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Hodzic A, Gendron P, Baron E, Éthier A, Bonnefous O, Saloux E, Milliez P, Normand H, Tournoux F. Inter-season training effects on cardiovascular health in American-style football players. BMC Sports Sci Med Rehabil 2024; 16:108. [PMID: 38741116 DOI: 10.1186/s13102-024-00888-4] [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: 05/19/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Recent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players. METHODS A prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen). RESULTS Fifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions. CONCLUSIONS Our study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France.
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France.
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France.
| | - Patrick Gendron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Emmanuelle Baron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Amélie Éthier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
| | - Odile Bonnefous
- Philips Research, Medical Imaging (Medisys), Suresnes, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - Hervé Normand
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - François Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
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Loo G, Puar T, Foo R, Ong TK, Wang TD, Nguyen QN, Chin CT, Chin CWL. Unique characteristics of Asians with hypertension: what is known and what can be done? J Hypertens 2024:00004872-990000000-00426. [PMID: 38509747 DOI: 10.1097/hjh.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Hypertension remains the leading modifiable risk factor for cardiovascular disease worldwide. Over the past 30 years, the prevalence of hypertension has been increasing in East and Southeast Asia to a greater extent as compared with other Western countries. Asians with hypertension have unique characteristics. This can be attributed to increased impact of obesity on Asians with hypertension, excessive salt intake and increased salt sensitivity, loss of diurnal rhythm in blood pressure and primary aldosteronism. The impact of hypertension on cardiovascular (particularly strokes) and chronic kidney disease is greater in Asians. These unique characteristics underpinned by the diverse socioeconomic backgrounds pose its own challenges in the diagnosis and management of hypertension in Asia.
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Affiliation(s)
- Germaine Loo
- Department of Cardiology, National Heart Centre Singapore
| | - Troy Puar
- Department of Endocrinology, Changi General Hospital
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Medical ACP, Duke-NUS Medical School, Singapore
| | - Roger Foo
- Department of Cardiology, National University Heart Centre, National University Health System
- Cardiovascular Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Malaysia
| | - Tzung-Dau Wang
- Cardiovascular Centre and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Calvin W L Chin
- Department of Cardiology, National Heart Centre Singapore
- Cardiovascular ACP, Duke-NUS Medical School, Singapore
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Lundin M, Heiberg E, Nordlund D, Gyllenhammar T, Steding-Ehrenborg K, Engblom H, Carlsson M, Atar D, van der Pals J, Erlinge D, Borgquist R, Khoshnood A, Ekelund U, Nickander J, Themudo R, Nordin S, Kozor R, Bhuva AN, Moon JC, Maret E, Caidahl K, Sigfridsson A, Sörensson P, Schelbert EB, Arheden H, Ugander M. Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Sci Rep 2023; 13:22806. [PMID: 38129418 PMCID: PMC10740032 DOI: 10.1038/s41598-023-48173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12-1.20], p < 0.001), followed by GTI (HR 1.14[1.09-1.19], p < 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35-1.94], p < 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p < 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).
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Affiliation(s)
- Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - David Nordlund
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tom Gyllenhammar
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dan Atar
- Department of Cardiology, and Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Jesper van der Pals
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Raquel Themudo
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Institute of Medicine, University of Gothenburg and Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Peder Sörensson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Royal North Shore Hospital, University of Sydney, Kolling Building, Level 12, Room 612017, St Leonards, NSW, 2065, Australia.
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Dong X, Strudwick M, Wang WY, Borlaug BA, van der Geest RJ, Ng AC, Delgado V, Bax JJ, Ng AC. Impact of body mass index and diabetes on myocardial fat content, interstitial fibrosis and function. Int J Cardiovasc Imaging 2023; 39:379-390. [PMID: 36306044 PMCID: PMC9870836 DOI: 10.1007/s10554-022-02723-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE We hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes mellitus. BACKGROUND Increased body weight and diabetes mellitus are both individually associated with a higher incidence of heart failure with preserved ejection fraction. However, it is unclear how increased myocardial steatosis and interstitial fibrosis interact to influence myocardial composition and function. METHODS A total of 100 subjects (27 healthy lean volunteers, 21 healthy but overweight volunteers, and 52 asymptomatic overweight patients with diabetes) were prospectively recruited to measure left ventricular (LV) myocardial steatosis (LV-myoFat) and interstitial fibrosis (by extracellular volume [ECV]) using magnetic resonance imaging, and then used to determine their combined impact on LV global longitudinal strain (GLS) analysis by 2-dimensional (2D) speckle tracking echocardiography on the same day. RESULTS On multivariable analysis, both increased body mass index and diabetes were independently associated with increased LV-myoFat. In turn, increased LV-myoFat was independently associated with increased LV ECV. Both increased LV-myoFat and LV ECV were independently associated with impaired 2D LV GLS. CONCLUSION Patients with increased body weight and patients with diabetes display excessive myocardial steatosis, which is related to a greater burden of myocardial interstitial fibrosis. LV myocardial contractile function was determined by both the extent of myocardial steatosis and interstitial fibrosis, and was independent of increasing age. Further study is warranted to determine how weight loss and improved diabetes management can improve myocardial composition and function.
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Affiliation(s)
- Xin Dong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Mark Strudwick
- Centre for Advanced Imaging, The University of Queensland, Queensland, Australia
| | - William Ys Wang
- Centre for Advanced Imaging, The University of Queensland, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Austin Cc Ng
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Arnold Ct Ng
- Centre for Advanced Imaging, The University of Queensland, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Warwick Farm, Australia
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5
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Iyer NR, Le TT, Kui MSL, Tang HC, Chin CT, Phua SK, Bryant JA, Pua CJ, Ang B, Toh DF, Aw TC, Lee CH, Cook SA, Ugander M, Chin CWL. Markers of Focal and Diffuse Nonischemic Myocardial Fibrosis Are Associated With Adverse Cardiac Remodeling and Prognosis in Patients With Hypertension: The REMODEL Study. Hypertension 2022; 79:1804-1813. [PMID: 35603595 PMCID: PMC9278715 DOI: 10.1161/hypertensionaha.122.19225] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognostic significance of focal and diffuse myocardial fibrosis in patients with cardiovascular risk factors is unclear. METHODS REMODEL (Response of the Myocardium to Hypertrophic Conditions in the Adult Population) is an observational cohort of asymptomatic patients with essential hypertension. All participants underwent cardiovascular magnetic resonance to assess for myocardial fibrosis: nonischemic late gadolinium enhancement (LGE), native myocardial T1, postcontrast myocardial T1, extracellular volume fraction including/excluding LGE regions, interstitial volume (extracellular volume×myocardial volume), and interstitial/myocyte ratio. Primary outcome was a composite of first occurrence acute coronary syndrome, heart failure hospitalization, strokes, and cardiovascular mortality. Patients were recruited from February 2016 and followed until June 2021. RESULTS Of the 786 patients with hypertension (58±11 years; 39% women; systolic blood pressure, 130±14 mm Hg), 145 (18%) had nonischemic LGE. Patients with nonischemic LGE were more likely to be men, have diabetes, be current smokers, and have higher blood pressure (P<0.05 for all). Compared with those without LGE, patients with nonischemic LGE had greater left ventricular mass (66±22 versus 49±9 g/m2; P<0.001), worse multidirectional strain (P<0.001 for all measures), and elevated circulating markers of myocardial wall stress and myocardial injury, adjusted for potential confounders. Twenty-four patients had primary outcome over 39 (30-50) months of follow-up. Of all the cardiovascular magnetic resonance markers of myocardial fibrosis assessed, only nonischemic LGE (hazard ratio, 6.69 [95% CI, 2.54-17.60]; P<0.001) and indexed interstitial volume (hazard ratio, 1.11 [95% CI, 1.04-1.19]; P=0.002) demonstrated independent association with primary outcome. CONCLUSIONS In patients with hypertension, myocardial fibrosis on cardiovascular magnetic resonance is associated with adverse cardiac remodeling and outcomes.
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Affiliation(s)
- Nithin R Iyer
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Thu-Thao Le
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
| | - Michelle S L Kui
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Hak-Chiaw Tang
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Chee-Tang Chin
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Soon-Kieng Phua
- Department of Laboratory Medicine, Changi General Hospital, Singapore (S.-K.P., T.-C.A.)
| | - Jennifer A Bryant
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Chee-Jian Pua
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Briana Ang
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore (S.-K.P., T.-C.A.)
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore (C.-H.L., S.A.C.)
| | - Stuart A Cook
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Department of Cardiology, National University Heart Centre Singapore (C.-H.L., S.A.C.)
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Australia (M.U.).,Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden (M.U.)
| | - Calvin W L Chin
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
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Zhao Q, Cui C, Li Y, Liu Y, Huang D, Wang Y, Hu Y, Liu R, Zhu H, Liu L. Evaluation of myocardial work in patients with hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy based on non-invasive pressure-strain loops. Front Cardiovasc Med 2022; 9:767875. [PMID: 35958393 PMCID: PMC9360312 DOI: 10.3389/fcvm.2022.767875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The capacity to distinguish hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) based on morphological features obtained by conventional echocardiography is limited. We investigated the global myocardial work of the left ventricle in two types of hypertrophies using the non-invasive myocardial work index (NMWI). Methods Conventional echocardiography was performed on 107 subjects with preserved left ventricular ejection fraction (LVEF ≥ 50%), who comprised patients with HCM (n = 40), H-LVH (n = 35), and healthy people with normal blood pressure and left ventricular structure (n = 32). Except for the conventional echocardiographic parameters, the left ventricular myocardial work parameters based on pressure-strain loops, including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were evaluated in three groups. Multivariate discriminant analysis and receiver operating characteristic (ROC) curve were used to evaluate the incremental value of NMWI for distinguishing HCM from H-LVH. Results Compared to the control group, GWI and GCW were significantly lower in HCM patients (P < 0.05), whereas GWI was significantly higher in H-LVH patients. GWW was higher and GWE was significantly decreased in both HCM and H-LVH patients than in the control group (P < 0.05). Multivariate discriminant analysis and ROC curve revealed that the inter-ventricular septum thickness (IVST)/left ventricular posterior wall thickness (LVPWT) and GCW were each able to distinguish HCM from H-LVH. The combination of IVST/LVPWT and GCW discriminated HCM and H-LVH with a higher predictive accuracy of 94.7%. Conclusion NMWI may provide additional information in evaluating the myocardial function in patients with HCM and H-LVH. Myocardial work combined with conventional echocardiography could improve the clinical diagnostic accuracy of distinguishing HCM and H-LVH.
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Zhan J, Van den Eynde J, Ozdemir E, Long R, Hays A, Danford DA, Barnes B, Kutty S. Left ventricular myocardial work indices in pediatric hypertension: correlations with conventional echocardiographic assessment and subphenotyping. Eur J Pediatr 2022; 181:2643-2654. [PMID: 35366110 DOI: 10.1007/s00431-022-04447-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 12/18/2022]
Abstract
Myocardial work (MW) is a novel parameter that incorporates non-invasive estimates of left ventricular (LV) systolic pressure into the interpretation of strain, thus overcoming the limitations of load dependency traditionally encountered with LV fractional shortening (LVFS), ejection fraction (LVEF), and global longitudinal strain (GLS). However, data on MW in the pediatric population with hypertension are lacking. Conventional markers of LV function and MW indices were obtained from 88 echocardiographic examinations in 76 children with hypertension (47 males, 15.5 ± 2.96 years). When compared with a previously published cohort of 52 healthy controls, global work index (GWI) and global constructive work (GCW) were both significantly elevated while LVEF and GLS were not impaired but rather mildly increased. On multivariable analysis, GWI was correlated with systolic blood pressure (slope = + 16, p < 0.001) and GLS (slope = -100, p < 0.001), while GCW was correlated with systolic blood pressure (slope = + 18, p < 0.001), GLS (slope = -101, p < 0.001), male sex (slope = -75, p = 0.016), and LV mass (slope = -0.93, p < 0.001). Global wasted work (GWW) was correlated with age at echo visit (slope = -4.5, p = 0.005) and GLS (slope = + 5.5, p < 0.001). The opposite occurred for global work efficiency (GWE; slope = + 0.20, p = 0.011, and slope = -0.48, p < 0.001, respectively). Principal component analysis and k-means clustering revealed 4 subphenotypes which differed in terms of etiology, afterload, and compensation stage of the disease. Conclusion: Non-invasive MW shows a good correlation with conventional markers of LV function and may help refine the assessment of hypertensive heart disease in children. What is Known: • Myocardial work (MW) is a novel parameter that incorporates non-invasive estimates of left ventricular (LV) systolic pressure into the interpretation of strain, thereby accounting for both deformation and afterload. • Although the usefulness of MW in the assessment of myocardial function beyond conventional markers has been demonstrated in various clinical populations, data in the pediatric population with hypertension are currently lacking. What is New: • Compared to normal values in healthy children, global work index and global constructive work were increased in those with hypertension, while LV ejection fraction and global longitudinal strain were not impaired. • Machine learning identified 4 subphenotypes which differed in terms of etiology, afterload, and compensation stage of the disease.
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Affiliation(s)
- Junzhen Zhan
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Jef Van den Eynde
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA.,Department of Cardiovascular Sciences, KU Leuven & Congenital and Structural Cardiology, UZ Leuven, Leuven, Belgium
| | - Ege Ozdemir
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Rita Long
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Allison Hays
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - David A Danford
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Benjamin Barnes
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Shelby Kutty
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA.
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8
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Chua J, Le T, Sim YC, Chye HY, Tan B, Yao X, Wong D, Ang BWY, Toh D, Lim H, Bryant JA, Wong TY, Chin CWL, Schmetterer L. Relationship of Quantitative Retinal Capillary Network and Myocardial Remodeling in Systemic Hypertension. J Am Heart Assoc 2022; 11:e024226. [PMID: 35253475 PMCID: PMC9075291 DOI: 10.1161/jaha.121.024226] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background
This study examined the associations between quantitative optical coherence tomography angiography (OCTA) parameters and myocardial abnormalities as documented on cardiovascular magnetic resonance imaging in patients with systemic hypertension.
Methods and Results
We conducted a cross‐sectional study of 118 adults with hypertension (197 eyes). Patients underwent cardiovascular magnetic resonance imaging and OCTA (PLEX Elite 9000, Carl Zeiss Meditec). Associations between OCTA parameters (superficial and deep retinal capillary density) and adverse cardiac remodeling (left ventricular mass, remodeling index, interstitial fibrosis, global longitudinal strain, and presence of left ventricular hypertrophy) were studied using multivariable linear regression analysis with generalized estimating equations. Of the 118 patients with hypertension enrolled (65% men; median [interquartile range] age, 59 [13] years), 29% had left ventricular hypertrophy. After adjusting for age, sex, systolic blood pressure, diabetes, and signal strength of OCTA scans, patients with lower superficial capillary density had significantly higher left ventricular mass (β=−0.150; 95% CI, −0.290 to −0.010), higher interstitial volume (β=−0.270; 95% CI, −0.535 to −0.0015), and worse global longitudinal strain (β=−0.109; 95% CI, −0.187 to −0.032). Lower superficial capillary density was found in patients with hypertension with replacement fibrosis versus no replacement fibrosis (16.53±0.64 mm
‐1
versus 16.96±0.64 mm
‐1
;
P
=0.003).
Conclusions
We showed significant correlations between retinal capillary density and adverse cardiac remodeling markers in patients with hypertension, supporting the notion that the OCTA could provide a non‐invasive index of microcirculation alteration for vascular risk stratification in people with hypertension.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- Academic Clinical Program Duke‐NUS Medical School National University of Singapore Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
| | - Thu‐Thao Le
- Academic Clinical Program Duke‐NUS Medical School National University of Singapore Singapore Singapore
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Yin Ci Sim
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
| | - Hui Yi Chye
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
| | - Bingyao Tan
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore
| | - Xinwen Yao
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore
| | - Damon Wong
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore
| | - Briana W. Y. Ang
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Desiree‐Faye Toh
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Huishan Lim
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Jennifer A. Bryant
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Tien Yin Wong
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- Academic Clinical Program Duke‐NUS Medical School National University of Singapore Singapore Singapore
| | - Calvin Woon Loong Chin
- Academic Clinical Program Duke‐NUS Medical School National University of Singapore Singapore Singapore
- National Heart Research Institute SingaporeNational Heart Centre Singapore Singapore Singapore
| | - Leopold Schmetterer
- Singapore Eye Research InstituteSingapore National Eye Centre Singapore Singapore
- Academic Clinical Program Duke‐NUS Medical School National University of Singapore Singapore Singapore
- SERI‐NTU Advanced Ocular Engineering (STANCE) Singapore Singapore
- School of Chemical and Biomedical Engineering Nanyang Technological University Singapore
- Department of Clinical Pharmacology Medical University Vienna Vienna Austria
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9
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Tan W, Yao X, Le TT, Tan B, Schmetterer L, Chua J. The New Era of Retinal Imaging in Hypertensive Patients. Asia Pac J Ophthalmol (Phila) 2022; 11:149-159. [PMID: 35533334 DOI: 10.1097/apo.0000000000000509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
ABSTRACT Structural and functional alterations in the microcirculation by systemic hypertension can cause significant organ damage at the eye, heart, brain, and kidneys. As the retina is the only tissue in the body that allows direct imaging of small vessels, the relationship of hypertensive retinopathy signs with development of disease states in other organs have been extensively studied; large-scale epidemiological studies using fundus photography and advanced semi-automated analysis software have reported the association of retinopathy signs with hypertensive end-organ damage includes the following: stroke, dementia, and coronary heart disease. Although yielding much useful information, the vessels assessed from fundus photographs remain limited to the larger retinal arterioles and venules, and abnormalities observed may not be that of the earliest changes. Newer imaging modalities such as optical coherence tomography angiography and adaptive optics technology, which allow a greater precision in the structural quantification of retinal vessels, including capillaries, may facilitate the assessment and management of these patients. The advent of deep learning technology has also augmented the utility of fundus photographs to help create diagnostic and risk stratification systems. Particularly, deep learning systems have been shown in several large studies to be able to predict multiple cardiovascular risk factors, major adverse cardiovascular events within 5 years, and presence of coronary artery calcium, from fundus photographs alone. In the future, combining deep learning systems with the imaging precision offered by optical coherence tomography angiography and adaptive optics could pave way for systems that are able to predict adverse clinical outcomes even more accurately.
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Affiliation(s)
- Wilson Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
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10
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Le TT, Huang W, Singh GK, Toh DF, Ewe SH, Tang HC, Loo G, Bryant JA, Ang B, Tay ELW, Soo WM, Yip JWL, Oon YY, Gong L, Lunaria JB, Yong QW, Lee EM, Yeo PSD, Chai SC, Goh PP, Ling LF, Ong HY, Richards AM, Delgado V, Bax JJ, Ding ZP, Ling LH, Chin CWL. Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis. Front Cardiovasc Med 2021; 8:750016. [PMID: 34859068 PMCID: PMC8631398 DOI: 10.3389/fcvm.2021.750016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′. Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Weiting Huang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - See Hooi Ewe
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Hak Chaw Tang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Germaine Loo
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Briana Ang
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Wern Miin Soo
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - James Wei-Luen Yip
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Kota Samarahan, Malaysia
| | - Lingli Gong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Josephien B Lunaria
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Quek Wei Yong
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Evelyn Min Lee
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Poh Shuan Daniel Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore
| | - Siang Chew Chai
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Ping Ping Goh
- Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Lee Fong Ling
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Hean Yee Ong
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Christchurch, Christchurch, New Zealand
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Zee Pin Ding
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Lieng-Hsi Ling
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
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11
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Echocardiographic Advances in Dilated Cardiomyopathy. J Clin Med 2021; 10:jcm10235518. [PMID: 34884220 PMCID: PMC8658091 DOI: 10.3390/jcm10235518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Although the overall survival of patients with dilated cardiomyopathy (DCM) has improved significantly in the last decades, a non-negligible proportion of DCM patients still shows an unfavorable prognosis. DCM patients not only need imaging techniques that are effective in diagnosis, but also suitable for long-term follow-up with frequent re-evaluations. The exponential growth of echocardiography’s technology and performance in recent years has resulted in improved diagnostic accuracy, stratification, management and follow-up of patients with DCM. This review summarizes some new developments in echocardiography and their promising applications in DCM. Although nowadays cardiac magnetic resonance (CMR) remains the gold standard technique in DCM, the echocardiographic advances and novelties proposed in the manuscript, if properly integrated into clinical practice, could bring echocardiography closer to CMR in terms of accuracy and may certify ultrasound as the technique of choice in the follow-up of DCM patients. The application in DCM patients of novel echocardiographic techniques represents an interesting emergent research area for scholars in the near future.
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12
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Paysal J, Merlin E, Rochette E, Terral D, Nottin S. Global and Regional Myocardial Work in Female Adolescents with Weight Disorders. J Clin Med 2021; 10:jcm10204671. [PMID: 34682793 PMCID: PMC8537237 DOI: 10.3390/jcm10204671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Anorexia nervosa (AN) and obesity (OB) lead to changes in SBP (i.e., loading conditions) that may affect left ventricular (LV) myocardial work (MW). The novel concept of LV pressure-strain loops allows non-invasive estimation of MW, this latter being correlated with cardiac energy metabolism. In addition, the study of regional MW can detect subtle alterations in cardiac function by highlighting an abnormal distribution of MW. Objective: The aim of this study was to assess the cardiac function of AN and OB patients by evaluating global and regional LV strains and MW. Methods: Eighty-seven female adolescents, comprising 26 with AN (14.6 ± 1.9 yrs. old), 28 with OB (13.2 ± 1.4 yrs. old), and 33 controls (14.0 ± 2.0 yrs. old) underwent speckle-tracking echography to assess global and regional LV strains and MW. Results: SBP was higher in adolescents with obesity than in AN patients or controls. Global MW was similar between groups. In AN patients and controls, longitudinal strains were higher at the apex than at the base of the LV, whereas they were similar in obesity patients, owing to a decrease in their apical longitudinal strain. Consequently, their MW was higher at the basal level than either of the other two groups (1854 ± 272 vs. 1501 ± 280 vs. 1575 ± 295 mmHg% in OB patients, AN patients, and controls, respectively. Conclusion: Despite altered SBP, the global MW of adolescents with weight disorders was unaffected. However, in adolescents with obesity, the distribution of their regional LV MW was altered, which might reflect specific regional remodeling.
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Affiliation(s)
- Justine Paysal
- LAPEC EA4278 Laboratory, Avignon University, F-84000 Avignon, France;
- Néonatologie et Réanimation Pédiatrique, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Etienne Merlin
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Daniel Terral
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
| | - Stéphane Nottin
- LAPEC EA4278 Laboratory, Avignon University, F-84000 Avignon, France;
- Correspondence: ; Tel.: +33-490-162-931
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13
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Le TT, Lim V, Ibrahim R, Teo MT, Bryant J, Ang B, Su B, Aw TC, Lee CH, Bax J, Cook S, Chin CWL. The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2021; 22:670-679. [PMID: 32255186 PMCID: PMC8110315 DOI: 10.1093/ehjci/jeaa040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/26/2019] [Accepted: 03/03/2020] [Indexed: 01/19/2023] Open
Abstract
Aims Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications. Methods and results Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (EDV3t, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P < 0.001). The RI provided incremental prognostic value over and above a model consisting of clinical variables, LVH and concentricity; and predicted adverse events independent of clinical variables, LVH, and other prognostic markers. Concentric and eccentric LVH were associated with adverse prognosis (log-rank P = 0.62) that was similar to the natural history of hypertensive LVH (5.1 events/100 patient-years). Conclusion The RI provides prognostic value that improves risk stratification of hypertensive LVH.
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Affiliation(s)
- Thu-Thao Le
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Vanessa Lim
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Rositaa Ibrahim
- Department of Cardiology, National Heart Center Singapore, Singapore.,Department of Radiology, Penang General Hospital, Penang, Malaysia
| | - Muh-Tyng Teo
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Jennifer Bryant
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Briana Ang
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Boyang Su
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Jeroen Bax
- Faculty in Medicine, Leiden University, the Netherlands
| | - Stuart Cook
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Calvin W L Chin
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
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14
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Choriocapillaris microvasculature dysfunction in systemic hypertension. Sci Rep 2021; 11:4603. [PMID: 33633311 PMCID: PMC7907127 DOI: 10.1038/s41598-021-84136-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022] Open
Abstract
We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. BP levels, serum creatinine and urine microalbumin/creatinine ratio (MCR) specimens were collected. The estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. The main outcome was choriocapillaris flow deficits (CFD) metrics (density, size and numbers). The CFD occupied a larger area and were fewer in number in the hypertensive patients with poor BP control (407 ± 10 µm2; 3260 ± 61) compared to the hypertensives with good BP control (369 ± 5 µm2; 3551 ± 41) and healthy controls (365 ± 11 µm2; 3581 ± 84). Higher systolic BP (β = 9.90, 95% CI, 2.86–16.93), lower eGFR (β = − 0.85; 95% CI, − 1.58 to − 0.13) and higher urine MCR (β = 1.53, 95% CI, 0.32–2.78) were associated with larger areas of CFD. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD. These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease.
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15
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Loncaric F, Marciniak M, Nunno L, Mimbrero M, Fernandes JF, Fabijanovic D, Sanchis L, Doltra A, Montserrat S, Cikes M, Lamata P, Bijnens B, Sitges M. Distribution of myocardial work in arterial hypertension: insights from non-invasive left ventricular pressure-strain relations. Int J Cardiovasc Imaging 2021; 37:145-154. [PMID: 32789553 DOI: 10.1007/s10554-020-01969-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
A index of non-invasive myocardial work (MWI) can account for pressure during the assessment of cardiac function, potentially separating the influence of loading conditions from the influence of the underlying tissue remodelling. The aim is to assess LV function accounted for loading and explore hypertensive MWI distribution by comparing healthy individuals to hypertensive patients without and with localized basal septal hypertrophy (BSH). An echocardiogram was performed in 170 hypertensive patients and 20 healthy individuals. BSH was defined by a basal-to-mid septal wall thickness ratio ≥ 1.4. LV speckle-tracking was performed, and the MWI calculated globally and regionally for the apical, mid and basal regions. An apex-to-base gradient, seen in regional strain values, was preserved in the distribution of myocardial work, with the apical region compensating for the impairment of the basal segments. This functional redistribution was further pronounced in patients with localized BSH. In these patients, segmental MWI analysis revealed underlying impairment of regional work unrelated to acute loading conditions. Non-invasive MWI analysis offers the possibility to compare LV function regardless of blood pressure at the time of observation. Changes in MWI distribution can be seen in hypertension unrelated to the load-dependency of strain. Accentuated functional changes affirm the role of BSH as an echocardiographic marker in hypertension.
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Affiliation(s)
- Filip Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain.
| | - Maciej Marciniak
- Department of Biomedical Engineering, Kings College London, London, UK
| | - Loredana Nunno
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Maria Mimbrero
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Joao F Fernandes
- Department of Biomedical Engineering, Kings College London, London, UK
| | - Dora Fabijanovic
- University Hospital Centre Zagreb, Department for Cardiovascular Diseases and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Laura Sanchis
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Adelina Doltra
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Silvia Montserrat
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III (CB16/11/00354); CERCA Programme / Generalitat de Catalunya, Madrid, Spain
| | - Maja Cikes
- University Hospital Centre Zagreb, Department for Cardiovascular Diseases and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Pablo Lamata
- Department of Biomedical Engineering, Kings College London, London, UK
| | - Bart Bijnens
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- La Institució Catalana de Recerca i Estudis Avançats, (ICREA), Barcelona, Spain
| | - Marta Sitges
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III (CB16/11/00354); CERCA Programme / Generalitat de Catalunya, Madrid, Spain
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16
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Cabral-Pacheco GA, Garza-Veloz I, Castruita-De la Rosa C, Ramirez-Acuña JM, Perez-Romero BA, Guerrero-Rodriguez JF, Martinez-Avila N, Martinez-Fierro ML. The Roles of Matrix Metalloproteinases and Their Inhibitors in Human Diseases. Int J Mol Sci 2020; 21:E9739. [PMID: 33419373 PMCID: PMC7767220 DOI: 10.3390/ijms21249739] [Citation(s) in RCA: 540] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Matrix metalloproteinases (MMPs) are a family of zinc-dependent extracellular matrix (ECM) remodeling endopeptidases that have the capacity to degrade almost every component of the ECM. The degradation of the ECM is of great importance, since it is related to embryonic development and angiogenesis. It is also involved in cell repair and the remodeling of tissues. When the expression of MMPs is altered, it can generate the abnormal degradation of the ECM. This is the initial cause of the development of chronic degenerative diseases and vascular complications generated by diabetes. In addition, this process has an association with neurodegeneration and cancer progression. Within the ECM, the tissue inhibitors of MMPs (TIMPs) inhibit the proteolytic activity of MMPs. TIMPs are important regulators of ECM turnover, tissue remodeling, and cellular behavior. Therefore, TIMPs (similar to MMPs) modulate angiogenesis, cell proliferation, and apoptosis. An interruption in the balance between MMPs and TIMPs has been implicated in the pathophysiology and progression of several diseases. This review focuses on the participation of both MMPs (e.g., MMP-2 and MMP-9) and TIMPs (e.g., TIMP-1 and TIMP-3) in physiological processes and on how their abnormal regulation is associated with human diseases. The inclusion of current strategies and mechanisms of MMP inhibition in the development of new therapies targeting MMPs was also considered.
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Affiliation(s)
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Carretera Zacatecas-Guadalajara Km.6. Ejido la Escondida, Zacatecas 98160, Mexico; (G.AC.-P.); (C.C.-D.l.R.); (J.MR.-A.); (B.AP.-R.); (J.FG.-R.); (N.M.-A.)
| | | | | | | | | | | | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Carretera Zacatecas-Guadalajara Km.6. Ejido la Escondida, Zacatecas 98160, Mexico; (G.AC.-P.); (C.C.-D.l.R.); (J.MR.-A.); (B.AP.-R.); (J.FG.-R.); (N.M.-A.)
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17
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Dou W, Wang L, Malhi M, Liu H, Zhao Q, Plakhotnik J, Xu Z, Huang Z, Simmons CA, Maynes JT, Sun Y. A microdevice platform for characterizing the effect of mechanical strain magnitudes on the maturation of iPSC-Cardiomyocytes. Biosens Bioelectron 2020; 175:112875. [PMID: 33303322 DOI: 10.1016/j.bios.2020.112875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 11/28/2020] [Indexed: 12/12/2022]
Abstract
The use of human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) as an in vitro model of the heart is limited by their structurally and functionally immature phenotypes. During heart development, mechanical stimuli from in vivo microenvironments are known to regulate cardiomyocyte gene expression and maturation. Accordingly, protocols for culturing iPSC-CMs have recently incorporated mechanical or electromechanical stimulation to induce cellular maturation in vitro; however, the response of iPSC-CMs to different mechanical strain magnitudes is unknown, and existing techniques lack the capability to dynamically measure changes to iPSC-CM contractility in situ as maturation progresses. We developed a microdevice platform which applies cyclical strains of varying magnitudes (5%, 10%, 15% and 20%) to a monolayer of iPSC-CMs, coincidentally measuring contractile stress during mechanical stimulation using fluorescent nanobeads embedded in the microdevice's suspended membrane. Cyclic strain was found to induce circumferential cell alignment on the actuated membranes. In situ contractility measurements revealed that cyclic stimulation gradually increased cardiomyocyte contractility during a 10-day culture period. The contractile stress of iPSC-CM monolayers was found to increase with a higher strain magnitude and plateaued at 15% strain. Cardiomyocyte contractility positively correlated with the elongation of sarcomeres and an increased expression of β-myosin heavy chain (MYH7) in a strain magnitude-dependent manner, illustrating how mechanical stress can be optimized for the phenotypic and proteomic maturation of the cells. iPSC-CMs with improved maturity have the potential to create a more accurate heart model in vitro for applications in disease modeling and therapeutic discovery.
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Affiliation(s)
- Wenkun Dou
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada
| | - Li Wang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada; School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, 250353, China
| | - Manpreet Malhi
- Program in Molecular Medicine, Hospital for Sick Children, Toronto, M5G 1X8, Canada; Department of Biochemistry, University of Toronto, Toronto, M5S 1A8, Canada
| | - Haijiao Liu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, M5S 3G9, Canada
| | - Qili Zhao
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada
| | - Julia Plakhotnik
- Program in Molecular Medicine, Hospital for Sick Children, Toronto, M5G 1X8, Canada; Department of Biochemistry, University of Toronto, Toronto, M5S 1A8, Canada
| | - Zhensong Xu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada
| | - Zongjie Huang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada
| | - Craig A Simmons
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, M5S 3G9, Canada; Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, M5G 1M1, Canada.
| | - Jason T Maynes
- Program in Molecular Medicine, Hospital for Sick Children, Toronto, M5G 1X8, Canada; Department of Biochemistry, University of Toronto, Toronto, M5S 1A8, Canada; Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, M5G 1X8, Canada.
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, M5S 3G9, Canada; Department of Electrical and Computer Engineering, University of Toronto, M5S 3G4, Canada; Department of Computer Science, University of Toronto, M5T 3A1, Canada.
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18
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Xu Y, Lin J, Liang Y, Wan K, Li W, Wang J, Zhu Y, Mui D, Wang L, Li Y, Cheng W, Sun J, Zhang Q, Han Y, Chen Y. Prognostic value of left ventricular remodelling index in idiopathic dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020; 22:1197-1207. [PMID: 32658979 DOI: 10.1093/ehjci/jeaa144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/04/2020] [Accepted: 05/03/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS To evaluate the prognostic value of left ventricular (LV) remodelling index (RI) in idiopathic dilated cardiomyopathy (DCM) patients. METHODS AND RESULTS We prospectively enrolled 412 idiopathic DCM patients and 130 age- and sex-matched healthy volunteers who underwent cardiovascular magnetic resonance imaging between September 2013 and March 2018. RI was defined as the cubic root of the LV end-diastolic volume divided by the mean LV wall thickness on basal short-axis slice. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included the primary endpoint and heart failure (HF) readmission. During the median follow-up of 28.1 months (interquartile range: 19.3-43.0 months), 62 (15.0%) and 143 (34.7%) patients reached the primary and secondary endpoints, respectively. Stepwise multivariate Cox regression showed that RI [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.11-1.30, P < 0.001], late gadolinium enhancement (LGE) presence and log (N-terminal pro-B-type natriuretic peptide) were independent predictors of the primary endpoint, while RI (HR 1.15, 95% CI 1.08-1.23, P < 0.001) and extracellular volume were independent predictors of the secondary endpoint. The addition of RI to LV ejection fraction (EF) and LGE presence showed significantly improved global χ2 for predicting primary and secondary endpoints (both P < 0.001). Furthermore, RI derived from echocardiography also showed independent prognostic value for primary and secondary endpoints with clinical risk factors. CONCLUSIONS RI is an independent predictor of all-cause mortality, heart transplantation, and HF readmission in DCM patients and provides incremental prognostic value to LVEF and LGE presence.
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Affiliation(s)
- Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Jiayi Lin
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yaodan Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.,Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, No.1, Dahua Road, Dongcheng District, Beijing 100730, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yanjie Zhu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., Shenzhen University Town, Nanshan, Shenzhen, Guangdong 518055, China
| | - David Mui
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, 3400 civic center boulevard, Philadelphia, PA 19104, USA
| | - Lili Wang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yuancheng Li
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, 3400 civic center boulevard, Philadelphia, PA 19104, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
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19
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Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography. J Hypertens 2020; 37:572-580. [PMID: 30113530 PMCID: PMC6365272 DOI: 10.1097/hjh.0000000000001916] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: Reduction in capillary density or rarefaction is a hallmark of essential hypertension. We measured the retinal capillary density using noninvasive optical coherence tomographic angiography (OCT-A) in adults with treated systemic hypertension and determined possible correlations with ambulatory blood pressure (BP) and renal parameters. Methods: This observational cross-sectional study consisted of 153 normal eyes from 77 nondiabetic hypertensive adults [mean (SD) age, 58 (9) years; 49% women; 23% poorly controlled BP]. Data on 24-h ambulatory BP monitoring, serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. Retinal capillary density measured with the OCT-A (AngioVue) at superficial (SVP) and deep vascular plexuses (DVP). Linear regression was used to investigate the association of risk factors with capillary density. Results: Retinal capillary density (percentage) at DVP was reduced in patients with poorly controlled BP (SBP = 148 ± 8 mmHg; 27.2 ± 13.0) compared with those with well controlled BP (SBP = 125 ± 9 mmHg; 34.7 ± 11.3). In the multivariable analysis, poorly controlled BP [β = −6.49, 95% confidence interval (CI), −12.39 to −0.59], higher SBP (β = −0.23, 95% CI −0.44 to −0.02) and lower eGFR (β = 6.42, 95% CI 1.25–11.60) were associated with sparser retinal capillary density. Systemic factors were not associated with capillary density at SVP (all P > 0.05). Conclusion: In adults with treated systemic hypertension, retinal capillary density reduced with higher BP and poorer eGFR. These findings highlight the potential role of OCT-A to study early microvascular changes because of systemic hypertension.
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20
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Loncaric F, Nunno L, Mimbrero M, Marciniak M, Fernandes JF, Tirapu L, Fabijanovic D, Sanchis L, Doltra A, Cikes M, Lamata P, Bijnens B, Sitges M. Basal Ventricular Septal Hypertrophy in Systemic Hypertension. Am J Cardiol 2020; 125:1339-1346. [PMID: 32164912 DOI: 10.1016/j.amjcard.2020.01.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023]
Abstract
Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography, and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional volumes, as well as speckle tracking echocardiography. The population was 54% men, mean age 57 (53 to 60) years. BSH was seen in 20% (n = 32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease.
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Affiliation(s)
- Filip Loncaric
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Loredana Nunno
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Maria Mimbrero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Maciej Marciniak
- Department of Biomedical Engineering, Kings College London, London, United Kingdom
| | | | - Laia Tirapu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Dora Fabijanovic
- Department for Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Laura Sanchis
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Adelina Doltra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain
| | - Maja Cikes
- Department for Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pablo Lamata
- Department of Biomedical Engineering, Kings College London, London, United Kingdom
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; La Institució Catalana de Recerca i Estudis Avançats, (ICREA), Barcelona, Spain
| | - Marta Sitges
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III (CB16/11/00354), CERCA Programme/Generalitat de Catalunya, Madrid, Spain
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21
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Yang EY, Khan MA, Graviss EA, Nguyen DT, Bhimaraj A, Nambi V, Hoogeveen RC, Ballantyne CM, Zoghbi WA, Shah DJ. Relationship of extracellular volume assessed on cardiac magnetic resonance and serum cardiac troponins and natriuretic peptides with heart failure outcomes. Sci Rep 2019; 9:20168. [PMID: 31882822 PMCID: PMC6934524 DOI: 10.1038/s41598-019-56213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022] Open
Abstract
Measures of serum cardiac troponins and natriuretic peptides have become established as prognostic heart failure risk markers. In addition to detecting myocardial fibrosis through late gadolinium enhancement (LGE), extracellular volume fraction (ECV) measures by cardiac magnetic resonance (CMR) have emerged as a phenotypic imaging risk marker for incident heart failure outcomes. We sought to examine the relationship between cardiac troponins, natriuretic peptides, ECV and their associations with incident heart failure events in a CMR referral base. Mid short axis T1 maps were divided into 6 cardiac segments, each classified as LGE absent or present. Global ECV was derived from T1 maps using the area-weighted average of only LGE-absent segments. ECV was considered elevated if measured >30%, the upper 95% bounds of a reference healthy group without known cardiac disease (n = 28). Patients were dichotomized by presence of elevated ECV. High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal B-type natriuretic peptide (NT-proBNP) were measured using serum samples acquired and stored at time of CMR scan, and patients were categorized into 3 groups for each blood marker based on recommended cutoff values. Subsequent heart failure admission and any death were ascertained. Relationships with ECV, hs-cTnT, and NT-proBNP were examined separately and as a composite with Cox proportional hazard models. Of 1,604 serial patients referred for a clinical CMR with myocardial T1 maps, 331 were eligible after exclusions and had blood available and were followed over a median 25.0 [interquartile range 21.8, 31.7] months. After adjustments for age (mean 57.3 [standard deviation (SD) 15.1 years), gender (61% male), and ethnicity (12.7% black), elevated ECV remained a predictor of a first composite heart failure outcome for patients with high levels of hs-cTnT (≥14 ng/L; hazard ratio [HR] 2.42 [95% confidence interval (CI) 1.17, 5.03]; p = 0.02) and NT-proBNP (≥300 pg/mL; HR 2.28 [95% CI 1.24, 4.29]; p = 0.01). Similar trends were seen for lower category levels of blood markers, but did not persist with minimal covariate adjustments. Elevated measures of ECV by CMR are associated with incident heart failure outcomes in patients with high hs-cTnT and NT-proBNP levels. This imaging marker may have a role for additional heart failure risk stratification.
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Affiliation(s)
- Eric Y Yang
- Houston Methodist Hospital, Houston, TX, USA
| | | | | | | | | | - Vijay Nambi
- Houston Methodist Hospital, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Houston Methodist Hospital, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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22
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Chua J, Chin CWL, Tan B, Wong SH, Devarajan K, Le TT, Ang M, Wong TY, Schmetterer L. Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension. Sci Rep 2019; 9:5819. [PMID: 30967575 PMCID: PMC6456612 DOI: 10.1038/s41598-019-41917-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/20/2019] [Indexed: 12/29/2022] Open
Abstract
We investigated the characteristics of the choriocapillaris flow voids using optical coherence tomography angiography (OCTA) in 85 patients (164 eyes) with hypertension (mean ± SD age, 56 ± 11 years; 45% women; 20% poorly controlled BP; 16% diabetes) who are without ocular diseases and determined possible correlations with systemic vascular risk factors. Data on 24-hour ambulatory blood pressure (BP), serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. OCTA imaging (6 × 6 mm scans; AngioVue) with quantitative microvascular analysis of the choriocapillaris was performed. Linear regression was used to investigate the association of systemic risk factors with area (percentage), size (pixels) and number of choriocapillaris flow voids. Diabetes (β = 0.33; 95% CI, 0.02 to 0.63) and daytime systolic BP (β = -0.13; 95% CI, -0.24 to -0.02) were associated with areas of flow voids. Age (β = 0.21; 95% CI, 0.06 to 0.36) and daytime diastolic BP (β = -0.18; 95% CI, -0.34 to -0.02) were associated with size of flow voids. Age (β = -21.21; 95% CI, -31.79 to -10.63) and nighttime diastolic BP (β = 13.89; 95% CI, 0.61 to 27.17) were associated with number of flow voids. Kidney parameters were not associated with any features of flow voids. In patients with hypertension, a higher BP appeared to increase blood flow in the choriocapillaris which needs to be considered when using the OCTA to study eye diseases in hypertensives.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Si Han Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kavya Devarajan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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23
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Aw TC, Huang WT, Le TT, Pua CJ, Ang B, Phua SK, Yeo KK, Cook SA, Chin CWL. High-Sensitivitycardiac Troponinsin Cardio-Healthy Subjects: A Cardiovascular Magnetic Resonance Imaging Study. Sci Rep 2018; 8:15409. [PMID: 30337631 PMCID: PMC6194119 DOI: 10.1038/s41598-018-33850-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/07/2018] [Indexed: 12/22/2022] Open
Abstract
The 99th percentile upper reference limits (URL) of high-sensitivity cardiac troponin (hs-cTn) in healthy subjects are essential for diagnosis and management of cardiovascular diseases. Unless screened stringently, subclinical disease affects the derived URL. In 779 healthy subjects(49% males; 17-88 years) screened by cardiovascular magnetic resonance (CMR), the gold standard for assessing cardiac volumes and myocardial mass; and estimated glomerular filtration rate (eGFR), the 99th percentile URL of hsTnT (Roche) and hs-cTnI (Abbott) were similar to the published URL. The overall 99th percentile URL of hsTnT and hsTnI were 15.2 and 21.2 ng/L, respectively; males had higher values than females (hsTnT: 16.8 versus 11.9 ng/L and hsTnI: 38.8 versus 14.4 ng/L). Correlation between hsTnT and hsTnI was modest (r = 0.45; p < 0.001). A larger proportion of healthy volunteers <60 years had detectable hsTnI compared to hsTnT (n = 534; 30.0% versus 18.3%, p < 0.001). Lower eGFR was an independent clinical determinant of hsTnT, but not hsTnI. Both hs-cTn concentrations were independently associated with myocardial mass and cardiac volumes (p < 0.01 for all), but only hsTnI was independently associated with CMR multi-directional strain measures and extent of LV trabeculations (p < 0.05 for all). Differences exist between hs-cTn assays and may influence their selection depending on cardiac conditions, patient population and local factors.
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Affiliation(s)
- Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Wei-Ting Huang
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Thu-Thao Le
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Chee-Jian Pua
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Briana Ang
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Soon-Kieng Phua
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Khung-Keong Yeo
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Stuart A Cook
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Calvin W L Chin
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Alex L, Russo I, Holoborodko V, Frangogiannis NG. Characterization of a mouse model of obesity-related fibrotic cardiomyopathy that recapitulates features of human heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2018; 315:H934-H949. [PMID: 30004258 PMCID: PMC6230908 DOI: 10.1152/ajpheart.00238.2018] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is caused, or exacerbated by, a wide range of extracardiac conditions. Diabetes, obesity, and metabolic dysfunction are associated with a unique HFpEF phenotype, characterized by inflammation, cardiac fibrosis, and microvascular dysfunction. Development of new therapies for HFpEF is hampered by the absence of reliable animal models. The leptin-resistant db/ db mouse has been extensively studied as a model of diabetes-associated cardiomyopathy; however, data on the functional and morphological alterations in db/ db hearts are conflicting. In the present study, we report a systematic characterization of the cardiac phenotype in db/ db mice, focusing on the time course of functional and histopathological alterations and on the identification of sex-specific cellular events. Although both male and female db/ db mice developed severe obesity, increased adiposity, and hyperglycemia, female mice had more impressive weight gain and exhibited a modest but significant increase in blood pressure. db/ db mice had hypertrophic ventricular remodeling and diastolic dysfunction with preserved ejection fraction; the increase in left ventricular mass was accentuated in female mice. Histological analysis showed that both male and female db/ db mice had cardiomyocyte hypertrophy and interstitial fibrosis, associated with marked thickening of the perimysial collagen, and expansion of the periarteriolar collagen network, in the absence of replacement fibrosis. In vivo and in vitro experiments showed that fibrotic changes in db/ db hearts were associated with increased collagen synthesis by cardiac fibroblasts, in the absence of periostin, α-smooth muscle actin, or fibroblast activation protein overexpression. Male db/ db mice exhibited microvascular rarefaction. In conclusion, the db/ db mouse model recapitulates functional and histological features of human HFpEF associated with metabolic dysfunction. Development of fibrosis in db/ db hearts, in the absence of myofibroblast conversion, suggests that metabolic dysfunction may activate an alternative profibrotic pathway associated with accentuated extracellular matrix protein synthesis. NEW & NOTEWORTHY We provide a systematic analysis of the sex-specific functional and structural myocardial alterations in db/ db mice. Obese diabetic C57BL6J db/ db mice exhibit diastolic dysfunction with preserved ejection fraction, associated with cardiomyocyte hypertrophy, interstitial/perivascular fibrosis, and microvascular rarefaction, thus recapitulating aspects of human obesity-related heart failure with preserved ejection fraction. Myocardial fibrosis in db/ db mice is associated with a matrix-producing fibroblast phenotype, in the absence of myofibroblast conversion, suggesting an alternative mechanism of activation.
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MESH Headings
- Adiposity
- Animals
- Cardiomyopathies/etiology
- Cardiomyopathies/metabolism
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Cells, Cultured
- Disease Models, Animal
- Echocardiography, Doppler
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Extracellular Matrix Proteins/metabolism
- Female
- Fibroblasts/metabolism
- Fibroblasts/pathology
- Fibrosis
- Heart Failure/etiology
- Heart Failure/metabolism
- Heart Failure/pathology
- Heart Failure/physiopathology
- Heart Ventricles/metabolism
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Humans
- Hypertension/etiology
- Hypertension/physiopathology
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Mice, Inbred C57BL
- Mice, Obese
- Myocardium/metabolism
- Myocardium/pathology
- Obesity/complications
- Obesity/genetics
- Obesity/physiopathology
- Sex Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
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Affiliation(s)
- Linda Alex
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Ilaria Russo
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Volodymir Holoborodko
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Nikolaos G Frangogiannis
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
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Chen Y, Luo HQ, Sun LL, Xu MT, Yu J, Liu LL, Zhang JY, Wang YQ, Wang HX, Bao XF, Meng GL. Dihydromyricetin Attenuates Myocardial Hypertrophy Induced by Transverse Aortic Constriction via Oxidative Stress Inhibition and SIRT3 Pathway Enhancement. Int J Mol Sci 2018; 19:E2592. [PMID: 30200365 PMCID: PMC6164359 DOI: 10.3390/ijms19092592] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
Dihydromyricetin (DMY), one of the flavonoids in vine tea, exerts several pharmacological actions. However, it is not clear whether DMY has a protective effect on pressure overload-induced myocardial hypertrophy. In the present study, male C57BL/6 mice aging 8⁻10 weeks were subjected to transverse aortic constriction (TAC) surgery after 2 weeks of DMY (250 mg/kg/day) intragastric administration. DMY was given for another 2 weeks after surgery. Blood pressure, myocardial structure, cardiomyocyte cross-sectional area, cardiac function, and cardiac index were observed. The level of oxidative stress in the myocardium was assessed with dihydroethidium staining. Our results showed that DMY had no significant effect on the blood pressure. DMY decreased inter ventricular septum and left ventricular posterior wall thickness, relative wall thickness, cardiomyocyte cross-sectional areas, as well as cardiac index after TAC. DMY pretreatment also significantly reduced arterial natriuretic peptide (ANP), brain natriuretic peptide (BNP) mRNA and protein expressions, decreased reactive oxygen species production and malondialdehyde (MDA) level, while increased total antioxidant capacity (T-AOC), activity of superoxide dismutase (SOD), expression of sirtuin 3 (SIRT3), forkhead-box-protein 3a (FOXO3a) and SOD2, and SIRT3 activity in the myocardium of mice after TAC. Taken together, DMY ameliorated TAC induced myocardial hypertrophy in mice related to oxidative stress inhibition and SIRT3 pathway enhancement.
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Affiliation(s)
- Yun Chen
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
- School of Medicine, Nantong University, Nantong 226001, China.
| | - Hui-Qin Luo
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Lin-Lin Sun
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Meng-Ting Xu
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Jin Yu
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Lu-Lu Liu
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Jing-Yao Zhang
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Yu-Qin Wang
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Hong-Xia Wang
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Xiao-Feng Bao
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
| | - Guo-Liang Meng
- Department of Pharmacology, School of Pharmacy and Key Laboratory of Inflammation and Molecular Drug Target of Jiangsu Province, Nantong University, Nantong 226001, China.
- School of Medicine, Nantong University, Nantong 226001, China.
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26
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Aurigemma GP, Salerno M. A Novel Index of Remodeling in Hypertensive Heart Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006975. [DOI: 10.1161/circimaging.117.006975] [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: 11/16/2022]
Affiliation(s)
- Gerard P. Aurigemma
- From the Departments of Medicine and Radiology, University of Massachusetts Medical School, Worcester (G.P.A.); and Departments of Medicine, Biomedical Engineering, Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville (M.S.)
| | - Michael Salerno
- From the Departments of Medicine and Radiology, University of Massachusetts Medical School, Worcester (G.P.A.); and Departments of Medicine, Biomedical Engineering, Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville (M.S.)
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