What can adiponectin say about left ventricular function?
What can adiponectin say about left ventricular function?
复制标题
脂联素对左心室功能有何影响？
DOI：
10.1136/hrt.2009.178590
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Walsh,Kenneth
中科院分区：
文献类型：
--
作者：
Sam,Flora;Walsh,Kenneth
Adiponectin is an adipocyte-derived cytokine that is abundantly present in human plasma. 1 2 Adiponectin levels are highest in lean subjects, but levels decline as body mass increases. Work in experimental models has shown that adiponectin mediates beneficial actions in cardiovascular and metabolic-associated diseases. For example, in mouse models, adiponectin modulates hypertrophic signals in the heart and exhibits direct anti-hypertrophic properties; in addition to improving vascular function and pathological remodelling. 3 4 Despite the agreement and consistency of experimental studies on adiponectin, a number of clinical findings have questioned the utility of this adipokine as a biomarker for human diseases. On one hand, depressed adiponectin levels have been associated with greater cardiovascular risk and inflammation since hypoadiponectinaemia occurs in coronary artery disease, hypertension and insulin resistance. 5e8 On the other hand, high adiponectin levels are present in chronic inflammatory and autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, type 1 diabetes and inflammatory bowel disease independently of adiposity. 9 In addition, chronic systolic heart failure is associated with elevated adiponectin levels. 10e13 Now, Unno and colleagues report that adiponectin levels are elevated in non-obstructive hypertrophic cardiomyopathy (HCM) with diastolic dysfunction (see page 357). 14 Hypertrophic cardiomyopathy (HCM), a genetic disease of the cardiac sarcomeres, is caused by mutations in one of the many genes that encode components of the contractile apparatus of the heart. HCM has an autosomal dominant pattern of inheritance and is characterised by left ventricular hypertrophy (LVH), with variable clinical, morphological and haemodynamic phenotypes. In this study by Unno et al, the patients with HCM had no left ventricular (LV) outflow tract obstruction, which probably explains the paucity of cardiac symptoms such as dyspnoea and angina (New York heart Association functional class I/II or mild chest pain). However, the left ventricle is often not compliant in HCM resulting in diminished diastolic function. Thus, the significance of diastolic dysfunction is unclear in this minimally symptomatic patient population studied by Unno et al. This subject is of concern because diastolic heart failure is a clinical syndrome of pulmonary congestion in the presence of preserved LV ejection fraction; whereas diastolic dysfunction denotes an abnormality of mechanical properties that exist during LV relaxation and filling. 15 16 If diastolic dysfunction were considered a ‘preclinical’diagnosis to the development of symptoms in HCM or diastolic heart failure then its early recognition, by biomarker analysis, would represent a means of identifying patient populations at high risk of developing congestive heart failure. 17 However, Unno et al did not conduct a longitudinal study, and this hypothesis remains to be tested. In the study by Unno et al, the relationship between HCM and diastolic dysfunction as determined by LV pressure half-time (T1/2) and adiponectin level appears to be at odds with a prior crosssectional analysis of non-hypertensive and hypertensive patients demonstrating that low adiponectin levels were associated with LVH progression and diastolic dysfunction. 18 Taken together, these findings suggest that elevated adiponectin may not necessarily be associated with LVH and/or diastolic dysfunction but with non-obstructive HCM. Thus, hyperadiponectinaemia may identify patients with stable HCM and evidence of impaired LV relaxation. However, because LV pressure half time (T1/2) is not a …
