Fibrosis and cardiac function in obesity: a randomised controlled trial of aldosterone blockade

Kosmala, Wojciech; Przewlocka‐Kosmala, M.; Szczepanik-Osadnik, Hanna; Mysiak, Andrzej; Marwick, Thomas H.

doi:10.1136/heartjnl-2012-303329

Cited by 96 publications

(93 citation statements)

References 31 publications

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“…Odds ratio (95% CI) P Odds ratio (95% CI) P [28][29][30]. Kosmala et al [7] used surrogate serological markers of fibrotic processes and myocardial deformation parameters, and showed that subclinical LV systolic dysfunction and diastolic dysfunction is associated with a high degree of fibrosis in MetS patients.…”

Section: Unadjusted Adjustedmentioning

confidence: 99%

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Oner

Ertürk²,

Birant³

et al. 2015

Cardiol J.

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041). MetS was associated with subclinical LV systolic and LV diastolic dysfunctions. In subgroup analyses of MetS patients, the presence of fQRS on ECG had a higher E/E' ratio and lower E' velocity, indicating pronounced diastolic dysfunction, as well as lower isovolumic acceleration (IVA), indicating profound subclinical LV systolic dysfunction. E/E' ratio and IVA were independent predictors of fQRS presence in patients with MetS. Conclusions: Fragmented QRS is more common among MetS patients compared to non--MetS patients. The presence of fQRS is associated with pronounced subclinical LV systolic and diastolic dysfunctions in MetS patients. (Cardiol J 2015; 22, 6: 691-698)

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Section: Unadjusted Adjustedmentioning

confidence: 99%

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Oner

Ertürk²,

Birant³

et al. 2015

Cardiol J.

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show abstract

“…7 Increased levels of aldosterone are associated with brown fat dysfunction and inflammation of white fat, 8 as well as several other adverse cardiovascular and renal effects including mitochondrial dysfunction, an increase in reactive oxygen species, macrophage infiltration and inflammatory cytokine activation, myocardial and vascular fibrosis and hypertrophy, endothelial dysfunction, mesangial cell inflammation and fibrosis, podocyte loss, albuminuria, progressive renal dysfunction, insulin resistance, pancreatic β-cell dysfunction, sympathetic nervous system activation, ventricular and atrial arrhythmias, as well as sodium retention, potassium loss, and hypertension. Mineralocorticoid receptor antagonists (MRAs) have been shown to decrease inflammation and myocardial fibrosis in patients with obesity 9 and the metabolic syndrome, as well as to provide target organ protection in patients with hypertension independent of a drop in blood pressure and to reduce total mortality and total hospitalizations in patients with chronic heart failure and a reduced left ventricular ejection fraction. One can therefore postulate that aldosterone and activation of the MR play a critical role in the cardiovascular and renal consequences of the metabolic syndrome and that MRAs would have a beneficial effect in preventing these consequences.…”

Section: See Related Article Pp 45-53mentioning

confidence: 99%

Mineralocorticoid Receptor Antagonists for the Treatment of Hypertension and the Metabolic Syndrome

Pitt

2015

Hypertension

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“…Furthermore, MRAs have been shown to improve CV outcomes in subjects with HFREF 15, 16, 17, 18, 19. Several studies have evaluated the efficacy and safety of MRAs in patients with asymptomatic LVDD20, 21, 22, 23, 24 as well as established HFPEF 25, 26, 27, 28, 29, 30…”

mentioning

confidence: 99%

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Pandey

Garg

Matulevicius

et al. 2015

JAHA

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BackgroundThere has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta‐analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.Methods & ResultsRandomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e’, a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy‐terminal peptide of procollagen type I [PICP] and amino‐terminal peptide of pro‐collagen type‐II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e’ (weighted mean difference [WMD] [95% confidence interval {CI}]: −1.68 [−2.03 to −1.33]; P<0.0001) and deceleration time (WMD [95% CI]: −12.0 ms [−23.3 to −0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.Conclusion MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.

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Fibrosis and cardiac function in obesity: a randomised controlled trial of aldosterone blockade

Cited by 96 publications

References 31 publications

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Mineralocorticoid Receptor Antagonists for the Treatment of Hypertension and the Metabolic Syndrome

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

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