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Dysfunctional Postprandial Flow Changes, Adverse Cardiac Remodeling, and Hypertension

2019; Lippincott Williams & Wilkins; Volume: 12; Issue: 11 Linguagem: Inglês

10.1161/circimaging.119.009981

1942-0080

Ricardo Ladeiras‐Lopes, Chiara Bucciarelli‐Ducci,

Cardiac Health and Mental Health

HomeCirculation: Cardiovascular ImagingVol. 12, No. 11Dysfunctional Postprandial Flow Changes, Adverse Cardiac Remodeling, and Hypertension Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBDysfunctional Postprandial Flow Changes, Adverse Cardiac Remodeling, and HypertensionFollow Your Heart but Trust Your Gut? Ricardo Ladeiras-Lopes, MD and Chiara Bucciarelli-Ducci, MD, PhD Ricardo Ladeiras-LopesRicardo Ladeiras-Lopes Cardiology Department, Gaia Hospital Centre, Vila Nova de Gaia, Portugal (R.L.-L.). Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Portugal (R.L.-L.). Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom (R.L.-L., C.B.-D.). and Chiara Bucciarelli-DucciChiara Bucciarelli-Ducci Chiara Bucciarelli-Ducci, MD, PhD, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Upper Maudlin St, Bristol BS1 5HH. Email E-mail Address: [email protected] Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom (R.L.-L., C.B.-D.). Originally published11 Nov 2019https://doi.org/10.1161/CIRCIMAGING.119.009981Circulation: Cardiovascular Imaging. 2019;12:e009981This article is a commentary on the followingPostprandial Vascular Dysfunction Is Associated With Raised Blood Pressure and Adverse Left Ventricular Remodeling in Adolescent AdipositySee Article by Hauser et alObesity is a major public health problem in the pediatric population in the United States, with ≈1 of 5 individuals aged 2 to 19 years being obese.1 Even at this early stage of life, obesity negatively impacts cardiovascular health, being associated with myocardial impairment, endothelial dysfunction, and systemic hypertension, as well as increased inflammation and impaired glucose metabolism.2 The autonomic nervous system—a modulatory hub of cardiovascular function and metabolic homeostasis—is also deranged in obese children,3 and, therefore, its dysfunction might provide an integrative understanding of the full pathophysiological cascade.In the current issue, Hauser et al4 describe that overweight/obese adolescents are more likely to have a dysfunctional splanchnic vascular response to high-calorie food ingestion (mediated by sympathetic nervous system), which was associated with higher prevalence of concentric left ventricular hypertrophy (LVH) and hypertension (take-home Figure). The normal splanchnic vascular response to the ingestion of high-calorie food is mediated by the sympathetic nervous system and is associated with vasodilatation and increased blood flow.5 In the present study, after a highly caloric meal, there was an increase in cardiac output and some blood flow redistribution toward the splanchnic circulation. Evaluation of postprandial gut blood flow was nicely performed using a fast acquisition in magnetic resonance imaging at the level of the superior mesenteric artery, and this was performed before and after a high-calorie liquid meal.Download figureDownload PowerPointFigure. Overweight/obese adolescents showed blunted postprandial increase in splanchnic blood flow. This finding was associated with arterial hypertension and left ventricular hypertrophy (LVH). BP indicates blood pressure.The method developed to evaluate the splanchnic vascular response merits consideration. The authors used a new cardiac-gated spiral phase-contrast magnetic resonance imaging sequence that provides high spatial resolution in a single breath hold (≈6 s), therefore, allowing an improved characterization of dynamic physiology in specific vascular beds such as the splanchnic circulation.5 This represents a powerful noninvasive tool for a comprehensive evaluation of flow dynamics of several vascular beds and the effect of neurohumoral modulation.Hauser et al demonstrated that overweight and obese individuals showed a blunted increase in flow in the superior mesenteric artery after the meal, suggesting the presence of a dysfunctional sympathetic blood flow response. Hemodynamically, this might translate in an episodic but chronic exposure to higher afterload, starting early in life. Therefore, it is plausible that there is an association with higher blood pressure and markers of chronic cardiac pressure overload such as LVH. Considering that most obese adolescents then become obese adults and that both obesity and LVH are associated with increased morbidity and mortality,6 the authors described a potential new marker of abnormal hemodynamic conditions that underlines the interaction between brain, heart, and gut.Overall, the findings should be interpreted in a continuum of hemodynamic and metabolic derangements that are difficult to be placed in a sequential order. Adiposity is not a single entity because we know that adipose tissue from different locations portends a different impact in cardiovascular risk.7 In addition, adiposity is usually associated to the other components of the metabolic syndrome, including high blood pressure, abnormal lipid blood profile, and impaired glucose homeostasis. This study adds one more piece of evidence to the concomitant presence of abnormal autonomic nervous system function and obesity.8 The 5 components of metabolic syndrome, including increased waist circumference, not only take part in a complex interplay between inflammation, insulin resistance, endothelial dysfunction, and impaired autonomic balance but are also associated with subclinical cardiac changes in children and adults.9–11 Although the exact mechanisms linking postprandial vascular dysfunction in the gut and LVH are not clarified on this study, the authors suggested that increased afterload caused by raised splanchnic vascular resistance in this context could promote development of hypertension and LVH. The exact order of events and the detailed pathophysiological sequence is still unknown, but the authors should be congratulated by presenting results that shed some light in these intricate associations that can start early in life.AcknowledgmentsCBD is in part supported by the National Institute for Heath Research (NIHR) Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Chiara Bucciarelli-Ducci, MD, PhD, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Upper Maudlin St, Bristol BS1 5HH. Email c.[email protected]ac.ukReferences1. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014.JAMA. 2016; 315:2292–2299. doi: 10.1001/jama.2016.6361CrossrefMedlineGoogle Scholar2. Van Putte-Katier N, Rooman RP, Haas L, Verhulst SL, Desager KN, Ramet J, Suys BE. Early cardiac abnormalities in obese children: importance of obesity per se versus associated cardiovascular risk factors.Pediatr Res. 2008; 64:205–209. doi: 10.1203/PDR.0b013e318176182bCrossrefMedlineGoogle Scholar3. Baum P, Petroff D, Classen J, Kiess W, Blüher S. Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study.PLoS One. 2013; 8:e54546. doi: 10.1371/journal.pone.0054546CrossrefMedlineGoogle Scholar4. Hauser JA, Muthurangu V, Sattar N, Taylor AM, Jones A. Postprandial vascular dysfunction is associated with raised blood pressure and adverse left ventricular remodeling in adolescent adiposity.Circ Cardiovasc Imaging. 2019; 12:e009172. doi: 10.1161/CIRCIMAGING.119.009172LinkGoogle Scholar5. Hauser JA, Muthurangu V, Steeden JA, Taylor AM, Jones A. Comprehensive assessment of the global and regional vascular responses to food ingestion in humans using novel rapid MRI.Am J Physiol Regul Integr Comp Physiol. 2016; 310:R541–R545. doi: 10.1152/ajpregu.00454.2015CrossrefMedlineGoogle Scholar6. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935.N Engl J Med. 1992; 327:1350–1355. doi: 10.1056/NEJM199211053271904CrossrefMedlineGoogle Scholar7. Ladeiras-Lopes R, Sampaio F, Bettencourt N, Fontes-Carvalho R, Ferreira N, Leite-Moreira A, Gama V. The ratio between visceral and subcutaneous abdominal fat assessed by computed tomography is an independent predictor of mortality and cardiac events.Rev Esp Cardiol (Engl Ed). 2017; 70:331–337. doi: 10.1016/j.rec.2016.09.010CrossrefMedlineGoogle Scholar8. Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The role of the autonomic nervous system in the pathophysiology of obesity.Front Physiol. 2017; 8:665. doi: 10.3389/fphys.2017.00665CrossrefMedlineGoogle Scholar9. Chinali M, de Simone G, Roman MJ, Best LG, Lee ET, Russell M, Howard BV, Devereux RB. Cardiac markers of pre-clinical disease in adolescents with the metabolic syndrome: the strong heart study.J Am Coll Cardiol. 2008; 52:932–938. doi: 10.1016/j.jacc.2008.04.013CrossrefMedlineGoogle Scholar10. Ladeiras-Lopes R, Moreira HT, Bettencourt N, Fontes-Carvalho R, Sampaio F, Ambale-Venkatesh B, Wu C, Liu K, Bertoni AG, Ouyang P, Bluemke DA, Lima JA. Metabolic syndrome is associated with impaired diastolic function independently of MRI-derived myocardial extracellular volume: the MESA Study.Diabetes. 2018; 67:1007–1012. doi: 10.2337/db17-1496CrossrefMedlineGoogle Scholar11. Kumar V, Hsueh WA, Raman SV. Multiorgan, multimodality imaging in cardiometabolic disease.Circ Cardiovasc Imaging. 2017; 10:e005447. doi: 10.1161/CIRCIMAGING.117.005447LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesPostprandial Vascular Dysfunction Is Associated With Raised Blood Pressure and Adverse Left Ventricular Remodeling in Adolescent AdiposityJakob A. Hauser, et al. Circulation: Cardiovascular Imaging. 2019;12 November 2019Vol 12, Issue 11 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.119.009981PMID: 31707791 Originally publishedNovember 11, 2019 Keywordshypertrophy, left ventricularautonomic nervous systemobesitymetabolic syndromeEditorialsPDF download Advertisement SubjectsAutonomic Nervous SystemHypertrophyMagnetic Resonance Imaging (MRI)Metabolic SyndromeObesity