Echocardiographic and Histologic Correlations in Patients with Severe Aortic Stenosis: Influence of Overweight and Obesity
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitantoverweight and obesity (OW/O). Methods: We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating thepercentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) andits relationship to global longitudinal strain (GLS) in patients with OW/O. Results: 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricularejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy wasobtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001)and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect importantPIEF (AUC: 0.928, 95% confidence interval: 0.798–1.00). On multivariate analysis, OW/O and PIELV were independentlyassociated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount ofPIELV and PIEF were found. Conclusion: Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presenceof higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.
Abstract
Background: Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitantoverweight and obesity (OW/O). Methods: We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating thepercentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) andits relationship to global longitudinal strain (GLS) in patients with OW/O. Results: 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricularejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy wasobtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001)and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect importantPIEF (AUC: 0.928, 95% confidence interval: 0.798–1.00). On multivariate analysis, OW/O and PIELV were independentlyassociated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount ofPIELV and PIEF were found. Conclusion: Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presenceof higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.
참고문헌 (28)
- Mokdad AH, "The spread of the obesity epidemic in the United States, 1991-1998", JAMA, 282, pp.1519~1522 (1999)
- Hubert HB, "Obesity as an independent risk factor for cardiovascular disease : a 26-year follow-up of participants in the Framingham Heart Study", Circulation, 67, pp.968~977 (1983)
- Chen YT, "Risk factors for heart failure in the elderly : a prospective community-based study", Am J Med, 106, pp.605~612 (1999)
- Murphy NF, "Long-term cardiovascular consequences of obesity : 20-year follow-up of more than 15 000 middle-aged men and women(the Renfrew-Paisley study)", Eur Heart J, 27, pp.96~106 (2006)
- Kenchaiah S, "Obesity and the risk of heart failure", N Engl J Med, 347, pp.305~313 (2002)
- Ritchie RH, "Evidence for a causal role of oxidative stress in the myocardial complications of insulin resistance", Heart Lung Circ, 18, pp.11~18 (2009)
- Iozzo P, "Contribution of glucose tolerance and gender to cardiac adiposity", J Clin Endocrinol Metab, 94, pp.4472~4482 (2009)
- Alpert MA, "Obesity cardiomyopathy : pathophysiology and evolution of the clinical syndrome", Am J Med Sci, 321, pp.225~236 (2001)
- Iozzo P, "Myocardial, perivascular, and epicardial fat", Diabetes Care, 34(Suppl 2), pp.S371~S379 (2011)
- Menini S, "Role of galectin-3 in obesity and impaired glucose homeostasis", Oxid Med Cell Longev, 2016, pp.9618092~ (2016)
- Kupari M, "Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?", Eur Heart J, 26, pp.1790~1796 (2005)
- Allard MF, "Energy substrate metabolism in cardiac hypertrophy", Curr Hypertens Rep, 6, pp.430~435 (2004)
- Carasso S, "Relation of myocardial mechanics in severe aortic stenosis to left ventricular ejection fraction and response to aortic valve replacement", Am J Cardiol, 107, pp.1052~1057 (2011)
- Di Salvo G, "Abnormal myocardial deformation properties in obese, non-hypertensive children:an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study", Eur Heart J, 27, pp.2689~2695 (2006)
- Caputo M, "Detection of early left ventricular and atrial dysfunction in overweight patients with preserved ejection fraction : a speckle tracking analysis", Echocardiography, 30, pp.551~557 (2013)
- Lang RM, "Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", J Am Soc Echocardiogr, 28, pp.1~39.e14 (2015)
- Mor-Avi V, "Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics : ASE", EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography, 2011, pp.24, 277~313
- de Simone G, "Left ventricular mass and body size in normotensive children and adults : assessment of allometric relations and impact of overweight", J Am Coll Cardiol, 20, pp.1251~1260 (1992)
- Iacobellis G, "Echocardiographic epicardial fat: a review of research and clinical applications", J Am Soc Echocardiogr, 22, pp.1311~1319 (2009)
- Hein S, "Progression from compensated hypertrophy to failure in the pressure-overloaded human heart : structural deterioration and compensatory mechanisms", Circulation, 107, pp.984~991 (2003)
- Heymans S, "Increased cardiac expression of tissue inhibitor of metalloproteinase-1 and tissue inhibitor of metalloproteinase-2 is related to cardiac fibrosis and dysfunction in the chronic pressure-overloaded human heart", Circulation, 23(112), pp.1136~1144 (2005)
- Marfella R, "Myocardial lipid accumulation in patients with pressure-overloaded heart and metabolic syndrome", J Lipid Res, 50, pp.2314~2323 (2009)
- Pagé A, "Metabolic syndrome is associated with more pronounced impairment of left ventricle geometry and function in patients with calcific aortic stenosis: a substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin)", J Am Coll Cardiol, 55, pp.1867~1874 (2010)
- Mahmod M, "Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis", Circ Cardiovasc Imaging, 6, pp.808~816 (2013)
- Goldberg IJ, "Lipid metabolism and toxicity in the heart", Cell Metab, 15, pp.805~812 (2012)
- Akki A, "Compensated cardiac hypertrophy is characterised by a decline in palmitate oxidation", Mol Cell Biochem, 311, pp.215~224 (2008)
- Hoffmann R, "Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography in comparison to late gadolinium enhancement cardiac magnetic resonance for analysis of myocardial fibrosis in severe aortic stenosis", Am J Cardiol, 114, pp.1083~1088 (2014)
- Querejeta R, "Increased collagen type I synthesis in patients with heart failure of hypertensive origin : relation to myocardial fibrosis", Circulation, 110, pp.1263~1268 (2004)