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Ibănescu R, Mîțu DA, Goje ID, Goje GI, Lighezan DF. History of Heart Failure Definition. Card Fail Rev 2025; 11:e07. [PMID: 40171550 PMCID: PMC11959578 DOI: 10.15420/cfr.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 12/28/2024] [Indexed: 04/03/2025] Open
Abstract
The concept of heart failure (HF) has undergone significant transformation from ancient times to the present, evolving from rudimentary understandings to a complex clinical syndrome. Early descriptions by Egyptian, Greek and Roman physicians laid the groundwork for understanding cardiac dysfunction. The Renaissance period brought crucial insights with Harvey's discovery of blood circulation. In the 20th century, the Framingham Heart Study provided a pivotal shift, formally defining HF as a clinical syndrome with diagnostic criteria. Over the decades, definitions of HF have evolved, integrating advancements in pathophysiology, biomarkers and imaging techniques. Initially focused on symptomatic and clinical presentations, modern definitions emphasise underlying structural and functional cardiac abnormalities. This evolution reflects the growing complexity and precision of diagnosing and managing HF. A historical perspective underscores the progressive refinement in HF definitions, which enhances diagnostic precision and therapeutic strategies, ultimately improving patient outcomes. Understanding this evolution is crucial for appreciating contemporary HF management and anticipating future advances.
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Affiliation(s)
- Raluca Ibănescu
- Advanced Cardiology and Haemostaseology Research Centre, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Department of Medical Semiology I, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Emergency Clinical Municipal HospitalTimișoara, Romania
| | - Diana-Alexandra Mîțu
- Advanced Cardiology and Haemostaseology Research Centre, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Department of Medical Semiology I, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Emergency Clinical Municipal HospitalTimișoara, Romania
| | - Iacob-Daniel Goje
- Advanced Cardiology and Haemostaseology Research Centre, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Department of Medical Semiology I, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Emergency Clinical Municipal HospitalTimișoara, Romania
| | - Greta-Ionela Goje
- Advanced Cardiology and Haemostaseology Research Centre, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Emergency Clinical Municipal HospitalTimișoara, Romania
- Department of Clinical Practical Skills, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
| | - Daniel-Florin Lighezan
- Advanced Cardiology and Haemostaseology Research Centre, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Department of Medical Semiology I, Victor Babeș University of Medicine and PharmacyTimișoara, Romania
- Emergency Clinical Municipal HospitalTimișoara, Romania
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Khanum A, Khan JA, Shahid A, Riyazuddin M, Siddiqui MA. Effect of a polyherbal Unani formulation on left ventricular diastolic dysfunction in hypertensive patients - a randomized single blind placebo controlled clinical trial. Drug Metab Pers Ther 2024; 39:137-144. [PMID: 39135328 DOI: 10.1515/dmpt-2024-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/09/2024] [Indexed: 10/16/2024]
Abstract
OBJECTIVES Diastolic dysfunction represents an important pathophysiological intermediate between hypertension and heart failure. In the last two decades, the prevalence of heart failure patients having normal or near normal ejection fraction (EF) has increased to around 60 %. It thus poses a great morbidity and mortality risk to the population. In view of present scenario of high prevalence, lack of evidence-based therapy, and limited clinical trials, this study aimed to evaluate how a Unani formulation affects the improvement of the left ventricular diastolic function. METHODS This clinical trial was set up as a randomized, placebo-controlled study involving 35 participants, with 18 individuals in the test group and 17 in the control group. Test group received 3.5 g of a polyherbal Unani formulation in capsule form along with 35 mL of an extract of Borago officinalis L. (Arq-e-Gaozaban), divided into two doses after meals. Meanwhile, the control group received a placebo in the same manner over an eight-week period. Follow-ups were conducted every 15 days to assess both subjective and objective parameters in all participants. RESULTS The test formulation shows significant improvement in dyspnea and diastolic function from baseline to the end of trial (p<0.05), slight improvement in palpitations (p>0.05) and highly significant improvement in easy fatigability (p=0.001) as compared to the control. CONCLUSIONS The present study shows the effectiveness of the test drug in enhancing the diastolic function of left ventricle and alleviating other symptoms associated with ventricular diastolic dysfunction. Nevertheless, additional research with longer follow-up durations is necessary to clarify its efficacy and establish optimal treatment approaches for ventricular diastolic dysfunction in Unani medicine.
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Affiliation(s)
- Asia Khanum
- Department of Moalajat, Rehbar Ayurvedic & Unani Tibbi Medical College Hospital and Research Centre, Sangrur, Punjab, India
| | - Javed Ali Khan
- Department of Ilaj Bit-Tadbeer, Rehbar Ayurvedic & Unani Tibbi Medical College Hospital and Research Centre, Sangrur, Punjab, India
| | - Arisha Shahid
- Ayush Wellness Centre, Rashtrapati Bhawan, New Delhi, India
| | - Mohd Riyazuddin
- Department of Moalajat (Medicine), 80104 National Institute of Unani Medicine , Bengaluru, Karnataka, India
| | - Mansoor Ahmad Siddiqui
- Department of Moalajat (Medicine), 80104 National Institute of Unani Medicine , Bengaluru, Karnataka, India
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Maged R, Sinha M, Koneru HM, Sarwar H, Bandi VV, Tarar P, Halawa N. Efficacy of Sodium-Glucose 2 Transporter Inhibitors in Heart Failure With Preserved Ejection Fraction: A Narrative Review. Cureus 2024; 16:e69623. [PMID: 39429273 PMCID: PMC11488994 DOI: 10.7759/cureus.69623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 09/17/2024] [Indexed: 10/22/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent condition. It occurs more commonly in older patient populations with multiple comorbidities, such as hypertension, diabetes, and obesity. However, managing HFpEF has been challenging due to its complex pathophysiology, and medications effective for heart failure with reduced ejection fraction (HFrEF) have not shown similar efficacy in HFpEF. Sodium-glucose 2 transporter (SGLT2) inhibitors were originally developed for the treatment of type 2 diabetes mellitus, yet several trials and papers have proved their significant role in HFpEF. Through a variety of mechanisms, including natriuresis, diuresis, and anti-inflammatory effects, to name a few, this class of drugs has shown promising results in HFpEF patients. The use of SGLT2 inhibitors in HFpEF has resulted in improvements in several aspects, including biomarkers, imaging, symptomatology, and mortality. Moreover, SGLT2 inhibitors have a favorable safety profile, which is especially significant given the high comorbidity burden in HFpEF patients. This feature is particularly notable given the type of patient being managed. Extensive research is still being undertaken for their use in HFpEF, given the positive results obtained thus far.
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Affiliation(s)
- Rafik Maged
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mohit Sinha
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hema Manvi Koneru
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hooria Sarwar
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Venkata Varshitha Bandi
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Pakeeza Tarar
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nouran Halawa
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Dandel M. Load Dependency of Ventricular Pump Function: Impact on the Non-Invasive Evaluation of the Severity and the Prognostic Relevance of Myocardial Dysfunction. Rev Cardiovasc Med 2024; 25:272. [PMID: 39228470 PMCID: PMC11366997 DOI: 10.31083/j.rcm2508272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 09/05/2024] Open
Abstract
Ventricular pump function, which is determined by myocyte contractility, preload and afterload, and, additionally, also significantly influenced by heart rhythm, synchrony of intraventricular contraction and ventricular interdependence, explains the difficulties in establishing the contribution of myocardial contractile dysfunction to the development and progression of heart failure. Estimating myocardial contractility is one of the most difficult challenges because the most commonly used clinical measurements of cardiac performance cannot differentiate contractility changes from alterations in ventricular loading conditions. Under both physiological and pathological conditions, there is also a permanent complex interaction between myocardial contractility, ventricular anatomy and hemodynamic loading conditions. All this explains why no single parameter can alone reveal the real picture of ventricular dysfunction. Over time there has been increasing recognition that a load-independent contractility parameter cannot truly exist, because loading itself changes the myofilament force-generating capacity. Because the use of a single parameter is inadequate, it is necessary to perform multiparametric evaluations and also apply integrative approaches using parameter combinations which include details about ventricular loading conditions. This is particularly important for evaluating the highly afterload-sensitive right ventricular function. In this regard, the existence of certain reluctance particularly to the implementation of non-invasively obtainable parameter combinations in the routine clinical praxis should be reconsidered in the future. Among the non-invasive approaches used to evaluate ventricular function in connection with its current loading conditions, assessment of the relationship between ventricular contraction (e.g., myocardial displacement or deformation) and pressure overload, or the relationship between ejection volume (or ejection velocity) and pressure overload, as well as the relationship between ventricular dilation and pressure overload, were found useful for therapeutic decision-making. In the future, it will be unavoidable to take the load dependency of ventricular function much more into consideration. A solid basis for achieving this goal will be obtainable by intensifying the clinical research necessary to provide more evidence for the practical importance of this largely unsolved problem.
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Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
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Gándara-Mireles JA, Lares-Asseff I, Reyes Espinoza EA, Córdova Hurtado LP, Payan Gándara H, Botello Ortiz M, Loera Castañeda V, Patrón Romero L, Almanza Reyes H. Nutritional Status as a Risk Factor for Doxorubicin Cardiotoxicity in Mexican Children with Acute Lymphoblastic Leukemia. Nutr Cancer 2024; 76:952-962. [PMID: 38994569 DOI: 10.1080/01635581.2024.2378502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer in the world. Doxorubicin (Dox) is a very useful drug in these patients, however, one of the main adverse effects caused by the use of Dox is cardiotoxicity (CT). Protein-calorie malnutrition (PCM) is a factor that, among others, can influence the development of CT due to Dox. The aim of our study was to associate PCM as a risk factor for CT induced by Dox in Mexican children with ALL. We included 89 children with ALL who were treated with Dox, from October 2018 to July 2023, and of whom 14 developed some type of CT, 15 were underweight and 3 were overweight. The analysis of the association risk of CT due to PCM shows a statistically significant association of risk of developing CT due to PCM. On the other hand, healthy weight was associated with protection for developing CT due to Dox use. Of the total number of girls who presented CT, all had systolic dysfunction, while 6 of them also had diastolic dysfunction. On the other hand, of the total number of boys who presented CT, all of them had systolic dysfunction and only one of them also had diastolic dysfunction. These results show that in patients in which Dox is being administered, special attention is suggested for girls with PCM, since systolic failure is a precursor and occurs before diastolic failure in girls with PCM.
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Affiliation(s)
- Jesús Alonso Gándara-Mireles
- Academia de Genómica, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED)
| | - Ismael Lares-Asseff
- Academia de Genómica, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED)
| | | | | | - Hugo Payan Gándara
- Servicio de Hemato-Oncología Pediátrica, Centro Estatal de Cancerología, CECAN Durango, México
| | | | - Verónica Loera Castañeda
- Academia de Genómica, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED)
| | - Leslie Patrón Romero
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, México
| | - Horacio Almanza Reyes
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED)
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, México
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Benson LN, Guo Y, Deck K, Mora C, Liu Y, Mu S. The link between immunity and hypertension in the kidney and heart. Front Cardiovasc Med 2023; 10:1129384. [PMID: 36970367 PMCID: PMC10034415 DOI: 10.3389/fcvm.2023.1129384] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Hypertension is the primary cause of cardiovascular disease, which is a leading killer worldwide. Despite the prevalence of this non-communicable disease, still between 90% and 95% of cases are of unknown or multivariate cause ("essential hypertension"). Current therapeutic options focus primarily on lowering blood pressure through decreasing peripheral resistance or reducing fluid volume, but fewer than half of hypertensive patients can reach blood pressure control. Hence, identifying unknown mechanisms causing essential hypertension and designing new treatment accordingly are critically needed for improving public health. In recent years, the immune system has been increasingly implicated in contributing to a plethora of cardiovascular diseases. Many studies have demonstrated the critical role of the immune system in the pathogenesis of hypertension, particularly through pro-inflammatory mechanisms within the kidney and heart, which, eventually, drive a myriad of renal and cardiovascular diseases. However, the precise mechanisms and potential therapeutic targets remain largely unknown. Therefore, identifying which immune players are contributing to local inflammation and characterizing pro-inflammatory molecules and mechanisms involved will provide promising new therapeutic targets that could lower blood pressure and prevent progression from hypertension into renal or cardiac dysfunction.
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Affiliation(s)
- Lance N. Benson
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, United States
| | | | | | | | | | - Shengyu Mu
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, United States
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Scholten M, Midlöv P, Halling A. Disparities in prevalence of heart failure according to age, multimorbidity level and socioeconomic status in southern Sweden: a cross-sectional study. BMJ Open 2022; 12:e051997. [PMID: 35351700 PMCID: PMC8966525 DOI: 10.1136/bmjopen-2021-051997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of heart failure (HF) in relation to age, multimorbidity and socioeconomic status of primary healthcare centres in southern Sweden. DESIGN A cross-sectional study. SETTING The data were collected concerning diagnoses at each consultation in all primary healthcare centres and secondary healthcare in the southernmost county of Sweden at the end of 2015. PARTICIPANTS The individuals living in southern Sweden in 2015 aged 20 years and older. The study population of 981 383 inhabitants was divided into different categories including HF, multimorbidity, different levels of multimorbidity and into 10 CNI (Care Need Index) groups depending on the socioeconomic status of their listed primary healthcare centre. OUTCOMES Prevalence of HF was presented according to age, multimorbidity level and socioeconomic status. Logistic regression was used to further analyse the associations between HF, age, multimorbidity level and socioeconomic status in more complex models. RESULTS The total prevalence of HF in the study population was 2.06%. The prevalence of HF increased with advancing age and the multimorbidity level. 99.07% of the patients with HF fulfilled the criteria for multimorbidity. The total prevalence of HF among the multimorbid patients was only 5.30%. HF had a strong correlation with the socioeconomic status of the primary healthcare centres with the most significant disparity between 40 and 80 years of age: the prevalence of HF in primary healthcare centres with the most deprived CNI percentile was approximately twice as high as in the most affluent CNI percentile. CONCLUSION The patients with HF were strongly associated with having multimorbidity. HF patients was a small group of the multimorbid population associated with socioeconomic deprivation that challenges efficient preventive strategies and health policies.
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Affiliation(s)
- Mia Scholten
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Al-Ghamdi S, Alzubaidi FK, Alharthai SA, Alzahim MS, Al Bahily FM, Alsifaee MI, Alshehri HA, Anazi MS. Prevalence and correlates of diastolic dysfunction in patients with hypertension: a cross-sectional study from in The Kingdom of Saudi Arabia. Pan Afr Med J 2022; 40:159. [PMID: 34970401 PMCID: PMC8683461 DOI: 10.11604/pamj.2021.40.159.31089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction diastolic dysfunction refers to impaired ventricular relaxation or filling regardless of ejection fraction and symptoms. It accounts for 8% and 25% in the hospitalized and general population, respectively. The present study was conducted to determine the prevalence and correlates of diastolic dysfunction in hypertensive patients living in Saudi Arabia. Methods a multicentric, cross-sectional study was conducted from February 2019 to February 2020 at King Khalid Hospital and Prince Sultan Center for Health Services, Prince Sattam Bin Abdulaziz University hospital in Al Kharj, and Al Kharj Military Industries Corporation hospital, KSA. All patients with hypertension who underwent an echocardiography were included in the study. Logistic regression analysis was performed to determine factors associated with left ventricular diastolic dysfunction (LVDD). Results the study included a total of 104 participants, where 51.9% were females and the mean age of the patients was 48.01±12.81 years. Most patients had an abnormal echocardiography finding (64.4%, n = 67). The most common abnormalities were left ventricular (LV) hypertrophy (44.2%, n = 46), and diastolic dysfunction, (35.6%, n = 37). The study revealed that age (aOR: 6.1, 95% CI 1.17-31.3; p = 0.032) and dyslipidemia (aOR: 3.45, 95% CI 1.16-10.24; p = 0.026) have significant association with LVDD in the patients with hypertension. Conclusion in conclusion, diastolic dysfunction is prevalent among older hypertensive patients and those with dyslipidaemia. Age and dyslipidaemia were non-modifiable and modifiable factors associated with LVDD in hypertensive patients, respectively.
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Affiliation(s)
- Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | | | | | | | | | | | - Muath Salman Anazi
- Imam Muhammad Ibn Saud Islamic University, College of Medicine, Riyadh, Saudi Arabia
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Li S, Wang M, Ma J, Pang X, Yuan J, Pan Y, Fu Y, Laher I. MOTS-c and Exercise Restore Cardiac Function by Activating of NRG1-ErbB Signaling in Diabetic Rats. Front Endocrinol (Lausanne) 2022; 13:812032. [PMID: 35370955 PMCID: PMC8969227 DOI: 10.3389/fendo.2022.812032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Pathologic cardiac remodeling and dysfunction are the most common complications of type 2 diabetes. Physical exercise is important in inhibiting myocardial pathologic remodeling and restoring cardiac function in diabetes. The mitochondrial-derived peptide MOTS-c has exercise-like effects by improving insulin resistance, combatting hyperglycemia, and reducing lipid accumulation. We investigated the effects and transcriptomic profiling of MOTS-c and aerobic exercise on cardiac properties in a rat model of type 2 diabetes which was induced by feeding a high fat high sugar diet combined with an injection of a low dose of streptozotocin. Both aerobic exercise and MOTS-c treatment reduced abnormalities in cardiac structure and function. Transcriptomic function enrichment analysis revealed that MOTS-c had exercise-like effects on inflammation, myocardial apoptosis, angiogenesis and endothelial cell proliferation and migration, and showed that the NRG1-ErbB4 pathway might be an important component in both MOTS-c and exercise induced attenuation of cardiac dysfunction in diabetes. Moreover, our findings suggest that MOTS-c activates NRG1-ErbB4 signaling and mimics exercise-induced cardio-protection in diabetes.
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Affiliation(s)
- Shunchang Li
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Manda Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Jiacheng Ma
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Xiaoli Pang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Jinghan Yuan
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Yanrong Pan
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Yu Fu
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Ismail Laher,
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Çetin M, Erdoğan T, Özyıldız AG, Özer S, Ayhan AÇ, Kırış T. Blood urea nitrogen is associated with long-term all-cause mortality in stable angina pectoris patients: 8-year follow-up results. ACTA ACUST UNITED AC 2021; 61:66-70. [PMID: 33849421 DOI: 10.18087/cardio.2021.3.n1368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/14/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022]
Abstract
Background Elevation of blood urea nitrogen (BUN) indicates renal dysfunction and is associated with increased mortality in cardiovascular diseases. We investigated the relationship between the BUN concentration measured at hospital admission and the long-term all-cause mortality in patients with stable angina pectoris (SAP).Methods The mortality rate of 344 patients who underwent coronary angiography (CAG) in our clinic due to SAP was analyzed during a mean follow-up period of 8 yrs.Results Age (p<0.001), male gender (p=0.020), waist circumference (p=0.007), body-mass index (p=0.002), fasting glucose (p=0.004), BUN (p<0.001), serum creatinine (Cr) (p<0.001), hemoglobin (p=0.015), triglyceride concentrations (p=0.033), and the Gensini score (p<0.001) were related to all-cause mortality as shown by univariate Cox regression analysis. Age (OR 1.056, 95 % CI 1.015-1.100, p=0.008), fasting glucose (OR 1.006, 95 % CI 1.001-1.011, p=0.018), BUN, (OR 1.077, 95 % CI 1.026-1.130, p=0.003), and the Gensini score (OR 2.269, 95 % CI 1.233-4.174, p=0.008) were significantly related with mortality as shown by multivariate Cox regression analysis. According to receiver operating characteristic analysis ofthe sensitivity and specificity of BUN and Cr for predicting mortality, the area under the curve values of BUN and Cr were 0.789 (p<0.001) and 0.652 (p=0.001), respectively. BUN had a stronger relationship with mortality than Cr. A concentration of BUN above 16.1 mg / dl had 90.1 % sensitivity and 60 % specificity for predicting mortality (OR=2.23).Conclusion In patients who underwent CAG due to SAP, the BUN concentration was associated with all-cause mortality during a mean follow-up period of 8 yrs.
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Affiliation(s)
- Mustafa Çetin
- Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Department of Cardiology, Rize, Turkey
| | - Turan Erdoğan
- Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Department of Cardiology, Rize, Turkey
| | - Ali Gökhan Özyıldız
- Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Department of Cardiology, Rize, Turkey
| | - Savaş Özer
- Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Department of Cardiology, Rize, Turkey
| | - Ahmet Çağrı Ayhan
- Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Cardiology, Kahramanmaraş, Turkey
| | - Tuncay Kırış
- Katip Çelebi University Atatürk Training and Research Hospital, Department of Cardiology, İzmir, Turkey
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Fernandes LP, Barreto ATF, Neto MG, Câmara EJN, Durães AR, Roever L, Aras-Júnior R. Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2754. [PMID: 34190849 PMCID: PMC8221562 DOI: 10.6061/clinics/2021/e2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 01/19/2023] Open
Abstract
Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.
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Affiliation(s)
- Luciana Pereira Fernandes
- Programa de Pos Graduacao em Medicina e Saude, Universidade Federal da Bahia, Salvador, BA, BR
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
- *Corresponding author. E-mail:
| | - Ana Terra Fonseca Barreto
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
| | - Mansueto Gomes Neto
- Grupo de Pesquisa em Fisioterapia, Universidade Federal da Bahia, Salvador, BA, BR
| | | | | | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Roque Aras-Júnior
- Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA, BR
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12
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Hamza M, Fatima M, Masood M, Masood HU, Tasleem G, Ahmed H, Nadir M, Satti Z. Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above). Afr Health Sci 2020; 20:1749-1753. [PMID: 34394235 PMCID: PMC8351830 DOI: 10.4314/ahs.v20i4.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD. Methods A case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography. Results Patients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35–1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS. Conclusion IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.
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13
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Borovac JA, D'Amario D, Bozic J, Glavas D. Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers. World J Cardiol 2020; 12:373-408. [PMID: 32879702 PMCID: PMC7439452 DOI: 10.4330/wjc.v12.i8.373] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/19/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues. The sympathetic nervous system (SNS) is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes, circulating and neuronal catecholamine spillover, attenuated parasympathetic response, and augmented sympathetic outflow to the heart, kidneys and skeletal muscles. When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis, maladaptive ventricular and vascular remodeling, arrhythmogenesis, and poor prognosis in patients with HF. These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities. Therefore, this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF. Finally, special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.
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Affiliation(s)
- Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome 00168, Italy
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Duska Glavas
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
- Clinic for Cardiovascular Diseases, University Hospital of Split, Split 21000, Croatia
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14
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de Wit-Verheggen VHW, Altintas S, Spee RJM, Mihl C, van Kuijk SMJ, Wildberger JE, Schrauwen-Hinderling VB, Kietselaer BLJH, van de Weijer T. Pericardial fat and its influence on cardiac diastolic function. Cardiovasc Diabetol 2020; 19:129. [PMID: 32807203 PMCID: PMC7430122 DOI: 10.1186/s12933-020-01097-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/25/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pericardial fat (PF) has been suggested to directly act on cardiomyocytes, leading to diastolic dysfunction. The aim of this study was to investigate whether a higher PF volume is associated with a lower diastolic function in healthy subjects. METHODS 254 adults (40-70 years, BMI 18-35 kg/m2, normal left ventricular ejection fraction), with (a)typical chest pain (otherwise healthy) from the cardiology outpatient clinic were retrospectively included in this study. All patients underwent a coronary computed tomographic angiography for the measurement of pericardial fat volume, as well as a transthoracic echocardiography for the assessment of diastolic function parameters. To assess the independent association of PF and diastolic function parameters, multivariable linear regression analysis was performed. To maximize differences in PF volume, the group was divided in low (lowest quartile of both sexes) and high (highest quartile of both sexes) PF volume. Multivariable binary logistic analysis was used to study the associations within the groups between PF and diastolic function, adjusted for age, BMI, and sex. RESULTS Significant associations for all four diastolic parameters with the PF volume were found after adjusting for BMI, age, and sex. In addition, subjects with high pericardial fat had a reduced left atrial volume index (p = 0.02), lower E/e (p < 0.01) and E/A (p = 0.01), reduced e' lateral (p < 0.01), reduced e' septal p = 0.03), compared to subjects with low pericardial fat. CONCLUSION These findings confirm that pericardial fat volume, even in healthy subjects with normal cardiac function, is associated with diastolic function. Our results suggest that the mechanical effects of PF may limit the distensibility of the heart and thereby directly contribute to diastolic dysfunction. Trial registration NCT01671930.
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Affiliation(s)
- Vera H W de Wit-Verheggen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sibel Altintas
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Romy J M Spee
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Vera B Schrauwen-Hinderling
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bas L J H Kietselaer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Tineke van de Weijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.
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Patel R, Desai AR, Patel P, Vanka V, Ghadiam H, Kizhakekuttu T. Physician Variability in Diastology Reporting in Patients With Preserved Ejection Fraction: A Single Center Experience. Cureus 2020; 12:e9062. [PMID: 32782880 PMCID: PMC7413311 DOI: 10.7759/cureus.9062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To help standardize the assessment of diastolic dysfunction in the United States, the American Society of Echocardiography (ASE) released criteria for the assessment of diastology in patients with normal and abnormal ejection fraction. As heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality in cardiac patients, it is imperative to assess diastology appropriately. Echocardiography is the mainstay in the assessment of diastolic function; with the new ASE guidelines, diagnosis is simplified especially in patients that have preserved baseline ejection fraction. Our study aimed to determine the extent of physician variability in diastology reporting at our medical center after the release of the new ASE criteria.
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16
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Erdoğan T, Çetin M, Çinier G, Özer S, Yõlmaz AS, Karakişi O, Kõrõş T. Preoperative blood urea nitrogen-to-left ventricular ejection fraction ratio is an independent predictor of long-term major adverse cardiac events in patients undergoing coronary artery bypass grafting surgery. J Saudi Heart Assoc 2020; 32:79-85. [PMID: 33154896 PMCID: PMC7640607 DOI: 10.37616/2212-5043.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Long-term mortality rate following coronary artery bypass grafting (CABG) procedure is still considered to be high despite advances in surgical techniques and perioperative management. Identifying high-risk patients by using cost-effective and clinically useful parameters is needed. METHODS Patients who were admitted to our cardiology clinic with the diagnosis of coronary artery disease and underwent CABG between January 2008 and August 2010 were included. Study patients were followed-up for 112.6 ± 17.8 months for major adverse cardiac events (MACE) which were defined as all-cause mortality and new-onset decompensated heart failure (HF). RESULTS Patients in MACE (+) group were older (p < 0.001), had higher additive Euroscore (p < 0.001), and lower left ventricular ejection fraction (p < 0.001). Multivariate Cox regression analysis showed that additive Euroscore [odds ratio (OR) = 1.601; 95% confidence interval (CI) = 1.374-1.864; p < 0.001)] and blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr; OR = 1.028; 95% CI = 1.006-1.050; p = 0.011) independently predicted MACE. Receiver operating characteristic curve analysis demonstrated that BUNEFr had an area under curve of 0.794 and BUNEFr >33 had a sensitivity and specificity of 74% and 64%, respectively. CONCLUSION BUNEFr is a clinically useful and cost-effective parameter for the prediction of long-term mortality and new-onset decompensated HF in patients undergoing CABG.
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Affiliation(s)
- Turan Erdoğan
- Department of Cardiology, RTE University, Faculty of Medicine, Rize, Turkey
| | - Mustafa Çetin
- Department of Cardiology, RTE University, Faculty of Medicine, Rize, Turkey
| | - Göksel Çinier
- Department of Cardiology, Kackar State Hospital, Rize, Turkey
| | - Savaş Özer
- Department of Cardiology, RTE Education and Research Hospital, Rize, Turkey
| | - Ahmet Seyda Yõlmaz
- Department of Cardiology, RTE University, Faculty of Medicine, Rize, Turkey
| | - Ozan Karakişi
- Department of Cardiovascular Surgery, RTE University, Faculty of Medicine, Rize, Turkey
| | - Tuncay Kõrõş
- Department of Cardiology, Katip Çelebi Üniversity, Atatürk Educational and Research Hospital, İzmir, Turkey
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17
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Wong S, Feng HZ, Jin JP. The evolutionarily conserved C-terminal peptide of troponin I is an independently configured regulatory structure to function as a myofilament Ca 2+-desensitizer. J Mol Cell Cardiol 2019; 136:42-52. [PMID: 31505197 DOI: 10.1016/j.yjmcc.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
The C-terminal end segment of troponin subunit I (TnI) is a structure highly conserved among the three muscle type-specific isoforms and across vertebrate species. Partial deletion or point mutation in this segment impairs cardiac muscle relaxation. In the present study, we characterized the C-terminal 27 amino acid peptide of human cardiac TnI (HcTnI-C27) for its role in modulating muscle contractility. Biologically or chemically synthesized HcTnI-C27 peptide retains an epitope structure in physiological solutions similarly to that in intact TnI as recognized by an anti-TnI C-terminus monoclonal antibody (mAb TnI-1). Protein binding studies found that HcTnI-C27 retains the binding affinity for tropomyosin as previously shown with intact cardiac TnI. A restrictive cardiomyopathy mutation R192H in this segment abolishes the bindings to mAb TnI-1 and tropomyosin, demonstrating a pathogenic loss of function. Contractility studies using skinned muscle preparations demonstrated that addition of HcTnI-C27 peptide reduces the Ca2+-sensitivity of myofibrils without decreasing maximum force production. The results indicate that the C-terminal end segment of TnI is a regulatory element of troponin, which retains the native configuration in the form of free peptide to confer an effect on myofilament Ca2+-desensitization. Without negative inotropic impact, this short peptide may be developed into a novel reagent to selectively facilitate cardiac muscle relaxation at the activated state as a potential treatment for heart failure.
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Affiliation(s)
- Sienna Wong
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | - Han-Zhong Feng
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA
| | - J-P Jin
- Department of Physiology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, USA.
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18
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Associations between relevant cardiovascular pharmacotherapies and incident heart failure in patients with atrial fibrillation: a cohort study in primary care. J Hypertens 2019; 36:1929-1935. [PMID: 29870433 DOI: 10.1097/hjh.0000000000001813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study association between relevant cardiovascular pharmacotherapy and incident congestive heart failure (CHF) in patients with atrial fibrillation treated in primary health care. METHODS Study population included all adults (n = 7975) aged 45 years and older diagnosed with atrial fibrillation at 75 primary care centers in Sweden between 2001 and 2007. Outcome was defined as a first diagnosis of CHF post-atrial fibrillation diagnosis. Association between CHF and treatment with relevant cardiovascular pharmacotherapies (beta blockers, calcium blockers, digitalis, diuretics, RAS blockers, and statins) was explored using Cox regression analysis with hazard ratios and 95% CIs. Adjustments were made for age, sociodemographic variables, and comorbid conditions (with or without cardiovascular disorders). RESULTS During a mean of 5.7 years (SD 2.3) of follow-up, totally 1552 patients (19.5%; 803 women and 749 men) had a recorded CHF diagnosis. Thiazides (hazard ratio 0.74, 95% CI 0.65-0.84), vessel-active calcium channel blockers (hazard ratio 0.76, 95% CI 0.67-0.86), and nonselective beta blockers (hazard ratio 0.84, 95% CI 0.72-0.98), with specifically sotalol representing 80% of nonselective beta blockers (hazard ratio 0.81, 95% CI 0.69-0.97), were associated with lower CHF risk in fully adjusted models. Loop diuretics (hazard ratio 1.41, 95% CI 1.25-1.57) were associated with a higher risk. Findings for thiazides and vessel-active channel blockers were consistent in the tested subgroups. CONCLUSION In this clinical setting, we found that thiazides, vessel-active calcium channel blockers, and nonselective beta blockers (specifically sotalol) were associated with a lower risk of incident CHF among patients with atrial fibrillation. The findings of the present study need to be confirmed in other settings.
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19
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Li S, Liang M, Gao D, Su Q, Laher I. Changes in Titin and Collagen Modulate Effects of Aerobic and Resistance Exercise on Diabetic Cardiac Function. J Cardiovasc Transl Res 2019; 12:404-414. [PMID: 30820865 DOI: 10.1007/s12265-019-09875-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Diastolic dysfunction is a common complication that occurs early in diabetes mellitus. Titin and collagen are two important regulators of myocardial passive tension, which contributes to diabetic myocardial diastolic dysfunction. Exercise therapy significantly improves the impaired diabetic cardiac function, but its benefits appear to depend on the type of exercise used. We investigated the effect of aerobic and resistance exercise on cardiac diastolic function in diabetic rats induced by high-fat diet combined with low-dose streptozotocin injection. Interestingly, although resistance training had a more pronounced effect on blood glucose control than did aerobic training in type 2 diabetic rats, improvements in cardiac diastolic parameters benefited more from aerobic training. Moreover, aerobic exercise did significantly increase the expression levels of titin and decrease collagen I, TGFβ1 expression level. In summary, out data suggest that aerobic exercise may improve diabetic cardiac function through changes in titin-dependent myocardial stiffness rather than collagen-dependent interstitial fibrosis.
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Affiliation(s)
- Shunchang Li
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Min Liang
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Derun Gao
- Institute of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Quansheng Su
- School of Sports Medicine and Health, Chengdu Sport Institute, Chengdu, 610041, China
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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20
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Wölkart G, Schrammel A, Koyani CN, Scherübel S, Zorn‐Pauly K, Malle E, Pelzmann B, Andrä M, Ortner A, Mayer B. Cardioprotective effects of 5-hydroxymethylfurfural mediated by inhibition of L-type Ca 2+ currents. Br J Pharmacol 2017; 174:3640-3653. [PMID: 28768052 PMCID: PMC5610158 DOI: 10.1111/bph.13967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The antioxidant 5-hydroxymethylfurfural (5-HMF) exerts documented beneficial effects in several experimental pathologies and is currently tested as an antisickling drug in clinical trials. In the present study, we examined the cardiovascular effects of 5-HMF and elucidated the mode of action of the drug. EXPERIMENTAL APPROACH The cardiovascular effects of 5-HMF were studied with pre-contracted porcine coronary arteries and rat isolated normoxic-perfused hearts. Isolated hearts subjected to ischaemia/reperfusion (I/R) injury were used to test for potential cardioprotective effects of the drug. The effects of 5-HMF on action potential and L-type Ca2+ current (ICa,L ) were studied by patch-clamping guinea pig isolated ventricular cardiomyocytes. KEY RESULTS 5-HMF relaxed coronary arteries in a concentration-dependent manner and exerted negative inotropic, lusitropic and chronotropic effects in rat isolated perfused hearts. On the other hand, 5-HMF improved recovery of inotropic and lusitropic parameters in isolated hearts subjected to I/R. Patch clamp experiments revealed that 5-HMF inhibits L-type Ca2+ channels. Reduced ICa,L density, shift of ICa,L steady-state inactivation curves toward negative membrane potentials and slower recovery of ICa,L from inactivation in response to 5-HMF accounted for the observed cardiovascular effects. CONCLUSIONS AND IMPLICATIONS Our data revealed a cardioprotective effect of 5-HMF in I/R that is mediated by inhibition of L-type Ca2+ channels. Thus, 5-HMF is suggested as a beneficial additive to cardioplegic solutions, but adverse effects and contraindications of Ca2+ channel blockers have to be considered in therapeutic application of the drug.
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Affiliation(s)
- G Wölkart
- Institute of Pharmaceutical Sciences, Department of Pharmacology and ToxicologyUniversity of GrazGrazAustria
| | - A Schrammel
- Institute of Pharmaceutical Sciences, Department of Pharmacology and ToxicologyUniversity of GrazGrazAustria
| | - C N Koyani
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - S Scherübel
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - K Zorn‐Pauly
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - E Malle
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - B Pelzmann
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - M Andrä
- Department of Thoracic and Cardiovascular SurgeryKlinikum KlagenfurtKlagenfurtAustria
| | - A Ortner
- Institute of Pharmaceutical Sciences, Department of Pharmaceutical ChemistryUniversity of GrazGrazAustria
| | - B Mayer
- Institute of Pharmaceutical Sciences, Department of Pharmacology and ToxicologyUniversity of GrazGrazAustria
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Chen HH, Zhao P, Zhao WX, Tian J, Guo W, Xu M, Zhang C, Lu R. Stachydrine ameliorates pressure overload-induced diastolic heart failure by suppressing myocardial fibrosis. Am J Transl Res 2017; 9:4250-4260. [PMID: 28979698 PMCID: PMC5622267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/31/2017] [Indexed: 06/07/2023]
Abstract
Stachydrine (Sta), a major constituent of Leonurus japonicus Houtt, has been reported to possess numerous cardioprotective effects. In this study, we evaluated the effect of Sta on pressure overload-induced diastolic heart failure in rats and investigated the mechanisms underlying the effect. Wistar rats were randomized to transverse aortic constriction (TAC) or sham operation. After 3 days, the rats that underwent TAC were randomized to treatment for a total of four experimental groups (n=10 each group): sham operation, TAC only, TAC + telmisartan (Tel), and TAC + stachydrine (Sta). After 12 weeks, we evaluated left ventricular hypertrophy, function, and fibrosis by echocardiography, pressure-volume loop analysis, and histology. In addition, levels of fibrosis-related proteins in the heart were determined by Western blot analysis. Our results showed that Sta significantly suppressed TAC-induced cardiac hypertrophy, and TAC-induced increases in heart weight/body weight and heart weight/tibial length. In addition, Sta attenuated TAC-induced decreases in left ventricular ejection fraction and improved other hemodynamic parameters. Compared with the TAC only group, rats treated with Sta exhibited significant decreases in interstitial and perivascular fibrosis, TGF-βR1 protein levels, and phosphorylation of Smad2/3; however, protein levels of TGF-β1, TGF-βR2, and Smad4 did not differ significantly between the two groups. Taken together, our results demonstrate that Sta protects against diastolic heart failure by attenuating myocardial hypertrophy and fibrosis via the TGF-β/Smad pathway.
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Affiliation(s)
- Hui-Hua Chen
- Department of Pathology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Pei Zhao
- The Public Experiment Platform, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Wen-Xia Zhao
- Center of Drug Safety Evaluation Research, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Jing Tian
- Department of Pathology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Wei Guo
- Department of Pathology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Ming Xu
- Department of Physiology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Chen Zhang
- Department of Pathology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
| | - Rong Lu
- Department of Pathology, Shanghai University of Traditional Chinese Medicine1200 Cailun Road, Shanghai 201203, China
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22
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Abstract
The heart pumps blood to maintain circulation and ensure the delivery of oxygenated blood to all the organs of the body. Mechanics play a critical role in governing and regulating heart function under both normal and pathological conditions. Biological processes and mechanical stress are coupled together in regulating myocyte function and extracellular matrix structure thus controlling heart function. Here, we offer a brief introduction to the biomechanics of left ventricular function and then summarize recent progress in the study of the effects of mechanical stress on ventricular wall remodeling and cardiac function as well as the effects of wall mechanical properties on cardiac function in normal and dysfunctional hearts. Various mechanical models to determine wall stress and cardiac function in normal and diseased hearts with both systolic and diastolic dysfunction are discussed. The results of these studies have enhanced our understanding of the biomechanical mechanism in the development and remodeling of normal and dysfunctional hearts. Biomechanics provide a tool to understand the mechanism of left ventricular remodeling in diastolic and systolic dysfunction and guidance in designing and developing new treatments.
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Affiliation(s)
- Andrew P. Voorhees
- Department of Mechanical Engineering, The University of Texas at San Antonio, Biomedical Engineering Program, UTSA-UTHSCSA
| | - Hai-Chao Han
- Department of Mechanical Engineering, The University of Texas at San Antonio, Biomedical Engineering Program, UTSA-UTHSCSA
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