Uncoupling between intravascular and distending pressures leads to underestimation of circulatory congestion in obesity
Jazyk angličtina Země Anglie, Velká Británie Médium print-electronic
Typ dokumentu časopisecké články, Research Support, N.I.H., Extramural, práce podpořená grantem
PubMed
34755429
DOI
10.1002/ejhf.2377
Knihovny.cz E-zdroje
- Klíčová slova
- Biomarker, Diagnosis, Filling pressure, Heart failure, Obesity, Surrogate marker,
- MeSH
- echokardiografie MeSH
- funkce levé komory srdeční MeSH
- hemodynamika MeSH
- lidé MeSH
- obezita komplikace MeSH
- plicní tlak v zaklínění MeSH
- srdeční selhání * diagnóza etiologie MeSH
- tepový objem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
AIMS: Patients with obesity frequently present with dyspnoea. Biomarkers that reflect wall stress are often used to evaluate circulatory congestion and help determine whether dyspnoea is of cardiac causes. Patients with obesity display greater external restraint on the heart, which may alter relationships between intravascular pressures and stress markers. METHODS AND RESULTS: Subjects with unexplained dyspnoea (n = 212) underwent cardiac catheterization with simultaneous echocardiography. Blood sampling was performed in a subset (n = 58). Relationships between echocardiographic and blood biomarkers of circulatory congestion and directly-measured haemodynamics were compared between participants with severe obesity [body mass index (BMI) ≥35 kg/m2 , Group B) and those without (BMI <35 kg/m2 , Group A). Circulatory congestion was assessed by pulmonary capillary wedge pressure (PCWP), and vascular distending pressure was assessed by left ventricular transmural pressure (LVTMP). As compared to Group A, participants in Group B displayed higher PCWP relative to N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide, troponin T, and growth differentiation factor-15 (all p < 0.01). In contrast, the relationships between LVTMP and the biomarkers were superimposable. Echocardiographic biomarkers revealed the same pattern: PCWP was higher for any E/e' ratio in Group B compared to Group A, but the relationship between LVTMP and E/e' was similar. In contrast, levels of C-terminal pro-endothelin-1 and mid-regional pro-adrenomedullin were more robustly correlated with PCWP (r = 0.67 and r = 0.62, both p < 0.0001), with no differential relationship based upon BMI. CONCLUSIONS: Non-invasive haemodynamic markers underestimate circulatory congestion in patients with obesity, an effect that appears related to uncoupling between cardiac wall stress and intravascular pressures. This may lead to systematic under-recognition of congestion in patients with obesity.
Brigham and Women's Hospital Harvard Medical School Boston MA USA
Department of Cardiovascular Diseases Mayo Clinic Rochester MN USA
Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan
Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic
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