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Pubblicazioni recenti - cardiorenal
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A case of a coronary covered stent for repeated restenosis at the anastomosis site between saphenous vein graft and graft prosthesis.
J Cardiol Cases2022 Feb;25(2):110-114. doi: 10.1016/j.jccase.2021.07.007.
Gohbara Masaomi, Sugano Teruyasu, Ishikawa Toshiyuki, Tamura Kouichi, Kimura Kazuo,
Abstract
A 56-year-old man was admitted with a diagnosis of non-ST-segment elevation myocardial infarction, after surgery for total arch replacement, aortic root replacement with a mechanical aortic valve, and coronary artery reconstruction by the Piehler method for acute aortic dissection. Coronary angiography (CAG) revealed a 99% stenosis of the anastomosis site between the J Graft (Japan Lifeline, Tokyo, Japan) and the saphenous vein graft (SVG), which was distally sutured to his right coronary artery (posterior descending artery). After percutaneous coronary intervention (PCI) with a drug-eluting stent to the anastomosis site, repeated in-stent restenosis unfortunately occurred. Despite repeated PCIs, he was again admitted due to exertional angina pectoris, with proven inferior myocardial ischemia by stress myocardial perfusion imaging. We therefore decided to use a coronary covered stent for the anastomosis site to seal neointimal proliferation. GRAFTMASTER 2.8/19 mm (Abbott, CA, USA) was implanted in the anastomosis site, and a follow-up CAG one-year later revealed that the covered stent was clearly opened. To the best of our knowledge, this is the first paper to demonstrate the usefulness of a covered stent for repeated restenosis of the anastomosis site between SVG and graft prostheses. .
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Interplay between mineral bone disorder and cardiac damage in acute kidney injury: from Ca mishandling and preventive role of Klotho in mice to its potential mortality prediction in human.
Transl Res2022 Jan;():. doi: S1931-5244(22)00002-0.
González-Lafuente Laura, Navarro-García José Alberto, Rodríguez-Sánchez Elena, Aceves-Ripoll Jennifer, Poveda Jonay, Vázquez-Sánchez Sara, Mercado-García Elisa, Fernández-Velasco María, Kuro-O Makoto, Liaño Fernando, Ruilope Luis M, Ruiz-Hurtado Gema,
Abstract
Biomarkers of mineral bone disorders (MBD) including phosphorus, fibroblast growth factor (FGF)-23 and Klotho are strongly altered in patients with acute kidney injury (AKI) who have high cardiac outcomes and mortality rates. However, the crosslink between MBD and cardiac damage after an AKI episode still remains unclear. We tested MBD and cardiac biomarkers in an experimental AKI model after 24 or 72 hours of folic acid injection and we analyzed structural cardiac remodeling, intracellular calcium (Ca) dynamics in cardiomyocytes and cardiac rhythm. AKI mice presented high levels of FGF-23, phosphorus and cardiac troponin T (cTnT) and exhibited a cardiac hypertrophy phenotype accompanied by an increase in systolic Ca release 24 hours after AKI. Ca transients and contractile dysfunction were reduced 72 hours after AKI while diastolic sarcoplasmic reticulum Ca leak, pro-arrhythmogenic Ca events and ventricular arrhythmias were increased. These cardiac events were linked to the activation of the calcium/calmodulin-dependent kinase II pathway through the increased phosphorylation of ryanodine receptors and phospholamban specific sites after AKI. Cardiac hypertrophy and the altered intracellular Ca dynamics were prevented in transgenic mice overexpressing Klotho after AKI induction. In a translational retrospective longitudinal clinical study, we determined that combining FGF-23 and phosphorus with cTnT levels achieved a better prediction of mortality in AKI patients at hospital admission. Thus, monitoring MBD and cardiac damage biomarkers could be crucial to prevent mortality in AKI patients. In this setting, Klotho might be considered as a new cardioprotective therapeutic tool to prevent deleterious cardiac events in AKI conditions.
Copyright © 2022. Published by Elsevier Inc.
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Validation of cardiogenic shock phenotypes in a mixed cardiac intensive care unit population.
Catheter Cardiovasc Interv2022 Jan;():. doi: 10.1002/ccd.30103.
Jentzer Jacob C, Soussi Sabri, Lawler Patrick R, Kennedy Jason N, Kashani Kianoush B,
Abstract
BACKGROUND:
Proposed phenotypes have recently been identified in cardiogenic shock (CS) populations using unsupervised machine learning clustering methods. We sought to validate these phenotypes in a mixed cardiac intensive care unit (CICU) population of patients with CS.
METHODS:
We included Mayo Clinic CICU patients admitted from 2007 to 2018 with CS. Agnostic K means clustering was used to assign patients to three clusters based on admission values of estimated glomerular filtration rate, bicarbonate, alanine aminotransferase, lactate, platelets, and white blood cell count. In-hospital mortality and 1-year mortality were analyzed using logistic regression and Cox proportional-hazards models, respectively.
RESULTS:
We included 1498 CS patients with a mean age of 67.8?±?13.9 years, and 37.1% were females. The acute coronary syndrome was present in 57.3%, and cardiac arrest was present in 34.0%. Patients were assigned to clusters as follows: Cluster 1 (noncongested), 603 (40.2%); Cluster 2 (cardiorenal), 452 (30.2%); and Cluster 3 (hemometabolic), 443 (29.6%). Clinical, laboratory, and echocardiographic characteristics differed across clusters, with the greatest illness severity in Cluster 3. Cluster assignment was associated with in-hospital mortality across subgroups. In-hospital mortality was higher in Cluster 3 (adjusted odds ratio [OR]: 2.6 vs. Cluster 1 and adjusted OR: 2.0 vs. Cluster 2, both p?0.001). Adjusted 1-year mortality was incrementally higher in Cluster 3 versus Cluster 2 versus Cluster 1 (all p?0.01).
CONCLUSIONS:
We observed similar phenotypes in CICU patients with CS as previously reported, identifying a gradient in both in-hospital and 1-year mortality by cluster. Identifying these clinical phenotypes can improve mortality risk stratification for CS patients beyond standard measures.
© 2022 Wiley Periodicals LLC.
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Quality of Beverage Intake and Cardiometabolic and Kidney Outcomes: Insights From the STANISLAS Cohort.
Front Nutr2021 ;8():738803. doi: 10.3389/fnut.2021.738803.
Wagner Sandra, Merkling Thomas, Girerd Nicolas, Bozec Erwan, Van den Berghe Laurie, Hoge Axelle, Guillaume Michèle, Kanbay Mehmet, Cakir-Kiefer Céline, Thornton Simon N, Boivin Jean-Marc, Mercklé Ludovic, Laville Martine, Rossignol Patrick, Nazare Julie-Anne,
Abstract
Beverages are an important aspect of diet, and their quality can possibly affect health. The Healthy Beverage Index (HBI) has been developed to take into account these effects. This study aimed to highlight the relationships between health and beverage quality by assessing the association of the HBI and its components with kidney and cardiometabolic (CM) outcomes in an initially healthy population-based familial cohort. This study included 1,271 participants from the STANISLAS cohort. The HBI, which includes 10 components of habitual beverage consumption, was calculated. Associations of the HBI and its components with estimated glomerular filtration rate (eGFR), albuminuria, hypertriglyceridemic waist (HTG waist), metabolic syndrome (MetS), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass (LV mass) were analyzed using multivariable linear or logistic regression models. The median HBI score was 89.7 (78.6-95) out of 100 points. While the overall HBI score was not significantly associated with any of the studied outcomes, individual HBI components were found differently associated with the outcomes. cfPWV and cIMT were lower in participants who did not meet the full-fat milk criteria ( = 0.03 and 0.001, respectively). In men, higher cfPWV was observed for the "low Fat milk" ( = 0.06) and "alcohol" ( = 0.03) non-adherence criteria. Odds of HTG waist were higher with the non-adherence to sugar-sweetened beverages criteria (
Copyright © 2022 Wagner, Merkling, Girerd, Bozec, Van den Berghe, Hoge, Guillaume, Kanbay, Cakir-Kiefer, Thornton, Boivin, Mercklé, Laville, Rossignol and Nazare.
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Cardiovascular benefits from SGLT2 inhibition in type 2 diabetes mellitus patients is not impaired with phosphate flux related to pharmacotherapy.
World J Cardiol2021 Dec;13(12):676-694. doi: 10.4330/wjc.v13.i12.676.
Nashawi Mouhamed, Ahmed Mahmoud S, Amin Toka, Abualfoul Mujahed, Chilton Robert,
Abstract
The beneficial cardiorenal outcomes of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) have been substantiated by multiple clinical trials, resulting in increased interest in the multifarious pathways by which their mechanisms act. The principal effect of SGLT2i (-flozin drugs) can be appreciated in their ability to block the SGLT2 protein within the kidneys, inhibiting glucose reabsorption, and causing an associated osmotic diuresis. This ameliorates plasma glucose elevations and the negative cardiorenal sequelae associated with the latter. These include aberrant mitochondrial metabolism and oxidative stress burden, endothelial cell dysfunction, pernicious neurohormonal activation, and the development of inimical hemodynamics. Positive outcomes within these domains have been validated with SGLT2i administration. However, by modulating the sodium-glucose cotransporter in the proximal tubule (PT), SGLT2i consequently promotes sodium-phosphate cotransporter activity with phosphate retention. Phosphatemia, even at physiologic levels, poses a risk in cardiovascular disease burden, more so in patients with type 2 diabetes mellitus (T2DM). There also exists an association between phosphatemia and renal impairment, the latter hampering cardiovascular function through an array of physiologic roles, such as fluid regulation, hormonal tone, and neuromodulation. Moreover, increased phosphate flux is associated with an associated increase in fibroblast growth factor 23 levels, also detrimental to homeostatic cardiometabolic function. A contemporary commentary concerning this notion unifying cardiovascular outcome trial data with the translational biology of phosphate is scant within the literature. Given the apparent beneficial outcomes associated with SGLT2i administration notwithstanding negative effects of phosphatemia, we discuss in this review the effects of phosphate on the cardiometabolic status in patients with T2DM and cardiorenal disease, as well as the mechanisms by which SGLT2i counteract or overcome them to achieve their net effects. Content drawn to develop this conversation begins with proceedings in the basic sciences and works towards clinical trial data.
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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Editorial: The Impact of Adipose Tissue Dysfunction on Cardiovascular and Renal Disease.
Front Endocrinol (Lausanne)2021 ;12():815894. doi: 10.3389/fendo.2021.815894.
Sun Xiaodong, Ruan Cheng-Chao, da Silva Alexandre A,
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Murine models of uremic cardiomyopathy as a necessary tool to unravel mechanisms involved in cardiorenal syndrome.
Kidney Int2022 Feb;101(2):214-216. doi: S0085-2538(21)01134-0.
Navarro-García José Alberto, Ruiz-Hurtado Gema,
Abstract
Chronic kidney disease (CKD) and cardiovascular disease frequently run in parallel. Herein, Soppert et al. provide an interesting meta-analysis of the effects of CKD on cardiac remodeling and/or function in mice based on the model, strain, and duration. The authors sought to determine the most appropriate experimental model to unravel the specific underlying pathologic mechanisms involved in cardiac damage in CKD (single hit) or to investigate new strategies to prevent CKD-induced cardiovascular disease (multifactorial hits representing cardiovascular comorbidities of patients with CKD).
Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
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Association between expanded criteria for living kidney donors and renal biopsy findings.
J Nephrol2022 Jan;():. doi: 10.1007/s40620-021-01228-2.
Goto Shunsuke, Oguchi Hideyo, Sakai Ken, Mikami Tetsuo, Ichikawa Daisuke, Yazawa Masahiko, Koike Junki, Furuichi Kengo, Kawabata Masahiko, Yokoyama Hitoshi, Sofue Tadashi, Ibuki Emi, Nishi Shinichi,
Abstract
BACKGROUND:
There are certain criteria for selecting living kidney donors. However, the association between clinical characteristics of these criteria and kidney biopsy findings in living kidney donors have not yet been elucidated. Thus, we investigated the association between kidney biopsy findings and clinical characteristics defined in the Japanese guidelines for living kidney donors.
METHODS:
A retrospective multicentre study was conducted on donors and their recipients who underwent kidney transplantation between July 2014 and June 2017. Multiple linear regression analysis and multiple logistic regression analysis were performed to investigate the association between biopsy findings and clinical characteristics.
RESULTS:
A total of 240 donors and 240 recipients were included. Age was significantly correlated with global glomerulosclerosis and intimal thickening in multiple linear regression analysis and multiple logistic regression analysis, whereas diabetes was correlated with tubular atrophy in multiple linear regression analysis after multiple imputation and multiple logistic regression analysis.
CONCLUSIONS:
Amongst the clinical factors investigated in our study, age was positively correlated and diabetes was possibly correlated with kidney tissue injury in living kidney donors. Age and diabetes may be more important for selecting suitable living kidney donors than other clinical factors.
© 2021. The Author(s) under exclusive licence to Italian Society of Nephrology.
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Right ventricular overloading is attenuated in monocrotaline-induced pulmonary hypertension model rats with a disrupted Gpr143 gene, the gene that encodes the 3,4-l-dihydroxyphenyalanine (l-DOPA) receptor.
J Pharmacol Sci2022 Feb;148(2):214-220. doi: S1347-8613(21)00115-8.
Nakano Masayuki, Koga Motokazu, Hashimoto Tatsuo, Matsushita Natsuki, Masukawa Daiki, Mizuno Yusuke, Uchimura Hiraku, Niikura Ryo, Miyazaki Tomoyuki, Nakamura Fumio, Zou Suo, Shimizu Takahiro, Saito Motoaki, Tamura Kouichi, Goto Takahisa, Goshima Yoshio,
Abstract
Pulmonary hypertension (PH) is a severe and progressive disease that causes elevated right ventricular systolic pressure, right ventricular hypertrophy and ultimately right heart failure. However, the underlying pathophysiologic mechanisms are poorly understood. We previously showed that 3,4-l-dihydroxylphenyalanine (DOPA) sensitizes vasomotor response to sympathetic tone via coupling between the adrenergic receptor alpha1 (ADRA1) and a G protein-coupled receptor 143 (GPR143), a DOPA receptor. We investigated whether DOPA similarly enhances ADRA1-mediated contraction in pulmonary arteries isolated from rats, and whether GPR143 is involved in the PH pathogenesis. Pretreating the isolated pulmonary arteries with DOPA 1 ?M enhanced vasoconstriction in response to phenylephrine, an ADRA1 agonist, but not to U-46619, a thromboxane A2 agonist or endothelin-1. We generated Gpr143 gene-deficient (Gpr143) rats, and confirmed that DOPA did not augment phenylephrine-induced contractile response in Gpr143 rat pulmonary arteries. We utilized a rat model of monocrotaline (MCT)-induced PH. In the MCT model, the right ventricular systolic pressure was attenuated in the Gpr143 rats than in WT rats. Phenylephrine-induced cell migration and proliferation were also suppressed in Gpr143 pulmonary artery smooth muscle cells than in WT cells. Our result suggests that GPR143 is involved in the PH pathogenesis in the rat models of PH.
Copyright © 2021 The Authors. Production and hosting by Elsevier B.V. All rights reserved.
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Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes According to Baseline HbA1c and Insulin Use: An Analysis From the FIDELIO-DKD Study.
Diabetes Care2022 Jan;():. doi: dc211944.
Rossing Peter, Burgess Ellen, Agarwal Rajiv, Anker Stefan D, Filippatos Gerasimos, Pitt Bertram, Ruilope Luis M, Gillard Pieter, MacIsaac Richard J, Wainstein Julio, Joseph Amer, Brinker Meike, Roessig Lothar, Scott Charlie, Bakris George L,
Abstract
OBJECTIVE:
Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes.
RESEARCH DESIGN AND METHODS:
Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30-5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to
RESULTS:
Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c
CONCLUSIONS:
Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.
© 2022 by the American Diabetes Association.
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Predialysis serum lactate levels could predict dialysis withdrawal in Type 1 cardiorenal syndrome patients.
EClinicalMedicine2022 Feb;44():101232. doi: 10.1016/j.eclinm.2021.101232.
Pan Heng-Chih, Huang Tao-Min, Sun Chiao-Yin, Chou Nai-Kuan, Tsao Chun-Hao, Yeh Fang-Yu, Lai Tai-Shuan, Chen Yung-Ming, Wu Vin-Cent,
Abstract
Background:
Renal replacement therapy (RRT) is an effective rescue therapy for Type 1 cardiorenal syndrome (CRS). Previous studies have demonstrated that type 1 CRS patients with severe renal dysfunction were susceptible to sepsis, and that serum lactate has been correlated with the risk of mortality in patients with sepsis. However, the association between serum lactate level and the prognosis of type 1 CRS patients requiring RRT is unknown.
Methods:
An inception cohort of 500 type 1 CRS patients who received RRT in a tertiary-care referral hospital in Taiwan from August 2011 to January 2018 were enrolled. The outcomes of interest were dialysis withdrawal and 90-day mortality. The results were further externally validated using sampling data of type 1 CRS patients requiring dialysis from multiple tertiary-care centers.
Findings:
The 90-day mortality rate was 52.8% and the incidence rate of dialysis withdrawal was 34.8%. Lower pre-dialysis lactate was correlated with a higher rate of dialysis withdrawal and lower rate of mortality. Generalized additive model showed that 4.2 mmol/L was an adequate cut-off value of lactate to predict mortality. Taking mortality as a competing risk, Fine-Gray subdistribution hazard analysis further indicated that a low lactate level (? 4.2 mmol/L) was an independent predictor for the possibility of dialysis withdrawal, as also shown in external validation. The interaction of quick Sequential Organ Failure Assessment score and lactate was associated with dialysis dependence in a disease severity-dependent manner. Furthermore, the associations between hyperlactatemia and dialysis dependence were consistent in the patients with and without sepsis.
Interpretation:
Serum lactate level is accurate and capable of forecasting the prognosis along with qSOFA severity for clinical decision-making for treating type 1 CRS patients. Further studies are needed to validate our results.
Funding:
This study was supported by grants from Taiwan National Science Council [104-2314-B-002-125-MY3,106-2314-B-002-166-MY3,107-2314-B-002-026-MY3], National Taiwan University Hospital [106-FTN20,106-P02,UN106-014,106-S3582,107-S3809,107-T02,PC1246,VN109-09,109-S4634,UN109-041], Ministry of Science and Technology of the Republic of China [MOST106-2321-B-182-002,106-2314-B-182A-064,MOST107-2321-B-182-004,MOST107-2314-B-182A-138, MOST108-2321-B-182-003,MOST109-2321-B-182-001, MOST108-2314-B-182A-027], Chang Gung Memorial Hospital [CMRPG-2G0361,CMRPG-2H0161,CMRPG-2J0261, CMRPG-2K0091], and Ministry of Health and Welfare of the Republic of China [PMRPG-2L0011].
© 2021 Published by Elsevier Ltd.
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Are high- or low-dose SGLT2 inhibitors associated with cardiovascular and respiratory adverse events? A meta-analysis.
J Cardiovasc Pharmacol2022 Jan;():. doi: 10.1097/FJC.0000000000001222.
Zou Hai-Tao, Yang Guo-Huan, Cai Yu-Jun, Chen Hao, Zheng Xiao-Qin, Hu Rong,
Abstract
ABSTRACT:
The association between high-dose or low-dose sodium-glucose cotransporter 2 (SGLT2) inhibitors and various cardiovascular and respiratory serious adverse events (SAE) is unclear. Our meta-analysis aimed to define the association between high-dose or low-dose SGLT2 inhibitors and 86 kinds of cardiovascular SAE and 58 kinds of respiratory SAE. We included large cardiorenal outcome trials of SGLT2 inhibitors. Meta-analysis was conducted stratified by the dose of SGLT2 inhibitors (high dose or low dose) to synthesize risk ratio (RR) and 95% confidence interval (CI). We included nine trials. Compared to placebo, SGLT2 inhibitors used at high dose or low dose were associated with the decreased risks of 6 kinds of cardiovascular SAE (e.g., bradycardia [RR 0.60, 95% CI 0.41-0.89], atrial fibrillation [RR 0.79, 95% CI 0.69-0.92], and hypertensive emergency [RR 0.34, 95% CI 0.15-0.78]) and 6 kinds of respiratory SAE (e.g., asthma [RR 0.59, 95% CI 0.37-0.93], chronic obstructive pulmonary disease [RR 0.77, 95% CI 0.62-0.96], and sleep apnoea syndrome [RR 0.37, 95% CI 0.17-0.81]). SGLT2 inhibitors used at high dose or low dose did not show significant associations with 132 other cardiopulmonary SAE. For any outcome of interest, the subgroup difference according to the dose of SGLT2 inhibitors was not significant (Psubgroup > 0.05). SGLT2 inhibitors used at whether high dose or low dose are associated with the decreased risks of 12 cardiopulmonary disorders (e.g., bradycardia, atrial fibrillation, hypertensive emergency, asthma, chronic obstructive pulmonary disease, and sleep apnoea syndrome). These findings may suggest the potential efficacy of high- or low-dose SGLT2 inhibitors for prevention and treatment of these cardiopulmonary disorders.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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SPECT and PET Radiotracers in Renal Imaging.
Semin Nucl Med2022 Jan;():. doi: S0001-2998(21)00104-5.
Werner Rudolf A, Pomper Martin G, Buck Andreas K, Rowe Steven P, Higuchi Takahiro,
Abstract
Diuretic scintigraphy includes single-photon emitting radiotracers for planar and single photon emission computed tomography (SPECT) imaging as well as agents for positron emission tomography (PET). These radiotracers provide split-renal functional parameters, including glomerular filtration rate, effective renal plasma flow, tubular function, and/or renal blood flow. Beyond measuring kidney function, the tracer principle also allows for the assessment of various pathophysiological processes in the renal parenchyma, for example ongoing inflammation, activation of angiotensin II type 1 receptor in patients with renovascular hypertension, deterioration of mitochondrial complex I following acute or chronic kidney injury, or characterization of indeterminate renal masses. Providing a whole-body read-out, PET also enables the assessment of kidney-organ interactions, for example cardiorenal crosstalk after primary cardiac injury. This manuscript provides an overview of established clinical applications for single-photon-emitting and PET radiotracers for renal radionuclide imaging. Future perspectives in the field will also be highlighted, such as introduction of PET-guided strategies for drug dose optimization and the recent introduction of radiotracers targeting fibroblast activation protein inhibition, which may allow differentiation between acute inflammatory vs chronic fibrosis in the kidneys.
Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.
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Exploring New Kingdoms: The Role of Extracellular Vesicles in Oxi-Inflamm-Aging Related to Cardiorenal Syndrome.
Antioxidants (Basel)2021 Dec;11(1):. doi: 78.
Mas-Bargues Cristina, Alique Matilde, Barrús-Ortiz María Teresa, Borrás Consuelo, Rodrigues-Díez Raquel,
Abstract
The incidence of age associated chronic diseases has increased in recent years. Although several diverse causes produce these phenomena, abundant evidence shows that oxidative stress plays a central role. In recent years, numerous studies have focused on elucidating the role of oxidative stress in the development and progression of both aging and chronic diseases, opening the door to the discovery of new underlying mechanisms and signaling pathways. Among them, senolytics and senomorphics, and extracellular vesicles offer new therapeutic strategies to slow the development of aging and its associated chronic diseases by decreasing oxidative stress. In this review, we aim to discuss the role of extracellular vesicles in human cardiorenal syndrome development and their possible role as biomarkers, targets, or vehicles of drugs to treat this syndrome.
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Relation of Cardiorenal Syndrome to Mitral and Tricuspid Regurgitation in Acute Decompensated Heart Failure.
Am J Cardiol2022 Jan;():. doi: S0002-9149(21)01251-0.
Seghatol Frank F, Martin Kimberly D, Haj-Asaad Ayman, Xie Min, Prabhu Sumanth D,
Abstract
This study aimed to investigate the role of secondary mitral regurgitation (MR) and tricuspid regurgitation (TR) in the pathogenesis of cardiorenal syndrome (CRS). Worsening renal function in patients with acute decompensated heart failure receiving diuretic therapy is defined as CRS and is related to central venous congestion. The role of secondary MR and TR is not well studied. We retrospectively reviewed the electronic medical records of 80 consecutive patients hospitalized with acute decompensated heart failure. Patients were divided into 2 groups: group 1 (CRS) if creatinine increased >0.3 mg/dl from baseline and group 2 (no CRS) if creatinine remained stable or improved with diuretic therapy. Admission creatinine was higher in group 1 compared with group 2 (1.5 vs 1.2 mg/dl, p = 0.033). The magnitude of MR and TR were higher by both visual assessment (moderate to severe [3+] or severe [4+] MR in 68% of patients in group 1 vs 3% in group 2, p
Copyright © 2021 Elsevier Inc. All rights reserved.
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MANP (M-Atrial Natriuretic Peptide) Reduces Blood Pressure and Furosemide-Induced Increase in Aldosterone in Hypertension.
Hypertension2022 Jan;():HYPERTENSIONAHA12118837. doi: 10.1161/HYPERTENSIONAHA.121.18837.
Dzhoyashvili Nina A, Iyer Seethalakshmi R, Chen Horng H, Burnett John C,
Abstract
BACKGROUND:
MANP (M-atrial natriuretic peptide) is a best-in-class activator of the pGC-A (particulate guanylyl cyclase A) receptor. Furosemide increases the effectiveness of antihypertensive agents, but activates renin-angiotensin-aldosterone system. We aimed to investigate for the first time cardiorenal and neurohumoral actions of MANP in a genetic model of hypertension in spontaneously hypertensive rats. We also assessed how MANP would potentiate the blood pressure (BP)-lowering actions of furosemide while reducing the production of aldosterone.
METHODS:
Spontaneously hypertensive rats (n=60) were randomized in vehicle, MANP, furosemide, or MANP+furosemide groups. Furosemide (1, 5, 10 mg/kg) was given as a single bolus which in MANP+furosemide groups was followed by a 60-minute infusion of MANP.
RESULTS:
BP was reduced in MANP300 (300 pmol/[kg·min]) and MANP600 (600 pmol/[kg·min]) groups (
CONCLUSIONS:
We provide novel evidence that MANP potentiates the BP-lowering actions of furosemide, suppresses the activation of renin-angiotensin-aldosterone system, and preserves renal function. These data are highly relevant to clinical needs in the treatment of hypertension and heart failure.
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The anti-aging factor Klotho protects against acquired long QT syndrome induced by uremia and promoted by fibroblast growth factor 23.
BMC Med2022 01;20(1):14. doi: 10.1186/s12916-021-02209-9.
Navarro-García José Alberto, Salguero-Bodes Rafael, González-Lafuente Laura, Martín-Nunes Laura, Rodríguez-Sánchez Elena, Bada-Bosch Teresa, Hernández Eduardo, Mérida-Herrero Evangelina, Praga Manuel, Solís Jorge, Arribas Fernando, Bueno Héctor, Kuro-O Makoto, Fernández-Velasco María, Ruilope Luis Miguel, Delgado Carmen, Ruiz-Hurtado Gema,
Abstract
BACKGROUND:
Chronic kidney disease (CKD) is associated with increased propensity for arrhythmias. In this context, ventricular repolarization alterations have been shown to predispose to fatal arrhythmias and sudden cardiac death. Between mineral bone disturbances in CKD patients, increased fibroblast growth factor (FGF) 23 and decreased Klotho are emerging as important effectors of cardiovascular disease. However, the relationship between imbalanced FGF23-Klotho axis and the development of cardiac arrhythmias in CKD remains unknown.
METHODS:
We carried out a translational approach to study the relationship between the FGF23-Klotho signaling axis and acquired long QT syndrome in CKD-associated uremia. FGF23 levels and cardiac repolarization dynamics were analyzed in patients with dialysis-dependent CKD and in uremic mouse models of 5/6 nephrectomy (Nfx) and Klotho deficiency (hypomorphism), which show very high systemic FGF23 levels.
RESULTS:
Patients in the top quartile of FGF23 levels had a higher occurrence of very long QT intervals (>?490?ms) than peers in the lowest quartile. Experimentally, FGF23 induced QT prolongation in healthy mice. Similarly, alterations in cardiac repolarization and QT prolongation were observed in Nfx mice and in Klotho hypomorphic mice. QT prolongation in Nfx mice was explained by a significant decrease in the fast transient outward potassium (K) current (I), caused by the downregulation of K channel 4.2 subunit (Kv4.2) expression. Kv4.2 expression was also significantly reduced in ventricular cardiomyocytes exposed to FGF23. Enhancing Klotho availability prevented both long QT prolongation and reduced I current. Likewise, administration of recombinant Klotho blocked the downregulation of Kv4.2 expression in Nfx mice and in FGF23-exposed cardiomyocytes.
CONCLUSION:
The FGF23-Klotho axis emerges as a new therapeutic target to prevent acquired long QT syndrome in uremia by minimizing the predisposition to potentially fatal ventricular arrhythmias and sudden cardiac death in patients with CKD.
© 2022. The Author(s).
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Clinical Utility of a Biomarker to Detect Contrast-Induced Acute Kidney Injury during Percutaneous Cardiovascular Procedures.
Cardiorenal Med2022 Jan;():1-9. doi: 10.1159/000520820.
Peabody John, Paculdo David, Valdenor Czarlota, McCullough Peter A, Noiri Eisei, Sugaya Takeshi, Dahlen Jeffrey R,
Abstract
INTRODUCTION:
Contrast-induced acute kidney injury (CI-AKI) is a major clinical complication of percutaneous cardiovascular procedures requiring iodinated contrast. Despite its relative frequency, practicing physicians are unlikely to identify or treat this condition.
METHODS:
In a 2-round clinical trial of simulated patients, we examined the clinical utility of a urine-based assay that measures liver-type fatty acid-binding protein (L-FABP), a novel marker of CI-AKI. We sought to determine if interventional cardiologists' ability to diagnose and treat potential CI-AKI improved using the biomarker assay for 3 different patient types: pre-procedure, peri-procedure, and post-procedure patients.
RESULTS:
154 participating cardiologists were randomly divided into either control or intervention. At baseline, we found no difference in the demographics or how they identified and treated potential complications of AKI, with both groups providing less than half the necessary care to their patients (46.4% for control vs. 47.6% for intervention, p = 0.250). The introduction of L-FABP into patient care resulted in a statistically significant improvement of 4.6% (p = 0.001). Compared to controls, physicians receiving L-FABP results were 2.9 times more likely to correctly identify their patients' risk for AKI (95% CI 2.1-4.0) and were more than twice as likely to treat for AKI by providing volume expansion and withholding nephrotoxic medications. We found the greatest clinical utility in the pre-procedure and peri-procedure settings but limited value in the post-procedure setting.
CONCLUSION:
This study suggests L-FABP as a clinical marker for assessing the risk of potential CI-AKI, has clinical utility, and can lead to more accurate diagnosis and treatment.
© 2022 The Author(s). Published by S. Karger AG, Basel.
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Cardiorenal Function and Survival in In-Hospital Cardiac Arrest: A Nationwide Study of 22,819 Cases.
Resuscitation2022 Jan;():. doi: S0300-9572(21)00545-1.
Berglund Sara, Andreasson Axel, Rawshani Aidin, Hirlekar Geir, Lundgren Peter, Angerås Oscar, Mandalenakis Zacharias, Redfors Björn, Holm Astrid, Hagberg Eva, Ricksten Sven-Erik, Friberg Hans, Gustafsson Linnea, Dworeck Christian, Herlitz Johan, Rawshani Araz,
Abstract
BACKGROUND:
We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital cardiac arrest (IHCA).
METHODS:
We included cases aged ?18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC).
RESULTS:
We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR
CONCLUSIONS:
All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.
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The Comparison of the Kidney Effects of Dipeptidyl Peptidase 4 Inhibitors and Glucagon-Like Peptide 1 Agonist-Administered Concomitant with Sodium-Glucose Cotransporter 2 Inhibitors in Japanese Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease.
J Diabetes Res2021 ;2021():6573369. doi: 10.1155/2021/6573369.
Kobayashi Kazuo, Toyoda Masao, Hatori Nobuo, Sato Kazuyoshi, Miyakawa Masaaki, Tamura Kouichi, Kanamori Akira,
Abstract
Methods:
We retrospectively constructed database of 763 Japanese patients with T2DM and CKD who received sSGLT2is for more than 1 year. Among these SGLT2i-treated patients, 338 were receiving concomitant DPP4i (DPP4i group), and 99 were receiving concomitant GLP1Ra (GLP1Ra group). The two groups were compared using the propensity score matching method.
Results:
In the matched model including 86 cases per group, the decrease in the logarithmic value of the ACR and rate of reduction in the estimated glomerular filtration rate (eGFR; mL/min/1.73?m) of the GLP1Ra group showed no significant difference from those in the DPP4i group (-0.12 ± 0.48 vs. -0.13 ± 0.45 and -2.3 ± 18.5 vs. -6.2 ± 13.8, respectively, = 0.10). However, the incidence of a >6.4% decrease in the eGFR was significantly lower in the GLP1Ra group than in the DPP4i group (35% vs. 52%, respectively, = 0.03). The level of hemoglobin A (mmol/mol) after SGLT2i treatment was significantly lower in the DPP4i group than in the GLP1Ra group in the matched model (58.3 ± 11.8 and 62.7 ± 14.8, respectively, = 0.02).
Conclusion:
Among the SGLT2i-treated patients with T2DM and CKD, concomitant treatment with GLP1Ra has a marked improving effect on the change in the eGFR.
Copyright © 2021 Kazuo Kobayashi et al.
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