Interplay Between Gut Microbiota and Amino Acid Metabolism in Heart Failure.
Tuerhongjiang Gulinigaer,Guo Manyun,Qiao Xiangrui,Lou Bowen,Wang Chen,Wu Haoyu,Wu Yue,Yuan Zuyi,She Jianqing
Frontiers in cardiovascular medicine
Heart failure (HF) is a complex clinical syndrome of which the incidence is on the rise worldwide. Cardiometabolic disorders are associated with the deterioration of cardiac function and progression of HF. Recently, there has been renewed interest in gut microbiota (GM) and its metabolites in the cardiovascular disease. HF-caused hypoperfusion could increase intestinal permeability, and a "leaky" bowel leads to bacterial translocation and make its metabolites more easily enter the circulation. Considerable evidence shows that the composition of microbiota and amino acids (AAs) has been altered in HF patients, and AAs could serve as a diagnostic and prognostic biomarker in HF. The findings indicate that the gut-amino acid-HF axis may play a key role in the progression of HF. In this paper, we focus on the interrelationship between the AA metabolism and GM alterations during the development of heart failure. We also discuss the potential prognostic and therapeutic value of the gut-amino acid-HF axis in the cortex of HF.
10.3389/fcvm.2021.752241
Muscle Wasting and Sarcopenia in Heart Failure-The Current State of Science.
Lena Alessia,Anker Markus S,Springer Jochen
International journal of molecular sciences
Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.
10.3390/ijms21186549
How Can Malnutrition Affect Autophagy in Chronic Heart Failure? Focus and Perspectives.
Corsetti Giovanni,Pasini Evasio,Romano Claudia,Chen-Scarabelli Carol,Scarabelli Tiziano M,Flati Vincenzo,Saravolatz Louis,Dioguardi Francesco S
International journal of molecular sciences
Chronic heart failure (CHF) is a disease with important clinical and socio-economic ramifications. Malnutrition and severe alteration of the protein components of the body (protein disarrangements), common conditions in CHF patients, are independent correlates of heart dysfunction, disease progression, and mortality. Autophagy, a prominent occurrence in the heart of patients with advanced CHF, is a self-digestive process that prolongs myocardial cell lifespan by the removal of cytosolic components, such as aging organelles and proteins, and recycles the constituent elements for new protein synthesis. However, in specific conditions, excessive activation of autophagy can lead to the destruction of molecules and organelles essential to cell survival, ultimately leading to organ failure and patient death. In this review, we aim to describe the experimental and clinical evidence supporting a pathophysiological role of nutrition and autophagy in the progression of CHF. The understanding of the mechanisms underlying the interplay between nutrition and autophagy may have important clinical implications by providing molecular targets for innovative therapeutic strategies in CHF patients.
10.3390/ijms22073332
CD14CD16 monocyte subset levels in heart failure patients.
Barisione Chiara,Garibaldi Silvano,Ghigliotti Giorgio,Fabbi Patrizia,Altieri Paola,Casale Maria Carla,Spallarossa Paolo,Bertero Giovanni,Balbi Manrico,Corsiglia Luca,Brunelli Claudio
Disease markers
Our aim was to define the distribution of monocyte subsets in a cohort of congestive heart failure (CHF) patients, to verify whether increased severity of CHF is linked to the expansion of specific monocyte subsets, and finally to investigate the relationship between monocyte subset relative frequencies, laboratory parameters of inflammation, and monocyte ACE expression. Thirty consecutive CHF patients and 26 healthy control subjects were evaluated for peripheral blood monocyte expression of CD14, CD16 and CD143 (ACE) by flow-cytometry, and for endothelial-derived soluble CD146 levels by ELISA. CD14++ CD16+ frequency was significantly higher in CHF patients than in Controls (%, median value and IQ) (12.3, 8.7-14.8 vs 5.9, 4.7-6.9, p< 0.05, CHF vs Controls), and it increased depending on how high NYHA class was, on worsening LV ejection fraction and on circulating pro-BNP values. Furthermore, it was associated with increasing creatinine and with decreasing GFR and albumin levels. Monocyte CD143 expression was significantly elevated in CHF patients as compared to Controls, and positively associated with CD14++ CD16+ levels. Frequencies of CD14+ CD16+ monocytes were significantly lower in CHF patients as compared to Controls, and negatively correlated with levels of soluble CD146 (r=-0.529; p 0.048). In conclusion, monocytic CD14++ CD16+ frequency and CD143 levels are increased and reflect disease status and progressive cardiac deterioration in CHF patients. The CD14+ CD16+ subset is depleted in CHF and is linked to endothelial damage in this group of patients. Although the question of whether differences in monocyte CD14CD16 expansion are causal or whether they represent a marker of HF progression which is potentially relevant for risk prediction remains unanswered, we believe that our data represent an important tool for exploring the role of selective inflammatory pathways in CHF progression.
10.3233/DMA-2010-0691
Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC).
European journal of heart failure
New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.
10.1002/ejhf.2346
Prognostic Significance of Insomnia in Heart Failure.
Kanno Yuki,Yoshihisa Akiomi,Watanabe Shunsuke,Takiguchi Mai,Yokokawa Tetsuro,Sato Akihiko,Miura Shunsuke,Shimizu Takeshi,Nakamura Yuichi,Abe Satoshi,Sato Takamasa,Suzuki Satoshi,Oikawa Masayoshi,Saitoh Shu-Ichi,Takeishi Yasuchika
Circulation journal : official journal of the Japanese Circulation Society
BACKGROUND:Insomnia is associated with incident heart failure (HF), but the clinical significance and impact of insomnia on HF remain unclear. METHODS AND RESULTS:Consecutive 1,011 patients admitted for HF were divided into 2 groups according to the presence of insomnia: HF with insomnia (insomnia group, n=519) and HF without insomnia (non-insomnia group, n=492). We compared (1) cardiac event rates including cardiac death and worsening HF; and (2) underlying clinical background including laboratory data, echocardiographic data, and cardiopulmonary exercise test between the 2 groups. On Kaplan-Meier analysis, cardiac event rate was significantly higher in the insomnia group than in the non-insomnia group (39.1 vs. 23.4%, P<0.001). The insomnia group, as compared with the non-insomnia group, had (1) higher plasma renin activity (P=0.042), renin concentration (P=0.007), and aldosterone (P=0.047); (2) lower peak V̇O2(14.9 vs. 16.3 ml/kg/min, P=0.002) and higher V̇E/V̇CO2slope (36.0 vs. 33.5, P=0.001); and (3) similar B-type natriuretic peptide and left ventricular ejection fraction. Importantly, on multivariate Cox proportional hazard analysis after adjusting for potential confounding factors, insomnia was an independent predictor of cardiac events in HF patients (hazard ratio, 1.899; P<0.001). CONCLUSIONS:Insomnia is an independent predictor of cardiac events in HF patients. HF patients with insomnia have activated renin-angiotensin-aldosterone system and lower exercise capacity. (Circ J 2016; 80: 1571-1577).
10.1253/circj.CJ-16-0205
Elevated soluble ST2 and depression increased the risk of all-cause mortality and hospitalization in patients with heart failure.
Xu Su-Dan,Su Guan-Hua,Lu Yong-Xin,Shuai Xin-Xin,Tao Xiao-Fang,Meng Yi-Di,Luo Ping
International heart journal
This study aimed to assess the predictive effect of soluble ST2 (sST2) and depressive symptoms in patients with heart failure (HF) and to determine whether the prognosis of HF patients with preserved ejection fraction (HFpEF) differs from those with reduced ejection fraction (HFrEF). A cohort of 233 HF patients was followed for 1 year. Depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale. The primary endpoint was all-cause mortality and HF-related hospitalization. For the analysis of survival, the left ventricular ejection fraction (LVEF) cut-offs for defining HFpEF were set at 50%, 45%, and 40%, respectively. With increasing LVEF, levels of sST2 were gradually decreased (45.2 ng/mL, 35.8 ng/mL, and 32.1 ng/mL in patients with LVEF ≤ 40%, 41% to 49%, and ≥ 50%, respectively, P for trend < 0.001), as well as the prevalence of depressive symptoms (35.4%, 33.3%, and 20.4%, respectively, P for trend = 0.022). After 1-year follow-up, 128 patients (54.9%) achieved the primary endpoint and 47 patients (20.2%) died. Depressive symptoms were independent risk factors of all-cause mortality and HF-related hospitalization. The combined presence of elevated sST2 (> 36.0 ng/mL) and depressive symptoms was associated with a 4.9-fold increased risk of the primary endpoint. Regardless of LVEF cut-offs, the associated risk of adverse outcomes in HFpEF was as high as in HFrEF after adjustment for significant risk factors including sST2 and N-terminal pro-brain natriuretic peptide. In conclusion, depressive symptoms provided additional prognostic information to that of sST2 in HF patients. The prognosis of HFpEF patients was similar to that of HFrEF patients.
10.1536/ihj.13-371
The role of hormonal, metabolic and inflammatory biomarkers on sleep and appetite in drug free patients with major depression: A systematic review.
Caroleo Mariarita,Carbone Elvira Anna,Primerano Amedeo,Foti Daniela,Brunetti Antonio,Segura-Garcia Cristina
Journal of affective disorders
BACKGROUND:Major depressive disorder (MDD) is a complex and heterogeneous disorder in which clinical symptoms can widely differ among patients. Neurovegetative symptoms, i.e. decreased or increased appetite, changes in body weight and sleep disturbances, described as 'melancholic' or 'atypical' features of a depressive episode, are the most variable symptoms among patients with MDD. We hypothesized biomarkers differences underlying this neurovegetative variability in major depression. METHODS:We systematically reviewed, according to the PRISMA guidelines, the role of specific metabolic, hormonal and inflammatory biomarkers in drug-free MDD patients, that could have neurobiological effects on appetite, weight regulation and circadian rhythms, influencing eating behaviour and sleep patterns. All studies regarding the co-occurrence of disturbed sleep and appetite were examined. RESULTS:Besides the well-known leptin and ghrelin, other biomarkers such as BDNF, VEGF, NPY, orexin, and the recent discovered nesfatin-1 seem to be involved in neurovegetative changes in depressive disorders playing a role in the regulation of affective states, stress reactions and sleep patterns. Interestingly, based on the existing evidence, ghrelin, orexin and nesfatin-1 could be linked both to sleep and appetite regulation in depressed patients. LIMITATIONS:Heterogeneous studies with low sample size. CONCLUSIONS:Despite the wide heterogeneity of results, studies on biomarkers of appetite and sleep in MDD are an interesting field of research to explain the neurobiological substrates of depressive symptoms that deserve further investigation.
10.1016/j.jad.2019.03.015
Effects of ghrelin on psychopathology, sleep and secretion of cortisol and growth hormone in patients with major depression.
Kluge Michael,Schüssler Petra,Dresler Martin,Schmidt Doreen,Yassouridis Alexander,Uhr Manfred,Steiger Axel
Journal of psychiatric research
Ghrelin showed antidepressant-like effects in mice. Furthermore, ghrelin influences sleep and the activity of hypothalamic-pituitary-adrenal (HPA) and somatotropic axis in healthy humans as indicated by increased cortisol and growth hormone (GH) plasma levels. Both sleep and the activity of these endocrine axes are disturbed in depression. We therefore studied the impact of ghrelin on psychopathology, sleep and secretion of cortisol and GH in patients with major depression. Depressive symptoms as assessed by a validated self rating scale ('Befindlichkeits-Skala', [mental state scale]), secretion profiles of cortisol and GH and sleep-EEGs were determined in 14 unmedicated patients with major depression (7 women) twice, receiving 50 μg ghrelin or placebo at 22:00, 23:00, 00:00, and 01:00 hours. Overall, depressive symptoms did not change significantly after ghrelin administration (placebo: 37 ± 8; ghrelin: 33 ± 10, p = 0.178). However, there was an improvement at trend level in men (placebo: 36 ± 9 to ghrelin: 30 ± 9, p = 0.093) but not in women. In men, ghrelin was associated with less time awake (placebo: 149.0 ± 11.1; ghrelin: 88.0 ± 12.2 min, p = 0.029) and more non-REM sleep (placebo: 263.2 ± 24.1; ghrelin: 304.9 ± 14.1 min, p = 0.027), in women with less REM sleep (placebo: 108.6 ± 15.7; ghrelin: 74.1 ± 13.8 min, p = 0.031) and longer REM latency (placebo: 49.9 ± 6.5; ghrelin: 85.6 ± 14.1 min, p = 0.019). In both sexes, ghrelin caused strong transient increases of GH and cortisol. In conclusion, our study may provide some initial indication that ghrelin can exert antidepressant effects in patients with major depression. Ghrelin strongly affected sleep and secretion of GH and cortisol in a partly different way as previously reported in healthy subjects.
10.1016/j.jpsychires.2010.09.002
The effects of ghrelin on sleep, appetite, and memory, and its possible role in depression: A review of the literature.
Morin V,Hozer F,Costemale-Lacoste J-F
L'Encephale
OBJECTIVES:Ghrelin is an orexigenic digestive hormone that plays a role in sleep and memory. Our work aims is to synthesize the effects of ghrelin on appetite, sleep and memory, and also to evidence its role in depressive disorders. METHODS:A systematic search was carried out on PubMed with no time boundaries. The following MeSH terms were used: ghrelin AND (appetite regulation OR obesity), (sleep wake disorders OR sleep) (memory OR cognition disorders) (depression OR depressive disorder OR mood disorder). RESULTS:Ghrelin triggers appetite and alters meal patterns by making them longer and richer. This can lead to pathologies, obesity and insulin-resistance. Ghrelin seems to have a favourable effect on sleep in human beings. It tends to make sleep more efficacious and better quality. Finally, it seems to have an effect on synaptic plasticity in the zones involved in memory and it has been shown to improve memory capacity in rodents. Regarding depression, the administration of ghrelin leads to an anti-depressive effect in animals and in humans. Conversely, post anti-depressant ghrelin titrations have generally shown a decrease in ghrelin levels. Resistant patients seem to retain high levels. Finally, the seriousness of depression could be related to ghrelin levels. CONCLUSION:Ghrelin plays a probable part in depression, especially for particular endophenotypes. A better understanding of ghrelin in depression could potentially help to optimize future therapeutic treatments.
10.1016/j.encep.2017.10.012
Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial.
Rebora Paola,Spedale Valentina,Occhino Giuseppe,Luciani Michela,Alvaro Rosaria,Vellone Ercole,Riegel Barbara,Ausili Davide
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
PURPOSE:Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention. METHODS:This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year. RESULTS:We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2. CONCLUSION:Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).
10.1007/s11136-021-02788-3
Impact of Sleep Apnea, Daytime Sleepiness, Comorbidities, and Depression on Patients' Heart Failure Health Status.
Piamjariyakul Ubolrat,Shapiro April L,Wang Kesheng,Zulfikar Rafia,Petitte Trisha,Shafique Saima,Smith Carol E
Clinical nursing research
There is a gap in current research on common factors that impact patients with advanced heart failure (HF). The purpose of this secondary data analysis was to explore associations of those factors with three empirically verified measures of HF-related clinical, physical, and mental health status. Baseline data of 198 advanced systolic HF (EF < 40%) patients were analyzed. Patients were 61.6% male, with a mean age of 62.3 ( = 13.2) years. The multivariable general linear modeling results indicated that patients who had poorer scores on HF-related clinical status were those who had sleep apnea ( = -6.6, < .05), daytime sleepiness ( = -9.4, < .01), four or more comorbidities ( = -11.8, < .001), and depression ( = -18.7, < .001). Depression was associated with all three measures of HF-related health status. These findings alert nurses to assess for sleep apnea and to use known screening measures for daytime sleepiness, depression, and comorbidities.
10.1177/10547738211015545
Sleep Quality and Associated Factors among Diabetes, Hypertension, and Heart Failure Patients at Debre Markos Referral Hospital, Northwest Ethiopia.
Sleep disorders
BACKGROUND:Chronic illnesses have a negative impact on the quality of sleep; however, patients with chronic illness do not bring sleep issues while they are coming to a health institution for a follow-up. As a result, poor sleep quality among patients with chronic illness is often unrecognized and untreated, and it results to a negative impact on the prognosis of chronic illness. METHODS:An institutional-based cross-sectional study design was employed from February 22, 2018, to April 6, 2018. The total sample size was 396. The study employed a stratified random sampling technique, and study participants were selected by systematic sampling. The data were collected by a Pittsburgh Sleep Quality Index (PSQI) questionnaire which is a validated and standardized tool. The data were analyzed by SPSS version 25; text, tables, and figures were utilized for data presentation. By considering a 95% confidence level and value of 0.05, binary logistic regression and Kruskal-Wallis test were enrolled. RESULTS:The prevalence of poor sleep quality among diabetes, hypertension, and heart failure patients was 36.5%. The odds of being a poor sleeper are increased when age increased. Patients who have poor perception towards the prognosis of their illness were four times more likely to be a poor sleeper compared to patients with good perception (AOR = 4.21, 95%CI = 1.94-9.13, = 0.001). Patients who have anxiety were four times more likely to be a poor sleeper compared with patients without anxiety (AOR = 3.69, 95%CI = 2.19-6.20, = 0.001). The educational level and residence were other factors associated with sleep quality. There was a statistically significant difference of sleep quality between patients with diabetes and hypertension, and diabetes and heart failure ( (2, 384) = 10.92, = 0.004). . In this study, over one-third of patients had poor sleep quality. Age, educational level, residence, perception towards prognosis of illness, and anxiety were factors associated with sleep quality. All health care providers should assess and provide advice about sleep hygiene and influencing factors. Assessment of sleep quality for every diabetes, hypertension, and heart failure patients in every visit should be incorporated in the care package.
10.1155/2020/6125845
Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients.
Mills Paul J,Wilson Kathleen,Iqbal Navaid,Iqbal Fatima,Alvarez Milagros,Pung Meredith A,Wachmann Katherine,Rutledge Thomas,Maglione Jeanne,Zisook Sid,Dimsdale Joel E,Lunde Ottar,Greenberg Barry H,Maisel Alan,Raisinghani Ajit,Natarajan Loki,Jain Shamini,Hufford David J,Redwine Laura
Journal of behavioral medicine
Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.
10.1007/s10865-014-9615-0
Prognostic Importance of Sleep Quality in Patients With Heart Failure.
Lee Kyoung Suk,Lennie Terry A,Heo Seongkum,Song Eun Kyeung,Moser Debra K
American journal of critical care : an official publication, American Association of Critical-Care Nurses
BACKGROUND:Poor sleep quality is common and is associated with poor quality of life and health status in patients with heart failure. However, few investigators have focused on the impact of impaired sleep quality on survival in heart failure. OBJECTIVE:To examine whether self-reported sleep quality is associated with prognosis in patients with heart failure. METHODS:The study sample consisted of 204 patients with heart failure. Sleep quality was measured with the Pittsburgh Sleep Quality Index. Poor sleepers were defined as patients with scores greater than 5 on the index. Patients were followed up for a median of 364 days to determine cardiac events (a composite of cardiac death, hospitalizations, or emergency department visits for cardiac reasons). Multivariable Cox proportional hazard regression was used to examine whether poor sleepers were at a higher risk than good sleepers for shorter cardiac event-free survival after covariates were adjusted for. RESULTS:Of 204 patients, 129 (63%) reported poor sleep quality. Poor sleepers were 2.5 times more likely to have a shorter cardiac event-free survival (95% CI, 1.164-5.556) than were good sleepers after covariates were controlled for. CONCLUSIONS:Impaired sleep quality was prevalent in patients with heart failure and was associated with poor cardiac event-free survival. Clinicians should assess and manage sleep quality in patients with heart failure to improve outcomes.
10.4037/ajcc2016219
Sleep quality and depression in hospitalized congestive heart failure patients.
Nasir Usamabin,Shahid Hania,Shabbir Muhammad Omar
JPMA. The Journal of the Pakistan Medical Association
OBJECTIVE:To assess the sleep pattern and depression in patients hospitalised with congestive heart failure, and to study the correlation of poor-quality sleep and depression. METHODS:The cross-sectional, descriptive, co-relational study was conducted from October 2011 to March 2012 and comprised New York Heart Association Class III or IV congestive heart failure patients aged >18 years, admitted at teaching hospitals of Rawalpindi, Pakistan. A standardised questionnaire designed in collaboration with cardiologists and psychiatrists of Rawalpindi Medical College and allied teaching hospitals was administered to the patients while they were hospitalised. Pittsburgh Sleep Quality Index and Beck Depression Inventory questionnaire were also used. Statistical analysis was done using SPSS 20. RESULTS:Of the 40 patients recruited, 26(65%) were males and 14(35%) were females. The overall mean age was 60±13 years. The mean Pittsburgh Sleep Quality Index score was 15.6±3, with 37(92.5%) patients having poor sleep quality. The mean depression score was 27.65±7.5, with all 40(100%) patients affected. Among them, 14(35.7%) patients had severe clinical depression. Class IV congestive heart failure patients suffered from greater daytime dysfunction (p<0.008) and poor sleep efficiency (p<0.009) compared to Class III. No association of poor sleep quality and depression was found with previous history of smoking, diabetes and hypertension. The study revealed a significant relationship between sleep quality and depression (p<0.005). CONCLUSIONS:Hospitalised congestive heart failure patients suffered from poor sleep and depressive symptoms with overall female predominance. The two symptoms were highly co-related and were more severe in Class IV patients than in Class III. A regular screening of such patients is thus essential for prognosis.
Higher galectin-3 levels are independently associated with lower anxiety in patients with risk factors for heart failure.
BioPsychoSocial medicine
BACKGROUND:Galectin-3 promotes the proliferation of neural progenitor cells and is engaged in cell-cell adhesion, cell-matrix interactions, and macrophage activation. In addition, in patients with heart failure this carbohydrate-binding protein is a known prognostic marker for cardiovascular mortality. However, its association with psychological variables has not been investigated so far. METHODS:Using data from the multicenter, observational Diast-CHF (Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure) trial, we studied in participants with cardiovascular risk factors ( = 1260, age 66.7 ± 8.0 years, males 51%, left ventricular ejection fraction 60.0 ± 8.1%) the relationship between serum concentrations of galectin-3 and anxiety. Galectin-3 levels were measured by means of a sandwich enzyme-linked immunosorbent assay, and anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS:In univariate analysis, there was a weak but significant inverse correlation between galectin-3 and HADS anxiety (rho = - 0.076; = 0.008). Linear regression models adjusted for sex, age, body-mass index, estimated glomerular filtration rate, left ventricular ejection fraction, 6-min walking distance, the 36-item Short-Form Health Survey (SF-36) subscale physical functioning, and known biomarkers for heart failure confirmed that serum galectin-3 significantly and independently predicted self-rated anxiety (B = -2.413; 95%CI = -2.413--4.422; = 0.019). CONCLUSION:In patients with cardiovascular risk factors, serum concentrations of galectin-3 showed an inverse association with anxiety, which was independent of both the severity of physical impairment and established risk factors for the progression of heart failure.
10.1186/s13030-020-00195-7
Lipotoxicity: a driver of heart failure with preserved ejection fraction?
Clinical science (London, England : 1979)
Heart failure with preserved ejection fraction (HFpEF) is a growing public health concern, with rising incidence alongside high morbidity and mortality. However, the pathophysiology of HFpEF is not yet fully understood. The association between HFpEF and the metabolic syndrome (MetS) suggests that dysregulated lipid metabolism could drive diastolic dysfunction and subsequent HFpEF. Herein we summarise recent advances regarding the pathogenesis of HFpEF in the context of MetS, with a focus on impaired lipid handling, myocardial lipid accumulation and subsequent lipotoxicity.
10.1042/CS20210127
Increased ratio of sST2/LVMI predicted cardiovascular mortality and heart failure rehospitalization in heart failure with reduced ejection fraction patients: a prospective cohort study.
Li Fuhai,Xu Mengying,Fu Mingqiang,Cui Xiaotong,Lian Zhexun,Xin Hui,Zhou Jingmin,Ge Junbo
BMC cardiovascular disorders
BACKGROUND:Inflammation is one of the principal triggering mechanisms for left ventricular fibrosis and remodeling in heart failure, leading to adverse clinical outcomes. Soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, is assumed to play a significant role in the fibrotic response to inflammation. Left ventricular mass index (LVMI) is a parameter of the prefibrotic inflammatory phase of heart failure preceding remodeling. The present study aimed to investigate the prognostic value of the sST2/LVMI ratio in heart failure with reduced ejection fraction. METHODS:This was a prospective cohort study. A total of 45 consecutive patients with heart failure with reduced ejection fraction, treated between September 2015 and December 2016, were enrolled. The sST2/LVMI ratio was measured at baseline. The primary endpoint was a composite of cardiovascular mortality and readmission for heart failure. The prognostic impact of the sST2/LVMI ratio was evaluated using a multivariable Cox proportional hazards regression model. RESULTS:Forty-five patients were enrolled in this study. Their average age was 48 ± 14 years, and approximately 20% of them were men. Patients were followed for 9 months, during which the primary outcome occurred in 15 patients. Kaplan-Meier analysis showed that patients with a high sST2/LVMI ratio (≥ 0.39) had shorter event-free survival than those with intermediate (between 0.39 and 0.24) and low ratios (< 0.24) (log-rank, P = 0.022). The fully adjusted multivariable Cox regression analysis showed that the sST2/LVMI ratio was positively associated with the composite outcome in patients with heart failure with reduced ejection fraction after adjusting for confounders (hazard ratio 1.64, 95% confidence interval 1.06 to 2.54). By subgroup analysis, a stronger association was found with age between 40 and 55 years, systolic blood pressure < 115 or ≥ 129 mmHg, diastolic blood pressure < 74 mmHg, hematocrit < 44.5%, and interventricular septum thickness ≥ 8.5 mm. CONCLUSION:In patients with heart failure with reduced ejection fraction, the relationship between the sST2/LVMI ratio and the composite outcome was linear. A higher baseline ratio of sST2/LVMI was associated with an increased risk of cardiovascular mortality and heart failure rehospitalization in the short-term follow-up.
10.1186/s12872-021-02191-3