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Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

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Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

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Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
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Cardiomyopathy IV: Restrictive Cardiomyopathy01:29

Cardiomyopathy IV: Restrictive Cardiomyopathy

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Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
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Myocardial Gene Expression Signatures in Human Heart Failure With Preserved Ejection Fraction.

Virginia S Hahn1, Hildur Knutsdottir2, Xin Luo3

  • 1Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (V.S.H., J.V., D.A.K., K.S.).

Circulation
|October 29, 2020
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Heart failure with preserved ejection fraction (HFpEF) has unique molecular signatures. Identifying distinct HFpEF subgroups reveals potential new therapeutic targets for this challenging heart condition.

Keywords:
computational biologyheart failurehumanssequence analysis, RNA

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Area of Science:

  • Cardiology
  • Molecular Biology
  • Genomics

Background:

  • Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure cases but lacks effective treatments.
  • Limited molecular analysis of heart tissue hinders understanding of HFpEF myocardial biology.

Purpose of the Study:

  • To perform comprehensive transcriptomic analysis on heart tissue from HFpEF patients.
  • To identify molecular subgroups within HFpEF and correlate them with clinical and hemodynamic data.
  • To compare transcriptomic profiles of HFpEF with heart failure with reduced ejection fraction (HFrEF) and healthy controls.

Main Methods:

  • RNA sequencing was performed on endomyocardial biopsies from HFpEF (n=41), HFrEF (n=30), and donor controls (n=24).
  • Principal component analysis and hierarchical clustering were used to assess transcriptomic distinctiveness and group separation.
  • Non-negative matrix factorization and weighted gene coexpression network analysis identified molecular subgroups within HFpEF.

Main Results:

  • Transcriptomic analysis clearly separated HFpEF from HFrEF and controls, even after adjusting for comorbidities.
  • HFpEF exhibited unique gene expression patterns, including upregulated mitochondrial pathways and downregulated endoplasmic reticulum stress/autophagy pathways compared to controls.
  • Three distinct HFpEF molecular subgroups were identified, correlating with specific clinical features and mortality risk.

Conclusions:

  • HFpEF displays unique transcriptomic signatures and molecular subgroupings associated with distinct clinical characteristics and outcomes.
  • These findings highlight novel signaling pathways and molecular subgroups within HFpEF, suggesting potential targets for precision medicine.