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Pubblicazioni recenti - cardiac fibrosis
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Patient-reported outcome measures in systemic sclerosis-related interstitial lung disease for clinical practice and clinical trials.
J Scleroderma Relat Disord2020 Mar;5(2 Suppl):48-60. doi: 10.1177/2397198320904178.
Saketkoo Lesley Ann, Scholand Mary Beth, Lammi Matthew R, Russell Anne-Marie,
Abstract
Systemic sclerosis (SSc) is a progressive vasculopathic, fibrosing autoimmune condition, portending significant mortality; wherein interstitial lung disease (ILD) is the leading cause of death. Although lacking a definitive cure, therapeutics for (SSc-ILD) that stave progression exist with further promising primary and adjuvant compounds in development, as well as interventions to reduce symptom burden and increase quality of life. To date, there has been a significant but varied history related to systemic sclerosis-related interstitial lung disease trial design and endpoint designation. This is especially true of endpoints measuring patient-reported perceptions of efficacy and tolerability. This article describes the underpinnings and complexity of the science, methodology, and current state of patient-reported outcome measures used in (SSc-ILD) systemic sclerosis-related interstitial lung disease in clinical practice and trials.
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Secreted Frizzled-Related Protein 2 and Extracellular Volume Fraction in Patients with Heart Failure.
Oxid Med Cell Longev2020 ;2020():2563508. doi: 10.1155/2020/2563508.
Yang Shaomin, Chen Haixiong, Tan Kuan, Cai Fusheng, Du Yongxing, Lv Weibiao, Hu Qiugen, Hu Yunzhao, Huang Yuli,
Abstract
Background:
Quantification of extracellular volume (ECV) fraction by cardiovascular magnetic resonance (CMR) has emerged as a noninvasive diagnostic tool to assess myocardial fibrosis. Secreted frizzled-related protein 2 (SFRP2) appears to play an important role in cardiac fibrosis. We aimed to evaluate the association between SFRP2 and myocardial fibrosis and the prognostic value of ECV fraction in patients with heart failure (HF).
Methods:
In this prospective cohort study, 72 hospitalized adult patients (age ? 18 years) with severe decompensated HF were included. CMR measurements and T1 mapping were performed to calculate ECV fraction. Serum SFRP2 level was detected by an enzyme-linked immunosorbent assay kit. All patients were followed up, and the primary outcomes were composite events including all-cause mortality and HF hospitalization.
Results:
During the median follow-up of 12 months, 27 (37.5%) patients experienced primary outcome events and had higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), SFRP2, and ECV fraction compared with those without events. In Pearson correlation analysis, levels of SFRP2 ( = 0.33), high-sensitivity C-reactive protein ( = 0.31), and hemoglobin A1c ( = 0.29) were associated with ECV fraction (all < 0.05); however, in multivariate linear regression analysis, SFRP2 was the only significant factor determined for ECV fraction ( = 0.33, = 0.02). In multivariate Cox regression analysis, age (each 10 years, hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.04-1.22), ECV fraction (per doubling, HR 1.68, 95% CI 1.03-2.74), and NT-proBNP (per doubling, HR 2.46, 95% CI 1.05-5.76) were independent risk factors for primary outcomes.
Conclusions:
Higher ECV fraction is associated with worsened prognosis in HF. SFRP2 is an independent biomarker for myocardial fibrosis. Further studies are needed to explore the potential therapeutic value of SFRP2 in myocardial fibrosis.
Copyright © 2020 Shaomin Yang et al.
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The preventive strategy for pandemics in the elderly is to collect in advance samples & data to counteract chronic inflammation (inflammaging).
Ageing Res Rev2020 May;():101091. doi: S1568-1637(20)30226-9.
Fuellen Georg, Liesenfeld Oliver, Kowald Axel, Barrantes Israel, Bastian Manuela, Simm Andreas, Jansen Ludger, Tietz-Latza Alexander, Quandt Dagmar, Franceschi Claudio, Walter Michael,
Abstract
Fighting the current COVID-19 pandemic, we must not forget to prepare for the next. Since elderly and frail people are at high risk, we wish to predict their vulnerability, and intervene if possible. For example, it would take little effort to take additional swabs or dried blood spots. Such minimally-invasive sampling, exemplified here during screening for potential COVID-19 infection, can yield the data to discover biomarkers to better handle this and the next respiratory disease pandemic. Longitudinal outcome data can then be combined with other epidemics and old-age health data, to discover the best biomarkers to predict (i) coping with infection & inflammation and thus hospitalization or intensive care, (ii) long-term health challenges, e.g. deterioration of lung function after intensive care, and (iii) treatment & vaccination response. Further, there are universal triggers of old-age morbidity & mortality, and the elimination of senescent cells improved health in pilot studies in idiopathic lung fibrosis & osteoarthritis patients alike. Biomarker studies are needed to test the hypothesis that resilience of the elderly during a pandemic can be improved by countering chronic inflammation and/or removing senescent cells. Our review suggests that more samples should be taken and saved systematically, following minimum standards, and data be made available, to maximize healthspan & minimize frailty, leading to savings in health care, gains in quality of life, and preparing us better for the next pandemic, all at the same time.
Copyright © 2020. Published by Elsevier B.V.
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Healthcare Resources Utilization and Costs of Patients with Non-IPF Progressive Fibrosing Interstitial Lung Disease Based on Insurance Claims in the USA.
Adv Ther2020 May;():. doi: 10.1007/s12325-020-01380-4.
Olson Amy L, Maher Toby M, Acciai Valentina, Mounir Baher, Quaresma Manuel, Zouad-Lejour Leila, Wells Christopher D, De Loureiro Lou,
Abstract
INTRODUCTION:
Idiopathic pulmonary fibrosis (IPF) is the classic progressive fibrosing interstitial lung disease (ILD), but some patients with ILDs other than IPF also develop a progressive fibrosing phenotype (PF-ILD). Information on use and cost of healthcare resources in patients with PF-ILD is limited.
METHODS:
We used USA-based medical insurance claims (2014-2016) to assess use and cost of healthcare resources in PF-ILD. Patients with at least two ILD claims and at least one pulmonologist visit were considered to have ILD. Pulmonologist visit frequency was used as a proxy to identify PF-ILD (at least four visits in 2016, or at least three more visits in 2016 vs. 2014).
RESULTS:
Of 2517 patients with non-IPF ILD, 15% (n?=?373) had PF-ILD. Mean annual medical costs associated with ILD claims were $35,364 in patients with non-IPF PF-ILD versus $20,211 in the non-IPF ILD population. In 2016, patients with non-IPF PF-ILD made more hospital ILD claims than patients with non-IPF ILD (10.5 vs. 4.7).
CONCLUSIONS:
These findings suggest higher disease severity and overall healthcare use for patients with a non-IPF ILD manifesting a progressive fibrosing phenotype (non-IPF PF-ILD).
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Intravenously delivered mesenchymal stem cells prevent microvascular obstruction formation after myocardial ischemia/reperfusion injury.
Basic Res Cardiol2020 May;115(4):40. doi: 10.1007/s00395-020-0800-8.
Wang Junzhuo, Chen Ziwei, Dai Qing, Zhao Jinxuan, Wei Zilun, Hu Jiaxin, Sun Xuan, Xie Jun, Xu Biao,
Abstract
Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) is identified as an independent risk factor for poor prognosis in patients with acute myocardial infarction (AMI). The inflammatory response induced by ischemia and reperfusion (I/R) injury is considered one of the main mechanisms of MVO. Mesenchymal stem cells (MSCs) are a unique stromal cell type that confers an immunomodulatory effect in cardiac disease. The present study aimed to investigate whether immediate intravenous delivery of MSCs could be used as a potential therapeutic method to attenuate MVO formation. A cardiac catheterization-induced porcine model of myocardial I/R injury was established, and allograft MSCs were immediately delivered intravenously. Cardiac magnetic resonance (CMR) imaging was performed on days 2 and 7 after the operation to determine the infarct area, MVO, and cardiac function. The pigs with allograft MSCs showed decreased MVO and infarct size, as well as an improved left ventricular ejection fraction (LVEF). Histological analysis revealed decreased myocyte area, fibrosis, and inflammatory cell infiltration in the peri-infarct zone of pigs with allograft MSCs. Moreover, the concentrations of interleukin-1? (IL-1?), interleukin-6 (IL-6) and C-reactive protein (CRP) in the serum were reduced in the allograft MSC group compared to the control group. Flow cytometry indicated decreased natural killer (NK) cells in the peripheral blood and ischemic heart tissue in the pigs with allograft MSCs. In summary, allograft MSCs delivered intravenously and immediately after myocardial I/R injury can attenuate MVO formation in a porcine model through a decline in the number of NK cells in the myocardium.
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Subclinical liver fibrosis in patients with idiopathic pulmonary fibrosis.
Intern Emerg Med2020 May;():. doi: 10.1007/s11739-020-02376-2.
Cocconcelli Elisabetta, Tonelli Roberto, Abbati Gianluca, Marchioni Alessandro, Castaniere Ivana, Pelizzaro Filippo, Russo Francesco Paolo, Vegetti Alberto, Balestro Elisabetta, Pietrangelo Antonello, Richeldi Luca, Luppi Fabrizio, Spagnolo Paolo, Clini Enrico, Cerri Stefania,
Abstract
Data on the presence of subclinical fibrosis across multiple organs in patients with idiopathic lung fibrosis (IPF) are lacking. Our study aimed at investigating through hepatic transient elastography (HTE) the prevalence and clinical impact of subclinical liver fibrosis in a cohort of patients with IPF. Patients referred to the Centre for Rare Lung Disease of the University Hospital of Modena (Italy) from March 2012 to February 2013 with established diagnosis of IPF and without a documented history of liver diseases were consecutively enrolled and underwent HTE. Based on hepatic stiffness status as assessed through METAVIR score patients were categorized as "with liver fibrosis" (corresponding to a METAVIR score of F1-F4) and "without liver fibrosis" (METAVIR F0). Potential predictors of liver fibrosis were investigated through logistic regression model among clinical and serological variables. The overall survival (OS) was assessed according to liver fibrosis and multivariate Cox regression analysis was used to identify independent predictors. In 13 out of 37 patients (35%) with IPF, a certain degree of liver fibrosis was documented. No correlation was found between liver stiffness and clinical-functional parameters. OS was lower in patients 'with liver fibrosis' than in patients 'without liver fibrosis' (median months 33 [23-55] vs. 63 [26-94], p?=?0.038). Patients 'with liver fibrosis' presented a higher risk of death at seven years as compared to patients 'without liver fibrosis' (HR?=?2.6, 95% CI [1.003-6.7], p?=?0.049). Higher level of AST to platelet ratio index (APRI) was an independent predictor of survival (HR?=?4.52 95% CI [1.3-15.6], p?=?0.02). In our cohort, more than one-third of IPF patients had concomitant subclinical liver fibrosis that negatively affected OS. These preliminary claims further investigation aimed at clarifying the mechanisms beyond multiorgan fibrosis and its clinical implication in patients with IPF.
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To what extent are perfusion defects seen by myocardial perfusion SPECT in patients with left bundle branch block related to myocardial infarction, ECG characteristics, and myocardial wall motion?
J Nucl Cardiol2020 May;():. doi: 10.1007/s12350-020-02180-7.
Hedeer Fredrik, Ostenfeld Ellen, Hedén Bo, Prinzen Frits W, Arheden Hĺkan, Carlsson Marcus, Engblom Henrik,
Abstract
INTRODUCTION:
We investigated if uptake pattern on myocardial perfusion SPECT (MPS) in patients with left bundle branch block (LBBB) is related to myocardial fibrosis, myocardial wall motion, and electrocardiography (ECG) characteristics.
METHODS:
Twenty-three patients (9 women) with LBBB, examined with MPS and cardiac magnetic resonance (CMR), were included. Tracer uptake on MPS was classified by visual interpretation as typical LBBB pattern (Defect+, n?=?13) or not (Defect-, n?=?10) and quantitatively. CMR images were evaluated for wall thickness and for myocardial wall motion both by visual assessment and by regional myocardial radial strain from feature tracking, and for presence and location of myocardial fibrosis. ECGs were analyzed regarding QRS duration and the presence of strict criteria for LBBB.
RESULTS:
Wall thickness was slightly lower in the septum compared to the lateral wall in Defect+?patients (5.6?±?1.1 vs 6.0?±?1.3 mm, P?=?0.03) but not in Defect- patients (5.6?±?1.0 vs 5.6?±?0.9 mm, P?=?0.84). Defect+ patients showed a larger proportion of dyskinetic segments in the septum and hyperkinetic segments in the lateral wall compared to Defect- patients (P?=?0.006 and P?=?0.004, respectively). Decreased myocardial radial strain was associated with decreased tracer uptake by MPS (R?=?0.37, P?
CONCLUSION:
The heterogeneous regional tracer uptake in some patients with LBBB is related to underlying regional myocardial dyskinesia, wall thickening, and wall thickness rather than stress-induced ischemia, myocardial fibrosis, or specific ECG characteristics.
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Sudden Cardiac Arrest in an Asymptomatic Zinc Phosphide-Poisoned Patient: A Case Report.
Cardiovasc Toxicol2020 May;():. doi: 10.1007/s12012-020-09578-2.
Parhizgar Parinaz, Forouzanfar Reza, Hadeiy Seyed Kaveh, Zamani Nasim, Hassanian-Moghaddam Hossein,
Abstract
Zinc phosphide is a gray to black powder mainly used as a rodenticide. In contact with gastric fluid, it releases phosphine which is the main toxic material of this compound. Phosphine interferes with oxidative respiratory cycle of the cells, but is generally expected to manifest its toxicity with prodromal signs and symptoms including abdominal pain, nausea and vomiting, metabolic acidosis, and increased liver function tests. A 64-year-old man was referred to our center with the history of ingestion of three full table spoons of zinc phosphide powder with only a mild GI discomfort. Abdominal X-ray revealed radiopaque material in epigastric and abdominal right upper quadrant. Despite treatment with polyethylene glycol and completely normal vital signs and lab tests, he experienced sudden cardiac arrest 19 h after admission. Autopsy showed clues of focal myopathy and fibrosis with evidences of ischemia and congestion in cardiac tissue, pulmonary edema, shrunken bilateral kidneys, and nutmeg yellow liver. Toxicology panel confirmed the presence of phosphine and zinc phosphide in the gastric fluid. The patient deteriorated suddenly despite being completely symptom-free during the hours preceding cardiovascular arrest. Since the cardiopulmonary injury is the most rampant cause of early death, checking of the cardiac enzymes and cardiac monitoring could be beneficial for early detection and efficient management of these patients.
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Microvascular and lymphatic dysfunction in HFpEF and its associated comorbidities.
Basic Res Cardiol2020 May;115(4):39. doi: 10.1007/s00395-020-0798-y.
Cuijpers Ilona, Simmonds Steven J, van Bilsen Marc, Czarnowska El?bieta, González Miqueo Arantxa, Heymans Stephane, Kuhn Annika R, Mulder Paul, Ratajska Anna, Jones Elizabeth A V, Brakenhielm Ebba,
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex heterogeneous disease for which our pathophysiological understanding is still limited and specific prevention and treatment strategies are lacking. HFpEF is characterised by diastolic dysfunction and cardiac remodelling (fibrosis, inflammation, and hypertrophy). Recently, microvascular dysfunction and chronic low-grade inflammation have been proposed to participate in HFpEF development. Furthermore, several recent studies demonstrated the occurrence of generalized lymphatic dysfunction in experimental models of risk factors for HFpEF, including obesity, hypercholesterolaemia, type 2 diabetes mellitus (T2DM), hypertension, and aging. Here, we review the evidence for a combined role of coronary (micro)vascular dysfunction and lymphatic vessel alterations in mediating key pathological steps in HFpEF, including reduced cardiac perfusion, chronic low-grade inflammation, and myocardial oedema, and their impact on cardiac metabolic alterations (oxygen and nutrient supply/demand imbalance), fibrosis, and cardiomyocyte stiffness. We focus primarily on HFpEF caused by metabolic risk factors, such as obesity, T2DM, hypertension, and aging.
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Discontinuing Anticoagulation After Catheter Ablation of Atrial Fibrillation.
Card Electrophysiol Clin2020 Jun;12(2):259-264. doi: S1877-9182(20)30021-6.
Pothineni Naga Venkata K, Frankel David S,
Abstract
Atrial fibrillation is a leading cause of ischemic stroke. Stroke risk can be reduced with oral anticoagulation. Current guidelines recommend that decisions regarding anticoagulation after ablation be based solely on preprocedural risk. Factors that favor stopping oral anticoagulationafter atrial fibrillation ablation include lower CHADS-VASc score, lesser extent of atrial cardiopathy as defined by atrial size, and fibrosis and higher bleeding risk. More extensive monitoring with insertable cardiac monitors, smart devices, and frequent pulse checks provide greater sensitivity for recurrence. The authors' strategy for managing oral anticoagulation after atrial fibrillation ablation is provided.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Utility of Cardiac MRI in Atrial Fibrillation Management.
Card Electrophysiol Clin2020 Jun;12(2):131-139. doi: S1877-9182(20)30020-4.
Habibi Mohammadali, Chrispin Jonathan, Spragg David D, Zimmerman Stefan L, Tandri Harikrishna, Nazarian Saman, Halperin Henry, Trayanova Natalia, Calkins Hugh,
Abstract
Advances in cardiac magnetic resonance (CMR) techniques and image acquisition have made it an excellent tool in the assessment of atrial myopathy. Remolding of the left atrium is the mainstay of atrial fibrillation (AF) development and its progression. CMR can detect phasic atrial volumes, atrial function, and atrial fibrosis using cine, and contrast-enhanced or non-contrast-enhanced images. These abilities make CMR a versatile and extraordinary tool in management of patients with AF including for risk stratification, ablation prognostication and planning, and assessment of stroke risk. We review the latest advancements in utility of CMR in management of patients with AF.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Corrigendum to "Irisin attenuates angiotensin II-induced cardiac fibrosis via Nrf2 mediated inhibition of ROS/ TGF?1/Smad2/3 signaling axis" [Chem Biol Interact 302 (2019) 11-21].
Chem Biol Interact2020 May;():109130. doi: S0009-2797(20)30791-2.
Chen Rui-Rui, Fan Xue-Hui, Chen Gang, Zeng Guang-Wei, Xue Yu-Gang, Liu Xiong-Tao, Wang Chi-Yao,
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Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure.
Int J Cardiovasc Imaging2020 May;():. doi: 10.1007/s10554-020-01887-5.
Sonaglioni Andrea, Caminati Antonella, Lipsi Roberto, Nicolosi Gian Luigi, Lombardo Michele, Anzŕ Claudio, Harari Sergio,
Abstract
No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case-control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e' ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (- 22.6 ± 3.3% vs - 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = - 0.87 and - 0.82, respectively) but not in controls (r = - 0.29 and - 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
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Variability in electrophysiological properties and conducting obstacles controls re-entry risk in heterogeneous ischaemic tissue.
Philos Trans A Math Phys Eng Sci2020 Jun;378(2173):20190341. doi: 10.1098/rsta.2019.0341.
Lawson Brodie A J, Oliveira Rafael S, Berg Lucas A, Silva Pedro A A, Burrage Kevin, Dos Santos Rodrigo Weber,
Abstract
Ischaemia, in which inadequate blood supply compromises and eventually kills regions of cardiac tissue, can cause many types of arrhythmia, some life-threatening. A significant component of this is the effects of the resulting hypoxia, and concomitant hyperklaemia and acidosis, on the electrophysiological properties of myocytes. Clinical and experimental data have also shown that regions of structural heterogeneity (fibrosis, necrosis, fibro-fatty infiltration) can act as triggers for arrhythmias under acute ischaemic conditions. Mechanistic models have successfully captured these effects . However, the relative significance of these separate facets of the condition, and how sensitive arrhythmic risk is to the extents of each, is far less explored. In this work, we use partitioned Gaussian process emulation and new metrics for source-sink mismatch that rely on simulations of bifurcating cardiac fibres to interrogate a model of heterogeneous ischaemic tissue. Re-entries were most sensitive to the level of hypoxia and the fraction of non-excitable tissue. In addition, our results reveal both protective and pro-arrhythmic effects of hyperklaemia, and present the levels of hyperklaemia, hypoxia and percentage of non-excitable tissue that pose the highest arrhythmic risks. This article is part of the theme issue 'Uncertainty quantification in cardiac and cardiovascular modelling and simulation'.
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Quantification of uncertainty in a new network model of pulmonary arterial adventitial fibroblast pro-fibrotic signalling.
Philos Trans A Math Phys Eng Sci2020 Jun;378(2173):20190338. doi: 10.1098/rsta.2019.0338.
Wang Ariel, Cao Shulin, Aboelkassem Yasser, Valdez-Jasso Daniela,
Abstract
Here, we present a novel network model of the pulmonary arterial adventitial fibroblast (PAAF) that represents seven signalling pathways, confirmed to be important in pulmonary arterial fibrosis, as 92 reactions and 64 state variables. Without optimizing parameters, the model correctly predicted 80% of 39 results of input-output and inhibition experiments reported in 20 independent papers not used to formulate the original network. Parameter uncertainty quantification (UQ) showed that this measure of model accuracy is robust to changes in input weights and half-maximal activation levels (EC), but is more affected by uncertainty in the Hill coefficient (), which governs the biochemical cooperativity or steepness of the sigmoidal activation function of each state variable. Epistemic uncertainty in model structure, due to the reliance of some network components and interactions on experiments using non-PAAF cell types, suggested that this source of uncertainty had a smaller impact on model accuracy than the alternative of reducing the network to only those interactions reported in PAAFs. UQ highlighted model parameters that can be optimized to improve prediction accuracy and network modules where there is the greatest need for new experiments. This article is part of the theme issue 'Uncertainty quantification in cardiac and cardiovascular modelling and simulation'.
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Impact of respiratory motion on liver stiffness measurements according to different shear wave elastography techniques and region of interest methods: a phantom study.
Ultrasonography2020 Apr;():. doi: 10.14366/usg.19079.
Lee Jee Hyeon, Lee Sang Min, Yoon Jeong Hee, Kim Min-Jeong, Ha Hong Il, Park Sung-Joon, Kim Eun Soo, Lee Kwanseop, Lee Jeong Min,
Abstract
PURPOSE:
This study quantified the impact of respiratory motion on liver stiffness measurements according to different shear wave elastography (SWE) techniques and region of interest (ROI) methods, using liver fibrosis phantoms.
METHODS:
Three operators measured stiffness values in four phantoms with different stiffness on a moving platform with two SWE techniques (point-SWE [pSWE] and 2-dimensional SWE [2D-SWE]), three types of motion (static mode and moving mode at low and high speeds), and four ROI methods in 2D-SWE (circle, point, box, and multiple). The circular ROI method was used to compare the two SWE techniques. The occurrence of technical failure and unreliable measurements, stiffness values, and measurement time were evaluated.
RESULTS:
Technical failure was observed only in moving mode for pSWE and 2D-SWE (n=1 for both). Unreliable measurements were also only observed in moving mode and were significantly less common in 2D-SWE (n=1) than in pSWE (n=12) (P<0.001). No statistically significant differences in the technical failure rate or stiffness values were noted between the static and moving modes for both SWE techniques. The technical failure and unreliable measurement rates were not significantly different among the ROI methods for 2D-SWE. Stiffness values did not differ significantly according to the ROI method used in any moving mode. However, the multiple ROI method had significantly shorter measurement times than the circular ROI method for all moving modes.
CONCLUSION:
2D-SWE may be preferable for evaluating liver fibrosis in patients with poor breath-hold. Furthermore, 2D-SWE with multiple ROIs enables rapid measurements, without affecting liver stiffness values.
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Cardioprotective effects of melatonin: Focusing on its roles against diabetic cardiomyopathy.
Biomed Pharmacother2020 May;128():110260. doi: S0753-3322(20)30452-2.
Song Yan-Jun, Zhong Chong-Bin, Wu Wei,
Abstract
Melatonin is a pineal-produced indole known for its anti-aging, antiapoptotic and antioxidant properties. In past decades, the protective potentials of melatonin for cardiovascular diseases, such as atherosclerosis and myocardial infarction, have been widely revealed, triggering more investigations focused on other cardioprotective effects of melatonin. Recently, the roles of melatonin in diabetic cardiomyopathy (DCM) have attracted increased attention. In this regard, researchers found that melatonin attenuated cardiac fibrosis and hypertrophy, thus interrupting the development of DCM. Retinoid-related orphan receptor ? is a key melatonin receptor that contributed to the cardioprotective effect of melatonin in hearts with DCM. For the downstream mechanisms, the inhibition of mammalian STE20-like kinase 1 plays a pivotal role, which exerts antiapoptotic and proautophagic effects, thus enhancing cardiac tolerance in high-glucose conditions. In addition, other signalling mechanisms, such as sirtuin-1/peroxisome proliferator-activated receptor gamma-coactivator alpha and endoplasmic reticulum-related signalling, are also involved in the protective effects of melatonin on cardiomyocytes under diabetic conditions. This review will focus on the protective signalling mechanisms regulated by melatonin and provide a better understanding of the therapeutic applications of melatonin signalling in DCM.
Copyright © 2020 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Focusing Heart Failure Research on Myocardial Fibrosis to Prioritize Translation.
J Card Fail2020 May;():. doi: S1071-9164(20)30255-4.
Lindsey Merry L, DeLeon-Pennell Kristine Y, Bradshaw Amy D, LaRue R Amanda C, Anderson Daniel R, Thiele Geoffrey M, Baicu Catalin F, Jones Jeffrey A, Menick Donald R, Zile Michael R, Spinale Francis G,
Abstract
Heart failure (HF) was traditionally been defined by symptoms due to fluid accumulation and poor perfusion, but it is now recognized that specific HF classifications hold prognostic and therapeutic relevance. Specifically, HF with reduced ejection fraction (HFrEF) is characterized by reduced left ventricular (LV) systolic pump function and dilation and HFpEF is defined primarily due to abnormal LV filling (diastolic failure) with relatively preserved LV systolic function. These forms of HF are distributed equally amongst patients with HF and will likely require distinctly different strategies to mitigate the morbidity, mortality and medical resource utilization of this disease. In particular, HF is a significant medical issue within the Veteran Administration (VA) hospital system and constitutes a major translational research priority for the VA. Since a common underpinning of both HFrEF and HFpEF appears to be changes in the structure and function of the myocardial extracellular matrix (ECM), a conference was convened sponsored by the VA, entitled, "Targeting Myocardial Fibrosis in Heart Failure" to explore the ECM as a potential therapeutic target and to propose specific research directions. The conference was conceptually framed around the hypothesis that while HFrEF and HFpEF clearly have distinct mechanisms, they may share modifiable pathways and biological mediators in common. Inflammation and ECM were identified as major converging themes. A summary of our discussion on unmet challenges and possible solutions to move the field forward, as well as recommendations for future research opportunities, are provided.
Copyright © 2020. Published by Elsevier Inc.
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From the gut to the heart: L. plantarum and inulin administration as a novel approach to control cardiac apoptosis via 5-HT2B and TrkB receptors in diabetes.
Clin Nutr2020 May;():. doi: S0261-5614(20)30220-X.
Sefidgari-Abrasi Safa, Roshangar Leila, Karimi Pouran, Morshedi Mohammad, Rahimiyan-Heravan Marziyeh, Saghafi-Asl Maryam,
Abstract
BACKGROUND & AIMS:
Type 2 diabetes mellitus, as a metabolic disorder, can lead to diabetic cardiomyopathy, identified by cardiomyocyte apoptosis and myocardial fibrosis. Brain-derived neurotrophic factor (BDNF) and serotonin are two neurotransmitters that can control cardiomyocyte apoptosis and myocardial fibrosis through their cardiac receptors. In the present study, we investigated the impacts of L. plantarum and inulin supplementation on the inhibition of cardiac apoptosis and fibrosis by modulating intestinal, serum, and cardiac levels of serotonin and BDNF as well as their cardiac receptors.
METHODS:
Diabetes was induced by a high-fat diet and streptozotocin in male Wistar rats. Rats were divided into six groups and were supplemented with L. plantarum, inulin or their combination for 8 weeks. Finally, the rats were killed and levels of intestinal, serum, and cardiac parameters were evaluated.
RESULTS:
Concurrent administration of L. plantarum and inulin caused a significant rise in the expression of cardiac serotonin and BDNF receptors (P < 0.001) as well as a significant fall in cardiac interstitial and perivascular fibrosis (P < 0.001, both) and apoptosis (P = 0.01). Moreover, there was a strong correlation of cardiac 5-Hydroxytryptamine 2B (5-HT2B) and tropomyosin receptor kinase B (TrkB) receptors with interstitial/perivascular fibrosis and apoptosis (P < 0.001, both).
CONCLUSIONS/INTERPRETATION:
Results revealed beneficial effects of L. plantarum, inulin or their combination on intestinal, serum, and cardiac serotonin and BDNF accompanied by higher expression of their cardiac receptors and lower levels of cardiac apoptotic and fibrotic markers. It seems that L. plantarum and inulin supplementation could be considered as a novel adjunct therapy to reduce cardiac complications of type 2 diabetes mellitus.
Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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