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Wu Z, Huang Z, Li Y, Chen S, Wu S, Gao X. Association between life's essential 8 and risk of heart failure: A prospective community-based study. Chin Med J (Engl) 2025:00029330-990000000-01519. [PMID: 40235313 DOI: 10.1097/cm9.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Indexed: 04/17/2025] Open
Affiliation(s)
- Zhijun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei 063000, China
| | - Yaqi Li
- Institute of Nutrition, Clinical Research Institute, Fudan University, Shanghai 200032, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei 063000, China
| | - Xiang Gao
- Institute of Nutrition, Clinical Research Institute, Fudan University, Shanghai 200032, China
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2
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Mołek-Dziadosz P, Natorska J, Matusik PT, Wojciechowska W, Rajzer M, Rajtar-Salwa R, Bartuś S, Surdacki A, Malinowski KP, Lenart-Migdalska A, Olszowska M, Ząbczyk M. Left ventricular remodeling in atrial fibrillation is associated with elevated NAP-2 and 3-nitrotyrosine. Biomark Med 2025; 19:157-164. [PMID: 39935376 PMCID: PMC11916376 DOI: 10.1080/17520363.2025.2463882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 02/04/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Atrial fibrillation (AF) coexists with left ventricular (LV) dysfunction and remodeling. Neutrophil infiltration of cardiac muscle tissue and oxidative stress are associated with cardiac remodeling. MATERIALS AND METHODS In 221 AF patients aged 70 (62-76) years, LV remodeling was assessed using echocardiography. Plasma concentrations of neutrophil-activating peptide 2 (NAP-2) and 3-nitrotyrosine were measured. RESULTS AF patients with concentric and eccentric hypertrophy showed higher NAP-2 levels than those with normal LV geometry (+41% and + 29%, p = 0.001 and p = 0.025, respectively). Moreover, concentric hypertrophy was associated with 85% higher 3-nitrotyrosine level (p = 0.01) compared to normal LV geometry. CONCLUSIONS Elevated NAP-2, associated with oxidative damage, may contribute to the development of LV hypertrophy.
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Affiliation(s)
- Patrycja Mołek-Dziadosz
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Natorska
- Krakow Centre for Medical Research and Technologies, The St. John Paul II Hospital, Krakow, Poland
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł T. Matusik
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Department of Electrocardiology, the St. John Paul II Hospital, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Lenart-Migdalska
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Ząbczyk
- Krakow Centre for Medical Research and Technologies, The St. John Paul II Hospital, Krakow, Poland
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Brown JM, Honzel B, Tsai LC, Milks J, Neibuhr Y, Newman AJ, Cherney M, Stouffer D, Auchus RJ, Vaidya A. Characterizing the Origins of Primary Aldosteronism. Hypertension 2025; 82:306-318. [PMID: 39660429 PMCID: PMC11735322 DOI: 10.1161/hypertensionaha.124.24153] [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: 10/11/2024] [Accepted: 11/25/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Renin-independent aldosterone production in normotensive people increases risk for developing hypertension. In parallel, normotensive adrenal glands frequently harbor aldosterone-producing micronodules with pathogenic somatic mutations known to induce primary aldosteronism (PA). A deeper understanding of these phenomena would inform the origins of PA and its role in hypertension pathogenesis. METHODS Prospectively recruited normotensives underwent detailed characterization of PA features via the following: oral sodium suppression test to evaluate renin-independent aldosterone production, dexamethasone suppression and adrenocorticotropic hormone-stimulation tests to evaluate adrenocorticotropic hormone-mediated aldosterone production, and 24-hour ambulatory blood pressure monitoring. The magnitude of renin-independent aldosterone production was defined via tertiles of 24-hour urinary aldosterone production during the oral sodium suppression test to create unbiased categorizations of the magnitude of PA. Serum aldosterone, serum 18-hybrid steroids, urine tetrahydroaldosterone (biomarkers of aldosterone synthase activity), urinary potassium, and blood pressure (biomarkers of mineralocorticoid receptor activation) were evaluated across tertiles. RESULTS There was a spectrum of autonomous, nonsuppressible, and renin-independent production of aldosterone, 18-hybrid steroids, and 24-hour urinary tetrahydroaldosterone (P-trend <0.01). Correspondingly, there was a continuum of adrenocorticotropic hormone-mediated aldosterone production and 18-hybrid steroid production that also paralleled renin-independent aldosterone production. The spectrum of PA pathophysiology was associated with higher ambulatory daytime systolic BP (P-trend <0.05), even within the normotensive range, and greater urinary potassium excretion (P-trend <0.05), indicating a continuum of mineralocorticoid receptor activation. CONCLUSIONS The pathophysiologic continuum of PA, characterized by renin-independent and adrenocorticotropic hormone-mediated aldosterone production, and enhanced aldosterone synthase and mineralocorticoid receptor activity, is evident in normotensive people. These findings provide mechanistic explanations to implicate PA in the pathogenesis of a substantial proportion of hypertension.
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Affiliation(s)
- Jenifer M. Brown
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brooke Honzel
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura C. Tsai
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Milks
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Yvonne Neibuhr
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J. Newman
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Cherney
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - David Stouffer
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Richard J. Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Endocrinology and Metabolism Section, LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Wang A, Ma Q, Mbikyo MB, Miao L, Cui N, Fu H, Yu J, Wu Q, Sun Y, Li Z. Successful treatment of resistant hypertension and severe complications in a 63-year-old man with primary aldosteronism without adrenalectomy: A case report. Heliyon 2024; 10:e33688. [PMID: 39044991 PMCID: PMC11263627 DOI: 10.1016/j.heliyon.2024.e33688] [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: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Primary aldosteronism (PA), often due to aldosteronoma, commonly causes secondary hypertension and typically requires surgery. We present a case of an elderly man with longstanding hypertension, complicated by cerebral hemorrhage and myocardial infarction. Enhanced CT imaging identified a right-sided aldosteronoma and left adrenal gland fullness. Combined with upright supine aldosterone ratio, captopril challenge test, bilateral adrenal venous sampling, and CYP11B1/CYP11B2 fusion gene testing, the diagnosis of PA was confirmed. Despite the absence of surgical intervention in this patient, pharmacotherapy effectively managed hypertension and enhanced cardiac function, thereby underscoring the advantageous utilization of aldosterone antagonists in non-surgical candidates diagnosed with PA.
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Affiliation(s)
- Ai Wang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Qun Ma
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Muisha B. Mbikyo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Linlin Miao
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Nan Cui
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Haoran Fu
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Jiahui Yu
- Department of Radiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Qiao Wu
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
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Lai B, Huang B, Li L. Causal relationship between inflammatory markers and left ventricle geometry and function: A 2-sample Mendelian randomization study. Medicine (Baltimore) 2024; 103:e38735. [PMID: 38996142 PMCID: PMC11245243 DOI: 10.1097/md.0000000000038735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/07/2024] [Indexed: 07/14/2024] Open
Abstract
Studies have shown that some inflammatory markers can predict the risk of cardiovascular disease (CVD) and affect the structure and function of the heart. However, a causal relationship between inflammatory markers and the cardiac structure and function has not yet been established. Thus, we conducted a 2-sample Mendelian randomization (MR) study to explore the potential causal relationship between inflammatory markers and prognostically-related left ventricular (LV) parameters. Instrumental variables (IVs) for C-reactive protein (CRP), interleukin-6 (IL-6), and myeloperoxidase (MPO) levels were selected from the databases of large genome-wide association studies (GWAS). Summary statistics for LV parameters, including LV mass, ejection fraction, end-diastolic and systolic volumes, and the ratio of LV mass to end-diastolic volume, were obtained from cardiovascular magnetic resonance studies of the UK Biobank (n = 16923). The inverse-variance weighted (IVW) method was the primary analytical method used, and was complemented with the MR-Egger, weighted median, simple mode, weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. Sensitivity analysis was performed to evaluate the robustness of the results. CRP was significantly associated with the LV mass in the IVW method (β = -0.13 g [95% confidence interval [CI], 0.78 g-1.00 g], P = .046). A higher standard deviation of genetically-predicted CRP levels was associated with a 0.13 ± 0.06 g lower LV mass. No causal relationships of IL-6 and MPO with LV parameters were found. No evidence of heterogeneity and pleiotropy was detected. Sensitivity analyses confirmed the robustness of the results. Two-sample MR analysis revealed a causal association between increased CRP level and decreased LV mass, whereas IL-6 and MPO levels did not influence the LV parameters. However, further research is required to validate our findings.
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Affiliation(s)
- Bolin Lai
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Bin Huang
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Li Li
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
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6
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Al-Hashedi EM, Abdu FA. Aldosterone Effect on Cardiac Structure and Function. Curr Cardiol Rev 2024; 20:e290224227534. [PMID: 38425104 PMCID: PMC11327832 DOI: 10.2174/011573403x281390240219063817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cardiac remodelling could be a key mechanism in aldosteronemediated cardiovascular morbidity and mortality. Experimental and clinical evidence has demonstrated that aldosterone causes cardiac structural remodelling and dysfunction by its profibrotic and pro-hypertrophic effects, which result mainly from the direct effects on myocardial collagen deposition, inflammation, and oxidative stress. Clinical studies have investigated the aldosterone effects on the heart in different clinical conditions, including general population, essential hypertension, primary aldosteronism, heart failure, and atrial fibrillation. Robust findings indicate that aldosterone or the activation of the cardiac mineralocorticoid receptor can cause damage to myocardial tissue by mechanisms independent of the blood pressure, leading to tissue hypertrophy, fibrosis, and dysfunction. CONCLUSION Aldosterone-mediated cardiovascular morbidity and mortality mainly result from cardiac structural and functional alterations. In different clinical settings, aldosterone can induce cardiac structural remodelling and dysfunction via several pathological mechanisms, including cardiac fibrosis, inflammation, and oxidative stress. Aldosterone antagonists could effectively decrease or reverse the detrimental aldosterone-mediated changes in the heart.
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Affiliation(s)
- Ekhlas Mahmoud Al-Hashedi
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Department of Cardiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fuad A. Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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7
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Chao CT, Liao MT, Wu CK. Left Ventricular Hypertrophy Geometry and Vascular Calcification Co-Modify the Risk of Cardiovascular Mortality in Patients with End-Stage Kidney Disease: A Retrospective Cohort Study. J Atheroscler Thromb 2023; 30:1242-1254. [PMID: 36567124 PMCID: PMC10499460 DOI: 10.5551/jat.63870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 12/25/2022] Open
Abstract
AIM Patients with end-stage kidney disease (ESKD) have an unparalleled risk of left ventricular hypertrophy (LVH) and vascular calcification (VC), both of which introduce excessive cardiovascular risk. However, it remains unclear whether LVH geometry co-modulates cardiovascular outcomes with VC in this population. METHODS A retrospective cohort study was conducted. Patients with ESKD requiring chronic hemodialysis were identified from Shin Kong Wu Ho-Su Memorial Hospital between October and December 2018, with echocardiographic LVH geometry and aortic arch calcification (AoAC) determined. They were divided into four groups according to AoAC severity and eccentric or concentric LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyze their cardiovascular and all-cause mortality after multivariate adjustment. RESULTS Overall, 223 patients with ESKD with LVH were analyzed, among whom 29.1%, 23.3%, 25.1%, and 22.4% had non-to-mild AoAC with eccentric and concentric LVH and moderate-to-severe AoAC with eccentric and concentric LVH, respectively. After 3.5 years of follow-up, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher risk of cardiovascular mortality than those with non-to-mild AoAC and eccentric LVH (hazard ratio 3.35, p=0.002). However, those with moderate-to-severe AoAC but eccentric LVH did not have higher cardiovascular mortality. Similarly, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher all-cause mortality than those with non-to-mild AoAC and eccentric LVH, whereas the other two groups did not have higher risk. CONCLUSION LVH geometry could help stratify the risk of patients with ESKD when they had severe VC, and co-existing severe VC and concentric LVH aggravated cardiovascular risk.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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8
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Cohen JB, Bancos I, Brown JM, Sarathy H, Turcu AF, Cohen DL. Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys. Annu Rev Med 2023; 74:217-230. [PMID: 36375469 PMCID: PMC9892285 DOI: 10.1146/annurev-med-042921-100438] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are bettertolerated than steroidal MRAs. While their blood pressure-lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.
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Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; ,
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irina Bancos
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Jenifer M Brown
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Harini Sarathy
- Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA;
| | - Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA;
| | - Debbie L Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; ,
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9
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Al‐Hashedi EM, Zhao X, Mohammed AA, Juvenal H, Yu J. Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension. J Clin Hypertens (Greenwich) 2022; 25:213-222. [PMID: 36585812 PMCID: PMC9903192 DOI: 10.1111/jch.14612] [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: 09/11/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/01/2023]
Abstract
Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3 ± 12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e' velocity, a' velocity, and E/e' ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P = 0.003), interventricular septum (P = 0.001), LV posterior wall thickness (P = 0.001) and E/e' ratio (P ˂ 0.001), but a decrease in e' velocity (P = 0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11-1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.
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Affiliation(s)
| | - Xu Zhao
- Department of CardiologyLanzhou University Second HospitalLanzhouGansuChina
| | - Ayman A. Mohammed
- Department of CardiologyLanzhou University Second HospitalLanzhouGansuChina
| | | | - Jing Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouGansuChina
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Brown JM, Wijkman MO, Claggett BL, Shah AM, Ballantyne CM, Coresh J, Grams ME, Wang Z, Yu B, Boerwinkle E, Vaidya A, Solomon SD. Cardiac Structure and Function Across the Spectrum of Aldosteronism: the Atherosclerosis Risk in Communities Study. Hypertension 2022; 79:1984-1993. [PMID: 35582954 PMCID: PMC9759338 DOI: 10.1161/hypertensionaha.122.19134] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aldosterone production and mineralocorticoid receptor activation are implicated in myocardial fibrosis and cardiovascular events. METHODS Cardiac structure and function were assessed in 4547 participants without prevalent heart failure (HF) in the ARIC study (Atherosclerosis Risk in Communities), with echocardiography, aldosterone, and plasma renin activity measurement (2011-2013). Subjects were characterized by plasma renin activity as suppressed (≤0.5 ng/mL per hour) or unsuppressed (>0.5 ng/mL per hour). Cross-sectional relationships with cardiac structure and function, and longitudinal relationships with outcomes (HF hospitalization; HF and all-cause death; HF, death, myocardial infarction, and stroke; and incident atrial fibrillation) were assessed. Models were adjusted for demographic and anthropometric characteristics and additively, for blood pressure and antihypertensives. RESULTS Evidence of primary aldosteronism physiology was prevalent (11.6% with positive screen) and associated with echocardiographic parameters. Renin suppression was associated with greater left ventricular mass, left ventricular volumes, and left atrial volume index, and a lower E/A ratio (adjusted P<0.001 for all). Higher aldosterone was associated with greater left ventricular mass and lower global longitudinal strain and lateral E'. The highest tertile of aldosterone was associated with a hazard ratio of 1.37 (95% CI, 1.06-1.77; 5.5-year follow-up) for incident atrial fibrillation relative to the lowest. Renin suppression was associated with HF (hazard ratio, 1.34 [95% CI, 1.05-1.72]; 7.3-year follow-up), although these relationships did not remain statistically significant after additional adjustment for hypertension. CONCLUSIONS Renin suppression and aldosterone excess, consistent with primary aldosteronism pathophysiology, were associated with cardiac structural and functional alterations and may represent an early target for mitigation of fibrosis with mineralocorticoid receptor antagonists.
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Affiliation(s)
- Jenifer M. Brown
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Magnus O. Wijkman
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Brian L. Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Zhiying Wang
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
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Sahiti F, Morbach C, Cejka V, Albert J, Eichner FA, Gelbrich G, Heuschmann PU, Störk S. Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study. Front Cardiovasc Med 2021; 8:669335. [PMID: 34179134 PMCID: PMC8232934 DOI: 10.3389/fcvm.2021.669335] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure. Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of Würzburg, Germany, aged 30–79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg% per mL/m2, p < 0.001) and lower global work efficiency (GWE) (−0.02% per mL/m2, p < 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg% per g/m2, p < 0.001) and global constructive work (GCW) (+2.05 mmHg% per g/m2, p < 0.01) and lower GWE (−0.015% per g/m2, p < 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension. Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease.
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Affiliation(s)
- Floran Sahiti
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
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Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study. Br J Nutr 2021; 126:1888-1896. [PMID: 33618785 DOI: 10.1017/s0007114521000660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e' ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e' ratio: logβ = -0·03) and systolic function (GCS: β = -0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = -0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.
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14
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Galizzi A, Bagardi M, Stranieri A, Zanaboni AM, Malchiodi D, Borromeo V, Brambilla PG, Locatelli C. Factors affecting the urinary aldosterone-to-creatinine ratio in healthy dogs and dogs with naturally occurring myxomatous mitral valve disease. BMC Vet Res 2021; 17:15. [PMID: 33413406 PMCID: PMC7792040 DOI: 10.1186/s12917-020-02716-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic renin-angiotensin-aldosterone system (RAAS) activation in course of heart diseases contributes to cardiac remodeling and heart failure. Myxomatous mitral valve disease (MMVD) is characterized by different stages of severity and trend of RAAS activity during the course of the disease is still uncertain. The urinary aldosterone-to-creatinine ratio (UAldo:C) has been proven to reflect RAAS activation in dogs and might be a useful marker in monitoring therapy and disease progression, but data about this parameter need to be expanded. The objective of this study was to evaluate the UAldo:C in healthy dogs and dogs with naturally occurring MMVD, and to investigate the relationships between this parameter and clinical, echocardiographic and laboratory variables. RESULTS The study population consisted of 149 dogs: 49 healthy and 100 MMVD dogs (45 stage B1, 13 stage B2 and 42 stage C). Urinary aldosterone-to-creatinine ratio was not significantly different among healthy and MMVD dogs of any stages. Breed, sex and age showed a significant impact on UAldo:C. In particular, Chihuahua and Cavalier King Charles spaniel showed significantly higher UAldo:C than other breeds, as well as intact females than other genders. In stage C dogs, UAldo:C appeared to be increased by spironolactone and was positively associated with furosemide dose (P = 0.024). Aldosterone breakthrough (ABT) appeared to occur in 36% (8/22) of stage C dogs not receiving spironolactone. A significant positive association between UAldo:C and left atrium-to-aortic root ratio (LA/Ao) was found. CONCLUSIONS Individual factors such as breed, sex and age appeared to influence UAldo:C, and therapy seemed to add further variability. In the light of these results, comparing the UAldo:C of a single patient with a population-based reference value might lead to wrong interpretations and an individual monitoring should be considered. The prevalence of ABT in the present study (36%) was in line with those previously reported. However, due to the high individual variability of UAldo:C found in the study, even this result should be re-evaluated in the setting of an individual longitudinal approach. The positive association between UAldo:C and LA/Ao supports the mutual relationship between RAAS and cardiac remodeling.
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Affiliation(s)
- Alberto Galizzi
- Department of Veterinary Medicine, University of Milan, Via dell'Università 6, 26900, Lodi, Italy.
| | - Mara Bagardi
- Department of Veterinary Medicine, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - Angelica Stranieri
- Department of Veterinary Medicine, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - Anna Maria Zanaboni
- Department of Computer Science & Data Science Research Center, University of Milan, Milan, Italy
| | - Dario Malchiodi
- Department of Computer Science & Data Science Research Center, University of Milan, Milan, Italy
| | - Vitaliano Borromeo
- Department of Veterinary Medicine, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | | | - Chiara Locatelli
- Department of Veterinary Medicine, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
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15
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Bostan MM, Stătescu C, Anghel L, Șerban IL, Cojocaru E, Sascău R. Post-Myocardial Infarction Ventricular Remodeling Biomarkers-The Key Link between Pathophysiology and Clinic. Biomolecules 2020; 10:E1587. [PMID: 33238444 PMCID: PMC7700609 DOI: 10.3390/biom10111587] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Studies in recent years have shown increased interest in developing new methods of evaluation, but also in limiting post infarction ventricular remodeling, hoping to improve ventricular function and the further evolution of the patient. This is the point where biomarkers have proven effective in early detection of remodeling phenomena. There are six main processes that promote the remodeling and each of them has specific biomarkers that can be used in predicting the evolution (myocardial necrosis, neurohormonal activation, inflammatory reaction, hypertrophy and fibrosis, apoptosis, mixed processes). Some of the biomarkers such as creatine kinase-myocardial band (CK-MB), troponin, and N-terminal-pro type B natriuretic peptide (NT-proBNP) were so convincing that they immediately found their place in the post infarction patient evaluation protocol. Others that are related to more complex processes such as inflammatory biomarkers, atheroma plaque destabilization biomarkers, and microRNA are still being studied, but the results so far are promising. This article aims to review the markers used so far, but also the existing data on new markers that could be considered, taking into consideration the most important studies that have been conducted so far.
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Affiliation(s)
- Maria-Madălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
| | | | - Elena Cojocaru
- Department of Morphofunctional Sciences I—Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania;
| | - Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iasi, Romania; (M.-M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iasi, Romania
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Nayor M, Short MI, Rasheed H, Lin H, Jonasson C, Yang Q, Hveem K, Felix JF, Morrison AC, Wild PS, Morley MP, Cappola TP, Benson MD, CHARGE-Heart Failure Working Group, CHARGE-EchoGen Consortium, Ngo D, Sinha S, Keyes MJ, Shen D, Wang TJ, Larson MG, Brumpton BM, Gerszten RE, Omland T, Vasan RS. Aptamer-Based Proteomic Platform Identifies Novel Protein Predictors of Incident Heart Failure and Echocardiographic Traits. Circ Heart Fail 2020; 13:e006749. [PMID: 32408813 PMCID: PMC7236427 DOI: 10.1161/circheartfailure.119.006749] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND We used a large-scale, high-throughput DNA aptamer-based discovery proteomic platform to identify circulating biomarkers of cardiac remodeling and incident heart failure (HF) in community-dwelling individuals. METHODS We evaluated 1895 FHS (Framingham Heart Study) participants (age 55±10 years, 54% women) who underwent proteomic profiling and echocardiography. Plasma levels of 1305 proteins were related to echocardiographic traits and to incident HF using multivariable regression. Statistically significant protein-HF associations were replicated in the HUNT (Nord-Trøndelag Health) study (n=2497, age 63±10 years, 43% women), and results were meta-analyzed. Genetic variants associated with circulating protein levels (pQTLs) were related to echocardiographic traits in the EchoGen (n=30 201) and to incident HF in the CHARGE (n=20 926) consortia. RESULTS Seventeen proteins associated with echocardiographic traits in cross-sectional analyses (false discovery rate <0.10), and 8 of these proteins had pQTLs associated with echocardiographic traits in EchoGen (P<0.0007). In Cox models adjusted for clinical risk factors, 29 proteins demonstrated associations with incident HF in FHS (174 HF events, mean follow-up 19 [limits, 0.2-23.7] years). In meta-analyses of FHS and HUNT, 6 of these proteins were associated with incident HF (P<3.8×10-5; 3 with higher risk: NT-proBNP [N-terminal proB-type natriuretic peptide], TSP2 [thrombospondin-2], MBL [mannose-binding lectin]; and 3 with lower risk: ErbB1 [epidermal growth factor receptor], GDF-11/8 [growth differentiation factor-11/8], and RGMC [hemojuvelin]). For 5 of the 6 proteins, pQTLs were associated with echocardiographic traits (P<0.0006) in EchoGen, and for RGMC, a protein quantitative trait loci was associated with incident HF (P=0.001). CONCLUSIONS A large-scale proteomics approach identified new predictors of cardiac remodeling and incident HF. Future studies are warranted to elucidate how biological pathways represented by these proteins may mediate cardiac remodeling and HF risk and to assess if these proteins can improve HF risk prediction.
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Affiliation(s)
- Matthew Nayor
- Framingham Heart Study, Framingham, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Meghan I. Short
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX
| | - Humaira Rasheed
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Honghuang Lin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Christian Jonasson
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Kristian Hveem
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
| | - Janine F. Felix
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alanna C. Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, and Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany
| | - Michael P. Morley
- The Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, PA
| | - Thomas P. Cappola
- The Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, PA
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - Mark D. Benson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | - Debby Ngo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sumita Sinha
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michelle J. Keyes
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Dongxiao Shen
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Thomas J. Wang
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ben M. Brumpton
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Robert E. Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ramachandran S. Vasan
- Framingham Heart Study, Framingham, MA
- Sections of Preventive Medicine & Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
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Park SM, Kim MN, Kim S, Shim WJ. Serum Aldosterone Is Related to Left Ventricular Geometry and Function in Young Adults with Never-Treated Primary Hypertension. J Clin Med 2019; 8:jcm8071045. [PMID: 31319630 PMCID: PMC6679090 DOI: 10.3390/jcm8071045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Although aldosterone has been demonstrated to induce left ventricular (LV) hypertrophy not only in primary aldosteronism but also in primary hypertension (HT), it can be affected by multiple factors, including age, and the effect of aldosterone on LV function is controversial. This study was to investigate the relationship of aldosterone to changes in LV geometry and function in young adults with never-treated HT. Methods: Seventy-five consecutive patients (age, 29.8 ± 6.3 years) with never-treated HT and 45 normal controls were enrolled. Echocardiographic values and LV global longitudinal strain (LVGLS) were obtained. Serum aldosterone concentration (SAC) and serum procollagen type III amino-terminal peptide (PIIINP) level were obtained in HT patients. Results: HT patients had higher LV mass index, higher relative wall thickness (RWT), and worse LV function than normal controls. LVGLS and e’ velocity were worse in HT patients with normal geometry than in normal controls. SAC was well correlated with LV mass index, RWT, e’ velocity, LVGLS, and PIIINP (all p < 0.05). LV geometry pattern was most related to SAC among clinical parameters (p = 0.019). LVGLS was most related to LV geometry and diastolic blood pressure. In contrast, e’ velocity was most related to PIIINP. Conclusion: Our findings may indicate that in young patients with never-treated HT, aldosterone significantly contributes to changes in LV geometry and functional impairment through its pro-hypertrophic and myocardial fibrosis effects beyond blood pressure.
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Affiliation(s)
- Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea.
| | - Mi-Na Kim
- Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Sua Kim
- Division of Intensive Care Medicine, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea
| | - Wan-Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
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Association between elevated plasma aldosterone concentration and left atrial conduit function in hypertension. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 2:100015. [PMID: 33447748 PMCID: PMC7803024 DOI: 10.1016/j.ijchy.2019.100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 12/11/2022]
Abstract
Aldosterone affects myocardial fibrosis and remodeling. The aim was to investigate the relationship between plasma aldosterone concentration (PAC) and left atrial (LA) function in hypertension. 148 hypertensive patients were studied. LA phasic function was evaluated by strain and strain rate imaging. Patients were divided into two groups based on PAC. LA early diastolic strain and strain rate (LAS-E and LASR-E) were lower in group II compared with group I (P < 0.05). Multivariate regression analysis showed that LAS-E was independently related to PAC (β = −0.581, P < 0.001). In conclusion, PAC is associated with LA conduit function in hypertension.
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Restrictive Spirometry and Cardiovascular Risk: Cause or Comorbidity? Ann Am Thorac Soc 2018; 15:1142-1143. [DOI: 10.1513/annalsats.201807-494ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Grytaas MA, Sellevåg K, Thordarson HB, Husebye ES, Løvås K, Larsen TH. Cardiac magnetic resonance imaging of myocardial mass and fibrosis in primary aldosteronism. Endocr Connect 2018; 7:413-424. [PMID: 29440130 PMCID: PMC5834771 DOI: 10.1530/ec-18-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Primary aldosteronism (PA) is associated with increased cardiovascular morbidity, presumably due to left ventricular (LV) hypertrophy and fibrosis. However, the degree of fibrosis has not been extensively studied. Cardiac magnetic resonance imaging (CMR) contrast enhancement and novel sensitive T1 mapping to estimate increased extracellular volume (ECV) are available to measure the extent of fibrosis. OBJECTIVES To assess LV mass and fibrosis before and after treatment of PA using CMR with contrast enhancement and T1 mapping. METHODS Fifteen patients with newly diagnosed PA (PA1) and 24 age- and sex-matched healthy subjects (HS) were studied by CMR with contrast enhancement. Repeated imaging with a new scanner with T1 mapping was performed in 14 of the PA1 and 20 of the HS median 18 months after specific PA treatment and in additional 16 newly diagnosed PA patients (PA2). RESULTS PA1 had higher baseline LV mass index than HS (69 (53-91) vs 51 (40-72) g/m2; P < 0.001), which decreased significantly after treatment (58 (40-86) g/m2; P < 0.001 vs baseline), more with adrenalectomy (n = 8; -9 g/m2; P = 0.003) than with medical treatment (n = 6; -5 g/m2; P = 0.075). No baseline difference was found in contrast enhancement between PA1 and HS. T1 mapping showed no increase in ECV as a myocardial fibrosis marker in PA. Moreover, ECV was lower in the untreated PA2 than HS 10 min post-contrast, and in both PA groups compared with HS 20 min post-contrast. CONCLUSION Specific treatment rapidly reduced LV mass in PA. Increased myocardial fibrosis was not found and may not represent a common clinical problem.
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Affiliation(s)
- Marianne Aa Grytaas
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of MedicineHaukeland University Hospital, Bergen, Norway
| | - Kjersti Sellevåg
- Department of Heart DiseaseHaukeland University Hospital, Bergen, Norway
| | - Hrafnkell B Thordarson
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of MedicineHaukeland University Hospital, Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of MedicineHaukeland University Hospital, Bergen, Norway
| | - Kristian Løvås
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of MedicineHaukeland University Hospital, Bergen, Norway
| | - Terje H Larsen
- Department of Heart DiseaseHaukeland University Hospital, Bergen, Norway
- Department of BiomedicineUniversity of Bergen, Bergen, Norway
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Prevalence and correlates of new-onset left ventricular geometric abnormalities in a general population: the PAMELA study. J Hypertens 2017; 34:1423-31. [PMID: 27136313 DOI: 10.1097/hjh.0000000000000956] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM We sought to evaluate new-onset abnormal LV (left ventricle) patterns and their correlates over a 10-year period in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 817 patients with normal LV geometry at baseline evaluation having a readable echocardiogram at the end of follow-up. Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the Pressioni Arteriose Monitorate e Loro Associazioni population. RESULTS Over a 10-year period 39% of participants progressed to abnormal LV geometric patterns as follows: LV concentric remodelling (15.2%), eccentric dilated left ventricular hypertrophy (LVH) (8.4%), concentric LVH (7.9%), eccentric nondilated LVH (6.8%), and concentric dilated LVH (0.7%). Age [odds ratio (OR): 1.039; 95% confidence interval (CI) 1.023-1.056, P < 0.0001], LV mass index (OR: 1.039; 95% CI 1.026-1.052, P < 0.0001), night-time SBP (OR: 1.024; 95% CI 1.005-1.043, P = 0.01), office SBP changes during follow-up (OR: 1.017 95% CI 1.007-1028, P = 0.001), and BMI (OR: 1.067; 95% CI 1.017-1.120, P = 0.009) emerged as key correlates of new-onset abnormal LV geometry. Age and LV mass index turned out to be strong determinants of all sub-types of LVH; whereas blood pressure, BMI, and sex exhibited a different predictive value across the various LV geometric patterns. CONCLUSIONS Our study provides the first evidence that long-term changes from normal cardiac morphology toward abnormal LV geometry represent a clinically relevant phenomenon at the community level. From a practical perspective this finding reinforces the concept that life-style changes and pharmacologic treatment aimed to reduce over-weight/obesity and optimize blood pressure are of paramount importance for prevention of subclinical cardiac damage.
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Catena C, Colussi G, Novello M, Verheyen ND, Bertin N, Pilz S, Tomaschitz A, Sechi LA. Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism. Hypertension 2016; 68:204-12. [DOI: 10.1161/hypertensionaha.116.07615] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Cristiana Catena
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - GianLuca Colussi
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Marileda Novello
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Nicolas D. Verheyen
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Nicole Bertin
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Stefan Pilz
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Andreas Tomaschitz
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
| | - Leonardo A. Sechi
- From the Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (C.C., M.N., N.B., L.A.S.); and Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Graz, Graz, Austria (N.D.V., S.P., A.T.)
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Moody WE, Ferro CJ, Edwards NC, Chue CD, Lin ELS, Taylor RJ, Cockwell P, Steeds RP, Townend JN. Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors. HYPERTENSION (DALLAS, TEX. : 1979) 2016. [PMID: 26754643 DOI: 10.116/hypertensionaha.115.06608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
UNLABELLED There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a multicenter, parallel group, blinded end point study of living kidney donors and healthy controls (n=124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months). At 12 months, the decrease in isotopic GFR in donors was -30±12 mL/min/1.73m(2). In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus -3±8 g; P<0.001) and mass:volume ratio (+0.06±0.12 versus -0.01±0.09 g/mL; P<0.01), whereas aortic distensibility (-0.29±1.38 versus +0.28±0.79×10(-3) mm Hg(-1); P=0.03) and global circumferential strain decreased (-1.1±3.8 versus +0.4±2.4%; P=0.04). Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6-100.1]; P<0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1-12.8]; P=0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R(2)=0.28; P=0.01). These findings suggest that reduced GFR should be regarded as an independent causative cardiovascular risk factor. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01028703.
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Affiliation(s)
- William E Moody
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Charles J Ferro
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Nicola C Edwards
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Colin D Chue
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Erica Lai Sze Lin
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Robin J Taylor
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Paul Cockwell
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Richard P Steeds
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Jonathan N Townend
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom.
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Abstract
In the latter half of the 20th century, among participants of the Framingham Heart Study, incidence of heart failure (HF) has declined by about a third in women but not in men and survival after the onset of HF has improved in both sexes; however, HF remains highly lethal with over 50% dying within 5 years after onset of HF. Overall, the 8-year relative risk of HF is 24% lower in women compared with men. The 8-year incidence rates of HF with preserved ejection fraction (HFPEF; EF >45%) and HF with reduced EF (HFREF; EF ≤ 45%) in women and HFPEF in men are similar; however, men have a 2-fold higher cumulative incidence of HFREF than HFPEF. The lifetime risk of HF is about 20% in both women and men at 40, 50, 60, 70, and 80 years of age. Contribution of hypertension and diabetes mellitus to the risk of HF was more prominent in women than in men. Serum levels of several biomarkers were distinctly different in women compared with men and had differential effects on left ventricular structure and function; however, the strength and direction of the association between biomarkers levels and HF risk were generally similar in women and men. In individuals with HF, about two-thirds of the underlying cause of death and about one-half of the immediate cause of death were due to cardiovascular causes. Non-cardiovascular underlying and immediate causes of death were more evident in HFPEF.
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Affiliation(s)
- Satish Kenchaiah
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St., #532, Little Rock, AR, 72205, USA,
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Tadic M, Cuspidi C, Vukomanovic V, Kocijancic V, Celic V. The impact of different left ventricular geometric patterns on right ventricular deformation and function in hypertensive patients. Arch Cardiovasc Dis 2016; 109:311-20. [PMID: 27020514 DOI: 10.1016/j.acvd.2015.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 08/31/2015] [Accepted: 12/18/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Right ventricular (RV) hypertrophy and RV systolic dysfunction are predictors of poor outcome. No study has investigated RV deformation and function in hypertensive patients with different left ventricular (LV) geometry patterns. AIM To investigate RV deformation and function in hypertensive patients with different LV geometric patterns, by using two-dimensional (2D) strain analysis and three-dimensional (3D) echocardiography. METHODS This cross-sectional study included 184 hypertensive subjects, all of whom underwent complete 2D and 3D examinations. The participants were separated into two groups (with and without LV hypertrophy [LVH]), and were then divided into four further groups according to different LV geometry patterns: normal LV geometry, concentric remodelling, eccentric LVH and concentric LVH. RESULTS Patients with LVH had significantly higher RV end-diastolic and end-systolic volume indexes and stroke volumes than those without LVH. Conversely, 3D RV ejection fraction was lower among subjects with LVH. 3D RV volume indexes gradually increased from subjects with normal LV geometry to those with concentric LVH, whereas 3D RV ejection fraction progressively decreased in the same direction. Global RV longitudinal strain was significantly lower in LVH subjects than in patients without LVH. 2D RV mechanics progressively deteriorated from patients with normal LV geometry to those with concentric LVH. Eccentric and concentric LVH were associated with reduced longitudinal lateral wall RV strain and early diastolic strain rate. CONCLUSIONS 2D RV myocardial deformation and 3D RV function are affected significantly by LV geometry in hypertensive patients. Concentric and eccentric LVH patterns have the greatest unfavourable effect on RV deformation.
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Affiliation(s)
- Marijana Tadic
- Cardiology Department, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia; Faculty of Medicine, Doktora Subotica 6, Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Vladan Vukomanovic
- Cardiology Department, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Vesna Kocijancic
- Cardiology Department, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Vera Celic
- Cardiology Department, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia; Faculty of Medicine, Doktora Subotica 6, Belgrade, Serbia
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27
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Moody WE, Ferro CJ, Edwards NC, Chue CD, Lin ELS, Taylor RJ, Cockwell P, Steeds RP, Townend JN. Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors. Hypertension 2016; 67:368-77. [PMID: 26754643 PMCID: PMC4716285 DOI: 10.1161/hypertensionaha.115.06608] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/29/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a multicenter, parallel group, blinded end point study of living kidney donors and healthy controls (n=124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months). At 12 months, the decrease in isotopic GFR in donors was -30±12 mL/min/1.73m(2). In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus -3±8 g; P<0.001) and mass:volume ratio (+0.06±0.12 versus -0.01±0.09 g/mL; P<0.01), whereas aortic distensibility (-0.29±1.38 versus +0.28±0.79×10(-3) mm Hg(-1); P=0.03) and global circumferential strain decreased (-1.1±3.8 versus +0.4±2.4%; P=0.04). Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6-100.1]; P<0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1-12.8]; P=0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R(2)=0.28; P=0.01). These findings suggest that reduced GFR should be regarded as an independent causative cardiovascular risk factor. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01028703.
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Affiliation(s)
- William E Moody
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Charles J Ferro
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Nicola C Edwards
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Colin D Chue
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Erica Lai Sze Lin
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Robin J Taylor
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Paul Cockwell
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Richard P Steeds
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom
| | - Jonathan N Townend
- From the Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Departments of Cardiology (W.E.M., N.C.E., C.D.C., E.L.S.L., R.J.T., R.P.S., J.N.T.) and Nephrology (C.J.F., P.C.), Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, United Kingdom.
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Aceña Á, Pello AM, Carda R, Lorenzo Ó, Gonzalez-Casaus ML, Blanco-Colio LM, Martín-Ventura JL, Palfy J, Orejas M, Rábago R, Gonzalez-Parra E, Mahíllo-Fernández I, Farré J, Egido J, Tuñón J. Parathormone Levels Are Independently Associated with the Presence of Left Ventricular Hypertrophy in Patients with Coronary Artery Disease. J Nutr Health Aging 2016; 20:659-64. [PMID: 27273357 DOI: 10.1007/s12603-015-0649-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abnormalities of mineral metabolism and inflammation may affect the cardiovascular system. We have assessed the relationship of left ventricular hypertrophy (LVH) with inflammation and mineral metabolism. METHODS LVH was measured in 146 outpatients with stable coronary artery disease (SCAD) using echocardiography. Calcidiol (a vitamin D metabolite), parathyroid hormone (PTH), fibroblast growth factor-23, high-sensitivity C-reactive protein, MCP-1 (monocyte chemoattractant protein-1), galectin-3, NGAL (neutrophil gelatinase-associated lipocalin), and sTWEAK (soluble TNF-related weak inducer of apoptosis) plasma levels were studied. RESULTS LVH, defined as septal thickness ≥11 mm, was present in 19.9% of cases. These patients were older [75.0 (61.0-81.0) vs 64.0 (51.0-76.0) years; p=0.002], had higher prevalence of left ventricular ejection fraction (LVEF)>40%, and had higher PTH [84.7 (59.6-104.7) vs 63.2 (49.2-85.2) pg/ml; p=0.007], galectin-3 [9.6 (8.0-11.1) vs 8.3 (6.9-9.9) ng/ml; p=0.037], and NGAL (208.5±87.6 vs 173.9±73.4 ng/ml; p=0.031) plasma levels than those without LVH. Glomerular filtration rate was lower in patients with LVH than in those without it (65.1±20.0 vs 74.7±19.9 mL/min/1.73 m2; p=0.021). There were no significant differences in hypertension (79.3 vs 68.4%; p=0.363) or sex between both groups. Variables showing differences based on univariate analysis and hypertension were entered into a logistic regression analysis. Only age [odds ratio (OR) =1.052 (1.011-1.096); p=0.013], PTH plasma levels [OR=1.017 (1.003-1.031); p=0.021], and LVEF>40% [OR=7.595 (1.463-39.429); p=0.016] were independent predictors of LVH. CONCLUSIONS In patients with SCAD, elevated PTH levels are independently associated with the presence of LVH. Further studies are needed to elucidate the role of PTH in the development of myocardial hypertrophy.
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Affiliation(s)
- Á Aceña
- José Tuñón, Department of Cardiology, IIS-Fundación Jiménez Díaz-UAM, Avenida Reyes Católicos 2, 28040 Madrid, Spain, , Phone: 00-34-915504800 Ext-3701, Fax 00-34-915504904
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Nayor M, Enserro DM, Vasan RS, Xanthakis V. Cardiovascular Health Status and Incidence of Heart Failure in the Framingham Offspring Study. Circ Heart Fail 2015; 9:e002416. [PMID: 26699391 DOI: 10.1161/circheartfailure.115.002416] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 10/28/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The American Heart Association Cardiovascular Health (CVH) score is inversely associated with cardiovascular disease, but its relations to cardiac remodeling traits and heart failure (HF) incidence have not been examined. METHODS AND RESULTS A 14-point score was constructed for each participant based on the presence of poor, intermediate, or ideal status on each of the 7 CVH metrics (ideal score=14). We related the CVH score to echocardiographic traits cross-sectionally and to HF incidence prospectively in the Framingham Offspring Study. In age- and sex-adjusted models, a higher CVH score was associated with lower left ventricular (LV) mass, LV wall thickness, LV diastolic dimension, and left atrial dimension (P<0.01 for all; n=2392; mean age, 58 years; 56% women), and with a 12% to 15% lower odds of prevalent LV concentric remodeling and concentric hypertrophy, respectively (P<0.0001 for both). On follow-up (mean, 12.3 years), 188 incident HF events were observed in 3201 participants (mean age, 59 years; 53% women). In age- and sex-adjusted Cox proportional hazard models, the CVH score was inversely associated with HF incidence (hazard ratio per 1-point higher CVH score, 0.77; 95% confidence interval, 0.72-0.83). This association was partially attenuated upon adjustment for LV mass and interim myocardial infarction (hazard ratio, 0.84; 95% confidence interval, 0.76-0.93), and it was consistent for HF with preserved and reduced ejection fractions. CONCLUSIONS In our community-based sample, comprised predominantly of middle-aged white individuals of European descent, better CVH was associated with lower HF incidence, in part due to a lower prevalence of adverse cardiac remodeling.
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Affiliation(s)
- Matthew Nayor
- From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA
| | - Danielle M Enserro
- From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA
| | - Ramachandran S Vasan
- From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA
| | - Vanessa Xanthakis
- From the Framingham Heart Study, MA (M.N., R.S.V., V.X.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.N.); Departments of Biostatistics (D.M.E., V.X.), Epidemiology (R.S.V., V.X.), and Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine (R.S.V., V.X.), Boston University School of Public Health, MA.
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Abstract
Experimental and clinical evidence obtained in the last 2 decades clearly indicates that protracted exposure to inappropriately elevated aldosterone levels causes significant changes in left ventricular structure and function. Animal studies have demonstrated that aldosterone induces myocardial inflammatory changes and fibrosis in the presence of a high salt diet. Moreover, the effects of aldosterone on the heart have been investigated in different clinical conditions. These conditions include systolic and diastolic heart failure, essential hypertension, and primary aldosteronism that offers a unique clinical model to study the cardiac effects of excess aldosterone because these effects are isolated from those of the renin-angiotensin axis. A relatively clear picture is emerging from these studies with regard to aldosterone-related changes in left ventricular mass and geometry. Conversely, no direct effect of aldosterone on left ventricular diastolic function can be demonstrated and improvement of diastolic function obtained in some studies that have employed mineralocorticoid receptor blockers could result from left ventricular mass reduction. Animal experiments demonstrate that effects of aldosterone on the left ventricle require high salt intake to occur, but the evidence of this contribution of salt to aldosterone-induced cardiac changes in humans remains weaker and needs further research. The article reviews the results of clinical studies addressing the role of aldosterone in regulation of LV remodeling and diastolic function, and focuses on the possible relevance of salt intake.
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Affiliation(s)
- C Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy
| | - G Colussi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy
| | - G Brosolo
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy
| | - M Novello
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy
| | - L A Sechi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy
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A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy. Int J Mol Sci 2015; 16:17456-68. [PMID: 26263970 PMCID: PMC4581202 DOI: 10.3390/ijms160817456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 01/11/2023] Open
Abstract
Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥ 40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% ± 9.3%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%-12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.
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Cuspidi C, Tadic M, Sala C. Aldosterone and abnormal left ventricular geometry in chronic kidney disease. Hypertens Res 2015; 38:314-6. [PMID: 25787043 DOI: 10.1038/hr.2015.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Cesare Cuspidi
- 1] Department of Health Science, University of Milano-Bicocca, Milano, Italy [2] Istituto Auxologico Italiano, Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Carla Sala
- 1] Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy [2] Fondazione Policlinico di Milano, Milano, Italy
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Buglioni A, Cannone V, Cataliotti A, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Dessì-Fulgheri P, Sarzani R, Burnett JC. Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease. Hypertension 2014; 65:45-53. [PMID: 25368032 DOI: 10.1161/hypertensionaha.114.03936] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to investigate the role of aldosterone as a mediator of disease and its relationship with the counter-regulatory natriuretic peptide (NP) system. We measured plasma aldosterone (n=1674; aged≥45 years old) in a random sample of the general population from Olmsted County, MN. In a multivariate logistic regression model, aldosterone analyzed as a continuous variable was associated with hypertension (odds ratio [OR]=1.75; 95% confidence interval [CI]=1.57-1.96; P<0.0001), obesity (OR=1.34; 95% CI=1.21-1.48; P<0.0001), chronic kidney disease (OR=1.39; 95% CI=1.22-1.60; P<0.0001), central obesity (OR=1.47; 95% CI=1.32-1.63; P<0.0001), metabolic syndrome (OR=1.41; 95% CI=1.26-1.58; P<0.0001), high triglycerides (OR=1.23; 95% CI=1.11-1.36; P<0.0001), concentric left ventricular hypertrophy (OR=1.22; 95% CI=1.09-1.38; P=0.0007), and atrial fibrillation (OR=1.24; 95% CI=1.01-1.53; P=0.04), after adjusting for age and sex. The associations with hypertension, central obesity, metabolic syndrome, triglycerides, and concentric left ventricular hypertrophy remained significant after further adjustment for body mass index, NPs, and renal function. Furthermore, aldosterone in the highest tertile correlated with lower NP levels and increased mortality. Importantly, most of these associations remained significant even after excluding subjects with aldosterone levels above the normal range. In conclusion, we report that aldosterone is associated with hypertension, chronic kidney disease, obesity, metabolic syndrome, concentric left ventricular hypertrophy, and lower NPs in the general community. Our data suggest that aldosterone, even within the normal range, may be a biomarker of cardiorenal and metabolic disease. Further studies are warranted to evaluate a therapeutic and preventive strategy to delay the onset and progression of disease, using mineralocorticoid antagonists or chronic NP administration in high-risk subjects identified by plasma aldosterone.
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Affiliation(s)
- Alessia Buglioni
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.).
| | - Valentina Cannone
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Alessandro Cataliotti
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Paolo Dessì-Fulgheri
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Riccardo Sarzani
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - John C Burnett
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
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Nadruz W. Myocardial remodeling in hypertension. J Hum Hypertens 2014; 29:1-6. [PMID: 24804791 DOI: 10.1038/jhh.2014.36] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023]
Abstract
Left ventricular (LV) hypertrophy and remodeling are frequently seen in hypertensive subjects and result from a complex interaction of several hemodynamic and non-hemodynamic variables. Although increased blood pressure is considered the major determinant of LV structural alterations, ethnicity, gender, environmental factors, such as salt intake, obesity and diabetes mellitus, as well as neurohumoral and genetic factors might influence LV mass and geometry. The conventional concept of hypertensive LV remodeling has been that hypertension leads to concentric hypertrophy, as an adaptive response to normalize wall stress, which is then followed by chamber dilation and heart failure. However, several lines of evidence have challenged this dogma. Concentric hypertrophy is not the most frequent geometric pattern and is less usually seen than eccentric hypertrophy in hypertensive subjects. In addition, data from recent studies suggested that transition from LV concentric hypertrophy to dilation and systolic dysfunction is not a common finding, especially in the absence of coronary heart disease. LV hypertrophy is also consistently associated with increased cardiovascular morbidity and mortality, raising doubts whether this phenotype is an adaptive response. Experimental evidence exists that a blunting of load-induced cardiomyocyte hypertrophy does not necessarily result in LV dysfunction or failure. Furthermore, the hypertrophic myocardium shows fibrosis, alterations in the coronary circulation and cardiomyocyte apoptosis, which may result in heart failure, myocardial ischemia and arrhythmias. Overall, this body of evidence suggests that LV hypertrophy is a complex phenotype that predicts adverse cardiovascular outcomes and may not be necessarily considered as an adaptive response to systemic hypertension.
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Affiliation(s)
- W Nadruz
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Vizzardi E, Regazzoni V, Caretta G, Gavazzoni M, Sciatti E, Bonadei I, Trichaki E, Raddino R, Metra M. Mineralocorticoid receptor antagonist in heart failure: Past, present and future perspectives. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:6-14. [PMID: 29450163 PMCID: PMC5801434 DOI: 10.1016/j.ijchv.2014.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/08/2014] [Indexed: 12/24/2022]
Abstract
Aldosterone is involved in various deleterious effects on the cardiovascular system, including sodium and fluid retention, myocardial fibrosis, vascular stiffening, endothelial dysfunction, catecholamine release and stimulation of cardiac arrhythmias. Therefore, aldosterone receptor blockade may have several potential benefits in patients with cardiovascular disease. Mineralocorticoid receptor antagonists (MRAs) have been shown to prevent many of the maladaptive effects of aldosterone, in particular among patients with heart failure (HF). Randomized controlled trials have demonstrated efficacy of MRA in heart failure with reduced ejection fraction, both in patients with NYHA functional classes III and IV and in asymptomatic and mildly symptomatic patients (NYHA classes I and II). Recent data in patients with heart failure with preserved ejection fraction are encouraging. MRA could also have anti-arrhythmic effects on atrial and ventricular arrhythmias and may be helpful in patient ischemic heart disease through prevention of myocardial fibrosis and vascular damage. This article aims to discuss the pathophysiological effects of aldosterone in patients with cardiovascular disease and to review the current data that support the use of MRA in heart failure.
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Affiliation(s)
- Enrico Vizzardi
- Corresponding author. Tel.: + 39 303995679; fax: + 39 303996801Corresponding author.Tel.: + 39 303995679; fax: + 39 303996801
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Peer M, Boaz M, Zipora M, Shargorodsky M. Determinants of left ventricular hypertrophy in hypertensive patients: identification of high-risk patients by metabolic, vascular, and inflammatory risk factors. Int J Angiol 2014; 22:223-8. [PMID: 24436616 DOI: 10.1055/s-0033-1348880] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Left ventricular hypertrophy (LVH) is recognized as an independent predictor of cardiovascular morbidity and mortality in hypertensive patients. Thus, it is critical to understand the mechanisms underlying the development of LVH for formulation screening and treatment strategies. This study was designed to determine the association between echographically determined LVH measures and markers of inflammation, neurohormonal activity, glomerular function, oxidative stress, insulin resistance, and vascular endothelial function. In this study, 129 hypertensive subjects were evaluated for lipids, glucose, HbA1C, insulin, homeostasis model assessment-insulin resistance, C-reactive protein (CRP), urinary microalbumin, homocysteine, aldosterone, renin, and endothelin. LVH parameters including interventricular septum thickness, posterior wall thickness (PWT), and left ventricular mass index (LVMI) were assessed echographically. Serum aldosterone levels were significantly positively associated with left ventricular mass (LVM) and marginally positively associated with LVMI and PWT. Both LVM and LVMI were significantly elevated in subjects with high versus normal serum aldosterone levels (p = 0.018 for LVM and p = 0.050 for LVMI). Serum endothelin was positively associated with LVM and LVMI. In multiple linear regression analysis, aldosterone remained a significant predictor of LVM (standardized β = 0.229, p = 0.024), and endothelin a marginally significant predictor of LVM (standardized β = 0.178, p = 0.077). Among serum lipids, high-density lipoprotein cholesterol only had a significant inverse association with LVM and PWT. Homocysteine as well as CRP were significantly positively associated with LVM and LVMI in females. This study found that aldosterone and endothelin levels are the most important independent determinants of LVH in hypertensive subjects. These markers may be useful to identify asymptomatic hypertensive subjects at risk for heart failure.
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Affiliation(s)
- Maya Peer
- Department of Internal Medicine, Woltson Medical Center, Holon, Israel
| | - Mona Boaz
- Department of Epidemiology and Statistics, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matas Zipora
- Department of Biochemistry, Wolfson Medical Center, Holon, Israel
| | - Marina Shargorodsky
- Department of Endocrinology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tadic M, Ivanovic B, Cuspidi C. Metabolic syndrome and right ventricle: an updated review. Eur J Intern Med 2013; 24:608-16. [PMID: 24001437 DOI: 10.1016/j.ejim.2013.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
Abstract
The cluster of metabolic and hemodynamic abnormalities which characterize the metabolic syndrome (MS) is responsible for subclinical cardiac and extra-cardiac damage such as left ventricular hypertrophy, diastolic dysfunction, carotid atherosclerosis and microalbuminuria. The development of different non-invasive imaging methods enabled a detail investigation of right ventricular structure and function, and revealed that right ventricular remodeling followed changes in the left ventricular structure and function in patients with arterial hypertension, diabetes or obesity. Previous investigations also reported that the coexistence of two components of the MS induced more significant cardiac remodeling than the presence of only one MS risk-factor. The relationship between different components of the MS (increased blood pressure, abdominal obesity, increased fasting glucose level and dyslipidemia) and right ventricular remodeling could be explained by several hemodynamic and non-hemodynamic mechanisms. However, the association between right ventricular remodeling and the MS has not been sufficiently investigated so far. The aim of this article was to review recent articles focusing on the association between metabolic syndrome components and the metabolic syndrome itself with impairments in right ventricular structure and function assessed by different imaging techniques.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dr Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
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Soriano EA, Azevedo PS, Miot HA, Minicucci MF, Pansani MC, Matsubara LS, Okoshi K, Zornoff LAM, Matsubara BB, Paiva SAR. Cardiac remodeling induced by 13-cis retinoic acid treatment in acne patients. Int J Cardiol 2013; 163:68-71. [PMID: 21663986 DOI: 10.1016/j.ijcard.2011.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/22/2011] [Accepted: 05/13/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND Currently, 13-cis-retinoic acid (13-cis-RA) is the most effective therapy for acne. Isotretinoin, a first-generation synthetic 13-cis-RA compound, is associated with numerous adverse effects. To investigate the cardiac effects of 13-cis-RA, acne patients receiving 13-cis-RA were studied. METHODS Twenty male patients with acne were enrolled in the study. Patients were treated with a dose of 0.5 mg/kg/d of isotretinoin. All participants were assessed prior to treatment and after 10 weeks of therapy with Doppler-echocardiogram. RESULTS Patients showed reductions in right atrium vertical diameter, left atrium longitudinal diameter, left atrium volume and left ventricular diastolic diameter over the course of treatment. Significant increases in interventricular septum diastolic thickness, posterior wall diastolic thickness, relative wall relative thickness and left ventricle (LV) mass were observed. The LV mass index showed an increase in ventricular mass and a decrease in the cavity size. Examining LV systolic function, a decrease was observed for the cardiac index. CONCLUSION In this study, 10 weeks of 13-cis-RA therapy at a dose of 0.5 mg/kg/d was found to promote concentric-type heart remodeling due to the occurrence of two associated events: heart hypertrophy and hypovolemia.
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Affiliation(s)
- Eline A Soriano
- Department of Internal Medicine, Botucatu Medical School, UNESP, Sao Paulo, Brazil
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Catena C, Colussi G, Valeri M, Sechi LA. Association of aldosterone with left ventricular mass in hypertension: interaction with plasma fibrinogen levels. Am J Hypertens 2013; 26:111-7. [PMID: 23382334 DOI: 10.1093/ajh/hps006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Plasma aldosterone concentration is an independent determinant of left ventricular (LV) mass in hypertensive patients, and is related to some hemostatic variables along with it may contribute to a prothrombotic state. We conducted a study to investigate the relationship between hemostatic variables, plasma aldosterone, and cardiac morphology and function in essential hypertension. METHODS In 205 patients with untreated essential hypertension, we measured components of the renin-angiotensin-aldosterone system, plasma levels of fibrinogen, D-dimer, prothrombin fragment 1 + 2 (F1 + 2), and plasminogen activator inhibitor-1 (PAI-1), and assessed cardiac characteristics with standard echocardiography. For statistical purpose, patients were divided into two groups according to whether their median value of plasma aldosterone was > 125 pg/ml or < 125 pg/ml. RESULTS Left ventricular mass index (LVMI) was significantly greater in patients with a high (> 51 ± 13 g/m(2.7)) than with a low plasma aldosterone level (< 41 ± 11 g/m(2.7); P < 0.01) only in patients with fibrinogen levels in the highest tertile. Significant interaction was observed between plasma fibrinogen and aldosterone in the association with LVMI (P = 0.04). Left ventricular mass index was significantly and directly related to age, systolic blood pressure (BP), body mass index (BMI), plasma aldosterone, fibrinogen, and D-dimer levels, whereas no relationships were observed between echocardiographic parameters and other hemostatic variables. Fibrinogen was directly related to age, systolic BP, plasma aldosterone, LVMI, relative wall thickness, and left atrial diameter. Multivariate analysis indicated that LVMI was related to plasma fibrinogen and aldosterone (both P < 0.01) independently of age, BP, and BMI. CONCLUSIONS Plasma fibrinogen levels interact with plasma aldosterone in its association with left ventricular mass in patients with hypertension.
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Affiliation(s)
- Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Italy.
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Bo S, Mandrile C, Milanesio N, Pagani A, Gentile L, Gambino R, Villois P, Ghinamo L, Canil S, Durazzo M, Cassader M, Cavallo-Perin P. Is left ventricular hypertrophy a low-level inflammatory state? A population-based cohort study. Nutr Metab Cardiovasc Dis 2012; 22:668-676. [PMID: 21429721 DOI: 10.1016/j.numecd.2010.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 10/24/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Cross-sectional studies have shown that chronic sub-clinical inflammation is associated with left ventricular hypertrophy (LVH), but results are conflicting. We investigated the association between baseline LVH and high-sensitivity C-reactive protein (CRP) values, both cross-sectionally and after a six-year-follow-up, in a population-based cohort (n = 1564) and a subgroup from this cohort (n = 515), without obesity, diabetes, metabolic syndrome or any drugs. METHODS AND RESULTS ECG tracings at baseline were interpreted according to the Cornell voltage-duration product criteria: 166/1564 subjects (10.6%) showed LVH. Patients with baseline LVH showed increased BMI, waist circumference, blood pressure, and a worse metabolic pattern. Their CRP values both at baseline and at follow-up were almost two-fold higher than in patients without LVH. Similar results were found in the healthier sub-sample. In a multiple regression model, CRP at follow-up was directly associated with baseline LVH (expressed as Cornell voltage-duration product) in the whole cohort (β = 0.0003; 95%CI 0.0002-0.0006; p < 0.001) and in the sub-sample (β = 0.0003; 0.0002-0.0004; p < 0.001), after adjusting for age, sex, BMI, waist circumference, smoking, exercise levels, blood pressure and baseline CRP values. CONCLUSION Baseline LVH, which is associated with systemic inflammation, predicts increased CRP values at follow-up, independently of cardiovascular and metabolic risk factors, both in a population-based cohort and a healthier sub-sample. The inflammatory consequences of LVH might be an intriguing subject for further researches.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
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Affiliation(s)
- Susan Cheng
- The Framingham Heart Study, MA 01702-5803, USA
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Baliga RR, Young JB. Reducing the Burden of Stage B Heart Failure Will Require Connecting the Dots Between “Knowns” and “Known Unknowns”. Heart Fail Clin 2012; 8:xi-xv. [DOI: 10.1016/j.hfc.2011.10.001] [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: 11/30/2022]
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Arnett DK, McClelland RL, Bank A, Bluemke DA, Cushman M, Szalai AJ, Jain N, Gomes AS, Heckbert SR, Hundley WG, Lima JA. Biomarkers of inflammation and hemostasis associated with left ventricular mass: The Multiethnic Study of Atherosclerosis (MESA). INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2011; 2:391-400. [PMID: 22200000 PMCID: PMC3243453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/20/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE Biomarkers of inflammation and hemostasis have been associated with left ventricular (LV) mass. We studied relationships of C-reactive protein (CRP), interleukin-6 (IL6), D-dimer, soluble intercellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor 1 (PAI-1), soluble thrombomodulin (sTM), soluble tumor necrosis factor type 1 receptor (sTNFR1), von Willebrand factor (vWF), soluble E-selectin (sE-selectin), factor VIII, fibrinogen, matrix metalloproteinase 3 (MMP3), and matrix metalloproteinase 9 (MMP9) with LV mass in an asymptomatic population. Multi-Ethnic Study of Atherosclerosis participants underwent magnetic resonance imaging to characterize LV mass; biomarkers were measured using standardized protocols (N = 763 to 4979). Adjusted models were used to associate each biomarker with LV mass while correcting for potential confounding. FINDINGS LV mass was associated with many biomarkers after adjustment for demographic characteristics and traditional cardiovascular risk factors. Although the demographic and risk factor adjustments attenuated the association of CRP and IL6 with LV mass, further adjustment for weight changed regression coefficients from positive to negative for CRP and IL6 for LV mass. sTM, Factor VIII, and vWF were directly associated with LV mass in fully-adjusted models. For sTNFR1, sICAM-1, D-dimer, fibrinogen, and PAI-1, adjustment for risk factors and weight rendered associations with LV mass nonsignificant. CONCLUSIONS In this large cohort free of clinical cardiovascular disease, several hemostasis and inflammation markers were associated with LV mass. The unusual finding of a negative relationship of CRP and IL6 with LV mass only after adjustment for weight suggests that the effects of inflammation on LV mass are strongly influenced by obesity.
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Affiliation(s)
- Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Eggers KM, Kempf T, Lind L, Sundström J, Wallentin L, Wollert KC, Siegbahn A. Relations of growth-differentiation factor-15 to biomarkers reflecting vascular pathologies in a population-based sample of elderly subjects. Scand J Clin Lab Invest 2011; 72:45-51. [DOI: 10.3109/00365513.2011.626072] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Coutinho T, Al-Omari M, Mosley TH, Kullo IJ. Biomarkers of left ventricular hypertrophy and remodeling in blacks. Hypertension 2011; 58:920-5. [PMID: 21986506 DOI: 10.1161/hypertensionaha.111.178095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Left ventricular (LV) hypertrophy, a marker for adverse cardiovascular events, is more common in blacks than in non-Hispanic whites. Mechanisms leading to LV hypertrophy and mediating its clinical sequelae in blacks are not fully understood. We investigated the associations of 39 candidate biomarkers in distinct biological pathways with LV mass and geometry in blacks. Participants included 1193 blacks (63±9 years of age; 72% women; 78% hypertensive) belonging to hypertensive sibships. LV mass was measured by transthoracic echocardiography and indexed to height.(2.7) LV geometry was categorized as normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Generalized estimating equations were used to assess associations of the 39 biomarkers with LV mass index after adjustment for age, sex, and conventional risk factors. After adjustment for potential confounders, log-transformed levels of the following biomarkers were independently associated with LV mass index: N-terminal pro-brain natriuretic peptide (β±SE=0.07±0.01 pg/mL; P<0.0001), mid-regional pro-atrial natriuretic peptide (β±SE=0.08±0.02 pmol/L; P<0.0001), mid-regional pro-adrenomedullin (β±SE=0.09±0.03 nmol/L; P=0.0006), C-terminal pro-endothelin (β± SE=0.05±0.02 pmol/L; P=0.0009), and osteoprotegerin (β±SE=0.07±0.02 pg/mL; P=0.0005) (β is for 1 log increase in biomarker level). The associations of these biomarkers with LV mass index were mainly due to their association with eccentric hypertrophy. Higher circulating levels of natriuretic peptides, adrenomedullin, endothelin, and osteoprotegerin were associated with increased LV mass index, providing insights into the pathophysiology of LV hypertrophy in blacks.
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Affiliation(s)
- Thais Coutinho
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Edelmann F, Tomaschitz A, Wachter R, Gelbrich G, Knoke M, Dungen HD, Pilz S, Binder L, Stahrenberg R, Schmidt A, Marz W, Pieske B. Serum aldosterone and its relationship to left ventricular structure and geometry in patients with preserved left ventricular ejection fraction. Eur Heart J 2011; 33:203-12. [DOI: 10.1093/eurheartj/ehr292] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pouleur AC, Uno H, Prescott MF, Desai A, Appelbaum E, Lukashevich V, Smith BA, Dahlöf B, Solomon SD. Suppression of aldosterone mediates regression of left ventricular hypertrophy in patients with hypertension. J Renin Angiotensin Aldosterone Syst 2011; 12:483-90. [DOI: 10.1177/1470320311414453] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: High circulating aldosterone levels stimulate myocardial fibrosis and left ventricular hypertrophy (LVH). However, it is not clear whether suppression of aldosterone directly contributes to LVH regression in hypertensive patients. Methods: The Aliskiren in Left Ventricular Hypertrophy (ALLAY) trial randomised 465 hypertensive overweight subjects with LVH to the direct renin inhibitor aliskiren 300 mg, losartan 100 mg or the combination and followed patients for 9 months. All patients were treated to standard blood pressure targets. Left ventricular (LV) mass index (LVMI) and LV wall thickness (LVWT) were assessed by cardiac magnetic resonance. A subset of 136 patients who had plasma aldosterone concentration (ALDO) measured at baseline and study end was analysed. Results: At baseline, plasma ALDO was modestly related to systolic blood pressure, LVMI, and wall thickness (all, p < 0.05). Aliskiren, either alone or in combination, was associated with a significantly greater reduction from baseline to 9 months in plasma aldosterone than losartan alone ( p < 0.02). Reduction in ALDO was related to reduction in LVMI even after adjustment for baseline ALDO, BP reduction and treatment group ( p for trend = 0.042). Conclusion: In hypertensive patients with increased LVWT, aliskiren alone or in combination with the angiotensin receptor blocker losartan provides greater reduction in aldosterone compared to losartan alone. Moreover, suppression of aldosterone was associated with reduction of LVH, independently of the change in SBP, suggesting that suppression of aldosterone, a known mediator of LVH, may be particularly important for LVH regression and as a target for therapy.
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Affiliation(s)
| | - Hajime Uno
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | | | | | - Björn Dahlöf
- Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Giannessi D. Multimarker approach for heart failure management: Perspectives and limitations. Pharmacol Res 2011; 64:11-24. [DOI: 10.1016/j.phrs.2011.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/10/2011] [Accepted: 03/20/2011] [Indexed: 12/29/2022]
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