Pathophysiology of Vascular Calcification and Bone Loss: Linked Disorders of Ageing?

Vascular Calcification (VC), low bone mass and fragility fractures are frequently observed in ageing subjects. Although this clinical observation could be the mere coincidence of frequent age-dependent disorders, clinical and experimental data suggest that VC and bone loss could share pathophysiological mechanisms. Indeed, VC is an active process of calcium and phosphate precipitation that involves the transition of the vascular smooth muscle cells (VSMCs) into osteoblast-like cells. Among the molecules involved in this process, parathyroid hormone (PTH) plays a key role acting through several mechanisms which includes the regulation of the RANK/RANKL/OPG system and the Wnt/ß-catenin pathway, the main pathways for bone resorption and bone formation, respectively. Furthermore, some microRNAs have been implicated as common regulators of bone metabolism, VC, left ventricle hypertrophy and myocardial fibrosis. Elucidating the common mechanisms between ageing; VC and bone loss could help to better understand the potential effects of osteoporosis drugs on the CV system.

Multi-species transcriptomic data analysis reveal three candidate genes, responsible for the transition from compensated left ventricle hypertrophy to heart failure

Introduction Heart failure (HF) is the common final event for a wide spectrum of compensated left ventricle hypertrophy (LVH), including hypertrophic cardiomyopathy, hypertension, aortic stenosis and aortic coarctation. Despite its importance, the transition from hypertrophy to HF in humans is poorly understood. In this study, we aimed to find a molecular signature for the transition from compensated hypertrophy to decompensated HF conserved within species and disease induction methods. Methods Four datasets, containing gene expression data of hypertrophy and heart failure samples, were selected from GEO data repository. The selected datasets include three different species: Rattus norvegicus (GSE4286 and GSE47495), Canis lupus familiaris (GSE5247) and Cavia porcellus (GSE78077); with different models of left ventricle hypertrophy (pressure-overload, genetic, and both). The CEL files containing the expression data were analyzed using the Transcriptome Analysis Console 4.0 (TAC 4.0.2.15, Applied Biosystems). To identify differentially expressed genes a p-value cutoff of 0.05 was applied. Results The lists of DEGs obtained in the comparison hypertrophy versus HF, in each dataset, were uniformized to human identifiers and merged, resulting in a list containing 8307 genes. Most of the genes were differentially expressed in only one dataset (6252, 75.3%). DEGs present in two datasets were 1850 (22.3%), in three datasets 202 (2.4%), and finally, present in all datasets were only 3 genes. The first gene identified was CDKS1B, which belongs to a family of proteases related to the cell cycle. CKS1B upregulation activates the STAT3 and MEK/ERK pathways and promotes cell proliferation. Indeed, negative regulation of the MEK/ERK reduces cardiac hypertrophy induced by pressure overload. Secondly, type 2 phosphatidylinositol-5-phosphate 4-kinase (PI5P4K) converts phosphatidylinositol-5-phosphate to phosphatidylinositol-4,5-bisphosphate, and plays an important role in inflammatory response and autophagy. However, its role in the heart remains unknow. Lastly, the adipokine MEDAG was also differentially expressed in HF. Its role in myocyte metabolism is not defined but may parallel nutrient uptake role seen in adipose and reflect reliance on lipid oxidation. Conclusions We identified three genes that are differentially expressed in HF compared to compensated hypertrophy, involved in cell proliferation, autophagy, inflammation and lipid metabolism. This data requires confirmation in human studies. Such advance would be an important step toward identifying those risk factors, especially genetic variation, that predispose individuals to develop HF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT Portugal

The interobserver agreement of ECG abnormalities using Minnesota codes in people with type 2 diabetes

Objectives To assess the interobserver agreement in categories of electrocardiogram (ECG) abnormalities using the Minnesota Code criteria. Methods We used a random sample of 180 ECGs from people with type 2 diabetes. ECG abnormalities were classified and coded using the Minnesota ECG Classification. Each ECG was independently rated on several abnormalities by an experienced rater (rater 1) and by two cardiologists (raters 2 and 3) trained to apply the Minnesota codes on four Minnesota codes; 1-codes as an indication for myocardial infarction, 4 en 5-codes as an indication for ischemic abnormalities, 3-codes as an indication for left ventricle hypertrophy, 7-1-codes as an indication for ventricular conduction abnormalities, and 8-3-codes as an indication for atrial fibrillation / atrial flutter. After all pairwise tables were summed, the overall agreement, the specific positive and negative agreement were calculated with a 95% confidence interval (CI) for each abnormality. Also, Kappa’s with a 95% CI were calculated. Results The overall agreement (with 95% CI) were for myocardial infarction, ischemic abnormalities, left ventricle hypertrophy, conduction abnormalities and atrial fibrillation/atrial flutter respectively: 0.87 (0.84–0.91), 0.79 (0.74–0.84), 0.81 (0.76–0.85), 0.93 (0.90–0.95), 0.96 (0.93–0.97). Conclusion This study shows that the overall agreement of the Minnesota code is good to excellent.

Diagnosis dan Tatalaksana Terkini Penyakit Jantung Hipertensi

Hypertensive heart disease is a response to a prolonged increase in blood pressure that causes various changes in the myocardial structure. This study was aimed to obtain the recent diagnosis and management of hypertensive heart disease. This was a literature review study using 4 databases, as follows: Pubmed, Clinical Key, Science Direct, and Google Scholar. The keywords used were Hypertensive Heart Disease diagnosis of Hypertensive heart disease OR Screening of hypertensive heart disease OR imaging of hypertensive heart disease AND therapy OR treatment OR management of hypertensive heart disease. The results showed that there were 10 literatures that fulfilled the criteria, consisting of 6 randomized controlled trials and 4 article reviews. Among patients with hypertensive heart disease, left ventricle hypertrophy, left ventricular dilation, and diastolic and systolic disfunction were the most commonly found in ECG, echocardiography, chest X-ray, and CMR. Therapy of hypertensive heart disease was according to ACC/AHA guidelines with non-pharmacological therapy by adopting the DASH diet and pharmacological therapy of choice was ACE-I or ARB. In conclusion, in hypertensive heart disease, the most common structural changes were left ventricle hypertrophy, left ventricular dilation, diastolic and systolic disfunction found in ECG, echocardiography, chest X-ray, and CMR. Therapy of hypertensive heart disease was according to ACC/AHA guidelines.Keywords: hypertensive heart disease Abstrak: Penyakit jantung hipertensi merupakan respon terhadap peningkatan tekanan darah berkepanjangan yang menyebabkan berbagai perubahan pada struktur miokard. Penelitian ini bertujuan untuk mendapatkan diagnosis dan tatalaksana terkini mengenai penyakit jantung hipertensi. Jenis penelitian ialah literature review menggunakan 4 database, yaitu Pubmed, Clinical Key, Science Direct, dan Google Scholar. Kata kunci yang digunakan ialah Hypertensive Heart Disease diagnosis of Hypertensive heart disease OR Screening of hypertensive heart disease OR imaging of hypertensive heart disease AND therapy OR treatment OR management of hypertensive heart disease. Hasil penelitian mendapatkan 10 literatur yang memenuhi kriteria penelitian, terdiri dari 6 randomized controlled trial dan 4 review article. Pada penyakit jantung hipertensi kelainan struktural yang sering ditemukan ialah hipertrofi ventrikel kiri (konsentrik maupun eksentrik), dilatasi ventrikel kiri, disfungsi diastolik dan sistolik, yang dapat dideteksi lewat pemeriksaan EKG, ekokardiografi, rontgen toraks, dan CMR. Terapi penyakit jantung hipertensi menurut pedoman ACC/AHA yakni nonfarmakologi seperti pola diet DASH dan terapi farmakologi pilihan yaitu ACE-I atau ARB. Simpulan penelitian ini ialah pada penyakit jantung hipertensi terdapat hipertrofi ventrikel kiri, dilatasi ventirkel kiri, disfungsi diastolik maupun sistolik, dideteksi menggunakan EKG, ekokardiografi, rontgen toraks dan CMR. Terapi penyakit jantung hipertensi sesuai dengan pedoman penatalaksanaan ACC/AHA.Kata kunci: penyakit jantung hipertensi

The potential of cardioscreening in oil and gas refinery

Aim: to compare the results of examination conducted among oil and gas refinery employees, obtained during yearly periodic medical examination with the results obtained during cardioscreening. Material and Methods – 47 employees (64% - men, mean age 52 ± 8 yrs) of large oil and gas refinery were examined by cardiologist in 2018. Six months before the cardioscreening all employees underwent yearly periodic medical examination. The data of anamnesis, laboratory and instrumental findings (blood glucose, lipids, ECG) of examinees were analyzed. Revealed risk factors, the levels of risk SCORE, diagnosis and recommendations made during periodic medical examination and during cardioscreening were compared. Results – In the studied group dyslipidemia was observed in 39 employees (83%). Elevated blood glucose was revealed in 30 examinees (64%). Left ventricle hypertrophy on ECG was determined in 6 patients (13%). Hypertension was diagnosed in 35 subjects (75%) by cardiologist vs 26 subjects (55%) by therapeutist, diabetes mellitus was diagnosed in 8 (15%) vs 4 (8,5%) subjects by cardiologist and therapeutist correspondingly, smoking – in 20 (43%) and 16 (34%) of employees correspondingly (p < 0,001). Mean systolic BP was 152±20 mm Hg during cardioscreening versus 133±24 mm Hg during periodic medical examination (p < 0,001). High and very high risk SCORE have had 26 subjects (55%) according the data of cardiologist and 15 subjects (32%) according the data of therapeutist (p < 0,001). Conclusion – In the companies with abusive working conditions it is necessary to distinguish high and very high cardiovascular risk groups by means of cardioscreening.

Cardiac hypertrophic risk markers of left ventricle and left atrium in chronic heart failure due to aortic and mitral valve disease

Background Chronic valvular heart disease leads to systolic dysfunction and left atrial enlargement that ultimately results in heart failure. Purpose To investigate prognostic importance of Echocardiography and plasma natriuretic peptide levels that increase as a compensatory response and can be used as predictive markers for cardiac hypertrophy. Material and Methods The patients were divided into three groups: 51 with left ventricle hypertrophy due to aortic valve disease; 126 with left atrial enlargement due to mitral valve dysfunction; and 76 with both conditions. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels were measured in all three respective groups showing dilated cardiomyopathy. Results The mean left ventricular end-diastolic dimension at 64.3 ± 1.6 mm ( P < 0.00) and left atrial dimension at 58.3 ± 3.7 mm ( P < 0.00) were significantly high. However, patients with both conditions showed significantly high values for left ventricular end-diastolic dimension (63.3 ± 3 mm, P < 0.00) and left atrial dimension (54.9 ± 4 mm, P < 0.00) when compared with controls. A significant positive correlation was found between plasma natriuretic peptides levels and dilated cardiomyopathy. The mean values of ANP were 173 ± 46.6 pg/mL ( P < 0.00), 140.4 ± 42.4 pg/mL ( P < 0.00), and 295.1 ± 67.5 pg/mL ( P < 0.00), significantly high in all three respective disease groups. The levels of BNP were also significantly high at 189 ± 44.5 pg/mL ( P < 0.00), 166.6 ± 36.6 pg/mL ( P < 0.00), and 323 ± 69.1 pg/mL ( P < 0.00) in the disease groups with left ventricular hypertrophy, left atrial enlargement, and the disease group showing both characteristics, respectively. Conclusion Significant positive associations were found between left ventricle hypertrophy and left atrial enlargement with ANP and BNP.

Gender Features of the Prevalence, Development and Progression of Left Ventricle Hypertrophy in Chronic Kidney Disease

Aim of the Study: To study the features of the prevalence of left ventricular hypertrophy in chronic kidney disease, taking into account gender differences. Materials and Methods: This were an instant study. We examined 945 patients (360 female and 585 male) with chronic kidney disease (CKD) from the 1st to the 5th stage of the disease. The average age of the patients was 39.0±13.0 years. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. Results: In patients with female CKD, a significant decrease in hemoglobin, erythrocyte count, and eGFR was detected compared with males, while the incidence of hyperuricemia was significantly higher. Daily proteinuria was significantly higher in men compared with women. The prevalence of LVH was significantly higher in females compared with men (49.4% versus 35.7%; p<0.05). In women and men, the eccentric type prevailed in the structure of LVH. The number of patients with an eccentric type of LVH was significantly higher in the subgroup of females (p<0.05), and with concentric remodeling of the LV were significantly higher in males (p<0.05). Conclusion: The prevalence of LVH among the examined individuals with CKD was 40.9%. Among women, the most common type of LVH was the eccentric type of remodeling (79.2%), and among men, the concentric type of LVH was 39.7% of cases.

Left ventricular hypertrophy: differential diagnosis

There are some imaging methods for the diagnosis of left ventricular hypertrophy. Such as echocardiography, computed tomography, magnetic resonance imaging. These methods help to identify changes at different stages, evaluate the prognosis, stratify the risk and differential diagnosis.The left ventricle hypertrophy is a condition that may be due to physiological adaptation due to overload. For example, in patients with arterial hypertension, in athletes, and so on. Left ventricle hypertrophy may also be associated with a change in the actual structure: for example, with hypertrophic cardiomyopathy.Signs of left ventricle hypertrophy by echocardiography are a very significant predictor of mortality in patients with arterial hypertension in the general population. The presence of left ventricle hypertrophy by echocardiography is a high cardiovascular risk for the patient.It is important to diagnose diseases with a high risk of sudden cardiac death on time. One of these diseases is hypertrophic cardiomyopathy. A clinical diagnosis of hypertrophic cardiomyopathy is impossible without visualization. Therefore, the European Association of Cardiovascular Imaging recommends a multimodal approach in examining patients with hypertrophic cardiomyopathy.Сomputed tomography, echocardiography, and magnetic resonance imaging are used to diagnose which patient’s hypertrophy is pathological or physiological. The choice of which method to use depends on the diagnostic task, and also on the specific advantages and disadvantages of the method. Different visualization methods should be considered complementary, not competing. It is also important to choose a particular imaging technique given its diagnostic value, availability, benefits, risks and costs.