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Capone F, Nambiar N, Schiattarella GG. Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF. Curr Opin Cardiol 2024; 39:148-153. [PMID: 38294187 DOI: 10.1097/hco.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Incretin-based drugs are potent weight-lowering agents, emerging as potential breakthrough therapy for the treatment of obesity-related phenotype of heart failure with preserved ejection fraction (HFpEF). In this review article, we will discuss the contribution of weight loss as part of the benefits of incretin-based medications in obese patients with HFpEF. Furthermore, we will describe the potential effects of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists on the heart, particularly in relation to HFpEF pathophysiology. RECENT FINDINGS In the STEP-HFpEF trial, the GLP-1 receptor agonist semaglutide significantly improved quality of life outcomes in obese HFpEF patients. Whether the beneficial effects of semaglutide in obese patients with HFpEF are merely a consequence of body weight reduction is unclear. Considering the availability of other weight loss strategies (e.g., caloric restriction, exercise training, bariatric surgery) to be used in obese HFpEF patients, answering this question is crucial to provide tailored therapeutic options in these subjects. SUMMARY Incretin-based drugs may represent a milestone in the treatment of obesity in HFpEF. Elucidating the contribution of weight loss in the overall benefit observed with these drugs is critical in the management of obese HFpEF patients, considering that other weight-lowering strategies are available and might represent potential alternative options for these patients.
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Affiliation(s)
- Federico Capone
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Division of Internal Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Natasha Nambiar
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Gabriele G Schiattarella
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité -Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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2
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Lygate CA. Maintaining energy provision in the heart: the creatine kinase system in ischaemia-reperfusion injury and chronic heart failure. Clin Sci (Lond) 2024; 138:491-514. [PMID: 38639724 DOI: 10.1042/cs20230616] [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: 12/18/2023] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
The non-stop provision of chemical energy is of critical importance to normal cardiac function, requiring the rapid turnover of ATP to power both relaxation and contraction. Central to this is the creatine kinase (CK) phosphagen system, which buffers local ATP levels to optimise the energy available from ATP hydrolysis, to stimulate energy production via the mitochondria and to smooth out mismatches between energy supply and demand. In this review, we discuss the changes that occur in high-energy phosphate metabolism (i.e., in ATP and phosphocreatine) during ischaemia and reperfusion, which represents an acute crisis of energy provision. Evidence is presented from preclinical models that augmentation of the CK system can reduce ischaemia-reperfusion injury and improve functional recovery. Energetic impairment is also a hallmark of chronic heart failure, in particular, down-regulation of the CK system and loss of adenine nucleotides, which may contribute to pathophysiology by limiting ATP supply. Herein, we discuss the evidence for this hypothesis based on preclinical studies and in patients using magnetic resonance spectroscopy. We conclude that the correlative evidence linking impaired energetics to cardiac dysfunction is compelling; however, causal evidence from loss-of-function models remains equivocal. Nevertheless, proof-of-principle studies suggest that augmentation of CK activity is a therapeutic target to improve cardiac function and remodelling in the failing heart. Further work is necessary to translate these findings to the clinic, in particular, a better understanding of the mechanisms by which the CK system is regulated in disease.
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Affiliation(s)
- Craig A Lygate
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
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3
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Bolz C, Blaszczyk E, Mayr T, Lim C, Haufe S, Jordan J, Barckow P, Gröschel J, Schulz-Menger J. Adiposity influences on myocardial deformation: a cardiovascular magnetic resonance feature tracking study in people with overweight to obesity without established cardiovascular disease. Int J Cardiovasc Imaging 2024; 40:643-654. [PMID: 38308113 PMCID: PMC10951011 DOI: 10.1007/s10554-023-03034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024]
Abstract
The objective of this study was to assess whether dietary-induced weight loss improves myocardial deformation in people with overweight to obesity without established cardiovascular disease applying cardiovascular magnetic resonance (CMR) with feature tracking (FT) based strain analysis. Ninety people with overweight to obesity without established cardiovascular disease (age 44.6 ± 9.3 years, body mass index (BMI) 32.6 ± 4 kg/m2) underwent CMR. We retrospectively quantified FT based strain and LA size and function at baseline and after a 6-month hypocaloric diet, with either low-carbohydrate or low-fat intake. The study cohort was compared to thirty-four healthy normal-weight controls (age 40.8 ± 16.0 years, BMI 22.5 ± 1.4 kg/m2). At baseline, the study cohort with overweight to obesity without established cardiovascular disease displayed significantly increased global circumferential strain (GCS), global radial strain (GRS) and LA size (all p < 0.0001 versus controls) but normal global longitudinal strain (GLS) and normal LA ejection fraction (all p > 0.05 versus controls). Dietary-induced weight loss led to a significant reduction in GCS, GRS and LA size irrespective of macronutrient composition (all p < 0.01). In a population with overweight to obesity without established cardiovascular disease subclinical myocardial changes can be detected applying CMR. After dietary-induced weight loss improvement of myocardial deformation could be shown. A potential clinical impact needs further studies.
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Affiliation(s)
- Constantin Bolz
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Edyta Blaszczyk
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Thomas Mayr
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Carolin Lim
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Sven Haufe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Philipp Barckow
- Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada
| | - Jan Gröschel
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
- Helios Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany.
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4
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Henry JA, Couch LS, Rider OJ. Myocardial Metabolism in Heart Failure with Preserved Ejection Fraction. J Clin Med 2024; 13:1195. [PMID: 38592048 PMCID: PMC10931709 DOI: 10.3390/jcm13051195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent and now accounts for half of all heart failure cases. This rise is largely attributed to growing rates of obesity, hypertension, and diabetes. Despite its prevalence, the pathophysiological mechanisms of HFpEF are not fully understood. The heart, being the most energy-demanding organ, appears to have a compromised bioenergetic capacity in heart failure, affecting all phenotypes and aetiologies. While metabolic disturbances in heart failure with reduced ejection fraction (HFrEF) have been extensively studied, similar insights into HFpEF are limited. This review collates evidence from both animal and human studies, highlighting metabolic dysregulations associated with HFpEF and its risk factors, such as obesity, hypertension, and diabetes. We discuss how changes in substrate utilisation, oxidative phosphorylation, and energy transport contribute to HFpEF. By delving into these pathological shifts in myocardial energy production, we aim to reveal novel therapeutic opportunities. Potential strategies include modulating energy substrates, improving metabolic efficiency, and enhancing critical metabolic pathways. Understanding these aspects could be key to developing more effective treatments for HFpEF.
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Affiliation(s)
- John Aaron Henry
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
- Department of Cardiology, Jersey General Hospital, Gloucester Street, St. Helier JE1 3QS, Jersey, UK
| | - Liam S. Couch
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
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Oneglia AP, Szczepaniak LS, Zaha VG, Nelson MD. Myocardial steatosis across the spectrum of human health and disease. Exp Physiol 2024; 109:202-213. [PMID: 38063136 PMCID: PMC10841709 DOI: 10.1113/ep091566] [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: 10/10/2023] [Accepted: 11/15/2023] [Indexed: 02/02/2024]
Abstract
Preclinical data strongly suggest that myocardial steatosis leads to adverse cardiac remodelling and left ventricular dysfunction. Using 1 H cardiac magnetic resonance spectroscopy, similar observations have been made across the spectrum of health and disease. The purpose of this brief review is to summarize these recent observations. We provide a brief overview of the determinants of myocardial triglyceride accumulation, summarize the current evidence that myocardial steatosis contributes to cardiac dysfunction, and identify opportunities for further research.
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Affiliation(s)
- Andrew P. Oneglia
- Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, College of Nursing and Health InnovationUniversity of Texas at ArlingtonArlingtonTexasUSA
| | | | - Vlad G. Zaha
- Division of Cardiology, Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Advanced Imaging Research CenterUniversity of Texas Southwestern Medical CenterArlingtonTexasUSA
| | - Michael D. Nelson
- Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, College of Nursing and Health InnovationUniversity of Texas at ArlingtonArlingtonTexasUSA
- Clinical Imaging Research CenterUniversity of Texas at ArlingtonArlingtonTexasUSA
- Center for Healthy Living and LongevityUniversity of Texas at ArlingtonArlingtonTexasUSA
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6
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Ritterhoff J, Tian R. Metabolic mechanisms in physiological and pathological cardiac hypertrophy: new paradigms and challenges. Nat Rev Cardiol 2023; 20:812-829. [PMID: 37237146 DOI: 10.1038/s41569-023-00887-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Cardiac metabolism is vital for heart function. Given that cardiac contraction requires a continuous supply of ATP in large quantities, the role of fuel metabolism in the heart has been mostly considered from the perspective of energy production. However, the consequence of metabolic remodelling in the failing heart is not limited to a compromised energy supply. The rewired metabolic network generates metabolites that can directly regulate signalling cascades, protein function, gene transcription and epigenetic modifications, thereby affecting the overall stress response of the heart. In addition, metabolic changes in both cardiomyocytes and non-cardiomyocytes contribute to the development of cardiac pathologies. In this Review, we first summarize how energy metabolism is altered in cardiac hypertrophy and heart failure of different aetiologies, followed by a discussion of emerging concepts in cardiac metabolic remodelling, that is, the non-energy-generating function of metabolism. We highlight challenges and open questions in these areas and finish with a brief perspective on how mechanistic research can be translated into therapies for heart failure.
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Affiliation(s)
- Julia Ritterhoff
- Molecular and Translational Cardiology, Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany.
- Mitochondria and Metabolism Center, Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Rong Tian
- Mitochondria and Metabolism Center, Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
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7
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Kasa G, Bayes-Genis A, Delgado V. Latest Updates in Heart Failure Imaging. Heart Fail Clin 2023; 19:407-418. [PMID: 37714583 DOI: 10.1016/j.hfc.2023.03.007] [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] [Indexed: 09/17/2023]
Abstract
Heart failure (HF), a challenging and heterogeneous syndrome, still remains a major health problem worldwide, despite all the advances in prevention, diagnosis, and treatment of cardiovascular disease. Cardiac imaging plays a pivotal role in the classification of HF, accurate diagnosis of underlying etiology and decision-making. Integration of other imaging techniques such as cardiac magnetic resonance, nuclear imaging, and exercise imaging testing is important to characterize HF accurately. This article reviews the role of multimodality imaging to diagnose patients with HF.
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Affiliation(s)
- Gizem Kasa
- Cardiovascular Imaging Section, Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Antoni Bayes-Genis
- Cardiovascular Imaging Section, Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Victoria Delgado
- Cardiovascular Imaging Section, Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.
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8
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Kerstens TP, Weerts J, van Dijk APJ, Weijers G, Knackstedt C, Eijsvogels TMH, Oxborough D, van Empel VPM, Thijssen DHJ. Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:1168-1176. [PMID: 37259911 PMCID: PMC10445262 DOI: 10.1093/ehjci/jead117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
AIMS Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by impaired diastolic function. Left ventricular (LV) strain-volume loops (SVL) represent the relation between strain and volume during the cardiac cycle and provide insight into systolic and diastolic function characteristics. In this study, we examined the association of SVL parameters and adverse events in HFpEF. METHODS AND RESULTS In 235 patients diagnosed with HFpEF, LV-SVL were constructed based on echocardiography images. The endpoint was a composite of all-cause mortality and Heart Failure (HF)-related hospitalization, which was extracted from electronic medical records. Cox-regression analysis was used to assess the association of SVL parameters and the composite endpoint, while adjusting for age, sex, and NYHA class. HFpEF patients (72.3% female) were 75.8 ± 6.9 years old, had a BMI of 29.9 ± 5.4 kg/m2, and a left ventricular ejection fraction of 60.3 ± 7.0%. Across 2.9 years (1.8-4.1) of follow-up, 73 Patients (31%) experienced an event. Early diastolic slope was significantly associated with adverse events [second quartile vs. first quartile: adjusted hazards ratio (HR) 0.42 (95%CI 0.20-0.88)] after adjusting for age, sex, and NYHA class. The association between LV peak strain and adverse events disappeared upon correction for potential confounders [adjusted HR 1.02 (95% CI 0.96-1.08)]. CONCLUSION Early diastolic slope, representing the relationship between changes in LV volume and strain during early diastole, but not other SVL-parameters, was associated with adverse events in patients with HFpEF during 2.9 years of follow-up.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
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9
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Rajiah PS, Moore A, Broncano J, Anand V, Kolluri N, Shah DJ, Flamm SD, François CJ. Diastology with Cardiac MRI: A Practical Guide. Radiographics 2023; 43:e220144. [PMID: 37535462 DOI: 10.1148/rg.220144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Diastolic filling of the ventricle is a complex interplay of volume and pressure, contingent on active energy-dependent myocardial relaxation and myocardial stiffness. Abnormal diastolic function is the hallmark of the clinical entity of heart failure with preserved ejection fraction (HFpEF), which is now the dominant type of heart failure and is associated with significant morbidity and mortality. Although echocardiography is the current first-line imaging modality used in evaluation of diastolic function, cardiac MRI (CMR) is emerging as an important technique. The principal role of CMR is to categorize the cause of diastolic dysfunction (DD) and distinguish other entities that manifest similarly to HFpEF, particularly infiltrative and pericardial disorders. CMR also provides prognostic information and risk stratification based on late gadolinium enhancement and parametric mapping techniques. Advances in hardware, sequences, and postprocessing software now enable CMR to diagnose and grade DD accurately, a role traditionally assigned to echocardiography. Two-dimensional or four-dimensional velocity-encoded phase-contrast sequences can measure flow and velocities at the mitral inflow, mitral annulus, and pulmonary veins to provide diastolic functional metrics analogous to those at echocardiography. The commonly used cine steady-state free-precession sequence can provide clues to DD including left ventricular mass, left ventricular filling curves, and left atrial size and function. MR strain imaging provides information on myocardial mechanics that further aids in diagnosis and prognosis of diastolic function. Research sequences such as MR elastography and MR spectroscopy can help evaluate myocardial stiffness and metabolism, respectively, providing additional insights on diastolic function. The authors review the physiology of diastolic function, mechanics of diastolic heart failure, and CMR techniques in the evaluation of diastolic function. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Alastair Moore
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Jordi Broncano
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Vidhu Anand
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Nikhil Kolluri
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Dipan J Shah
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Scott D Flamm
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Christopher J François
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
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10
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Soghomonian A, Dutour A, Kachenoura N, Thuny F, Lasbleiz A, Ancel P, Cristofari R, Jouve E, Simeoni U, Kober F, Bernard M, Gaborit B. Is increased myocardial triglyceride content associated with early changes in left ventricular function? A 1H-MRS and MRI strain study. Front Endocrinol (Lausanne) 2023; 14:1181452. [PMID: 37424866 PMCID: PMC10323751 DOI: 10.3389/fendo.2023.1181452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Type 2 diabetes (T2D) and obesity induce left ventricular (LV) dysfunction. The underlying pathophysiological mechanisms remain unclear, but myocardial triglyceride content (MTGC) could be involved. Objectives This study aimed to determine which clinical and biological factors are associated with increased MTGC and to establish whether MTGC is associated with early changes in LV function. Methods A retrospective study was conducted using five previous prospective cohorts, leading to 338 subjects studied, including 208 well-phenotyped healthy volunteers and 130 subjects living with T2D and/or obesity. All the subjects underwent proton magnetic resonance spectroscopy and feature tracking cardiac magnetic resonance imaging to measure myocardial strain. Results MTGC content increased with age, body mass index (BMI), waist circumference, T2D, obesity, hypertension, and dyslipidemia, but the only independent correlate found in multivariate analysis was BMI (p=0.01; R²=0.20). MTGC was correlated to LV diastolic dysfunction, notably with the global peak early diastolic circumferential strain rate (r=-0.17, p=0.003), the global peak late diastolic circumferential strain rate (r=0.40, p<0.0001) and global peak late diastolic longitudinal strain rate (r=0.24, p<0.0001). MTGC was also correlated to systolic dysfunction via end-systolic volume index (r=-0.34, p<0.0001) and stroke volume index (r=-0.31, p<0.0001), but not with longitudinal strain (r=0.009, p=0.88). Interestingly, the associations between MTGC and strain measures did not persist in multivariate analysis. Furthermore, MTGC was independently associated with LV end-systolic volume index (p=0.01, R²=0.29), LV end-diastolic volume index (p=0.04, R²=0.46), and LV mass (p=0.002, R²=0.58). Conclusions Predicting MTGC remains a challenge in routine clinical practice, as only BMI independently correlates with increased MTGC. MTGC may play a role in LV dysfunction but does not appear to be involved in the development of subclinical strain abnormalities.
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Affiliation(s)
- Astrid Soghomonian
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Anne Dutour
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Nadjia Kachenoura
- Sorbonne Université, INSERM, CNRS, Laboratoire d’Imagerie Biomédicale, Paris, France
| | - Franck Thuny
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Adele Lasbleiz
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Patricia Ancel
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
| | | | - Elisabeth Jouve
- UPCET, Clinical Pharmacology, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Umberto Simeoni
- Division of Pediatrics & DOHaD Laboratory, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frank Kober
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | | | - Bénédicte Gaborit
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
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11
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Kerstens TP, Weerts J, van Dijk APJ, Weijers G, Knackstedt C, Eijsvogels TMH, Oxborough D, van Empel VPM, Thijssen DHJ. Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection fraction. Int J Cardiol 2023; 378:144-150. [PMID: 36796492 DOI: 10.1016/j.ijcard.2023.01.084] [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: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Presence of left ventricular diastolic dysfunction (DD) is key in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). However, non-invasive assessment of diastolic function is complex, cumbersome, and largely based on consensus recommendations. Novel imaging techniques may help detecting DD. Therefore, we compared left ventricular strain-volume loop (SVL) characteristics and diastolic (dys-)function in suspected HFpEF patients. METHOD AND RESULTS 257 suspected HFpEF patients with sinus rhythm during echocardiography were prospectively included. 211 patients with quality-controlled images and strain and volume analysis were classified according to the 2016 ASE/EACVI recommendations. Patients with indeterminate diastolic function were excluded, resulting in two groups: normal diastolic function (control; n = 65) and DD (n = 91). Patients with DD were older (74.8 ± 6.9 vs. 68.5 ± 9.4 years, p < 0.001), more often female (88% vs 72%, p = 0.021), and more often had a history of atrial fibrillation (42% vs. 23%, p = 0.024) and hypertension (91% vs. 71%, p = 0.001) compared to normal diastolic function. SVL analysis showed a larger uncoupling i.e., a different longitudinal strain contribution to volume change, in DD compared to controls (0.556 ± 1.10% vs. -0.051 ± 1.14%, respectively, P < 0.001). This observation suggests different deformational properties during the cardiac cycle. After adjustment for age, sex, history of atrial fibrillation and hypertension, we found an adjusted odds ratio of 1.68 (95% confidence interval 1.19-2.47) for DD per unit increase in uncoupling (range: -2.95-3.20). CONCLUSION Uncoupling of the SVL is independently associated with DD. This might provide novel insights in cardiac mechanics and new opportunities to assess diastolic function non-invasively.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - C Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom.
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12
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Hahn VS, Petucci C, Kim MS, Bedi KC, Wang H, Mishra S, Koleini N, Yoo EJ, Margulies KB, Arany Z, Kelly DP, Kass DA, Sharma K. Myocardial Metabolomics of Human Heart Failure With Preserved Ejection Fraction. Circulation 2023; 147:1147-1161. [PMID: 36856044 PMCID: PMC11059242 DOI: 10.1161/circulationaha.122.061846] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The human heart primarily metabolizes fatty acids, and this decreases as alternative fuel use rises in heart failure with reduced ejection fraction (HFrEF). Patients with severe obesity and diabetes are thought to have increased myocardial fatty acid metabolism, but whether this is found in those who also have heart failure with preserved ejection fraction (HFpEF) is unknown. METHODS Plasma and endomyocardial biopsies were obtained from HFpEF (n=38), HFrEF (n=30), and nonfailing donor controls (n=20). Quantitative targeted metabolomics measured organic acids, amino acids, and acylcarnitines in myocardium (72 metabolites) and plasma (69 metabolites). The results were integrated with reported RNA sequencing data. Metabolomics were analyzed using agnostic clustering tools, Kruskal-Wallis test with Dunn test, and machine learning. RESULTS Agnostic clustering of myocardial but not plasma metabolites separated disease groups. Despite more obesity and diabetes in HFpEF versus HFrEF (body mass index, 39.8 kg/m2 versus 26.1 kg/m2; diabetes, 70% versus 30%; both P<0.0001), medium- and long-chain acylcarnitines (mostly metabolites of fatty acid oxidation) were markedly lower in myocardium from both heart failure groups versus control. In contrast, plasma levels were no different or higher than control. Gene expression linked to fatty acid metabolism was generally lower in HFpEF versus control. Myocardial pyruvate was higher in HFpEF whereas the tricarboxylic acid cycle intermediates succinate and fumarate were lower, as were several genes controlling glucose metabolism. Non-branched-chain and branched-chain amino acids (BCAA) were highest in HFpEF myocardium, yet downstream BCAA metabolites and genes controlling BCAA metabolism were lower. Ketone levels were higher in myocardium and plasma of patients with HFrEF but not HFpEF. HFpEF metabolomic-derived subgroups were differentiated by only a few differences in BCAA metabolites. CONCLUSIONS Despite marked obesity and diabetes, HFpEF myocardium exhibited lower fatty acid metabolites compared with HFrEF. Ketones and metabolites of the tricarboxylic acid cycle and BCAA were also lower in HFpEF, suggesting insufficient use of alternative fuels. These differences were not detectable in plasma and challenge conventional views of myocardial fuel use in HFpEF with marked diabetes and obesity and suggest substantial fuel inflexibility in this syndrome.
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Affiliation(s)
- Virginia S. Hahn
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher Petucci
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Min-Soo Kim
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kenneth C. Bedi
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Hanghang Wang
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sumita Mishra
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Navid Koleini
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edwin J. Yoo
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth B. Margulies
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Zoltan Arany
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Daniel P. Kelly
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David A. Kass
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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13
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Li Q, Zhong H, Yu S, Cheng Y, Dai Y, Huang F, Lin Z, Zhu P. The Role of MR Assessments of Cardiac Morphology, Function, and Tissue Characteristics on Exercise Capacity in Well-Functioning Older Adults. J Magn Reson Imaging 2023; 57:1262-1274. [PMID: 35924395 DOI: 10.1002/jmri.28373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The relationship between resting cardiac indices and exercise capacity in older adults was still not well understood. New developments in cardiac magnetic resonance imaging (MRI) enable a much fuller assessment of cardiac characteristics. PURPOSE/HYPOTHESIS To assess the association between exercise capacity and specific aspects of resting cardiac structure, function, and tissue. STUDY TYPE Cross-sectional study. POPULATION A total of 112 well-functioning older adults (mean age 69 years, 52 men). FIELD STRENGTH/SEQUENCE All participants underwent 3.0 T MRI, using scan protocols including balanced steady-state free precession cine sequence, modified look-locker inversion recovery, and T2-prepared single-shot balanced steady-state free precession. ASSESSMENT Demographic and geriatric characteristics were collected. Blood samples were assayed for lipid and glucose related biomarkers. All participants performed a symptom-limited cardiopulmonary exercise test to achieve peakVO2 . Cardiac MRI parameters were measured with semi-automatic software by S.Y., an 18-year experienced radiologist. STATISTICAL TESTS Demographic, geriatric characteristics and MR measurements were compared among quartiles of peakVO2, with different methods according to the data type. Spearman's partial correlation and least absolute shrinkage selection operator regression were performed to select significant MR features associated with peakVO2 . Mediation effect analysis was conducted to test any indirect connection between age and peakVO2 . A two-sided P value of <0.05 was defined statistical significance. RESULTS Epicardial fat volume, left atrial volume indexed to height, right ventricular end-systolic volume indexed to body surface area and global circumferential strain (GCS) were correlated with peakVO2 (regression coefficients were -0.040, -0.093, 0.127, and 0.408, respectively). Mediation analysis showed that the total effect of peakVO2 change was 43.6% from the change of age. The proportion of indirect effect from epicardial fat volume and GCS were 11.8% and 15.1% in total effect, respectively. DATA CONCLUSION PeakVO2 was associated with epicardial fat volume, left atrial volume, right ventricular volume and GCS of left ventricle. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Qiaowei Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Huijuan Zhong
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Shun Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
| | - Yanling Cheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Yalan Dai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Feng Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Zhonghua Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, People's Republic of China.,Fujian Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, People's Republic of China
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14
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Abstract
The ketone bodies beta-hydroxybutyrate and acetoacetate are hepatically produced metabolites catabolized in extrahepatic organs. Ketone bodies are a critical cardiac fuel and have diverse roles in the regulation of cellular processes such as metabolism, inflammation, and cellular crosstalk in multiple organs that mediate disease. This review focuses on the role of cardiac ketone metabolism in health and disease with an emphasis on the therapeutic potential of ketosis as a treatment for heart failure (HF). Cardiac metabolic reprogramming, characterized by diminished mitochondrial oxidative metabolism, contributes to cardiac dysfunction and pathologic remodeling during the development of HF. Growing evidence supports an adaptive role for ketone metabolism in HF to promote normal cardiac function and attenuate disease progression. Enhanced cardiac ketone utilization during HF is mediated by increased availability due to systemic ketosis and a cardiac autonomous upregulation of ketolytic enzymes. Therapeutic strategies designed to restore high-capacity fuel metabolism in the heart show promise to address fuel metabolic deficits that underpin the progression of HF. However, the mechanisms involved in the beneficial effects of ketone bodies in HF have yet to be defined and represent important future lines of inquiry. In addition to use as an energy substrate for cardiac mitochondrial oxidation, ketone bodies modulate myocardial utilization of glucose and fatty acids, two vital energy substrates that regulate cardiac function and hypertrophy. The salutary effects of ketone bodies during HF may also include extra-cardiac roles in modulating immune responses, reducing fibrosis, and promoting angiogenesis and vasodilation. Additional pleotropic signaling properties of beta-hydroxybutyrate and AcAc are discussed including epigenetic regulation and protection against oxidative stress. Evidence for the benefit and feasibility of therapeutic ketosis is examined in preclinical and clinical studies. Finally, ongoing clinical trials are reviewed for perspective on translation of ketone therapeutics for the treatment of HF.
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Affiliation(s)
- Timothy R. Matsuura
- Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Patrycja Puchalska
- Department of Medicine, Division of Molecular Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Peter A. Crawford
- Department of Medicine, Division of Molecular Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Daniel P. Kelly
- Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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15
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Diabetes Mellitus and Heart Failure: Epidemiology, Pathophysiologic Mechanisms, and the Role of SGLT2 Inhibitors. Life (Basel) 2023; 13:life13020497. [PMID: 36836854 PMCID: PMC9968235 DOI: 10.3390/life13020497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Diabetes mellitus (DM) and heart failure (HF) are frequently encountered afflictions that are linked by a common pathophysiologic background. According to landmark studies, those conditions frequently coexist, and this interaction represents a poor prognostic indicator. Based on mechanistic studies, HF can be propagated by multiple pathophysiologic pathways, such as inflammation, oxidative stress, endothelial dysfunction, fibrosis, cardiac autonomic neuropathy, and alterations in substrate utilization. In this regard, DM may augment myocardial inflammation, fibrosis, autonomic dysfunction, and lipotoxicity. As the interaction between DM and HF appears critical, the new cornerstone in DM and HF treatment, sodium-glucose cotransporter-2 inhibitors (SGLT2i), may be able to revert the pathophysiology of those conditions and lead to beneficial HF outcomes. In this review, we aim to highlight the deleterious pathophysiologic interaction between DM and HF, as well as demonstrate the beneficial role of SGLT2i in this field.
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16
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Capone F, Sotomayor-Flores C, Bode D, Wang R, Rodolico D, Strocchi S, Schiattarella GG. Cardiac metabolism in HFpEF: from fuel to signalling. Cardiovasc Res 2023; 118:3556-3575. [PMID: 36504368 DOI: 10.1093/cvr/cvac166] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) is marked by distinctive changes in myocardial uptake and utilization of energy substrates. Among the different types of HF, HF with preserved ejection fraction (HFpEF) is a highly prevalent, complex, and heterogeneous condition for which metabolic derangements seem to dictate disease progression. Changes in intermediate metabolism in cardiometabolic HFpEF-among the most prevalent forms of HFpEF-have a large impact both on energy provision and on a number of signalling pathways in the heart. This dual, metabolic vs. signalling, role is played in particular by long-chain fatty acids (LCFAs) and short-chain carbon sources [namely, short-chain fatty acids (SCFAs) and ketone bodies (KBs)]. LCFAs are key fuels for the heart, but their excess can be harmful, as in the case of toxic accumulation of lipid by-products (i.e. lipotoxicity). SCFAs and KBs have been proposed as a potential major, alternative source of energy in HFpEF. At the same time, both LCFAs and short-chain carbon sources are substrate for protein post-translational modifications and other forms of direct and indirect signalling of pivotal importance in HFpEF pathogenesis. An in-depth molecular understanding of the biological functions of energy substrates and their signalling role will be instrumental in the development of novel therapeutic approaches to HFpEF. Here, we summarize the current evidence on changes in energy metabolism in HFpEF, discuss the signalling role of intermediate metabolites through, at least in part, their fate as substrates for post-translational modifications, and highlight clinical and translational challenges around metabolic therapy in HFpEF.
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Affiliation(s)
- Federico Capone
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Division of Internal Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Cristian Sotomayor-Flores
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - David Bode
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Rongling Wang
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Strocchi
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Gabriele G Schiattarella
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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17
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Shitole SG, Naveed M, Wang Z, Wang T, Kato Y, Ambale-Venkatesh B, Kaplan RC, Tien PC, Anastos K, Lazar JM, Lima JAC, Qi Q, Kizer JR. Metabolomic Profiling of Cardiac Fibrosis and Steatosis in Women With or at Risk for HIV. J Acquir Immune Defic Syndr 2023; 92:162-172. [PMID: 36215981 PMCID: PMC9839486 DOI: 10.1097/qai.0000000000003118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Heart failure is a prevalent disorder whose prognosis remains poor despite advances in treatment. Women with or at risk for HIV may be particularly susceptible, yet the metabolic pathways that promote myocardial disease and heart failure in this context remain incompletely characterized. METHODS To evaluate the metabolomic signatures of cardiac magnetic resonance measured phenotypes, we used available plasma metabolomic measures from participants in the Women's Interagency HIV Study who underwent cardiac magnetic resonance imaging. Our primary outcomes were myocardial extracellular volume fraction (MECV) and intramyocardial triglyceride content (IMTG). We applied partial least squares and identified the top 10 lipid and polar metabolites associated with MECV and IMTG. We used multivariable linear regression to evaluate these metabolites' individual associations with each phenotype. RESULTS The mean age of participants (n = 153) was 53 ± 7, 93% were Black or Hispanic, and 74% were HIV positive. Phenylacetylglutamine, a microbial metabolite, was positively associated with MECV after full adjustment and false discovery rate correction. Three phosphatidylcholine species, N-acetylaspartic acid, and a lysophosphatidylcholine species were inversely associated with IMTG, while prolylglycine, methionine sulfoxide, sphingosine, taurine, and phosphorylcholine were positively associated with this phenotype. We found no evidence of interaction by HIV for the observed associations, but there was effect modification by hepatitis C virus of taurine's and phosphorylcholine's associations with IMTG. CONCLUSION Among women with or at risk for HIV, we related various lipid and polar metabolites to cardiac fibrosis or steatosis, of which phenylacetylglutamine, N-acetylaspartic acid, and prolylglycine are novel. These findings implicate plausible mechanisms that could be targetable for therapeutics.
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Affiliation(s)
- Sanyog G. Shitole
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Mahim Naveed
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Zheng Wang
- Albert Einstein College of Medicine, Bronx, NY
| | - Tao Wang
- Albert Einstein College of Medicine, Bronx, NY
| | - Yoko Kato
- Johns Hopkins University, Baltimore, MD
| | | | - Robert C. Kaplan
- Albert Einstein College of Medicine, Bronx, NY
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Phyllis C. Tien
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Qibin Qi
- Albert Einstein College of Medicine, Bronx, NY
| | - Jorge R. Kizer
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- University of California San Francisco, San Francisco, CA
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18
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Abstract
Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.
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Affiliation(s)
- Katharine E Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
| | - Anastasia Fotaki
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
| | - René M Botnar
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B.)
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.M.B.)
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
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19
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Jia R, Ji Y, Sun D. Progress and prospects of Sacubitril/Valsartan: Based on heart failure with preserved ejection fraction. Biomed Pharmacother 2022; 155:113701. [PMID: 36116249 DOI: 10.1016/j.biopha.2022.113701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 12/20/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is present in nearly half of patients with heart failure. The prevalence of heart failure with normal or near-normal ejection fractions increases more rapidly than in patients with reduced ejection fractions. Angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), aldosterone antagonist, β-blocker, and calcium channel blocker have not shown significant efficacy in HFpEF clinical trials. Sacubitril/Valsartan, combined angiotensin receptor blocker (Valsartan) with neprilysin inhibitor (Sacubitril), was the first-of-its-kind angiotensin receptor-neprilysin inhibitor (ARNI) to be developed. It has shown significant efficacy on HFpEF in recent studies. It is considered that most of the current Sacubitril/Valsartan studies are still concentrated in the field of heart failure, especially heart failure with reduced ejection fraction (HFrEF). This review discusses the latest advances in cardiovascular, renal, and metabolic aspects of Sacubitril/Valsartan, mainly in HFpEF, providing more evidence for further future research on Sacubitril/Valsartan and raising issues that should be paid attention. At the same time, this review will introduce the academic consensus on Sacubitril/Valsartan in treating HFpEF in China.
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Affiliation(s)
- Ruoyu Jia
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Ying Ji
- Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Institute of Nephrology, Xuzhou Medical University, Xuzhou 221002, China.
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20
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Arvidsson PM, Nelsson A, Edlund J, Smith JG, Magnusson M, Jin N, Heiberg E, Carlsson M, Steding-Ehrenborg K, Arheden H. Kinetic energy of left ventricular blood flow across heart failure phenotypes and in subclinical diastolic dysfunction. J Appl Physiol (1985) 2022; 133:697-709. [PMID: 36037442 DOI: 10.1152/japplphysiol.00257.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Kinetic energy (KE) of intracardiac blood flow reflects myocardial work spent on accelerating blood and provides a mechanistic window into diastolic filling dynamics. Diastolic dysfunction may represent an early stage in the development of heart failure (HF). Here we evaluated the hemodynamic effects of impaired diastolic function in subjects with and without HF, testing the hypothesis that left ventricular KE differs between controls, subjects with subclinical diastolic dysfunction (SDD), and HF patients. METHODS We studied 77 subjects (16 controls, 20 subjects with SDD, 16 HFpEF, 9 HFmrEF, and 16 HFrEF patients, age- and sex-matched at the group level). Cardiac magnetic resonance at 1.5T included intracardiac 4D flow and cine imaging. Left ventricular KE was calculated as 0.5*m*v2. RESULTS Systolic KE was similar between groups (p>0.4), also after indexing to stroke volume (p=0.25), and was primarily driven by ventricular emptying rate (p<0.0001, R2=0.52). Diastolic KE was higher in heart failure patients than controls (p<0.05) but similar between SDD and HFpEF (p>0.18), correlating with inflow conditions (E-wave velocity, p<0.0001, R2=0.24) and end-diastolic volume (p=0.0003, R2=0.17) but not with average e' (p=0.07). CONCLUSIONS Diastolic KE differs between controls and heart failure, suggesting more work is spent filling the failing ventricle, while systolic KE does not differentiate between well-matched groups with normal ejection fraction even in the presence of relaxation abnormalities and heart failure. Mechanistically, KE reflects the acceleration imparted on the blood and is driven by variations in ventricular emptying and filling rates, volumes, and heart rate, regardless of underlying pathology.
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Affiliation(s)
- Per Martin Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonathan Edlund
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Martin Magnusson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, Ohio, United States
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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21
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Smith AN, Altara R, Amin G, Habeichi NJ, Thomas DG, Jun S, Kaplan A, Booz GW, Zouein FA. Genomic, Proteomic, and Metabolic Comparisons of Small Animal Models of Heart Failure With Preserved Ejection Fraction: A Tale of Mice, Rats, and Cats. J Am Heart Assoc 2022; 11:e026071. [PMID: 35904190 PMCID: PMC9375492 DOI: 10.1161/jaha.122.026071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) remains a medical anomaly that baffles researchers and physicians alike. The overall phenotypical changes of diastolic function and left ventricular hypertrophy observed in HFpEF are definable; however, the metabolic and molecular alterations that ultimately produce these changes are not well established. Comorbidities such as obesity, hypertension, and diabetes, as well as general aging, play crucial roles in its development and progression. Various animal models have recently been developed to better understand the pathophysiological and metabolic developments in HFpEF and to illuminate novel avenues for pharmacotherapy. These models include multi‐hit rodents and feline aortic constriction animals. Recently, genomic, proteomic, and metabolomic approaches have been used to define altered signaling pathways in the heart associated with HFpEF, including those involved in inflammation, cGMP‐related, Ca2+ handling, mitochondrial respiration, and the unfolded protein response in endoplasmic reticulum stress. This article aims to present an overview of what has been learnt by these studies, focusing mainly on the findings in common while highlighting unresolved issues. The knowledge gained from these research models will not simply be of benefit for treating HFpEF but will undoubtedly provide new insights into the mechanisms by which the heart deals with external stresses and how the processes involved can fail.
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Affiliation(s)
- Alex N Smith
- Department of Pharmacology and Toxicology, School of Medicine University of Mississippi Medical Center Jackson MS
| | - Raffaele Altara
- Department of Pathology, School of Medicine University of Mississippi Medical Center Jackson MS
| | - Ghadir Amin
- Department of Pharmacology and Toxicology, Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Nada J Habeichi
- Department of Pharmacology and Toxicology, Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon.,Laboratory of Signaling and Cardiovascular Pathophysiology, Inserm Unit UMR-S 1180, Faculty of Pharmacy Paris-Saclay University Châtenay-Malabry France
| | - Daniel G Thomas
- Department of Pharmacology and Toxicology, School of Medicine University of Mississippi Medical Center Jackson MS
| | - Seungho Jun
- Division of Cardiology The Johns Hopkins Medical Institutions Baltimore MD
| | - Abdullah Kaplan
- Department of Pharmacology and Toxicology, Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon.,Cardiology Clinic Rumeli Hospital Istanbul Turkey
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine University of Mississippi Medical Center Jackson MS
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, School of Medicine University of Mississippi Medical Center Jackson MS.,Department of Pharmacology and Toxicology, Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon.,Laboratory of Signaling and Cardiovascular Pathophysiology, Inserm Unit UMR-S 1180, Faculty of Pharmacy Paris-Saclay University Châtenay-Malabry France.,The Cardiovascular, Renal, and Metabolic Diseases Research Center of Excellence American University of Beirut Medical Center Beirut Lebanon
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22
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Remodeling of Cardiac Metabolism in Heart Failure with Preserved Ejection Fraction. CURRENT OPINION IN PHYSIOLOGY 2022. [DOI: 10.1016/j.cophys.2022.100559] [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]
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23
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Xu J, Yang W, Zhao S, Lu M. State-of-the-art myocardial strain by CMR feature tracking: clinical applications and future perspectives. Eur Radiol 2022; 32:5424-5435. [PMID: 35201410 DOI: 10.1007/s00330-022-08629-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 01/13/2023]
Abstract
Based on conventional cine sequences of cardiac magnetic resonance (CMR), feature tracking (FT) is an emerging tissue tracking technique that evaluates myocardial motion and deformation quantitatively by strain, strain rate, torsion, and dyssynchrony. It has been widely accepted in modern literature that strain analysis can offer incremental information in addition to classic global and segmental functional analysis. Furthermore, CMR-FT facilitates measurement of all cardiac chambers, including the relatively thin-walled atria and the right ventricle, which has been a difficult measurement to obtain with the reference standard technique of myocardial tagging. CMR-FT objectively quantifies cardiovascular impairment and characterizes myocardial function in a novel way through direct assessment of myocardial fiber deformation. The purpose of this review is to discuss the current status of clinical applications of myocardial strain by CMR-FT in a variety of cardiovascular diseases. KEY POINTS: • CMR-FT is of great value for differential diagnosis and provides incremental value for evaluating the progression and severity of diseases. • CMR-FT guides the early diagnosis of various cardiovascular diseases and provides the possibility for the early detection of myocardial impairment and additional information regarding subclinical cardiac abnormalities. • Direct assessment of myocardial fiber deformation using CMR-FT has the potential to provide prognostic information incremental to common clinical and CMR risk factors.
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Affiliation(s)
- Jing Xu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wenjing Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China. .,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, 100037, China.
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24
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In Vivo Magnetic Resonance Spectroscopy Methods for Investigating Cardiac Metabolism. Metabolites 2022; 12:metabo12020189. [PMID: 35208262 PMCID: PMC8877606 DOI: 10.3390/metabo12020189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive and non-ionizing technique, enabling in vivo investigation of cardiac metabolism in normal and diseased hearts. In vivo measurement tools are critical for studying mechanisms that regulate cardiac energy metabolism in disease developments and to assist in early response assessments to novel therapies. For cardiac MRS, proton (1H), phosphorus (31P), and hyperpolarized 13-carbon (13C) provide valuable metabolic information for diagnosis and treatment assessment purposes. Currently, low sensitivity and some technical limitations limit the utility of MRS. An essential step in translating MRS for clinical use involves further technological improvements, particularly in coil design, improving the signal-to-noise ratios, field homogeneity, and optimizing radiofrequency sequences. This review addresses the recent advances in metabolic imaging by MRS from primarily the literature published since 2015.
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25
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Weerts J, Mourmans SGJ, Barandiarán Aizpurua A, Schroen BLM, Knackstedt C, Eringa E, Houben AJHM, van Empel VPM. The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction. Biomolecules 2022; 12:biom12020278. [PMID: 35204779 PMCID: PMC8961612 DOI: 10.3390/biom12020278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing incidence, leading to a health care problem of epidemic proportions for which no curative treatments exist. Consequently, an urge exists to better understand the pathophysiology of HFpEF. Accumulating evidence suggests a key pathophysiological role for coronary microvascular dysfunction (MVD), with an underlying mechanism of low-grade pro-inflammatory state caused by systemic comorbidities. The systemic entity of comorbidities and inflammation in HFpEF imply that patients develop HFpEF due to systemic mechanisms causing coronary MVD, or systemic MVD. The absence or presence of peripheral MVD in HFpEF would reflect HFpEF being predominantly a cardiac or a systemic disease. Here, we will review the current state of the art of cardiac and systemic microvascular dysfunction in HFpEF (Graphical Abstract), resulting in future perspectives on new diagnostic modalities and therapeutic strategies.
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Affiliation(s)
- Jerremy Weerts
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
- Correspondence: ; Tel.: +31-43-387-7097
| | - Sanne G. J. Mourmans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Arantxa Barandiarán Aizpurua
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Blanche L. M. Schroen
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Christian Knackstedt
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Etto Eringa
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands;
| | - Vanessa P. M. van Empel
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
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26
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Paolisso P, Gallinoro E, Mileva N, Moya A, Fabbricatore D, Esposito G, De Colle C, Beles M, Spapen J, Heggermont W, Collet C, Van Camp G, Vanderheyden M, Barbato E, Bartunek J, Penicka M. Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction. ESC Heart Fail 2021; 9:373-384. [PMID: 34821061 PMCID: PMC8788027 DOI: 10.1002/ehf2.13740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. We aim to investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LV ejection fraction. METHODS AND RESULTS Twenty-nine patients with transthoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death [major adverse cardiovascular events (MACE)] and all-cause of death [major adverse events (MAE)] were assessed. At baseline, future HFpEF patients showed lower global work index, global constructive work, GWE, and higher GWW than controls (all P < 0.05). At admission vs. baseline, GWE significantly decreased, and GWW increased in the HFpEF group (P < 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest area under the curve (AUC) to predict first HFpEF hospitalization [AUC = 0.80, 95% confidence interval (CI) 0.69-0.91, P < 0.001], MACE (AUC = 0.80, 95% CI 0.66-0.90, P < 0.001), and MAE (AUC = 0.79, 95% CI 0.62-0.88, P = 0.001). GWW > 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59-13.12, P = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24-6.6, P = 0.014). CONCLUSIONS In ambulatory patients with preserved LV ejection fraction and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnoea.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Cardiology Clinic, 'Alexandrovska' University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ana Moya
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Jerrold Spapen
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Ward Heggermont
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
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27
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Lipotoxicity: a driver of heart failure with preserved ejection fraction? Clin Sci (Lond) 2021; 135:2265-2283. [PMID: 34643676 PMCID: PMC8543140 DOI: 10.1042/cs20210127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a growing public health concern, with rising incidence alongside high morbidity and mortality. However, the pathophysiology of HFpEF is not yet fully understood. The association between HFpEF and the metabolic syndrome (MetS) suggests that dysregulated lipid metabolism could drive diastolic dysfunction and subsequent HFpEF. Herein we summarise recent advances regarding the pathogenesis of HFpEF in the context of MetS, with a focus on impaired lipid handling, myocardial lipid accumulation and subsequent lipotoxicity.
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28
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Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets. Int J Mol Sci 2021; 22:ijms22147650. [PMID: 34299270 PMCID: PMC8304780 DOI: 10.3390/ijms22147650] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients' outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease's natural course.
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29
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Bojer AS, Soerensen MH, Gaede P, Myerson S, Madsen PL. Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function. Diagnostics (Basel) 2021; 11:diagnostics11071282. [PMID: 34359363 PMCID: PMC8305340 DOI: 10.3390/diagnostics11071282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
- Correspondence:
| | - Martin Heyn Soerensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
| | - Saul Myerson
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX1 2JD, UK;
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, 2730 Herlev, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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30
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Abdellatif M, Trummer-Herbst V, Koser F, Durand S, Adão R, Vasques-Nóvoa F, Freundt JK, Voglhuber J, Pricolo MR, Kasa M, Türk C, Aprahamian F, Herrero-Galán E, Hofer SJ, Pendl T, Rech L, Kargl J, Anto-Michel N, Ljubojevic-Holzer S, Schipke J, Brandenberger C, Auer M, Schreiber R, Koyani CN, Heinemann A, Zirlik A, Schmidt A, von Lewinski D, Scherr D, Rainer PP, von Maltzahn J, Mühlfeld C, Krüger M, Frank S, Madeo F, Eisenberg T, Prokesch A, Leite-Moreira AF, Lourenço AP, Alegre-Cebollada J, Kiechl S, Linke WA, Kroemer G, Sedej S. Nicotinamide for the treatment of heart failure with preserved ejection fraction. Sci Transl Med 2021; 13:13/580/eabd7064. [PMID: 33568522 DOI: 10.1126/scitranslmed.abd7064] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and intractable form of cardiac decompensation commonly associated with diastolic dysfunction. Here, we show that diastolic dysfunction in patients with HFpEF is associated with a cardiac deficit in nicotinamide adenine dinucleotide (NAD+). Elevating NAD+ by oral supplementation of its precursor, nicotinamide, improved diastolic dysfunction induced by aging (in 2-year-old C57BL/6J mice), hypertension (in Dahl salt-sensitive rats), or cardiometabolic syndrome (in ZSF1 obese rats). This effect was mediated partly through alleviated systemic comorbidities and enhanced myocardial bioenergetics. Simultaneously, nicotinamide directly improved cardiomyocyte passive stiffness and calcium-dependent active relaxation through increased deacetylation of titin and the sarcoplasmic reticulum calcium adenosine triphosphatase 2a, respectively. In a long-term human cohort study, high dietary intake of naturally occurring NAD+ precursors was associated with lower blood pressure and reduced risk of cardiac mortality. Collectively, these results suggest NAD+ precursors, and especially nicotinamide, as potential therapeutic agents to treat diastolic dysfunction and HFpEF in humans.
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Affiliation(s)
- Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | | | - Franziska Koser
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Sylvère Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France.,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France
| | - Rui Adão
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Johanna K Freundt
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | | | - Michael Kasa
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Clara Türk
- Institute for Genetics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne 50931, Germany.,Center for Molecular Medicine (CMMC), University of Cologne, Cologne 50931, Germany
| | - Fanny Aprahamian
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France.,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France
| | - Elías Herrero-Galán
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid 28029, Spain
| | - Sebastian J Hofer
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Tobias Pendl
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Lavinia Rech
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Julia Kargl
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz 8010, Austria
| | | | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | - Julia Schipke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Christina Brandenberger
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Martina Auer
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria.,Division of Cell Biology, Histology and Embryology, Medical University of Graz, Graz 8010, Austria
| | - Renate Schreiber
- Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Chintan N Koyani
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Akos Heinemann
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz 8010, Austria
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Albrecht Schmidt
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Dirk von Lewinski
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Daniel Scherr
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria
| | - Peter P Rainer
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria.,BioTechMed Graz, Graz 8010, Austria
| | | | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover 30625, Germany
| | - Marcus Krüger
- Institute for Genetics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne 50931, Germany.,Center for Molecular Medicine (CMMC), University of Cologne, Cologne 50931, Germany
| | - Saša Frank
- BioTechMed Graz, Graz 8010, Austria.,Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria
| | - Frank Madeo
- BioTechMed Graz, Graz 8010, Austria.,Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Tobias Eisenberg
- BioTechMed Graz, Graz 8010, Austria.,Institute of Molecular Biosciences, University of Graz, NAWI Graz, Graz 8010, Austria
| | - Andreas Prokesch
- BioTechMed Graz, Graz 8010, Austria.,Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Graz 8010, Austria.,Division of Cell Biology, Histology and Embryology, Medical University of Graz, Graz 8010, Austria
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Cardiovascular Research and Development Centre (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | | | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria.,VASCage, Research Centre for Promoting Vascular Health in the Ageing Community, Innsbruck 6020, Austria
| | - Wolfgang A Linke
- Institute of Physiology II, University of Münster, Münster 48149, Germany
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif 94805, France. .,Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institut Universitaire de France, Paris 75006, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris 75015, France.,Suzhou Institute for Systems Medicine, Chinese Academy of Sciences, Suzhou 215000, China.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Solna 17164, Sweden
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz 8036, Austria. .,BioTechMed Graz, Graz 8010, Austria.,Faculty of Medicine, University of Maribor, Maribor 2000, Slovenia
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31
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Zhou G, Sun S, Yuan Q, Zhang R, Jiang P, Li G, Wang Y, Li X. Multiple-Tissue and Multilevel Analysis on Differentially Expressed Genes and Differentially Correlated Gene Pairs for HFpEF. Front Genet 2021; 12:668702. [PMID: 34306013 PMCID: PMC8296822 DOI: 10.3389/fgene.2021.668702] [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: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex disease characterized by dysfunctions in the heart, adipose tissue, and cerebral arteries. The elucidation of the interactions between these three tissues in HFpEF will improve our understanding of the mechanism of HFpEF. In this study, we propose a multilevel comparative framework based on differentially expressed genes (DEGs) and differentially correlated gene pairs (DCGs) to investigate the shared and unique pathological features among the three tissues in HFpEF. At the network level, functional enrichment analysis revealed that the networks of the heart, adipose tissue, and cerebral arteries were enriched in the cell cycle and immune response. The networks of the heart and adipose tissues were enriched in hemostasis, G-protein coupled receptor (GPCR) ligand, and cancer-related pathway. The heart-specific networks were enriched in the inflammatory response and cardiac hypertrophy, while the adipose-tissue-specific networks were enriched in the response to peptides and regulation of cell adhesion. The cerebral-artery-specific networks were enriched in gene expression (transcription). At the module and gene levels, 5 housekeeping DEGs, 2 housekeeping DCGs, 6 modules of merged protein–protein interaction network, 5 tissue-specific hub genes, and 20 shared hub genes were identified through comparative analysis of tissue pairs. Furthermore, the therapeutic drugs for HFpEF-targeting these genes were examined using molecular docking. The combination of multitissue and multilevel comparative frameworks is a potential strategy for the discovery of effective therapy and personalized medicine for HFpEF.
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Affiliation(s)
- Guofeng Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shaoyan Sun
- School of Mathematics and Statistics, Ludong University, Yantai, China
| | - Qiuyue Yuan
- CEMS, NCMIS, MDIS, Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China.,School of Mathematical Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Run Zhang
- School of Mathematics and Statistics, Ludong University, Yantai, China
| | - Ping Jiang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyu Li
- CEMS, NCMIS, MDIS, Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China
| | - Yong Wang
- CEMS, NCMIS, MDIS, Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China.,School of Mathematical Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao Li
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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32
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Mishra S, Kass DA. Cellular and molecular pathobiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2021; 18:400-423. [PMID: 33432192 PMCID: PMC8574228 DOI: 10.1038/s41569-020-00480-6] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/30/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) affects half of all patients with heart failure worldwide, is increasing in prevalence, confers substantial morbidity and mortality, and has very few effective treatments. HFpEF is arguably the greatest unmet medical need in cardiovascular disease. Although HFpEF was initially considered to be a haemodynamic disorder characterized by hypertension, cardiac hypertrophy and diastolic dysfunction, the pandemics of obesity and diabetes mellitus have modified the HFpEF syndrome, which is now recognized to be a multisystem disorder involving the heart, lungs, kidneys, skeletal muscle, adipose tissue, vascular system, and immune and inflammatory signalling. This multiorgan involvement makes HFpEF difficult to model in experimental animals because the condition is not simply cardiac hypertrophy and hypertension with abnormal myocardial relaxation. However, new animal models involving both haemodynamic and metabolic disease, and increasing efforts to examine human pathophysiology, are revealing new signalling pathways and potential therapeutic targets. In this Review, we discuss the cellular and molecular pathobiology of HFpEF, with the major focus being on mechanisms relevant to the heart, because most research has focused on this organ. We also highlight the involvement of other important organ systems, including the lungs, kidneys and skeletal muscle, efforts to characterize patients with the use of systemic biomarkers, and ongoing therapeutic efforts. Our objective is to provide a roadmap of the signalling pathways and mechanisms of HFpEF that are being characterized and which might lead to more patient-specific therapies and improved clinical outcomes.
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Affiliation(s)
- Sumita Mishra
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Kass
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,
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33
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Selvaraj S, Claggett BL, Packer M, Zannad F, Anand IS, Pieske B, Zhao Z, Shi VC, Lefkowitz MP, McMurray JJV, Solomon SD. Effects of Sacubitril/Valsartan on Serum Lipids in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e022069. [PMID: 33998278 PMCID: PMC8649234 DOI: 10.1161/jaha.121.022069] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Dyslipidemia is common in heart failure with preserved ejection fraction. Sacubitril/valsartan improves glycemic control and augments natriuretic peptide signaling, providing mechanisms by which sacubitril/valsartan may affect serum lipids. However, empiric data on these effects are lacking. Methods and Results We analyzed 4774 participants from PARAGON‐HF (Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor With Angiotensin‐Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) with available screening lipids. During follow‐up visits, we analyzed the treatment effect on lipid levels and assessed for interaction by baseline lipid levels. At the 16‐week visit, we adjusted these treatment effects for the change in several biomarkers (including hemoglobin A1c and urinary cyclic guanosine monophosphate/creatinine [a biomarker of natriuretic peptide activation]). The average age was 73±8 years, 52% were women, 43% had diabetes mellitus, and 64% were on statin therapy. Compared with valsartan, sacubitril/valsartan reduced triglycerides −5.0% (95% CI, −6.6% to −3.5%), increased high‐density lipoprotein cholesterol +2.6% (95% CI, +1.7% to +3.4%), and increased low‐density lipoprotein cholesterol +1.7% (95% CI, +0.4% to +3.0%). Sacubitril/valsartan reduced triglycerides most among those with elevated baseline levels (triglycerides≥200 mg/dL) (P‐interaction<0.001), and at 16 weeks by −13.0% (95% CI, −18.1% to −7.6%), or −29.9 (95% CI, −44.3 to −15.5) mg/dL, in this group. Adjusting for the change in urinary cyclic guanosine monophosphate/creatinine significantly attenuated treatment effects on triglycerides and high‐density lipoprotein cholesterol, but not low‐density lipoprotein cholesterol, while adjusting for other biomarkers did not significantly alter the treatment effects. Conclusions Sacubitril/valsartan significantly reduces triglycerides compared with valsartan, an effect that was nearly threefold stronger in those with elevated baseline triglycerides. Modest increases in high‐density lipoprotein cholesterol and low‐density lipoprotein cholesterol cholesterol were also observed with therapy. The underlying mechanism(s) of changes in high‐density lipoprotein cholesterol and triglycerides are related to sacubitril/valsartan’s effects on natriuretic peptide activity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology Department of Medicine Hospital of the University of Pennsylvania Philadelphia PA
| | - Brian L Claggett
- Division of Cardiology Department of Medicine Brigham and Women's Hospital Boston MA
| | - Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical Center Dallas TX.,Imperial College London UK
| | - Faiez Zannad
- INSERM Centre d'Investigation Clinic 1433 and Universite de LorraineCentre Hospitalier Regional et Universitaire Nancy France
| | - Inder S Anand
- Department of Cardiovascular Medicine University of Minnesota Minneapolis MN
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology German Center for Cardiovascular Research partner site Berlin Berlin Germany
| | | | | | | | | | - Scott D Solomon
- Division of Cardiology Department of Medicine Brigham and Women's Hospital Boston MA
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34
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Samuel TJ, Wei J, Sharif B, Tamarappoo BK, Pattisapu V, Maughan J, Cipher DJ, Suppogu N, Aldiwani H, Thomson LEJ, Shufelt C, Berman DS, Li D, Bairey Merz CN, Nelson MD. Diastolic dysfunction in women with ischemia and no obstructive coronary artery disease: Mechanistic insight from magnetic resonance imaging. Int J Cardiol 2021; 331:1-7. [PMID: 33545261 PMCID: PMC8026746 DOI: 10.1016/j.ijcard.2021.01.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/11/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ischemia with no obstructive coronary artery disease (INOCA) is prevalent in women and is associated with increased risk of developing heart failure with preserved ejection fraction (HFpEF); however, the mechanism(s) contributing to this progression remains unclear. Given that diastolic dysfunction is common in women with INOCA, defining mechanisms related to diastolic dysfunction in INOCA could identify therapeutic targets to prevent HFpEF. METHODS Cardiac MRI was performed in 65 women with INOCA and 12 reference controls. Diastolic function was defined by left ventricular early diastolic circumferential strain rate (eCSRd). Contributors to diastolic dysfunction were chosen a priori as coronary vascular dysfunction (myocardial perfusion reserve index [MPRI]), diffuse myocardial fibrosis (extracellular volume [ECV]), and aortic stiffness (aortic pulse wave velocity [aPWV]). RESULTS Compared to controls, eCSRd was lower in INOCA (1.61 ± 0.33/s vs. 1.36 ± 0.31/s, P = 0.016); however, this difference was not exaggerated when the INOCA group was sub-divided by low and high MPRI (P > 0.05) nor was ECV elevated in INOCA (29.0 ± 1.9% vs. 28.0 ± 3.2%, control vs. INOCA; P = 0.38). However, aPWV was higher in INOCA vs. controls (8.1 ± 3.2 m/s vs. 6.1 ± 1.5 m/s; P = 0.045), and was associated with eCSRd (r = -0.50, P < 0.001). By multivariable linear regression analysis, aPWV was an independent predictor of decreased eCSRd (standardized β = -0.39, P = 0.003), as was having an elevated left ventricular mass index (standardized β = -0.25, P = 0.024) and lower ECV (standardized β = 0.30, P = 0.003). CONCLUSIONS These data provide mechanistic insight into diastolic dysfunction in women with INOCA, identifying aortic stiffness and ventricular remodeling as putative therapeutic targets.
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Affiliation(s)
- T Jake Samuel
- The University of Texas at Arlington, Arlington, TX, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji K Tamarappoo
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Varun Pattisapu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jenna Maughan
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Nissi Suppogu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Haider Aldiwani
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Daniel S Berman
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Michael D Nelson
- The University of Texas at Arlington, Arlington, TX, USA; Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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35
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Zhou J, Chen X, Chen W, Zhong L, Cui M. Comprehensive plasma metabolomic and lipidomic analyses reveal potential biomarkers for heart failure. Mol Cell Biochem 2021; 476:3449-3460. [PMID: 33974232 DOI: 10.1007/s11010-021-04159-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
Heart failure is a syndrome with symptoms or signs caused by cardiac dysfunction. In clinic, four stages (A, B, C, and D) were used to describe heart failure progression. This study was aimed to explore plasma metabolomic and lipidomic profiles in different HF stages to identify potential biomarkers. Metabolomics and lipidomics were performed using plasma of heart failure patients at stages A (n = 49), B (n = 61), and C+D (n = 26). Analysis of Variance (ANOVA) was used for screening dysregulated molecules. Bioinformatics was used to retrieve perturbed metabolic pathways. Univariate and multivariate receiver operating characteristic curve (ROC) analyses were used for potential biomarker screening. Stage A showed significant difference to other stages, and 142 dysregulated lipids and 134 dysregulated metabolites were found belonging to several metabolic pathways. Several marker panels were proposed for the diagnosis of heart failure stage A versus stage B-D. Several molecules, including lysophosphatidylcholine 18:2, cholesteryl ester 18:1, alanine, choline, and Fructose, were found correlated with B-type natriuretic peptide or left ventricular ejection fractions. In summary, using untargeted metabolomic and lipidomic profiling, several dysregulated small molecules were successfully identified between HF stages A and B-D. These molecules would provide valuable information for further pathological researches and biomarker development.
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Affiliation(s)
- Juntuo Zhou
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, No. 49, Hua Yuan North Rd, Hai Dian District, Beijing, 100191, China.,Center of Medical and Health Analysis, Peking University Health Science Center, Beijing, 100191, China
| | - Xi Chen
- Department of Pathology, School of Basic Medical Science, Peking University Health Science Center, Beijing, 100191, China
| | - Wei Chen
- Center of Medical and Health Analysis, Peking University Health Science Center, Beijing, 100191, China
| | - Lijun Zhong
- Center of Medical and Health Analysis, Peking University Health Science Center, Beijing, 100191, China.
| | - Ming Cui
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, No. 49, Hua Yuan North Rd, Hai Dian District, Beijing, 100191, China. .,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, 100191, China. .,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China. .,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China.
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36
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Lewis GA, Pearce K, Williams SG, Schelbert EB, Macnab A, Miller CA. The utility of cardiovascular imaging in heart failure with preserved ejection fraction: diagnosis, biological classification and risk stratification. Heart Fail Rev 2021; 26:661-678. [PMID: 33155067 PMCID: PMC8024231 DOI: 10.1007/s10741-020-10047-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) does not exist as a singular clinical or pathological entity but as a syndrome encompassing a wide range of clinical and biological phenotypes. There is an urgent need to progress from the unsuccessful 'one-size-fits-all' approach to more precise disease classification, in order to develop targeted therapies, personalise risk stratification and guide future research. In this regard, this review discusses the current and emerging roles of cardiovascular imaging for the diagnosis of HFpEF, for distilling HFpEF into distinct disease entities according to underlying pathobiology and for risk stratification.
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Affiliation(s)
- Gavin A Lewis
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Keith Pearce
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Simon G Williams
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anita Macnab
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK.
- Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Wellcome Centre for Cell-Matrix Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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37
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Samuel TJ, Kitzman DW, Haykowsky MJ, Upadhya B, Brubaker P, Nelson MB, Hundley WG, Nelson MD. Left ventricular diastolic dysfunction and exercise intolerance in obese heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2021; 320:H1535-H1542. [PMID: 33577436 PMCID: PMC8260389 DOI: 10.1152/ajpheart.00610.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese patients with heart failure with preserved ejection fraction (HFpEF), and related to decreased peak exercise oxygen uptake (peak V̇o2). LV strain and strain rate were measured by feature tracking of magnetic resonance cine images in 79 older obese patients with HFpEF (mean age: 66 yr; mean body mass index: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak V̇o2. LV circumferential early diastolic strain rate was impaired in HFpEF compared with controls (0.93 ± 0.05/s vs. 1.20 ± 0.07/s, P = 0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08 ± 0.03 vs. 0.13 ± 0.05, P < 0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak V̇o2 (R = 0.36, -0.27, and 0.35, respectively, all P < 0.01); this response, however, was almost entirely driven by E/e' itself, (R = -0.52, P < 0.001). Taken together, we found that although LV relaxation is impaired in older obese patients with HFpEF, and modestly correlates with their severely reduced peak exercise V̇o2, LV filling pressures appear to play a much more important role in determining exercise intolerance.NEW & NOTEWORTHY Using a multimodal imaging approach to uncouple tissue deformation from atrial pressure, we found that left ventricular (LV) relaxation is impaired in older obese patients with HFpEF, but only modestly correlates with their severely reduced peak V̇o2. In contrast, the data show a much stronger relationship between elevated LV filling pressures and exercise intolerance, refocusing future therapeutic priorities.
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Affiliation(s)
- T Jake Samuel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.,Section on Gerontology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, North Carolina
| | - M Benjamin Nelson
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - W Gregory Hundley
- Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas.,Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
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38
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Cardiac 1H MR spectroscopy: development of the past five decades and future perspectives. Heart Fail Rev 2021; 26:839-859. [PMID: 33409666 DOI: 10.1007/s10741-020-10059-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 01/01/2023]
Abstract
Continued advances in laboratory medicine are required to realize the potential of individualized medicine to impact common cardiovascular diseases. Magnetic resonance imaging (MRI) and spectroscopy (MRS) techniques have advanced over recent years and offer unique, powerful insights into cardiac anatomic and metabolic changes, respectively, occurring in both nascent and advanced heart disease. Although numerous MRI-based in vivo diagnostics are already used in routine clinical practice and more are anticipated, MRS has been less incorporated into routine clinical practice. Given the ability of 1H MRS to identify and quantify specific molecules with high sensitivity and specificity, its potential utility should be successfully transition from "bench-to-bedside" is tantalizing. The present review will highlight the development of 1H MRS techniques for cardiac applications, observations in seminal studies with 1H MRS, and the prospects and challenges for widespread application in patients with cardiovascular disease.
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Abstract
Understanding the energetic state of the heart is essential for unraveling the central tenets of cardiac physiology. The heart uses a tremendous amount of energy and reductions in that energy supply can have lethal consequences. While ischemic events clearly result in significant metabolic perturbations, heart failure with both preserved and reduced ejection fraction display reductions in energetic status. To date, most cardiac energetics have been performed using 31P-NMR, which requires dedicated access to a specialized NMR spectrometer. This has limited the availability of this method to a handful of centers around the world. Here we present a method of assessing myocardial energetics in the isolated mouse heart using 1H-NMR spectrometers that are widely available in NMR core facilities. In addition, this methodology provides information on many other important metabolites within the heart, including unique metabolic differences between the hypoxic and ischemic hearts. Furthermore, we demonstrate the correlation between myocardial energetics and measures of contractile function in the mouse heart. These methods will allow a broader examination of myocardial energetics providing a valuable tool to aid in the understanding of the nature of these energetic deficits and to develop therapies directed at improving myocardial energetics in failing hearts.
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Quarta G, Gori M, Iorio A, D'Elia E, Moon JC, Iacovoni A, Burocchi S, Schelbert EB, Brambilla P, Sironi S, Caravita S, Parati G, Gavazzi A, Maisel AS, Butler J, Lam CSP, Senni M. Cardiac magnetic resonance in heart failure with preserved ejection fraction: myocyte, interstitium, microvascular, and metabolic abnormalities. Eur J Heart Fail 2020; 22:1065-1075. [PMID: 32654354 DOI: 10.1002/ejhf.1961] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/11/2022] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a chronic cardiac condition whose prevalence continues to rise, with high social and economic burden, but with no specific approved treatment. Patients diagnosed with HFpEF have a high prevalence of comorbidities and exhibit a high misdiagnosis rate. True HFpEF is likely to have multiple pathophysiological causes - with these causes being clinically ill-defined due to limitations of current measurement techniques. Myocyte, interstitium, microvascular, and metabolic abnormalities have been regarded as key components of the pathophysiology and potential therapeutic targets. Cardiac magnetic resonance (CMR) has the capability to look deeper with a number of tissue characterization techniques which are closer to the underlying specific abnormalities and which could be linked to personalized medicine for HFpEF. This review aims to discuss the potential role of CMR to better define HFpEF phenotypes and to infer measurable therapeutic targets.
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Affiliation(s)
- Giovanni Quarta
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annamaria Iorio
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - James C Moon
- University College London and Barts Heart Centre, London, UK
| | - Attilio Iacovoni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Simone Burocchi
- Cardiovascular Department, Azienda Ospedaliera S. Andrea, Rome, Italy
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paolo Brambilla
- Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (Bergamo), Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS, Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonello Gavazzi
- FROM - Fondazione per la Ricerca dell'Ospedale di Bergamo, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Carolyn S P Lam
- National Heart Centre, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Epicardial Adipose Tissue and Invasive Hemodynamics in Heart Failure With Preserved Ejection Fraction. JACC-HEART FAILURE 2020; 8:667-676. [DOI: 10.1016/j.jchf.2020.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/07/2023]
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42
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Peterzan MA, Lewis AJM, Neubauer S, Rider OJ. Non-invasive investigation of myocardial energetics in cardiac disease using 31P magnetic resonance spectroscopy. Cardiovasc Diagn Ther 2020; 10:625-635. [PMID: 32695642 DOI: 10.21037/cdt-20-275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiac metabolism and function are intrinsically linked. High-energy phosphates occupy a central and obligate position in cardiac metabolism, coupling oxygen and substrate fuel delivery to the myocardium with external work. This insight underlies the widespread clinical use of ischaemia testing. However, other deficits in high-energy phosphate metabolism (not secondary to supply-demand mismatch of oxygen and substrate fuels) may also be documented, and are of particular interest when found in the context of structural heart disease. This review introduces the scope of deficits in high-energy phosphate metabolism that may be observed in the myocardium, how to assess for them, and how they might be interpreted.
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Affiliation(s)
- Mark A Peterzan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J M Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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43
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Gao Y, Ren Y, Guo YK, Liu X, Xie LJ, Jiang L, Shen MT, Deng MY, Yang ZG. Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study. Cardiovasc Diabetol 2020; 19:70. [PMID: 32471503 PMCID: PMC7260782 DOI: 10.1186/s12933-020-01044-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that collectively cause an increased risk of type 2 diabetes mellitus (T2DM) and nonatherosclerotic cardiovascular disease. This study aimed to evaluate the role of myocardial steatosis in T2DM patients with or without MetS, as well as the relationship between subclinical left ventricular (LV) myocardial dysfunction and myocardial steatosis. METHODS AND MATERIALS We recruited 53 T2DM patients and 20 healthy controls underwent cardiac magnetic resonance examination. All T2DM patients were subdivide into two group: MetS group and non-MetS. LV deformation, perfusion parameters and myocardial triglyceride (TG) content were measured and compared among these three groups. Pearson's and Spearman analysis were performed to investigate the correlation between LV cardiac parameters and myocardial steatosis. The receiver operating characteristic curve (ROC) was performed to illustrate the relationship between myocardial steatosis and LV subclinical myocardial dysfunction. RESULTS An increase in myocardial TG content was found in the MetS group compared with that in the other groups (MetS vs. non-MetS: 1.54 ± 0.63% vs. 1.16 ± 0.45%; MetS vs. normal: 1.54 ± 0.63% vs. 0.61 ± 0.22%; all p < 0.001). Furthermore, reduced LV deformation [reduced longitudinal and radial peak strain (PS); all p < 0.017] and microvascular dysfunction [increased time to maximum signal intensity (TTM) and reduced Upslope; all p < 0.017)] was found in the MetS group. Myocardial TG content was positively associated with MetS (r = 0.314, p < 0.001), and it was independently associated with TTM (β = 0.441, p < 0.001) and LV longitudinal PS (β = 0.323, p = 0.021). ROC analysis exhibited that myocardial TG content might predict the risk of decreased LV longitudinal myocardial deformation (AUC = 0.74) and perfusion function (AUC = 0.71). CONCLUSION Myocardial TG content increased in T2DM patients with concurrent MetS. Myocardial steatosis was positively associated with decreased myocardial deformation and perfusion dysfunction, which may be an indicator for predicting diabetic cardiomyopathy.
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Affiliation(s)
- Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ming-Yan Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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Kintscher U, Foryst-Ludwig A, Haemmerle G, Zechner R. The Role of Adipose Triglyceride Lipase and Cytosolic Lipolysis in Cardiac Function and Heart Failure. CELL REPORTS MEDICINE 2020; 1:100001. [PMID: 33205054 PMCID: PMC7659492 DOI: 10.1016/j.xcrm.2020.100001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure is one of the leading causes of death worldwide. New therapeutic concepts are urgently required to lower the burden of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), the two major forms of heart failure. Lipolytic processes are induced during the development of heart failure and occur in adipose tissue and multiple organs, including the heart. Increasing evidence suggests that cellular lipolysis, in particular, adipose triglyceride lipase (ATGL) activity, has an important function in cardiac (patho)physiology. This review summarizes the crucial role of cellular lipolysis for normal cardiac function and for the development of HFrEF and HFpEF. We discuss the most relevant pre-clinical studies and elaborate on the cardiac consequences of non-myocardial and myocardial lipolysis modulation. Finally, we critically analyze the therapeutic importance of pharmacological ATGL inhibition as a potential treatment option for HFrEF and/or HFpEF in the future.
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Affiliation(s)
- Ulrich Kintscher
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Corresponding author
| | - Anna Foryst-Ludwig
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Guenter Haemmerle
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Rudolf Zechner
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
- Einstein BIH Visiting Fellow, Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Berlin, Germany
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45
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Maurer MS, Packer M. How Should Physicians Assess Myocardial Contraction? JACC Cardiovasc Imaging 2020; 13:873-878. [DOI: 10.1016/j.jcmg.2019.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/05/2019] [Accepted: 12/05/2019] [Indexed: 12/22/2022]
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46
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Manning WJ. Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review. J Cardiovasc Magn Reson 2019; 21:79. [PMID: 31884956 PMCID: PMC6936125 DOI: 10.1186/s12968-019-0594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 76 original research papers, 4 reviews, 5 technical notes, 1 guideline, and 3 corrections. The volume was down slightly from 2017 with a corresponding 15% decrease in manuscript submissions from 405 to 346 and thus reflects a slight increase in the acceptance rate from 25 to 26%. The decrease in submissions for the year followed the initiation of the increased author processing charge (APC) for Society for Cardiovascular Magnetic Resonance (SCMR) members for manuscripts submitted after June 30, 2018. The quality of the submissions continues to be high. The 2018 JCMR Impact Factor (which is published in June 2019) was slightly lower at 5.1 (vs. 5.46 for 2017; as published in June 2018. The 2018 impact factor means that on average, each JCMR published in 2016 and 2017 was cited 5.1 times in 2018. Our 5 year impact factor was 5.82.In accordance with Open-Access publishing guidelines of BMC, the JCMR articles are published on-line in a continuus fashion in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful for the JCMR audience to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and contemporaneous JCMR publications. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, as in the past two years, I have used this publication to also convey information regarding the editorial process and as a "State of our JCMR."This is the 12th year of JCMR as an open-access publication with BMC (formerly known as Biomed Central). The timing of the JCMR transition to the open access platform was "ahead of the curve" and a tribute to the vision of Dr. Matthias Friedrich, the SCMR Publications Committee Chair and Dr. Dudley Pennell, the JCMR editor-in-chief at the time. The open-access system has dramatically increased the reading and citation of JCMR publications and I hope that you, our authors, will continue to send your very best, high quality manuscripts to JCMR for consideration. It takes a village to run a journal and I thank our very dedicated Associate Editors, Guest Editors, Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. This entire process would also not be possible without the dedication and efforts of our managing editor, Diana Gethers. Finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 4th year as your editor-in-chief. It has been a tremendous experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Brar PC, Chun A, Fan X, Jani V, Craft M, Bhatla P, Kutty S. Impaired myocardial deformation and ventricular vascular coupling in obese adolescents with dysglycemia. Cardiovasc Diabetol 2019; 18:172. [PMID: 31856856 PMCID: PMC6921397 DOI: 10.1186/s12933-019-0976-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background It is unknown that dysglycemia in obese adolescents has effects on myocardial deformation that are more pronounced when compared to obesity alone. We hypothesized that obesity associated abnormal glucose tolerance (dysglycemia) would have adverse effects on two-dimensional speckle tracking echocardiography derived longitudinal, radial and circumferential strain (LS, RS, CS) compared to age and gender lean controls. We also examined if changes in deformation would be reflected in abnormal ventricular vascular coupling indices (VVI). Methods In a prospective cross-sectional design 39 obese adolescents (15.9 ± 1.7 years; 101.5 ± 39 kg; female − 58%) were compared to age and gender matched lean controls (15.7 ± 1.8 yrs, 60 ± 12.8 kg). Based on results from an oral glucose tolerance test (OGTT), obese adolescents were categorized as obese normoglycemic (ONG, n = 25) or obese dysglycemic (ODG, n = 14). Left ventricular (LV) global and average LS, CS, RS and strain rate were measured. LV ejection fraction and mass index were measured and VVI approximated as ratio of arterial elasticity (Ea) and end-systolic elastance (Ees). Results Adolescents with ODG had significantly (P = 0.005) impaired global LS (− 20.98% ± 2.8%) compared to controls (− 23.01% ± 2.3%). A similar (P = 0.0027) reduction was observed in average LS for adolescents with ODG (18.87% ± 2.5%) compared to controls (20.49% ± 2%). Global CS was also decreased (P = 0.03) in ODG (− 23.95%) compared to ONG (− 25.80). A similar trend was observed in average CS after multivariate regression for BMI and blood pressure. CS correlated with HbA1c in both groups (P = 0.05). VVI had a negative correlation with both LS (r = − 0.4, P = 0.025) and CS rate (r = − 0.36, P = 0.04). Conclusions Myocardial strain and strain rate were significantly altered in obese adolescents. Unfavorable subclinical reductions in global and average CS were more pronounced in adolescents with dysglycemia compared to obese adolescents with normoglycemia and controls. These data indicate progressive worsening of subendocardial function across the spectrum of glucose tolerance. Strain rate was predictive of VVI in obese adolescents, suggesting strain rate may be a sensitive marker for cardiac remodeling in abnormal glucose homeostasis states.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Endocrinology and Diabetes, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Anne Chun
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Xiazhou Fan
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Vivek Jani
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA
| | - Mary Craft
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Omaha, NE, 68918, USA
| | - Puneet Bhatla
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA.
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49
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Hiebert JB, Vacek J, Shah Z, Rahman F, Pierce JD. Use of speckle tracking to assess heart failure with preserved ejection fraction. J Cardiol 2019; 74:397-402. [PMID: 31303358 DOI: 10.1016/j.jjcc.2019.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) currently represents approximately 50% of heart failure (HF) cases in the USA and is increasingly recognized as a leading cause of morbidity and mortality. Recent data suggest that the prevalence of HFpEF relative to HF with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. With an aging population and increasing risk factors such as hypertension, obesity, and diabetes mellitus, HFpEF will soon be the most prevalent HF phenotype. Two-dimensional speckle-tracking echocardiography (STE) has been used to diagnose HFpEF specifically by focusing on the longitudinal systolic function of the left ventricle (LV). Yet there are many patients with HFpEF in whom there are no differences in LV global longitudinal systolic strain, but there are changes in left atrial function and structure. There are several proposed pathophysiological mechanisms for HFpEF such as endothelial dysfunction, interactions among proteins, signaling pathways, and myocardial bioenergetics. Yet only one specific therapy, mineralocorticoid receptor antagonist, spironolactone, is recommended as a treatment for patients with HFpEF. However, spironolactone does not address many of the pathophysiologic changes that occur in HFpEF, thus new novel therapeutic agents are needed. With the limited available therapies, clinicians should use STE to assess for the presence of this syndrome in their patients to provide effective diagnosis and management.
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Affiliation(s)
- John B Hiebert
- University of Kansas, School of Nursing, Kansas City, KS, USA
| | - James Vacek
- Clinical Cardiology and Cardiovascular Research, Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, KS, USA
| | - Zubair Shah
- The University of Kansas Health System, Kansas City, KS, USA
| | - Faith Rahman
- University of Kansas, School of Nursing, Kansas City, KS, USA.
| | - Janet D Pierce
- Department of Molecular and Integrative Physiology, University of Kansas, School of Nursing, Kansas City, KS, USA
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50
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Gastl M, Peereboom SM, Fuetterer M, Boenner F, Kelm M, Manka R, Kozerke S. Retrospective phase-based gating for cardiac proton spectroscopy with fixed scan time. J Magn Reson Imaging 2019; 50:1973-1981. [PMID: 31125172 DOI: 10.1002/jmri.26802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/13/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Respiratory motion is a major limiting factor for spectral quality and duration of in vivo proton MR spectroscopy of the heart. Prospective navigator gating is frequently applied to minimize the effects of respiratory motion, but scan durations are subject-dependent and hence difficult to predict. PURPOSE To implement cardiac proton MRS with fixed scan time by employing retrospective phase-based gating and to compare the proposed method to conventional navigator-gated MRS. STUDY TYPE Prospective. SUBJECTS Eighteen healthy volunteers (29.7 ± 7.8 years). FIELD STRENGTH/SEQUENCE 1.5, navigator-gated (16 averages without, 96 with water suppression [WS]) data acquisition as reference and navigator-free data acquisition with a fixed scan time (48 without WS, 304 with WS), cardiac-triggered point-resolved spectroscopy (PRESS). ASSESSMENT Navigator-free data acquisition with retrospective phase-based gating was compared with prospective navigator-gating. Navigator-free acquisition was repeated in 10 subjects to assess reproducibility. Scan time was assessed for prospective and retrospective gating. Retrospective phase-based gating was performed using a threshold based on the standard deviation (SD) of individual water (W) and triglyceride (TG) phases. STATISTICAL TESTS T-tests and Bland-Altman analysis. RESULTS The duration of the prospective navigator-gated scans ranged from 6:09 minutes to 21:50 minutes (mean 10:05 ± 3:46 min, gating efficiency 40.4 ± 10.5%), while data acquisition for retrospective phase-based gating had a fixed scan time of 11:44 minutes. Retrospective phase-based gating using a threshold of 1 × SD yielded a gating efficiency of 72.7 ± 4.3% and a coefficient of variation (CoV) of triglyceride-to-water ratios of 9.8% compared with the navigated reference. The intrasubject reproducibility of retrospective gating revealed a CoV of 9.5%. DATA CONCLUSION Cardiac proton MRS employing retrospective phase-based gating is feasible and provides reproducible assessment of TG/W in a fixed scan time. Since scan time is independent of respiratory motion, retrospective phase-based gating offers an approach to motion compensation with predictable exam time for proton MRS of the heart. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1973-1981.
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Affiliation(s)
- Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Sophie M Peereboom
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Florian Boenner
- Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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