Preterm birth and cardiac function in adulthood

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318241
Author(s):  
Charlotte Greer ◽  
Richard W Troughton ◽  
Philip D Adamson ◽  
Sarah L Harris
Keyword(s):  
Heart Failure ◽  
Preterm Birth ◽  
Physiological Stress ◽  
Survival Rates ◽  
Current Evidence ◽  
Developing Heart ◽  
Haemodynamic Changes ◽  
Preterm Born ◽  
And Function ◽  
The Impact

Preterm birth affects 1 in 10 pregnancies worldwide, with increasing survival rates over the last 30 years. However, as this new generation of long-term survivors approaches middle age, recent studies have revealed increased cardiovascular risk factors and higher rates of ischaemic heart disease and heart failure. Cardiovascular imaging has identified smaller cardiac chamber size, changes in myocardial mass and impaired ventricular function, particularly under physiological stress. Accordingly, this population should be recognised as having a higher risk of heart failure as they age. In this review, we present current evidence for increased rates of heart failure and evidence of alterations in cardiac structure and function in those born preterm. We discuss potential mechanisms to explain this risk including greater frequency of co-morbidities known to be associated with heart failure. We also explore potential mechanistic links specific to the preterm-born population, including the impact of premature birth on myocardial and vascular development and the effects of perinatal haemodynamic changes and chronic lung disease on the developing heart. We highlight gaps in our knowledge and consider implications for patient management relevant to the adult physician.

scholarly journals Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment

2021 ◽  
Vol 10 (17) ◽  
pp. 3896
Author(s):  
Amanda Vrselja ◽  
J. Jane Pillow ◽  
M. Jane Black
Keyword(s):  
Preterm Birth ◽  
Perinatal Care ◽  
Early Adulthood ◽  
Survival Rates ◽  
Later Life ◽  
Glucocorticoid Treatment ◽  
Cardiac Growth ◽  
And Function ◽  
The Impact

Preterm birth coincides with a key developmental window of cardiac growth and maturation, and thus has the potential to influence long-term cardiac function. Individuals born preterm have structural cardiac remodelling and altered cardiac growth and function by early adulthood. The evidence linking preterm birth and cardiovascular disease in later life is mounting. Advances in the perinatal care of preterm infants, such as glucocorticoid therapy, have improved survival rates, but at what cost? This review highlights the short-term and long-term impact of preterm birth on the structure and function of the heart and focuses on the impact of antenatal and postnatal glucocorticoid treatment on the immature preterm heart.

scholarly journals Mechanical shear stress and leukocyte phenotype and function: Implications for ventricular assist device development and use

2018 ◽  
Vol 42 (3) ◽  
pp. 133-142 ◽  
Author(s):  
Gemma Radley ◽  
Sabrina Ali ◽  
Ina Laura Pieper ◽  
Catherine A Thornton
Keyword(s):  
Heart Failure ◽  
Shear Stress ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Modern World ◽  
Mechanical Trauma ◽  
Ventricular Assist ◽  
End Stage ◽  
And Function ◽  
The Impact

Heart failure remains a disease of ever increasing prevalence in the modern world. Patients with end-stage heart failure are being referred increasingly for mechanical circulatory support. Mechanical circulatory support can assist patients who are ineligible for transplant and stabilise eligible patients prior to transplantation. It is also used during cardiopulmonary bypass surgery to maintain circulation while operating on the heart. While mechanical circulatory support can stabilise heart failure and improve quality of life, complications such as infection and thrombosis remain a common risk. Leukocytes can contribute to both of these complications. Contact with foreign surfaces and the introduction of artificial mechanical shear stress can lead to the activation of leukocytes, reduced functionality and the release of pro-inflammatory and pro-thrombogenic microparticles. Assessing the impact of mechanical trauma to leukocytes is largely overlooked in comparison to red blood cells and platelets. This review provides an overview of the available literature on the effects of mechanical circulatory support systems on leukocyte phenotype and function. One purpose of this review is to emphasise the importance of studying mechanical trauma to leukocytes to better understand the occurrence of adverse events during mechanical circulatory support.

scholarly journals Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone

2015 ◽  
Vol 8 (6) ◽  
pp. 1052-1058 ◽  
Author(s):  
Amil M. Shah ◽  
Brian Claggett ◽  
Nancy K. Sweitzer ◽  
Sanjiv J. Shah ◽  
Anita Deswal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Structure And Function ◽  
Cardiac Structure ◽  
Preserved Ejection Fraction ◽  
Prognostic Importance ◽  
Cardiac Structure And Function ◽  
And Function ◽  
The Impact

scholarly journals Myomas and Adenomyosis: Impact on Reproductive Outcome

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Nikos F. Vlahos ◽  
Theodoros D. Theodoridis ◽  
George A. Partsinevelos
Keyword(s):  
Preterm Birth ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Reproductive Age ◽  
Current Evidence ◽  
Reproductive Outcome ◽  
Increased Risk ◽  
Structural Abnormalities ◽  
Adverse Pregnancy ◽  
The Impact

Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.

scholarly journals Obstructive Sleep Apnea in Neurodegenerative Disorders: Current Evidence in Support of Benefit from Sleep Apnea Treatment

2020 ◽  
Vol 9 (2) ◽  
pp. 297 ◽  
Author(s):  
Annie C. Lajoie ◽  
Anne-Louise Lafontaine ◽  
R. John Kimoff ◽  
Marta Kaminska
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Current Knowledge ◽  
Upper Airway ◽  
Current Evidence ◽  
Obstructive Sleep ◽  
Intermittent Hypoxemia ◽  
And Function ◽  
The Impact ◽  
Sleep Apnea Treatment

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent upper airway obstruction during sleep resulting in intermittent hypoxemia and sleep fragmentation. Research has recently increasingly focused on the impact of OSA on the brain’s structure and function, in particular as this relates to neurodegenerative diseases. This article reviews the links between OSA and neurodegenerative disease, focusing on Parkinson’s disease, including proposed pathogenic mechanisms and current knowledge on the effects of treatment.

scholarly journals Apabetalone and hospitalization for heart failure in patients following an acute coronary syndrome: a prespecified analysis of the BETonMACE study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephen J. Nicholls ◽  
◽  
Gregory G. Schwartz ◽  
Kevin A. Buhr ◽  
Henry N. Ginsberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Secondary Analysis ◽  
Cardiovascular Death ◽  
Major Adverse Cardiovascular Events ◽  
Double Blind ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
And Function ◽  
The Impact

Abstract Background Patients with diabetes and acute coronary syndrome (ACS) are at high risk for subsequent heart failure. Apabetalone is a selective inhibitor of bromodomain and extra-terminal (BET) proteins, epigenetic regulators of gene expression. Preclinical data suggest that apabetalone exerts favorable effects on pathways related to myocardial structure and function and therefore could impact subsequent heart failure events. The effect of apabetalone on heart failure events after an ACS is not currently known. Methods The phase 3 BETonMACE trial was a double-blind, randomized comparison of apabetalone versus placebo on the incidence of major adverse cardiovascular events (MACE) in 2425 patients with a recent ACS and diabetes. This prespecified secondary analysis investigated the impact of apabetalone on hospitalization for congestive heart failure, not previously studied. Results Patients (age 62 years, 74.4% males, 90% high-intensity statin use, LDL-C 70.3 mg/dL, HDL-C 33.3 mg/dL and HbA1c 7.3%) were followed for an average 26 months. Apabetalone treated patients experienced the nominal finding of a lower rate of first hospitalization for heart failure (2.4% vs. 4.0%, HR 0.59 [95%CI 0.38–0.94], P = 0.03), total number of hospitalizations for heart failure (35 vs. 70, HR 0.47 [95%CI 0.27–0.83], P = 0.01) and the combination of cardiovascular death or hospitalization for heart failure (5.7% vs. 7.8%, HR 0.72 [95%CI 0.53–0.98], P = 0.04). Conclusion Apabetalone treatment was associated with fewer hospitalizations for heart failure in patients with type 2 diabetes and recent ACS. Future studies are warranted to define the potential for BET inhibition with apabetalone to prevent heart failure in patients with diabetes and ACS.

scholarly journals Metabolic Aspects of Anthracycline Cardiotoxicity

2021 ◽  
Vol 22 (2) ◽  
Author(s):  
Michele Russo ◽  
Angela Della Sala ◽  
Carlo Gabriele Tocchetti ◽  
Paolo Ettore Porporato ◽  
Alessandra Ghigo
Keyword(s):  
Heart Failure ◽  
Anticancer Agents ◽  
Energy Demand ◽  
Cardiac Metabolism ◽  
Current Evidence ◽  
Anthracycline Cardiotoxicity ◽  
Cardiac Side Effects ◽  
The Impact

Opinion statementHeart failure (HF) is increasingly recognized as the major complication of chemotherapy regimens. Despite the development of modern targeted therapies such as monoclonal antibodies, doxorubicin (DOXO), one of the most cardiotoxic anticancer agents, still remains the treatment of choice for several solid and hematological tumors. The insurgence of cardiotoxicity represents the major limitation to the clinical use of this potent anticancer drug. At the molecular level, cardiac side effects of DOXO have been associated to mitochondrial dysfunction, DNA damage, impairment of iron metabolism, apoptosis, and autophagy dysregulation. On these bases, the antioxidant and iron chelator molecule, dexrazoxane, currently represents the unique FDA-approved cardioprotectant for patients treated with anthracyclines.A less explored area of research concerns the impact of DOXO on cardiac metabolism. Recent metabolomic studies highlight the possibility that cardiac metabolic alterations may critically contribute to the development of DOXO cardiotoxicity. Among these, the impairment of oxidative phosphorylation and the persistent activation of glycolysis, which are commonly observed in response to DOXO treatment, may undermine the ability of cardiomyocytes to meet the energy demand, eventually leading to energetic failure. Moreover, increasing evidence links DOXO cardiotoxicity to imbalanced insulin signaling and to cardiac insulin resistance. Although anti-diabetic drugs, such as empagliflozin and metformin, have shown interesting cardioprotective effects in vitro and in vivo in different models of heart failure, their mechanism of action is unclear, and their use for the treatment of DOXO cardiotoxicity is still unexplored.This review article aims at summarizing current evidence of the metabolic derangements induced by DOXO and at providing speculations on how key players of cardiac metabolism could be pharmacologically targeted to prevent or cure DOXO cardiomyopathy.

scholarly journals Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Veronica Artanian ◽  
Valeria E Rac ◽  
Heather J Ross ◽  
Emily Seto
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Controlled Trial ◽  
Survival Rates ◽  
Physiological Data ◽  
Randomized Controlled ◽  
Patients With Heart Failure ◽  
The Impact

BACKGROUND Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. OBJECTIVE The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. METHODS A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. RESULTS Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. CONCLUSIONS This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. CLINICALTRIAL ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19705

scholarly journals Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial

10.2196/19705 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e19705 ◽  
Author(s):  
Veronica Artanian ◽  
Valeria E Rac ◽  
Heather J Ross ◽  
Emily Seto
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Controlled Trial ◽  
Survival Rates ◽  
Physiological Data ◽  
Randomized Controlled ◽  
Patients With Heart Failure ◽  
The Impact

Background Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. Objective The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. Methods A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. Results Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. Conclusions This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. Trial Registration ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID) DERR1-10.2196/19705

Mathematical modelling of the impact of preoperative hypertrophy on the outcomes of completion of the Fontan circuit

2005 ◽  
Vol 15 (S3) ◽  
pp. 57-60 ◽  
Author(s):  
Andrea Ripoli ◽  
Sergio Berti ◽  
Daniele Della Latta ◽  
Emiliano Rocca ◽  
Adrian Crucean ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mathematical Modelling ◽  
Compensatory Mechanism ◽  
Lower Stress ◽  
Myocardial Wall ◽  
Large Size ◽  
Important Relationship ◽  
Ideal Sphere ◽  
And Function ◽  
The Impact

The identification of the important relationship between shape and function of ventricular chambers represents a milestone of modern cardiology. Application of the law of Laplace for an ideal sphere furnishes intuitive insights on the progression of heart failure. A dilated heart, by virtue of its large size, must generate greater stress in the myocardial wall to achieve sufficient pressure so as to eject the required amount of blood. The mural hypertrophy represents a compensatory mechanism, guaranteeing a lower stress. When the ratio between the radius of the chamber and the thickness of its wall increases abnormally, the heart fails.

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