Sex-Related Differences in the Impact of Systemic Hypertension on Left Ventricular Remodeling in Patients with Hypertrophic Obstructive Cardiomyopathy

Cardiology ◽  
2020 ◽  
Vol 145 (4) ◽  
pp. 203-214 ◽  
Author(s):  
Yue Zhou ◽  
Miao Yu ◽  
Jiansong Yuan ◽  
Fenghuan Hu ◽  
Shengwen Liu ◽  
...  
Keyword(s):  
Troponin I ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Logistic Analysis ◽  
Lv Remodeling ◽  
Sudden Cardiac Death Risk ◽  
The Impact

Background: The clinical condition of hypertrophic obstructive cardiomyopathy (HOCM) and concomitant systemic hypertension is growing more and more prevalent, and it brings about a challenging diagnostic and therapeutic dilemma. However, whether systemic hypertension has an impact on HOCM, and whether sex-related differences exist in this impact, remains unclear. Methods: A total of 453 HOCM patients (age 48.7 ± 12.8 years, 252 [55.6%] males) were recruited in this study. There were 150 patients (33.1%, 81 males and 69 females) with a history of controlled systemic hypertension. Cardiac magnetic resonance (CMR) imaging was performed in all patients. Left ventricular (LV) remodeling index (LVRI) was determined by CMR. LVRI >1.3 g/mL was defined as pathological LV remodeling. Results: Men had significantly greater LVRI (1.40 ± 0.54 vs. 1.15 ± 0.38 g/mL, p < 0.001) and LVRI >1.3 g/mL (p = 0.002), compared with women. The incidence of syncope and 5-year sudden cardiac death risk score were significantly lower in HOCM with hypertension than those without hypertension. LVRI (p = 0.003) and LVRI >1.3 g/mL (p = 0.007) were significantly smaller in males with hypertension, but not in females with hypertension. However, log cardiac troponin I and log N-terminal pro-B-type natriuretic peptide were positively correlated with LVRI in men and women. On multivariable logistic analysis, hypertension (OR 0.172, 95% CI 0.056–0.528, p = 0.002) remained an independent determinant of pathological LV remodeling in males, whereas not in females. Conclusions: There were significant sex differences in the impact of systemic hypertension on LV remodeling in patients with HOCM. Controlled systemic hypertension may contribute to improving LV remodeling in male patients with HOCM, but not in females.

P3490Intravenous administration of atorvastatin early after cardiac ischemia attenuates adverse left ventricular remodeling, ameliorates cardiac function and limits the deleterious effects of reinfarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Vilahur ◽  
S Ben-Aicha ◽  
M Gutierrez ◽  
M Arzanauskaite ◽  
L G Mendieta Badimon ◽  
...  
Keyword(s):  
Infarct Size ◽  
Intravenous Administration ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
High Cholesterol Diet ◽  
Myocardial Salvage ◽  
Global Improvement ◽  
Lv Remodeling ◽  
The Impact

Abstract Background Statins have shown to attenuate reperfusion-induced myocardial injury. However, whether statins directly target ischemia-related cardiac damage attenuating adverse left ventricular (LV) remodeling and post-myocardial infarction (MI) complications remains unknown. Purpose We examined the impact of a single intravenous administration of IV-STATIN early after ischemia onset on LV remodeling and reinfarction in a dyslipidemic pig model by serial CMR. Methods Diet-induced hypercholesterolemic pigs (N=14; cholesterol: 394±61mg/dL) were subjected to 90min of ischemia (MI-induction by LAD-coronary balloon occlusion) and further reperfusion. One group of pigs received an intravenous bolus of IV-STATIN (a modified preparation of atorvastatin; 0.3mg/kg) at 15min of ischemia (IV-STATIN-ISCH; n=7) whereas the other was orally treated with atorvastatin shortly post-MI (ATORVA-POST-MI; n=7). 40 days thereafter animals underwent a second MI-induction (reinfarction) and were sacrificed at day43. All animals remained post-MI and until sacrifice on p.o. atorvastatin treatment and a high-cholesterol diet. Serial CMR analysis was performed at day3 (early LV remodeling), prior-reinfarction (late LV remodeling; day40) and post-reinfarction (day43) for the assessment of global anatomical and functional parameters and segmental motility. Myocardial tissue was collected for molecular and histological analyses of cell death-, inflammatory-, and angiogenic-related markers. Results CMR revealed 3 days post-MI an absolute 6% reduction on infarct size in IV-STATIN-ISCH pigs as compared to ATORVA-POST-MI pigs (18.0±0.8% LV vs. 23.9±1.9% LV; p<0.05) with the resultant 25% increase in myocardial salvage (p<0.05). These infarct size-limiting effects remained up to day40 and lead to 30% smaller scars vs. ATORVA-POST-MI pigs (9.9±0.8% LV vs. 13.9±1.9% LV; respectively; p=0.06). Interestingly, reinfarction did not expand the damage produced by MI in IV-STATIN-ISCH animals whereas it increased by 13% the scar size of ATORVA-POST-MI pigs (p<0.05). These IV-STATIN-ISCH- related benefits detected throughout the study were associated with a significant global improvement in stroke volume and LVEF as well and less regional wall motion abnormalities and dysfunctional segments in the jeopardized region (p<0.05 vs. ATORVA-POST-MI). The scar of reinfarcted IV-STATIN-ISCH pigs showed lower apoptosis execution and MCP-1 expression and higher vessel density vs. ATORVA-POST-MI (p<0.05). Lipids levels and liver/renal parameters remained unchanged in all animals throughout the study. Conclusions This is the first study to prove that intravenous administration of IV-STATIN early after MI improves structural and functional cardiac remodeling and limits the worsening effects of reinfarction. The potential cardiac benefits afforded by CardioshieldTM infusion early after MI-diagnosis (i.e., out-of-hospital and/or cath lab setting) deserves to be clinically investigated. Acknowledgement/Funding Fundaciό Investigaciό Marato TV3 #20154310; PNS 2015-71653-R and PNS SAF2016-76819-R MINECO, ISCIII; CIBERCV CN16/11/00411

scholarly journals Noninvasive Detection of Early Metabolic Left Ventricular Remodeling in Systemic Hypertension

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 157-162 ◽  
Author(s):  
Yasmin S. Hamirani ◽  
Bijoy K. Kundu ◽  
Min Zhong ◽  
Andrew McBride ◽  
Yinlin Li ◽  
...  
Keyword(s):  
Glucose Uptake ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Pressure Overload ◽  
Positron Emission Tomography Imaging ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Myocardial Glucose Uptake ◽  
Positron Emission ◽  
Metabolic Remodeling

Objectives: Hypertension (HTN) is a common cause of left ventricular hypertrophy (LVH). Sustained pressure overload induces a permanent myocardial switch from fatty-acid to glucose metabolism. In this study, we tested the hypothesis that metabolic remodeling, characterized by increased myocardial glucose uptake, precedes structural and functional remodeling in HTN-induced LVH. Methods: We recruited 31 patients: 11 with HTN only, 9 with HTN and LVH and 11 normotensive controls without LVH. Transthoracic echocardiography was performed to assess the function, mass, wall thickness and diastolic function of the left ventricle. Positron emission tomography imaging was performed, and the rate of myocardial 2-deoxy-2-[18F]fluoro-D-glucose uptake, Ki, was determined using a 3-compartment kinetic model. Results: The mean Ki values were significantly higher in HTN patients than in those with HTN and LVH (p < 0.001) and in controls (p = 0.003). The unexpected decrease in Ki with LVH may be secondary to a decreased Ki with diastolic dysfunction (DD), 0.039 ± 0.032 versus 0.072 ± 0.013 (p = 0.004). There was also a significant stepwise decrease in Ki with increasing DD grade (p = 0.04). Conclusion: Glucose metabolic remodeling is detectable in hypertensive patients before the development of LVH. Furthermore, lower glucose uptake rates are observed in patients with DD. The mechanism for this last finding requires further investigation.

scholarly journals Assessment of the Utility of the SeptalE/(E′×S′)Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Selma Kenar Tiryakioglu ◽  
Hakan Ozkan ◽  
Hasan Ari ◽  
Kıvanc Yalin ◽  
Senol Coskun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Doppler Echocardiography ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Tissue Doppler Echocardiography ◽  
Anterior Myocardial Infarction ◽  
Lv Remodeling ◽  
Group 1

Background. The aim of this study is to show whether the septalE/(E′×S′)ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention.Methods. Consecutive patients (n=111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. SeptalE/(E′×S′)ratio was assessed by pulsed Doppler echocardiography.Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling.E/(E′×S′)was significantly higher in Group 1 (4.1±1.9versus1.65±1.32,p=0.001). The optimal cutoff value forE/(E′×S′)ratio was 2.34 with 87.0% sensitivity and 82.1% specificity.Conclusion. SeptalE/(E′×S′)values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septalE/(E′×S′)can be evaluated together with the conventional echocardiographic techniques.

Abstract 18200: Intracoronary Delivery of Bioabsorbable Alginate Matrix (IK-5001) Ameliorates Adverse Post-infarction Left Ventricular Remodeling and Improves Left Ventricular Function in a Porcine Model of Reperfused Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Carlos G Santos-Gallego ◽  
Belén Picatoste ◽  
Ida U Njerve ◽  
Kiyotake Ishikawa ◽  
Jaime Aguero ◽  
...  
Keyword(s):  
Porcine Model ◽  
Ventricular Remodeling ◽  
Interstitial Fibrosis ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Cardiomyocyte Hypertrophy ◽  
Lv Function ◽  
Contractile Reserve ◽  
Intracoronary Injection ◽  
Lv Remodeling

Background: Adverse cardiac remodeling after MI is associated with excessive degradation of the extracellular matrix (ECM). IK-5001 is a low viscosity injectable solution that provides the polysaccharide alginate. After intracoronary injection into the MI area it undergoes phase transition forming a hydrogel which can support the ECM. We hypothesized that administration of alginate post-MI would provide a temporary scaffold and attenuate adverse LV remodeling. Methods: Acute MI was induced in 16 pigs by balloon occlusion of the proximal LAD for 2 hours. Animals randomly received intracoronary alginate or saline 4 days post-MI. LV function and remodeling were evaluated with cardiac MRI, 3D-echo and pressure-volume loops at 1 and 2 months post-MI. Histology and Western blot analysis were performed after 2 months. Results: Both groups had similar LVEF and infarct size 4 days post-MI. Coronary angiography immediately after alginate injection showed no impairment in coronary flow. However, 2 months post-MI, alginate-treated pigs exhibited reduced LV remodeling compared with controls demonstrated by reduced LV end-systolic volume, LV mass and sphericity (Table). Alginate-treated pigs had less cardiomyocyte hypertrophy and decreased interstitial fibrosis. Consistent with this, chronic activation of Akt and ERK was reduced. Alginate pigs also showed lower plasma levels of BNP and aldosterone. Interestingly, after 2 months, alginate pigs showed better systolic LV function: higher LVEF, better contractile reserve with dobutamine, and higher dP/dt. Conclusions: Intracoronary administration of alginate ameliorates adverse post-MI LV remodeling at the anatomical, histological and molecular level, and mitigates neurohormonal activation in a porcine model of MI. Alginate also improves systolic LV function. Intracoronary injection of alginate represents an exciting novel treatment option to reduce post-MI remodeling that merits assessment in clinical studies.

scholarly journals A short duration of high-fat diet induces insulin resistance and predisposes to adverse left ventricular remodeling after pressure overload

2008 ◽  
Vol 295 (6) ◽  
pp. H2495-H2502 ◽  
Author(s):  
Michael J. Raher ◽  
Helene B. Thibault ◽  
Emmanuel S. Buys ◽  
Darshini Kuruppu ◽  
Nobuyuki Shimizu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Myocardial Perfusion ◽  
Short Duration ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
High Fat ◽  
Lv Remodeling ◽  
And Function ◽  
The Impact

Insulin resistance is an increasingly prevalent condition in humans that frequently clusters with disorders characterized by left ventricular (LV) pressure overload, such as systemic hypertension. To investigate the impact of insulin resistance on LV remodeling and functional response to pressure overload, C57BL6 male mice were fed a high-fat (HFD) or a standard diet (SD) for 9 days and then underwent transverse aortic constriction (TAC). LV size and function were assessed in SD- and HFD-fed mice using serial echocardiography before and 7, 21, and 28 days after TAC. Serial echocardiography was also performed on nonoperated SD- and HFD-fed mice over a period of 6 wk. LV perfusion was assessed before and 7 and 28 days after TAC. Nine days of HFD induced systemic and myocardial insulin resistance (assessed by myocardial 18F-fluorodeoxyglucose uptake), and myocardial perfusion response to acetylcholine was impaired. High-fat feeding for 28 days did not change LV size and function in nonbanded mice; however, TAC induced greater hypertrophy, more marked LV systolic and diastolic dysfunction, and decreased survival in HFD-fed compared with SD-fed mice. Compared with SD-fed mice, myocardial perfusion reserve was decreased 7 days after TAC, and capillary density was decreased 28 days after TAC in HFD-fed mice. A short duration of HFD induces insulin resistance in mice. These metabolic changes are accompanied by increased LV remodeling and dysfunction after TAC, highlighting the impact of insulin resistance in the development of pressure-overload-induced heart failure.

Circulating MicroRNA-146a and MicroRNA-21 Predict Left Ventricular Remodeling after ST-Elevation Myocardial Infarction

Cardiology ◽  
2015 ◽  
Vol 132 (4) ◽  
pp. 233-241 ◽  
Author(s):  
Xiaoxia Liu ◽  
Yumei Dong ◽  
Song Chen ◽  
Guangde Zhang ◽  
Mingyu Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circulating Microrna ◽  
Ventricular Ejection Fraction ◽  
Creatine Kinase Mb ◽  
Acute Mi

Objectives: MicroRNA (miR)-146a and miR-21 have been reported to participate in inflammatory reactions and fibrosis. Excessive inflammation and cardiac fibrosis may play important roles in the development of left ventricular remodeling (LVR). This study assessed whether miR-146a, miR-21 and other biomarkers could predict LVR after myocardial infarction (MI). Methods: Circulating miR-146a, miR-21 and other biomarker levels were measured in 198 patients with acute MI 5 days after primary percutaneous coronary intervention (PCI). All patients were assessed by transthoracic echocardiography on day 5 and 1 year after primary PCI. Results: Concentrations of circulating miR-146a, miR-21, C-reactive protein, creatine kinase MB type and troponin I, as well as estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF), were significantly higher in patients with than in those without LVR (p < 0.05). Multivariate logistic regression analysis showed that circulating miR-146a (odds ratio, OR = 2.127, p < 0.0001), miR-21 (OR = 1.119, p < 0.0001), eGFR (OR = 0.939, p = 0.0137) and LVEF (OR = 0.802, p = 0.0048) were independent predictors of LVR development. The area under the curve for the combination of miR-146a and miR-21 was significantly higher than for either alone. Conclusion: Circulating miR-146a and miR-21 may be novel biomarkers predictive of LVR after acute MI. Their combination may better predict LVR than either alone.

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