Pulmonary Circulation in Obesity, Diabetes, and Metabolic Syndrome

Khaing, Phue; Pandit, Pooja; Awsare, Bharat; Summer, Ross

doi:10.1002/cphy.c190018

Cited by 10 publications

(4 citation statements)

References 154 publications

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“…A close relationship between obesity and PH is has been shown by echocardiography-based and invasive hemodynamic measurements ( 127 ). Apart from epidemiological evidence, several groups have revealed a link between obesity-related metabolic defects and pulmonary vascular remodeling utilizing various genetic and diet-induced models ( 238 , 239 ). The precise pathogenic cue for obesity-induced PH is complex and undefined.…”

Section: Cardiac Remodeling In Obesitymentioning

confidence: 99%

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

Ren

Wang

et al. 2021

Physiological Reviews

200

120

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The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical and experimental evidence supports the existence of a unique disease entity termed "obesity cardiomyopathy", which develops independent of hypertension, coronary heart disease and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically-predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca2+ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.

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Section: Cardiac Remodeling In Obesitymentioning

confidence: 99%

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

Ren

Wang

et al. 2021

Physiological Reviews

200

120

View full text Add to dashboard Cite

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“…Цей процес ассоційований із підвищеним ризиком розвитку гіповентиляції та гострого респіраторного дистресс синдрому (ГРДС). В свою чергу порушення проліферативних процесів, збільшення продукції вазоконстрикторів (таких як ендотелін-1) та гіпопродукція вазодилятаторів (таких як оксид азоту (NO)) в комбінації з потовщенням комплексу інтима-медіа судини шляхом гіперпроліферації фібробластів та гладком'язових клітин створюють передумови для розвитку хронічної легеневої гіпертензії [9].…”

Section: патофізіологічні механізми метаболічного синдрому та їх впли...unclassified

Implementation of enhanced recovery after surgery (ERAS) protocols in patients with metabolic syndrome in abdominal surgery

Todurov,

Plehutsa,

Perekhrestenko

et al. 2023

DOMS

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Efforts to standardize methods of perioperative management of patients prompted the creation of appropriate algorithms. The rapid development of modern surgery, the introduction of minimally invasive surgical techniques, the improvement of anesthesiological services, and also the placing of emphasis on the deepening of pathophysiological processes, which are important for achieving the maximum effectiveness of treatment and patient safety. Thus began the era of implementation of enhanced recovery after surgery (ERAS) protocols on the practice. At the same time, such tactics, in certain cases, do not take into account individual concomitant conditions of patients, which can complicate the course of the perioperative period and endanger the life and health of the patient. Metabolic syndrome is just such a condition, the neglect of which is frivolous on the part of the doctor, because with much greater risks it can provoke the development of cardiovascular, respiratory, infectious and other complications, which worsens the prognosis of treatment and also increases the economic costs of treating such patients. The paradox is that, despite its significant prevalence in the world population, there are relatively few scientific works investigating the influence of metabolic syndrome on the course of the perioperative period in the context of ERAS. Considering the prevalence of this condition among the population and the presence of hidden forms of metabolic disorders, the metabolic syndrome clearly deserves additional attention from the doctor and may require additional research on the development and implementation of new strategies for enhanced recovery after surgery protocols taking into account this pathology in the long term. This article presents the main components of ERAS protocols in colorectal and general abdominal surgery with an emphasis on the specifics of their implementation in patients with metabolic syndrome. In particular, specific details of both the surgical and anesthetic pathways of ERAS are provided in terms of preoperative, postoperative, and postoperative care.

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“…A recently published study performed on biopsies of patients undergoing cardiac surgery demonstrated that left atrium of T2Dpatients displayed greater stiffness and reduced contractile forces mainly due to a worse calcium metabolism [41]. Backward transmission of increased filling pressure from the left heart combined with loss of compliance and dysfunction of the pulmonary microcirculation in the T2D patient are likely to lead to right heart chamber overload [42]. According to our data, patients with T2D showed worse TAPSE/PASP ratio, which may represent a good surrogate of right ventricular arterial coupling, given its good correlation with its invasively assessment [43].…”

Section: Type 2 Diabetes Impacts Dramatically On Right Heart Performa...mentioning

confidence: 99%

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Salzano

D’Assante

Iacoviello

et al. 2022

Cardiovasc Diabetol

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Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017

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Pulmonary Circulation in Obesity, Diabetes, and Metabolic Syndrome

Cited by 10 publications

References 154 publications

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

Implementation of enhanced recovery after surgery (ERAS) protocols in patients with metabolic syndrome in abdominal surgery

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

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