13 research outputs found
Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction
Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may revealmyocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantablecardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall isrelated to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was toassess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.Methods: Sixty-seven patients were included (17.9% female, aged 45 [29–60] years), who underwentLGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.Results: In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE wereobserved in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in theposterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previousmyocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78%vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2%of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for itsassociation with older age and previous MI (p = 0.08 and p = 0.12, respectively).Conclusions: Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, andprevious MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures
Fibrosis of extracellular matrix is related to the duration of the disease but is unrelated to the dynamics of collagen metabolism in dilated cardiomyopathy
Background Fibrosis of extracellular matrix (ECM) in
dilated cardiomyopathy (DCM) corresponds to the
myocardial over-production of various types of collagens.
However, mechanism of this process is poorly understood.
Objective To investigate whether enhanced metabolism of
ECM occur in DCM.
Methods Seventy consecutive DCM patients (pts)
(48 ± 12.1 years, EF 24.4 ± 7.4 %) and 20 healthy volunteers
were studied. Based on symptoms duration, pts
were divided into new-onset (n = 35, 6 months) and
chronic DCM (n = 35, >6 months). Markers of collagen
type I and III synthesis-procollagen type I carboxy- and
amino-terminal peptides (PICP and PINP) and procollagen
type III carboxy- and amino-terminal peptides (PIIICP and
PIIINP), collagen 1 (col-1), ECM metabolism controlling
factors-tumor growth factor beta-1 (TGF1-b), connective
tissue growth factor (CTGF), and ECM degradation
enzymes-matrix metalloproteinases (MMP-2, MMP-9)
and their tissue inhibitor (TIMP-1) were measured in serum. All pts underwent right ventricular endomyocardial
biopsy to study ECM fibrosis.
Results The presence of fibrosis was detected in 24
(34.3 %) pts and was more prevalent in chronic DCM
[17 (48.6 %) vs. 7 (20 %), p\0.01]. The levels of
PIIINP [4.41 (2.17-6.08) vs. 3.32 (1.69-5.02) ng/ml,
p\0.001], CTGF [3.82 (0.48-23.87) vs. 2.37
(0.51-25.32) ng/ml, p\0.01], MMP-2 [6.06 (2.72-14.8)
vs. 4.43 (2.27=7.4) ng/ml, p\0.001], MMP-9 [1.98
(0.28-9.25) vs. 1.01 (0.29-3.59) ng/ml, p\0.002)], and
TIMP-1 [15.29 (1.8-36.17) vs. 2.61 (1.65-24.09) ng/ml,
p\0.004] were significantly higher in DCM, whereas
levels of col-1 [57.7 (23.1-233.4) vs. 159.4 (31.2-512.9)
pg/ml, p\0.001] were significantly lower in DCM
compared to controls. There were no differences in all
measured serum markers of ECM metabolism between
newonset and chronic DCM and as well as fibrosis
positive and negative pts. Fibrosis was weakly correlated
only with the duration of DCM (r = 0.23, p\0.05),
however, not a single serum marker of fibrosis correlated
with fibrosis. Neither unadjusted nor adjusted models,
constructed from serum markers of ECM metabolism,
predicted the probability of myocardial fibrosis.
Conclusions Dynamics of ECM turnover in DCM is high,
which is reflected by the increased levels CTGF and
degradation enzymes. Synthesis of collagen type III prevailed
over collagen type I. ECM metabolism was not
different in DCM regardless of the duration of the disease
and status of myocardial fibrosis. Serum markers of ECM
metabolism were found not to be useful for the prediction
of myocardial fibrosis in DCM
Clinical data, chest radiograph and electrocardiography in the screening for left ventricular hypertrophy : The CAR<SUB>2</SUB>E<SUB>2</SUB> score
Left ventricular hypertrophy (LVH) is associated with adverse clinical outcomes and implicates clinical decision-making. The aim of our study was to assess the importance of different approaches in the screening for LVH. We included patients who underwent cardiac magnetic resonance (CMR) imaging and had available chest radiograph in medical documentation. Cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), clinical and selected electrocardiographic (ECG)-LVH data, including the Peguero-Lo Presti criterion, were assessed. CMR–LVH was defined based on indexed left ventricular mass-to-body surface area. Receiver operating characteristics analyses showed that both the CTR and TCD (CTR: area under the curve: [AUC] = 0.857, p < 0.001; TCD: AUC = 0.788, p = 0.001) were predictors for CMR–LVH. However, analyses have shown that diagnoses made with TCD, but not CTR, were consistent with CMR–LVH. From the analyzed ECG–LVH criteria, the Peguero-Lo Presti criterion was the best predictor of LVH. The best sensitivity for screening for LVH was observed when the presence of heart failure, ≥40 years in age (each is assigned 1 point), increased TCD and positive Peguero-Lo Presti criterion (each is assigned 2 points) were combined (CAR(2)E(2) score ≥ 3 points). CAR(2)E(2) score may improve prediction of LVH compared to other approaches. Therefore, it may be useful in the screening for LVH in everyday clinical practice in patients with prevalent cardiovascular diseases
Neuroimaging studies of the neural correlates of heart rate variability : a systematic review
Direct and indirect links between brain regions and cardiac function have been reported. We performed a systematic literature review to summarize current knowledge regarding the associations of heart rate variability (HRV) and brain region morphology, activity and connectivity involved in autonomic control at rest in healthy subjects. Both positive and negative correlations of cortical thickness and gray matter volumes of brain structures with HRV were observed. The strongest were found for a cluster located within the cingulate cortex. A decline in HRV, as well as cortical thickness with increasing age, especially in the orbitofrontal cortex were noted. When associations of region-specific brain activity with HRV were examined, HRV correlated most strongly with activity in the insula, cingulate cortex, frontal and prefrontal cortices, hippocampus, thalamus, striatum and amygdala. Furthermore, significant correlations, largely positive, between HRV and brain region connectivity (in the amygdala, cingulate cortex and prefrontal cortex) were observed. Notably, right-sided neural structures may be preferentially involved in heart rate and HRV control. However, the evidence for left hemispheric control of cardiac vagal function has also been reported. Our findings provide support for the premise that the brain and the heart are interconnected by both structural and functional networks and indicate complex multi-level interactions. Further studies of brain-heart associations promise to yield insights into their relationship to health and disease
Neuroimaging Studies of the Neural Correlates of Heart Rate Variability: A Systematic Review
Direct and indirect links between brain regions and cardiac function have been reported. We performed a systematic literature review to summarize current knowledge regarding the associations of heart rate variability (HRV) and brain region morphology, activity and connectivity involved in autonomic control at rest in healthy subjects. Both positive and negative correlations of cortical thickness and gray matter volumes of brain structures with HRV were observed. The strongest were found for a cluster located within the cingulate cortex. A decline in HRV, as well as cortical thickness with increasing age, especially in the orbitofrontal cortex were noted. When associations of region-specific brain activity with HRV were examined, HRV correlated most strongly with activity in the insula, cingulate cortex, frontal and prefrontal cortices, hippocampus, thalamus, striatum and amygdala. Furthermore, significant correlations, largely positive, between HRV and brain region connectivity (in the amygdala, cingulate cortex and prefrontal cortex) were observed. Notably, right-sided neural structures may be preferentially involved in heart rate and HRV control. However, the evidence for left hemispheric control of cardiac vagal function has also been reported. Our findings provide support for the premise that the brain and the heart are interconnected by both structural and functional networks and indicate complex multi-level interactions. Further studies of brain–heart associations promise to yield insights into their relationship to health and disease