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Journal of Cardiovascular Imaging Jun 2024Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). In this study,...
BACKGROUND
Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). In this study, we estimated the prevalence of HF pre- and post-HD in ESRD using the current guidelines.
METHODS
We prospectively investigated HF in ESRD patients on HD using echocardiography pre- and post-HD. We used the structural and functional abnormality criteria of the 2021 European Society of Cardiology guidelines.
RESULTS
A total of 54 patients were enrolled. The mean age was 62.6 years, and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, and 20 (37.0%) had ischemic heart disease. The mean N-terminal-pro brain natriuretic peptide BNP (NT-proBNP) level was 12,388.8 ± 2,592.2 pg/dL. The mean ideal body weight was 59.3 kg, mean hemodialysis time was 237.4 min, and mean real filtration was 2.8 kg. The mean left ventricular ejection fraction (LVEF) was 62.4%, and mean left ventricular end-diastolic diameter was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower left atrial volume index (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), tricuspid regurgitation jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p < 0.001), and right ventricular systolic pressure (32.1 ± 10.3 vs. 38.4 ± 11.6, p = 0.005) compared with pre-HD. There were no differences in LVEF, E/E' ratio, or left ventricular global longitudinal strain. A total of 88.9% of pre-HD patients and 66.7% of post-HD patients had either structural or functional abnormalities in echocardiographic parameters according to recent HF guidelines (p = 0.007).
CONCLUSIONS
Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria for HF according to current HF guidelines. Pre-HD patients had a 22.2% higher incidence in the prevalence of functional or structural abnormalities as compared with post-HD patients.
PubMed: 38907294
DOI: 10.1186/s44348-024-00003-8 -
Colloids and Surfaces. B, Biointerfaces Jun 2024Rhamnolipids are glycolipid surfactants composed by a hydrophilic head of either one (mono-RL) or two (di-RL) rhamnose moieties coupled to hydroxyaliphatic chains that...
Rhamnolipids are glycolipid surfactants composed by a hydrophilic head of either one (mono-RL) or two (di-RL) rhamnose moieties coupled to hydroxyaliphatic chains that can be of different lengths. In spite of their importance in different fields of applications, as bioremediation processes for instance, self-aggregation physico-chemical properties of RLs are not unique. This because a variety of aggregates morphologies (shape and size) can either exist or coexist in aqueous dispersion due to mono-RL:di-RL molar ratio, hydrophobic tails length, pH and the presence of co-surfactants and additives. Recently, a theorethical approach reported the self-assembling morphologies of either pure mono or di-RL in aqueous environment, predicting the formation of spherical to ellipsoidal micelles to worm-like and disk-like aggregates depending on RL concentration and fatty acid chain length. In order to add new information to those previously available, the present work investigated the self-assembling properties of mono-RL-C10-C10 and di-RL-C10-C10 separately in aqueous dispersion by small angle X-Ray scattering (SAXS). A novel approach was applied to the data analysis coupling the scattering length density profiles of the RLs chemical groups and Monte Carlo simulations. Such an approach allowed us to infer about the preferred mono-RL and di-RL conformations that fit better in the self-assembling morphologies. In this way, we show that mono-RL-C10-C10 self-assembles into lamella-like aggregates coexisting with 30 % of multi-lamella aggregates (circa of 5 closed stacked lamella) from a concentration ranging from 10 to 50 mM, with hydrophobic thickness of about 12 Å, a hydrated polar head thickness of 10 Å, and an area per glycolipid of 76 Å. On the other hand, di-RL prefers to self-associate into flexible cylinder-like aggregates, from 70 mM to 110 mM concentration, with hydrophobic radius on the order of 7.5 Å, a hydrated polar shell of 21.5 Å, with hydropobic/polar interface of 110 Å per glycolipid. Interestingly, the parameters obtained from the best fitting to the experimental data associated to the volume fraction distribution of the chemical groups within the aggregates revealed that the hydrophobic chains are more disordered in mono-RL planar aggregates than in di-RL worm-like aggregates, as well as the hydration properties. Further, the addition of 100 mM NaCl in di-RL aqueous dispersion leads to the formation of longer worm-like aggregates. Taking together, this work opens a new avenue regarding characterization of biosurfactants self-assembling properties by using SAXS, also contributing to prepare more efficient biosurfactant dispersions depending on the desired applications in industrial sectors and bioremediation.
PubMed: 38905813
DOI: 10.1016/j.colsurfb.2024.114038 -
Alternative Therapies in Health and... Jun 2024This study aimed to explore the effects of combining cardiac rehabilitation exercise training with mindfulness care on cardiac function, exercise capacity, and mood in...
OBJECTIVE
This study aimed to explore the effects of combining cardiac rehabilitation exercise training with mindfulness care on cardiac function, exercise capacity, and mood in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).
METHODS
A total of 108 patients admitted to our hospital from January 2020 to January 2022, following PCI for CHD, were selected for this study. The participants were randomly assigned to either the control group or the observation group, with 54 patients in each group. The control group underwent standard rehabilitation exercise training, while the observation group received a combination of rehabilitation exercise training and mindfulness care. Cardiac function, exercise capacity, and psychological status were assessed and compared between the two groups before and after the intervention.
RESULTS
Post-intervention, both groups showed significant improvements in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) compared to pre-intervention levels, with the observation group demonstrating significantly greater improvements than the control group (P < .05). Additionally, the left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic dimension (LVEDD) decreased in both groups, with more significant reductions observed in the observation group (P < .05). Exercise capacity, as measured by the 6-minute walk distance, exercise time, and maximum exercise load, improved in both groups post-intervention, with the observation group showing greater improvements (P < .05). Psychological assessments indicated reductions in Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores in both groups after the intervention, with the observation group experiencing more substantial reductions (P < .05).
CONCLUSION
Integrating mindfulness care with cardiac rehabilitation exercise training significantly improves cardiac function, enhances exercise capacity, and reduces anxiety and depression in CHD patients post-PCI. This combined approach offers a more effective rehabilitation strategy compared to exercise training alone.
PubMed: 38904635
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024This study specifically investigates the impact of sacubitril/valsartan on cardiac structural remodeling and modulation of blood levels of miRNA-328 and NT-proBNP in...
OBJECTIVE
This study specifically investigates the impact of sacubitril/valsartan on cardiac structural remodeling and modulation of blood levels of miRNA-328 and NT-proBNP in patients with coronary heart disease (CHD) complicated by chronic heart failure (CHF). We aim to determine whether sacubitril/valsartan offers advantages over traditional therapies regarding cardiac morphology and molecular biomarkers, thus providing insights into its potential role in managing CHD and CHF.
METHODS
From January 2020 to January 2023, CHD patients with chronic heart failure were randomized into two groups for this study. Both groups received standard treatments: the control group received valsartan, while the study group received sacubitril/valsartan. Therapeutic outcomes were analyzed, including changes in cardiac structure, function, miRNA-328, and NT-proBNP levels in the blood, along with noting any adverse reactions.
RESULTS
The total effective rate in the study group was 86.67%, significantly higher than that in the control group (71.67%) (P < .05). After treatment, both groups exhibited reductions in left atrial anterior and posterior diameter, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter compared to before treatment, with the study group showing lower values than the control group (P < .05). The left ventricular ejection fraction (LVEF) increased in both groups, with the study group showing a higher increase than the control group. Additionally, the end-diastolic volume and end-systolic volume decreased in both groups after treatment, with the study group showing greater decreases than the control group (P < .05). Moreover, both groups exhibited reductions in peripheral blood levels of miRNA-328 and NT-proBNP, with the study group showing greater reductions than the control group (P < .05). There was no significant difference in the incidence of adverse reactions between the study group and the control group during treatment (P > .05).
CONCLUSION
Sacubitril/valsartan significantly improves cardiac function and structure in patients with CHD complicated by CHF, effectively reducing levels of miRNA-328 and NT-proBNP in the blood. It demonstrates safety and high value in clinical applications.
PubMed: 38904619
DOI: No ID Found -
Journal of the American Heart... Jul 2024Prognostic markers and biological pathways linked to detrimental clinical outcomes in heart failure with preserved ejection fraction (HFpEF) remain incompletely defined. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Prognostic markers and biological pathways linked to detrimental clinical outcomes in heart failure with preserved ejection fraction (HFpEF) remain incompletely defined.
METHODS AND RESULTS
We measured serum levels of 4123 unique proteins in 1117 patients with HFpEF enrolled in the PARAGON-HF (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction) trial using a modified aptamer proteomic assay. Baseline circulating protein concentrations significantly associated with the primary end point and the timing and occurrence of total heart failure hospitalization and cardiovascular death were identified by recurrent events regression, accounting for multiple testing, adjusted for age, sex, treatment, and anticoagulant use, and compared with published analyses in 2515 patients with heart failure with reduced ejection fraction from the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Efficacy and Safety of Aliskiren and Aliskiren/Enalapril Combination on Morbidity-Mortality in Patients With Chronic Heart Failure) clinical trials. We identified 288 proteins that were robustly associated with the risk of heart failure hospitalization and cardiovascular death in patients with HFpEF. The baseline proteins most strongly related to outcomes included B2M (β-2 microglobulin), TIMP1 (tissue inhibitor of matrix metalloproteinase 1), SERPINA4 (serpin family A member 4), and SVEP1 (sushi, von Willebrand factor type A, EGF, and pentraxin domain containing 1). Overall, the protein-outcome associations in patients with HFpEF did not markedly differ as compared with patients with heart failure with reduced ejection fraction. A proteomic risk score derived in patients with HFpEF was not superior to a previous proteomic score derived in heart failure with reduced ejection fraction nor to clinical risk factors, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or high-sensitivity cardiac troponin.
CONCLUSIONS
Numerous serum proteins linked to metabolic, coagulation, and extracellular matrix regulatory pathways were associated with worse HFpEF prognosis in the PARAGON-HF proteomic substudy. Our results demonstrate substantial similarities among serum proteomic risk markers for heart failure hospitalization and cardiovascular death when comparing clinical trial participants with heart failure across the ejection fraction spectrum.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique Identifiers: NCT01920711, NCT01035255, NCT00853658.
Topics: Humans; Heart Failure; Proteomics; Male; Female; Aged; Biomarkers; Valsartan; Stroke Volume; Aminobutyrates; Middle Aged; Tetrazoles; Drug Combinations; Biphenyl Compounds; Angiotensin Receptor Antagonists; Aptamers, Nucleotide; Prognosis; Ventricular Function, Left
PubMed: 38904251
DOI: 10.1161/JAHA.123.033544 -
Journal of the American Heart... Jul 2024Gender- and sex-based disparities in mitral valve disease exist; however the factors associated with these differences are unknown. Identifying these differences is...
BACKGROUND
Gender- and sex-based disparities in mitral valve disease exist; however the factors associated with these differences are unknown. Identifying these differences is essential in devising mitigating strategies. We evaluated gender and sex differences among patients with severe primary mitral regurgitation (MR) across treatment phases.
METHODS AND RESULTS
We conducted a retrospective cohort study of patients with new diagnoses of severe primary MR between 2016 and 2020. We compared multidisciplinary evaluation incidence and 2-year survival between men and women. We analyzed a subgroup meeting class 1 indications for intervention, which includes severe symptomatic MR or severe asymptomatic MR with ejection fraction <60% or left ventricular end-systolic diameter >40 mm. Logistic regression models identified predictors associated with the likelihood of multidisciplinary evaluation. Among 330 patients meeting class 1 indications, women were older (79 versus 76 years, =0.01) and had higher Society of Thoracic Surgeons risk scores for mitral valve repair than men (2.5% versus 1.4%, =0.003). Women were less likely to undergo multidisciplinary evaluation (57% versus 84%, <0.001) and intervention (47% versus 69%, <0.001) than men. Median days to intervention for women and men were 77 and 43, respectively. Women had a higher 2-year mortality rate than men (31% versus 21%, =0.035). On a multivariable model, female sex and older age were associated with lower odds of undergoing multidisciplinary evaluation (odds ratio, 0.26; <0.001; odds ratio, 0.95; <0.001, respectively).
CONCLUSIONS
Women with severe primary MR with class 1 indication for intervention were less likely to undergo multidisciplinary evaluation and intervention and had a longer interval to intervention than men. Survival was comparable after accounting for age and comorbidity differences.
Topics: Humans; Mitral Valve Insufficiency; Female; Male; Aged; Retrospective Studies; Sex Factors; Severity of Illness Index; Aged, 80 and over; Treatment Outcome; Mitral Valve; Risk Factors; Middle Aged; Stroke Volume
PubMed: 38904244
DOI: 10.1161/JAHA.123.033635 -
Journal of the American Heart... Jul 2024The epidemiology and pathophysiology of heart failure (HF) differ in women and men. Whether these differences extend to the subgroup of patients with advanced HF is not...
BACKGROUND
The epidemiology and pathophysiology of heart failure (HF) differ in women and men. Whether these differences extend to the subgroup of patients with advanced HF is not well defined.
METHODS AND RESULTS
This is a retrospective cohort study of all adult Olmsted County, Minnesota residents with advanced HF (European Society of Cardiology criteria) from 2007 to 2017. Differences in survival and hospitalization risks in women and men following advanced HF development were examined using Cox proportional hazard regression and Andersen-Gill models, respectively. Of 936 individuals with advanced HF, 417 (44.6%) were women and 519 (55.4%) were men (self-reported sex). Time from development of HF to advanced HF was similar in women and men (median 3.2 versus 3.6 years). Women were older at diagnosis (mean age 79 versus 75 years), less often had coronary disease and hyperlipidemia, but more often had hypertension and depression (<0.05 for each). Advanced HF with preserved ejection fraction was more prevalent in women than men (60% versus 30%, p<0.001). There were no differences in adjusted risks of all-cause mortality (hazard ratio [HR], 0.89 [95% CI, 0.77-1.03]), cardiovascular mortality (HR, 0.85 [95% CI, 0.70-1.02]), all-cause hospitalizations (HR, 1.04 [95% CI, 0.90-1.20]), or HF hospitalizations (HR, 0.91 [95% CI, 0.75-1.11]) between women and men. However, adjusted cardiovascular mortality was lower in women versus men with advanced HF with reduced ejection fraction (HR, 0.72 [95% CI, 0.56-0.93]).
CONCLUSIONS
Women more often present with advanced HF with preserved ejection fraction and men with atherosclerotic disease and advanced HF with reduced ejection fraction. Despite these differences, survival and hospitalization risks are largely comparable in women and men with advanced HF.
Topics: Humans; Heart Failure; Female; Male; Aged; Retrospective Studies; Minnesota; Sex Factors; Hospitalization; Stroke Volume; Aged, 80 and over; Risk Factors; Prognosis; Risk Assessment; Middle Aged; Cause of Death; Time Factors
PubMed: 38904243
DOI: 10.1161/JAHA.123.033374 -
Journal of the American Heart... Jul 2024Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This...
BACKGROUND
Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry.
METHODS AND RESULTS
The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], =0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] =0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], =0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; =0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; =0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; =0.044) were significant risk factors for poor prognosis.
CONCLUSIONS
While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
Topics: Humans; Female; Registries; Adult; Pregnancy; Republic of Korea; Cardiomyopathies; Peripartum Period; Pregnancy Complications, Cardiovascular; Risk Factors; Time Factors; Heart Transplantation; Prognosis; Ventricular Function, Left; Stroke Volume; Cause of Death; Hospitalization; Puerperal Disorders; Retrospective Studies; Heart Failure; Incidence
PubMed: 38904229
DOI: 10.1161/JAHA.123.034055 -
BioRxiv : the Preprint Server For... Feb 2024Septic shock, in humans and in our well-established animal model, is associated with increases in biventricular end diastolic volume (EDV) and decreases in ejection...
BACKGROUND
Septic shock, in humans and in our well-established animal model, is associated with increases in biventricular end diastolic volume (EDV) and decreases in ejection fraction (EF). These abnormalities occur over 2 days and reverse within 10 days. Septic non-survivors do not develop an increase in EDV. The mechanism for this cardiac dysfunction and EDV differences is unknown.
METHODS
Purpose-bred beagles randomized to receive intrabronchial (n=27) or saline (n=6) were provided standard ICU care including sedation, mechanical ventilation, and fluid resuscitation to a pulmonary arterial occlusion pressure of over 10mmHg. No catecholamines were administered. Over 96h, cardiac magnetic resonance imaging, echocardiograms, and invasive hemodynamics were serially performed, and laboratory data was collected. Tissue was obtained at 66h from six septic animals.
RESULTS
From 0-96h after bacterial challenge, septic animals controls had significantly increased left ventricular wall edema (6%) and wall thinning with loss of mass (15%) which was more pronounced at 48h in non-survivors than survivors. On histology, edema was located predominantly in myocytes, the interstitium, and endothelial cells. Edema was associated with significantly worse biventricular function (lower EFs), ventricular-arterial coupling, and circumferential strain. In septic animals, from 0-24h, the EDV decreased from baseline and, despite cardiac filling pressures being similar, decreased significantly more in non-survivors. From 24-48h, all septic animals had increases in biventricular chamber sizes. Survivors biventricular EDVs were significantly greater than baseline and in non-survivors, where biventricular EDVs were not different from baseline. Preload, afterload, or HR differences did not explain these differential serial changes in chamber size.
CONCLUSION
Systolic and diastolic cardiac dysfunction during sepsis is associated with ventricular wall edema. Rather than differences in preload, afterload, or heart rate, structural alterations to the ventricular wall best account for the volume changes associated with outcome during sepsis. In non-survivors, from 0-24h, sepsis induces a more severe diastolic dysfunction, further decreasing chamber size. The loss of left ventricular mass with wall thinning in septic survivors may, in part explain, the EDV increases from 24-48h. However, these changes continued and even accelerated into the recovery phase consistent with a reparative process rather than ongoing injury.
PubMed: 38903100
DOI: 10.1101/2024.02.05.578971 -
BMC Cardiovascular Disorders Jun 2024This study aimed to explore the application of cardiopulmonary exercise testing in coronary artery disease (CAD) patients, evaluate its impact on exercise ability and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
This study aimed to explore the application of cardiopulmonary exercise testing in coronary artery disease (CAD) patients, evaluate its impact on exercise ability and cardiopulmonary function in patients with coronary heart disease (CHD), and promote the application of cardiopulmonary exercise testing in CAD management.
METHODS
Fifty CHD patients after percutaneous coronary intervention (PCI) were recruited and randomly enrolled into the control (Ctrl) group and intervention (Int) group. Routine health education and health education combined with RT training were carried out for the two groups. Blood lipid levels and lung function were compared between the two groups after intervention. Cardiac function was evaluated by Doppler ultrasonography, and cardiopulmonary fitness and exercise ability were evaluated by a cardiopulmonary exercise test (CPET). The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate negative emotions. The 36-item short-form (SF-36) was adopted to evaluate quality of life.
RESULT
Compared with those in the Ctrl group, the levels of serum total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) decreased in the Int group, while the levels of high-density lipoprotein increased (P < 0.05). The quantitative load results showed that compared with the Ctrl group, the heart rate (HR) and self-perceived fatigue degree of the Int group decreased, and the ST segment increased (P < 0.05). Compared with the Ctrl group, the left ventricular ejection fraction (LVEF), forced expiratory volume at 1 s (FEV), ratio of forced expiratory volume to forced vital volume (FEV/FVC%), and maximum chase volume (MVV) increased in the Int group, while the left ventricular end diastolic diameter and left ventricular end contractile diameter decreased (P < 0.05). The results of the CPET showed that compared with the Ctrl group, minute ventilation/carbon dioxide production slope, VE/VCO, anaerobic threshold (AT), peak oxygen pulse (VO/HR ), oxygen uptake efficiency platform (OUEP), increasing power exercise time (IPEt), HR recovery 1 min after exercise, peak load power (Watt ), and value metabolic equivalent (Watt ) increased in the Int group (P < 0.05). Compared with the Ctrl group, the SAS and SDS scores in the Int group decreased (P < 0.05). The results of the quality of life evaluation showed that compared with the Ctrl group, the score of the SF-36 dimensions increased in the Int group (P < 0.05).
CONCLUSION
RT training can reduce postoperative blood lipid and quantitative load levels in CAD patients and improve adverse mood. Furthermore, it can improve patients' cardiopulmonary function, cardiopulmonary fitness, exercise ability, and quality of life.
Topics: Humans; Coronary Artery Disease; Male; Middle Aged; Female; Exercise Tolerance; Quality of Life; Exercise Test; Treatment Outcome; Aged; Recovery of Function; Cardiorespiratory Fitness; Lung; Predictive Value of Tests; Lipids; Cardiac Rehabilitation; Percutaneous Coronary Intervention; Time Factors; Exercise Therapy; Biomarkers; Ventricular Function, Left
PubMed: 38902630
DOI: 10.1186/s12872-024-03958-0