scholarly journals Correlation of gene expression and clinical parameters identifies a set of genes reflecting LV systolic dysfunction and morphological alterations

2019 ◽  
Vol 51 (8) ◽  
pp. 356-367 ◽  
Author(s):  
Eric Witt ◽  
Elke Hammer ◽  
Marcus Dörr ◽  
Kerstin Weitmann ◽  
Daniel Beug ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Heart Function ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Expression Patterns ◽  
Peptide Hormone ◽  
Left Ventricular ◽  
Cardiac Morphology ◽  
Morphological Alterations

To gain new insights into the complex pathophysiology of dilated cardiomyopathy (DCM) we performed a quantitative approach to identify genes with expression patterns that linearly correlate with parameters of cardiac morphology (left ventricular end-diastolic diameter indexed by body surface are (LVEDDI), systolic function [LV ejection fraction (LVEF)], and serum levels of cardiac peptide hormone NH2-terminal probrain natriuretic peptide (NT-proBNP) in human endomyocardial biopsies of 47 DCM patients and eight individuals with normal LVEF. A set of genes was identified as common heart failure markers characterized by correlation of their expression with cardiac morphology, systolic function, and NT-proBNP. Among them are already known genes encoding e.g., the natriuretic peptide hormones NPPA and NPPB and its converting enzyme corin, but also potential new heart failure markers like EP300 antisense RNA1 and dimethylarginine dimethylaminohydrolase 1 (DDAH1) along with other genes with so far unknown relation to heart function. In contrast, the expression of other genes including the Ca2+ flux regulating genes phospholamban (PLN), sarcoplasmic/endoplasmic reticulum calcium ATPase 2 (SERCA), and extracellular matrix proteins showed significant correlation with LVEF and LVEDDI only. Those genes seem to reflect more specifically pathological alterations of systolic function and morphology in DCM hearts.

The role of LVOT-VTI measurement in the evaluation of systolic heart function in pulmonary ICU patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Meltem Çimen ◽  
Selin Eyüboğlu ◽  
Uğur Özdemir ◽  
Burhan Sami Kalın ◽  
Tuba Güney ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Function ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Poor Correlation ◽  
Cross Sectional ◽  
Predictive Values ◽  
Sensitivity Specificity

Introduction: The detection of cardiac systolic dysfunction is very important for well management of pulmonary critical care patients (PCCPs). However, there is a poor correlation between echocardiographic cardiac systolic function (CSF) parameters and it is not easy to obtain these parameters in PCCPs. Therefore, this cross-sectional observational study was planned for the detection of a more easily obtainable echocardiographic CSF parameter that is well correlated with other CSF parameters in PCCPs. Materials and Methods: Total 88 PCCPs were included. Demographic and clinical information and laboratory tests of all patients were recorded. The CSF parameters of the heart were obtained by transthoracic echocardiography with appropriate technique. LVOT-VTI (Left ventricular outflow tract velocity time integral), CO (cardiac output), EPSS (e point septal separation), Left ventricular EF (ejection fraction) and TAPSE (Tricuspid Annular Plane Systolic Excursion) as an indicator of CSF were tried to obtain from all pateints. We also calculated sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 parameter to diagnose heart failure. Results: The mean age of the patients was 73±12, 40% were female, 38% were intubated and 52% had COPD. LVOTVTI, EF, CO, EPSS parameters were obtained in 54(61%), 24(27%), 48(54%), 48(54%) patients, respectively. Decreased LVOT-VTI (<20 cm) was well correlated with decreased EF (<45%) (p=0.001, r=0.77), decreased CO (<5 L/dk) (p=0.03, r=0.64) and decreased TAPSE (<17 mm) (p=0.001, r=0.71). Also, there was good agreement between the EF and LVOTVTI measurements (Kappa:0.78, p:0.001). Sensitivity, specificity, positive and negative predictive values of LVOTVTI<20 for heart failure were 58, 78, 84, 49 repectively. Conclusion: LVOT-VTI is more easily obtainable and well correlated parameter which can be used as an indicator of CSF in PCCPs.

scholarly journals Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borrelli ◽  
P Sciarrone ◽  
F Gentile ◽  
N Ghionzoli ◽  
G Mirizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Preserved Ejection Fraction ◽  
2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p&lt;0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p&lt;0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p&lt;0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index &gt;15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p&lt;0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p&lt;0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p&lt;0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p&lt;0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

Abstract 2793: Comparison of Midregional Pro-atrial Natriuretic Peptide, B-type Natriuretic Peptide, and Amino-terminal Pro-B-type Natriuretic Peptide in Patients with Chronic Heart Failure: Influencing Factors, Detection of Left Ventricular Systolic Dysfunction, and Prediction of Death

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Deddo Moertl ◽  
Martin Huelsmann ◽  
Joachim Struck ◽  
Andreas Gleiss ◽  
Alexandra Hammer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Influencing Factors ◽  
Natriuretic Peptides ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Background: Although natriuretic peptides are increasingly used for the management of chronic heart failure (CHF), there are sparse comparative data. Therefore, we compared the importance of influencing factors, the ability to detect left ventricular systolic dysfunction, and the prognostic power of midregional pro-atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) in patients with chronic heart failure. Methods and Results: MR-proANP, using a new assay directed at the midregion of aminoterminal-proANP, was compared with BNP and NT-proBNP, using conventional assays, in 797 patients with CHF. All three natriuretic peptides were independently influenced by left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and the presence of ankle edema. Area under receiver-operator characteristic curves for detection of an LVEF <40% were similar between MR-proANP (0.799 [0.753– 0.844]) and BNP (0.803 [0.757– 0.849]), and NT-proBNP (0.730 [0.681– 0.778]. During a median observation time of 68 months, 492 patients died. In multiple Cox regression analysis each natriuretic peptide was the strongest prognostic parameter among various clinical variables, but proportion of explained variation showed that NT-proANP was a significantly stronger predictor of death than NT-proBNP and BNP (Figure ). Conclusions: Despite similarities in influencing factors and detection of reduced LVEF, MR-proANP outperformed BNP and NT-proBNP in the prediction of death. A new assay technology and the high biological stability of MR-proANP are potential explanations for these findings.

Plasma cardiotrophin-1 following acute myocardial infarction: relationship with left ventricular systolic dysfunction

2001 ◽  
Vol 102 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Suneel TALWAR ◽  
Iain B. SQUIRE ◽  
Russell J. O'BRIEN ◽  
Paul F. DOWNIE ◽  
Joan E. DAVIES ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Clinic Visit ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Remodelling

The glycoprotein 130 (gp130) signalling pathway is important in the development of heart failure. Cardiotrophin-1 (CT-1), a cytokine acting via the gp130 pathway, is involved in the process of ventricular remodelling following acute myocardial infarction (AMI) in animals. The aims of the present study were to examine the profile of plasma CT-1 following AMI in humans, and its relationship with echocardiographic parameters of left ventricular (LV) systolic function. Serial measurements of plasma CT-1 levels were made in 60 patients at 14-48h, 49-72h, 73-120h and 121-192h following AMI and at a later clinic visit. LV function was assessed using a LV wall motion index (WMI) score on admission (WMI-1) and at the clinic visit (WMI-2). Compared with values in control subjects (29.5±3.6fmol/ml), the plasma CT-1 concentration was elevated in AMI patients at 14-48h (108.1±15.1fmol/ml), 49-72h (105.2±19.7fmol/ml), 73-120h (91.2±14.9fmol/ml) and 121-192h (118.8±22.6fmol/ml), and at the clinic visit (174.9±30.9 fmol/ml) (P < 0.0001). Levels were higher following anterior compared with inferior AMI. For patients with anterior AMI, CT-1 levels were higher at the clinic visit than at earlier times. WMI-1 correlated with CT-1 at all times prior to hospital discharge (P < 0.05). On best subsets analysis, the strongest correlate with WMI-1 was CT-1 level at 49-72h (R2 = 20%, P < 0.05). In conclusion, plasma levels of CT-1 are elevated soon after AMI in humans and rise further in the subsequent weeks in patients after anterior infarction. CT-1 measured soon after AMI is indicative of LV dysfunction, and this cytokine may have a role in the development of ventricular remodelling and heart failure after AMI.

2371Electrocardiographic features and their echocardiographic correlates in peripartum cardiomyopathy based on the EURObservational registry on PPCM

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A C Mbakwem ◽  
J Bauersachs ◽  
C Viljoen ◽  
P Van Der Meer ◽  
M Petrie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ethnic Differences ◽  
Regional Differences ◽  
Sinus Tachycardia ◽  
Systolic Function ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Qtc Interval

Abstract Background Cardiac disease remains an important cause of maternal morbidity and mortality globally. Peripartum cardiomyopathy (PPCM), defined as heart failure secondary to left ventricular (LV) systolic dysfunction in previously healthy women towards the end of pregnancy or up to five months following delivery, can result in cardiogenic shock due to severe LV dysfunction or arrhythmias leading to sudden cardiac death. Cardiac electrical activity and its relationship to cardiac dysfunction have not yet been interrogated in large multi-centre studies. Purpose This study aimed to identify the ECG abnormalities associated with PPCM; their relationship with echocardiographic structural and functional abnormalities and explore regional and ethnic differences in ECG features. Methods We included the first 411 patients enrolled into the EURObservational PPCM registry (EORP). Baseline demographic, clinical and echocardiographic data were collected. ECGs were analysed for rate; rhythm; QRS width, axis and morphology; and QTc interval. Results Mean age of the women (from >40 countries) was 30.7±6.4 years. More than two thirds of patients presented with NYHA class III or IV (with no regional differences). The median QRS rate was 102bpm (IQR 87–117). More than half presented with sinus tachycardia (QRS rate >100bpm), whereas atrial fibrillation was rare (2.27%). The mean QRS width was 90.1ms ±21.5, with regional differences (ESC 93.8ms ±21.7 vs. non-ESC 86.8ms ±20.8, P<0.001). Left bundle branch block (LBBB) was reported in 9.30% with no regional or ethnic differences. Left ventricular hypertrophy (LVH) was present in a quarter of the cohort, and more prevalent amongst African (59.62%) and Asian (23.17%) than Caucasians (7.63%, P<0.001). The median QTc by Bazett was 456.7ms (IQR 409–490.7) and almost half (47.11%) had prolonged QTc (>460ms). The median LVEDD was 60mm (IQR 55–65) on echocardiography. Compared with their Asian and Caucasian counterparts, African patients were more likely to have LV dilatation (LVEDD>53mm: 70.11%, 79.31% and 89.42% respectively; P=0.004). The median LV ejection fraction (LVEF) was 32.50% (IQR 25–39) with no significant regional or ethnic differences. Sinus tachycardia predicted poor systolic function (OR 1.85 [95% CI 1.20–2.85], p=0.006). LVEF <35% was associated with a significantly higher QRS rate (median rate 107 vs. 98bpm, p=0.002). Women with LVEDD ≥53mm had a longer mean QRS duration (92.0±22.4 vs. 82.4±15.4ms, p<0.001) and frequency of LBBB (11.15% vs 1.54%, p=0.016). LBBB was a predictor of LVEDD >53mm (sensitivity 11.15%; specificity 98.46%; PPV 97.14%; NPV 19.10%; OR 8.02 [95% CI 1.08–59.66], p=0.042). Conclusion Patients with PPCM commonly present with sinus tachycardia, LVH, and/or prolonged QTc interval on their ECG. Wide QRS and/or LBBB, were associated with LVEDD>53mm. Sinus tachycardia, however, was associated with LVEF<35%. Risk of arrhythmia in those with prolonged QTc remains to be ascertained. Acknowledgement/Funding Heart Failure Association of the ESC

scholarly journals The heart regulates the endocrine response to heart failure: cardiac contribution to circulating neprilysin

2017 ◽  
Vol 39 (20) ◽  
pp. 1794-1798 ◽  
Author(s):  
Mattia Arrigo ◽  
Nicolas Vodovar ◽  
Hélène Nougué ◽  
Malha Sadoune ◽  
Chris J Pemberton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Sinus ◽  
Artificial Heart ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Venous Blood ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Total Artificial Heart ◽  
Endocrine Response

Abstract Aims Heart failure (HF) is accompanied by major neuroendocrine changes including the activation of the natriuretic peptide (NP) pathway. Using the unique model of patients undergoing implantation of the CARMAT total artificial heart and investigating regional differences in soluble neprilysin (sNEP) in patients with reduced or preserved systolic function, we studied the regulation of the NP pathway in HF. Methods and results Venous blood samples from two patients undergoing replacement of the failing ventricles with a total artificial heart were collected before implantation and weekly thereafter until post-operative week 6. The ventricular removal was associated with an immediate drop in circulating NPs, a nearly total disappearance of circulating glycosylated proBNP and furin activity and a marked decrease in sNEP. From post-operative week 1 onwards, NP concentrations remained overall unchanged. In contrast, partial recoveries in glycosylated proBNP, furin activity, and sNEP were observed. Furthermore, while in patients with preserved systolic function (n = 6), sNEP concentrations in the coronary sinus and systemic vessels were similar (all P > 0.05), in patients with reduced left-ventricular systolic function, sNEP concentration, and activity were ∼three-fold higher in coronary sinus compared to systemic vessels (n = 21, all P < 0.0001), while the trans-pulmonary gradient was neutral (n = 5, P = 1.0). Conclusion The heart plays a pivotal role as a regulator of the endocrine response in systolic dysfunction, not only by directly releasing NPs but also by contributing to circulating sNEP, which in turn determines the bioavailability of other numerous vasoactive peptides.

scholarly journals HDAC6 contributes to pathological responses of heart and skeletal muscle to chronic angiotensin-II signaling

2014 ◽  
Vol 307 (2) ◽  
pp. H252-H258 ◽  
Author(s):  
Kimberly M. Demos-Davies ◽  
Bradley S. Ferguson ◽  
Maria A. Cavasin ◽  
Jennifer H. Mahaffey ◽  
Sarah M. Williams ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Angiotensin Ii ◽  
Muscle Wasting ◽  
Striated Muscle ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ang Ii ◽  
Skeletal Muscle Wasting

Little is known about the function of the cytoplasmic histone deacetylase HDAC6 in striated muscle. Here, we addressed the role of HDAC6 in cardiac and skeletal muscle remodeling induced by the peptide hormone angiotensin II (ANG II), which plays a central role in blood pressure control, heart failure, and associated skeletal muscle wasting. Comparable with wild-type (WT) mice, HDAC6 null mice developed cardiac hypertrophy and fibrosis in response to ANG II. However, whereas WT mice developed systolic dysfunction upon treatment with ANG II, cardiac function was maintained in HDAC6 null mice treated with ANG II for up to 8 wk. The cardioprotective effect of HDAC6 deletion was mimicked in WT mice treated with the small molecule HDAC6 inhibitor tubastatin A. HDAC6 null mice also exhibited improved left ventricular function in the setting of pressure overload mediated by transverse aortic constriction. HDAC6 inhibition appeared to preserve systolic function, in part, by enhancing cooperativity of myofibrillar force generation. Finally, we show that HDAC6 null mice are resistant to skeletal muscle wasting mediated by chronic ANG-II signaling. These findings define novel roles for HDAC6 in striated muscle and suggest potential for HDAC6-selective inhibitors for the treatment of cardiac dysfunction and muscle wasting in patients with heart failure.

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