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Liang LW, Ladanyi A, Kennel PJ, Axsom KM, Sayer GT, Takeda K, Sekulic M, Uriel N, Drakos S, Colombo PC, Yuzefpolskaya M. Myocardial Recovery With HeartMate 3 Left Ventricular Assist Device: An Attainable Goal That Needs Better Precision. ASAIO J 2024; 70:e65-e68. [PMID: 37963291 DOI: 10.1097/mat.0000000000002099] [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: 11/16/2023] Open
Abstract
Despite advances in our understanding of myocardial recovery among left ventricular assist device (LVAD) patients, with 10-30% of patients achieving substantial myocardial improvement, the rates of LVAD support cessation remain extremely low (1-2%). These numbers are in stark contrast to clinical trial data where successful LVAD cessation is reported in up to 47% of patients. The majority of LVAD programs lack structured recovery programs and targeted protocols, likely underscoring the heterogeneity that exists among LVAD patients with myocardial recovery. This perspective summarizes the current medical and surgical challenges with respect to 1) identifying the appropriate candidates for LVAD cessation; 2) methods to wean LVAD support; 3) reviewing surgical techniques for cessation of current generation HeartMate 3 LVAD; and 4) approaching shared decision making for LVAD cessation between patients and providers given the uncertainties that remain in the field.
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Affiliation(s)
- Lusha W Liang
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Annamaria Ladanyi
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Peter J Kennel
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kelly M Axsom
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Gabriel T Sayer
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Koji Takeda
- Division of Thoracic and Cardiac Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nir Uriel
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Stavros Drakos
- Department of Medicine, Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melana Yuzefpolskaya
- From the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
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2
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Liao X, Kennel PJ, Liu B, Nash TR, Zhuang RZ, Godier-Furnemont AF, Xue C, Lu R, Colombo PC, Uriel N, Reilly MP, Marx SO, Vunjak-Novakovic G, Topkara VK. Effect of mechanical unloading on genome-wide DNA methylation profile of the failing human heart. JCI Insight 2023; 8:161788. [PMID: 36656640 PMCID: PMC9977498 DOI: 10.1172/jci.insight.161788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Heart failure (HF) is characterized by global alterations in myocardial DNA methylation, yet little is known about the epigenetic regulation of the noncoding genome and potential reversibility of DNA methylation with left ventricular assist device (LVAD) therapy. Genome-wide mapping of myocardial DNA methylation in 36 patients with HF at LVAD implantation, 8 patients at LVAD explantation, and 7 nonfailing (NF) donors using a high-density bead array platform identified 2,079 differentially methylated positions (DMPs) in ischemic cardiomyopathy (ICM) and 261 DMPs in nonischemic cardiomyopathy (NICM). LVAD support resulted in normalization of 3.2% of HF-associated DMPs. Methylation-expression correlation analysis yielded several protein-coding genes that are hypomethylated and upregulated (HTRA1, FBXO16, EFCAB13, and AKAP13) or hypermethylated and downregulated (TBX3) in HF. A potentially novel cardiac-specific super-enhancer long noncoding RNA (lncRNA) (LINC00881) is hypermethylated and downregulated in human HF. LINC00881 is an upstream regulator of sarcomere and calcium channel gene expression including MYH6, CACNA1C, and RYR2. LINC00881 knockdown reduces peak calcium amplitude in the beating human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). These data suggest that HF-associated changes in myocardial DNA methylation within coding and noncoding genomes are minimally reversible with mechanical unloading. Epigenetic reprogramming strategies may be necessary to achieve sustained clinical recovery from heart failure.
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Affiliation(s)
- Xianghai Liao
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Peter J Kennel
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Bohao Liu
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Trevor R Nash
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Richard Z Zhuang
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | | | - Chenyi Xue
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Rong Lu
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Muredach P Reilly
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | - Steven O Marx
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
| | | | - Veli K Topkara
- Division of Cardiology, Columbia University Irving Medical Center - New York Presbyterian, New York, New York, USA
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Chiu L, Jairam MP, Chow R, Chiu N, Shen M, Alhassan A, Lo CH, Chen A, Kennel PJ, Poterucha TJ, Topkara VK. Erratum to 'Meta-Analysis of Point-of-Care Lung Ultrasonography Versus Chest Radiography in Adults With Symptoms of Acute Decompensated Heart Failure' The American Journal of Cardiology Volume 174, 1 July 2022, Pages 89-95. Am J Cardiol 2022; 180:173. [PMID: 36064260 DOI: 10.1016/j.amjcard.2022.08.016] [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: 11/30/2022]
Affiliation(s)
- Leonard Chiu
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Ronald Chow
- Temerity Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Chiu
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Max Shen
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Adam Alhassan
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chun-Han Lo
- Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Austin Chen
- Columbia University, Vagelos College of Physicians and Surgeons, Columbia University, Department of Medicine, New York, NY
| | - Peter J Kennel
- New York Presbyterian Hospital/Columbia University Irving Medical Center, Columbia University, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Timothy J Poterucha
- New York Presbyterian Hospital/Columbia University Irving Medical Center, Columbia University, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Veli K Topkara
- New York Presbyterian Hospital/Columbia University Irving Medical Center, Columbia University, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
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Chiu L, Jairam MP, Chow R, Chiu N, Shen M, Alhassan A, Lo CH, Chen A, Kennel PJ, Poterucha TJ, Topkara VK. Meta-Analysis of Point-of-Care Lung Ultrasonography Versus Chest Radiography in Adults With Symptoms of Acute Decompensated Heart Failure. Am J Cardiol 2022; 174:89-95. [PMID: 35504747 DOI: 10.1016/j.amjcard.2022.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 12/26/2022]
Abstract
Acute decompensated heart failure (ADHF) is a primary cause of older adults presenting to the emergency department with acute dyspnea. Point-of-care lung ultrasound (LUS) has shown comparable or superior diagnostic accuracy in comparison with a chest x-ray (CXR) in patients presenting with symptoms of ADHF. The systematic review and meta-analysis aimed to elucidate the sensitivity and specificity of LUS in comparison with CXR for diagnosing ADHF and summarize the rapidly growing body of evidence in this domain. A total of 5 databases were searched through February 18, 2021, to identify observational studies that reported on the use of LUS compared with CXR in diagnosing ADHF in patients presenting with shortness of breath. Meta-analysis was conducted on the sensitivities and specificities of each diagnostic method. A total of 8 studies reporting on 2,787 patients were included in this meta-analysis. For patients presenting with signs and symptoms of ADHF, LUS was found to be more sensitive than CXR (91.8% vs 76.5%) and more specific than CXR (92.3% vs 87.0%) for the detection of cardiogenic pulmonary edema. In conclusion, LUS is more sensitive and specific than CXR in detecting pulmonary edema. This highlights the importance of sonographic B-lines, along with the accurate interpretation of clinical data, in the diagnosis of ADHF. In addition to its convenience, reduced costs, and reduced radiation exposure, LUS should be considered an effective alternative to CXR for evaluating patients with dyspnea in the setting of ADHF.
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Kennel PJ, Rosenblum H, Axsom KM, Alishetti S, Brener M, Horn E, Kirtane AJ, Lin E, Griffin JM, Maurer MS, Burkhoff D, Sayer G, Uriel N. Remote Cardiac Monitoring in Patients With Heart Failure: A Review. JAMA Cardiol 2021; 7:556-564. [PMID: 34964805 DOI: 10.1001/jamacardio.2021.5090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/25/2022]
Abstract
Importance Heart failure (HF) is often characterized by an insidious disease course leading to frequent rehospitalizations and a high use of ambulatory care. Remote cardiac monitoring is a promising approach to detect worsening HF early and intervene prior to an overt decompensation. Observations Recently, a multitude of novel technologies for remote cardiac monitoring (RCM) in patients with HF have been developed and are undergoing clinical trials. This development has been accelerated by the COVID-19 pandemic. Conclusions and Relevance This review summarizes the major clinical trials on RCM in patients with HF and present the most recent developments in noninvasive and invasive RCM technologies.
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Affiliation(s)
- Peter J Kennel
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Hannah Rosenblum
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Kelly M Axsom
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Shudhanshu Alishetti
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Michael Brener
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Evelyn Horn
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York.,Division of Cardiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Edward Lin
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Jan M Griffin
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York
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Kennel PJ, Schulze PC. A Review on the Evolving Roles of MiRNA-Based Technologies in Diagnosing and Treating Heart Failure. Cells 2021; 10:cells10113191. [PMID: 34831414 PMCID: PMC8617680 DOI: 10.3390/cells10113191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/24/2022] Open
Abstract
MiRNA-regulated processes are pivotal in cardiovascular homeostasis and disease. These short non-coding RNAs have ideal properties that could be utilized as potential biomarkers; moreover, their functions as post-transcriptional regulators of mRNA make them interesting therapeutic targets. In this review, we summarize the current state of miRNA-based biomarkers in a variety of diseases leading to heart failure, as well as provide an outlook on developing miRNA-based therapies in the heart failure field.
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Kennel PJ, Lumish H, Kaku Y, Fried J, Kirtane AJ, Karmpaliotis D, Takayama H, Naka Y, Sayer G, Uriel N, Takeda K, Masoumi A. A case series analysis on the clinical experience of Impella 5.5® at a large tertiary care centre. ESC Heart Fail 2021; 8:3720-3725. [PMID: 34402210 PMCID: PMC8497328 DOI: 10.1002/ehf2.13512] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 07/04/2021] [Indexed: 11/06/2022] Open
Abstract
Aims We aimed to detail the early clinical experience with pVAD 5.5 at a large academic medical centre. Impella® 5.5 (Abiomed) is a temporary peripherally inserted left ventricular assist device (pVAD) used for the treatment of cardiogenic shock (CS). This system has several modifications aimed at improving deliverability and durability over the pVAD 5.0 system, but real‐world experience with this device remains limited. Methods and results We collected clinical and outcome data on all patients supported with pVAD 5.5 at our centre between February and December 2020, including procedural and device‐related complications. Fourteen patients with pVAD 5.5 were included. Aetiology of CS was acute myocardial infarction (n = 6), decompensated heart failure (n = 6), suspected myocarditis (n = 1), and post‐cardiotomy CS (n = 1). Four patients received pVAD 5.5 after being on inotropes alone, two were escalated from intra‐aortic balloon pump, two were escalated from pVAD CP, and six patients were transitioned to pVAD 5.5 from extracorporeal membrane oxygenation. Median duration of pVAD 5.5 support was 12 (interquartile range 7, 25) days. Complications included axillary insertion site haematoma (n = 3), acute kidney injury (n = 3), severe thrombocytopenia (n = 1), and stroke (n = 1). No valve injury or limb complications occurred. Survival to device explant for recovery or transition to another therapy was 11/14 (79%) patients. Conclusions In this early experience of the pVAD 5.5, procedural and device‐related complications were observed but were manageable, and overall survival was high in this critically ill cohort, particularly when the device was used as a bridge to other therapies.
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Affiliation(s)
- Peter J Kennel
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Heidi Lumish
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Justin Fried
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA.,Division of Cardiology, Cardiovascular Research Foundation, New York, NY, USA
| | - Dimitri Karmpaliotis
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
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Kennel PJ, Yahi A, Naka Y, Mancini DM, Marboe CC, Max K, Akat K, Tuschl T, Vasilescu EM, Zorn E, Tatonetti NP, Schulze PC. Longitudinal profiling of circulating miRNA during cardiac allograft rejection: a proof-of-concept study. ESC Heart Fail 2021; 8:1840-1849. [PMID: 33713567 PMCID: PMC8120386 DOI: 10.1002/ehf2.13238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS Allograft rejection following heart transplantation (HTx) is a serious complication even in the era of modern immunosuppressive regimens and causes up to a third of early deaths after HTx. Allograft rejection is mediated by a cascade of immune mechanisms leading to acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR). The gold standard for monitoring allograft rejection is invasive endomyocardial biopsy that exposes patients to complications. Little is known about the potential of circulating miRNAs as biomarkers to detect cardiac allograft rejection. We here present a systematic analysis of circulating miRNAs as biomarkers and predictors for allograft rejection after HTx using next-generation small RNA sequencing. METHODS AND RESULTS We used next-generation small RNA sequencing to investigate circulating miRNAs among HTx recipients (10 healthy controls, 10 heart failure patients, 13 ACR, and 10 AMR). MiRNA profiling was performed at different time points before, during, and after resolution of the rejection episode. We found three miRNAs with significantly increased serum levels in patients with biopsy-proven cardiac rejection when compared with patients without rejection: hsa-miR-139-5p, hsa-miR-151a-5p, and hsa-miR-186-5p. We identified miRNAs that may serve as potential predictors for the subsequent development of ACR: hsa-miR-29c-3p (ACR) and hsa-miR-486-5p (AMR). Overall, hsa-miR-486-5p was most strongly associated with acute rejection episodes. CONCLUSIONS Monitoring cardiac allograft rejection using circulating miRNAs might represent an alternative strategy to invasive endomyocardial biopsy.
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Affiliation(s)
- Peter J. Kennel
- Division of Cardiology, Department of MedicineColumbia UniversityNew YorkNYUSA
- Department of Medicine I, Division of CardiologyUniversity Hospital of Friedrich Schiller University JenaAm Klinikum 1Jena07747Germany
| | - Alexandre Yahi
- Department of Biomedical InformaticsColumbia UniversityNew YorkNYUSA
- Department of Systems BiologyColumbia UniversityNew YorkNYUSA
- Department of MedicineColumbia UniversityNew YorkNYUSA
| | | | | | - Charles C. Marboe
- Department of Pathology and Cell BiologyColumbia UniversityNew YorkNYUSA
| | - Klaas Max
- Laboratory of RNA Molecular BiologyRockefeller UniversityNew YorkNYUSA
| | - Kemal Akat
- Laboratory of RNA Molecular BiologyRockefeller UniversityNew YorkNYUSA
| | - Thomas Tuschl
- Laboratory of RNA Molecular BiologyRockefeller UniversityNew YorkNYUSA
| | | | - Emmanuel Zorn
- Columbia Center for Translational ImmunologyColumbia UniversityNew YorkNYUSA
| | - Nicholas P. Tatonetti
- Department of Biomedical InformaticsColumbia UniversityNew YorkNYUSA
- Department of Systems BiologyColumbia UniversityNew YorkNYUSA
- Department of MedicineColumbia UniversityNew YorkNYUSA
| | - Paul Christian Schulze
- Department of Medicine I, Division of CardiologyUniversity Hospital of Friedrich Schiller University JenaAm Klinikum 1Jena07747Germany
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Kennel PJ, Raza F, Kim J, Singh P, Borczuk A, Krishnan U, Karas M, Sobol I. A case series on inflammatory cardiomyopathy and suspected cardiac sarcoidosis: role of cardiac PET in management. Eur Heart J Case Rep 2020; 4:1-9. [PMID: 32974478 DOI: 10.1093/ehjcr/ytaa146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022]
Abstract
Background Presentation of life-threatening arrhythmias concomitantly with a new-onset non-ischaemic cardiomyopathy raises concern for an inflammatory cardiomyopathy such as cardiac sarcoidosis or cardiac manifestations of connective tissue disease. Comprehensive workup for specific aetiologies may be unrevealing except for signs of myocardial inflammation identified on cardiac positron emission tomography (PET). Here, we present five cases of such subjects and their clinical course. Case summary We collected clinical, imaging, pathological, and follow-up data of five subjects presenting with arrhythmias and unexplained new-onset cardiomyopathy. Mean age was 56.2 ± 5.8 years. Three subjects presented with ventricular tachycardia and two with atrial arrhythmias. Echocardiography showed a mean left ventricular ejection fraction of 37 ± 9%. Significant coronary artery disease was ruled out in all cases as the cause of the cardiomyopathy. All patients underwent cardiac magnetic resonance imaging (MRI) and PET scan at presentation and follow-up. In all patients, cardiac MRI revealed hyperenhancement in epicardial and mid-myocardial pattern in a non-coronary distribution, while PET scan revealed fluorodeoxyglucose (FDG) mismatch defects in multiple foci in a non-coronary distribution. Right ventricular biopsy was obtained in all patients and revealed interstitial fibrosis and cardiomyocyte hypertrophy. On median follow-up of 210 days, all subjects had improvement in both heart failure symptoms and arrhythmias and repeat PET in four out of five patients showed decreased inflammation. Discussion A high level of suspicion for inflammatory cardiomyopathy is needed in patients presenting with new unexplained cardiomyopathy and arrhythmias. A cardiac FDG-PET should be considered for diagnosis if cardiac inflammation is in the differential. This can inform further decisions regarding targeted immunomodulation therapy that may be helpful in this cohort.
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Affiliation(s)
- Peter J Kennel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Farhan Raza
- Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
| | - Parmanand Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
| | - Alain Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
| | - Udhay Krishnan
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
| | - Maria Karas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
| | - Irina Sobol
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, New York City, NY 10021, USA
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10
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Saxon DT, Kennel PJ, Guyer HM, Goyal P, Hummel SL, Konerman MC. Specialty-Based Variability in Diagnosing and Managing Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2020; 95:669-675. [PMID: 32247341 DOI: 10.1016/j.mayocp.2019.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 05/28/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To quantify differences in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF) between cardiologists and noncardiologists, who often diagnose and manage HFpEF. METHODS Cardiologists and noncardiologists (internal medicine, medicine/pediatrics, family medicine, geriatrics) were anonymously surveyed between January 16, 2018, and March 2, 2018, regarding practices related to diagnosing and managing HFpEF at the University of Michigan and Weill Cornell Medical Center. Response data were compared using χ2 analysis. RESULTS Of 1010 physicians surveyed, 211 completed a significant portion of the survey: 32 cardiologists and 179 noncardiologists. Most noncardiologists were unaware of HFpEF diagnostic guidelines and commonly used left ventricular diastolic dysfunction and natriuretic peptides to diagnose HFpEF. Noncardiologists (32.3%, n=52) were less likely than cardiologists (64.5%, n= 20) to prescribe an aldosterone antagonist for HFpEF (P=.001). Both groups reported similar use of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and exercise programs. Noncardiologists were more likely to refer patients with HFrEF to cardiology (63.1%, n=111) compared with patients with HFpEF (33.5%, n=59; P<.001). Noncardiologists were more likely to discuss prognosis and goals of care with patients with HFrEF (84.4%, n=151) than with patients with HFpEF (65.9%, n=118; P<.001). CONCLUSION Cardiologists and noncardiologists vary significantly in their HFpEF diagnosis and treatment practices. As diagnostic criteria continue to be evaluated for HFpEF, dissemination of these guidelines to noncardiologists, with an emphasis on the morbidity and mortality associated with HFpEF, is imperative.
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Affiliation(s)
- David T Saxon
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Peter J Kennel
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Heidi M Guyer
- Survey Research Center, University of Michigan, Ann Arbor, MI; RTI International, Durham, NC
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
| | - Matthew C Konerman
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
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Kennel PJ, Liao X, Saha A, Ji R, Zhang X, Castillero E, Brunjes D, Takayama H, Naka Y, Thomas T, George I, Mancini D, Schulze PC. Impairment of Myocardial Glutamine Homeostasis Induced By Suppression of the Amino Acid Carrier SLC1A5 in Failing Myocardium. Circ Heart Fail 2019; 12:e006336. [DOI: 10.1161/circheartfailure.119.006336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Affiliation(s)
- Peter J. Kennel
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Germany (P.J.K., P.C.S.)
| | - Xianghai Liao
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
| | - Amit Saha
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
| | - Ruiping Ji
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
| | - Xiaokan Zhang
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
| | - Estibaliz Castillero
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons (E.C., H.T., Y.N., I.G.)
| | - Danielle Brunjes
- Division of Cardiology (P.J.K., X.L., A.S., R.J., X.Z., D.B.)
- Mount Sinai Heart, New York (D.B., D.M.)
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons (E.C., H.T., Y.N., I.G.)
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons (E.C., H.T., Y.N., I.G.)
| | - Tiffany Thomas
- Department of Pathology and Cell Biology (T.T.), Columbia University, New York, NY
| | - Isaac George
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons (E.C., H.T., Y.N., I.G.)
| | | | - P. Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Germany (P.J.K., P.C.S.)
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12
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Kennel PJ, Kneifati-Hayek J, Bryan J, Banerjee S, Sobol I, Lachs MS, Safford MM, Goyal P. Prevalence and determinants of Hyperpolypharmacy in adults with heart failure: an observational study from the National Health and Nutrition Examination Survey (NHANES). BMC Cardiovasc Disord 2019; 19:76. [PMID: 30935411 PMCID: PMC6444677 DOI: 10.1186/s12872-019-1058-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF. Methods We studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003–2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF. Results The prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy. Conclusion Hyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
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Affiliation(s)
- Peter J Kennel
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Joanna Bryan
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Samprit Banerjee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Irina Sobol
- Division of Cardiology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Parag Goyal
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA. .,Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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13
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Derda AA, Pfanne A, Bär C, Schimmel K, Kennel PJ, Xiao K, Schulze PC, Bauersachs J, Thum T. Blood-based microRNA profiling in patients with cardiac amyloidosis. PLoS One 2018; 13:e0204235. [PMID: 30332417 PMCID: PMC6192556 DOI: 10.1371/journal.pone.0204235] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/17/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Amyloidosis is caused by dysregulation of protein folding resulting in systemic or organ specific amyloid aggregation. When affecting the heart, amyloidosis can cause severe heart failure, which is associated with a high morbidity and mortality. Different subtypes of cardiac amyloidosis exist e.g. transthyretin cardiac amyloidosis and senile cardiac amyloidosis. Today, diagnostics is primarily based on cardiac biopsies and no clinically used circulating blood-based biomarkers existing. Therefore, our aim was to identify circulating microRNAs in patients with different forms of amyloidosis. Methods Blood was collected from healthy subjects (n = 10), patients with reduced ejection fraction (EF < 35%; n = 10), patients affected by transthyretin cardiac amyloidosis (n = 13) as well as senile cardiac amyloidosis (n = 11). After performing TaqMan array profiling, promising candidates, in particular miR-99a-5p, miR-122-5p, miR-27a-3p, miR-221-3p, miR-1180-3p, miR-155-5p, miR-339-3p, miR-574-3p, miR-342-3p and miR-329-3p were validated via quantitative real time PCR. Results The validation experiments revealed a significant upregulation of miR-339-3p in patients affected with senile cardiac amyloidosis compared to controls. This corresponded to the array profiling results. In contrast, there was no deregulation in the other patient groups. Conclusion MiR-339-3p was increased in blood of patients with senile cardiac amyloidosis. Therefore, miR-339-3p is a potential candidate as biomarker for senile cardiac amyloidosis in future studies. Larger patient cohorts should be investigated.
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Affiliation(s)
- Anselm A. Derda
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Angelika Pfanne
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Katharina Schimmel
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Peter J. Kennel
- Division of Cardiology, Columbia University Medical Center, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Ke Xiao
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - P. Christian Schulze
- Division of Cardiology, Columbia University Medical Center, New York, New York, United States of America
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany
- Imperial College London, NHLI London, United Kingdom
- * E-mail:
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Kennel PJ, Kneifati-Hayek J, Bryan J, Mehta K, Banerjee S, Sobol I, Safford M, Goyal P. Prevalence and Determinants of Hyperpolypharmacy in Adults with Heart Failure. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.096] [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: 11/26/2022]
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15
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Birati EY, Hanff TC, Maldonado D, Grandin EW, Kennel PJ, Mazurek JA, Vorovich E, Seigerman M, Howard JLL, Acker MA, Naka Y, Wald J, Goldberg LR, Jessup M, Atluri P, Margulies KB, Schulze PC, Rame JE. Predicting Long Term Outcome in Patients Treated With Continuous Flow Left Ventricular Assist Device: The Penn-Columbia Risk Score. J Am Heart Assoc 2018. [PMID: 29514805 PMCID: PMC5907534 DOI: 10.1161/jaha.117.006408] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Predicting which patients are unlikely to benefit from continuous flow left ventricular assist device (LVAD) treatment is crucial for the identification of appropriate patients. Previously developed scoring systems are limited to past eras of device or restricted to specific devices. Our objective was to create a risk model for patients treated with continuous flow LVAD based on the preimplant variables. Methods and Results We performed a retrospective analysis of all patients implanted with a continuous flow LVAD between 2006 and 2014 at the University of Pennsylvania and included a total of 210 patients (male 78%; mean age, 56±15; mean follow‐up, 465±486 days). From all plausible preoperative covariates, we performed univariate Cox regression analysis for covariates affecting the odds of 1‐year survival following implantation (P<0.2). These variables were included in a multivariable model and dropped if significance rose above P=0.2. From this base model, we performed step‐wise forward and backward selection for other covariates that improved power by minimizing Akaike Information Criteria while maximizing the Harrell Concordance Index. We then used Kaplan–Meier curves, the log‐rank test, and Cox proportional hazard models to assess internal validity of the scoring system and its ability to stratify survival. A final optimized model was identified based on clinical and echocardiographic parameters preceding LVAD implantation. One‐year mortality was significantly higher in patients with higher risk scores (hazard ratio, 1.38; P=0.004). This hazard ratio represents the multiplied risk of death for every increase of 1 point in the risk score. The risk score was validated in a separate patient cohort of 260 patients at Columbia University, which confirmed the prognostic utility of this risk score (P=0.0237). Conclusion We present a novel risk score and its validation for prediction of long‐term survival in patients with current types of continuous flow LVAD support.
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Affiliation(s)
- Edo Y Birati
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas C Hanff
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawn Maldonado
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - E Wilson Grandin
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Peter J Kennel
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Jeremy A Mazurek
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Esther Vorovich
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Seigerman
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica L L Howard
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Acker
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yoshifumi Naka
- Division of Cardiovascular Surgery, Columbia University Medical Center, New York, NY
| | - Joyce Wald
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lee R Goldberg
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mariell Jessup
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kenneth B Margulies
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Christian Schulze
- Division of Cardiology, Columbia University Medical Center, New York, NY.,Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany
| | - J Eduardo Rame
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
Muscle weakness and atrophy are key characteristics of the aging adult but can also be found in chronically ill patients with heart failure, cancer, renal failure, and chronic infectious diseases all associated with an accelerated level of muscle dysfunction. Reduced physical activity levels and exercise intolerance increase muscle loss and decrease quality of life in both the aging and heart failure populations. The purpose of this review is to provide an overview of the effects of aging and heart failure on skeletal muscle function and how exercise training can improve long-term outcomes associated with skeletal muscle dysfunction.
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Affiliation(s)
- Danielle L Brunjes
- Department of Internal Medicine I Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, Jena, 07747, Germany
| | - Peter J Kennel
- Department of Internal Medicine I Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, Jena, 07747, Germany
| | - P Christian Schulze
- Department of Internal Medicine I Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, Jena, 07747, Germany.
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17
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Zhang X, Ji R, Liao X, Castillero E, Kennel PJ, Brunjes DL, Franz M, Möbius-Winkler S, Drosatos K, George I, Chen EI, Colombo PC, Schulze PC. MicroRNA-195 Regulates Metabolism in Failing Myocardium Via Alterations in Sirtuin 3 Expression and Mitochondrial Protein Acetylation. Circulation 2018; 137:2052-2067. [PMID: 29330215 DOI: 10.1161/circulationaha.117.030486] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [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: 12/14/2016] [Accepted: 12/11/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart failure leads to mitochondrial dysfunction and metabolic abnormalities of the failing myocardium coupled with an energy-depleted state and cardiac remodeling. The mitochondrial deacetylase sirtuin 3 (SIRT3) plays a pivotal role in the maintenance of mitochondrial function through regulating the mitochondrial acetylome. It is interesting to note that unique cardiac and systemic microRNAs have been shown to play an important role in cardiac remodeling by modulating key signaling elements in the myocardium. METHODS Cellular signaling was analyzed in human cardiomyocyte-like AC16 cells, and acetylation levels in rodent models of SIRT3-/-and transgenic microRNA-195 (miR-195) overexpression were compared with wild type. Luciferase assays, Western blotting, immunoprecipitation assays, and echocardiographic analysis were performed. Enzymatic activities of pyruvate dehydrogenase (PDH) and ATP synthase were measured. RESULTS In failing human myocardium, we observed induction of miR-195 along with decreased expression of the mitochondrial deacetylase SIRT3 that was associated with increased global protein acetylation. We further investigated the role of miR-195 in SIRT3-mediated metabolic processes and its impact on regulating enzymes involved in deacetylation. Proteomic analysis of the total acetylome showed increased overall acetylation, and specific lysine acetylation of 2 central mitochondrial metabolic enzymes, PDH and ATP synthase, as well. miR-195 downregulates SIRT3 expression through direct 3'-untranslated region targeting. Treatments with either sirtuin inhibitor nicotinamide, small interfering RNA-mediated SIRT3 knockdown or miR-195 overexpression enhanced acetylation of PDH complex and ATP synthase. This effect diminished PDH and ATP synthase activity and impaired mitochondrial respiration.SIRT3-/- and miR-195 transgenic mice consistently showed enhanced global protein acetylation, including PDH complex and ATP synthase, associated with decreased enzymatic activity. CONCLUSIONS Altogether, these data suggest that increased levels of miR-195 in failing myocardium regulate a novel pathway that involves direct SIRT3 suppression and enzymatic inhibition via increased acetylation of PDH and ATP synthase that are essential for cardiac energy metabolism.
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Affiliation(s)
- Xiaokan Zhang
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - Xianghai Liao
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - Estibaliz Castillero
- Department of Surgery, Columbia University Medical Center, New York, NY (E.C., I.G.)
| | - Peter J Kennel
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - Danielle L Brunjes
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - Marcus Franz
- Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (M.F., S.M.-W., P.C.S.)
| | - Sven Möbius-Winkler
- Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (M.F., S.M.-W., P.C.S.)
| | - Konstantinos Drosatos
- Metabolic Biology Laboratory, Department of Pharmacology, Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (K.D.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, NY (E.C., I.G.)
| | - Emily I Chen
- Department of Pharmacology, Columbia University Medical Center, New York, NY (E.I.C.).,Proteomics Shared Resource at the Herbert Irving Comprehensive Cancer Center, New York, NY (E.I.C.)
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.)
| | - P Christian Schulze
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (X.Z., R.J., X.L., P.J.K., D.L.B., P.C.C., P.C.S.). .,Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (M.F., S.M.-W., P.C.S.)
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18
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Ji R, Akashi H, Drosatos K, Liao X, Jiang H, Kennel PJ, Brunjes DL, Castillero E, Zhang X, Deng LY, Homma S, George IJ, Takayama H, Naka Y, Goldberg IJ, Schulze PC. Increased de novo ceramide synthesis and accumulation in failing myocardium. JCI Insight 2017; 2:96203. [PMID: 28724803 DOI: 10.1172/jci.insight.96203] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Kennel PJ, Saha A, Maldonado DA, Givens R, Brunjes DL, Castillero E, Zhang X, Ji R, Yahi A, George I, Mancini DM, Koller A, Fine B, Zorn E, Colombo PC, Tatonetti N, Chen EI, Schulze PC. Serum exosomal protein profiling for the non-invasive detection of cardiac allograft rejection. J Heart Lung Transplant 2017; 37:409-417. [PMID: 28789823 DOI: 10.1016/j.healun.2017.07.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Exosomes are cell-derived circulating vesicles that play an important role in cell-cell communication. Exosomes are actively assembled and carry messenger RNAs, microRNAs and proteins. The "gold standard" for cardiac allograft surveillance is endomyocardial biopsy (EMB), an invasive technique with a distinct complication profile. The development of novel, non-invasive methods for the early diagnosis of allograft rejection is warranted. We hypothesized that the exosomal proteome is altered in acute rejection, allowing for a distinction between non-rejection and rejection episodes. METHODS Serum samples were collected from heart transplant (HTx) recipients with no rejection, acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of serum exosome was performed using a mass spectrometer (Orbitrap Fusion Tribrid). RESULTS Principal component analysis (PCA) revealed a clustering of 3 groups: (1) control and heart failure (HF); (2) HTx without rejection; and (3) ACR and AMR. A total of 45 proteins were identified that could distinguish between groups (q < 0.05). Comparison of serum exosomal proteins from control, HF and non-rejection HTx revealed 17 differentially expressed proteins in at least 1 group (q < 0.05). Finally, comparisons of non-rejection HTx, ACR and AMR serum exosomes revealed 15 differentially expressed proteins in at least 1 group (q < 0.05). Of these 15 proteins, 8 proteins are known to play a role in the immune response. Of note, the majority of proteins identified were associated with complement activation, adaptive immunity such as immunoglobulin components and coagulation. CONCLUSIONS Characterizing of circulating exosomal proteome in different cardiac disease states reveals unique protein expression patterns indicative of the respective pathologies. Our data suggest that HTx and allograft rejection alter the circulating exosomal protein content. Exosomal protein analysis could be a novel approach to detect and monitor acute transplant rejection and lead to the development of predictive and prognostic biomarkers.
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Affiliation(s)
- Peter J Kennel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Department of Medicine, Weill-Cornell Medical College, New York, New York, USA; Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Amit Saha
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Dawn A Maldonado
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Raymond Givens
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Danielle L Brunjes
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Estibaliz Castillero
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Xiaokan Zhang
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Ruiping Ji
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Alexandre Yahi
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Donna M Mancini
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Mount Sinai Heart, New York, New York, USA
| | - Antonius Koller
- The Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, USA
| | - Barry Fine
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Nicholas Tatonetti
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Emily I Chen
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York, USA; Department of Pharmacology, Columbia University Medical Center, New York, New York, USA
| | - P Christian Schulze
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA; Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany.
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Vest AR, Kennel PJ, Maldonado D, Young JB, Mountis MM, Naka Y, Colombo PC, Mancini DM, Starling RC, Schulze PC. Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002881. [PMID: 27623768 DOI: 10.1161/circheartfailure.115.002881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/20/2015] [Accepted: 08/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125-150 mg/dL, 67-85 mg/dL, 32-42 mg/dL, and 97-126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212-0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092-0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. CONCLUSIONS Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.).
| | - Peter J Kennel
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Dawn Maldonado
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - James B Young
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Maria M Mountis
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Donna M Mancini
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Randall C Starling
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - P Christian Schulze
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
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21
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Ji R, Akashi H, Drosatos K, Liao X, Jiang H, Kennel PJ, Brunjes DL, Castillero E, Zhang X, Deng LY, Homma S, George IJ, Takayama H, Naka Y, Goldberg IJ, Schulze PC. Increased de novo ceramide synthesis and accumulation in failing myocardium. JCI Insight 2017; 2:82922. [PMID: 28469091 PMCID: PMC5414571 DOI: 10.1172/jci.insight.82922] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/21/2017] [Indexed: 01/26/2023] Open
Abstract
Abnormal lipid metabolism may contribute to myocardial injury and remodeling. To determine whether accumulation of very long-chain ceramides occurs in human failing myocardium, we analyzed myocardial tissue and serum from patients with severe heart failure (HF) undergoing placement of left ventricular assist devices and controls. Lipidomic analysis revealed increased total and very long-chain ceramides in myocardium and serum of patients with advanced HF. After unloading, these changes showed partial reversibility. Following myocardial infarction (MI), serine palmitoyl transferase (SPT), the rate-limiting enzyme of the de novo pathway of ceramide synthesis, and ceramides were found increased. Blockade of SPT by the specific inhibitor myriocin reduced ceramide accumulation in ischemic cardiomyopathy and decreased C16, C24:1, and C24 ceramides. SPT inhibition also reduced ventricular remodeling, fibrosis, and macrophage content following MI. Further, genetic deletion of the SPTLC2 gene preserved cardiac function following MI. Finally, in vitro studies revealed that changes in ceramide synthesis are linked to hypoxia and inflammation. In conclusion, cardiac ceramides accumulate in the failing myocardium, and increased levels are detectable in circulation. Inhibition of de novo ceramide synthesis reduces cardiac remodeling. Thus, increased de novo ceramide synthesis contributes to progressive pathologic cardiac remodeling and dysfunction.
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Affiliation(s)
- Ruiping Ji
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Hirokazu Akashi
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Konstantinos Drosatos
- Metabolic Biology Laboratory, Temple University School of Medicine, Center for Translational Medicine, Department of Pharmacology, Philadelphia, Pennsylvania, USA
| | - Xianghai Liao
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Hongfeng Jiang
- Division of Preventive Medicine and Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Peter J Kennel
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Danielle L Brunjes
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | | | - Xiaokan Zhang
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Lily Y Deng
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac J George
- Division of Cardiothoracic Surgery, Department of Surgery
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery
| | - Ira J Goldberg
- Division of Preventive Medicine and Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,Division of Endocrinology, Diabetes and Metabolism, New York University Langone Medical Center, New York, New York, USA
| | - P Christian Schulze
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA.,Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
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22
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See SB, Clerkin KJ, Kennel PJ, Zhang F, Weber MP, Rogers KJ, Chatterjee D, Vasilescu ER, Vlad G, Naka Y, Restaino SW, Farr MA, Topkara VK, Colombo PC, Mancini DM, Schulze PC, Levin B, Zorn E. Ventricular assist device elicits serum natural IgG that correlates with the development of primary graft dysfunction following heart transplantation. J Heart Lung Transplant 2017; 36:862-870. [PMID: 28431981 DOI: 10.1016/j.healun.2017.03.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pre-transplant sensitization is a limiting factor in solid-organ transplantation. In heart transplants, ventricular assist device (VAD) implantation has been associated with sensitization to human leukocyte antigens (HLA). The effect of VAD on non-HLA antibodies is unclear. We have previously shown that polyreactive natural antibodies (Nabs) contribute to pre-sensitization in kidney allograft recipients. Here we assessed generation of Nabs after VAD implantation in pre-transplant sera and examined their contribution to cardiac allograft outcome. METHODS IgM and IgG Nabs were tested in pre-transplant serum samples collected from 206 orthotopic heart transplant recipients, including 128 patients with VAD (VAD patients) and 78 patients without VAD (no-VAD patients). Nabs were assessed by testing serum reactivity to apoptotic cells by flow cytometry and to the generic oxidized epitope, malondialdehyde, by enzyme-linked immunosorbent assay. RESULTS No difference was observed in serum levels of IgM Nabs between VAD and no-VAD patients. However, serum IgG Nabs levels were significantly increased in VAD compared with no-VAD patients. This increase was likely due to the presence of the VAD, as revealed by lower serum IgG Nabs levels before implantation. Elevated pre-transplant IgG Nabs level was associated with development of primary graft dysfunction (PGD). CONCLUSIONS Our study demonstrates that VAD support elicits IgG Nabs reactive to apoptotic cells and oxidized epitopes. These findings further support broad and non-specific B-cell activation by VAD, resulting in IgG sensitization. Moreover, the association of serum IgG Nabs levels with development of PGD suggests a possible role for these antibodies in the inflammatory reaction accompanying this complication.
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Affiliation(s)
- Sarah B See
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Kevin J Clerkin
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter J Kennel
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Feifan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Matthew P Weber
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Kortney J Rogers
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Debanjana Chatterjee
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Elena R Vasilescu
- Department of Pathology and Cell Biology, Department of Surgery, Columbia University Medical Center, New York, New York
| | - George Vlad
- Department of Pathology and Cell Biology, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Susan W Restaino
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - P Christian Schulze
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York.
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23
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Ip JE, Wu MS, Kennel PJ, Thomas G, Liu CF, Cheung JW, Markowitz SM, Lerman BB. Eligibility of Pacemaker Patients for Subcutaneous Implantable Cardioverter Defibrillators. J Cardiovasc Electrophysiol 2017; 28:544-548. [PMID: 28185354 DOI: 10.1111/jce.13182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/23/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter defibrillator (ICD) has emerged as a viable therapeutic option for patients who are deemed high risk for sudden cardiac death. Previous studies have shown that 7-15% of patients are not candidates for the S-ICD based on their intrinsic QRS/T-wave morphology. Presently, it is not known if the S-ICD can be considered as supplementary therapy in patients who are ventricularly paced. We sought to determine the proportion of ventricularly paced patients who would qualify for an S-ICD. METHODS AND RESULTS We evaluated 100 patients with transvenous pacemakers/ICDs, including 25 biventricular devices to determine S-ICD candidacy during right ventricular (RV) pacing and biventricular pacing based on the recommended QRS:T-wave ratio screening template. Fifty-eight percent of patients qualified for an S-ICD based on their QRS morphology during ventricular pacing. More patients during biventricular pacing met criteria compared to during RV pacing alone (80% vs. 46%, P <0.01). Patients that were paced from the RV septum were more likely to qualify compared to those paced from the RV apex (67% vs. 37%, respectively, P <0.01). CONCLUSION While S-ICD implantation may be considered as supplemental therapy in select patients with preexisting transvenous devices, relatively fewer candidates who are paced from the RV apex qualify. QRS morphologies generated from biventricular pacing as well as from septal RV pacing are more likely to screen in based on the recommended S-ICD template.
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Affiliation(s)
- James E Ip
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Michael S Wu
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Peter J Kennel
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - George Thomas
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Steven M Markowitz
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
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24
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Schulze-Späte U, Mizani I, Salaverry KR, Chang J, Wu C, Jones M, Kennel PJ, Brunjes DL, Choo TH, Kato TS, Mancini D, Grbic J, Schulze PC. Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation. ESC Heart Fail 2017; 4:169-177. [PMID: 28451454 PMCID: PMC5396042 DOI: 10.1002/ehf2.12126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/05/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022] Open
Abstract
Aims Heart failure (HF) is a multiorgan, pro‐inflammatory syndrome that impairs bone metabolism. Pro‐inflammatory cytokines and bone catabolism enhance periodontal disease, a local inflammatory, bacteria‐induced disease that causes bone loss and periodontal soft tissue destruction. Methods and results Medical and dental examinations were performed on patients with HF (n = 39), following heart transplantation (post‐HTx, n = 38) and controls (n = 32). Blood, saliva, and gingival crevicular fluid were analysed for bone metabolism and inflammation markers. HF average New York Heart Association classification was III. Average time since HTx was 1414 days. Pro‐inflammatory tumour necrosis factor‐alpha was higher in HF and HTx as compared with controls (P < 0.05). Both HF and HTx participants had higher levels of bone resorption marker C‐terminal telopeptide and parathyroid hormone with subjects in the HF group having the highest serum levels of all groups (P ≤ 0.05). In contrast, 25‐hydroxyvitamin D was lowest in HF. HF patients had greater clinical attachment loss, cumulative pockets depth (greater than 3 mm) and probing depth (P < 0.05) as compared with controls. Cumulative pockets depth correlated significantly with measures of the inflammatory burden, β‐glucuronidase in saliva (r = 0.4863, P < 0.01), interleukin‐1b in saliva (r = 0.5149, P < 0.01), and gingival crevicular fluid (r = 0.6056, P < 0.001) in HF. However, adjustment of periodontal results for measures of oral hygiene (plaque, bleeding on probing), systemic 25‐hydroxyvitamin D, and race attenuated significant differences between groups. Conclusions Patients with HF exhibit more severe periodontal disease associated with increased bone turnover markers when compared with control patients. However, local and systemic factors may account for this association and should be evaluated in future studies.
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Affiliation(s)
- Ulrike Schulze-Späte
- Division of Periodontics, College of Dental MedicineColumbia UniversityNew YorkNYUSA.,Section of Geriodontics, Department of Conservative Dentistry and PeriodontologyUniversity Hospital Jena, Friedrich Schiller UniversityJenaGermany
| | - Iman Mizani
- Division of Periodontics, College of Dental MedicineColumbia UniversityNew YorkNYUSA
| | | | - Jaime Chang
- Division of Periodontics, College of Dental MedicineColumbia UniversityNew YorkNYUSA
| | - Christina Wu
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Meaghan Jones
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Peter J Kennel
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Danielle L Brunjes
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Tse-Hwei Choo
- Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Tomoko S Kato
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA
| | - Donna Mancini
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA.,Department of CardiologyThe Mount Sinai HospitalNew YorkNYUSA
| | - John Grbic
- Division of Periodontics, College of Dental MedicineColumbia UniversityNew YorkNYUSA
| | - P Christian Schulze
- Division of CardiologyColumbia University College of Physicians and SurgeonsNew YorkNYUSA.,Division of Cardiology, Angiology, Pneumology and Intensive Medical CareUniversity Hospital Jena, Friedrich-Schiller-UniversityJenaGermany
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25
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Brunjes DL, Dunlop M, Wu C, Jones M, Kato TS, Kennel PJ, Armstrong HF, Choo TH, Bartels MN, Forman DE, Mancini DM, Schulze PC. Analysis of Skeletal Muscle Torque Capacity and Circulating Ceramides in Patients with Advanced Heart Failure. J Card Fail 2016; 22:347-55. [PMID: 26879888 DOI: 10.1016/j.cardfail.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart failure (HF)-related exercise intolerance is thought to be perpetuated by peripheral skeletal muscle functional, structural, and metabolic abnormalities. We analyzed specific dynamics of muscle contraction in patients with HF compared with healthy, sedentary controls. METHODS Isometric and isokinetic muscle parameters were measured in the dominant upper and lower limbs of 45 HF patients and 15 healthy age-matched controls. Measurements included peak torque normalized to body weight, work normalized to body weight, power, time to peak torque, and acceleration and deceleration to maximum strength times. Body morphometry (dual energy X-ray absorptiometry scan) and circulating fatty acids and ceramides (lipodomics) were analyzed in a subset of subjects (18 HF and 9 controls). RESULTS Extension and flexion time-to-peak torque was longer in the lower limbs of HF patients. Furthermore, acceleration and deceleration times in the lower limbs were also prolonged in HF subjects. HF subjects had increased adiposity and decreased lean muscle mass compared with controls. Decreased circulating unsaturated fatty acids and increased ceramides were found in subjects with HF. CONCLUSIONS Delayed torque development suggests skeletal muscle impairments that may reflect abnormal neuromuscular functional coupling. These impairments may be further compounded by increased adiposity and inflammation associated with increased ceramides.
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Affiliation(s)
- Danielle L Brunjes
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
| | - Mark Dunlop
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Christina Wu
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Meaghan Jones
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Tomoko S Kato
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter J Kennel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Hilary F Armstrong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Donna M Mancini
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - P Christian Schulze
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
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26
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Abstract
Peak exercise performance in healthy man is limited not only by pulmonary or skeletal muscle function but also by cardiac function. Thus, abnormalities in cardiac function will have a major impact on exercise performance. Many cardiac diseases affect exercise performance and indeed for some cardiac conditions such as atherosclerotic heart disease, exercise testing is frequently used not only to measure functional capacity but also to make a diagnosis of heart disease, evaluate the efficacy of treatment, and predict prognosis. Early in the course of cardiac diseases, exercise performance will be minimally affected but with disease progression impairment in exercise capacity will become apparent. Ejection fraction, that is, the percent of blood volume ejected with each cardiac cycle is often used as a measure of cardiac performance but frequently there is a dissociation between the ejection fraction and exercise capacity in patients with heart disease. How abnormalities in cardiac function impacts the muscles, vasculature, and lungs to impact exercise performance will here be reviewed. The focus of this work will be on patients with systolic heart failure as the incidence and prevalence of heart failure is reaching epidemic proportions and heart failure is the end result of many other chronic cardiac diseases. The prognostic role of exercise and benefits of exercise training will also be discussed.
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Affiliation(s)
- Peter J Kennel
- Center for Advanced Cardiac Care, Division of Cardiology, New York-Presbyterian Hospital and Columbia University Medical Center, New York, USA
| | - Donna M Mancini
- Center for Advanced Cardiac Care, Division of Cardiology, New York-Presbyterian Hospital and Columbia University Medical Center, New York, USA
| | - P Christian Schulze
- Center for Advanced Cardiac Care, Division of Cardiology, New York-Presbyterian Hospital and Columbia University Medical Center, New York, USA
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27
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Wu C, Kato TS, Ji R, Zizola C, Brunjes DL, Deng Y, Akashi H, Armstrong HF, Kennel PJ, Thomas T, Forman DE, Hall J, Chokshi A, Bartels MN, Mancini D, Seres D, Schulze PC. Supplementation of l-Alanyl-l-Glutamine and Fish Oil Improves Body Composition and Quality of Life in Patients With Chronic Heart Failure. Circ Heart Fail 2015; 8:1077-87. [PMID: 26269566 DOI: 10.1161/circheartfailure.115.002073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 01/22/2015] [Accepted: 08/05/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Skeletal muscle dysfunction and exercise intolerance are clinical hallmarks of patients with heart failure. These have been linked to a progressive catabolic state, skeletal muscle inflammation, and impaired oxidative metabolism. Previous studies suggest beneficial effects of ω-3 polyunsaturated fatty acids and glutamine on exercise performance and muscle protein balance. METHODS AND RESULTS In a randomized double-blind, placebo-controlled trial, 31 patients with heart failure were randomized to either l-alanyl-l-glutamine (8 g/d) and polyunsaturated fatty acid (6.5 g/d) or placebo (safflower oil and milk powder) for 3 months. Cardiopulmonary exercise testing, dual-energy x-ray absorptiometry, 6-minute walk test, hand grip strength, functional muscle testing, echocardiography, and quality of life and lateral quadriceps muscle biopsy were performed at baseline and at follow-up. Oxidative capacity and metabolic gene expression were analyzed on muscle biopsies. No differences in muscle function, echocardiography, 6-minute walk test, or hand grip strength and a nonsignificant increase in peak VO2 in the treatment group were found. Lean body mass increased and quality of life improved in the active treatment group. Molecular analysis revealed no differences in muscle fiber composition, fiber cross-sectional area, gene expression of metabolic marker genes (PGC1α, CPT1, PDK4, and GLUT4), and skeletal muscle oxidative capacity. CONCLUSIONS The combined supplementation of l-alanyl-l-glutamine and polyunsaturated fatty acid did not improve exercise performance or muscle function but increased lean body mass and quality of life in patients with chronic stable heart failure. These findings suggest potentially beneficial effects of high-dose nutritional polyunsaturated fatty acids and amino acid supplementations in patients with chronic stable heart failure. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01534663.
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Affiliation(s)
- Christina Wu
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Tomoko S Kato
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Ruiping Ji
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Cynthia Zizola
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Danielle L Brunjes
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Yue Deng
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Hirokazu Akashi
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Hilary F Armstrong
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Peter J Kennel
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Tiffany Thomas
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Daniel E Forman
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Jennifer Hall
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Aalap Chokshi
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Matthew N Bartels
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - Donna Mancini
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - David Seres
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.)
| | - P Christian Schulze
- From the Division of Cardiology, Department of Medicine (C.W., R.J., C.Z., D.L.B., Y.D., H.F.A., P.J.K., T.T., D.E.F., J.H., A.C., M.N.B., D.M., D.S., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (H.F.A.), Columbia University Medical Center, New York, NY; and Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan (T.S.K.).
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Derda AA, Thum S, Lorenzen JM, Bavendiek U, Heineke J, Keyser B, Stuhrmann M, Givens RC, Kennel PJ, Schulze PC, Widder JD, Bauersachs J, Thum T. Blood-based microRNA signatures differentiate various forms of cardiac hypertrophy. Int J Cardiol 2015; 196:115-22. [PMID: 26086795 DOI: 10.1016/j.ijcard.2015.05.185] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 11/10/2014] [Revised: 04/27/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is caused by mutations in different structural genes and induces pathological hypertrophy with sudden cardiac death as a possible consequence. HCM can be separated into hypertrophic non-obstructive and obstructive cardiomyopathy (HNCM/HOCM) with different clinical treatment approaches. We here distinguished between HNCM, HOCM, cardiac amyloidosis and aortic stenosis by using microRNA profiling and investigated potential interactions between circulating miRNA levels and the most common mutations in MYH7and MYBPC3 genes. METHODS Our study included 4 different groups: 23 patients with HNCM, 28 patients with HOCM, 47 patients with aortic stenosis and 22 healthy controls. Based on previous findings, 8 different cardiovascular known microRNAs (miR-1, miR-21, miR-29a, miR-29b, miR-29c, miR-133a, miR-155 and miR-499) were studied in serum of all patients and compared with clinically available patient data. RESULTS We found miR-29a levels to be increased in patients with HOCM and correlating markers of cardiac hypertrophy. This was not the case in HNCM patients. In contrast, we identified miR-29c to be upregulated in aortic stenosis but not the other patient groups. ROC curve analysis of miR-29a/c distinguished between HOCM patients and aortic stenosis patients. MiR-29a and miR-155 levels discriminated HNCM patients from patients with senile cardiac amyloidosis. MiR-29a increased mainly in HOCM patients with a mutation in MYH7, whereas miR-155 was decreased in hypertrophic cardiomyopathy patients with a mutation in MYBPC3. CONCLUSION We demonstrated that miR-29a and miR-29c show a specific signature to distinguish between aortic stenosis, hypertrophic non-obstructive and obstructive cardiomyopathies and thus could be developed into clinically useful biomarkers.
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Affiliation(s)
- Anselm A Derda
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Sabrina Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Johan M Lorenzen
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Joerg Heineke
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Britta Keyser
- Institute for Human Genetics, Hannover Medical School, Hannover, Germany
| | - Manfred Stuhrmann
- Institute for Human Genetics, Hannover Medical School, Hannover, Germany
| | - Raymond C Givens
- Division of Cardiology, Columbia University Medical Center, New York, NY, 10032
| | - Peter J Kennel
- Division of Cardiology, Columbia University Medical Center, New York, NY, 10032
| | - P Christian Schulze
- Division of Cardiology, Columbia University Medical Center, New York, NY, 10032
| | - Julian D Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; National Heart and Lung Institute, Imperial College London, UK.
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29
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Zizola C, Kennel PJ, Akashi H, Ji R, Castillero E, George I, Homma S, Schulze PC. Activation of PPARδ signaling improves skeletal muscle oxidative metabolism and endurance function in an animal model of ischemic left ventricular dysfunction. Am J Physiol Heart Circ Physiol 2015; 308:H1078-85. [PMID: 25713305 DOI: 10.1152/ajpheart.00679.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/18/2015] [Indexed: 01/06/2023]
Abstract
Exercise intolerance in heart failure has been linked to impaired skeletal muscle oxidative capacity. Oxidative metabolism and exercise capacity are regulated by PPARδ signaling. We hypothesized that PPARδ stimulation reverts skeletal muscle oxidative dysfunction. Myocardial infarction (MI) was induced in C57BL/6 mice and the development of ventricular dysfunction was monitored over 8 wk. Mice were randomized to the PPARδ agonist GW501516 (5 mg/kg body wt per day for 4 wk) or placebo 8 wk post-MI. Muscle function was assessed through running tests and grip strength measurements. In muscle, we analyzed muscle fiber cross-sectional area and fiber types, metabolic gene expression, fatty acid (FA) oxidation and ATP content. Signaling pathways were studied in C2C12 myotubes. FA oxidation and ATP levels decreased in muscle from MI mice compared with sham- operated mice. GW501516 administration increased oleic acid oxidation levels in skeletal muscle of the treated MI group compared with placebo treatment. This was accompanied by transcriptional changes including increased CPT1 expression. Further, the PPARδ-agonist improved running endurance compared with placebo. Cell culture experiments revealed protective effects of GW501516 against the cytokine-induced decrease of FA oxidation and changes in metabolic gene expression. Skeletal muscle dysfunction in HF is associated with impaired PPARδ signaling and treatment with the PPARδ agonist GW501516 corrects oxidative capacity and FA metabolism and improves exercise capacity in mice with LV dysfunction. Pharmacological activation of PPARδ signaling could be an attractive therapeutic intervention to counteract the progressive skeletal muscle dysfunction in HF.
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Affiliation(s)
- Cynthia Zizola
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
| | - Peter J Kennel
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
| | - Hirokazu Akashi
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
| | - Estibaliz Castillero
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
| | - P Christian Schulze
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and
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30
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Castillero E, Akashi H, Wang C, Najjar M, Ji R, Kennel PJ, Sweeney HL, Schulze PC, George I. Cardiac myostatin upregulation occurs immediately after myocardial ischemia and is involved in skeletal muscle activation of atrophy. Biochem Biophys Res Commun 2014; 457:106-11. [PMID: 25528587 DOI: 10.1016/j.bbrc.2014.12.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/11/2014] [Indexed: 01/04/2023]
Abstract
UNLABELLED Myostatin (MSTN), a negative regulator of muscle growth and size, is increased after acute myocardial infarction (AMI) but timing of upregulation after injury is not known. In this study, we investigated the timing of the MSTN/AKT/p38 pathway activation in heart and skeletal muscle after AMI, as well as the potential effect of cardiac injury-related MSTN endocrine signaling on skeletal muscle and other circulating growth factors. METHODS Coronary artery ligation was performed in C57BL/6 mice at age 8 weeks to induce AMI. Mice were sacrificed at different time points (10 m, 1 h, 2 h, 6 h, 12 h, 24 h, 1 week, 2 weeks, 1 months and 2 months) after surgery (n=3 per time point, n=18 total). RESULTS Cardiac and circulating MSTN upregulation occurred as early as 10 min after AMI. Two months after AMI, increased cardiac MSTN/SMAD2,3 and p38 together with decreased IGF-1/AKT signaling suggest an anti-hypertrophic profile. In skeletal muscle, an absence of local MSTN increase was accompanied by increased MSTN-dependent SMAD2,3 signaling, suggestive of paracrine effects due to cardiac-derived MSTN. Protein degradation by the ubiquitin-proteasome system in the skeletal muscle was also evident. Serum from 24h post-MI mice effectively induced a MSTN-dependent increase in atrogin1 and MuRF1. CONCLUSION Our study shows that cardiac MTSN activation occurs rapidly after cardiac ischemia and may be involved in peripheral protein degradation in the skeletal muscle by activating atrogin1 and MuRF1.
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Affiliation(s)
- Estibaliz Castillero
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Hirokazu Akashi
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Catherine Wang
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Marc Najjar
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Ruiping Ji
- Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Peter J Kennel
- Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - H Lee Sweeney
- Department of Physiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Paul C Schulze
- Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Isaac George
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York, NY, United States.
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31
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Khawaja T, Chokshi A, Ji R, Kato TS, Xu K, Zizola C, Wu C, Forman DE, Ota T, Kennel PJ, Takayama H, Naka Y, George I, Mancini D, Schulze PC. Erratum to: Ventricular assist device implantation improves skeletal muscle function, oxidative capacity, and growth hormone/insulin-like growth factor-1 axis signaling in patients with advanced heart failure. J Cachexia Sarcopenia Muscle 2014; 5:349. [PMID: 25209627 PMCID: PMC4248417 DOI: 10.1007/s13539-014-0163-9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tuba Khawaja
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Aalap Chokshi
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Ruiping Ji
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Tomoko S. Kato
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Katherine Xu
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Cynthia Zizola
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Christina Wu
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Daniel E. Forman
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
- />Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Takeyoshi Ota
- />Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Peter J. Kennel
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - Hiroo Takayama
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
- />Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Yoshifumi Naka
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
- />Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Isaac George
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
- />Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Donna Mancini
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
| | - P. Christian Schulze
- />Center for Advanced Cardiac Care, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10, Room 203, New York, NY 10032 USA
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