1
|
Ameri P, Mercurio V, Pollesello P, Anker MS, Backs J, Bayes-Genis A, Borlaug BA, Burkhoff D, Caravita S, Chan SY, de Man F, Giannakoulas G, González A, Guazzi M, Hassoun PM, Hemnes AR, Maack C, Madden B, Melenovsky V, Müller OJ, Papp Z, Pullamsetti SS, Rainer PP, Redfield MM, Rich S, Schiattarella GG, Skaara H, Stellos K, Tedford RJ, Thum T, Vachiery JL, van der Meer P, Van Linthout S, Pruszczyk P, Seferovic P, Coats AJS, Metra M, Rosano G, Rosenkranz S, Tocchetti CG. A roadmap for therapeutic discovery in pulmonary hypertension associated with left heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Pulmonary Circulation & Right Ventricular Function. Eur J Heart Fail 2024. [PMID: 38639017 DOI: 10.1002/ejhf.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF.
Collapse
Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova, Genoa, Italy
- Cardiac, Thoracic, and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Piero Pollesello
- Content and Communication, Branded Products, Orion Pharma, Espoo, Finland
| | - Markus S Anker
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin (Campus CBF), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, University Hospital Heidelberg, University of Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
- Department of Cardiology, Istituto Auxologico Italiano IRCCS Ospedale San Luca, Milan, Italy
| | - Stephen Y Chan
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Frances de Man
- PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aránzazu González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain
- CIBERCV, Madrid, Spain
| | - Marco Guazzi
- University of Milan, Milan, Italy
- Cardiology Division, San Paolo University Hospital, Milan, Italy
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cristoph Maack
- Comprehensive Heart Failure Center (CHFC) and Medical Clinic I, University Clinic Würzburg, Würzburg, Germany
| | | | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Oliver J Müller
- Department of Internal Medicine V, University Hospital Schleswig-Holstein, and German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Soni Savai Pullamsetti
- Department of Internal Medicine and Excellence Cluster Cardio-Pulmonary Institute (CPI), Justus-Liebig University, Giessen, Germany
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
| | | | - Stuart Rich
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gabriele G Schiattarella
- Max-Rubner Center (CMR), Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Hall Skaara
- Pulmonary Hypertension Association Europe, Vienna, Austria
| | - Kostantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Heidelberg and Mannheim, Germany
- Department of Cardiology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Jean Luc Vachiery
- Department of Cardiology, Hopital Universitaire de Bruxelles Erasme, Brussels, Belgium
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité, BIH Center for Regenerative Therapies, University of Medicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK, partner site Berlin), Berlin, Germany
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade University Medical Center, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Stephan Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
| |
Collapse
|
2
|
Verheyen N, Batzner A, Zach D, Zirlik A, Gerull B, Stoerk S, Maack C, Seggewiss H, Morbach C. Quantification of systolic anterior motion of the mitral valve to predict left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with hypertrophic cardiomyopathy (HCM), left ventricular outflow tract obstruction (LVOTO) is associated with an increased risk of heart failure and death (1). It is typically caused by dynamic systolic anterior motion (SAM) of the mitral valve leaflet. SAM can be categorized by echocardiography but diagnostic accuracy is limited by high inter-observer variability.
Purpose
To investigate the accuracy of echocardiographic parameters quantifying systolic motion of the mitral valve leaflets to identify LVOTO in patients with HCM.
Methods
We present a cross-sectional analysis of the HyperCard Registry, a prospective single-center cohort study enrolling consecutive patients with suspected or confirmed HCM. For the present analysis, patients with confirmed HCM and a valid standardized transthoracic echocardiographic were included. LVOT gradients were measured at rest and during Valsalva maneuver using continuous wave Doppler. In patients with clinical suspicion of dynamic LVOTO, further provocation maneuvers were conducted. LVOTO was defined as a maximal peak LVOT gradient ≥30 mmHg. Parameters quantifying systolic motion of the mitral valve were measured in parasternal and apical views, both at early and late systole, by an investigator blinded to individual patient characteristics. SAM was visually assessed and categorized into grade 0 (no SAM), I (leaflet motion towards LVOT), II (late systolic septal contact), and III (early systolic septal contact).
Results
We analyzed 142 patients (59±13 years, 42% women). LVOTO was present in 68 (48%) patients of whom 30 (21% of all) exhibited LVOTO at rest, and 38 (27% of all) had LVOTO only during provocation maneuvers (ie. dynamic LVOTO). SAM was present in 86 patients (60%) and had a sensivitiy, specificity and PPV of LVOTO of 91%, 69% and 73%, respectively (table). The late-systolic distance between mitral leaflet tip and anterior septum (TISls) measured in apical 3-chamber view was best associated with the degree of SAM (F=123, P<0.001), and with peak LVOT gradient (at rest: Pearson r=−0.817; during Valsalva maneuver: r=−0.816, both P<0.001). In ROC analyses (figure), the AUC of TISls for identification of LVOTO and dynamic LVOTO were 0.914 (95% CI 0.868–0.959) and 0.857 (0.786–0.927), respectively. TISls ≤14 mm had a 97% sensitivity for LVOTO and of 94% for dynamic LVOTO. TISls ≤9 mm showed specificity and PPV of 95% and 92% for LVOTO, and 94% and 83% for dynamic LVOTO, respectively.
Conclusions
Quantification of SAM by TISls showed high diagnostic accuracy in identifying HCM patients with LVOTO. Prospective studies are needed to assess the incremental benefit of this novel parameter in the diagnostic work-up of HCM patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Verheyen
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - A Batzner
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - D Zach
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - A Zirlik
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - B Gerull
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - S Stoerk
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - C Maack
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - H Seggewiss
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| | - C Morbach
- University Hospital of Wurzburg, Comprehensive Heart Failure Center , Würzburg , Germany
| |
Collapse
|
3
|
Bertero E, Robusto F, Rulli E, D‘Ettore A, Staszewsky L, Maack C, Lepore V, Latini R, Ameri P. P148 CANCER INCIDENCE AND MORTALITY ACCORDING TO PRE–EXISTING HEART FAILURE IN A COMMUNITY–BASED COHORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer–related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community–based cohort.
Methods
By reviewing the health care records of the Puglia region in Italy, we first selected the individuals ≥50–year–old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow–up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Drug–Derived Complexity Index, and follow–up duration. Cancer incidence and mortality were analyzed by Kaplan–Meier method and Cox regression models. Fine and Grey’s regression model was also used to compare cancer–specific mortality while taking into account the competing risk of non–cancer death.
Results
Overall, the mean age of the study population was 76±10 years and the mean follow–up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95%CI, 20.98–21.74) and 12.42 (95%CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95%CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95%CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95%CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95%CI 3.44–4.19) and ≥80 years (HR 3.10, 95%CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (subdistribution HR 3.48, 95%CI 3.27–3.72), as well as the interaction with age: <70 years of age: SHR 6.65, 95%CI 5.60–7.94; 70–80 years: SHR 3.14, 95%CI 2.84–3.48; and ≥80 years: SHR 2.81, 95%CI 2.55–3.10. The HF–related risk applied to the majority of cancer types. Interestingly, among HF patients a high consumption of loop diuretic (≥80 mg/d of furosemide equivalents for ≥30 days in the year before the index date) was associated with a higher mortality for cancer (HR 1.35, 95%CI 1.19–1.53 vs. ≤37.5 mg/d).
Conclusions
The analysis of this large community–based sample suggests that HF does portend an increased risk of cancer and cancer–related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes.
Collapse
Affiliation(s)
- E Bertero
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - F Robusto
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - E Rulli
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - A D‘Ettore
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - L Staszewsky
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - C Maack
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - V Lepore
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - R Latini
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| | - P Ameri
- DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF GENOVA, GENOVA, ITALY, GENOVA; ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI IRCCS, MILANO, ITALY, MILANO; OMPREHENSIVE HEART FAILURE CENTER (CHFC), UNIVERSITY CLINIC WÜRZBURG, 97078, WÜRZBURG, GERMANY, WÜRZBURG, GERMANY; OSPEDALE POLICLINICO SAN MARTINO, GENOVA
| |
Collapse
|
4
|
Batzner A, Seggewiss H, Hahn P, Sahiti F, Maack C, Gerull B, Stoerk S, Morbach C. Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): DFG
Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance.
Purpose
In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM.
Methods
We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient <30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments.
Results
In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p < 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups.
Conclusions
Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.
Collapse
Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - P Hahn
- University Hospital of Wurzburg, Wurzburg, Germany
| | - F Sahiti
- University Hospital of Wurzburg, Wurzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - B Gerull
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - S Stoerk
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - C Morbach
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| |
Collapse
|
5
|
Bertero E, Robusto F, Rulli E, D'Ettorre A, Staszewsky L, Maack C, Lepore V, Latini R, Ameri P. Cancer incidence and mortality according to pre-existing heart failure in a community-based cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer-related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community-based cohort.
Methods
By reviewing the health care records of the Puglia region in Italy, we first selected individuals ≥50-year-old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow-up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Charlson Comorbidity Index, Drug-Derived Complexity Index, and follow-up duration. Cancer incidence and mortality were analyzed by Kaplan-Meier method and Cox regression models. Fine and Grey's regression model was also used to compare cancer-specific mortality while taking into account the competing risk of non-cancer death.
Results
Overall, the mean age of the study population was 76±10 years and the mean follow-up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95% CI, 20.98–21.74) and 12.42 (95% CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95% CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95% CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95% CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95% CI 3.44–4.19) and ≥80 years (HR 3.10, 95% CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (HR 3.48, 95% CI 3.27–3.72), as well as the interaction with age: <70 years of age: HR 6.65, 95% CI 5.60–7.94; 70–80 years: HR 3.14, 95% CI 2.84–3.48; and ≥80 years: HR 2.81, 95% CI 2.55–3.10.
The HF-related risk applied to the majority of cancer types, with the exception of neoplasm of the male reproductive system. Interestingly, among HF patients a high consumption of loop diuretic (>37.5 mg/d of furosemide) was associated with a higher mortality for cancer (HR 1.34, 95% CI 1.26–1.42 vs. ≤37.5 mg/d).
Conclusions
The analysis of this large community-based sample suggests that HF does portend an increased risk of cancer and cancer-related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes. The risk of cancer may be heightened when HF is poorly compensated.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Cancer mortality in HF patient
Collapse
Affiliation(s)
- E Bertero
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| | - F Robusto
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - E Rulli
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - A D'Ettorre
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - L Staszewsky
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - V Lepore
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - R Latini
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - P Ameri
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| |
Collapse
|
6
|
Bertero E, Carmisciano L, Jonasson C, Maack C, Ameri P. Role of inflammation and comorbidities in the association of heart failure with incident cancer in the HUNT3 cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Conflicting data exist regarding the risk of cancer in patients with heart failure (HF). It was first reported that incident cancer is more common among patients with than without HF, whereas more recent studies indicate that this association is primarily driven by comorbidities. HF, cancer, and comorbidities, such as chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), share numerous risk factors, including a state of chronic low-grade inflammation reflected by elevated circulating levels of pro-inflammatory cytokines. The objective of this analysis was to assess whether chronic low-grade inflammation, as measured by levels of high-sensitivity C-reactive protein (hsCRP), and comorbidities mediate the association of HF with incident cancer.
Methods
We used data from the 3rd wave of the Nord-Trøndelag Health Study (HUNT3), a population-based study that enrolled 50,803 individuals ≥18-year-old between October 2006 and June 2008 in the Nord-Trøndelag County (Norway), from the Cancer Registry of Norway and from the administrative health care records of the same region. Associations between baseline characteristics and the development of cancer were assessed using Cox proportional hazards regression models, using time from HUNT3 enrollment as the time scale. Analyses were performed using R statistical software, version 4.0.2.
Results
In HUNT3, hsCRP was measured in 47,571 individuals at the time of enrollment. Of these, we excluded 2,308 patients because of missing information, leaving a cohort of 45,263 subjects. Figure 1 shows the characteristics of the study population at baseline stratified by hsCRP tertiles. The prevalence of cardiovascular disease, comorbidities, and obesity was progressively higher with increasing concentrations of hsCRP.
During a median follow-up of 12 years, there were 66/408 cases of incident cancer in patients with HF at baseline and 5,024/47,163 in subjects without HF, with a more than 2-fold (HR 2.30; 95% CI 1.80–2.93; p<0.001) increase in risk of developing cancer. After adjusting for age and sex, the excess risk decreased to 43% (HR 1.43; 95% CI 1.12–1.82). When including hsCRP in the model, the HF-related risk of cancer was 33% (HR 1.33; CI 1.04–1.70; p=0.022). Furthermore, when body mass index, CKD, COPD, and smoking and drinking habits were included in the model, the risk of cancer in HF patients compared to individuals without HF was no longer significant (HR 1.23; 95% CI 0.94–1.60; p=0.127). Age, male sex, hsCRP, COPD, obesity, and smoking habits were all associated with an increased risk of cancer (Figure 2).
Conclusions
The increased risk of cancer in HF patients compared with the general population is at least in part explained by concomitant inflammation and comorbidities.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Collapse
Affiliation(s)
- E Bertero
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| | - L Carmisciano
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| | - C Jonasson
- Norwegian University of Science and Technology, Trondheim, Norway
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - P Ameri
- San Martino Hospital, Department of Internal Medicine, Genova, Italy
| |
Collapse
|
7
|
Kazakov A, Hermann J, Jankowski V, Speer T, Maack C, Laufs U, Jankowski J, Boehm M, Werner C. Fibrotic remodeling of left ventricle in the murine remnant kidney model of chronic kidney disease is independent of arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac fibrosis and arterial hypertension are common in patients with chronic kidney disease (CKD). We studied the mechanisms of cardiac fibrogenesis and the role of blood pressure in mice with CKD.
Methods and results
10-week-old male C57/BL6N (BL6) and SV129 wildtype (WT) mice were underwent 5/6 nephrectomy (remnant kidney model, RKM) or sham operation for 10 weeks. RKM significantly elevated plasma creatinine and urea. RKM elicited both interstitial and replacement renal and left ventricular (LV) (BL6: SHAM 5.6±0.4%, RKM 7.3±0.7%, p=0.04; SV129: SHAM 6.0±0.5%, RKM 14±2%, p=0.001) fibrosis as assessed by picrosirius red staining. In parallel, the number of cardiac fibroblasts per mm2 (BL6: SHAM 36±4, RKM 85±13, p=0.001; SV129: SHAM 82±11, RKM 200±34, p=0.006) was increased in RKM mice. With regard to possible mechanisms, cardiac oxidative stress as shown by co-immunostaining for intracellular fibronectin and 8-hydroxyguanosine (BL6: SHAM 44±14%, RKM 60±24%, p=0.03; SV129: SHAM 51±6%, RKM 70±7%, p=0.04) and the percentage of CXCR4+ fibroblasts in the myocardium (BL6: SHAM 47±5%, RKM 62±4%, p=0.04; SV129: SHAM 63±5%, RKM 81±3%, p=0.005) were increased. Furthermore, the number of circulating CD45+ / collagen I+ fibrocytes (FACS) in the peripheral blood was increased by RKM in BL6 (SHAM 100±23%, RKM 443±252%, p=0.04) and diminished in SV129 (SHAM 100±19%, RKM 43±11%, p=0.01), while an opposite regulation was seen in the bone marrow. To further confirm the role of bone-marrow derived fibroblasts in renal and cardiac remodeling 10-week-old WT BL6 mice were subjected to transplantation of bone marrow from 10-week-old WT BL6 mice expressing green fluorescent protein (GFP)+ ubiquitously. 28 days later, RKM or SHAM-operation was performed. RKM significantly increased the number of GFP+ fibroblasts in kidney and LV-myocardium. CKD significantly decreased myocardial capillarization assessed by immunostaining for podocalyxin in both mouse lines. In parallel, myocardial protein expression of fibrosis regulators fibronectin, collagen I, CTGF and Hif1a were up-regulated and expression of the active form of eNOS (phospho-S1177) was reduced.
As a possible confounder, tail-cuff blood pressure was moderately enhanced (Ø 30mmHg) 9 weeks after nephrectomy. In a control experiment using the vasodilator hydralazine (250 mg/L/day), peripheral blood pressure was equalized in all 4 experimental groups, but the extent of LV fibrosis and expression of the above-mentioned fibrosis markers remained unchanged.
Conclusions
Chronic kidney disease in the RKM model elicits left ventricle fibrosis by increasing myocardial protein expression of fibrosis regulators, reduction of myocardial capillarization and mobilization / recruitment of circulating fibroblasts, independently of blood pressure.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Deutsche Forschungsgemeinschaft
Collapse
Affiliation(s)
- A Kazakov
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - J Hermann
- RWTH Aachen University, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | - V Jankowski
- RWTH Aachen University, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | - T Speer
- Saarland University Hospital, Department of Internal Medicine IV Nephrology and Hypertension, Homburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - U Laufs
- Leipzig University Hospital, Leipzig, Germany
| | - J Jankowski
- RWTH Aachen University, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | - M Boehm
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - C Werner
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| |
Collapse
|
8
|
Morbach C, Gelbrich G, Tiffe T, Eichner FA, Christa M, Mattern R, Breunig M, Cejka V, Wagner M, Heuschmann PU, Störk S, Frantz S, Maack C, Ertl G, Fassnacht M, Wanner C, Leyh R, Volkmann J, Deckert J, Faller H, Jahns R. Prevalence and determinants of the precursor stages of heart failure: results from the population-based STAAB cohort study. Eur J Prev Cardiol 2020; 28:924-934. [DOI: 10.1177/2047487320922636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 12/16/2022]
Abstract
Abstract
Aims
Prevention of heart failure relies on the early identification and control of risk factors. We aimed to identify the frequency and characteristics of individuals at risk of heart failure in the general population.
Methods and Results
We report cross-sectional data from the prospective Characteristics and Course of Heart Failure Stages A–B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of Würzburg, Germany. Sampling was stratified 1:1 for sex and 10:27:27:27:10 for age groups of 30–39/40–49/50–59/60–69/70–79 years. Heart failure precursor stages were defined according to American College of Cardiology/American Heart Association: stage A (risk factors for heart failure), stage B (asymptomatic cardiac dysfunction). The main results were internally validated in the second half of the participants. The derivation sample comprised 2473 participants (51% women) with a distribution of 10%/28%/25%/27%/10% in respective age groups. Stages A and B were prevalent in 42% and 17% of subjects, respectively. Of stage B subjects, 31% had no risk factor qualifying for stage A (group ‘B-not-A’). Compared to individuals in stage B with A criteria, B-not-A were younger, more often women, and had left ventricular dilation as the predominant B qualifying criterion (all P < 0.001). These results were confirmed in the validation sample (n = 2492).
Conclusion
We identified a hitherto undescribed group of asymptomatic individuals with cardiac dysfunction predisposing to heart failure, who lacked established heart failure risk factors and therefore would have been missed by conventional primary prevention. Further studies need to replicate this finding in independent cohorts and characterise their genetic and -omic profile and the inception of clinically overt heart failure in subjects of group B-not-A.
Collapse
Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Germany
| | - Theresa Tiffe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Felizitas A Eichner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Martin Christa
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Renate Mattern
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kazakov A, Hall R, Weber SN, Trouvain A, Lammert F, Maack C, Boehm M, Laufs U, Werner C. P4997Raf kinase inhibitor protein of the bone marrow contributes to cardiac fibrogenesis in pressure-overloaded myocardium. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Raf Kinase Inhibitor Protein (RKIP) regulates myocardial remodeling under conditions of enhanced myocardial oxidative stress in pressure-overloaded left ventricle (LV) modulating myocardial production of reactive oxygen species (ROS). A second mode of action may be the mobilization of circulating fibroblasts (fibrocytes) from the bone-marrow (BM). However the underlying mechanisms are incompletely understood.
Methods and results
To further characterize the role of RKIP in BM cells for myocardial remodeling 10-week-old wild-type (WT) C57BL/6N mice were subjected to transplantation of bone marrow (BMT) from 10-week-old C57BL/6-RKIP-deficient (RKIP−/−) N or WT C57BL/6N mice expressing green fluorescent protein (GFP)+ ubiquitously. 28 days later, transverse aortic constriction (TAC, 360 μm) or SHAM-operation was performed. 5 weeks post TAC, LV systolic pressure (LVSP) and heart weight to tibia length ratio were significantly increased in both types of BMT, compared with corresponding SHAM. Increased afterload elicited myocardial fibrosis as assessed by picrosirius red staining (WT/WT SHAM 15±2.5%, WT/WT TAC 21.3±1.4%, p<0.05; RKIP−/−/WT SHAM 17±2%, RKIP−/−/WT TAC 18±3%, p=ns) and significantly increased the number of LV fibroblasts per mm2 estimated by immunostaining for intracellular fibronectin, which were further reduced by transplantation of RKIP−/−N BM (WT/WT SHAM 5499±313, WT/WT TAC 7493±741 per mm2, p<0.05; RKIP−/−/WT SHAM 5737±259, RKIP−/−/WT TAC 5282±551, per mm2, p=ns). Moreover, transplantation of RKIP−/−N BM significantly diminished the number of circulating BM-derived GFP+ fibroblasts in the peripheral blood and LV myocardium during pressure overload (WT/WT SHAM 961±129, WT/WT TAC 2326±273 per mm2, p<0.05; RKIP−/−/WT SHAM 1041±209, RKIP−/−/WT TAC 1518±107, per mm2, p=ns). The myocardial redox status was assessed by the co-immunostaining for ROS production marker 8-hydroxyguanosin (8-dOHG), cardiomyocyte marker α-sarcomeric actin and fibroblast marker intracellular fibronectin. Pressure overload during 5 weeks significantly increased the percentages of 8-dOHG+cardiomyocytes (WT/WT SHAM 34±9%, WT/WT TAC 63±6%, p<0.05; RKIP−/−/WT SHAM 29±6%, RKIP−/−/WT TAC 31±8%, p=ns) and 8-dOHG+fibroblasts (WT/WT SHAM 57±6%, WT/WT TAC 73±4%, p<0.05; RKIP−/−/WT SHAM 58±2%, RKIP−/−/WT TAC 58±7%, p=ns) in mice transplanted with WT BM but not with RKIP−/−N BM.
Conclusions
In pressure-overload induced enhanced myocardial ROS production, deficiency of RKIP-expression in the bone marrow abrogates left ventricular fibrosis by reduction of myocardial ROS production and mobilization of BM-derived fibroblasts. These findings suggest that the function of RKIP in the bone marrow may be important for maladaptive myocardial remodelling.
Acknowledgement/Funding
Deutsche Forschungsgemeinschaft: KA4024/3-1, SFB TRR219; Saarland University HOMFOR, Dr. Marija Orlovich foundation, Corona foundation s199/10060/2014
Collapse
Affiliation(s)
- A Kazakov
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - R Hall
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - S N Weber
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - A Trouvain
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - F Lammert
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Hepatology Endocrinology, Diabetology and Nutr, Homburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Department of translational research, Wurzburg, Germany
| | - M Boehm
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - U Laufs
- Leipzig University Hospital, Leipzig, Germany
| | - C Werner
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| |
Collapse
|
10
|
Morbach C, Gelbrich G, Tiffe T, Eichner F, Wagner M, Heuschmann PU, Störk S, Frantz S, Maack C, Ertl G, Fassnacht M, Wanner C, Leyh R, Volkmann J, Deckert J, Faller H, Jahns R. Variations in cardiovascular risk factors in people with and without migration background in Germany - Results from the STAAB cohort study. Int J Cardiol 2018; 286:186-189. [PMID: 30420145 DOI: 10.1016/j.ijcard.2018.10.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/02/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND About 20% of the German population have a migration background which might influence prevalence of preventable cardiovascular risk factors (CVRF). METHODS We report data of the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of inhabitants of the City of Würzburg, Germany, aged 30 to 79 years. Individuals without migration background were defined as follows: German as native language, no other native language, and/or born in Germany. All other participants were defined as individuals with migration background. RESULTS Of 2473 subjects (51% female, mean age 54 ± 12 years), 291 (12%) reported a migration background: n = 107 (37%) from a country within the EU, n = 117 (40%) from Russia, and n = 67 (23%) from other countries. Prevalence of hypertension, atherosclerotic disease, and diabetes mellitus was similar in individuals with and without migration background. By contrast, prevalence of obesity and metabolic syndrome was significantly higher in individuals with migration background, with the least favourable profile apparent in individuals from Russia (individuals without vs. with migration background: obesity 19 vs. 24%, p < 0.05; odds ratio: EU: 1.6, Russia: 2.2*, other countries: 0.6; metabolic syndrome 18 vs. 21%, p < 0.05; odds ratio: EU: 1.2, Russia: 1.7*, other countries: 1.5; *p < 0.05). CONCLUSION Individuals with migration background in Germany might exhibit a higher CVRF burden due to a higher prevalence of obesity and metabolic syndrome. Strategies for primary prevention of heart failure may benefit from deliberately considering the migration background.
Collapse
Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center and Dept. of Medicine I, University Hospital and University of Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Theresa Tiffe
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Felizitas Eichner
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, and Clinical Trial Center, University of Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center and Dept. of Medicine I, University Hospital and University of Würzburg, Germany.
| | | | - S Frantz
- Dept. of Medicine I, Div. of Cardiology, University Hospital Würzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Germany
| | - G Ertl
- University Hospital Würzburg, Germany
| | - M Fassnacht
- Dept. of Medicine I, Div. of Endocrinology, University Hospital Würzburg, Germany
| | - C Wanner
- Dept. of Medicine I, University Hospital Würzburg, Germany
| | - R Leyh
- Dept. of Cardiovascular Surgery, University Hospital Würzburg, Germany
| | - J Volkmann
- Dept. of Neurology, University Hospital Würzburg, Germany
| | - J Deckert
- Dept. of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Germany
| | - H Faller
- Dept. of Medical Psychology, University of Würzburg, Germany
| | - R Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital Würzburg, Germany
| |
Collapse
|
11
|
Kazakov A, Hall RA, Werner C, Meier T, Trouvain A, Rodionycheva S, Lammert F, Maack C, Bohm M, Laufs U. P141Raf kinase inhibitor protein mediates myocardial fibrosis in pressure overload through the regulation of the nuclear expression of nuclear factor erythroid 2-related factor 2. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Kazakov
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - R A Hall
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Homburg, Germany
| | - C Werner
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - T Meier
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - A Trouvain
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - S Rodionycheva
- Saarland University Hospital, Department of Thoracic and Cardiovascular Surgery , Homburg, Germany
| | - F Lammert
- Saarland University Hospital, Department of Internal Medicine II, Gastroenterology, Homburg, Germany
| | - C Maack
- Deutsches Zentrum für Herzinsuffizienz Würzburg, Würzburg, Germany
| | - M Bohm
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - U Laufs
- University of Leipzig, Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
12
|
Godsman N, Kohlhaas M, Nickel A, Cheyne L, Dawson D, Maack C. P136Defective mitochondrial calcium uptake and energetic mismatch in a rat model of takotsubo cardiomyopathy. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N Godsman
- University of Aberdeen, Aberdeen, United Kingdom
| | - M Kohlhaas
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - A Nickel
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - L Cheyne
- University of Aberdeen, Aberdeen, United Kingdom
| | - D Dawson
- University of Aberdeen, Aberdeen, United Kingdom
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| |
Collapse
|
13
|
Linz D, Hohl M, Linz B, Khoshkish S, Maack C, Schotten U, Boehm M, Sanders P. P798Application of intermittent negative upper airway pressure as a novel rat model for obstructive sleep apnea and atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Linz
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Hohl
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - B Linz
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - S Khoshkish
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - C Maack
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - U Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - M Boehm
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| |
Collapse
|
14
|
Siede D, Rapti K, Gorska A, Katus H, Altmüller J, Boeckel J, Meder B, Maack C, Völkers M, Müller O, Backs J, Dieterich C. Identification of circular RNAs with host gene-independent expression in human model systems for cardiac differentiation and disease. J Mol Cell Cardiol 2017; 109:48-56. [DOI: 10.1016/j.yjmcc.2017.06.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 01/01/2023]
|
15
|
Kazakov A, Trouvain A, Hall R, Werner C, Rodionycheva S, Lammert F, Maack C, Lorenz K, Boehm M, Laufs U. P1585Fibrotic myocardial remodeling is regulated by rkip and nrf2 depending on redox status. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Linz D, Hohl M, Linz B, Nickel A, Maack C, Lau D, Sanders P. P455Simulated obstructive respiratory events, but not intermittent hypoxia alone, result in the development of an atrial arrhythmogenic substrate in a novel rat model for sleep apnea. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
17
|
Linz D, Hohl M, Lang L, Nickel A, Mayr M, Boehm M, Maack C, Sadowski T. P4485Serine carboxypeptidase cathepsin A is upregulated in cardiac disease and cleaves the extracellular superoxide dismutase. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Abstract
Acute pulmonary embolism (PE) still represents a challenge regarding a rapid diagnosis and a risk-adapted therapy. In the 2014 guidelines of the European Society of Cardiology (ESC) on the diagnosis and management of acute PE, several new recommendations have been issued based on new study data. Some established scores for risk stratification were developed further and there is now good evidence for the use of age-adjusted D-dimer cut-off levels. For the risk stratification in patients without clinical features of shock, the utilization of the pulmonary embolism severity index (PESI) and simplified PESI (sPESI) scores is recommended. In patients with intermediate risk, right ventricular morphology and function can be evaluated by computer tomography or echocardiography and biomarkers facilitate further risk stratification. For the treatment of patients with venous thromboembolism with or without PE, the non-vitamin K-dependent oral anticoagulants (NOACs) are a safe alternative to the standard anticoagulation regimen with heparin and vitamin K antagonists. Systemic thrombolytic therapy should be restricted to patients with high risk or intermediate high risk with hemodynamic instability. Finally, new recommendations for the diagnosis and therapy of patients with chronic thromboembolic pulmonary hypertension (CTEPH), with cancer or during pregnancy are given.
Collapse
Affiliation(s)
- J A Saar
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - C Maack
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | | |
Collapse
|
19
|
Puhl SL, Kazakov A, Müller A, Fries P, Wagner DR, Böhm M, Maack C, Devaux Y. Adenosine A1 receptor activation attenuates cardiac hypertrophy and fibrosis in response to α1 -adrenoceptor stimulation in vivo. Br J Pharmacol 2015; 173:88-102. [PMID: 26406609 DOI: 10.1111/bph.13339] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Adenosine has been proposed to exert anti-hypertrophic effects. However, the precise regulation and the role of the different adenosine receptor subtypes in the heart and their effects on hypertrophic signalling are largely unknown. We aimed to characterize expression and function of adenosine A1 receptors following hypertrophic stimulation in vitro and in vivo. EXPERIMENTAL APPROACH Pro-hypertrophic stimuli and adenosine A1 receptor stimulation of neonatal rat cardiomyocytes and male C57/Bl6 mice, sc. drug administration, real-time PCR, (3) [H]-leucine-incorporation assay, immunostaining, tissue staining, Western blots, gravimetric analyses and echocardiography were applied in this study. KEY RESULTS In neonatal rat cardiomyocyte cultures, phenylephrine, but not angiotensin II or insulin-like growth factor 1 (IGF1), up-regulated adenosine A1 receptors concentration-dependently. The hypertrophic phenotype (cardiomyocyte size, sarcomeric organization, total protein synthesis, c-fos expression) mediated by phenylephrine (10 μM), but not that by angiotensinII (1 μM) or IGF1 (20 ng·mL(-1) ), was counteracted by the selective A1 receptor agonist, N6-cyclopentyladenosine. In C57/BL6 mice, continuous N6-cyclopentyladenosine infusion (2 mg·kg(-1) ·day(-1) ; 21 days) blunted phenylephrine (120 mg·kg(-1) ·day(-1) ; 21 days) induced hypertrophy (heart weight, cardiomyocyte size and fetal genes), fibrosis, MMP 2 up-regulation and generation of oxidative stress - all hallmarks of maladaptive remodelling. Concurrently, phenylephrine administration increased expression of adenosine A1 receptors. CONCLUSIONS AND IMPLICATIONS We have presented evidence for a negative feedback mechanism attenuating pathological myocardial hypertrophy following α1 -adrenoceptor stimulation. Our results suggest adenosine A1 receptors as potential targets for therapeutic strategies to prevent transition from compensated myocardial hypertrophy to decompensated heart failure due to chronic cardiac pressure overload.
Collapse
Affiliation(s)
- S-L Puhl
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Kazakov
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Müller
- Klinik for interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - P Fries
- Klinik for interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - D R Wagner
- Luxembourg Institute of Health, Strassen, Luxembourg
| | - M Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - C Maack
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Y Devaux
- Luxembourg Institute of Health, Strassen, Luxembourg
| |
Collapse
|
20
|
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs J, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M. Corrigendum to: 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2015. [PMID: 26224077 DOI: 10.1093/eurheartj/ehu479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M. Corrigendum to:2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism:. Eur Heart J 2015; 36:2666. [DOI: 10.1093/eurheartj/ehv131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Maack C, Lee I, Molina C, Richter W, Wannenmacher N, Zimmer A, Qvigstad E, Fischmeister R, Conti M, Bohm M. Carvedilol sensitizes cardiac beta1-adrenergic receptors by increasing subsarcolemmal cAMP levels through ligand-induced dissociation of PDE4 from beta1-adrenergic receptors. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Lenski M, Schleider G, Adrian L, Kohlhaas M, Maack C, Boehm M, Laufs U. Cardiac metabolism during atrial fibrillation is characterized by increased lipid accumulation and glycogen synthesis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
Leone A, Aquila I, Vicinanza C, Iaconetti C, Bochicchio A, Ottolenghi S, Indolfi C, Nadal-Ginard B, Ellison GM, Torella D, Mias C, Genet G, Guilbeau-Frugier C, Pathak A, Senard JM, Gales C, Egorova AD, Khedoe PSJ, Goumans MTH, Nauli SM, Ten Dijke P, Poelmann RE, Hierck BP, Miragoli M, Lab MJ, Singh A, Sikkel M, Lyon A, Gorelik J, Cheung C, Bernardo AS, Trotter MW, Pedersen RA, Sinha S, Mioulane M, Foldes G, Harding SE, Reglin B, Secomb TW, Pries AR, Buckingham M, Lescroart F, Meilhac S, Le Garrec JF, Rozmaritsa N, Christ T, Wettwer E, Knaut M, Ravens U, Tokar S, Schobesberger S, Singh A, Wright PT, Miragoli M, Lyon AR, Sikkel M, Harding SE, Gorelik J, Van Mil A, Grundmann S, Goumans MJ, Jaksani S, Doevendans PA, Sluijter JP, Tijsen AJ, Amin AS, Giudicessi JR, Tanck MW, Bezzina CR, Creemers EE, Wilde AM, Ackerman MJ, Pinto YM, Gedicke-Hornung C, Behrens-Gawlik V, Khajetoorians D, Mearini G, Reischmann S, Geertz B, Voit T, Dreyfus P, Eschenhagen T, Carrier L, Duerr GD, Heinemann JC, Wenzel D, Ghanem A, Alferink JC, Zimmer A, Lutz B, Welz A, Fleischmann BK, Dewald O, Sbroggio' M, Bertero A, Giuliano L, Brancaccio M, Tarone G, Meiser M, Kohlhaas M, Chen Y, Csordas G, Dorn G, Maack C, Stapel B, Hoch M, Haghikia A, Fischer P, Maack C, Hilfiker-Kleiner D, Schroen B, Corsten M, Verhesen W, De Windt L, Pinto YM, Zacchigna S, Thum T, Carmeliet P, Papageorgiou A, Heymans S, Lunde IG, Finsen AV, Florholmen G, Skrbic B, Kvaloy H, Jarstadmarken HO, Sjaastad I, Tonnessen T, Carlson CR, Christensen G, Paavola J, Schliffke S, Rossetti S, Kuo I, Yuan S, Sun Z, Harris P, Torres V, Ehrlich B, Robinson P, Adams K, Zhang YH, Casadei B, Watkins H, Redwood C, Seneviratne AN, Cole JE, Goddard ME, Mohri Z, Cross AJ, Krams R, Monaco C, Everaert BR, Van Laere SJ, Hoymans VY, Timmermans JP, Vrints CJ. Oral abstract presentations & Young Investigators Competition. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Maier LS, Maack C, Ritter O, Böhm M. Hotline update of clinical trials and registries presented at the German Cardiac Society meeting 2008. Clin Res Cardiol 2008; 97:356-63. [DOI: 10.1007/s00392-008-0664-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 04/08/2008] [Indexed: 11/25/2022]
|
26
|
Cremers B, Maack C, Böhm M. [Preoperative risk evaluation in heart failure]. Internist (Berl) 2007; 48:921-8. [PMID: 17712539 DOI: 10.1007/s00108-007-1911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The primary target in preoperative risk evaluation is not to classify patients as operable or inoperable but rather to reduce perioperative morbidity and mortality. Indications for perioperative diagnostic and therapeutic procedures are mostly the same as for patients without subsequent non-cardiac surgery. However, the time schedule often depends on cofactors such as urgency and severity of surgical interventions. Perioperative risk management requires exceedingly good communication and collaboration between surgeons, anesthesiologists and internists and offers the chance to diagnose and treat perioperative risk factors in a justifiable time and cost context.
Collapse
Affiliation(s)
- B Cremers
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland.
| | | | | |
Collapse
|
27
|
Cremers B, Maack C, Böhm M. [Preoperative cardiovascular risk evaluation--therapy]. Dtsch Med Wochenschr 2004; 129:1260-4. [PMID: 15170584 DOI: 10.1055/s-2004-826861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B Cremers
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar.
| | | | | |
Collapse
|
28
|
Cremers B, Maack C, Böhm M. [Preoperative cardiovascular risk evaluation--case report]. Dtsch Med Wochenschr 2004; 129:1255. [PMID: 15170582 DOI: 10.1055/s-2004-826859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B Cremers
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar.
| | | | | |
Collapse
|
29
|
Cremers B, Maack C, Böhm M. [Preoperative cardiovascular risk evaluation--diagnosis]. Dtsch Med Wochenschr 2004; 129:1256-9. [PMID: 15170583 DOI: 10.1055/s-2004-826860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B Cremers
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar.
| | | | | |
Collapse
|
30
|
Cremers B, Maack C, Böhm M. Präoperative kardiovaskuläre Risikoeinschätzung - Quiz zur Zertifizierung. Dtsch Med Wochenschr 2004. [DOI: 10.1055/s-2004-826862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Böhm M, Maack C, Wehrlen-Grandjean M, Erdmann E. Effect of bisoprolol on perioperative complications in chronic heart failure after surgery (Cardiac Insufficiency Bisoprolol Study II (CIBIS II)). Z Kardiol 2003; 92:668-76. [PMID: 12955414 DOI: 10.1007/s00392-003-0959-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Accepted: 04/30/2003] [Indexed: 10/26/2022]
Abstract
In patients with coronary artery disease undergoing noncardiac surgery, beta-blockers decrease perioperative mortality and nonfatal myocardial infarction. It is presently unknown whether beta-blockers reduce perioperative risk in patients with chronic heart failure. Thus, data of the CIBIS II study were analyzed regarding the effect of bisoprolol on perioperative outcome in patients with moderate to severe heart failure. A total of 2647 patients with heart failure in New York Heart Association (NYHA) class III-IV and left ventricular ejection fraction < or =35% were randomized to bisoprolol or placebo in a double-blind randomized study. Of these patients, 165 underwent surgery (bisoprolol, n = 87; placebo, n = 78). In patients undergoing surgery, mortality was not different between the placebo- and bisoprolol-treated group (7.7% vs 5.8%, p = 0.76). Neither postoperative hospital admission (placebo, 24.4%; bisoprolol, 34.5%, p = 0.17) nor time to postoperative hospital admission (placebo, < or =30 days, n = 2; 31-180 days, n=11; >180 days, n = 6; bisoprolol, n = 9/ 10/11; p = 0.14) were reduced by bisoprolol. Compared to coronary artery disease, perioperative beta-blockade has little effect in patients with chronic heart failure. Therefore, a controlled randomized trial with perioperative beta-blocker treatment in heart failure patients is warranted to further test this hypothesis.
Collapse
Affiliation(s)
- M Böhm
- Universitätskliniken des Saarlandes, Medizinische Klinik und Poliklinik, Innere Medizin III, 66421 Homburg/Saar, Germany.
| | | | | | | |
Collapse
|
32
|
Maack C, Elter T, Nickenig G, LaRosee K, Crivaro M, Stäblein A, Wuttke H, Böhm M. Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. J Am Coll Cardiol 2001; 38:939-46. [PMID: 11583862 DOI: 10.1016/s0735-1097(01)01471-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study investigates the effects of a change of beta-adrenergic blocking agent treatment from metoprolol to carvedilol and vice versa in patients with heart failure (HF). BACKGROUND Beta-blockers improve ventricular function and prolong survival in patients with HF. It has recently been suggested that carvedilol has more pronounced effects on left ventricular ejection fraction (LVEF) compared with metoprolol. It is uncertain whether a change from one beta-blocker to the other is safe and leads to any change of left ventricular function. METHODS Forty-four patients with HF due to ischemic (n = 17) or idiopathic cardiomyopathy (n = 27) that had responded well to long-term treatment with either metoprolol (n = 20) or carvedilol (n = 24) were switched to an equivalent dose of the respective other beta-blocker. Before and six months after crossover of treatment, echocardiography, radionuclide ventriculography and dobutamine stress echocardiography were performed. RESULTS Six months after crossover of beta-blocker treatment, LVEF had further improved with both carvedilol and metoprolol (carvedilol: 32 +/- 3% to 36 +/- 4%; metoprolol: 27 +/- 4% to 30 +/- 5%; both p < 0.05 vs. baseline), without interindividual differences. There were no changes in either New York Heart Association functional class or any other hemodynamic parameters at rest. Dobutamine stress echocardiography revealed a more pronounced increase of heart rate after dobutamine infusion in metoprolol- compared with carvedilol-treated patients. After dobutamine infusion, LVEF increased in the carvedilol- but not in the metoprolol-treated group. CONCLUSIONS When switching treatment from one beta-blocker to the other, improvement of LVEF in patients with HF is maintained. Despite similar long-term effects on hemodynamics at rest, beta-adrenergic responsiveness is different in both treatments.
Collapse
Affiliation(s)
- C Maack
- Medizinische Klinik und Poliklinik, Innere Medizin III, Universitätskliniken des Saarlandes, Homburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Sympathetic activation is a significant predictor of a poor prognosis in heart failure. Excessive stimulation with norepinephrine produces apoptosis, tachycardia and arrhythmias thereby leading to progression of left ventricular dysfunction and worsening of outcome. Beta-blockers reduce morbidity and improve cardiac function. They have been shown to improve survival (MERIT-HF, CIBIS II and US-Carvedilol Trials). A careful uptitration of dosages is achievable with a low rate of side effects. The mechanism of beta-blocker effects in heart failure are cardiac protection from beta1-adrenoceptor overstimulation, antiarrhythmic effects, reduction in heart rate and positive energetic effects or a combination thereof.
Collapse
Affiliation(s)
- M Böhm
- Medizinische Klinik und Poliklinik der Universität des Saarlandes, Innere Medizin III, Homburg/Saar, Germany.
| | | |
Collapse
|
34
|
Maack C, Tyroller S, Schnabel P, Cremers B, Dabew E, Südkamp M, Böhm M. Characterization of beta(1)-selectivity, adrenoceptor-G(s)-protein interaction and inverse agonism of nebivolol in human myocardium. Br J Pharmacol 2001; 132:1817-26. [PMID: 11309254 PMCID: PMC1572729 DOI: 10.1038/sj.bjp.0703992] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Intrinsic activity and beta(1)-selectivity are important features of beta-blockers in the treatment of patients with coronary syndromes and heart failure. In human myocardium, intrinsic activity and beta(1)-selectivity of the novel beta-adrenoceptor antagonist nebivolol have not yet been determined. The study examines intrinsic activity, beta-adrenoceptor-G-protein coupling and beta(1)-selectivity of nebivolol and bisoprolol in human ventricular myocardium. Furthermore, intrinsic activity of both compounds is compared to the one of bucindolol, carvedilol and metoprolol in human atrial myocardium. Radioligand binding studies ([(125)I]-lodocyanopindolol) were performed on membrane preparations of human failing and nonfailing myocardium and on COS-7 cells transfected with human beta(1)- and beta(2)-adrenoceptors, respectively. Functional experiments were carried out on isolated muscle preparations of human left ventricular and right atrial myocardium from failing and nonfailing hearts. Radioligand binding studies reveal 3 - 4 fold beta(1)-selectivity for nebivolol and 16 - 20 fold beta(1)-selectivity for bisoprolol in human myocardium. In COS-7-cells, beta(1)-selectivity is 3 fold for nebivolol and 15 fold for bisoprolol. Neither the binding of nebivolol nor of bisoprolol is affected by the presence of guanylylimidodiphosphate (Gpp(NH)p). Nebivolol and bisoprolol exert similar inverse agonist activity in human ventricular as well as atrial myocardium. In atrial myocardium, inverse agonism of both compounds is higher compared to bucindolol, equal to carvedilol and lower compared to metoprolol. Favourable haemodynamic effects of nebivolol in humans are not due to beta(1)-selectivity or partial agonist activity of this agent. Other mechanisms, i.e. the production of nitric oxide, may thus be responsible for its unique haemodynamic profile.
Collapse
Affiliation(s)
- C Maack
- Innere Medizin III, Universität Homburg/Saar, Germany.
| | | | | | | | | | | | | |
Collapse
|
35
|
Flesch M, Ettelbrück S, Rosenkranz S, Maack C, Cremers B, Schlüter KD, Zolk O, Böhm M. Differential effects of carvedilol and metoprolol on isoprenaline-induced changes in beta-adrenoceptor density and systolic function in rat cardiac myocytes. Cardiovasc Res 2001; 49:371-80. [PMID: 11164847 DOI: 10.1016/s0008-6363(00)00277-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE beta-Blockers improve cardiac function and survival in heart failure patients. The underlying mechanisms are not completely elucidated. Differences between agents might be important for the development of more specific therapeutical approaches. This study investigated whether metoprolol or carvedilol alter beta-adrenergic signaling differently. METHODS beta-Adrenoceptor density and systolic function were determined in rat adult ventricular cardiac myocytes. RESULTS 12 h isoprenaline-treatment (Iso, 1 micromol/l) reduced beta-adrenoceptor density by 33% (P<0.01). The effect was abolished by incubation with isoprenaline plus metoprolol (3 micromol/l), but was more pronounced after coincubation with carvedilol (0.003 micromol/l, P<0.05 Carv vs. Iso). Metoprolol alone had no effect on beta-adrenoceptor density, but carvedilol induced a decrease in receptor density even in absence of isoprenaline (P<0.05 Carv vs. ctr.). The isoprenaline (0.0003-10 micromol/l) induced concentration-dependent increase in myocyte shortening was blunted after 12 h preincubation with Iso (1 micromol/l, P<0.001). This reduction was abolished or partly prevented by coincubation with metoprolol or carvedilol, respectively. Carvedilol decreased the number of receptors which had to be occupied by isoprenaline in order to obtain 50% and 90% increase in myocyte cell shortening. Comparison of guanine nucleotide-dependent binding characteristics of isoprenaline, carvedilol and metoprolol revealed beta-receptor agonist like binding characteristics for carvedilol, but antagonist like binding characteristics for metoprolol. CONCLUSION Metoprolol but not carvedilol prevents isoprenaline-induced downregulation of myocyte beta-adrenoceptors. The difference might be due to specific binding properties of the beta-blockers. Restoration of isoprenaline responsiveness by carvedilol might be due to improved coupling of beta-receptors to postreceptor effects.
Collapse
Affiliation(s)
- M Flesch
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50924, Cologne, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The human heart contains at least four distinct beta-adrenoceptor subtypes, three of which have been cloned. However, the binding properties of beta-blockers to the different beta-adrenoceptor subpopulations are not yet thoroughly characterized. Human beta1-, beta2- and beta3-adrenoceptors were expressed in COS-7 cells and [125I]iodocyanopindolol saturation binding, and competition experiments with commonly used beta-blockers were performed in the respective membrane preparations. Atenolol and metoprolol were about fivefold selective for beta1- versus beta2- and beta3-adrenoceptors. Bisoprolol was approximately 15-fold selective for beta1- versus beta2- and approximately 31-fold selective for beta1- versus beta3-adrenoceptors. Carvedilol was nonselective for any beta-adrenoceptor subtype. We conclude that the beta1-selectivities of atenolol, metoprolol, and bisoprolol are lower in COS cell membranes compared with previous investigations performed in native membranes. All beta-blockers investigated bind to beta3-adrenoceptors. Differential binding properties to beta3-adrenoceptors might imply different responses as to body weight, cardiac contractility, heart rate, and growth regulation. This might imply differential indications for the drugs investigated.
Collapse
MESH Headings
- Adrenergic beta-Antagonists/metabolism
- Animals
- Binding, Competitive/drug effects
- COS Cells
- DNA, Complementary/biosynthesis
- DNA, Complementary/genetics
- Humans
- In Vitro Techniques
- Iodocyanopindolol/metabolism
- Myocardium/metabolism
- Radioligand Assay
- Receptors, Adrenergic, beta-1/drug effects
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/drug effects
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Receptors, Adrenergic, beta-3/drug effects
- Receptors, Adrenergic, beta-3/genetics
- Receptors, Adrenergic, beta-3/metabolism
- Transfection
Collapse
Affiliation(s)
- P Schnabel
- Klinik III für Innere Medizin der Universität zu Köln, Cologne, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Maack C, Cremers B, Flesch M, Höper A, Südkamp M, Böhm M. Different intrinsic activities of bucindolol, carvedilol and metoprolol in human failing myocardium. Br J Pharmacol 2000; 130:1131-9. [PMID: 10882399 PMCID: PMC1572161 DOI: 10.1038/sj.bjp.0703400] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
1. Clinical studies have shown different effects of beta-blockers on the beta-adrenergic system, tolerability and outcome in patients with heart failure. 2. The study examines beta-adrenoceptor-G-protein coupling and intrinsic activity of bucindolol, carvedilol and metoprolol in human ventricular myocardium. 3. Radioligand binding studies ([(125)I]-Iodocyanopindolol) were performed in membrane preparations of human failing and nonfailing myocardium. Functional experiments were carried out in isolated muscle preparations of human left ventricular myocardium from failing hearts. 4. Bucindolol and carvedilol bound non-selectively to beta(1)- and beta(2)-adrenoceptors and exerted guanine nucleotide modulatable binding. Metoprolol was 35-fold beta(1)-selective and lacked guanine nucleotide modulatable binding. 5. All beta-blockers antagonized isoprenaline-induced enhancement of contractility. 6. In preparations in which the coupling of the stimulatory G-protein to adenylate cyclase was facilitated by forskolin, bucindolol increased force of contraction in three and decreased it in five experiments. Carvedilol increased force in one and decreased it in six experiments. Metoprolol decreased force in all experiments by 89. 4+/-2.2% (P<0.01 metoprolol vs carvedilol and bucindolol). The negative inotropic effect of metoprolol was antagonized by bucindolol. 7. It is concluded that differences in intrinsic activity can be detected in human myocardium and have an impact on cardiac contractility. In human ventricular myocardium, bucindolol displays substantially higher intrinsic activity than metoprolol and carvedilol. Bucindolol can behave as partial agonist or partial inverse agonist depending on the examined tissue. 8. Differences in intrinsic activity may contribute to differences in beta-adrenoceptor regulation and possibly to differences in tolerability and outcomes of patients with heart failure.
Collapse
Affiliation(s)
- C Maack
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
| | - B Cremers
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
| | - M Flesch
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
| | - A Höper
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
| | - M Südkamp
- Klinik für Herzund Thoraxchirurgie der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
| | - M Böhm
- Klinik III für Innere Medizin der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany
- Author for correspondence:
| |
Collapse
|
38
|
Abstract
This study explores the main changes gained from Guided Imagery and Music (GIM) therapy as described by former clients. It also explores whether gains are integrated into the clients' lives and if those changes stabilize over periods of time after finishing GIM therapy. Questionnaires were sent to GIM therapists who forwarded them to former GIM clients. Twenty-five former GIM clients returned questionnaires directly to the researcher. Results show that the main gains reported by former clients of GIM therapy are (a) getting more in touch with one's emotions, (b) gaining insights into some problems, (c) spiritual growth, (d) increased relaxation, and (e) discovering new parts of oneself. Results also show that GIM therapy might be helpful for clients with symptoms of anxiety and/or fear, and for clients who want to increase their self-esteem. Changes gained during GIM therapy appear to stabilize over a period of time after finishing GIM therapy. They improved after termination of therapy, especially in the mental and transpersonal areas.
Collapse
Affiliation(s)
- C Maack
- Institut f&uulm;r k&oulm;rperorientierte Psychotherapie, Hamburg, Germany
| | | |
Collapse
|
39
|
Abstract
BACKGROUND We examined the effects of hydroxyl radicals (OH.) on human myocardial contractility and on sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) activity and the effects of the beta-receptor antagonists metoprolol, carvedilol, and its metabolite BM-910228. METHODS AND RESULTS Isometric force of contraction was determined in isolated human myocardium. H(2)O(2) 1 mmol/L and Fe(3+)-nitrilotriacetic acid (Fe(3+)-NTA) 0.1 mmol/L used for generation of OH. induced a decrease in basal force of contraction and an increase in diastolic tension in atrial and left ventricular myocardial preparations. After challenge with OH., the maximum positive inotropic response to Ca(2+) 1.8 to 15 mmol/L was decreased by 60% and by 39%, respectively. The effects of OH. could be blocked by catalase. Carvedilol and its metabolite BM-910228 attenuated the OH.-induced impairment of the inotropic response to Ca(2+) in atrial myocardial preparations. Metoprolol had no significant effect. The stimulation frequency (0.5 to 3.0 Hz)-dependent increase in force of contraction and decrease in diastolic tension were abolished after exposure of atrial trabeculae to OH. In parallel, SERCA activity was decreased by OH. concentration-dependently, as determined in myocardial membrane preparations. BM-910228 partially restored the force-frequency relationship and preserved SERCA activity. CONCLUSIONS OH. radicals induce an impairment of contraction and relaxation and an attenuation of the force-frequency relationship in human myocardium accompanied by an inhibition of SERCA. Carvedilol and BM-910228 partly prevented OH.-induced contractile dysfunction. These observations could explain the improvement of ejection fraction in heart failure trials with carvedilol without a restoration of beta-adrenergic receptor density.
Collapse
Affiliation(s)
- M Flesch
- Klinik III für Innere Medizin and Klinik für Herz- und Thoraxchirurgie (M.S.) der Universität zu Köln, Cologne, Germany
| | | | | | | | | | | |
Collapse
|
40
|
Schnabel P, Mies F, Maack C, Rosenkranz S, Zolk O, Böhm M. Beneficial effects of amiodarone in heart failure: interaction with beta-adrenoceptors rather than G proteins. Eur J Pharmacol 1999; 369:391-4. [PMID: 10225379 DOI: 10.1016/s0014-2999(99)00101-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effect of the antiarrhythmic drug amiodarone on the human myocardial beta-adrenoceptor-G protein-adenylyl cyclase signalling cascade was investigated. Amiodarone had no effect on myocardial G proteins and maximal adenylyl cyclase activity, but acted as a beta-adrenoceptor antagonist. This mechanism might be at least partially responsible for the beneficial effects of the drug in patients with arrhythmia and heart failure.
Collapse
Affiliation(s)
- P Schnabel
- Klinik III für Innere Medizin der Universität zu Köln, Cologne, Germany
| | | | | | | | | | | |
Collapse
|
41
|
Böhm M, Castellano M, Flesch M, Maack C, Moll M, Paul M, Schiffer F, Zolk O. Chamber-specific alterations of norepinephrine uptake sites in cardiac hypertrophy. Hypertension 1998; 32:831-7. [PMID: 9822440 DOI: 10.1161/01.hyp.32.5.831] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The present study investigated local differences of sympathetic activation and sympathetic neuroeffector defects in nonhypertrophied right and hypertrophied left ventricles in a rat model with renin-induced pressure overload [TG(mREN2)27]. As judged from the depletion of myocardial norepinephrine stores, sympathetic activation was more pronounced in the left than in the right ventricles. In addition, norepinephrine uptake1 carrier sites were reduced in left but unchanged in right ventricles. Gene expression of the carrier was unchanged in stellate ganglia. An increase of Gialpha expression and a heterologous adenylyl cyclase desensitization occurred only in the left but not in the right ventricles, whereas a reduction of beta-adrenergic receptors was observed in both chambers. We concluded that general sympathetic activation can lead to beta-adrenoceptor downregulation but that pressure overload further increases sympathetic activation involving norepinephrine uptake mechanisms in the left ventricles, resulting in heterologous beta-adrenergic desensitization.
Collapse
Affiliation(s)
- M Böhm
- Klinik III für Innere Medizin der Universität zu Köln, Köln, and the Institut für Klinische Pharmakologie und Toxikologie der Freien Universität Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Böhm M, Ettelbrück S, Flesch M, van Gilst WH, Knorr A, Maack C, Pinto YM, Paul M, Teisman AC, Zolk O. Beta-adrenergic signal transduction following carvedilol treatment in hypertensive cardiac hypertrophy. Cardiovasc Res 1998; 40:146-55. [PMID: 9876327 DOI: 10.1016/s0008-6363(98)00099-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Treatment with the beta-blocker carvedilol leads to an improvement of outcome and ejection fraction in heart failure. These effects occur without affecting the number of beta-adrenergic receptors, as determined in right ventricular biopsies from patients with heart failure. This study was aimed at investigating the effects of carvedilol on beta-adrenergic signal transduction alterations in a model of left ventricular pressure overload, which is characterized by sympathetic activation and a desensitized beta-adrenergic signal transduction. METHODS Transgenic rats with overexpression of renin [TG(mREN2)27] were treated with carvedilol (30 micrograms/kg) or held under control conditions and were compared with Sprague-Dawley rats. Myocardial beta-adrenoceptors (125I-labeled iodocyanopindolol binding), Gi alpha (pertussis toxin labeling), Gs alpha-activity (reconstitution into cyc--S49 membranes) and adenylyl cyclase activity were measured. Blood pressure and heart rate, increase in heart rate during sacrifice and pressure rate products were determined. RESULTS beta-Adrenoceptors were downregulated and Gi alpha-protein levels were significantly increased, producing a desensitization of basal, isoprenaline- and guanine nucleotide-stimulated adenylyl cyclase activity compared to controls. Carvedilol reduced heart rate, blood pressure and pressure rate product in TG(mREN2)27. Carvedilol did not restore biochemical alterations, but even further reduced beta-adrenoceptor numbers and adenylyl cyclase. It exhibited a two affinity state, guanine nucleotide-sensitive binding to cardiac beta-adrenergic receptors similar to isoprenaline but different from metoprolol. CONCLUSIONS Carvedilol did not restore beta-adrenergic signal transduction at concentrations producing antiadrenergic effects in vivo. This effect might be due to an atypical guanine nucleotide-dependent interaction with beta-adrenergic receptors. Thus, ancillary properties could explain the recently reported beneficial effects in patients with heart failure independent from an upregulation of beta-adrenergic receptors.
Collapse
Affiliation(s)
- M Böhm
- Klinik III für Innere Medizin der Universität zu Köln, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Booth BA, Boes M, Andress DL, Dake BL, Kiefer MC, Maack C, Linhardt RJ, Bar K, Caldwell EE, Weiler J. IGFBP-3 and IGFBP-5 association with endothelial cells: role of C-terminal heparin binding domain. Growth Regul 1995; 5:1-17. [PMID: 7538367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IGFBP-3 and IGFBP-5, but not the other 4 IGF binding proteins, specifically bound to endothelial cell (EC) monolayers. Charged compounds, such as heparin and heparan sulfate, competed for this binding. Of the 6 IGFBPs, IGFBP-3 and IGFBP-5 had the greatest heparin affinity. Peptides of 18 amino acids were synthesized, corresponding to a common basic region of IGFBP-3 (P3), IGFBP-5 and IGFBP-6 (P6) which contained a heparin binding sequence. P3 and P6 inhibited IGFBP-3 and -5 binding to endothelial cell monolayers and the peptides bound directly to EC extracellular matrix. This suggested that the C-terminal basic segment of IGFBP-3/-5 is important for the association of the binding protein with the EC monolayer.
Collapse
Affiliation(s)
- B A Booth
- Veterans Administration Medical Center, Department of Internal Medicine, Iowa City 52246, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|