Long-Term Treatment with Valsartan Improved Cyclic Variation of the Myocardial Integral Backscatter Signal and Diastolic Dysfunction in Hypertensive Patients: The Echocardiographic Assessment

Mizuta, Yoshihiko; Kai, Hisashi; Mizoguchi, Masahiro; Osada, Kensuke; Tahara, Nobuhiro; Nakaura, Hiroyuki; Kuwahara, Fumitaka; Imaizumi, Tsutomu

doi:10.1291/hypres.31.1835

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…As these integrated backscatter measures have been shown to reflect structural changes of the fibrous components of the myocardium, these findings suggest attenuation of myocardial fibrosis by losartan, but not by amlodipine. The losartan-induced reduction in myocardial fibrosis is an agreement with previous studies using biopsied tissues [11] and resembles the findings obtained using the same non-invasive technique in another recent study with valsartan [24].…”

Section: Discussionsupporting

confidence: 91%

Losartan and amlodipine on myocardial structure and function: a prospective, randomized, clinical trial

et al. 2011

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Section: Discussionsupporting

confidence: 91%

Losartan and amlodipine on myocardial structure and function: a prospective, randomized, clinical trial

et al. 2011

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“…Regression of ultrasonic myocardial texture alterations have been already documented in clinical scenarios of hypertrophy regression [26,27]. Although our results showed a trend toward regression of both IBS indices (CC IBS and CV) after treatment of patients with overt hypothyroidism or hyperthyroidism, this was only statistical significant in CV of hypothyroidism patients.…”

Section: Discussionsupporting

confidence: 43%

Myocardial ultrasonic tissue characterization in patients with thyroid dysfunction

Romano

Maciel

Almeida-Filho

et al. 2010

Cardiovasc Ultrasound

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BackgroundStructural myocardial abnormalities have been extensively documented in hypothyroidism. Experimental studies in animal models have also shown involvement of thyroid hormones in gene expression of myocardial collagen. This study was planned to investigate the ability of ultrasonic tissue characterization, as evaluated by integrated backscatter (IBS), to early identify myocardial involvement in thyroid dysfunction.Patients and MethodsWe studied 15 patients with hyperthyroidism (HYPER), 8 patients with hypothyroidism (HYPO), 14 patients with subclinical hypothyroidism (SCH) and 19 normal (N) subjects, who had normal LV systolic function. After treatment, 10 HYPER, 6 HYPO, and 8 SCH patients were reevaluated. IBS images were obtained and analyzed in parasternal short axis (papillary muscle level) view, at left ventricular (LV) posterior wall. The following IBS variables were analyzed: 1) the corrected coefficient (CC) of IBS, obtained by dividing IBS intensity by IBS intensity measured in a rubber phantom, using the same equipment adjustments, at the same depth; 2) cardiac cyclic variation (CV) of IBS - peak-to-peak difference between maximal and minimal values of IBS during cardiac cycle; 3) cardiac cyclic variation index (CVI) of IBS - percentual relationship between the cyclic variation (CV) and the mean value of IBS intensity.ResultsCC of IBS was significantly larger (p < 0.05) in HYPER (1.57 ± 0.6) and HYPO (1.53 ± 0.3) as compared to SCH (1.32 ± 0.3) or N (1.15 ± 0.27). The CV (dB) (HYPO: 7.5 ± 2.4; SCH: 8.2 ± 3.1; HYPER: 8.2 ± 2.0) and the CVI (HYPO: 35.6 ± 19.7%; SCH: 34.7 ± 17.5%; HYPER: 37.8 ± 11.6%) were not significantly different in patients with thyroid dysfunction as compared to N (7.0 ± 2.0 and 44.5 ± 15.1%).ConclusionsCC of IBS was able to differentiate cardiac involvement in patients with overt HYPO and HYPER who had normal LV systolic function. These early myocardial structural abnormalities were partially reversed by drug therapy in HYPER group. On the other hand, although mean IBS intensity tended to be slightly larger in patients with SCH as compared to N, this difference was not statistical significant.

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“…As a blocker in Ang II receptor, the potential effects of valsartan have been widely investigated in the diseases of different organs, including liver fibrosis , kidney injury and cardiovascular injury, especially heart failure and cardiac hypertrophy . It has been found that treatment with valsartan could significantly inhibit the TGF‐β pathway and further attenuate the progression of liver fibrosis of the liver .…”

Section: Introductionmentioning

confidence: 99%

Novel mechanism of cardiac protection by valsartan: synergetic roles of TGF‐β1 and HIF‐1α in Ang II‐mediated fibrosis after myocardial infarction

Sui

Wang³

2015

J Cellular Molecular Medi

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Transforming growth factor (TGF)-β1 is a known factor in angiotensin II (Ang II)-mediated cardiac fibrosis after myocardial infarction (MI). Hypoxia inducible factor-1 (Hif-1α) was recently demonstrated to involve in the tissue fibrosis and influenced by Ang II. However, whether Hif-1α contributed to the Ang II-mediated cardiac fibrosis after MI, and whether interaction or synergetic roles between Hif-1α and TGF-β pathways existed in the process was unclear. In vitro, cardiac cells were incubated under hypoxia or Ang II to mimic ischaemia. In vivo, valsartan was intravenously injected into Sprague–Dawley rats with MI daily for 1 week; saline and hydralazine (another anti-hypertensive agent like valsartan) was used as control. The fibrosis-related proteins were detected by Western blotting. Cardiac structure and function were assessed with multimodality methods. We demonstrated in vitro that hypoxia would induce the up-regulation of Ang II, TGF-β/Smad and Hif-1α, which further induced collagen accumulation. By blocking with valsartan, a blocker of Ang II type I (AT1) receptor, we confirmed that the up-regulation of TGF-β/Smad and Hif-1α was through the Ang II-mediated pathway. By administering TGF-β or dimethyloxalylglycine, we determined that both TGF-β/Smad and Hif-1α contributed to Ang II-mediated collagen accumulation and a synergetic effect between them was observed. Consistent with in vitro results, valsartan significantly attenuated the expression of TGF-β/Smad, Hif-1α and fibrosis-related protein in rats after MI. Heart function, infarcted size, wall thickness as well as myocardial vascularization of ischaemic hearts were also significantly improved by valsartan compared with saline and hydralazine. Our study may provide novel insights into the mechanisms of Ang II-induced cardiac fibrosis as well as into the cardiac protection of valsartan.

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Long-Term Treatment with Valsartan Improved Cyclic Variation of the Myocardial Integral Backscatter Signal and Diastolic Dysfunction in Hypertensive Patients: The Echocardiographic Assessment

Abstract: Myocardial fibrosis is the major determinant of diastolic property of the left ventricle (LV).

Cited by 9 publications

References 32 publications

Losartan and amlodipine on myocardial structure and function: a prospective, randomized, clinical trial

Losartan and amlodipine on myocardial structure and function: a prospective, randomized, clinical trial

Myocardial ultrasonic tissue characterization in patients with thyroid dysfunction

Novel mechanism of cardiac protection by valsartan: synergetic roles of TGF‐β1 and HIF‐1α in Ang II‐mediated fibrosis after myocardial infarction

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