Acyl ghrelin increases cardiac output while preserving right ventricular-pulmonary arterial coupling in heart failure
Erhardsson, Mikael ; Faxén, Ulrika L. ; Venkateshvaran, Ashwin LU
; Hage, Camilla
; Pironti, Gianluigi
; Thorvaldsen, Tonje
; Webb, Dominic Luc
; Hellström, Per M.
; Andersson, Daniel C.
and Ståhlberg, Marcus
, et al.
(2023)
In ESC Heart Failure
- Abstract
Aim: Acyl ghrelin increases cardiac output (CO) in heart failure with reduced ejection fraction (HFrEF). This could impair the right ventricular-pulmonary arterial coupling (RVPAC), both through an increased venous return and right ventricular afterload. We aim to investigate if acyl ghrelin increases CO with or without worsening the right-sided haemodynamics in HFrEF assessed by RVPAC. Methods and results: The Karolinska Acyl ghrelin Trial was a randomized double-blind placebo-controlled trial of acyl ghrelin versus placebo (120-min intravenous infusion) in HFrEF. RVPAC was assessed echocardiographically at baseline and 120 min. ANOVA was used for difference in change between acyl ghrelin versus placebo, adjusted for baseline values.... (More)
Aim: Acyl ghrelin increases cardiac output (CO) in heart failure with reduced ejection fraction (HFrEF). This could impair the right ventricular-pulmonary arterial coupling (RVPAC), both through an increased venous return and right ventricular afterload. We aim to investigate if acyl ghrelin increases CO with or without worsening the right-sided haemodynamics in HFrEF assessed by RVPAC. Methods and results: The Karolinska Acyl ghrelin Trial was a randomized double-blind placebo-controlled trial of acyl ghrelin versus placebo (120-min intravenous infusion) in HFrEF. RVPAC was assessed echocardiographically at baseline and 120 min. ANOVA was used for difference in change between acyl ghrelin versus placebo, adjusted for baseline values. Of the 30 randomized patients, 22 had available RVPAC (acyl ghrelin n = 12, placebo n = 10). Despite a 15% increase in CO in the acyl ghrelin group (from 4.0 (3.5–4.6) to 4.6 (3.9–6.1) L/min, P = 0.003), RVPAC remained unchanged; 5.9 (5.3–7.6) to 6.3 (4.8–7.5) mm·(m/s)−1, P = 0.372, while RVPAC was reduced in the placebo group, 5.2 (4.3–6.4) to 4.8 (4.2–5.8) mm·(m/s)−1, P = 0.035. Comparing change between groups, CO increased in the acyl ghrelin group versus placebo (P = 0.036) while RVPAC and the right ventricular pressure gradient remained unchanged. Conclusion: Treatment with acyl ghrelin increases CO while preserving or even improving RVPAC in HFrEF, possibly due to increased contractility, reduced PVR and/or reduced left sided filling pressures. These potential effects strengthen the role of acyl ghrelin therapy in HFrEF with right ventricular failure.
(Less)
- author
- Erhardsson, Mikael
; Faxén, Ulrika L.
; Venkateshvaran, Ashwin
LU
; Hage, Camilla
; Pironti, Gianluigi
; Thorvaldsen, Tonje
; Webb, Dominic Luc
; Hellström, Per M.
; Andersson, Daniel C.
and Ståhlberg, Marcus
, et al. (More)
- Erhardsson, Mikael
; Faxén, Ulrika L.
; Venkateshvaran, Ashwin
LU
; Hage, Camilla
; Pironti, Gianluigi
; Thorvaldsen, Tonje
; Webb, Dominic Luc
; Hellström, Per M.
; Andersson, Daniel C.
; Ståhlberg, Marcus
and Lund, Lars H
(Less)
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- in press
- subject
- keywords
- Acyl ghrelin, Heart failure, Inotrope
- in
- ESC Heart Failure
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:38030138
- scopus:85178196889
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.14580
- language
- English
- LU publication?
- yes
- id
- c7b58bae-cf44-4a5c-b3bc-69aa1646f6f1
- date added to LUP
- 2024-01-08 09:35:42
- date last changed
- 2024-04-23 05:14:22
@article{c7b58bae-cf44-4a5c-b3bc-69aa1646f6f1,
abstract = {{<p>Aim: Acyl ghrelin increases cardiac output (CO) in heart failure with reduced ejection fraction (HFrEF). This could impair the right ventricular-pulmonary arterial coupling (RVPAC), both through an increased venous return and right ventricular afterload. We aim to investigate if acyl ghrelin increases CO with or without worsening the right-sided haemodynamics in HFrEF assessed by RVPAC. Methods and results: The Karolinska Acyl ghrelin Trial was a randomized double-blind placebo-controlled trial of acyl ghrelin versus placebo (120-min intravenous infusion) in HFrEF. RVPAC was assessed echocardiographically at baseline and 120 min. ANOVA was used for difference in change between acyl ghrelin versus placebo, adjusted for baseline values. Of the 30 randomized patients, 22 had available RVPAC (acyl ghrelin n = 12, placebo n = 10). Despite a 15% increase in CO in the acyl ghrelin group (from 4.0 (3.5–4.6) to 4.6 (3.9–6.1) L/min, P = 0.003), RVPAC remained unchanged; 5.9 (5.3–7.6) to 6.3 (4.8–7.5) mm·(m/s)<sup>−1</sup>, P = 0.372, while RVPAC was reduced in the placebo group, 5.2 (4.3–6.4) to 4.8 (4.2–5.8) mm·(m/s)<sup>−1</sup>, P = 0.035. Comparing change between groups, CO increased in the acyl ghrelin group versus placebo (P = 0.036) while RVPAC and the right ventricular pressure gradient remained unchanged. Conclusion: Treatment with acyl ghrelin increases CO while preserving or even improving RVPAC in HFrEF, possibly due to increased contractility, reduced PVR and/or reduced left sided filling pressures. These potential effects strengthen the role of acyl ghrelin therapy in HFrEF with right ventricular failure.</p>}},
author = {{Erhardsson, Mikael and Faxén, Ulrika L. and Venkateshvaran, Ashwin and Hage, Camilla and Pironti, Gianluigi and Thorvaldsen, Tonje and Webb, Dominic Luc and Hellström, Per M. and Andersson, Daniel C. and Ståhlberg, Marcus and Lund, Lars H}},
issn = {{2055-5822}},
keywords = {{Acyl ghrelin; Heart failure; Inotrope}},
language = {{eng}},
publisher = {{John Wiley & Sons Inc.}},
series = {{ESC Heart Failure}},
title = {{Acyl ghrelin increases cardiac output while preserving right ventricular-pulmonary arterial coupling in heart failure}},
url = {{http://dx.doi.org/10.1002/ehf2.14580}},
doi = {{10.1002/ehf2.14580}},
year = {{2023}},
}