Background: Exercise intolerance in heart failure arises from multifactorial pathophysiological mechanisms. Hepatokines, liver-synthesized molecules, regulate systemic metabolisms in peripheral tissues. We previously identified the hepatokine fetuin-A as being linked to liver hypoperfusion in heart failure. Here, we investigated the role of fetuin-A in connecting cardiac-hepatic-peripheral interaction.
Methods And Results: We conducted a prospective study involving 202 consecutive hospitalized patients (mean age, 56.8 years; 76.2% men) with heart failure who underwent cardiopulmonary exercise testing. We measured the serum concentration of fetuin-A by ELISA. Correlation analysis revealed a negative association between fetuin-A levels and the ratio of minimum minute ventilation to carbon dioxide production, its slope, and a tendency toward a positive correlation with peak oxygen uptake. Patients with impaired exercise tolerance exhibited lower fetuin-A levels. During a median follow-up of 1045 days, 18.3% experienced cardiac events, including 4 cardiac deaths and 33 cases of worsening heart failure. Classification and regression tree analysis identified a high-risk subgroup with lower fetuin-A (<24.3 mg/L) and impaired exercise tolerance (peak oxygen uptake<14.2 mL/kg per min). Kaplan-Meier analysis revealed that this subgroup had the highest risk of cardiac events. In a multivariable Cox proportional hazard model, the combination of lower fetuin-A and exercise intolerance was independently associated with increased risks of cardiac events.
Conclusions: Reduced circulating fetuin-A levels were associated with exercise intolerance in heart failure patients. Fetuin-A could emerge as a target implicated in exercise capacity connecting cardiac-hepatic-peripheral interaction and as a valuable biomarker for predicting prognosis when combined with peak oxygen uptake.
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http://dx.doi.org/10.1161/JAHA.124.035139 | DOI Listing |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646492 | PMC |
The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance. The aims of the present study on patients with left heart disease, were to evaluate a novel echocardiographic right ventricular (RV) afterload score and to investigate its relation to risk of mortality or implantation of a left ventricular assist device. Patients ( = 220) with left ventricular ejection fraction < 50% consecutively referred for heart transplant or heart failure workup underwent echocardiography and right heart catheterization.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
June 2023
Adult Congenital Heart Disease Unit. Cardiology Department. Vall d'Hebron University Hospital, Barcelona, Spain.
Nutrition is the cornerstone of a healthy life and is crucial for the prevention of cardiovascular disease. Patients with congenital heart disease (CHD) are prone to nutrition disorders, including abnormalities in body composition such as overweight or obesity which, along with other classic cardiovascular risk factors, places our increasing and aging adult CHD (ACHD) population at a higher risk for acquired cardiovascular disease. These patients are also at risk of cachexia or sarcopenia as well as macronutrient and micronutrient deficiencies derived from the development of heart failure as a complication of their underlying cardiac disease.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
June 2023
Department of Cardiology, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia.
Despite striking improvement in survival of patients with congenital heart disease (CHD), the risk of long-term complications remains high. Stroke and systemic embolism are common and potentially devastating complications that significantly affect morbidity and mortality in CHD. The risk of stroke in adult congenital heart disease (ACHD) is higher than in the general population, patients are affected at an earlier age, and the risk continues to increase with age.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
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Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
Background: Patients with single ventricle (SV) without Fontan palliation are uncommon, and their long-term outcomes remain unclear.
Methods: Retrospective study of 35 adult patients with SV without Fontan from two tertiary centers. Primary outcome was mortality.
Int J Cardiol Congenit Heart Dis
September 2024
Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.
Background: Timely diagnosis of heart failure (HF) in patients with a systemic right ventricle (sRV) is difficult but important since clinical deterioration is fast once HF develops. We aimed to compare echocardiography and biomarker profile between sRV patients with and without HF and patients with a systemic left ventricle diagnosed with HF (sLV-HF).
Methods And Results: Eighty-seven sRV patients and 30 sLV-HF patients underwent echocardiographic evaluation and blood sampling.
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