Importantly, VCI and HFpEF often present together. With an increasingly older population, and increasing rates of obesity and type 2 diabetes, the prevalence of VCI and HFpEF can only increase. Both VCI and HFpEF are associated with increasing age, arterial hypertension, chronic kidney disease, obesity, and diabetes mellitus (DM). When stratified by left ventricular ejection fraction (LVEF), 50% of HF hospitalizations occur in those with LVEF >50%, termed HF with preserved ejection fraction (HFpEF). HF is highly prevalent, with 64 million cases worldwide and an estimated 5.2 million HF hospitalizations annually in Western Europe. VCI is the second most common form of dementia contributing to between 20 and 50% of cases, with a significant socioeconomic burden. VCI refers to cognitive impairment due to vascular diseases of the brain and can range from mild cognitive impairment to frank dementia. Vascular cognitive impairment (VCI) and heart failure (HF) are major causes of morbidity and mortality worldwide. Further knowledge of the relevance of microvascular rarefaction and its underlying mechanisms may provide new avenues for research and therapeutic targets. If microvascular rarefaction is an early marker of developing small vessel diseases, then measuring rarefaction may allow preclinical diagnosis, with implications for screening, risk stratification, and prevention. Furthermore, we will investigate surrogate biomarkers for non-invasive, faster, easier, and cheaper assessment of microvascular density since these are more likely to be disseminated into widespread clinical practice. Discussion: CRUCIAL will examine the pathophysiological role of microvascular rarefaction in VCI and HFpEF using advanced brain and cardiac MRI techniques. The AS cohort undergoing surgery will also have myocardial biopsy for histological microvascular assessment. Data collected will include medical history, physical examination, cognitive testing, advanced brain and cardiac MRI, ECG, echocardiography, sublingual capillary health, optical coherence tomography angiography (OCTa), extracellular vesicles RNA analysis, and myocardial remodelling-related serum biomarkers. We aim to recruit 75 VCI patients, 60 HFpEF patients, 60 patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement as a pressure overload HFpEF model, and 200 elderly participants with mixed comorbidities to serve as controls. Methods: The clinical research program of CRUCIAL consists of four observational cohort studies. Our consortium aims to investigate novel non-invasive tools to quantify microvascular health and rarefaction in both organs, as well as surrogate biomarkers for cerebral and/or cardiac rarefaction (via sublingual capillary health, vascular density of the retina, and RNA content of circulating extracellular vesicles), and to determine whether microvascular density relates to disease severity. Both diseases share common risk factors including hypertension, diabetes mellitus, obesity, and ageing in turn, these comorbidities are associated with microvascular rarefaction. Introduction: Microvascular rarefaction, the functional reduction in perfused microvessels and structural reduction of microvascular density, seems to be an important mechanism in the pathophysiology of small blood vessel-related disorders including vascular cognitive impairment (VCI) due to cerebral small vessel disease and heart failure with preserved ejection fraction (HFpEF).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |