Age-dependent cardiac remodelling – role of sex hormones

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Haider ◽  
S Bengs ◽  
G Warnock ◽  
A Akhmedov ◽  
S Kozerke ◽  
...  
Keyword(s):  
Sympathetic Activity ◽  
Left Ventricular ◽  
Sex Hormone ◽  
Funding Source ◽  
Male Mice ◽  
Cardiac Sympathetic Activity ◽  
Age Dependent ◽  
And Function ◽  
Hormone Deprivation ◽  
Cmr Imaging

Abstract Background While cardiovascular mortality in women has exceeded those in men, women continue to be underrepresented in cardiovascular clinical trials. Further, preclinical experiments are predominantly conducted in male animals, rendering sex-specific variables contributing to cardiovascular disease largely unknown. As age and menopause remain to be key risk factors for cardiovascular disease in women, the aim of this study was to identify key variables of cardiac remodelling in the aging female and male heart, as well as to assess effects of sex hormone deprivation on left ventricular (LV) morphology, LV function and cardiac sympathetic activity. Materials and methods Gonadectomized and sham-operated FVB/N mice of both sexes were subjected to positron emission tomography (PET) and cardiac magnetic resonance (CMR) imaging at the age of 4 (young cohort) and 20 (aged cohort) months (total n=123, 55% females). Following tail-vein injection of [11C]meta-hydroxynorephedrine ([11C]mHED), a widely used PET probe in preclinical and clinical assessment of cardiac sympathetic integrity, animals were scanned and cardiac sympathetic outflow was derived from myocardial [11C]mHED uptake. Cardiac parameters including LV volumes and left ventricular ejection fraction (LVEF) were obtained from electrocardiogram (ECG)-gated CMR imaging. Results and discussion A significant increase of LVEF was observed in aging females (p=0.012, Figure 1), but not in males. The latter was not associated with a higher cardiac output, and was a consequence of reduced LV end-systolic volumes (p=0.008), unveiling a substantial reduction of size in the aging female heart. As this age-dependent observation was not present in gonadectomized animals (p=0.414), the lack of growth-stimulating estrogen might account for reduction of cardiac size in aging females. Thus, despite a significantly heightened body weight, female heart size is reduced with age. Accordingly, sufficient cardiac output was maintained via increased heart rate (p=0.005) and cardiac sympathetic activity (p=0.040, Figure 1). Gonadectomy accelerated age-dependent changes in LV morphology and function in female mice. While sex hormone deprivation blunted cardiac sympathetic activity and norepinephrine levels in male mice, an opposite trend was observed in females. Conclusion Despite increasing body weight with age, aged female and male hearts maintain a stable circulatory blood supply, however, by distinct mechanisms. While the “shrinking” female heart requires an increased heart rate and cardiac sympathetic activity to compensate for smaller ventricular volumes, aging males maintain cardiac size. Importantly, sex hormone deprivation at a young age accelerates age-dependent changes in LV morphology and function in female mice, but not in male mice. The increased sympathetic activity reflects a higher stress level in aged females that might expose them to a higher cardiac vulnerability at postmenopausal age. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation; Swissheart Foundation

scholarly journals Relation Between Cardiac Sympathetic Activity and Hypertensive Left Ventricular Hypertrophy

Circulation ◽  
2003 ◽  
Vol 108 (5) ◽  
pp. 560-565 ◽  
Author(s):  
Markus P. Schlaich ◽  
David M. Kaye ◽  
Elisabeth Lambert ◽  
Marcus Sommerville ◽  
Flora Socratous ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Sympathetic Activity ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Cardiac Sympathetic Activity

Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension

2016 ◽  
Vol 202 ◽  
pp. 609-614 ◽  
Author(s):  
Peter M. van Brussel ◽  
Daan W. Eeftinck Schattenkerk ◽  
Linn C. Dobrowolski ◽  
Robbert J. de Winter ◽  
Jim A. Reekers ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Sympathetic Activity ◽  
Sympathetic Denervation ◽  
Renal Sympathetic Denervation ◽  
Cardiac Sympathetic Activity ◽  
And Function ◽  
Renal Sympathetic

Inflammation of conduction tissue in patients with arrhythmic phenotype of myocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Frustaci ◽  
R Verardo ◽  
M Alfarano ◽  
G Agnes ◽  
C Chimenti
Keyword(s):  
Influenza A ◽  
Left Ventricular ◽  
Funding Source ◽  
Viral Genomes ◽  
Immune Mediated ◽  
Positive Immunostaining ◽  
Ectopic Beats ◽  
Public Grant ◽  
And Function

Abstract Background Manifestation of arrhythmias in otherwise normal heart suggests a possible compromise of conduction tissue. It, however, remains, usually, a supposition with limited therapeutical implications. Purpose Reporting histology of inflammation/infection of conduction tissue as a cause of arrhythmic phenotype of myocarditis. Material and methods Among 420 patients with a biopsy proven myocarditis diagnosed from 2009 to 2019, 42 presented with an arrhythmic phenotype and normal cardiac anatomy and function (LVEF >50%). Of the latter, 12 subjects (28.5%; M 9; F 3; mean age 44,75±14.9 years) had included in a left ventricular endomyocardial biopsy sections of conduction tissue (CT). CT was identified by recognition of morphological Aschoff and Monckeberg criteria and positive immunostaining for HCN4. CT inflammation was defined by ≥7 CD3+ T lymphocytes with focal necrosis of adjacent cells. Cause of CT inflammation was investigated by polymerase chain reaction (PCR) of 2 frozen endomyocardial samples, immunohistochemistry for the identified viral antigens and for Tall like receptor 4 (TLR4). Results Four pts presented with non-sustained ventricular tachycardia (nsVT), seven pts with sustained (S) VT, 1 died during hospitalization because of ventricular fibrillation (VF). Inflammatory involvement of CT was documented in all 12 pts. PCR was positive for Influenza A virus in 2 pts and HHV2 in 1 with positive CT immunostaining for related antigens. In the remaining 8 pts negative PCR for viral genomes and overexpression of TLR4 suggested an immune-mediated pathway of CT inflammation. Pts with Influenza A myocarditis and CT infection responded to tamiflu (1 cp bid for 5 days) with ECG normalization while the pt with HHV2 infection died. The 8 pts with virus-negative myocarditis and TLR4 overexpession were treated with steroids and azathioprine based on TIMIC protocol. Seven of them had no more repetitive ventricular ectopic beats at Holter of 2 weeks follow-up. Conclusions Arrhythmic phenotype of myocarditis is caused by elective inflammation/infection of CT. Molecular characterization of CT damage may bring to pharmacologic control of arrhythmias in up to 75% of cases. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Project ERA-CVD “Transnational Research Projects on Cardiovascular Diseases”

scholarly journals Obstructive and restrictive ventilatory patterns are differentially associated with cardiac structure and function in late-life

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ramalho ◽  
B.L Claggett ◽  
D.W Kitzman ◽  
P.P Chang ◽  
G Cipriano Junior ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Late Life ◽  
Left Ventricular ◽  
Structure And Function ◽  
Public Institution ◽  
Volume Index ◽  
Funding Source ◽  
Cardiac Structure ◽  
Cardiac Structure And Function ◽  
And Function

Abstract Background Pulmonary and cardiac function both decline with age. However, few data exist regarding the associations of obstructive and restrictive spirometric patterns with cardiac structure and function in late-life. Purpose Determine the associations of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC with cardiac structure and function in late life. Methods In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 heart failure free participants underwent echocardiography and spirometry at the fifth study visit (2011–2013). Relationships were examined using multivariable linear regression. Models adjusted for demographics and clinical risk factors (Table legend). Results Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. In adjusted analyses, lower FEV1/FVC was associated with higher pulmonary arterial pressure (PASP) but not with measures of left ventricular (LV) structure or function (Table). In contrast, lower ppFVC, was associated with greater LV mass, worse LV strain, higher E/e' ratio, greater left atrial volume index, and higher PASP (all p<0.01; Table). Conclusion In late life, reductions in both FEV1/FVC and ppFVC are associated with higher pulmonary pressure, but only ppFVC was associated with worse LV structure and function. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services

scholarly journals Change in left atrial function predicts incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis

2019 ◽  
Vol 20 (9) ◽  
pp. 979-987 ◽  
Author(s):  
Daniel J Lim ◽  
Bharath Ambale-Ventakesh ◽  
Mohammad R Ostovaneh ◽  
Tarek Zghaib ◽  
Hiroshi Ashikaga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Left Atrial ◽  
Left Ventricular ◽  
Structure And Function ◽  
Model Discrimination ◽  
Ethnic Study ◽  
Improved Model ◽  
And Function ◽  
Cmr Imaging

Abstract Aims Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. Methods and results In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000–02), and at Exam 4 (2005–07) or 5 (2010–12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53–2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). Conclusion In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.

Association between natriuretic peptides and left atrial structural and functional properties in atrial fibrillation following catheter ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F.J Olsen ◽  
S Darkner ◽  
J.P Gotze ◽  
X Chen ◽  
K Henningsen ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Atrial ◽  
Left Ventricular ◽  
Structure And Function ◽  
Funding Source ◽  
And Function ◽  
The Relationship

Abstract Background Atrial natriuretic peptides (ANP) and brain natriuretic peptides (BNP) are acutely released from the atrial myocytes upon increased mechanical distension of the atria. The relationship between imaging measures of left atrial (LA) structure and function and natriuretic peptides following catheter ablation (CA) have not been clearly delineated. Purpose To characterize the relationship between LA structure and function and natriuretic peptides. Methods We performed an echocardiographic substudy of a randomized trial of AF patients scheduled for CA. Echocardiographic measurements included: LA volume at end-systole (LAVi), at end-diastole (LAEDVi), emptying fraction (LAEF), LA reservoir strain (LAs), and global longitudinal strain (GLS). Patients were stratified by tertiles of mid-regional proANP (MR-proANP) concentrations in circulation (&lt;92 pmol/l, 92–146 pmol/l, &gt;146 pmol/l), and NT-proBNP (&lt;10pmol/l, 10–38 pmol/l, &gt;38 pmol/l). Linear regressions were performed to compare baseline echocardiographic measures to natriuretic peptide concentrations at baseline, 1 month, 3 months and 6 months of follow-up. MR-proANP and NT-proBNP were logarithm transformed in these analyses. Multivariable adjustments were made for: age, gender, AF subtype, AF burden, rhythm during echocardiogram, rhythm at study visit for blood sampling, time known with AF, beta-blocker use, and CHA-2DS2-VASc score. Results We included 101 patients with AF. The mean age was 58 years, 82% were men, 46% had persistent AF. Increasing tertiles of MR-proANP at baseline were associated with abnormal LA size and function (3rd vs 1st tertile: LAVi: 42mL/m2 vs 32mL/m2; LAEDVi: 31mL/m2 vs 20mL/m2; LAEF: 38% vs 26%; LAs: 27% vs 19%; GLS: −18% vs −14%) whereas both LA and left ventricular measures were associated with increasing NT-proBNP concentrations at baseline. After multivariable adjustments, only LA volumes and LAEF remained significantly associated with MR-proANP, whereas only LA volumes and GLS remained significantly associated with NT-proBNP. At follow-up, impaired LA function associated with persistently elevated concentrations, which was not the case for LAVi (figure). Conclusion MR-proANP reflects LA dysfunction better than NT-proBNP. Measures of LA function rather than LAVi associates with persistently elevated natriuretic peptide concentrationsw, which may indicate that functional measures are more closely associated with evidence of LA myocardial stretch than LAVi. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation

Left atrial late gadolinium enhancement is associated with atrial fibrillation as detected by continuous monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Bertelsen ◽  
S.Z Diederichsen ◽  
K.J Haugan ◽  
A Brandes ◽  
C Graff ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Left Atrial ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Funding Source ◽  
Implantable Loop Recorder ◽  
Gadolinium Enhancement ◽  
Loop Recorder ◽  
And Function

Abstract Background Left atrial late gadolinium enhancement (LA LGE) measured with cardiac magnetic resonance (CMR) imaging is emerging as a marker of atrial fibrosis and has been associated with worse outcomes in AF ablation procedures. However, the prognostic value of LA LGE for incident AF remains unknown. Methods CMR including measurement of left ventricular (LV) and LA volumes and function, as well as LV extracellular volume fraction and LA LGE, was acquired in 68 patients aged at least 70 years with risk factors for stroke. All included patients received and implantable loop recorder and were continuously monitored for previously unknown AF. Incident AF was adjudicated by senior cardiologists. Results Patients were monitored for AF with implantable loop recorder during a median of 41 [36; 43] months. AF episodes lasting ≥6 minutes were detected in 32 patients (47%) and 16 patients (24%) experienced AF episodes lasting ≥5.5-hour. In Cox regression analyses adjusted for sex, age and comorbidities, we found that LA volumes and function and LA LGE were independently associated with incident AF. For LA LGE, the hazard ratio for time to AF episodes lasting ≥6 minutes and ≥5.5 hours were 1.40 (1.03, 1.89) per 10 cm2 increase (p=0.03) and 1.63 (1.11, 2.40) per 10 cm2 increase (p=0.01), respectively. LA LGE was significantly associated with high burden of AF. The addition of LA LGE to a multivariable risk prediction model for incident AF significantly increased the predictive value. Conclusions Extent of LA fibrosis measured by LA LGE was significantly associated with incident AF detected by implantable loop recorder. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Innovation Fund Denmark, The Research Foundation for the Capital Region of Denmark [no grant number]

scholarly journals CARDIAC SYMPATHETIC ACTIVITY, MYOCARDIAL PERFUSION AND HEART CONTRACTILITY IN PATIENTS WITH ISCHAEMIC AND NON-ISCHAEMIC HEART FAILURE

2018 ◽  
Vol 33 (2) ◽  
pp. 35-41
Author(s):  
A. I. Mishkina ◽  
K. V. Zavadovskiy ◽  
M. O. Gulya ◽  
V. V. Saushkin ◽  
D. I. Lebedev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Perfusion ◽  
Ejection Fraction ◽  
Sympathetic Activity ◽  
Left Ventricular ◽  
Washout Rate ◽  
Ventricular Ejection Fraction ◽  
Cardiac Sympathetic Activity ◽  
Heart Failure Patients ◽  
Heart To Mediastinum Ratio

Purpose:to assess the cardiac sympathetic activity, perfusion and contractility in ischemic and nonischemic chronic heart failure patients by using a radionuclide methods.Material and Methods.The study included 33 heart failure patients with NYHA class III and ischemic (n=13.39%) and non-ischemic (n=20.61%) heart failure. All patients underwent123I-MIBG imaging, myocardial perfusion imaging with  99mTc-MIBI and gated blood-pool single-photon emission computed tomography. Based on123I-MIBG study heart to mediastinum ratio as well as123I-MIBG washout rate were calculated. According to the myocardial perfusion imaging, Summed Rest Score was evaluated. Systolic and diastolic functions and ejection fraction as well as mechanical intraventricular dyssynchrony of both ventricles were analyzed by gated blood-pool single-photon emission computed tomography.Results.There was no statistically significant difference of hemodynamic parameters between the groups. In the first group, which include patients with ischemic heart failure, there were found the following correlations: washout rate and left ventricular end-diastolic volume (0.75; p<0.05), washout rate and left ventricular end-systolic volume (0.68; p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (–0.57; p<0.05). In the group of patients with non-ischemic heart failure there were the following correlation: heart to mediastinum ratio and left ventricular end-systolic volume (–0.77; p<0.05), heart to mediastinum ratio and left ventricular ejection fraction (0.77, p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (0.62, p<0.05), washout rate and left ventricular interventricular dyssynchrony (0.6; p<0.05).Conclusion.It was found out that heart failure patients were characterized by a correlation between sympathetic activity and volumes, hemodynamics and contractility of heart ventricles. The relationship between the cardiac sympathetic activity and myocardial perfusion as well as contractility depend on the etiology of chronic heart failure.

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