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Quarti-Trevano F, Dell’Oro R, Cuspidi C, Ambrosino P, Grassi G. Endothelial, Vascular and Sympathetic Alterations as Therapeutic Targets in Chronic Heart Failure. Biomedicines 2023; 11:803. [PMID: 36979781 PMCID: PMC10044749 DOI: 10.3390/biomedicines11030803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Vascular and sympathetic abnormalities characterize chronic heart failure (CHF). Alterations include (1) a reduction in arterial distensibility, (2) endothelial dysfunction, (3) a decrease in arterial compliance and a parallel increase in arterial stiffness, and (4) sympathetic cardiovascular activation. Altogether, these alterations represent important targets in therapeutic interventions, because they display an independent negative impact on the disease prognosis, favouring disease progression and the development of cardiovascular complications with direct and indirect mechanisms. The present review will examine the effects of the different therapeutic interventions targeting the vascular/sympathetic alterations detected in CHF. Non-pharmacological, pharmacological and device-based treatments will be discussed in detail, highlighting the possible mechanisms responsible for the vascular/sympathetic effects of each intervention. Finally, the unmet goals in treatment in relation to endothelial and adrenergic targets will be also discussed.
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Affiliation(s)
- Fosca Quarti-Trevano
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Cesare Cuspidi
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Guido Grassi
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
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Fuertes-Kenneally L, Manresa-Rocamora A, Blasco-Peris C, Ribeiro F, Sempere-Ruiz N, Sarabia JM, Climent-Paya V. Effects and Optimal Dose of Exercise on Endothelial Function in Patients with Heart Failure: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2023; 9:8. [PMID: 36739344 PMCID: PMC9899305 DOI: 10.1186/s40798-023-00553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal "dose" of exercise required to increase the benefits of exercise-based CR programmes on endothelial function is still unknown. OBJECTIVES (a) To estimate the effect of exercise-based CR on endothelial function, assessed by flow-mediated dilation (FMD), in patients with HF; (b) to determine whether high-intensity interval training (HIIT) is better than moderate-intensity training (MIT) for improving FMD; and (c) to investigate the influence of exercise modality (i.e. resistance exercise vs. aerobic exercise and combined exercise vs. aerobic exercise) on the improvement of endothelial function. METHODS Electronic searches were carried out in PubMed, Embase, and Scopus up to February 2022. Random-effects models of between-group mean differences were estimated. Heterogeneity analyses were performed by means of the chi-square test and I2 index. Subgroup analyses and meta-regressions were used to test the influence of potential moderator variables on the effect of exercise. RESULTS We found a FMD increase of 3.09% (95% confidence interval [CI] = 2.01, 4.17) in favour of aerobic-based CR programmes compared with control groups in patients with HF and reduced ejection fraction (HFrEF). However, the results of included studies were inconsistent (p < .001; I2 = 95.2%). Higher FMD improvement was found in studies which were randomised, reported radial FMD, or performed higher number of training sessions a week. Moreover, HIIT enhanced FMD to a greater extent than MIT (2.35% [95% CI = 0.49, 4.22]) in patients with HFrEF. Insufficient data prevented pooled analyses for the effect of exercise in patients with HF and preserved ejection fraction and the influence of exercise modality on the improvement of endothelial function. CONCLUSION Aerobic-based CR is a non-pharmacological treatment for enhancing endothelial function in patients with HFrEF. However, higher training frequency and HIIT induce greater adaptation of endothelial function in these patients, which should betaken into consideration when designing exercise-based CR programmes. Trial registration The protocol was prospectively registered on the PROSPERO database (CRD42022304687).
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Affiliation(s)
- Laura Fuertes-Kenneally
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,Cardiology Department, Alicante General University Hospital (HGUA), 03010 Alicante, Spain
| | - Agustín Manresa-Rocamora
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Carles Blasco-Peris
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Physical Education and Sport, University of Valencia, 46010 Valencia, Spain
| | - Fernando Ribeiro
- grid.7311.40000000123236065Institute of Biomedicine‑iBiMED and School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Noemí Sempere-Ruiz
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - José Manuel Sarabia
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Vicente Climent-Paya
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,Cardiology Department, Alicante General University Hospital (HGUA), 03010 Alicante, Spain
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Endothelial Dysfunction in Patients with Advanced Heart Failure Treated with Levosimendan Periodic Infusion Compared with Optimal Medical Therapy: A Pilot Study. Life (Basel) 2022; 12:life12091322. [PMID: 36143358 PMCID: PMC9501966 DOI: 10.3390/life12091322] [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: 07/27/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Endothelial dysfunction (ED) is frequently found in patients with heart failure (HF). Among several pharmacological agents reported to improve endothelial function, levosimendan seems to be a promising one, even though, to date, only two previously published studies have evaluated its effects on ED in these patients. The aim of our pilot study was to further investigate the role of periodic levosimendan infusion on endothelial function in patients affected by advanced HF. In this cross-sectional study, three different groups were enrolled: 20 patients with advanced HF treated with periodic levosimendan (LEVO), 20 patients with HF on optimal medical therapy (OMT), and 20 healthy subjects (control group). ED was evaluated through flow-mediated dilation (FMD) at the level of the brachial artery. The three groups presented similar ages with significant differences in gender distribution, systolic blood pressure, and chronic kidney disease (eGFR < 30 mL/min). In HF patients, ischaemic aetiology was more prevalent in the LEVO group than in the OMT group (60 vs. 40%, p < 0.001). The New York Heart Association (NYHA) functional class was worse in the LEVO group, as well as in NT-proBNP (5636.7 ± 6164.6 ng/dL and 1243.7 ± 1487.2 ng/dL, in the LEVO and OMT groups, respectively, p = 0.005). The FMD was significantly higher in the healthy control group compared to that of the OMT group (15.7 ± 6.4 vs. 9.1 ± 6.0%, p = 0.007) while it showed an intermediate value in LEVO patients (12.4 ± 7.1%) (ANOVA p = 0.010). In conclusion, levosimendan therapy seems to ameliorate endothelial dysfunction related to heart failure. Longitudinal studies in patients on periodic therapy are needed in order to confirm the long-term effects of levosimendan on ED.
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Dos Santos MR, Alves MJDNN, Jordão CP, Pinto CEN, Correa KTS, de Souza FR, da Fonseca GWP, Tomaz Filho J, Costa M, Pereira RMR, Negrão CE, Barretto ACP. Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study. Am Heart J 2021; 239:1-10. [PMID: 33992607 DOI: 10.1016/j.ahj.2021.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
Sacubitril/valsartan reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) when compared with enalapril. However, it is unknown the effect of both treatments on exercise capacity. We compared sacubitril/valsartan versus enalapril in patients with HFrEF based on peak oxygen consumption (VO2) and 6-minute walk test (6-MWT). METHODS We included 52 participants with HFrEF with a left ventricular ejection fraction <40% to receive either sacubitril/valsartan (target dose of 400 mg daily) or enalapril (target dose of 40 mg daily). Peak VO2 was measured by using cardiopulmonary exercise testing. Six-minute walk test was also performed. RESULTS At 12 weeks, the sacubitril/valsartan (mean dose 382.6 ± 57.6 mg daily) group had increased peak VO2 of 13.1% (19.35 ± 0.99 to 21.89 ± 1.04 mL/kg/min) and enalapril (mean dose 34.4 ± 9.2 mg daily) 5.6% (18.58 ± 1.19 to 19.62 ± 1.25 mL/kg/min). However, no difference was found between groups (P = .332 interaction). At 24 weeks, peak VO2 increased 13.5% (19.35 ± 0.99 to 21.96 ± 0.98 mL/kg/min) and 12.0% (18.58 ± 1.19 to 20.82 ± 1.18 mL/kg/min) in sacubitril/valsartan (mean dose 400 ± 0 mg daily) and enalapril (mean dose 32.7 ± 11.0 mg daily), respectively. However, no differences were found between groups (P= .332 interaction). At 12 weeks, 6-MWT increased in both groups (sacubitril/valsartan: 459 ± 18 to 488 ± 17 meters [6.3%] and enalapril: 443 ± 22 to 477 ± 21 meters [7.7%]). At 24 weeks, sacubitril/valsartan increased 18.3% from baseline (543 ± 26 meters) and enalapril decreased slightly to 6.8% (473 ± 31 meters), but no differences existed between groups (P= .257 interaction). CONCLUSIONS Compared to enalapril, sacubitril/valsartan did not substantially improve peak VO2 or 6-MWT after 12 or 24 weeks in participants with HFrEF. (NEPRIExTol-HF Trial, ClinicalTrials.gov number, NCT03190304).
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Affiliation(s)
- Marcelo Rodrigues Dos Santos
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - Camila Paixão Jordão
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Caio Eduardo Novaes Pinto
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kelly Thayane Souza Correa
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francis Ribeiro de Souza
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Joaquim Tomaz Filho
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcel Costa
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Laboratório de Metabolismo Ósseo, Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Negrão
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, Brazil
| | - Antônio Carlos Pereira Barretto
- Instituto Do Coração (InCor), Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Molitor M, Rudi WS, Garlapati V, Finger S, Schüler R, Kossmann S, Lagrange J, Nguyen TS, Wild J, Knopp T, Karbach SH, Knorr M, Ruf W, Münzel T, Wenzel P. Nox2+ myeloid cells drive vascular inflammation and endothelial dysfunction in heart failure after myocardial infarction via angiotensin II receptor type 1. Cardiovasc Res 2021; 117:162-177. [PMID: 32077922 DOI: 10.1093/cvr/cvaa042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS Heart failure (HF) ensuing myocardial infarction (MI) is characterized by the initiation of a systemic inflammatory response. We aimed to elucidate the impact of myelomonocytic cells and their activation by angiotensin II on vascular endothelial function in a mouse model of HF after MI. METHODS AND RESULTS HF was induced in male C57BL/6J mice by permanent ligation of the left anterior descending coronary artery. Compared to sham, HF mice had significantly impaired endothelial function accompanied by enhanced mobilization of Sca-1+c-Kit+ haematopoietic stem cells and Sca-1-c-Kit+ common myeloid and granulocyte-macrophage progenitors in the bone marrow as well as increased vascular infiltration of CD11b+Ly6G-Ly6Chigh monocytes and accumulation of CD11b+ F4/80+ macrophages, assessed by flow cytometry. Using mice with Cre-inducible expression of diphtheria toxin receptor in myeloid cells, we selectively depleted lysozyme M+ myelomonocytic cells for 10 days starting 28 days after MI. While the cardiac phenotype remained unaltered until 38 days post-MI, myeloid cell depletion attenuated vascular accumulation of Nox2+CD45+ cells, endothelial dysfunction, oxidative stress, and vascular expression of adhesion molecules and angiotensin II receptor type 1 (AT1R). Pharmacological blockade of this receptor for 4 weeks did not significantly alter cardiac function, but mimicked the effects of myeloid cell depletion: telmisartan (20 mg/kg/day, fed to C57BL/6J mice) diminished bone marrow myelopoesis and myeloid reactive oxygen species production, attenuated endothelial leucocyte rolling and vascular accumulation of CD11b+Ly6G-Ly6Chigh monocytes and macrophages, resulting in improved vascular function with less abundance of Nox2+CD45+ cells. CONCLUSION Endothelial dysfunction in HF ensuing MI is mediated by inflammatory Nox2+ myeloid cells infiltrating the vessel wall that can be targeted by AT1R blockade.
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Affiliation(s)
- Michael Molitor
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Wolf-Stephan Rudi
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Venkata Garlapati
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Stefanie Finger
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Rebecca Schüler
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Institute for Molecular Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Sabine Kossmann
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- The Heart Research Institute, 7 Eliza Street, Newtown, NSW 2042, Australia
| | - Jeremy Lagrange
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Thanh Son Nguyen
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Johannes Wild
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Tanja Knopp
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Institute for Molecular Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Susanne H Karbach
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Maike Knorr
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Wolfram Ruf
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
- Scripps Research Institute, La Jolla, CA, USA
| | - Thomas Münzel
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Philip Wenzel
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
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Nägele MP, Barthelmes J, Ludovici V, Cantatore S, von Eckardstein A, Enseleit F, Lüscher TF, Ruschitzka F, Sudano I, Flammer AJ. Retinal microvascular dysfunction in heart failure. Eur Heart J 2019; 39:47-56. [PMID: 29069316 DOI: 10.1093/eurheartj/ehx565] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022] Open
Abstract
Aims Retinal vessel analysis (RVA) represents a novel, non-invasive, and reliable method to study the microcirculation in the eye. The goal of this study was to assess the extent of retinal microvascular dysfunction in patients with chronic heart failure (CHF) compared to controls and established measures of vascular function. Methods and results In this prospective, single-centre, observational study, 74 patients with compensated CHF (mean age 63.5 ± 11.2 years, 32% female, mean left-ventricular ejection fraction 37 ± 12.8%), 74 patients with cardiovascular risk factors (CVRF; 64.1 ± 12.7 years, 34% female), and 74 healthy controls (HC; 57.8 ± 14.2 years, 35% female) were included. The primary endpoint, flicker-induced dilatation of retinal arterioles (FIDart), was significantly reduced in patients with CHF compared to CVRF and HC (mean FIDart 0.9 ± 0.2 vs. 2.3 ± 0.3 and vs. 3.6 ± 0.3%, respectively, both P < 0.001 before and after propensity score-weighted analysis). Similar differences were seen for venular FID. FIDart was less impaired in patients with dilated compared to ischaemic cardiomyopathy. No significant differences were observed for arteriovenous ratio and flow-mediated dilatation. Impaired FIDven was associated with echocardiographically estimated systolic pulmonary artery pressure and left atrial volume index. Conclusion Retinal microvascular dilatation in response to flicker light is impaired in CHF. RVA may represent a new and useful method to non-invasively monitor microvascular abnormalities in heart failure in an easy and standardized way without the use of radiation.
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Affiliation(s)
- Matthias P Nägele
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jens Barthelmes
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Valeria Ludovici
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Life, Health & Environmental Sciences, University of L'Aquila, Via Giovanni di Vincenzo 16/B, 67100 L'Aquila, Italy
| | - Silviya Cantatore
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Arnold von Eckardstein
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Frank Enseleit
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Isabella Sudano
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Wagner J, Knaier R, Infanger D, Arbeev K, Briel M, Dieterle T, Hanssen H, Faude O, Roth R, Hinrichs T, Schmidt-Trucksäss A. Functional aging in health and heart failure: the COmPLETE Study. BMC Cardiovasc Disord 2019; 19:180. [PMID: 31362698 PMCID: PMC6664502 DOI: 10.1186/s12872-019-1164-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/18/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases including heart failure are the leading causes of morbidity, with age being the primary risk factor. The combination of age-related organic functional impairment and reduced physical fitness can drastically impact an individual's healthspan. One's lifespan can potentially be prolonged by the preservation or improvement of physical fitness. However, it remains unclear as to which biomarkers are most suitable for distinguishing between healthy aging and the impaired organ function associated with heart failure. Therefore, a comprehensive assessment of the components of physical fitness and CV function will be performed to identify the most important factors contributing to aging in relation to both health and disease. METHODS This cross-sectional investigation will consist of two parts: COmPLETE-Health (C-Health) and COmPLETE-Heart (C-Heart). C-Health will examine the aging trajectories of physical fitness components and CV properties in a healthy population sample aged between 20 and 100 years (n = 490). Separately, C-Heart will assess the same markers in patients at different stages of chronic heart failure (n = 80). The primary outcome to determine the difference between C-Health and C-Heart will be cardiorespiratory fitness as measured by cardiopulmonary exercise testing on a bicycle ergometer. Secondary outcomes will include walking speed, balance, isometric strength, peak power, and handgrip strength. Physical activity as a behavioural component will be assessed objectively via accelerometry. Further, CV assessments will include pulse wave velocity; retinal, arterial, and venous diameters; brachial and retinal arterial endothelial function; carotid intima-media thickness; and systolic and diastolic function. The health distances for C-Health and C-Heart will be calculated using the methodology based on statistical (Mahalanobis) distance applied to measurements of quantitative biomarkers. DISCUSSION This research seeks to identify physical fitness and CV biomarkers that best resemble underlying CV risk with age. Further, it will examine which physical fitness markers are impaired most in heart failure. The presented integrative approach could define new recommendations for diagnostic guidance in aging. Ultimately, this study is expected to offer a better understanding of which functional characteristics should be specifically targeted in primary and secondary prevention to achieve an optimal healthspan.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Raphael Knaier
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC 27705 USA
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street, Hamilton, ONL8S4K1 Canada
| | - Thomas Dieterle
- University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
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Ramirez-Jimenez M, Morales-Palomo F, Ortega JF, Mora-Rodriguez R. Effects of intense aerobic exercise and/or antihypertensive medication in individuals with metabolic syndrome. Scand J Med Sci Sports 2018; 28:2042-2051. [PMID: 29771450 DOI: 10.1111/sms.13218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
We studied the blood pressure lowering effects of a bout of exercise and/or antihypertensive medicine with the goal of studying if exercise could substitute or enhance pharmacologic hypertension treatment. Twenty-three hypertensive metabolic syndrome patients chronically medicated with angiotensin II receptor 1 blockade antihypertensive medicine underwent 24-hr monitoring in four separated days in a randomized order; (a) after taking their habitual dose of antihypertensive medicine (AHM trial), (b) substituting their medicine by placebo medicine (PLAC trial), (c) placebo medicine with a morning bout of intense aerobic exercise (PLAC+EXER trial) and (d) combining the exercise and antihypertensive medicine (AHM+EXER trial). We found that in trials with AHM subjects had lower plasma aldosterone/renin activity ratio evidencing treatment compliance. Before exercise, the trials with AHM displayed lower systolic (130 ± 16 vs 133 ± 15 mm Hg; P = .018) and mean blood pressures (94 ± 11 vs 96 ± 10 mm Hg; P = .036) than trials with placebo medication. Acutely (ie, 30 min after treatments) combining AHM+EXER lowered systolic blood pressure (SBP) below the effects of PLAC+EXER (-8.1 ± 1.6 vs -4.9 ± 1.5 mm Hg; P = .015). Twenty-four hour monitoring revealed no differences among trials in body motion. However, PLAC+EXER and AHM lowered SBP below PLAC during the first 10 hours, time at which PLAC+EXER effects faded out (ie, at 19 PM). Adding exercise to medication (ie, AHM+EXER) resulted in longer reductions in SBP than with exercise alone (PLAC+EXER). In summary, one bout of intense aerobic exercise in the morning cannot substitute the long-lasting effects of antihypertensive medicine in lowering blood pressure, but their combination is superior to exercise alone.
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Affiliation(s)
- M Ramirez-Jimenez
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - F Morales-Palomo
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - J F Ortega
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - R Mora-Rodriguez
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain
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9
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Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine. Blood Press Monit 2018; 23:230-236. [PMID: 29768290 DOI: 10.1097/mbp.0000000000000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a growing tendency for physicians to prescribe exercise in accordance with the 'exercise is medicine' global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise. PARTICIPANTS AND METHODS Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial). RESULTS After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429). CONCLUSION ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.
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10
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Pearson MJ, Mungovan SF, Smart NA. Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2018; 22:229-242. [PMID: 28229273 DOI: 10.1007/s10741-017-9600-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diastolic dysfunction contributes to the development and progression of heart failure. Conventional echocardiography and tissue Doppler imaging are widely utilised in clinical research providing a number of indices of diastolic function valuable in the diagnosis and prognosis of heart failure patients. The aim of this meta-analysis was to quantify the effect of exercise training on diastolic function in patients with heart failure. Exercise training studies that investigate different indices of diastolic function in patients with heart failure have reported that exercise training improves diastolic function in these patients. We sought to add to the current literature by quantifying, where possible, the effect of exercise training on diastolic function. We conducted database searches (PubMed, EBSCO, EMBASE, and Cochrane Trials Register to 31 July 2016) for exercise based rehabilitation trials in heart failure, using the search terms 'exercise training, diastolic function and diastolic dysfunction'. Data from six studies, with a total of 266 heart failure with reduced ejection fraction (HFrEF) participants, 144 in intervention groups and 122 in control groups, indicated a significant reduction in the ratio of early diastolic transmitral velocity (E) to early diastolic tissue velocity (E') (E/E' ratio) with exercise training, exercise vs. control mean difference (MD) of -2.85 (95% CI -3.66 to -2.04, p < 0.00001). Data from five studies in heart failure with preserved ejection fraction (HFpEF) patients, with a total of 204 participants, 115 in intervention groups and 89 in control groups, also demonstrated a significant improvement in E/E' in exercise vs. control MD of -2.38 (95% CI -3.47 to -1.28, p < 0.0001).
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Affiliation(s)
- M J Pearson
- School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia
| | - S F Mungovan
- Westmead Private Physiotherapy Services and The Clinical Research Institute, Sydney, Australia.,Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - N A Smart
- School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
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11
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Pearson MJ, Smart NA. Effect of exercise training on endothelial function in heart failure patients: A systematic review meta-analysis. Int J Cardiol 2016; 231:234-243. [PMID: 28089145 DOI: 10.1016/j.ijcard.2016.12.145] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endothelial dysfunction contributes to the development and progression of cardiovascular disease and heart failure (HF) and is associated with an increased risk of mortality. Flow-mediated dilation (FMD) is widely utilised to assess endothelial function and is improved with exercise training in heart failure patients. The aim of this meta-analysis is to quantify the effect of exercise training in patients with heart failure. BACKGROUND A large number of studies now exist that have examined endothelial function in patients with heart failure. We sought to add to the current literature by quantifying the effect of exercise training on endothelial function. METHODS We conducted database searches (PubMed, EMBASE, PROQUEST and Cochrane Trials Register to June 2016) for exercise based rehabilitation trials in heart failure, using search terms exercise training, endothelial function, flow-mediated dilation (FMD) and endothelial progenitor cells (EPCs). RESULTS The 16 included studies provided a total of 529 participants, 293 in an intervention and 236 in controls groups. FMD was improved with exercise training in exercise vs. control, SMD of 1.08 (95%CI 0.70 to 1.46, p<0.00001). CONCLUSION Overall exercise training improved endothelial function, assessed via FMD, and endothelial progenitor cells in heart failure patients.
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Affiliation(s)
- M J Pearson
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
| | - N A Smart
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia.
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12
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Exercise modalities and endothelial function: a systematic review and dose-response meta-analysis of randomized controlled trials. Sports Med 2015; 45:279-96. [PMID: 25281334 DOI: 10.1007/s40279-014-0272-9] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regular exercise is associated with enhanced nitric oxide (NO) bioavailability. Flow-mediated dilation (FMD) is used widely to assess endothelial function (EF) and NO release. OBJECTIVES The aims of this systematic review and meta-analysis were to (i) investigate the effect of exercise modalities (aerobic, resistance or combined) on FMD; and (ii) determine which exercise and participant characteristics are most effective in improving FMD. METHODS We searched the MEDLINE, Embase, Cochrane Library, and Scopus databases for studies that met the following criteria: (i) randomized controlled trials of exercise with comparative non-exercise, usual care or sedentary groups; (ii) duration of exercise intervention ≥4 weeks; (iii) age ≥18 years; and (iv) EF measured by FMD before and after the intervention. Weighted mean differences (WMDs) with 95% confidence interval were entered into a random effect model to estimate the pooled effect of the exercise interventions. RESULTS All exercise modalities enhanced EF significantly: aerobic (WMD 2.79, 95% CI 2.12-3.45, p = 0.0001), resistance (WMD 2.52, 95% CI 1.11-3.93, p = 0.0001) and combined (WMD 2.07, 95% CI 0.70-3.44, p = 0.003). A dose-response relationship was observed between aerobic exercise intensity and improvement in EF. A 2 metabolic equivalents (MET) increase in absolute exercise intensity or a 10% increase in relative exercise intensity resulted in a 1% unit improvement in FMD. There was a positive relationship between frequency of resistance exercise sessions and improvement in EF (β 1.14, CI 0.16-2.12, p = 0.027). CONCLUSIONS All exercise modalities improve EF significantly and there was a significant, positive relationship between aerobic exercise intensity and EF. Greater frequency, rather than intensity, of resistance exercise training enhanced EF.
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13
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Maloberti A, Meani P, Varrenti M, Giupponi L, Stucchi M, Vallerio P, Giannattasio C. Structural and Functional Abnormalities of Carotid Artery and Their Relation with EVA Phenomenon. High Blood Press Cardiovasc Prev 2015; 22:373-9. [PMID: 25986075 DOI: 10.1007/s40292-015-0100-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022] Open
Abstract
Early vascular aging is a process characterized by a reduction in arterial elastin with an increase in collagen that has been related to cardiovascular risk factor and can determine an increased arterial stiffness and central blood pressure. It can be measured by several non invasive methods and in different arterial segment. The present paper will focus on functional (local stiffness parameter) and structural (intima media thickness) carotid arteries alterations typically evaluated by ultrasound methods. Methodological, research and clinical issue has been reviewed.
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Affiliation(s)
| | - Paolo Meani
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Marisa Varrenti
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Luca Giupponi
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Miriam Stucchi
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Paola Vallerio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. .,Health Science Department, Milano-Bicocca University, Milan, Italy.
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14
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Chen JD, Liu M, Chen XH, Yang ZJ. Effect of Angiotensin Receptor Blockers on Flow-Mediated Vasodilation: A Meta-Analysis of Randomized Controlled Trials. Cardiology 2015; 131:69-79. [DOI: 10.1159/000375259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022]
Abstract
Background: In a meta-analysis, we investigated the effects of angiotensin receptor blockers (ARBs) in comparison to placebo or other classes of antihypertensive drugs on endothelial function, which was measured by brachial flow-mediated vasodilation (FMD). Methods: We searched for randomized controlled trials that compared ARBs with placebo or other classes of antihypertensive drugs in improving FMD. A random-effect model was used to compute pooled estimates. Results: In 13 trials (n = 529), ARBs were more efficacious in improving brachial FMD than placebo [pooled weighted mean change difference (WMD) 1.34%, 95% CI, 0.93-1.75%, p < 0.001]. In 15 trials (n = 918), treatment with ARBs had a significant effect on brachial FMD when compared with other antihypertensive drugs (pooled WMD 0.59%, 95% CI, 0.20-0.98%, p = 0.003 with significant heterogeneity). ARBs were also more efficacious in improving brachial FMD than calcium channel blockers (CCBs; pooled WMD 1.61%, 95% CI, 0.72-2.49%, p < 0.001) but not the other classes of drugs (p ≥ 0.072). Conclusions: This meta-analysis shows that ARBs improve brachial FMD, a marker of endothelial function, and that they are superior to placebo and CCBs. There was no significant difference in the effect on brachial FMD between ARBs and the other antihypertensive drugs.
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15
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Sandoo A, Kitas GD, Carmichael AR. Breast cancer therapy and cardiovascular risk: focus on trastuzumab. Vasc Health Risk Manag 2015; 11:223-8. [PMID: 25897242 PMCID: PMC4397929 DOI: 10.2147/vhrm.s69641] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Breast cancer is the most common cancer in the UK. Advances in the methods of early diagnosis as well as newer and more effective treatments have led to improvements of disease-free and overall survival over the last decade. Almost one-third of breast cancers present with an aggressive form characterized by increased expression of human epidermal growth receptor 2 (HER2) proteins. A targeted treatment using monoclonal antibodies against HER2 expression such as trastuzumab has been shown to improve survival. Unfortunately, there is a degree of cardiotoxicity associated with these agents, as inhibition of HER2 pathways can also impair cardioprotective pathways. In the present review, we discuss the mechanisms by which trastuzumab might affect vascular homeostasis leading to endothelial dysfunction. We also provide suggestions for future research examining the effects of trastuzumab on the vasculature in breast cancer.
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Affiliation(s)
- Aamer Sandoo
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Wales, UK ; Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, UK
| | - George D Kitas
- Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, UK
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16
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Extension of Murray's law including nonlinear mechanics of a composite artery wall. Biomech Model Mechanobiol 2014; 14:83-91. [PMID: 24817182 PMCID: PMC4282710 DOI: 10.1007/s10237-014-0590-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/24/2014] [Indexed: 11/23/2022]
Abstract
A goal function approach is used to derive an extension of Murray’s law that includes effects of nonlinear mechanics of the artery wall. The artery is modeled as a thin-walled tube composed of different species of nonlinear elastic materials that deform together. These materials grow and remodel in a process that is governed by a target state defined by a homeostatic radius and a homeostatic material composition. Following Murray’s original idea, this target state is defined by a principle of minimum work. We take this work to include that of pumping and maintaining blood, as well as maintaining the materials of the artery wall. The minimization is performed under a constraint imposed by mechanical equilibrium. We derive a condition for the existence of a cost-optimal homeostatic state. We also conduct parametric studies using this novel theoretical frame to investigate how the cost-optimal radius and composition of the artery wall depend on flow rate, blood pressure, and elastin content
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17
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Nozaki T, Sugiyama S, Sugamura K, Ohba K, Matsuzawa Y, Konishi M, Matsubara J, Akiyama E, Sumida H, Matsui K, Jinnouchi H, Ogawa H. Prognostic value of endothelial microparticles in patients with heart failure. Eur J Heart Fail 2014; 12:1223-8. [DOI: 10.1093/eurjhf/hfq145] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Toshimitsu Nozaki
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Koichi Sugamura
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Keisuke Ohba
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Masaaki Konishi
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Junichi Matsubara
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Eiichi Akiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Hitoshi Sumida
- Interventional Cardiology, Faculty of Life Sciences; Kumamoto University; Kumamoto City Japan
| | - Kunihiko Matsui
- Department of General Medicine; Yamaguchi University Hospital; Yamaguchi Japan
| | | | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
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18
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Sarı C, Bayram NA, Doğan FEA, Baştuğ S, Bolat AD, Sarı SÖ, Ersoy O, Bozkurt M.D. E. The Evaluation of Endothelial Functions in Patients with Celiac Disease. Echocardiography 2011; 29:471-7. [DOI: 10.1111/j.1540-8175.2011.01598.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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19
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Arias-Loza PA, Hu K, Frantz S, Dienesch C, Bayer B, Wu R, Ertl G, Pelzer T. Medroxyprogesterone acetate aggravates oxidative stress and left ventricular dysfunction in rats with chronic myocardial infarction. Toxicol Pathol 2011; 39:867-78. [PMID: 21670166 DOI: 10.1177/0192623311410441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The role of estrogens during myocardial ischemia has been extensively studied. However, effects of a standard hormone replacement therapy including 17β-estradiol (E2) combined with medroxyprogesterone acetate (MPA) have not been assessed, and this combination could have contributed to the negative outcomes of the clinical studies on hormone replacement. We hypothesized that adding MPA to an E2 treatment would aggravate chronic heart failure after experimental myocardial infarction (MI). To address this issue, we evaluated clinical signs of heart failure as well as left ventricular (LV) dysfunction and remodeling in ovariectomized rats subjected to chronic MI receiving E2 or E2 plus MPA. After eight weeks MI E2 showed no effects. Adding MPA to E2 aggravated LV remodeling and dysfunction as judged by increased heart weight, elevated myocyte cross-sectional areas, increased elevated left ventricle end diastolic pressure, and decreased LV fractional shortening. Impaired LV function in rats receiving MPA plus E2 was associated with increased cardiac reactive oxygen species generation and myocardial expression levels of NADPH oxidase subunits. These results support the interpretation that adding MPA to an E2 treatment complicates cardiovascular injury damage post-MI and therefore contributes to explain the adverse outcome of prospective clinical studies.
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20
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Lewis GD, Murphy RM, Shah RV, Pappagianopoulos PP, Malhotra R, Bloch KD, Systrom DM, Semigran MJ. Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes. Circ Heart Fail 2011; 4:276-85. [PMID: 21292991 DOI: 10.1161/circheartfailure.110.959437] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized. METHODS AND RESULTS Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P<0.0001 for all). A linear increment in PAP relative to work (0.28±0.12 mm Hg/W) was observed in 65% of LVSD patients, which exceeded that observed in controls (0.07±0.02 mm Hg/W, P<0.0001). Exercise capacity and survival was worse in patients with a PAP/watt slope above the median than in patients with a lower slope. In the remaining 35% of LVSD patients, exercise induced a steep initial increment in PAP (0.41±0.16 mm Hg/W) followed by a plateau. The plateau pattern, compared with a linear pattern, was associated with reduced peak Vo(2) (10.6±2.6 versus 13.1±4.0 mL · kg(-1) · min(-1), P=0.005), lower right ventricular stroke work index augmentation with exercise (5.7±3.8 versus 9.7±5.0 g/m(2), P=0.002), and increased mortality (hazard ratio 8.1, 95% CI 2.7 to 23.8, P<0.001). CONCLUSIONS A steep increment in PAP during exercise and failure to augment PAP throughout exercise are associated with decreased exercise capacity and survival in patients with LVSD, and may therefore represent therapeutic targets. CLINICAL TRIAL INFORMATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.
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Affiliation(s)
- Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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21
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Miller JD, Peotta VA, Chu Y, Weiss RM, Zimmerman K, Brooks RM, Heistad DD. MnSOD protects against COX1-mediated endothelial dysfunction in chronic heart failure. Am J Physiol Heart Circ Physiol 2010; 298:H1600-7. [PMID: 20304815 DOI: 10.1152/ajpheart.01108.2009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Endothelial function is impaired by oxidative stress in chronic heart failure (HF). Mechanisms that protect against increases in oxidative stress in HF are not clear. The goal of this study was to determine whether manganese superoxide dismutase (MnSOD) plays a key role in protecting against endothelial dysfunction in HF. Endothelial function and gene expression were examined in aorta from wild-type mice (MnSOD(+/+)) and mice deficient in MnSOD (MnSOD(+/-)) 12 wk after ligation of the left coronary artery (LCA). LCA ligation produced similar size myocardial infarctions in MnSOD(+/+) and MnSOD(+/-) mice and reduced ejection fraction to approximately 20% in both groups. Maximal relaxation in response to acetylcholine was 78 +/- 3% (mean +/- SE) and 66 +/- 8% in sham-operated MnSOD(+/+) and MnSOD(+/-) mice, respectively. Expression of antioxidant enzymes increased in MnSOD(+/+) mice with HF, and maximal relaxation to acetylcholine was slightly impaired (68 +/- 4%). Greater endothelial dysfunction was observed in MnSOD(+/-) mice with HF (46 +/- 5%, P < 0.05), which was significantly improved by polyethylene glycol-catalase but not Tempol. Incubation with the nonspecific cyclooxygenase (COX) inhibitor indomethacin or the COX1 inhibitor valeryl salicylate, but not the COX-2 inhibitor NS-398, significantly improved relaxation to acetylcholine in HF mice (maximum relaxation = 74 +/- 5, 91 +/- 1, and 58 +/- 5%). These data suggest that MnSOD plays a key role in protecting against endothelial dysfunction in HF. A novel mechanism was identified whereby chronic increases in oxidative stress, produced by mitochondrial SOD deficiency, impair vascular function via a hydrogen peroxide-dependent, COX1-dependent, endothelium-derived contracting factor.
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Affiliation(s)
- Jordan D Miller
- Division of Cardiovascular Surgery and Department of Physiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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Vittorio TJ, Lanier G, Zolty R, Sarswat N, Tseng CH, Colombo PC, Jorde UP. Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy. Echocardiography 2010; 27:294-9. [PMID: 20070352 DOI: 10.1111/j.1540-8175.2009.01011.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Impairment of flow-mediated, endothelium-dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF. METHODS Thirty subjects with stable New York Heart Association (NYHA) functional class II-III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age-adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and beta-adrenoceptor blockers. RESULTS Brachial artery FMD averaged 1.3 +/- 2.4% and age-adjusted % MPHR 74.1 +/- 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55). CONCLUSIONS FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause-effect relationship underlies this association remains to be investigated.
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Affiliation(s)
- Timothy J Vittorio
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Vittorio TJ, Zolty R, Garg PK, Sarswat N, Tseng CH, Jorde UP, Colombo PC. Interdependence of Cardiac and Endothelial Function in Patients with Symptomatic Chronic Heart Failure of Nonischemic Etiology. Echocardiography 2009; 26:916-21. [DOI: 10.1111/j.1540-8175.2009.00907.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Geft D, Schwartzenberg S, Rogowsky O, Finkelstein A, Ablin J, Maysel-Auslender S, Wexler D, Keren G, George J. Circulating apoptotic progenitor cells in patients with congestive heart failure. PLoS One 2008; 3:e3238. [PMID: 18800166 PMCID: PMC2528948 DOI: 10.1371/journal.pone.0003238] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 08/04/2008] [Indexed: 11/18/2022] Open
Abstract
Background Circulating CD34+ endothelial progenitor cells (EPCs) are capable of differentiating into mature endothelial cells to assist in angiogenesis and vasculogenesis. We sought to quantify the numbers of apoptotic progenitors in patients with congestive heart failure. Methods and Results Peripheral blood mononuclear cells were isolated by Ficoll density-gradient from 58 patients with various degrees of heart failure and 23 matched controls. Apoptosis in progenitor CD34+ cells was assessed using the Annexin V-PE/PI detection kit, and FACS analysis was performed with triple staining for CD34, annexin-V and propidium iodide. The percentage of early and late apoptotic progenitor cells was determined in the subject groups and was correlated with clinical characteristics. While there was no significant difference in total CD34 positive cells or early apoptotic progenitors between control subjects and CHF patients (p = 0.42) or between severe and mild/moderate CHF groups (p = 0.544), there was an elevated number of late apoptotic progenitors in the severe CHF group compared with the mild/moderate CHF group (p = 0.03). Late apoptotic progenitors were significantly increased in CHF patients as compared to matched controls. There was also an inverse correlation between late apoptotic progenitors and ejection fraction (r = −0.252, p = 0.028) as well as a positive association with NYHA class (r = 0.223, p = 0.046). Conclusion Severe heart failure patients exhibited higher numbers of late apoptotic progenitors, and this was positively associated with NYHA class and negatively correlated with ejection fraction. This finding may shed light on the numerous factors governing the pathophysiology of CHF.
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Affiliation(s)
- Dael Geft
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Ori Rogowsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacob Ablin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Dov Wexler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacob George
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- * E-mail:
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25
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Bellien J, Iacob M, Eltchaninoff H, Bourkaib R, Thuillez C, Joannides R. AT1 receptor blockade prevents the decrease in conduit artery flow-mediated dilatation during NOS inhibition in humans. Clin Sci (Lond) 2007; 112:393-401. [PMID: 17125466 DOI: 10.1042/cs20060236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whether AT(1) (angiotenin II type 1) receptor blockade can prevent the decrease in conduit artery FMD (flow-mediated dilatation) during NOS (nitric oxide synthase) inhibition by alternative endothelial pathways has not been explored previously in humans. In 12 healthy subjects, we measured radial artery diameter (echotracking) and flow (Doppler) during FMD induced by sustained reactive hyperaemia during a control period and following NOS inhibition [1.5 mg.min(-1).l(-1) L-NMMA (N(G)-monomethyl-L-arginine)], after a single oral administration of telmisartan (80 mg) or placebo, using a randomized double-blind cross-over design. In six volunteers, we also assessed the roles of prostacyclin and EDHF (endothelium-derived hyperpolarizing factor) during radial FMD after AT(1) receptor blockade by oral administration of aspirin (500 mg) alone, aspirin+L-NMMA or aspirin+L-NMMA+fluconazole (a cytochrome epoxygenases inhibitor; 0.37 mg.min(-1).l(-1)). Telmisartan did not affect radial artery FMD in the control period (10.9+/-0.6% with placebo compared with 9.9+/-0.7% with telmisartan), but prevented its decrease after L-NMMA (9.3+/-0.8% with placebo compared with 12.6+/-1.2% with telmisartan; P<0.05) with no modification in baseline parameters, hyperaemia and radial artery endothelium-independent dilatation to sodium nitroprusside. Moreover, in telmisartan-treated subjects, radial artery FMD, compared with control (9.0+/-1.0%), was not modified by aspirin alone (9.4+/-0.7%) or associated with L-NMMA (9.5+/-0.5%), but was reduced by the combination of aspirin, L-NMMA and fluconazole (7.5+/-0.6%; P<0.05). These results demonstrate that AT(1) receptor blockade prevents the decrease in conduit artery FMD during NOS inhibition in humans, suggesting the development of a compensatory endothelial mechanism. This mechanism appears to be independent of prostacyclin and could possibly be related to an EDHF release.
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Affiliation(s)
- Jeremy Bellien
- Department of Pharmacology, Institut National de la Santé et de la Recherche Medicale (INSERM) U644, Institut Federatif de Recherche Multidisciplinaire sur les Peptides 23, Rouen University Hospital, Rouen Cedex, France
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26
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van de Wal RMA, Asselbergs FW, Plokker HWT, Smilde TDJ, Lok D, van Veldhuisen DJ, van Gilst WH, Voors AA. High prevalence of microalbuminuria in chronic heart failure patients. J Card Fail 2006; 11:602-6. [PMID: 16230263 DOI: 10.1016/j.cardfail.2005.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 05/11/2005] [Accepted: 05/17/2005] [Indexed: 02/01/2023]
Abstract
BACKGROUND Microalbuminuria is associated with increased risk for cardiovascular morbidity and mortality. However, the relation between microalbuminuria and chronic heart failure has not been well described yet. In this cross-sectional study, we aim to evaluate the prevalence of microalbuminuria and the association with neurohormonal parameters in severe chronic heart failure patients. METHODS AND RESULTS We studied 94 stable chronic heart failure patients (New York Heart Association class III/IV) receiving therapy with angiotensin-converting enzyme (ACE) inhibitors for over three months. In all patients, renal function and neurohormonal status were evaluated and correlated with urinary albumin/creatinine ratio. The studied population consisted of 70 men and 21 women (mean age 69 +/- 12 years). Ischemia was the underlying cause of heart failure in 61 patients. Overall, 100% of the patients were treated with an ACE inhibitor, 72% with a beta-blocker, and 47% with spironolactone. In 32% (95% confidence interval 22-42) of the patients, microalbuminuria was present, which is significantly higher than in the general population. However, we found no significant association between the presence of microalbuminuria and renal function. Plasma NT-proBNP, active renin protein, angiotensin I, angiotensin II, and aldosterone did not differ significantly between groups with and without microalbuminuria. CONCLUSION In 32% of the patients, microalbuminuria was present. No association was found with either renal or neurohormonal parameters.
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Affiliation(s)
- Ruud M A van de Wal
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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27
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Dean AS, Margulies KB, Nicholas JJ, Rubin S, Gaughan JP, Libonati JR. Impaired Vasoreactivity in End-Stage Heart Failure Patients on Intravenous Inotropic Support. J Card Fail 2005; 11:351-7. [PMID: 15948085 DOI: 10.1016/j.cardfail.2004.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vasoreactivity is known to be impaired in heart failure patients; however, it has not been determined whether standard medical therapy for end-stage heart failure patients (ES-HF) ameliorates this impairment. Therefore, we sought to investigate flow-mediated dilation (FMD) responses in ES-HF with normal or near normal cardiac indices from continuous inotropic support. METHODS AND RESULTS Vascular ultrasound was used to assess FMD responses to isometric exercise and cuff occlusion in 15 ES-HF patients and 5 control subjects (C). ES-HF patients had significant hyperemic response to maximal exercise (P < .05), which was blunted relative to C (ES-HF; 84 +/- 21 mL/min versus C; 299 +/- 85 mL/min, P < .05). ES-HF patients did not show a significant hyperemic response to submaximal exercise. C had a significant increase in arterial diameter that exceeded ES-HF after both maximal (C; 8 +/- 1% versus. ES-HF; -0.9 +/- 0.86%, P < .05) and submaximal exercise (C; 6 +/- 1% versus ES-HF; 0.57 +/- 1%, P < .05). FMD responses at similar absolute workloads showed that both the mean hyperemic response and the change in arterial diameter were significantly greater in C. After cuff occlusion, the mean hyperemic response for ES-HF was again significantly blunted compared with C (ES-HF; 117 +/- 26% versus C; 352 +/- 86%, P < .05). After cuff occlusion, arterial diameter in C significantly increased in response to hyperemia, whereas ES-HF patients had a paradoxical vasoconstrictive response (C; 10.7 +/- 1.1% versus ES-HF; -5.3 +/- 1.5%, P < .05). CONCLUSION Peripheral vasoreactivity in response to either maximal exercise, submaximal exercise, or hyperemic stimuli is impaired in ES-HF patients with normal resting cardiac outputs.
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Affiliation(s)
- Abigail S Dean
- Cardiovascular Research Center, Temple University, Philadelphia, Pennsylvania, USA
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28
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Brunner H, Cockcroft JR, Deanfield J, Donald A, Ferrannini E, Halcox J, Kiowski W, Lüscher TF, Mancia G, Natali A, Oliver JJ, Pessina AC, Rizzoni D, Rossi GP, Salvetti A, Spieker LE, Taddei S, Webb DJ. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension*. J Hypertens 2005; 23:233-46. [PMID: 15662207 DOI: 10.1097/00004872-200502000-00001] [Citation(s) in RCA: 524] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dysfunction of the vascular endothelium is a hallmark of most conditions that are associated with atherosclerosis and is therefore held to be an early feature in atherogenesis. However, the mechanisms by which endothelial dysfunction occurs in smoking, dyslipidaemia, hyperhomocysteinaemia, diabetes mellitus, arterial hypertension, cerebrovascular diseases, coronary artery disease and heart failure are complex and heterogeneous. Recent data indicate that endothelial dysfunction is often associated with erectile dysfunction, which can precede and predict cardiovascular disease in men. This paper will provide a concise overview of the mechanisms causing endothelial dysfunction in the different cardiovascular risk factors and disease conditions, and of the impact of the intervention measures and treatments.
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29
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Jorde UP, Vittorio TJ, Dimayuga CA, Homma S, Rizkala A, Le Jemtel TH, Katz SD. Comparison of suppression of the circulating and vascular renin-angiotensin system by enalapril versus trandolapril in chronic heart failure. Am J Cardiol 2004; 94:1501-5. [PMID: 15589004 DOI: 10.1016/j.amjcard.2004.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2004] [Accepted: 08/02/2004] [Indexed: 11/26/2022]
Abstract
Experimental studies suggest that angiotensin-converting enzyme (ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity despite similar suppression of the circulating renin-angiotensin system. To test this hypothesis in a clinical setting, we randomized subjects with chronic heart failure to receive the low tissue affinity ACE inhibitor enalapril or the high tissue affinity ACE inhibitor trandolapril, and assessed the degree of circulating and vascular renin-angiotensin system suppression. Vascular renin-angiotensin system suppression was determined by measuring the pressor response to intravenous injections of angiotensin I. Circulating renin-angiotensin system suppression was determined by measuring plasma angiotensin II. Vascular and circulating renin-angiotensin system suppression, endothelial function (flow-mediated vasodilation), and maximal exercise capacity (peak oxygen uptake) were assessed after a 4-week run-in period on open-label enalapril 40 mg/day and after 8 weeks of randomized double-blind treatment with enalapril 40 mg/day or trandolapril 4 mg/day. Twenty-six men and 4 women (mean age 52 +/- 11 years; mean left ventricular ejection fraction 25 +/- 9%; New York Heart Association class II [n = 16] and III [n = 14]) were studied. After a 2-month randomized treatment period, vascular renin-angiotensin system suppression, circulating renin-angiotensin system suppression, endothelial function, and exercise capacity did not differ between subjects treated with enalapril and those treated with trandolapril. Despite substantial differences in the tissue affinity of enalapril and trandolapril, the degree of vascular renin-angiotensin system suppression achieved with these agents did not differ in subjects with chronic heart failure during long-term therapy.
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Affiliation(s)
- Ulrich P Jorde
- Division of Cardiology, New York University School of Medicine, New York, New York, USA.
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30
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Chong AY, Blann AD, Lip GYH. Assessment of endothelial damage and dysfunction: observations in relation to heart failure. QJM 2003; 96:253-67. [PMID: 12651970 DOI: 10.1093/qjmed/hcg037] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- A-Y Chong
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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Pedersen HD, Schütt T, Søndergaard R, Qvortrup K, Olsen LH, Kristensen AT. Decreased plasma concentration of nitric oxide metabolites in dogs with untreated mitral regurgitation. J Vet Intern Med 2003; 17:178-84. [PMID: 12683618 DOI: 10.1111/j.1939-1676.2003.tb02431.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Endothelium-dependent (nitric oxide [NO]-mediated) vasodilation is impaired in humans with heart failure. This dysfunction is an important therapeutic target. The plasma concentration of the NO metabolites nitrate and nitrite (collectively referred to as NOx) is a measure of whole-body NO production, provided that the dietary intake of the ions is low. Fifty clinically healthy dogs older than I year (median 5.0 years; interquartile interval 2.6-8.2 years) were studied, including 9 controls of various breeds, 23 Cavalier King Charles Spaniels (CKCSs) with no or minimal mitral regurgitation (MR), 9 CKCSs with mild MR (regurgitant jet occupying 15-50% of the left atrial area), and 9 CKCS with moderate to severe MR (jet >50%) due to myxomatous valve disease. None of the dogs received medication. The dogs were given NOx-free water and a diet with a low concentration of NOx for 96 hours before blood sampling. Multiple linear regression analysis revealed that dog group, but not gender, age, serum creatinine concentration, and platelet count, was associated with NOx concentrations. Control dogs had the same NOx concentration (median 20.0 microM; interquartile interval 15.1-25.5 microM) as CKCSs without MR (median 18.7 microM; interquartile interval 15.5-25.9 microM). Compared to CKCSs without MR, the NOx concentration was lower in CKCSs with mild (median 12.9 microM; interquartile interval 11.0-13.5 microM; P = .04) and moderate to severe (median 11.2 microM; interquartile interval 6.9-17.1 microM; P = .02) MR. In conclusion, CKCSs with mild to severe, clinically silent MR have decreased plasma NOx concentrations, suggesting that endothelial dysfunction develops early in the course of developing MR in dogs.
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Affiliation(s)
- Henrik D Pedersen
- Department of Anatomy and Physiology, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.
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