Atrial Remodeling – ABC CARDIOL

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Original Article

High-Fat Diet and Heart: What is the Real Impact of Resistance Exercise Training?

André Rodrigues Lourenço Dias et al. Andrey Jorge Serra

Long-term consumption of a high-fat diet (HFD) causes macrophage infiltration in the myocardium, which begins to secrete cytokines involved in cardiac inflammation. In this regard, interleukin-1β (IL-1β) plays a key role. Elevated levels of IL-1β trigger mitochondrial production of reactive oxygen species (ROS). The burst of ROS in the myocardium contributes to the development of diastolic dysfunction and heart failure with preserved ejection fraction in an experimental HFD model.

A current systematic review by Portes et al. has shown that resistance training (RT) can mitigate a variety of harmful effects of HFD on the heart. The article by Portes et al. reviewed original articles carried out in HFD rodents subjected to an RT program of at least four weeks comparing non-trained animals. Five studies were considered eligible, and ladder climbing with external load was the RT method applied.^– Another three studies have found a reduction in body mass in animals subjected to RT,^,, indicating that one pathway through which RT may promote cardioprotection may be reducing HFD. However, none of these studies reported food intake.^,, A single study by Kim et al. assessed weekly food intake in middle-aged rats, who demonstrated that RT could upregulate proteins linked to mitochondrial biogenesis and reduce markers of sarcoplasmic reticulum stress without affecting HFD intake and body mass.

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ABCIC

Original Article

Heart Adaptation Mechanisms in Elite Female Athletes: Comparison With Healthy Individuals and Time of Training

José Maria Del Castillo et al. Thiago Boschilia Nemi Sabeh Junior Carlos Antônio da Mota Silveira Djair Brindeiro Filho

Abstract

Background:

Intense continuous exercise provokes adaptive remodeling phenotypes in athletes, the parameters of which can be evaluated through conventional echocardiography and myocardial deformation. We compared myocardial remodeling in female athletes (athlete group) with sedentary women of the same age range (control group) and between older and younger athletes.

Methods:

A total of 57 female soccer players and 25 healthy sedentary women were selected. The athlete group was subdivided into a main group and those under 17 years of age (< 17 group). The dimensions and systolic and diastolic function of the cardiac chambers and myocardial deformation (longitudinal and circumferential, as well as radial strain and rotational mechanics) was determined through echocardiography, using the Z statistic with a significance level of p< 0.05.

Results:

The mean age of the athlete, control, main, and < 17 groups was 22.1 (SD, 6.3); 21.2 (SD, 5.0); 26.5 (SD, 5.1); 16.5 (SD, 0.6) years, respectively. Weight, body mass index and heart rate were lower in the athlete group. Wall thickness, left ventricular mass index, left atrial (LA) volume, ejection fraction, and right ventricular dimensions were higher in athlete group, but remained within normal ranges. Regarding myocardial deformation, there was decreased radial strain, basal rotation, apical rotation, and twisting in the athlete group, suggesting a contractile reserve mechanism. These parameters were lesser in the main athlete group, who also had greater wall thickness, greater volume in the left atrium (LA) and larger size in the right ventricle (RV), suggesting that increased contractile reserve is related to longer time spent in the sport.

Conclusions:

In female athletes who had undergone intense long-term training, we observed adaptive remodeling of the cardiac chambers and increased contractile reserve (at rest), and these changes were more pronounced in those with longer involvement in the sport.

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ABC

Original Article

High Serum Netrin-1 and IL-1β in Elderly Females with ACS: Worse Prognosis in 2-years Follow-up

Paola Leocádio et al. Penélope Menta Melissa Dias Júlia Fraga … Alessandra Goulart Itamar Santos Paulo Lotufo Isabela Bensenor Jacqueline Alvarez-Leite

Abstract

Background

Several markers have been evaluated for a potential impact on clinical decisions or mortality prediction in acute coronary syndrome (ACS), including Netrin-1 and IL-1β that have been associated with cardiovascular disease.

Objective

Our study examined the prognostic value of Netrin-1 and IL-1β in patients with ACS (2-year follow-up).

Methods

We evaluate Netrin-1, IL-1β and other risk factors in the serum sample of 803 patients. Kaplan-Meier curves and Cox regression were used for the analysis of all-cause mortality, cardiovascular mortality, and a combined outcome of fatal myocardial infarction (MI) or new non-fatal MI, considering p-value < 0.05.

Results

There were 115 deaths from all causes, 78 deaths due to cardiovascular causes and 67 events in combined outcomes. Netrin-1 levels above the median (>44.8 pg/mL) were associated with a worse prognosis (all-cause mortality and cardiovascular mortality) in elderly females, even after model adjustment (HR: 2.08, p = 0.038 and HR: 2.68, p = 0.036). IL-1β levels above the median (>13.4 pg/mL) in elderly females were associated with increased risk of all outcomes after adjustment (all-cause mortality – HR: 2.03, p = 0.031; cardiovascular mortality – HR: 3.01, p = 0.013; fatal MI or new non-fatal MI – HR: 3.05, p = 0.029). For males, no associations were observed between Netrin-1 or IL-1β and outcomes.

Conclusion

High serum levels of Netrin-1 and IL-1β showed significant association with worse prognosis in elderly females. They may be useful as prognostic indicators in ACS. (Arq Bras Cardiol. 2020; 114(3):507-514)

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Editorial

Left Atrial Stiffness, a Marker of Atrial Cardiomyopathy, and Atrial Fibrillation – Relationships and Predictors for Procedure Success after Catheter Ablation

Tan Chen Wu

Over the past years, catheter ablation (CA) for atrial fibrillation (AF) has established itself as a well-recognized strategy in the management of patients with AF and an important option for rhythm control. Although CA is more effective than antiarrhythmic drug therapy, AF recurrences are common during the follow-up.

Late recurrence, during the first 9 months after the blanking period, occurs in 25%-40% of cases and is predominantly linked to the recovery of electrical conduction between the pulmonary veins (PVs) and the left atrium (LA), irrespective of the type of AF. The incidence of very late recurrence (after more than 12 months postablation) has been shown to be higher than previously expected, with an annual recurrence rate estimated at 7.6%. Bunch et al. reported AF recurrence rates ranging from 52% (≤ 50 years + paroxysmal AF) to 75% (> 80 years + paroxysmal AF). In a series of 509 consecutive patients undergoing paroxysmal AF ablation by Teunissen et al., after a single procedure, antiarrhythmic drugs free success rate was 41.3%. The predominant mechanism of very late recurrence includes, in addition to the PV connection, the development of non-PV triggers, and development and maturation of substrate. The predictors appears to be the nonparoxysmal form of AF at baseline, organic heart disease, advanced age, and obesity.

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ABC

Editorial

The Nature of Cardiac Remodeling Due to Physical Exercise: More Evidence Towards to the Normal Adaptive Responses of the Heart

Lucas Helal et al. Anderson Donelli da Silveira

Cardiac remodeling due to exercise training overload (the so-called “athlete’s heart”) has been widely investigated since the 70’s and is still acknowledged by the scientific community. To differentiate normal adaptive responses (“benign”) from abnormal ones remains a challenge. Here we address some important issues related to the discussion on cardiac remodeling in exercise, recently revisited by Vidaletti-Silva and colleagues in this issue.

In terms of morphological adaptations, the left atrial and ventricular hypertrophy call attention due to their potential association with the onset of supraventricular tachyarrhythmias and also of ventricular arrhythmias, which may result in undesirable events.

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ABC

Editorial

Obstructive Sleep Apnea: A Marker of Cardiac Remodeling in Patients with Chronic Chagas Disease

Reinaldo B. Bestetti

Chronic Chagas disease (CCD) continues to be a major scourge for people living in South America and an emergent medical problem outside the American Continent because of world globalization. Chronic Chagas heart disease (CCHD) affects about 30% of patients with CCD, appearing 20-30 years after infection with Trypanosoma cruzi. Prognosis of CCD patients is relentless, with a 5-year mortality approaching 35%. CCHD patients have an outcome even worse, particularly those with ventricular and atrial remodeling, which manifests by chronic systolic heart failure and atrial fibrillation.^,

It is, therefore, important to recognize predictors of ventricular and atrial remodeling in patients with CCHD to offer the proper available treatment for patients with this condition. Systolic blood pressure, male sex, and New York Heart Association Functional Class appear to predict ventricular remodeling in patients with CCD. Conversely, as far as I know, predictors of atrial remodeling have not yet been established for patients with this condition.

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ABC

Editorial

Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure

Mauricio Scanavacca et al. Edimar Alcides Bocchi

In the last years, atrial fibrillation (AF) and heart failure (HF) have been the two major epidemic syndromes in cardiology and they frequently coexist. HF increases mean right and left atria pressures promoting their progressive dilation. Such mechanical electro-anatomic remodeling predisposes to atrial fibrosis and electrical heterogeneity, increases ectopic rhythm formation and ultimately induces AF.

A new AF episode, in turn, immediately induces loss of atrial contraction, increases mean heart rate and provokes an important irregularity on ventricular contractions decreasing the heart’s pump function performance. Therefore, around 50% of patients who present with new-onset congestive HF have atrial fibrillation and up to one-third of patients with new-onset AF have congestive heart failure.

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IJCS

Original Article

Additional Cardiac Remodeling Induced by Intense Military Training in Competitive Athletes

Paulo Dinis et al. Hélder Dores Rogério Teixeira Luís Moreno … Joselito Mónico Marie Bergman Hanna Lekedal Maria Carmo Cachulo Joaquim Cardoso Lino Gonçalves

Abstract

Background:

Cardiac remodeling depends on the intensity, duration, and training method.

Objective:

To evaluate if the training performed in a Portuguese military special operations troop increases cardiac remodeling in a sample of young individuals who previously practiced competitive sports.

Methods:

A prospective study involving 76 military candidates for military special operations, 45 of whom previously practiced at competitive level (> 10 hours per week). Of these military athletes, only 17 successfully completed the course. The evaluation was performed at 6 months intervals and included a complete clinical history, physical examination, vital signs, anthropometric data and echocardiographic evaluation. Statistical significance was considered when p < 0.05, with a 95% confidence interval.

Results:

At the end of the course, there was a decrease in the percentage of fat mass (19.1 ± 3.3% vs. 13.1 ± 3.5%; p < 0.01), an increase in the percentage of lean mass (41.3 ± 2.1% vs. 44.4 ± 1.8%; p < 0.01), and decreased systolic and diastolic blood pressure and heart rate. Regarding cardiac remodeling, there was an increase in left ventricular diastolic diameter (49.7 ± 3.2 mm vs. 52.8 ± 3.4 mm; p < 0.01), an increase trend in left atrial volume (27.3 ± 4.5 mL/m² vs. 28.2 ± 4.1 mL/m²; p = 0.07) and increased left ventricular mass (93.1 ± 7.7 g/m² vs. 100.2 ± 11.4 g/m²; p < 0.01). Functional variables also changed, with an increase in S' (15 (13-16) cm/s vs. 17 (16-18) cm/s; p < 0,01) and a decrease in left ventricular ejection fraction (60 ± 6% vs. 54 ± 6%; p < 0.01).

Conclusion:

Intense military physical training resulted in additional cardiac remodeling in athletes of competitive level, both structural and functional.

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ABC

Original Article

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

Simone Nascimento dos Santos et al. Benhur Davi Henz André Rodrigues Zanatta José Roberto Barreto … Kelly Bianca Loureiro Clarissa Novakoski Marcus Vinícius Nascimento dos Santos Fabio F. Giuseppin Edna Maria Oliveira Luiz Roberto Leite

Background:

Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e’ ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process.

Objective:

To evaluate the impact of AF ablation on estimated LV filling pressure.

Methods:

A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e’ and E/e’) were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation.

Results:

One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m² ± 10.6 mL/m² to 22.6 mL/m² ± 1.1 mL/m², p < 0.001) compared to the non-successful group (37.7 mL/m² ± 14.3 mL/m² to 37.5 mL/m² ± 14.5 mL/m², p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e’ ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001).

Conclusion:

Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

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ABC

Original Article

Gender-Based Differences in Cardiac Remodeling and ILK Expression after Myocardial Infarction

Renato Rodrigues Sofia et al. Andrey Jorge Serra Jose Antonio Silva Jr Ednei Luiz Antonio … Martha Trindade Manchini Fernanda Aparecida Alves de Oliveira Vicente Paulo Castro Teixeira Paulo José Ferreira Tucci

Background:

Gender can influence post-infarction cardiac remodeling.

Objective:

To evaluate whether gender influences left ventricular (LV) remodeling and integrin-linked kinase (ILK) after myocardial infarction (MI).

Methods:

Female and male Wistar rats were assigned to one of three groups: sham, moderate MI (size: 20-39% of LV area), and large MI (size: ≥40% of LV area). MI was induced by coronary occlusion, and echocardiographic analysis was performed after six weeks to evaluate MI size as well as LV morphology and function. Real-time RT-PCR and Western blot were used to quantify ILK in the myocardium.

Results:

MI size was similar between genders. MI resulted in systolic dysfunction and enlargement of end-diastolic as well as end-systolic dimension of LV as a function of necrotic area size in both genders. Female rats with large MI showed a lower diastolic and systolic dilatation than the respective male rats; however, LV dysfunction was similar between genders. Gene and protein levels of ILK were increased in female rats with moderate and large infarctions, but only male rats with large infarctions showed an altered ILK mRNA level. A negative linear correlation was evident between LV dimensions and ILK expression in female rats with large MI.

Conclusions:

Post-MI ILK expression is altered in a gender-specific manner, and higher ILK levels found in females may be sufficient to improve LV geometry but not LV function.

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