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Chang YK, Philip J, Allen LA, McClung JA, Hui D. Criteria That Promote Timely Referral to Specialist Palliative Care for Patients With Advanced Heart Failure. J Card Fail 2024; 30:85-90. [PMID: 37595787 DOI: 10.1016/j.cardfail.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia; Royal Melbourne Hospital, Parkville, Australia
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado
| | - John A McClung
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chang YK, McClung JA, Allen LA, Philip J, Hui D. Reply: Early Integration of Specialist Palliative Care in Advanced Heart Failure: A Multipronged Approach. J Am Coll Cardiol 2022; 80:e205-e206. [PMID: 36423999 DOI: 10.1016/j.jacc.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
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Chang YK, Allen LA, McClung JA, Denvir MA, Philip J, Mori M, Perez-Cruz P, Cheng SY, Collins A, Hui D. Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care. J Am Coll Cardiol 2022; 80:332-344. [PMID: 35863850 PMCID: PMC10615151 DOI: 10.1016/j.jacc.2022.04.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with advanced heart failure have substantial supportive care needs. Specialist palliative care can be beneficial, but it is unclear who is most appropriate for referral and when patients should be referred. OBJECTIVES We conducted a Delphi study of international experts to identify consensus referral criteria for specialist palliative care for patients with advanced heart failure. METHODS Clinicians from 5 continents with expertise in the integration of cardiology and palliative care were asked to rate 34 disease-based, 24 needs-based, and 9 time-based criteria over 3 rounds. Consensus was defined a priori as ≥70% agreement. A criterion was coded as major if the experts endorsed that meeting that criterion alone was adequate to justify a referral. RESULTS The response rate was 44 of 46 (96%), 41 of 46 (89%), and 43 of 46 (93%) in the first, second, and third rounds, respectively. Panelists reached consensus on 25 major criteria for specialist palliative care referral. The 25 major criteria were categorized under 6 topics, including "advanced/refractory heart failure, comorbidities, and complications" (eg, cardiac cachexia, cardiorenal syndrome) (n = 8), "advanced heart failure therapies" (eg, chronic inotropes, precardiac transplant) (n = 4), "hospital utilization" (eg, emergency room visits, hospitalization) (n = 2), "prognostic estimate" (n = 1), "symptom burden/distress" (eg, severe physical/emotional/spiritual distress) (n = 6), and "decision making/social support" (eg, goals-of-care discussions) (n = 4). The majority (68%) of major criteria had ≥90% agreement. CONCLUSIONS International experts reached consensus on a large number of criteria for referral to specialist palliative care. With further validation, these criteria may be useful for standardizing palliative care access in the inpatient and/or outpatient settings.
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Affiliation(s)
- Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John A McClung
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Martin A Denvir
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Pedro Perez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Anna Collins
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Victoria, Australia
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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McClung JA, Levy L, Garcia V, Stec DE, Peterson SJ, Abraham NG. Heme-oxygenase and lipid mediators in obesity and associated cardiometabolic diseases: Therapeutic implications. Pharmacol Ther 2021; 231:107975. [PMID: 34499923 DOI: 10.1016/j.pharmthera.2021.107975] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
Obesity-mediated metabolic syndrome remains the leading cause of death worldwide. Among many potential targets for pharmacological intervention, a promising strategy involves the heme oxygenase (HO) system, specifically its inducible form, HO-1. This review collects and updates much of the current knowledge relevant to pharmacology and clinical medicine concerning HO-1 in metabolic diseases and its effect on lipid metabolism. HO-1 has pleotropic effects that collectively reduce inflammation, while increasing vasodilation and insulin and leptin sensitivity. Recent reports indicate that HO-1 with its antioxidants via the effect of bilirubin increases formation of biologically active lipid metabolites such as epoxyeicosatrienoic acid (EET), omega-3 and other polyunsaturated fatty acids (PUFAs). Similarly, HO-1and bilirubin are potential therapeutic targets in the treatment of fat-induced liver diseases. HO-1-mediated upregulation of EET is capable not only of reversing endothelial dysfunction and hypertension, but also of reversing cardiac remodeling, a hallmark of the metabolic syndrome. This process involves browning of white fat tissue (i.e. formation of healthy adipocytes) and reduced lipotoxicity, which otherwise will be toxic to the heart. More importantly, this review examines the activity of EET in biological systems and a series of pathways that explain its mechanism of action and discusses how these might be exploited for potential therapeutic use. We also discuss the link between cardiac ectopic fat deposition and cardiac function in humans, which is similar to that described in obese mice and is regulated by HO-1-EET-PGC1α signaling, a potent negative regulator of the inflammatory adipokine NOV.
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Affiliation(s)
- John A McClung
- Department of Medicine, New York Medical College, Valhalla, NY 10595, United States of America
| | - Lior Levy
- Department of Medicine, New York Medical College, Valhalla, NY 10595, United States of America
| | - Victor Garcia
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, United States of America
| | - David E Stec
- Department of Physiology and Biophysics, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
| | - Stephen J Peterson
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States of America; New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States of America
| | - Nader G Abraham
- Department of Medicine, New York Medical College, Valhalla, NY 10595, United States of America; Department of Pharmacology, New York Medical College, Valhalla, NY 10595, United States of America.
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Sasson A, Kristoferson E, Batista R, McClung JA, Abraham NG, Peterson SJ. The pivotal role of heme Oxygenase-1 in reversing the pathophysiology and systemic complications of NAFLD. Arch Biochem Biophys 2020; 697:108679. [PMID: 33248947 DOI: 10.1016/j.abb.2020.108679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
The pathogenesis and molecular pathways involved in non-alcoholic fatty liver disease (NAFLD) are reviewed, as well as what is known about mitochondrial dysfunction that leads to heart disease and the progression to steatohepatitis and hepatic fibrosis. We focused our discussion on the role of the antioxidant gene heme oxygenase-1 (HO-1) and its nuclear coactivator, peroxisome proliferator-activated receptor-gamma coactivator (PGC1-α) in the regulation of mitochondrial biogenesis and function and potential therapeutic benefit for cardiac disease, NAFLD as well as the pharmacological effect they have on the chronic inflammatory state of obesity. The result is increased mitochondrial function and the conversion of white adipocyte tissue to beige adipose tissue ("browning of white adipose tissue") that leads to an improvement in signaling pathways and overall liver function. Improved mitochondrial biogenesis and function is essential to preventing the progression of hepatic steatosis to NASH and cirrhosis as well as preventing cardiovascular complications.
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Affiliation(s)
- Ariel Sasson
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, USA; Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, USA
| | - Eva Kristoferson
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Rogerio Batista
- The Mount Sinai Bone Program, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - John A McClung
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Nader G Abraham
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, USA; Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, USA; Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, USA
| | - Stephen J Peterson
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA; New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA.
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Chang YK, Kaplan H, Geng Y, Mo L, Philip J, Collins A, Allen LA, McClung JA, Denvir MA, Hui D. Referral Criteria to Palliative Care for Patients With Heart Failure: A Systematic Review. Circ Heart Fail 2020; 13:e006881. [PMID: 32900233 DOI: 10.1161/circheartfailure.120.006881] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with heart failure have significant symptom burden, care needs, and often a progressive course to end-stage disease. Palliative care referrals may be helpful but it is currently unclear when patients should be referred and by whom. We conducted a systematic review of the literature to examine referral criteria for palliative care among patients with heart failure. METHODS We searched Ovid, MEDLINE, Ovid Embase, and PubMed databases for articles in the English language from the inception of databases to January 17, 2019 related to palliative care referral in patients with heart failure. Two investigators independently reviewed each citation for inclusion and then extracted the referral criteria. Referral criteria were then categorized thematically. RESULTS Of the 1199 citations in our initial search, 102 articles were included in the final sample. We identified 18 categories of referral criteria, including 7 needs-based criteria and 10 disease-based criteria. The most commonly discussed criterion was physical or emotional symptoms (n=51 [50%]), followed by cardiac stage (n=46 [45%]), hospital utilization (n=38 [37%]), prognosis (n=37 [36%]), and advanced cardiac therapies (n=36 [35%]). Under cardiac stage, 31 (30%) articles suggested New York Heart Association functional class ≥III and 12 (12%) recommended New York Heart Association class ≥IV as cutoffs for referral. Prognosis of ≤1 year was mentioned in 21 (21%) articles as a potential trigger; few other criteria had specific cutoffs. CONCLUSIONS This systematic review highlighted the lack of consensus regarding referral criteria for the involvement of palliative care in patients with heart failure. Further research is needed to identify appropriate and timely triggers for palliative care referral.
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Affiliation(s)
- Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Holland Kaplan
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yimin Geng
- Research Medical Library (Y.G.), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China (L.M.)
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia (J.P., A.C.).,Royal Melbourne Hospital, Parkville, Australia (J.P.)
| | - Anna Collins
- Department of Medicine, St Vincent's Hospital Campus, University of Melbourne, Fitzroy, Australia (J.P., A.C.)
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora (L.A.A.)
| | - John A McClung
- Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York (J.A.M.)
| | - Martin A Denvir
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (M.A.D.)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine (Y.K.C., H.K., L.M., D.H.), The University of Texas MD Anderson Cancer Center, Houston, TX
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Bellner L, Lebovics NB, Rubinstein R, Buchen YD, Sinatra E, Sinatra G, Abraham NG, McClung JA, Thompson EA. Heme Oxygenase-1 Upregulation: A Novel Approach in the Treatment of Cardiovascular Disease. Antioxid Redox Signal 2020; 32:1045-1060. [PMID: 31891663 PMCID: PMC7153645 DOI: 10.1089/ars.2019.7970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Significance: Heme oxygenase (HO) plays a pivotal role in both vascular and metabolic functions and is involved in many physiological and pathophysiological processes in vascular endothelial cells (ECs) and adipocytes. Recent Advances: From the regulation of adipogenesis in adipose tissue to the adaptive response of vascular tissue in the ECs, HO plays a critical role in the capability of the vascular system to respond and adjust to insults in homeostasis. Recent studies show that HO-1 through regulation of adipocyte and adipose tissue functions ultimately aid not only in local but also in systemic maintenance of homeostasis. Critical Issues: Recent advances have revealed the existence of a cross talk between vascular ECs and adipocytes in adipose tissue. In the pathological state of obesity, this cross talk contributes to the condition's adverse chronic effects, and we propose that specific targeting of the HO-1 gene can restore signaling pathways and improve both vascular and adipose functions. Future Directions: A complete understanding of the role of HO-1 in regulation of cardiovascular homeostasis is important to comprehend the homeostatic regulation as well as in cardiovascular disease. Efforts are required to highlight the effects and the ability to target the HO-1 gene in models of obesity with an emphasis on the role of pericardial fat on cardiovascular health.
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Affiliation(s)
- Lars Bellner
- Department of Pharmacology and New York Medical College, Valhalla, New York
| | - Nachum B Lebovics
- Department of Pharmacology and New York Medical College, Valhalla, New York
| | | | - Yosef D Buchen
- Department of Pharmacology and New York Medical College, Valhalla, New York
| | - Emilia Sinatra
- Department of Pharmacology and New York Medical College, Valhalla, New York
| | - Giuseppe Sinatra
- Department of Pharmacology and New York Medical College, Valhalla, New York
| | - Nader G Abraham
- Department of Pharmacology and New York Medical College, Valhalla, New York.,Department of Medicine, New York Medical College, Valhalla, New York
| | - John A McClung
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ellen A Thompson
- Department of Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
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Singh SP, McClung JA, Thompson E, Glick Y, Greenberg M, Acosta‐Baez G, Edris B, Shapiro JI, Abraham NG. Cardioprotective Heme Oxygenase-1-PGC1α Signaling in Epicardial Fat Attenuates Cardiovascular Risk in Humans as in Obese Mice. Obesity (Silver Spring) 2019; 27:1634-1643. [PMID: 31441604 PMCID: PMC6756945 DOI: 10.1002/oby.22608] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated whether levels of signaling pathways and inflammatory adipokines in epicardial fat regulate cardiovascular risks in humans and mice. METHODS Epicardial fat was obtained from the hearts of patients with heart failure requiring coronary artery bypass surgery, and signaling pathways were compared with visceral fat. The genetic profile of epicardial and visceral fat from humans was also compared with genetic profiles of epicardial and visceral fat in obese mice. Left ventricular (LV) fractional shortening was measured in obese mice before and after treatment with inducers of mitochondrial signaling heme oxygenase 1 (HO-1)-peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α). An RNA array/heat map on 88 genes that regulate adipose tissue function was used to identify a target gene network. RESULTS Human epicardial fat gene profiling showed decreased levels of mitochondrial signaling of HO-1-PGC1α and increased levels of the inflammatory adipokine CCN family member 3. Similar observations were seen in epicardial and visceral fat of obese mice. Improvement in LV function was linked to the increase in mitochondrial signaling in epicardial fat of obese mice. CONCLUSIONS There is a link between cardiac ectopic fat deposition and cardiac function in humans that is similar to that which is described in obese mice. An increase of mitochondrial signaling pathway gene expression in epicardial fat attenuates cardiometabolic dysfunction and LV fractional shortening in obese mice.
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Affiliation(s)
| | - John A. McClung
- Department of MedicineNew York Medical CollegeValhallaNew YorkUSA
| | - Ellen Thompson
- Department of CardiologyJoan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest VirginiaUSA
| | - Yosef Glick
- Department of PharmacologyNew York Medical CollegeValhallaNew YorkUSA
| | | | - Giancarlo Acosta‐Baez
- Department of CardiologyJoan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest VirginiaUSA
| | - Basel Edris
- Department of CardiologyJoan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest VirginiaUSA
| | - Joseph I. Shapiro
- Department of Internal MedicineJoan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest VirginiaUSA
| | - Nader G. Abraham
- Department of PharmacologyNew York Medical CollegeValhallaNew YorkUSA
- Department of MedicineNew York Medical CollegeValhallaNew YorkUSA
- Department of Internal MedicineJoan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest VirginiaUSA
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Schragenheim J, Bellner L, Cao J, Singh SP, Bamshad D, McClung JA, Maayan O, Meissner A, Grant I, Stier CT, Abraham NG. EET enhances renal function in obese mice resulting in restoration of HO-1-Mfn1/2 signaling, and decrease in hypertension through inhibition of sodium chloride co-transporter. Prostaglandins Other Lipid Mediat 2018; 137:30-39. [PMID: 29787809 DOI: 10.1016/j.prostaglandins.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/21/2017] [Revised: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have previously reported that epoxyeicosatrienoic acid (EET) has multiple beneficial effects on renal and adipose tissue function, in addition to its vasodilatory action; it increases insulin sensitivity and inhibits inflammation. In an examination of the signaling mechanisms by which EET reduces renal and peri-renal fat function, we hypothesized that EET ameliorates obesity-induced renal dysfunction by improving sodium excretion, reducing the sodium-chloride cotransporter NCC, lowering blood pressure, and enhancing mitochondrial and thermogenic gene levels in PGC-1α dependent mice. METHODS EET-agonist treatment normalized glucose metabolism, renal ENaC and NCC protein expression, urinary sodium excretion and blood pressure in obese (db/db) mice. A marked improvement in mitochondrial integrity, thermogenic genes, and PGC-1α-HO-1-adiponectin signaling occurred. Knockout of PGC-1α in EET-treated mice resulted in a reversal of these beneficial effects including a decrease in sodium excretion, elevation of blood pressure and an increase in the pro-inflammatory adipokine nephroblastoma overexpressed gene (NOV). In the elucidation of the effects of EET on peri-renal adipose tissue, EET increased adiponectin, mitochondrial integrity, thermogenic genes and decreased NOV, i.e. "Browning' peri-renal adipose phenotype that occurs under high fat diets. Taken together, these data demonstrate a critical role of an EET agonist in the restoration of healthy adipose tissue with reduced release of inflammatory molecules, such as AngII and NOV, thereby preventing their detrimental impact on sodium absorption and NCC levels and the development of obesity-induced renal dysfunction.
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Affiliation(s)
- Joseph Schragenheim
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Lars Bellner
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Jian Cao
- Chinese PLA General Hospital, Beijing, 100853, China
| | - Shailendra P Singh
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - David Bamshad
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - John A McClung
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Omri Maayan
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Aliza Meissner
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Ilana Grant
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Charles T Stier
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States.
| | - Nader G Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, United States.
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10
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Schragenheim J, Bellner L, Singh SP, McClung JA, Bamshad D, Rudman J, Meissner A, Grant I, Stier CT, Abraham NG. EET Enhances Renal Function in Obese Mice Resulting in Restoration of Mfn1/2 Signaling and a Decrease in Hypertension Through Inhibition of Sodium Chloride Co‐Transporter. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.561.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nader G. Abraham
- PharmacologyNew York Medical CollegeValhallaNY
- MedicineNew York Medical CollegeHawthorneNY
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11
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Singh SP, McClung JA, Bellner L, Schragenheim J, Abraham NG. EET‐agonist Prevents and Reverses Heart Failure in Obesity Induced Diabetic Cardiomyopathy. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.561.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Nader G. Abraham
- PharmacologyNew York Medical CollegeValhallaNY
- MedicineNew York Medical CollegeHawthorneNY
- Joan C. Edwards School of MedicineHuntingtonWV
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12
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Singh SP, McClung JA, Bellner L, Cao J, Waldman M, Schragenheim J, Arad M, Hochhauser E, Falck JR, Weingarten JA, Peterson SJ, Abraham NG. CYP-450 Epoxygenase Derived Epoxyeicosatrienoic Acid Contribute To Reversal of Heart Failure in Obesity-Induced Diabetic Cardiomyopathy via PGC-1 α Activation. ACTA ACUST UNITED AC 2018; 7. [PMID: 29707604 PMCID: PMC5922773 DOI: 10.4172/2329-6607.1000233] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 12/15/2022]
Abstract
We have previously shown that an Epoxyeicosatrienoic Acid (EET) -agonist has pleiotropic effects and reverses cardiomyopathy by decreasing inflammatory molecules and increasing antioxidant signaling. We hypothesized that administration of an EET agonist would increase Peroxisome proliferator-activated receptor-gamma coactivator (PGC-1α), which controls mitochondrial function and induction of HO-1 and negatively regulates the expression of the proinflammatory adipokines CCN3/NOV in cardiac and pericardial tissues. This pathway would be expected to further improve left ventricular (LV) systolic function as well as increase insulin receptor phosphorylation. Measurement of the effect of an EET agonist on oxygen consumption, fractional shortening, blood glucose levels, thermogenic and mitochondrial signaling proteins was performed. Control obese mice developed signs of metabolic syndrome including insulin resistance, hypertension, inflammation, LV dysfunction, and increased NOV expression in pericardial adipose tissue. EET agonist intervention decreased pericardial adipose tissue expression of NOV, while normalized FS, increased PGC-1α, HO-1 levels, insulin receptor phosphorylation and improved mitochondrial function, theses beneficial effect were reversed by deletion of PGC-1α. These studies demonstrate that an EET agonist increases insulin receptor phosphorylation, mitochondrial and thermogenic gene expression, decreased cardiac and pericardial tissue NOV levels, and ameliorates cardiomyopathy in an obese mouse model of the metabolic syndrome.
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Affiliation(s)
- S P Singh
- Departments of Pharmacology and Medicine, New York Medical College, Valhalla, New York, USA
| | - J A McClung
- Departments of Medicine, New York Medical College, Valhalla, New York, USA
| | - L Bellner
- Departments of Pharmacology and Medicine, New York Medical College, Valhalla, New York, USA
| | - J Cao
- Departments of Pharmacology and Medicine, New York Medical College, Valhalla, New York, USA.,Chinese PLA General Hospital, Beijing 100853, China
| | - M Waldman
- Departments of Pharmacology and Medicine, New York Medical College, Valhalla, New York, USA.,Cardiac Research Laboratory, Felsenstein Medical Research Institute and Sackler School of Medicine, Tel-Aviv University, Israel
| | - J Schragenheim
- Departments of Pharmacology and Medicine, New York Medical College, Valhalla, New York, USA
| | - M Arad
- Leviev Heart Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Israel
| | - E Hochhauser
- Cardiac Research Laboratory, Felsenstein Medical Research Institute and Sackler School of Medicine, Tel-Aviv University, Israel
| | - J R Falck
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J A Weingarten
- Weill Cornell Medicine, New York, USA.,New York Presbyterian Brooklyn Methodist Hospital, New York, USA
| | - S J Peterson
- Weill Cornell Medicine, New York, USA.,New York Presbyterian Brooklyn Methodist Hospital, New York, USA
| | - N G Abraham
- Departments of Medicine, New York Medical College, Valhalla, New York, USA.,Joan Edward School of Medicine, West Virginia, USA
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Cao J, Singh SP, McClung JA, Joseph G, Vanella L, Barbagallo I, Jiang H, Falck JR, Arad M, Shapiro JI, Abraham NG. EET intervention on Wnt1, NOV, and HO-1 signaling prevents obesity-induced cardiomyopathy in obese mice. Am J Physiol Heart Circ Physiol 2017; 313:H368-H380. [PMID: 28576832 PMCID: PMC5582926 DOI: 10.1152/ajpheart.00093.2017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 02/09/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 01/15/2023]
Abstract
We have previously reported that epoxyeicosatrienoic acid (EET) has multiple beneficial effects on vascular function; in addition to its antiapoptotic action, it increases insulin sensitivity and inhibits inflammation. To uncover the signaling mechanisms by which EET reduces cardiomyopathy, we hypothesized that EET infusion might ameliorate obesity-induced cardiomyopathy by improving heme oxygenase (HO)-1, Wnt1, thermogenic gene levels, and mitochondrial integrity in cardiac tissues and improved pericardial fat phenotype. EET reduced levels of fasting blood glucose and proinflammatory adipokines, including nephroblastoma overexpressed (NOV) signaling, while increasing echocardiographic fractional shortening and O2 consumption. Of interest, we also noted a marked improvement in mitochondrial integrity, thermogenic genes, and Wnt 1 and HO-1 signaling mechanisms. Knockout of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) in EET-treated mice resulted in a reversal of these beneficial effects including a decrease in myocardial Wnt1 and HO-1 expression and an increase in NOV. To further elucidate the effects of EET on pericardial adipose tissues, we observed EET treatment increases in adiponectin, PGC-1α, phospho-AMP-activated protein kinase, insulin receptor phosphorylation, and thermogenic genes, resulting in a "browning" pericardial adipose phenotype under high-fat diets. Collectively, these experiments demonstrate that an EET agonist increased Wnt1 and HO-1 signaling while decreasing NOV pathways and the progression of cardiomyopathy. Furthermore, this report presents a portal into potential therapeutic approaches for the treatment of heart failure and metabolic syndrome.NEW & NOTEWORTHY The mechanism by which EET acts on obesity-induced cardiomyopathy is unknown. Here, we describe a previously unrecognized function of EET infusion that inhibits nephroblastoma overexpressed (NOV) levels and activates Wnt1, hence identifying NOV inhibition and enhanced Wnt1 expression as novel pharmacological targets for the prevention and treatment of cardiomyopathy and heart failure.Listen to this article's corresponding podcast at http://ajpheart.physiology.org/content/early/2017/05/31/ajpheart.00093.2017.
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Affiliation(s)
- Jian Cao
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York.,Chinese PLA General Hospital, Beijing, China
| | - Shailendra P Singh
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - John A McClung
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - Gregory Joseph
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - Luca Vanella
- Department of Drug Science/Section of Biochemistry, University of Catania, Catania, Italy
| | - Ignazio Barbagallo
- Department of Drug Science/Section of Biochemistry, University of Catania, Catania, Italy
| | - Houli Jiang
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - John R Falck
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Arad
- Leviev Heart Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel; and
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Nader G Abraham
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York; .,Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
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Cao J, McClung JA, Waldman M, Singh SP, Schragenheim J, Arad M, Hochhauser E, Abraham N. Abstract 024: PGC-1α is a Critical Activator of HO-1 That Protects Against Cardiomyopathy in Diabetic Mice Through Recruitment of Mitochondrial Fusion Proteins and Function. Hypertension 2016. [DOI: 10.1161/hyp.68.suppl_1.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Diabetes mellitus type 2 (DM2) is associated with cardiovascular complications, which are characterized by increased oxidative stress (ROS) and inhibition of anti-oxidant genes such as heme oxygenase (HO-1), Super oxide dismutase (SOD2) and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α). The latter that controls mitochondrial biogenesis, oxidative metabolism, and increased degradation of epoxyeicosatrienoic acids (EETs). Inhibition of these genes leads to increased myocardial stiffness and the development of cardiac hypertrophy and diastolic dysfunction.
Aim:
To assess whether PGC-1α plays a significant role in the development of diabetic cardiomyopathy in chronically obese mice.
Methods:
Leptin resistant (db/db) mice develop cardiomyopathy at the age of 5-6 month. Mice were treated with the EET agonist (EET-A) and with either lentivirus (Ln)- PGC-1α (Sh) or EET-A-Ln-PGC-1α scrambled for 3 additional months.
Results:
db mice exhibited impaired glucose tolerance, increased fasting blood glucose (366±21.9mg/dL vs.112±9.2 mg/dL, p<0.004), decreased oxygen consumption (VO
2
) (25.09±1.1ml/min vs. 55.37±5.92ml/min, p<0.002) and heart weight (0.17±0.02g vs.0.12±0.006g, p<0.05) compared to WT mice. EET agonists treatments improved fasting glucose levels (366±21.9mg/dL vs. 134±18.4 mg/dL, p<0.007) and oxygen consumption (25.09±1.1ml/min vs. 33.7±3.75ml/min, p<0.018), and reduced heart weight (0.17±0.02g vs.0.13±0.002g, p<0.0026). HO-1 levels were increased in cardiac tissue 22-fold (p<0.016). The beneficial effects of EET were reversed inhibition of PGC-1α in the EET-A-Ln PGC-1α (Sh) not in EET-A-Ln-PGC-1α scrambled group. The inhibition of PGC-1α (52% reduction, p<0.022) resulted in a reduction in the beneficial effects of EET-A as manifested by weight gain, the development of severe dilated cardiomyopathy and the attenuation of HO-1 and SOD2 (90% and 76% reduction respectively, p<0.02) and a decrease in mitochondrial fusion proteins Mfn1, 2 and OPa1.
Conclusion:
EET mediated restoration of mitochondrial function by PGC1α is essential for the enhancement of HO-1-myocyte contraction and the prevention of LV dysfunction in chronic obesity.
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Affiliation(s)
- Jian Cao
- First Dept of Geriatric Cardiology, Chinese PLA General Hosp, Beijing, China
| | | | - Maayan Waldman
- Leviev Heart Cntr Sheba Med Cntr, Tel Hashomer and Sackler Sch of Medicine, Cardiac Rsch Laboratory, Felsenstein Med Rsch Institute, Tel-Aviv Univ, Petach-Tikva, Israel
| | | | | | - Michael Arad
- Cardiac Rsch Laboratory, Felsenstein Med Rsch Institute, Tel-Aviv Univ, Petach-Tikva, Israel
| | - Edith Hochhauser
- Leviev Heart Cntr Sheba Med Cntr, Tel Hashomer and Sackler Sch of Medicine, Petach-Tikva, Israel
| | - Nader Abraham
- The Rockefeller Univ, New York, NY, Dept of Medicine and Pharmacology, New York Med College, Valhalla, NY
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Cao J, McClung JA, Singh SP, Bellner L, Waldman M, Schragenheim J, Arad M, Hochhauser E, Shapiro JI, Abraham N. Abstract P233: Diabetic Cardiomyopathy is Reversed by Increased Mitochondrial Bioenergetics Due to PGC-1α Activation by EET Treatment of Obese Mice. Hypertension 2016. [DOI: 10.1161/hyp.68.suppl_1.p233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Obesity and diabetes are associated with progressive cardiac fibrosis that, sequentially, results in diastolic dysfunction, reduced contractility, and ultimately heart failure. Contributing factors include hyperglycemia, insulin resistance, mitochondrial dysfunction, and a reduction in AMPK signaling. PGC-1α activates mitochondrial biogenesis and oxidative phosphorylation and is decreased in patients with diabetes mellitus (DM). We hypothesize that an epoxyeicosatrienoic acids (EETs) agonist (EET-A) will increase PGC-1α levels in a db mouse model of DM attenuate cardiomyopathy, and prevent heart failure.
Methods:
Db mice (4-wks), were allowed to acclimatize for 16-wks and were then divided into 3 treatment groups for an additional 16 wks: A) control, B) EET-A 1.5mg/100g BW 2 weeks and C) EET-A-Ln-PGC-1α shRNA. Ln-PGC-1α shRNA suppressed PGC-1α protein in heart tissue by 40-50%. Oxygen consumption (VO
2
), and blood glucose was determined. Heart tissues were harvested to measure PGC-1α, HO-1, pAMPK, PGC-1α, echocardiographic fractional shortening, mitochondrial oxidative phosphorylation (OXPHOS) and mitofusion protein markers.
Results:
All mice developed heart failure by the end of 16 weeks and were characterized by a decrease in myocardial contractility, an increase in insulin resistance and blood pressure, decreased VO
2
, the appearance of mitochondria dysfunction and a decrease in AMPK and downstream PGC-1α signaling. Mice treated with EET-A demonstrated an increase in PGC-1α levels, improved mitochondrial function and oxidative phosphorylation (p<0.01 vs control), increased NO bioavailability (p<0.05 vs control), and normalization of glucose metabolism, insulin levels, VO
2
and LV systolic function (p<0.05 vs control). All of these findings were suppressed by PGC-1α inhibition which was accompanied by the onset of even more severe LV dysfunction than in the control group.
Conclusion:
Increased EET levels result in activation of PGC-1α-HO-1 which reverses diabetes induced insulin resistance, mitochondrial dysfunction, and cardiomyopathy. EET may have potential as a powerful agent for therapeutic application in the treatment of diabetic cardiomyopathy.
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Affiliation(s)
- Jian Cao
- First Dept of Geriatric Cardiology, Chinese PLA General Hosp, Beijing, China
| | | | | | - Lars Bellner
- Dept of Pharmacology, New York Med College, Valhalla, NY
| | - Maayan Waldman
- Leviev Heart Cntr Sheba Med Cntr, Tel Hashomer and Sackler Sch of Medicine, Cardiac Rsch Laboratory, Felsenstein Med Rsch Institute, Tel-Aviv Univ, Petach-Tikva, Israel
| | | | - Michael Arad
- Cardiac Rsch Laboratory, Felsenstein Med Rsch Institute, Tel-Aviv Univ, Petach-Tikva, Israel
| | - Edith Hochhauser
- Leviev Heart Cntr Sheba Med Cntr, Tel Hashomer and Sackler Sch of Medicine, Tel Aviv Univ, Petach-Tikva, Israel
| | - Joseph I Shapiro
- Dept of Medicine, Joan C. Edwards Sch of Medicine, Marshall Univ, Huntington, WV
| | - Nader Abraham
- Dept of Medicine and Pharmacology, New York Med College, Valhalla, NY
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Sinha N, Devabhaktuni S, Kadambi A, McClung JA, Aronow WS, Lehrman SG. Can echocardiographically estimated pulmonary arterial elastance be a non-invasive predictor of pulmonary vascular resistance? Arch Med Sci 2014; 10:692-700. [PMID: 25276152 PMCID: PMC4175770 DOI: 10.5114/aoms.2014.44860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/20/2013] [Accepted: 11/10/2013] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Measurement of pulmonary vascular resistance (PVR) is essential in evaluating a patient with pulmonary hypertension. MATERIAL AND METHODS Data from right heart catheterization (RHC) and echocardiograms performed within 90 days of each other on 45 non-consecutive adult patients were reviewed in this retrospective study. Patients were recruited using an assortment of strategies to ensure the presence of patients with a wide range of PVR. RESULTS The linear regression equation between RHC-derived PVR and echocardiographic pulmonary arterial elastance (PAE) was: PVR = (562.6 × PAE) - 38.9 (R = 0.56, p < 0.0001). An adjustment for echocardiographic PAE was made by multiplying it by hemoglobin (in g/dl) and (right atrial area)(1.5) (in cm(3)). As RHC-derived PVR varies with blood hemoglobin, an adjustment for PVR was made for hemoglobin of 12 g/dl. Visualization of the XY scatter plot of adjusted PVR and adjusted PAE isolated a subset of patients with PVR higher than 8.8 Wood units, where a strong linear relationship existed (adjusted PVR = (0.89 × adjusted PAE) + 137.4, R = 0.89, p = 0.008). CONCLUSIONS The correlation coefficient of the regression equation connecting echocardiographic PAE and RHC-derived PVR was moderate. In a subset of patients with very high PVR and after appropriate adjustment, a strong linear relationship existed with an excellent correlation coefficient.
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Affiliation(s)
- Neeraj Sinha
- Division of Pulmonary and Transplantation Medicine, Department of Medicine, The Methodist Hospital, Houston, TX, USA
| | - Srikala Devabhaktuni
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Aparna Kadambi
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - John A. McClung
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Stuart G. Lehrman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Balasubramaniyam N, Kolte D, Palaniswamy C, Yalamanchili K, Aronow WS, McClung JA, Khera S, Sule S, Peterson SJ, Frishman WH. Predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura. Am J Med 2013; 126:1016.e1-7. [PMID: 23993262 DOI: 10.1016/j.amjmed.2013.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 03/15/2013] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the widespread availability of plasmapheresis as a therapy, thrombotic thrombocytopenic purpura is associated with significant morbidity and mortality. There is a paucity of data on the predictors of poor clinical outcome in this population. Acute myocardial infarction is a recognized complication of thrombotic thrombocytopenic purpura. Little is known about the magnitude of this problem, its risk factors, and its influence on mortality in patients hospitalized with thrombotic thrombocytopenic purpura. METHODS We used the 2001-2010 Nationwide Inpatient Sample database to identify patients aged ≥18 years with the diagnosis of thrombotic thrombocytopenic purpura (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 446.6) who also received therapeutic plasmapheresis (ICD-9-CM code 99.71) during the hospitalization. Patients with acute myocardial infarction were identified using the Healthcare Cost and Utilization Project Clinical Classification Software code 100. Stepwise logistic regression was used to determine independent predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura patients. RESULTS Among the 4032 patients (mean age 47.5 years, 67.7% women, and 36.9% white) with thrombotic thrombocytopenic purpura who also underwent plasmapheresis, in-hospital mortality was 11.1%. Independent predictors of increased in-hospital mortality were older age (odds ratio [OR] 1.03; 95% confidence interval [CI], 1.02-1.04; P <.001), acute myocardial infarction (OR 1.89; 95% CI, 1.24-2.88; P = .003), acute renal failure (OR 2.75; 95% CI, 2.11-3.58; P <.001), congestive heart failure (OR 1.66; 95% CI, 1.17-2.34; P = .004), acute cerebrovascular disease (OR 2.68; 95% CI, 1.87-3.85; P <.001), cancer (OR 2.49; 95% CI, 1.83-3.40; P <.001), and sepsis (OR 2.59; 95% CI, 1.88-3.59; P <.001). Independent predictors of acute myocardial infarction were older age (OR 1.03; 95% CI, 1.02-1.04; P <.001), smoking (OR 1.60; 95% CI, 1.14-2.24; P = .007), known coronary artery disease (OR 2.59; 95% CI, 1.76-3.81; P <.001), and congestive heart failure (OR 2.40; 95% CI, 1.71-3.37; P <.001). CONCLUSION In this large national database, patients with thrombotic thrombocytopenic purpura had an in-hospital mortality rate of 11.1% and an acute myocardial infarction rate of 5.7%. Predictors of in-hospital mortality were older age, acute myocardial infarction, acute renal failure, congestive heart failure, acute cerebrovascular disease, cancer, and sepsis. Predictors of acute myocardial infarction were older age, smoking, known coronary artery disease, and congestive heart failure.
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Chhabra A, McClung JA, Kalapatapu S, Lafaro RJ, Fallon JT, Aronow WS. Giant myxoma causing heart failure symptoms. Am J Case Rep 2012; 13:29-32. [PMID: 23569480 PMCID: PMC3616051 DOI: 10.12659/ajcr.882593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/28/2012] [Accepted: 03/06/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myxomas arising from the eustachian valve are exceedingly rare. CASE REPORT A 72-year-old Jamaican-Chinese woman was evaluated for worsening dyspnea. The 2-dimensional and real time 3-dimensional transesophageal echocardiogram showed a 75 mm length × 44 mm width, multilobulated, mobile mass arising from the eustachian valve occupying the entire right atrial and right ventricular cavities extending into the coronary sinus, right ventricular outflow tract, and proximal inferior vena cava. The patient underwent successful resection of the mass and replacement of the tricuspid valve. Histopathologic examination confirmed the diagnosis of atrial myxoma. CONCLUSIONS This is the largest myxoma found on a Eustachian valve.
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Affiliation(s)
- Amit Chhabra
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
| | - John A. McClung
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
| | - Srirama Kalapatapu
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
| | - Rocco J. Lafaro
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
| | - John T. Fallon
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
| | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, U.S.A
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Amin H, Aronow WS, Lleva P, McClung JA, Desai H, Gandhi K, Marks S, Singh B. Prevalence of transthoracic echocardiographic abnormalities in patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Arch Med Sci 2010; 6:40-2. [PMID: 22371718 PMCID: PMC3278941 DOI: 10.5114/aoms.2010.13505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 10/02/2008] [Accepted: 10/17/2008] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION This study investigated the prevalence of transthoracic echocardiographic abnormalities in patients with ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH) in sinus rhythm. MATERIAL AND METHODS The patients included 120 with IS, 30 with SAH, and 41 with ICH. All diagnoses were confirmed by magnetic resonance imaging or brain computed tomography. Two-dimensional echocardiograms were taken at the time stroke was diagnosed. All echocardiograms were interpreted by an experienced echocardiographer. RESULTS Of 120 IS patients, 1 (1%) had a left ventricular (LV) thrombus, 1 (1%) had mitral valve vegetations, 30 (25%) had LV hypertrophy, 26 (22%) had abnormal LV ejection fraction, 4 (3%) had mitral valve prolapse, 33 (28%) had mitral annular calcium (MAC), 40 (33%) had aortic valve calcium (AVC), 3 (3%) had a bioprosthetic aortic valve, 10 (8%) had aortic stenosis (AS), 6 (5%) had atrial septal aneurysm, 2 (2%) had patent foramen ovale, and 40 (33%) had no abnormalities. Of 30 SAH patients, 5 (17%) had LV hypertrophy, 1 (3%) had abnormal LV ejection fraction, 1 (3%) had AS, 4 (13%) had MAC, 5 (17%) had AVC, and 20 (67%) had no abnormalities. Of 41 ICH patients, 9 (22%) had LVH, 1 (2%) had abnormal LV ejection fraction, 1 (3%) had AS, 6 (15%) had MAC, 8 (20%) had AVC, and 22 (54%) had no abnormalities. CONCLUSIONS Transthoracic echocardiographic abnormalities are more prevalent in patients with IS than in patients with SAH or ICH.
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Affiliation(s)
- Harshad Amin
- Department of Medicine, Cardiology Division, Department of Neurology, New York Medical College, Valhalla, NY, USA
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Abstract
BACKGROUND Warfarin affects the synthesis and function of the matrix Gla-protein, a vitamin K-dependent protein, which is a potent inhibitor of tissue calcification. OBJECTIVES To investigate the incidence of mitral valve calcium (MVC), mitral annular calcium (MAC) and aortic valve calcium (AVC) in patients with non-valvular atrial fibrillation (AF) treated with warfarin vs. no warfarin. PATIENTS AND METHODS Of 1155 patients, mean age 74 years, with AF, 725 (63%) were treated with warfarin and 430 (37%) without warfarin. The incidence of MVC, MAC and AVC was investigated in these 1155 patients with two-dimensional echocardiograms. Unadjusted logistic regression analysis was conducted to examine the association between the use of warfarin and the incidence of MVC, MAC or AVC. Logistic regression analyses were also conducted to investigate whether the relationship stands after adjustment for confounding risk factors such as age, sex, race, ejection fraction, smoking, hypertension, diabetes, dyslipidemia, coronary artery disease (CAD), glomerular filtration rate, calcium, phosphorus, calcium-phosphorus product, alkaline phosphatase, use of aspirin, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. RESULTS There was a significant association between the use of warfarin and the risk of calcification [unadjusted odds ratio = 1.71, 95% CI = (1.34-2.18)]. The association still stands after adjustment for confounding risk factors. MVC, MAC or AVC was present in 473 of 725 patients (65%) on warfarin vs. 225 of 430 patients (52%) not on warfarin (P < 0.0001). Whether this is a causal relationship remains unknown. CONCLUSIONS Use of warfarin in patients with AF is associated with an increased prevalence of MVC, MAC or AVC.
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Affiliation(s)
- R G Lerner
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA.
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Amin H, Aronow WS, Lleva P, McClung JA, Desai H, Gandhi K, Marks S, Singh B. PREVALENCE OF TRANSTHORACIC ECHOCARDIOGRAPHIC ABNORMALITIES. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.105s-a] [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: 11/01/2022] Open
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Ravipati G, Aronow WS, Kumbar S, Kumar A, Rapera-Lleva R, Menga G, Weiss MB, McClung JA. DIABETICS WITH STROKE HAVE A HIGHER HEMOGLOBIN ALC LEVEL AND A HIGHER SERUM LOW-DENSITY LIPOPROTEIN CHOLESTEROL THAN DIABETICS WITHOUT STROKE. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p43001] [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: 11/01/2022] Open
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Lai HM, Aronow WS, Rajdev A, Asija A, Lai KV, George J, McClung JA. INCIDENCE OF MORTALITY IN 1,040 PATIENTS WITH CARDIOVASCULAR DISEASE WITH NORMAL AND ABNORMAL QRS DURATION AND WITH NORMAL AND ABNORMAL LEFT VENTRICULAR EJECTION FRACTION. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p2001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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24
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Kim DH, Burgess AP, Li M, Tsenovoy PL, Addabbo F, McClung JA, Puri N, Abraham NG. Heme oxygenase-mediated increases in adiponectin decrease fat content and inflammatory cytokines tumor necrosis factor-alpha and interleukin-6 in Zucker rats and reduce adipogenesis in human mesenchymal stem cells. J Pharmacol Exp Ther 2008; 325:833-40. [PMID: 18334666 DOI: 10.1124/jpet.107.135285] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Adiponectin, an abundant adipocyte-derived plasma protein that modulates vascular function in type 2 diabetes, has been shown to provide cytoprotection to both pancreatic and vascular systems in diabetes. Therefore, we examined whether up-regulation of heme oxygenase (HO)-1 ameliorates the levels of inflammatory cytokines and influences serum adiponectin in Zucker fat (ZF) rats. ZF rats displayed a decrease in both HO activity and HO-1 and HO-2 protein levels and an increase in tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 compared with Zucker lean (ZL) rats. Treatment of ZF animals with 2 mg/kg cobalt protoporphyrin IX (CoPP) increased protein levels of HO-1 and HO activity, but HO-2 was unaffected. The increase in HO-1 was associated with a decrease in superoxide levels (p < 0.05) and an increase in plasma adiponectin (p < 0.005), compared with untreated ZF rats. CoPP treatment decreased visceral and s.c. fat content, and it reduced weight gain (p < 0.01). In addition, the inflammatory cytokines TNF-alpha and IL-6 were decreased (p < 0.04 and p < 0.008, respectively). Treatment of human bone marrow-derived adipocytes cultured with CoPP resulted in an increase in HO-1 and a decrease in superoxide levels. Up-regulation of HO-1 caused adipose remodeling, smaller adipocytes, and increased adiponectin secretion in the culture medium of human bone marrow-derived adipocytes. In summary, this study demonstrates that the antiobesity effect of HO-1 induction results in an increase in adiponectin secretion, in vivo and in vitro, a decrease in TNF-alpha and IL-6, and a reduction in weight gain. These findings highlight the pivotal role and symbiotic relationship of HO-1 and adiponectin in the modulation of the metabolic syndrome phenotype.
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Affiliation(s)
- Dong Hyun Kim
- Dept. of Pharmacology, New York Medical College, Valhalla, NY 10595, USA
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Kannam H, Aronow WS, Chilappa K, Singh T, McClung JA, Pucillo AL, Weiss MB, Kalapatapu K, Sullivan T, Monsen CE. Comparison of prevalence of >70% diameter narrowing of one or more major coronary arteries in patients with versus without mitral annular calcium and clinically suspected coronary artery disease. Am J Cardiol 2008; 101:467-70. [PMID: 18312759 DOI: 10.1016/j.amjcard.2007.09.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
The prevalence of >70% narrowing of 1, 2, or 3 major coronary arteries and of 3 major coronary arteries was investigated in 2,465 patients (1,437 men, 1,028 women; mean age 69 +/- 13 years) with severe, moderate, mild, or no mitral annular calcium (MAC) diagnosed by 2-dimensional echocardiography who underwent coronary angiography for suspected coronary artery disease. Greater than 70% narrowing of 1, 2, or 3 major coronary arteries was present in 259 of 315 patients (82%) with severe MAC (group 1), in 835 of 1,052 patients (79%) with moderate or mild MAC (group 2), and in 756 of 1,098 patients (69%) with no MAC (group 3) (p <0.001 comparing group 1 with group 3 and group 2 with group 3). Greater than 70% narrowing of 3 major coronary arteries was present in 149 of 315 patients (47%) in group 1, in 366 of 1,052 patients (35%) in group 2, and in 325 of 1,098 patients (30%) in group 3 (p <0.001 comparing group 1 with group 3 and group 1 with group 2; p <0.01 comparing group 2 with group 3). In conclusion, MAC is associated with obstructive >or=1-vessel coronary artery disease and with obstructive 3-vessel coronary artery disease.
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L'Abbate A, Neglia D, Vecoli C, Novelli M, Ottaviano V, Baldi S, Barsacchi R, Paolicchi A, Masiello P, Drummond GS, McClung JA, Abraham NG. Beneficial effect of heme oxygenase-1 expression on myocardial ischemia-reperfusion involves an increase in adiponectin in mildly diabetic rats. Am J Physiol Heart Circ Physiol 2007; 293:H3532-41. [PMID: 17906103 DOI: 10.1152/ajpheart.00826.2007] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transient reduction in coronary perfusion pressure in the isolated mouse heart increases microvascular resistance (paradoxical vasoconstriction) by an endothelium-mediated mechanism. To assess the presence and extent of paradoxical vasoconstriction in hearts from normal and diabetic rats and to determine whether increased heme oxygenase (HO)-1 expression and HO activity, using cobalt protoporphyrin (CoPP), attenuates coronary microvascular response, male Wistar rats were rendered diabetic with nicotinamide/streptozotocin for 2 wk and either CoPP or vehicle was administered by intraperitoneal injection weekly for 3 wk (0.5 mg/100 g body wt). The isolated beating nonworking heart was submitted to transient low perfusion pressure (20 mmHg), and coronary resistance (CR) was measured. During low perfusion pressure, CR increased and was associated with increased lactate release. In diabetic rats, CR was higher, HO-1 expression and endothelial nitric oxide synthase were downregulated, and inducible nitric oxide synthase and O(2)(-) were upregulated. After 3 wk of CoPP treatment, HO activity was significantly increased in the heart. Upregulation of HO-1 expression and HO activity by CoPP resulted in the abolition of paradoxical vasoconstriction and a reduction in oxidative ischemic damage. In addition, there was a marked increase in serum adiponectin. Elevated HO-1 expression was associated with increased expression of cardiac endothelial nitric oxide synthase, B-cell leukemia/lymphoma extra long, and phospho activator protein kinase levels and decreased levels of inducible nitric oxide synthase and malondialdehyde. These results suggest a critical role for HO-1 in microvascular tone control and myocardial protection during ischemia in both normal and mildly diabetic rats through the modulation of constitutive and inducible nitric oxide synthase expression and activity, and an increase in serum adiponectin.
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Affiliation(s)
- Antonio L'Abbate
- Scuola Superiore Sant'Anna and CNR Institute of Clinical Physiology, University of Pisa, Pisa 56124, Italy.
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Ravipati G, Aronow WS, Ahn C, Alappat RM, McClung JA, Weiss MB. Incidence of new stroke or new myocardial infarction or death at 39-month follow-up in patients with diabetes mellitus, hypertension or both with and without microalbuminuria. Cardiology 2007; 109:62-5. [PMID: 17627110 DOI: 10.1159/000105327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/06/2006] [Indexed: 11/19/2022]
Abstract
We investigated in 306 patients, mean age 57 +/- 10 years, with diabetes mellitus (202 patients) or hypertension (179 patients) whether microalbuminuria was a significant independent risk factor for the development of new stroke or new myocardial infarction (MI) or death. At 39-month follow-up, new stroke or new MI or death developed in 44 of 111 patients (40%) with microalbuminuria and in 38 of 195 patients (19%) without microalbuminuria (p = 0.0001). Stepwise Cox regression analysis showed that significant independent predictors of the time to development of new stroke or new MI or death were (1) diabetes (risk ratio = 1.76), (2) left ventricular (LV) mass index (risk ratio = 1.020 for each 1 g/m(2) increase), (3) prior stroke (risk ratio = 5.39), and (4) prior MI (risk ratio = 3.29). Microalbuminuria was not a significant independent predictor of new stroke or new MI or death, but LV mass index, diabetes mellitus, prior stroke, and prior MI were significant independent predictors.
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Affiliation(s)
- Gautham Ravipati
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, NY 10595, USA
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Park HS, Naik SD, Aronow WS, Ahn CW, McClung JA, Belkin RN. Age- and Sex-Related Differences in the Tissue Doppler Imaging Parameters of Left Ventricular Diastolic Dysfunction. Echocardiography 2007; 24:567-71. [PMID: 17584195 DOI: 10.1111/j.1540-8175.2007.00434.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/27/2022] Open
Abstract
BACKGROUND The effect of age and gender on tissue Doppler imaging measurements comparing the septal and mitral annulus needs to be investigated. METHODS We investigated in 276 outpatients in a university cardiology practice the relationship of age and gender to left atrial (LA) size, LA volume, mitral pulse-wave Doppler E/A ratio, E/Ea ratios by tissue Doppler image of mitral annular velocity (TDI), and left ventricular diastolic dysfunction (LVDD) by TDI. RESULTS Mitral E/A inflow was statistically decreased with age. E/Ea ratios of the lateral and mean of both lateral and septal annulus showed a statistical increase with age, while the E/Ea ratio of the septal annulus did not correlate with age. When comparing men and women of all ages, the mean LA volume for men was 59.2 cm3 +/- 24.36 cm3 versus 48.54 cm3 +/- 16.14 cm3 (P-value < 0.0001) and the mean LA size was 4.0 + 0.51 cm for men and 3.65 + 0.47 for women (P-value < 0.0001). There was no statistical difference between men and women when looking at mitral E/A inflow ratio, deceleration time, E/Ea ratio of the septal annulus, E/Ea ratio of the lateral annulus, E/Ea ratio of the mean of both septal and lateral annulus, and grades of LVDD. CONCLUSION In patients 70 years of age or older, the mean diastolic grade was mild-to-moderate LVDD when using lateral or mean of septal and lateral annular measurements. When only the septal annular measurements were used to determine diastolic grade, all four age groups showed a mean of mildly to moderately impaired LVDD and showed no correlation with age. There were no differences in tissue Doppler imaging measurements between men and women.
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Affiliation(s)
- Hyeun S Park
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York 10595, USA
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29
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Peterson SJ, Husney D, Kruger AL, Olszanecki R, Ricci F, Rodella LF, Stacchiotti A, Rezzani R, McClung JA, Aronow WS, Ikehara S, Abraham NG. Long-term treatment with the apolipoprotein A1 mimetic peptide increases antioxidants and vascular repair in type I diabetic rats. J Pharmacol Exp Ther 2007; 322:514-20. [PMID: 17488882 DOI: 10.1124/jpet.107.119479] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Apolipoprotein A1 mimetic peptide (D-4F), synthesized from D-amino acid, enhances the ability of high-density lipoprotein to protect low-density lipoprotein (LDL) against oxidation in atherosclerotic disease. Using a rat model of type I diabetes, we investigated whether chronic use of D-4F would lead to up-regulation of heme oxygenase (HO)-1, endothelial cell marker (CD31(+)), and thrombomodulin (TM) expression and increase the number of endothelial progenitor cells (EPCs). Sprague-Dawley rats were rendered diabetic with streptozotocin (STZ) and either D-4F or vehicle was administered, by i.p. injection, daily for 6 weeks (100 microg/100 g b.wt.). HO activity was measured in liver, kidney, heart, and aorta. After 6 weeks of D-4F treatment, HO activity significantly increased in the heart and aorta by 29 and 31% (p < 0.05 and p < 0.49), respectively. Long-term D-4F treatment also caused a significant increase in TM and CD31(+) expression. D-4F administration increased antioxidant capacity, as reflected by the decrease in oxidized protein and oxidized LDL, and enhanced EPC function and/or repair, as evidenced by the increase in EPC endothelial nitric-oxide synthase (eNOS) and prevention of vascular TM and CD31(+) loss. In conclusion, HO-1 and eNOS are relevant targets for D-4F and may contribute to the D-4F-mediated increase in TM and CD31(+), the antioxidant and anti-inflammatory properties, and confers robust vascular protection in this animal model of type 1 diabetes.
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MESH Headings
- Animals
- Antioxidants/metabolism
- Aorta/enzymology
- Aorta/metabolism
- Apolipoprotein A-I/administration & dosage
- Apolipoprotein A-I/pharmacology
- Apolipoprotein A-I/therapeutic use
- Blood Glucose/metabolism
- Body Weight/drug effects
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/physiopathology
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/physiopathology
- Heme Oxygenase (Decyclizing)/metabolism
- Heme Oxygenase-1/metabolism
- Kidney/enzymology
- Lipoproteins, LDL/blood
- Liver/enzymology
- Male
- Myocardium/enzymology
- Nitric Oxide Synthase Type III/metabolism
- Oxidative Stress/drug effects
- Platelet Endothelial Cell Adhesion Molecule-1/metabolism
- Rats
- Rats, Sprague-Dawley
- Stem Cells/metabolism
- Stem Cells/pathology
- Thrombomodulin/metabolism
- Time Factors
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Affiliation(s)
- Stephen J Peterson
- Department of Medicine, New York Medical College, Valhalla, NY 10595, USA
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Abstract
Since the discovery of sildenafil in 1989 as a highly selective inhibitor of the phosphodiesterase type-5 (PDE-5) receptor, 2 additional PDE-5 inhibitors, tadalafil and vardenafil, have emerged as safe and effective treatments of erectile dysfunction (ED). Enzymes in the PDE family catalyze the hydrolysis of the intracellular signaling molecules cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), which is the second messenger of nitric oxide (NO) and a principal mediator of smooth muscle relaxation and vasodilation. Sildenafil was initially introduced for clinical use as the result of extensive research on chemical agents targeting PDE-5 that might potentially be useful in the treatment of coronary heart disease. Erection is largely a hemodynamic event, which is regulated by vascular tone and blood flow balance in the penis. Endothelial dysfunction, an early component of atherosclerosis, may inhibit a vascular event such as erection and is rarely confined to the arteries supplying blood to the penis, but more likely occurs throughout the vascular bed. In addition to the effects of the NO-cGMP signaling pathway on cavernosal smooth muscle, clinical findings have suggested that vascular tone in the pulmonary, coronary, and other vascular tissues expressed by PDE-5 is also influenced by this signal transduction mechanism. This has led to the emergence of novel therapeutic indications for sildenafil over a range of cardiovascular conditions that are either well-established risk factors or comorbidities with ED. Recently, the U.S. Food and Drug Administration approved sildenafil as an orally active therapy for the treatment of primary pulmonary hypertension. The drug will be marketed under the trade name of Revatio, not Viagra, the name used for the ED indication. The approved dose for primary pulmonary hypertension is 20 mg 3 times daily.
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Affiliation(s)
- Gautham Ravipati
- Division of General Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York 10595, USA
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Park HS, Naik SD, Aronow WS, Visintainer PF, Das M, McClung JA, Belkin RN. Differences of lateral and septal mitral annulus velocity by tissue Doppler imaging in the evaluation of left ventricular diastolic function. Am J Cardiol 2006; 98:970-2. [PMID: 16996885 DOI: 10.1016/j.amjcard.2006.04.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 03/18/2006] [Revised: 04/14/2006] [Accepted: 04/14/2006] [Indexed: 11/18/2022]
Abstract
Left ventricular diastolic dysfunction (LVDD) was investigated in 276 outpatients at a university cardiology practice by tissue Doppler imaging of mitral valve annular velocity. The well-investigated parameters of mitral inflow were used as the standard. Using septal E/Ea ratios, 62 patients (22%) had no LVDD, 44 patients (16%) had mild LVDD, 126 patients (46%) had moderate LVDD, 25 patients (9%) had severe LVDD, and 19 patients (7%) had indeterminate LVDD. Using lateral E/Ea ratios, 131 patients (48%) had no LVDD, 40 patients (14%) had mild LVDD, 62 patients (22%) had moderate LVDD, 9 patients (3%) had severe LVDD, and 12 patients (13%) had indeterminate LVDD. In conclusion, the use of septal tissue Doppler imaging tends to overestimate the severity of LVDD compared with the use of lateral tissue Doppler imaging.
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Affiliation(s)
- Hyeun S Park
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York, USA
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Kruger AL, Peterson SJ, Schwartzman ML, Fusco H, McClung JA, Weiss M, Shenouda S, Goodman AI, Goligorsky MS, Kappas A, Abraham NG. Up-regulation of heme oxygenase provides vascular protection in an animal model of diabetes through its antioxidant and antiapoptotic effects. J Pharmacol Exp Ther 2006; 319:1144-52. [PMID: 16959961 DOI: 10.1124/jpet.106.107482] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Heme oxygenase (HO) plays a critical role in the regulation of cellular oxidative stress. The effects of the reactive oxygen species scavenger ebselen and the HO inducers cobalt protoporphyrin and stannous chloride (SnCl(2)) on HO protein levels and activity, indices of oxidative stress, and the progression of diabetes were examined in the Zucker rat model of type 2 diabetes. The onset of diabetes coincided with an increase in HO-1 protein levels and a paradoxical decrease in HO activity, which was restored by administration of ebselen. Up-regulation of HO-1 expressed in the early development of diabetes produced a decrease in oxidative/nitrosative stress as manifested by decreased levels of 3-nitrotyrosine, superoxide, and cellular heme content. This was accompanied by a decrease in endothelial cell sloughing and reduced blood pressure. Increased HO activity was also associated with a significant increase in the antiapoptotic signaling molecules Bcl-xl and phosphorylation of p38-mitogen-activated protein kinase but no significant increases in Bcl-2 or BAD proteins. In conclusion, 3-nitrotyrosine, cellular heme, and superoxide, promoters of vascular damage, are reduced by HO-1 induction, thereby preserving vascular integrity and protecting cardiac function involving an increase in antiapoptotic proteins.
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Affiliation(s)
- Adam L Kruger
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York 10595, USA
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33
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Abstract
We investigated the prevalence of intrapulmonary shunts in 82 patients with hepatic cirrhosis referred for echocardiography as part of liver transplantation evaluation. Intrapulmonary shunts were present in 49 of 82 patients (60%). Baseline characteristics were similar in patients with and without intrapulmonary shunts. Mean follow up was 41 +/- 15 months in patients with intrapulmonary shunts and 42 +/- 15 months in patients without intrapulmonary shunts (P not significant). At follow up, 8 of 49 patients (16%) with intrapulmonary shunts and 4 of 33 patients (12%) without intrapulmonary shunts had died (P not significant).
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Affiliation(s)
- Michael Langiulli
- Department of Medicine, New York Medical College, Valhalla, New York 10595, USA
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Das M, Aronow WS, McClung JA, Belkin RN. Increased prevalence of coronary artery disease, silent myocardial ischemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, mitral annular calcium, and aortic valve calcium in patients with chronic renal insufficiency. Cardiol Rev 2006; 14:14-7. [PMID: 16371761 DOI: 10.1097/01.crd.0000148162.88296.9f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cardiovascular morbidity and mortality is high in patients with chronic renal insufficiency. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, mitral annular calcium, and aortic valve calcium than patients with normal renal function. These risk factors for cardiovascular morbidity and mortality contribute to the increased incidence of cardiovascular morbidity and mortality seen in patients with chronic renal insufficiency.
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Affiliation(s)
- Manisha Das
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA
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35
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Langiulli M, Salomon P, Aronow WS, McClung JA, Belkin RN. Comparison of outcomes in patients with active infective endocarditis and a paravalvular abscess on a prosthetic valve versus a native valve. Cardiol Rev 2005; 13:271-3. [PMID: 16230883 DOI: 10.1097/01.crd.0000137252.53964.ae] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated in-hospital and long-term mortality in 16 patients with infective endocarditis and paravalvular abscess on a prosthetic valve (6 of whom underwent surgery) and in 12 patients with infective endocarditis and paravalvular abscess on a native valve (8 of whom underwent surgery). The only significant risk factor for in-hospital mortality in patients with prosthetic or native value paravalvular abscess was age (P < 0.001). In-hospital mortality was 33% in patients with prosthetic valve paravalvular abscess undergoing surgery and 33% in patients treated medically (P = not significant). In-hospital mortality was 25% in patients with native valve paravalvular abscess undergoing surgery and 25% in patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with prosthetic valve paravalvular abscess was 67% for patients treated surgically versus 40% for patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with native valve paravalvular abscess was 75% for patients treated surgically versus 50% for patients treated medically (P = not significant).
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Affiliation(s)
- Michael Langiulli
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, USA
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36
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Ravipati G, Aronow WS, De Luca AJ, Walia T, McClung JA, Belkin RN. PREVALENCE OF MODERATE OR SEVERE LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PERSONS WITH SUSPECTED MYOCARDIAL ISCHEMIA WITH AND WITHOUT AN ABNORMAL ADENOSINE OR EXERCISE SESTAMIBI STRESS TEST OR PRIOR CORONARY REVASCULARIZATION. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.279s-b] [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: 11/01/2022] Open
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37
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Das M, Aronow WS, Langiulli M, Salomon P, McClung JA, Kim-Schluger L, Wolf D, Belkin RN. PREVALENCE AND PROGNOSIS OF INTRAPULMONARY SHUNTS IN PATIENTS WITH HEPATIC CIRRHOSIS. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.289s-b] [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: 11/01/2022] Open
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38
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Sidana J, Aronow WS, Ravipati G, Di Stante B, McClung JA, Belkin RN, Lehrman SG. PREVALENCE OF MODERATE OR SEVERE LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN OBESE PERSONS WITH OBSTRUCTIVE SLEEP APNEA. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.134s-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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39
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Ravipati G, Aronow WS, Sidana J, Maguire GP, McClung JA, Belkin RN, Lehrman SG. ASSOCIATION OF REDUCED CARBON MONOXIDE DIFFUSING CAPACITY WITH MODERATE OR SEVERE LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN OBESE PERSONS. Chest 2005; 128:1620-2. [PMID: 16162766 DOI: 10.1378/chest.128.3.1620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine the association of reduced diffusing capacity of the lung for carbon monoxide (D(LCO)) with moderate or severe left ventricular diastolic dysfunction (LVDD) in obese persons. DESIGN We investigated the association of D(LCO) with LVDD in 105 patients with a mean +/- SD body mass index of 49 +/- 5 kg/m2. An abnormal D(LCO) was < 80%. LVDD was investigated by Doppler and by tissue Doppler echocardiography. The Doppler echocardiographic data were analyzed blindly without knowledge of the clinical characteristics or whether the D(LCO) was normal or abnormal. SETTING A university hospital. PATIENTS The 105 patients included 19 men and 86 women (mean age, 45 +/- 9 years). RESULTS An abnormal D(LCO) was present in 62 of 105 patients (59%). Moderate or severe LVDD was present in 35 of 105 patients (33%). Moderate or severe LVDD was present in 25 of 62 patients (40%) with an abnormal D(LCO) and in 10 of 43 patients (23%) with a normal D(LCO) (p < 0.05). CONCLUSION Obese patients with a decreased D(LCO) have an increased prevalence of moderate or severe LVDD.
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Affiliation(s)
- Gautham Ravipati
- Pulmonary and Critical Care, Department of Medicine, Westechester Medical Center, New York Medical College, Valhalla 10595, USA
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40
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Ravipati G, Aronow WS, Sidana J, Maguire GP, McClung JA, Belkin RN, Lehrman SG. Association of Reduced Carbon Monoxide Diffusing Capacity With Moderate or Severe Left Ventricular Diastolic Dysfunction in Obese Persons. Chest 2005. [DOI: 10.1016/s0012-3692(15)52196-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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41
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Sidana J, Aronow WS, Ravipati G, Di Stante B, McClung JA, Belkin RN, Lehrman SG. Prevalence of Moderate or Severe Left Ventricular Diastolic Dysfunction in Obese Persons with Obstructive Sleep Apnea. Cardiology 2005; 104:107-9. [PMID: 16043965 DOI: 10.1159/000087128] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 01/20/2005] [Accepted: 02/10/2005] [Indexed: 11/19/2022]
Abstract
We investigated prior to gastric bypass surgery the prevalence of left ventricular diastolic dysfunction (LVDD) by Doppler and tissue Doppler echocardiography in 14 obese women and in 6 obese men, mean age 45 years, with a mean body mass index of 49+/-5 kg/m2 who had nocturnal polysomnography for obstructive sleep apnea (OSA). The Doppler and tissue Doppler echocardiographic data were analyzed blindly without knowledge of the clinical characteristics or whether OSA was present or absent. Of 20 patients, 8 (40%) had no OSA, 4 (20%) had mild OSA, and 8 (40%) had moderate or severe OSA. Moderate or severe LVDD was present in 4 of 8 patients (50%) with moderate or severe OSA and in none of 12 patients (0%) with no or mild OSA (p<0.01). Obese patients with moderate or severe OSA have a higher prevalence of moderate or severe LVDD than obese patients with no or mild OSA.
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Affiliation(s)
- Jasdeep Sidana
- Department of Medicine, Divisions of Cardiology and Pulmonary/Critical Care, New York Medical College, Valhalla, NY 10595, USA
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Di Stante B, Galandauer I, Aronow WS, McClung JA, Alas L, Salabay C, Belkin RN. Prevalence of left ventricular diastolic dysfunction in obese persons with and without diabetes mellitus. Am J Cardiol 2005; 95:1527-8. [PMID: 15950591 DOI: 10.1016/j.amjcard.2005.02.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 02/08/2005] [Accepted: 02/07/2005] [Indexed: 02/05/2023]
Abstract
Forty obese diabetic patients (mean age 48 +/- 9 years) and 93 obese nondiabetic patients (mean age 43 +/- 9 years) underwent Doppler and tissue Doppler echocardiographic evaluation of left ventricular diastolic function before gastric bypass surgery. Moderate or severe left ventricular diastolic dysfunction was present in 24 of 40 obese diabetics (60%) and in 21 of 93 obese nondiabetics (23%) (p <0.001).
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Affiliation(s)
- Brian Di Stante
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York 10595, USA
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Sukhija R, Aronow WS, Nayak D, McClung JA, Monsen CE, Belkin RN. Use of reperfusion therapy and cardiovascular drugs in the treatment of 146 men and 54 women with ST-segment elevation myocardial infarction at a University Medical Center. Am J Ther 2005; 12:277-80. [PMID: 15891275] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We investigated the treatment of 146 men, mean age 62 years, and 54 women, mean age 69 years, with acute ST-segment elevation myocardial infarction (STEMI) in a university medical center. Coronary revascularization or thrombolytic therapy was given to 143 men (98%) and 52 women (96%) [P = not significant (NS)]. Antiplatelet therapy and antithrombotic therapy were given to 146 men (100%) and 54 women (100%) (P = NS). Beta-blockers were given to 133 men (91%) and 45 women (83%) (P = NS). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were given to 122 men (84%) and 42 women (78%) (P = NS). Statins were given to 128 men (88%) and 43 women (80%) (P = NS). Nitrates were given to 94 men (64%) and 36 women (67%) (P = NS). Diuretics were given to 97 men (66%) and 37 women (69%) (P = NS). Calcium channel blockers were given to 26 men (18%) and 12 women (22%) (P = NS). There was no significant difference in the treatment of men versus women with acute STEMI.
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Affiliation(s)
- Rishi Sukhija
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA
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Saleem MA, McClung JA, Aronow WS, Kannam H. Inpatient Telemetry Does Not Need To Be Used in the Management of Older Patients Hospitalized With Chest Pain at Low Risk for In-Hospital Coronary Events and Mortality. J Gerontol A Biol Sci Med Sci 2005; 60:605-6. [PMID: 15972612 DOI: 10.1093/gerona/60.5.605] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about patients admitted with chest pain to inpatient telemetry units directly from an emergency department. METHODS We analyzed data from 105 consecutive patients who presented with chest pain to an emergency department and who were hospitalized in an inpatient telemetry unit but who were at low risk for a coronary event. RESULTS Telemetry yielded no information which was used to manage any patient. None of the 105 patients (0%) developed a myocardial infarction or died during hospitalization. At 4.8-year follow-up, 8 of 105 patients (8%) died. Significant risk factors for long-term mortality were age (p < .001), prior coronary artery disease (p < .05), and diabetes (p < .02). CONCLUSIONS Inpatient telemetry was of no value in predicting short-term coronary events or mortality or long-term mortality in low-risk patients hospitalized with chest pain.
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Affiliation(s)
- Mohammad A Saleem
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595, USA
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Park H, Das M, Aronow WS, McClung JA, Belkin RN. Relation of decreased ankle-brachial index to prevalence of atherosclerotic risk factors, coronary artery disease, aortic valve calcium, and mitral annular calcium. Am J Cardiol 2005; 95:1005-6. [PMID: 15820178 DOI: 10.1016/j.amjcard.2004.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Revised: 12/20/2004] [Accepted: 12/20/2004] [Indexed: 10/25/2022]
Abstract
Coronary artery disease was present in 89 of 118 patients (75%) with a decreased ankle-brachial index (ABI) and in 34 of 118 age- and gender-matched patients (29%) with a normal ABI (p <0.001). Aortic valve calcium or mitral annular calcium was present in 81 of 118 patients (69%) with a decreased ABI and in 43 of 118 patients (36%) with a normal ABI (p <0.001).
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Affiliation(s)
- Hyeun Park
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla 10595, USA
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Sukhija R, Aronow WS, Yalamanchili K, Lee J, McClung JA, Levy JA, Belkin RN. Association of Right Ventricular Dilatation with Bilateral Pulmonary Embolism, Pulmonary Embolism in a Main Pulmonary Artery and Lobar, Segmental and Subsegmental Pulmonary Embolism in 190 Patients with Acute Pulmonary Embolism. Cardiology 2005; 103:156-7. [PMID: 15785020 DOI: 10.1159/000084585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 08/24/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) may result in right ventricular (RV) pressure overload with a dilated RV which can be diagnosed by two-dimensional echocardiography. METHODS A retrospective analysis was performed in 190 unselected patients who had acute PE documented by contrast-enhanced spiral computed tomographic scanning. The 190 patients included 104 women and 86 men, mean age 58 +/- 15 years. RESULTS RV dilatation was present in 45 of 70 patients (64%) with bilateral PE, in 19 of 120 patients (16%) without bilateral PE, in 42 of 47 patients (89%) with main pulmonary artery embolism, in 34 of 84 patients (40%) with lobar PE, in 16 of 70 patients (23%) with segmental PE and in 6 of 36 patients (17%) with subsegmental PE; p < 0.001 comparing bilateral with no bilateral PE and main pulmonary artery embolism with no main pulmonary artery embolism, with lobar, segmental and subsegmental PE; p < 0.025 comparing lobar with segmental PE, and p < 0.02 comparing lobar with subsegmental PE. CONCLUSION The prevalence of RV dilatation is highest in patients with main pulmonary artery embolism or bilateral pulmonary artery embolism; furthermore, the prevalence of RV dilatation is higher in patients with lobar PE than in patients with segmental or subsegmental PE.
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Affiliation(s)
- Rishi Sukhija
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, USA
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Varma R, Aronow WS, McClung JA, Garrick R, Vistainer PF, Weiss MB, Belkin RN. Prevalence of valve calcium and association of valve calcium with coronary artery disease, atherosclerotic vascular disease, and all-cause mortality in 137 patients undergoing hemodialysis for chronic renal failure. Am J Cardiol 2005; 95:742-3. [PMID: 15757600 DOI: 10.1016/j.amjcard.2004.11.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022]
Abstract
Of 137 patients (mean age 63 years) who underwent hemodialysis for chronic renal failure, 65 (47%) had mitral valve calcium, mitral annular calcium, or aortic valve calcium. Thirty-eight of 65 patients (59%) who had valve calcium died at 3.5-year follow-up versus 21 of 72 patients (29%) who did not have valve calcium and who died at 4.3-year follow-up (p = 0.0005).
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Affiliation(s)
- Raja Varma
- Department of Medicine, Cardiology and Renal Divisions, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA
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Sukhija R, Aronow WS, Lee J, Kakar P, McClung JA, Levy JA, Belkin RN. Association of right ventricular dysfunction with in-hospital mortality in patients with acute pulmonary embolism and reduction in mortality in patients with right ventricular dysfunction by pulmonary embolectomy. Am J Cardiol 2005; 95:695-6. [PMID: 15721126 DOI: 10.1016/j.amjcard.2004.10.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 09/07/2004] [Revised: 10/18/2004] [Accepted: 10/18/2004] [Indexed: 11/28/2022]
Abstract
Twenty-one of 64 patients (33%) with pulmonary embolisms with right ventricular (RV) dilation and 6 of 126 patients (5%) with pulmonary embolisms without RV dilation died during hospitalization (p <0.001). In the 64 patients with RV dilation, in-hospital mortality occurred in 2 of 18 hemodynamically unstable patients (11%) who underwent pulmonary embolectomy, in 2 of 6 hemodynamically stable patients (33%) treated with thrombolytic therapy plus intravenous heparin, and in 17 of 40 hemodynamically stable patients (43%) treated with intravenous heparin (p <0.025 comparing pulmonary embolectomy with no pulmonary embolectomy).
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Affiliation(s)
- Rishi Sukhija
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
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McClung JA, Naseer N, Saleem M, Rossi GP, Weiss MB, Abraham NG, Kappas A. Circulating endothelial cells are elevated in patients with type 2 diabetes mellitus independently of HbA(1)c. Diabetologia 2005; 48:345-50. [PMID: 15660261 DOI: 10.1007/s00125-004-1647-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 09/11/2004] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS Patients with diabetes mellitus are well known to be at high risk for vascular disease. Circulating endothelial cells (CECs) have been reported to be an ex vivo indicator of vascular injury. We investigated the presence of CECs in the peripheral blood of 25 patients with diabetes mellitus and in nine non-diabetic control donors. METHODS Endothelial cells were isolated from peripheral blood with anti-CD-146-coated immunomagnetic Dynabeads, and were stained with acridine orange dye and counted by fluorescence microscopy. The cells were also stained for von Willebrand factor and Ulex europaeus lectin 1. RESULTS Patients with diabetes mellitus had an elevated number of CECs (mean 69+/-30 cells/ml, range 35-126) compared with healthy controls (mean 10+/-5 cells/ml, range 3-18) (p<0.001). The increase in CECs did not correlate with the levels of HbA(1)c. Circulating endothelial cell numbers were elevated regardless of glucose levels, suggesting that, even with control of glucose levels, there is increased endothelial cell sloughing. CONCLUSIONS Our study suggests that the higher number of CECs in patients with type 2 diabetes may reflect ongoing vascular injury that is not directly dependent on glucose control.
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Affiliation(s)
- J A McClung
- Cardiology Division and Medicine, New York Medical College, Valhalla, NY, 10595, USA
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Langiulli M, Salomon P, Aronow WS, McClung JA, Belkin RN. Comparison of outcomes in patients with active infective endocarditis with versus without paravalvular abscess and with and without valve replacement. Am J Cardiol 2004; 94:136-7. [PMID: 15219527 DOI: 10.1016/j.amjcard.2004.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 03/19/2004] [Accepted: 03/19/2004] [Indexed: 10/26/2022]
Abstract
In 82 patients with infective endocarditis, including 11 with a perivalvular abscess detected by transesophageal echocardiography, age was a significant predictor of in-hospital mortality (p <0.001). At 3.8-year follow-up, 5 of 7 patients with an abscess who had valve replacement and 2 of 4 patients with an abscess who did not have surgery survived (p = NS); 13 of 22 patients (59%) with no abscess who had valve replacement and 20 of 49 patients (41%) with no abscess who did not have surgery survived (p = NS).
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Affiliation(s)
- Michael Langiulli
- Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA
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