10.1146/annurev-med-050922-052324] [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: 01/31/2024]
Abstract
Congenital heart disease (CHD), a heterogeneous group of structural abnormalities of the cardiovascular system, is the most frequent cause of severe birth defects. Related to improved pediatric outcomes, there are now more adults living with CHD, including complex lesions, than children. Adults with CHD are at high risk for complications related to their underlying anatomy and past surgical palliative interventions. Adults with CHD require close monitoring and proactive management strategies to improve outcomes.
Collapse
Affiliation(s)
- Sarah A Goldstein
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard A Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA;
| |
Collapse
|
4
|
Miranda WR, Jain CC, Egbe AC, Reddy YN, Dearani JA, Hagler DJ, Connolly HM. Hemodynamics in Adults with Systemic Right Ventricles: Differences Between Congenitally Corrected and Complete Transposition of the Great Arteries. Pediatr Cardiol 2024:10.1007/s00246-023-03381-w. [PMID: 38231238 DOI: 10.1007/s00246-023-03381-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Abstract
Despite their anatomical differences, congenitally corrected (ccTGA) and complete transposition of the great arteries (d-TGA) post-atrial switch are frequently studied together and managed similarly from a medical standpoint due to the shared systemic right ventricle (sRV). The aim was to assess differences in their underlying hemodynamics. The study is a retrospective review of 138 adults with ccTGA or d-TGA post-atrial switch undergoing cardiac catheterization at Mayo Clinic, MN between 2000 and 2021. ccTGA was categorized into isolated or complex ccTGA depending on concomitant ventricular septal defect and/or left ventricular outflow obstruction. There were 53 patients with d-TGA (91% post-Mustard procedure), 51 with complex and 34 with isolated ccTGA. Isolated ccTGA patients were older (51.8 ± 13.1 years) than those with d-TGA (37.5 ± 8.3 years) or complex ccTGA (40.8 ± 13.4 years). There were no differences in sRV or left ventricular size and function across groups. The ccTGA group more commonly had ≥ moderate tricuspid regurgitation than those with d-TGA; ≥ moderate mitral and ≥ moderate pulmonary regurgitation were most prevalent in complex ccTGA. There were no differences in sRV end-diastolic pressure (sRVEDP) or PAWP between groups. However, the ratio of PAWP:sRVEDP was higher in those with d-TGA compared to those with ccTGA. Cardiac index was higher in the d-TGA group than both groups of ccTGA patients with the latter showing higher indices of ventricular afterload. In conclusion, despite sharing a sRV, adults with d-TGA and ccTGA have substantial differences in hemodynamics and structural/valvular abnormalities. Further investigation regarding disease-specific responses to heart failure therapy in those with d-TGA and ccTGA is warranted.
Collapse
Affiliation(s)
- William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Yogesh N Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Donald J Hagler
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Division of Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| |
Collapse
|
5
|
Arvanitaki A, Diller G, Giannakoulas G. The Right Heart in Congenital Heart Disease. Curr Heart Fail Rep 2023; 20:471-483. [PMID: 37773427 DOI: 10.1007/s11897-023-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE OF REVIEW To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options. RECENT FINDINGS The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.
Collapse
Affiliation(s)
- Alexandra Arvanitaki
- 1st Department of Cardiology, AHEPA University Hospital, St. Kiriakidi 1, 54621, Thessaloniki, Greece
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Gerhard Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
- National Register for Congenital Heart Defects, Berlin, Germany
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
| |
Collapse
|
6
|
Tedla BA, Kim YY, Vaikunth S. Novel Approaches to the Failing Congenital Heart. Curr Cardiol Rep 2023; 25:1633-1647. [PMID: 37889420 DOI: 10.1007/s11886-023-01979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure is the leading cause of morbidity and mortality in adults with congenital heart disease and is characterized by a variety of underlying mechanisms. Here, we aim to elaborate on the medical and technological advancements in the management of heart failure in adult patients with congenital heart disease and highlight the use of imaging modalities to guide therapy. RECENT FINDINGS There have been several advances over the past decade with angiotensin receptor neprilysin and sodium-glucose cotransporter-2 inhibitors, atrioventricular valve clips, transcatheter pulmonary valves, catheter ablation, and cardiac resynchronization therapy, as well as the introduction of lymphatic interventions. Expanded use of echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography has guided many of these therapies. Significant innovations in the management of heart failure in adults with congenital heart disease have evolved with advancements in imaging modalities playing a critical role in guiding treatment therapies.
Collapse
Affiliation(s)
- Bruke A Tedla
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Sumeet Vaikunth
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman Center for Advanced Medicine, 11th Floor, South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104-5127, USA.
| |
Collapse
|
7
|
Ansari Ramandi MM, Yarmohammadi H, Gareb B, Voors AA, van Melle JP. Long-term outcome of patients with transposition of the great arteries and a systemic right ventricle: A systematic review and meta-analysis. Int J Cardiol 2023; 389:131159. [PMID: 37433408 DOI: 10.1016/j.ijcard.2023.131159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Patients with a transposition of the great arteries (TGA) and a systemic right ventricle are at risk of heart failure (HF) development, arrhythmia and early mortality. Prognostic evaluations in clinical studies are hampered by small sample sizes and single-centred approaches. We aimed to investigate yearly rate of outcome and factors affecting it. METHODS A systematic literature search of four electronic databases (PubMed, EMBASE, Web of Science and Scopus) was conducted from inception to June 2022. Studies reporting the association of a systemic right ventricle with mortality with a minimal follow-up of 2 years during adulthood were selected. Incidence of HF hospitalization and/or arrhythmia were captured as additional endpoints. For each outcome, a summary effect estimate was calculated. RESULTS From a total of 3891 identified records, 56 studies met the selection criteria. These studies described the follow-up (on average 7.27 years) of 5358 systemic right ventricle patients. The mortality incidence was 1.3 (1-1.7) per 100 patients/year. The incidence of HF hospitalization was 2.6 (1.9-3.7) per 100 patients/year. Predictors of poor outcome were a lower left ventricular (LV) and right ventricular ejection fraction (RVEF) (standardized mean differences (SMD) of -0.43 (-0.77 to -0.09) and - 0.85 (-1.35 to -0.35), respectively), higher plasma concentrations of NT-proBNP (SMD of 1.24 (0.49-1.99)), and NYHA class ≥2 (risk ratio of 2.17 (1.40-3.35)). CONCLUSIONS TGA patients with a systemic right ventricle have increased incidence of mortality and HF hospitalization. A lower LVEF and RVEF, higher levels of NT-proBNP and NYHA class ≥2 are associated with poor outcome.
Collapse
Affiliation(s)
- Mohammad Mostafa Ansari Ramandi
- University of Groningen, Department of Cardiology, Center for Congenital Heart Disease, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, Center for Congenital Heart Disease, University Medical Center Groningen, Groningen, the Netherlands
| | - Joost P van Melle
- University of Groningen, Department of Cardiology, Center for Congenital Heart Disease, University Medical Center Groningen, Groningen, the Netherlands.
| |
Collapse
|
8
|
Minaev A, Podzolkov V, Danilov T, Chiaureli M, Mwela BM, Dontsova V. Improved Surgical Outcomes in Adults with Congenital Heart Disease and Decompensated Heart Failure: The Role of Perioperative Medical Optimization. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939230. [PMID: 37828735 PMCID: PMC10584196 DOI: 10.12659/ajcr.939230] [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: 12/13/2022] [Revised: 08/24/2023] [Accepted: 07/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Decompensated heart failure (HF) is recognized as a significant prognostic factor for unfavorable outcomes in both the general population and adults with congenital heart diseases (ACHD). Among ACHD patients, those with advanced heart failure may be candidates for heart transplantation. However, in ACHD patients requiring heart surgery, even with reduced ejection fraction, the administration of appropriate medications can result in improved circulatory parameters, functional class, and surgical outcomes. CASE REPORT We present 5 patients who exhibited indications for open-heart surgery, advanced heart failure (HF) accompanied by congestion, and significant physical activity limitations or symptoms at rest (NYHA class III-IV). Among the patients, 40% were male, with a mean age of 47.4 years (ranging from 32 to 62 years). Three patients displayed reduced systemic ventricular ejection fraction, while 4 patients experienced arrhythmia. Congenital heart diseases (CHD) observed in the patients included repaired double-outlet right ventricle, congenitally corrected transposition of the great arteries, repaired tetralogy of Fallot, partial anomalous right pulmonary venous return, and atrial septal defect. Comprehensive heart failure medications were administered, including an angiotensin receptor neprilysin inhibitor, levosimendan, beta-blockers, phosphocreatine, and diuretics. The preoperative period ranged from 8 days to 2 months. Notably, significant clinical and hemodynamic improvements were observed in all cases, and all open-heart surgeries were successfully completed. CONCLUSIONS Advanced and decompensated HF has a high impact on surgical outcomes. Preoperative care with prescribed medical management for ACHD patients is possible and provides good early and mid-term postoperative results.
Collapse
Affiliation(s)
- Anton Minaev
- Department of Congenital Heart Diseases, A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - Vladimir Podzolkov
- Department of Congenital Heart Diseases, A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - Timur Danilov
- Department of Congenital Heart Diseases, A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - Mikhail Chiaureli
- Department of Congenital Heart Diseases, A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - Bupe Mumba Mwela
- Medical Institute, Peoples’ Friendship University of Russia, Moscow, Russia
| | - Vera Dontsova
- Department of Congenital Heart Diseases, A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| |
Collapse
|
9
|
Vaikunth S, Sundaravel S, Saef J, Ortega-Legaspi J. Novel Therapeutic Strategies in Heart Failure in Adult Congenital Heart Disease: of Medicines and Devices. Curr Heart Fail Rep 2023; 20:401-416. [PMID: 37582901 DOI: 10.1007/s11897-023-00621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the latest literature on the growing field of heart failure in the adult congenital heart disease population. RECENT FINDINGS After highlighting the increasing prevalence and a few of the unique potential causes, including the concept of early senescence, this review begins with novel medical management strategies such as the angiotensin II receptor blocker and neprilysin inhibitors and sodium glucose cotransporter-2 inhibitors. Then, it addresses the latest applications of percutaneous techniques like implantable hemodynamic monitoring, transcatheter pulmonary and aortic valve replacement, and mitral clips. Cardiac resynchronization therapy and novel lymphatic system imaging and intervention are then described. Finally, the use of mechanical support devices, temporary and durable, is discussed as well as heart and combined heart and liver transplantation. There have been recent exciting advances in the strategies used to manage adult congenital heart disease patients with heart failure. As this population continues to grow, it is likely we will see further rapid evolution in this field.
Collapse
Affiliation(s)
- Sumeet Vaikunth
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Swethika Sundaravel
- Advanced Heart Failure Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Saef
- Philadelphia Adult Congenital Heart Center, Penn Medicine & Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Juan Ortega-Legaspi
- Advanced Heart Failure Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
10
|
Nederend M, Kiès P, Regeer MV, Vliegen HW, Mertens BJ, Robbers-Visser D, Bouma BJ, Tops LF, Schalij MJ, Jongbloed MRM, Egorova AD. Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure. Heart 2023; 109:1525-1532. [PMID: 37169551 DOI: 10.1136/heartjnl-2022-322332] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to sRV dysfunction. Pharmacological options for sRV failure remain poorly defined. This study aims to investigate the tolerability and effects of sacubitril/valsartan on sRV failure in adult patients with sRV. METHODS In this two-centre, prospective cohort study, all consecutive adult patients with symptomatic heart failure and at least moderately reduced sRV systolic function were initiated on sacubitril/valsartan and underwent structured follow-up. RESULTS Data of 40 patients were included (40% female, 30% ccTGA, median age 48 (44-53) years). Five patients discontinued therapy during titration. Median follow-up was 24 (12-36) months. The maximal dose was tolerated by 49% of patients. No episodes of hyperkalaemia or renal function decline occurred. Six-minute walking distance increased significantly after 6 months of treatment (569±16 to 597±16 m, p=0.016). Serum N-terminal-prohormone brain natriuretic peptide (NT-proBNP) levels decreased significantly after 3 months (567 (374-1134) to 404 (226-633) ng/L, p<0.001). Small, yet consistent echocardiographic improvements in sRV function were observed after 6 months (sRV global longitudinal strain: -11.1±0.5% to -12.6±0.7%, p<0.001, and fractional area change: 20% (16%-24%) to 26% (19%-30%), p<0.001). The linear mixed-effects model illustrated that after first follow-up moment, no time effect was present for the parameters. CONCLUSIONS Treatment with sacubitril/valsartan was associated with a low rate of adverse effects in this adult sRV cohort. Persisting improvement in 6-minute walking test distance, NT-proBNP levels and echocardiographic parameters of sRV function was observed in an on-treatment analysis and showed no differential response based on sex or anatomy.
Collapse
Affiliation(s)
- Marieke Nederend
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Madelien V Regeer
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert W Vliegen
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart Ja Mertens
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlle Robbers-Visser
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurens F Tops
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia D Egorova
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
11
|
Andi K, Abozied O, Miranda WR, Anderson JH, Connolly HM, Jain CC, Burchill LJ, Egbe AC. Clinical benefits of angiotensin receptor-Neprilysin inhibitor in adults with congenital heart disease. Int J Cardiol 2023; 387:131152. [PMID: 37429446 DOI: 10.1016/j.ijcard.2023.131152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND There are limited data about the clinical benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in adults with congenital heart disease (CHD). The purpose of the study was to assess the clinical benefits (chamber function and heart failure indices) of ARNI in adults with CHD. METHOD In this retrospective cohort study, we compared the temporal change in chamber function and heart failure indices between 35 patients that received ARNI for >6 months, and a propensity matched control group (n = 70) of patients that received angiotensin converting enzyme inhibitor or angiotensin-II receptor blocker (ACEI/ARB) within the same period. RESULTS Of the 35 patients in the ARNI group, 21 (60%) had systemic left ventricle (LV) while 14 (40%) had systemic right ventricle (RV). Compared to the ACEI/ARB group, the ARNI group had greater relative improvement in LV global longitudinal strain (GLS) (28% versus 11% increase from baseline, p < 0.001) and RV-GLS (11% versus 4% increase from baseline, p < 0.001), and greater relative improvement in New York Heart Association functional class (-14 versus -2% change from baseline, p = 0.006) and N-terminal pro-brain natriuretic peptide levels (-29% versus -13% change from baseline, p < 0.001). These results were consistent across different systemic ventricular morphologies. CONCLUSIONS ARNI was associated with improvement in biventricular systolic function, functional status, and neurohormonal activation, suggesting prognostic benefit. These results provide a foundation for a randomized clinical trial to empirically test the prognostic benefits of ARNI in adults with CHD, as the next step towards evidence-based recommendations for heart failure management in this population.
Collapse
Affiliation(s)
- Kartik Andi
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - Omar Abozied
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - William R Miranda
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - Jason H Anderson
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - Heidi M Connolly
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - C Charles Jain
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - Luke J Burchill
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA
| | - Alexander C Egbe
- From the Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, USA.
| |
Collapse
|
12
|
Chaix MA, Dore A, Mondésert B, Mongeon FP, Roy V, Guertin MC, White M, Ibrahim R, O’Meara E, Rouleau JL, Khairy P. Design of the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor Versus Pl acebo in Patients With Congenital Systemic Right Ventricle Heart Failure (PARACYS-RV) Trial. CJC Open 2023; 5:537-544. [PMID: 37496786 PMCID: PMC10366661 DOI: 10.1016/j.cjco.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/19/2023] [Indexed: 07/28/2023] Open
Abstract
The presence of a systemic right ventricle (sRV) with biventricular physiology (biV) is associated with increased patient morbidity and mortality. To date, no pharmacologic therapy for heart failure has been proven effective for patients with systolic dysfunction of the sRV-biV. We designed a randomized, double-blind, placebo-controlled crossover trial to compare sacubitril/valsartan treatment to placebo in adults (aged ≥ 18 years) with moderate-to-severe sRV-biV dysfunction and New York Heart Association functional class II to III symptoms. Two primary efficacy endpoints are assessed in the trial: exercise capacity (submaximal exercise duration) and neurohormonal activation (N-terminal prohormone brain natriuretic peptide). Secondary objectives include assessing a change in the Kansas City Cardiomyopathy Questionnaire score and evaluating the safety and tolerance of sacubitril/valsartan. A 6-week open run-in phase identifies the maximum tolerated dose of sacubitril/valsartan, up to 97 mg/103 mg twice daily. After a 2-week washout period, patients are randomized 1:1 to sacubitril/valsartan treatment vs placebo for a 24-week phase, followed by another 2-week washout period and subsequent crossover to the alternative treatment arm for an additional 24-week phase. Data to assess primary and secondary endpoints are collected at baseline and at the end of each phase. A total of 48 patients is required to provide > 80% power to detect a 30% difference in distance walked and in N-terminal prohormone brain natriuretic peptide levels with sacubitril/valsartan treatment vs placebo, each with a 2-sided P-value of 0.025. In summary, the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor vs Placebo in Patients With Congenital Systemic Right Ventricular Heart Failure Trial (PARACYS-RV) should determine the role of sacubitril/valsartan in treating heart failure in patients with sRV-biV and carries the potential to alter management of this patient population.
Collapse
Affiliation(s)
- Marie-A. Chaix
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Dore
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Roy
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Quebec, Canada
| | - Michel White
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Eileen O’Meara
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Lucien Rouleau
- Heart Failure Clinic, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Montreal Health Innovations Coordinating Centre (MHICC), Montreal, Quebec, Canada
| | | |
Collapse
|
13
|
Bevilacqua F, Pasqualin G, Ferrero P, Micheletti A, Negura DG, D'Aiello AF, Giamberti A, Chessa M. Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review. Diagnostics (Basel) 2023; 13:2205. [PMID: 37443599 DOI: 10.3390/diagnostics13132205] [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: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.
Collapse
Affiliation(s)
- Francesca Bevilacqua
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Giulia Pasqualin
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Paolo Ferrero
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Micheletti
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Diana Gabriela Negura
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Angelo Fabio D'Aiello
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
| | - Alessandro Giamberti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, 20097 Milano, Italy
| | - Massimo Chessa
- Adult Congenital Heart Disease Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20132 Milano, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, 00165 Rome, Italy
- Vita Salute San Raffaele University, 20132 Milano, Italy
| |
Collapse
|
14
|
Neijenhuis RML, Nederend M, Jongbloed MRM, Kiès P, Rotmans JI, Vliegen HW, Jukema JW, Egorova AD. The potential of sodium-glucose cotransporter 2 inhibitors for the treatment of systemic right ventricular failure in adults with congenital heart disease. Front Cardiovasc Med 2023; 10:1093201. [PMID: 37435053 PMCID: PMC10330719 DOI: 10.3389/fcvm.2023.1093201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Aims Given the compelling evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the conventional heart failure population, SGLT2i deserve exploration in systemic right ventricular (sRV) failure. The initial experience with dapagliflozin in sRV failure patients is described, with a focus on tolerability and short-term effects on clinical outcomes. Methods and results Ten patients (70% female, median age 50 years [46.5-52]) with symptomatic sRV failure who received dapagliflozin 10 mg per day on top of optimal medical therapy between 04-2021 and 01-2023 were included. Within 4 weeks, no significant changes in blood pressure, electrolytes, or serum glucose occurred. Creatinine and estimated glomerular filtration rate (eGFR) showed a slight decline (88 ± 17 to 97 ± 23 µmol/L, p = 0.036, and 72 ± 14 vs. 66 ± 16 ml/min/1.73m2, p = 0.020, respectively). At 6 months follow-up (n = 8), median NT-proBNP decreased significantly from 736.6 [589.3-1193.3] to 531.6 [400.8-1018] ng/L (p = 0.012). Creatinine and eGFR recovered to baseline levels. There were no significant changes in echocardiographic systolic sRV or left ventricular function. New York Heart Association class improved significantly in 4 out of 8 patients (p = 0.046), who also showed an improvement in the 6-minute walk test or bicycle exercise test performance. One female patient developed an uncomplicated urinary tract infection. No patients discontinued treatment. Conclusion Dapagliflozin was well-tolerated in this small cohort of sRV failure patients. While the early results on the reduction of NT-proBNP and clinical outcome parameters are encouraging, large-scale prospective studies are warranted to thoroughly evaluate the effects of SGLT2i in the growing sRV failure population.
Collapse
Affiliation(s)
- Ralph M L Neijenhuis
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine & Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
15
|
Daniels CJ. The development of adult congenital heart disease care in the United States. Curr Probl Pediatr Adolesc Health Care 2023:101400. [PMID: 37349150 DOI: 10.1016/j.cppeds.2023.101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Curt J Daniels
- Professor Internal Medicine and Pediatrics, USA; Dottie Dohan Hepard Professsor Cardiovascular Medicine, USA; COACH Program: olumbus Ohio Adult Congenital Heart Program, USA; Heart Disease Program, USA; Schooler Family Adult Congenital Heart Disease Fellowship Program, USA; The Ohio State University Medical Center, USA; Nationwide Children's Hospital, Columbus, Ohio, USA.
| |
Collapse
|
16
|
Shen M, Zheng C, Chen L, Li M, Huang X, He M, Liu C, Lin H, Liao W, Bin J, Cao S, Liao Y. LCZ696 (sacubitril/valsartan) inhibits pulmonary hypertension induced right ventricular remodeling by targeting pyruvate dehydrogenase kinase 4. Biomed Pharmacother 2023; 162:114569. [PMID: 37001183 DOI: 10.1016/j.biopha.2023.114569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Right ventricular (RV) function is a major prognostic factor in patients with cardiopulmonary disease. Effective medical therapies are available for left heart failure, but they are usually less effective or even ineffective in right heart failure. Here, we tested the hypothesis that LCZ696 (sacubitril/valsartan) can attenuate pressure overload-induced RV remodeling by inhibiting pyruvate dehydrogenase kinase 4 (PDK4). METHODS Adult male C57 mice were subjected to transverse aortic constriction (TAC), pulmonary artery constriction (PAC), or sham surgery. Bioinformatics analysis was used to screen for common differentially expressed genes (DEGs) between TAC and PAC. Chemical compounds targeting DEGs were predicted by molecular docking analysis. Effects of LCZ696 on PAC-induced RV remodeling and the associated PDK4-related mechanisms were investigated. RESULTS We found 60 common DEGs between PAC and TAC, and Pdk4 was one of the downregulated DEGs. From 47 chemical compounds with potential cardiovascular activity and PDK4 protein binding ability, we selected LCZ696 to treat PAC-induced RV remodeling because of its high docking score for binding PDK4. Compared with vehicle-treated PAC mice, LCZ696-treated mice had significantly smaller RV wall thickness and RV diameters, less myocardial fibrosis, lower expression of PDK4 protein, and less phosphorylation of glycogen synthase kinase-3β (p-GSK3β). In PAC mice, overexpression of Pdk4 blocked the inhibitory effect of LCZ696 on RV remodeling, whereas conditional knockout of Pdk4 attenuated PAC-induced RV remodeling. CONCLUSIONS Pdk4 is a common therapeutic target for pressure overload-induced left ventricular and RV remodeling, and LCZ696 attenuates RV remodeling by downregulating Pdk4 and inhibiting PDK4/p-GSK3β signal.
Collapse
|
17
|
Ladouceur M, Valdeolmillos E, Karsenty C, Hascoet S, Moceri P, Le Gloan L. Cardiac Drugs in ACHD Cardiovascular Medicine. J Cardiovasc Dev Dis 2023; 10:190. [PMID: 37233157 PMCID: PMC10219196 DOI: 10.3390/jcdd10050190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines on drug therapy are currently lacking. The aging ACHD population has led to an increase in late cardiovascular complications such as heart failure, arrhythmias, and pulmonary hypertension. Pharmacotherapy, with few exceptions, in ACHD is largely supportive, whereas significant structural abnormalities usually require interventional, surgical, or percutaneous treatment. Recent advances in ACHD have prolonged survival for these patients, but further research is needed to determine the most effective treatment options for these patients. A better understanding of the use of cardiac drugs in ACHD patients could lead to improved treatment outcomes and a better quality of life for these patients. This review aims to provide an overview of the current status of cardiac drugs in ACHD cardiovascular medicine, including the rationale, limited current evidence, and knowledge gaps in this growing area.
Collapse
Affiliation(s)
- Magalie Ladouceur
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 75015 Paris, France
- Centre de Recherche Cardiovasculaire de Paris, INSERM U970, Université de Paris Cité, 75015 Paris, France
| | - Estibaliz Valdeolmillos
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Clément Karsenty
- Pediatric and Congenital Cardiology, Children’s Hospital CHU Toulouse, 31300 Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, 31300 Toulouse, France
| | - Sébastien Hascoet
- Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C Groupe Hospitalier Saint-Joseph, Paris-Saclay University, 92350 Le Plessis Robinson, France
- UMRS 999, INSERM, Marie-Lannelongue Hospital, Paris-Saclay University, 92350 Le Plessis Robinson, France
| | - Pamela Moceri
- UR2CA, Equipe CARRES, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France
| | - Laurianne Le Gloan
- Cardiologie Congénitale Adulte, Institut du Thorax, CHU de Nantes, 44000 Nantes, France
| |
Collapse
|
18
|
Valli F, Bursi F, Santangelo G, Toriello F, Faggiano A, Rusconi I, Vella AM, Carugo S, Guazzi M. Long-Term Effects of Sacubitril-Valsartan on Cardiac Remodeling: A Parallel Echocardiographic Study of Left and Right Heart Adaptive Response. J Clin Med 2023; 12:2659. [PMID: 37048742 PMCID: PMC10094925 DOI: 10.3390/jcm12072659] [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: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8-13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.
Collapse
Affiliation(s)
- Federica Valli
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Bursi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | - Filippo Toriello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Irene Rusconi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Anna Maria Vella
- Montreal University Hospital Centre, Montreal, QC H2X 3E4, Canada
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marco Guazzi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| |
Collapse
|
19
|
Sabbah BN, Arabi TZ, Shafqat A, Abdul Rab S, Razak A, Albert-Brotons DC. Heart failure in systemic right ventricle: Mechanisms and therapeutic options. Front Cardiovasc Med 2023; 9:1064196. [PMID: 36704462 PMCID: PMC9871570 DOI: 10.3389/fcvm.2022.1064196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
d-loop transposition of the great arteries (d-TGA) and congenitally corrected transposition of the great arteries (cc-TGA) feature a right ventricle attempting to sustain the systemic circulation. A systemic right ventricle (sRV) cannot support cardiac output in the long run, eventually decompensating and causing heart failure. The burden of d-TGA patients with previous atrial switch repair and cc-TGA patients with heart failure will only increase in the coming years due to the aging adult congenital heart disease population and improvements in the management of advanced heart failure. Clinical data still lags behind in developing evidence-based guidelines for risk stratification and management of sRV patients, and clinical trials for heart failure in these patients are underrepresented. Recent studies have provided foundational data for the commencement of robust clinical trials in d-TGA and cc-TGA patients. Further insights into the multifactorial nature of sRV failure can only be provided by the results of such studies. This review discusses the mechanisms of heart failure in sRV patients with biventricular circulation and how these mediators may be targeted clinically to alleviate sRV failure.
Collapse
Affiliation(s)
| | | | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Adhil Razak
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Dimpna Calila Albert-Brotons
- Department of Pediatric Cardiology, Pediatric Heart Failure and Heart Transplant, Heart Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Alipour Symakani RS, van Genuchten WJ, Zandbergen LM, Henry S, Taverne YJHJ, Merkus D, Helbing WA, Bartelds B. The right ventricle in tetralogy of Fallot: adaptation to sequential loading. Front Pediatr 2023; 11:1098248. [PMID: 37009270 PMCID: PMC10061113 DOI: 10.3389/fped.2023.1098248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Right ventricular dysfunction is a major determinant of outcome in patients with complex congenital heart disease, as in tetralogy of Fallot. In these patients, right ventricular dysfunction emerges after initial pressure overload and hypoxemia, which is followed by chronic volume overload due to pulmonary regurgitation after corrective surgery. Myocardial adaptation and the transition to right ventricular failure remain poorly understood. Combining insights from clinical and experimental physiology and myocardial (tissue) data has identified a disease phenotype with important distinctions from other types of heart failure. This phenotype of the right ventricle in tetralogy of Fallot can be described as a syndrome of dysfunctional characteristics affecting both contraction and filling. These characteristics are the end result of several adaptation pathways of the cardiomyocytes, myocardial vasculature and extracellular matrix. As long as the long-term outcome of surgical correction of tetralogy of Fallot remains suboptimal, other treatment strategies need to be explored. Novel insights in failure of adaptation and the role of cardiomyocyte proliferation might provide targets for treatment of the (dysfunctional) right ventricle under stress.
Collapse
Affiliation(s)
- Rahi S. Alipour Symakani
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- Correspondence: Rahi S. Alipour Symakani
| | - Wouter J. van Genuchten
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Lotte M. Zandbergen
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
| | - Surya Henry
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Daphne Merkus
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| |
Collapse
|
21
|
Mustapic I, Bakovic D, Susilovic Grabovac Z, Borovac JA. Impact of SGLT2 Inhibitor Therapy on Right Ventricular Function in Patients with Heart Failure and Reduced Ejection Fraction. J Clin Med 2022; 12:jcm12010042. [PMID: 36614843 PMCID: PMC9820989 DOI: 10.3390/jcm12010042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in addition to optimal medical therapy (OMT) on the right ventricular (RV) systolic function using advanced echocardiographic analysis among outpatients with heart failure and a reduced ejection fraction (HFrEF) has thus far been poorly investigated. Methods: This was a single-center, prospective, single-blinded study in which an echocardiographic expert was blinded to the allocation of the treatment. A total of 36 outpatients with HFrEF were randomized to either OMT or OMT+SGLT2i. Both groups underwent an echocardiographic examination of the RV systolic function at the baseline and at the 3-month follow-up (3mFU). Results: The patients in both groups did not significantly differ with respect to the relevant baseline comorbidities, therapy, and clinical characteristics. The patients receiving OMT+SGLT2i showed a significant improvement from the baseline to the 3mFU in all the measured RV echocardiographic parameters, while for the OMT group, a significant improvement after the 3mFU was observed for TAPSE and s'. The mean percent change from the baseline to the 3mFU was significant when comparing OMT+SGLT2i to the OMT group concerning RV FWS (+91% vs. +28%, p = 0.039), TR maxPG (-27% vs. +19%, p = 0.005), and TR Vmax (-17% vs. +13%, p = 0.008), respectively. Conclusions: Adding SGLT2i to OMT in patients with HFrEF resulted in a greater improvement in the RV systolic function from the baseline to the 3mFU compared to the OMT alone.
Collapse
Affiliation(s)
- Ivona Mustapic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-95-2276-970
| | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Physiology, University of Split School of Medicine, 21000 Split, Croatia
| | | | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| |
Collapse
|
22
|
The pivotal role of tricuspid regurgitation in the failing systemic right ventricle: The “chicken and egg story‿. Arch Cardiovasc Dis 2022; 115:476-486. [DOI: 10.1016/j.acvd.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
|
23
|
Maitz TN, Gupta R, Persin K, Sundlof DW. Utilization of sacubitril-valsartan for right ventricular failure in a patient with arrhythmogenic right ventricular cardiomyopathy. Future Cardiol 2022; 18:547-552. [PMID: 35703395 DOI: 10.2217/fca-2021-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Arrhythmogenic right ventricular (RV) cardiomyopathy is an autosomal dominant inherited cardiomyopathy that is characterized by an increased risk of ventricular arrhythmias, sudden cardiac death and, less commonly, heart failure. The authors present the case of a 36-year-old woman with familial lamin cardiomyopathy with positive LMNA mutation and genetic testing revealing LMNA and TMEM43 mutations consistent with arrhythmogenic RV cardiomyopathy. The patient presented with clinical signs of RV failure. Transthoracic echocardiogram showed newly reduced RV function in the absence of left ventricular involvement. Cardiac MRI demonstrated diffuse late gadolinium enhancement of the mid-level and apical RV anterior free wall. Diuretics were started, and sacubitril-valsartan was added when the patient's symptoms persisted. Diuretics were then discontinued, and sacubitril-valsartan was the primary therapy. This is the first reported case of symptomatic and imaging-proven RV recovery in a patient with symptomatic RV failure in the setting of arrhythmogenic RV cardiomyopathy treated with sacubitril-valsartan.
Collapse
Affiliation(s)
- Theresa N Maitz
- Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kathryn Persin
- Department of the Sciences, Dartmouth University, Hanover, NH 03755, USA
| | - Deborah W Sundlof
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| |
Collapse
|
24
|
Medical Therapies for Heart Failure in Hypoplastic Left Heart Syndrome. J Cardiovasc Dev Dis 2022; 9:jcdd9050152. [PMID: 35621863 PMCID: PMC9143150 DOI: 10.3390/jcdd9050152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
Significant surgical and medical advances over the past several decades have resulted in a growing number of infants and children surviving with hypoplastic left heart syndrome (HLHS) and other congenital heart defects associated with a single systemic right ventricle (RV). However, cardiac dysfunction and ultimately heart failure (HF) remain the most common cause of death and indication for transplantation in this population. Moreover, while early recognition and treatment of single ventricle-related complications are essential to improving outcomes, there are no proven therapeutic strategies for single systemic RV HF in the pediatric population. Importantly, prototypical adult HF therapies have been relatively ineffective in mitigating the need for cardiac transplantation in HLHS, likely due to several unique attributes of the failing HLHS myocardium. Here, we discuss the most commonly used medical therapies for the treatment of HF symptoms in HLHS and other single systemic RV patients. Additionally, we provide an overview of potential novel therapies for systemic ventricular failure in the HLHS and related populations based on fundamental science, pre-clinical, clinical, and observational studies in the current literature.
Collapse
|
25
|
Kido K, Colvin BM, Szymanski TW, Guglin M. Sacubitril/Valsartan Off-Label Uses for Heart Failure. J Card Fail 2022; 28:1185-1201. [DOI: 10.1016/j.cardfail.2022.03.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/26/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
|
26
|
Egorova AD, Nederend M, Tops LF, Vliegen HW, Jongbloed MRM, Kiès P. The first experience with sodium-glucose cotransporter 2 inhibitor for the treatment of systemic right ventricular failure. ESC Heart Fail 2022; 9:2007-2012. [PMID: 35355435 PMCID: PMC9065858 DOI: 10.1002/ehf2.13871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 01/10/2023] Open
Abstract
In congenitally corrected transposition of the great arteries, the morphological right ventricle supports the systemic circulation. This chronic exposure to pressure overload ultimately leads to systemic right ventricular (sRV) dysfunction and heart failure. Pharmacological options for the treatment of sRV failure are poorly defined and no solid recommendations are made in the most recent guidelines. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a new class of antihyperglycaemic drugs that have been demonstrated to significantly reduce the risk of worsening heart failure and death from cardiovascular causes in patients with chronic heart failure with reduced left ventricular ejection fraction, yet no data are available in sRV patients. We report on the treatment and clinical follow-up of a patient with advanced heart failure and poor sRV function in the context of congenitally corrected transposition of the great arteries, who did not tolerate sacubitril/valsartan and had a high burden of heart-failure-related hospitalizations. Treatment with dapagliflozin was well tolerated and resulted in (small) subjective and objective functional and echocardiographic improvement and a reduction in heart-failure-related hospitalizations.
Collapse
Affiliation(s)
- Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| |
Collapse
|
27
|
Brida M, Lovrić D, Griselli M, Gil FR, Gatzoulis MA. Heart failure in adults with congenital heart disease. Int J Cardiol 2022; 357:39-45. [DOI: 10.1016/j.ijcard.2022.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
|
28
|
Selección de lo mejor del año 2021 en cardiopatías congénitas. REC: CARDIOCLINICS 2022. [PMCID: PMC8628611 DOI: 10.1016/j.rccl.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
En este artículo se muestran las publicaciones que consideramos más relevantes sobre cardiopatías congénitas (CC) en el último año. La pandemia de COVID-19 ha seguido marcando la actividad científica en este periodo, y ya desde el inicio se ha especulado sobre el riesgo de complicaciones por la COVID-19 entre los adultos con CC. Asimismo, se ha estudiado la afectación de los niños con CC. En este año destaca la publicación de la guía europea para el tratamiento de las CC, segunda edición tras 10 años, que será de gran utilidad en la estandarización del tratamiento de estos pacientes complejos. Entre las publicaciones originales destacan las relacionadas con los temas que más preocupan a los cardiólogos de CC: el avance en la prevención primaria de las arritmias ventriculares, la hepatopatía del Fontan, el avance en las técnicas percutáneas de valvulación pulmonar, la aplicación de nuevos fármacos para la insuficiencia cardiaca avanzada en las CC complejas y en ventrículo derecho sistémico y las complicaciones a largo plazo de los adultos jóvenes con transposición de grandes arterias sometidos a cirugía de switch arterial.
Collapse
|
29
|
Sacubitril/valsartan for heart failure in patients with complex adult congenital heart disease – Experience from a tertiary centre in Singapore. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
30
|
Gaur L, Cedars A, Diller GP, Kutty S, Orwat S. Management considerations in the adult with surgically modified d-transposition of the great arteries. Heart 2021; 107:1613-1619. [PMID: 33741578 DOI: 10.1136/heartjnl-2020-318833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/04/2022] Open
Abstract
Dextro-transposition of the great arteries (D-TGA) has undergone a significant evolution in surgical repair, leading to survivors with vastly different postsurgical anatomy which in turn guides their long-term cardiovascular morbidity and mortality. Atrial switch repair survivors are limited by a right ventricle in the systemic position, arrhythmia and atrial baffles prone to obstruction or leak. Functional assessment of the systemic right ventricle is complex, requiring multimodality imaging to include specialised echocardiography and cross-sectional imaging (MRI and CT). In the current era, most neonates undergo the arterial switch operation with increasing understanding of near-term and long-term outcomes specific to their cardiac anatomy. Long-term observations of the Lecompte manoeuvre or coronary stenoses following transfer continue, with evolving understanding to improve surveillance. Ultimately, an understanding of postsurgical anatomy, specialised imaging techniques and interventional and electrophysiological procedures is essential to comprehensive care of D-TGA survivors.
Collapse
Affiliation(s)
- Lasya Gaur
- Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ari Cedars
- Division of Adult Congenital Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerhard Paul Diller
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
| | - Shelby Kutty
- Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Stefan Orwat
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
31
|
Nederend M, Zandstra TE, Kiès P, Jongbloed MRM, Vliegen HW, Treskes RW, Schalij MJ, Atsma DE, Egorova AD. Potential of eHealth smart technology in optimization and monitoring of heart failure treatment in adults with systemic right ventricular failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:215-223. [PMID: 36712397 PMCID: PMC9707956 DOI: 10.1093/ehjdh/ztab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
Aims Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA are prone to heart failure and arrhythmias. This study evaluated feasibility, patient adherence, and satisfaction of a smart technology-based care pathway for heart failure treatment optimization in these patients. Methods and results Patients with symptomatic sRV failure eligible for initiation of sacubitril/valsartan were provided with four smartphone compatible devices (blood pressure monitor, weight scale, step counter, and rhythm monitor) and were managed according to a smart technology-based care pathway. Biweekly sacubitril/valsartan titration visits were replaced by electronical visits, patients were advised to continue measurements at least weekly after titration. Data of 24 consecutive sRV patients (median age 47 years, 50% female) who participated in the smart technology-based care pathway were analysed. Median home-hospital distance was 65 km (maximum 227 km). Most patients (20, 83.3%) submitted weekly measurements; 100% submitted prior to electronical visits. Titration conventionally occurs during a hospital visit. By implementing eHealth smart technology, 68 such trips to hospital were replaced by virtual visits facilitated by remote monitoring. An eHealth questionnaire was completed by 22 patients (92%), and 96% expressed satisfaction. After titration, 30 instances of remote adjustment of heart failure medication in addition to scheduled outpatient clinic visits occurred, one (4%) heart failure admission followed, despite ambulant adjustments. Five patients (21%) sent in rhythm registrations (n = 17), of these 77% showed sinus rhythm, whereas supraventricular tachycardia was detected in the remaining four registrations. Conclusion These data suggest that implementation of a smart technology-based care pathway for optimization of medical treatment sRV failure is feasible with high measurement adherence and patient satisfaction.
Collapse
Affiliation(s)
- Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,National eHealth Living Lab, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Corresponding author. Tel: +31 71 526 2020,
| |
Collapse
|