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Howden E, Foulkes S, Wright L, Janssens K, Dillon H, Costello B, La Gerche A. 432 Traditional markers of myocardial dysfunction fail to detect marked reductions in physical capacity amoung chemotherapy patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Left ventricular ejection fraction (LVEF) is the current standard of care for evaluating chemotherapy-associated cardiotoxicity but changes in LVEF are poorly associated with outcomes and long-term heart failure risk. We sought to compare a more global measure of integrative cardiovascular function (VO2peak) that is strongly associated heart failure and early mortality risk with LVEF, global longitudinal strain (GLS) and cardiac biomarkers.
Methods
95 patients who were due to commence anti-cancer treatment (n = 58 anthracycline chemotherapy for breast cancer; n = 25 Bruton’s tyrosine kinase inhibitor and n = 12 allogeneic stem cell transplant for haematological cancers) completed a pre-treatment and follow-up assessment within 6 months of initiating treatment. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP) and cardiopulmonary exercise test (CPET, VO2peak) were measured.
Results
Of 95 participants who underwent baseline testing, follow-up CPET and echocardiography data was available in 89 participants. LV function was normal prior to treatment (LVEF 61.5 ± 5.9%; GLS -19.4 ± 2.3) but VO2peak (23.4 ± 6.5ml/kg/min) was only 83 ± 21% (range 47-146%) of age-predicted. After treatment, we observed marked reductions in fitness (Δ-2.1 ± 3.7 ml/kg/min or -9 ± 15%, P < 0.001) which was associated with small non-clinically significant changes in LV function (LVEF Δ-2.4 ± 6.4% P = 0.001; GLS Δ-0.5 ± 1.9 P = 0.018). Troponin was increased significantly (4.0 ± 5.5 to 23.5 ± 22.5ng/ml, P < 0.001), with no change in BNP (37.5 ± 31.4 to 32.7 ± 22.0pg/ml, P = 0.87). Current diagnostic criteria for cardiac toxicity were not met in any patient despite some patients developing disabling reductions in functional capacity (VO2peak < 16ml/min/kg).
Conclusion
Despite normal resting LV function prior to commencing treatment VO2peak was below age predicted. Treatment further impaired exercise cardiovascular function with minimal impact on resting measures of LV function. The assessment of cardiovascular function using CPET prior to, and following chemotherapy may be a more sensitive means of identifying patients at increased risk of future heart failure.
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Janssens K, Wright L, Mooney D, Lourenco C, Climie R, La Gerche A. 417 The Influence of Left Atrial and Ventricular Volumes on Exercise Capacity in Endurance Athletes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D, Flather M, Zuhlke L, Beltrame JF, Huculeci R, Tavazzi L, Hindricks G, Bax J, Casadei B, Achenbach S, Wright L, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2019 (Executive Summary). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:7-9. [PMID: 31957796 DOI: 10.1093/ehjqcco/qcz065] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chee VA, Teran E, Hernandez I, Wright L, Izurieta R, Reina-Ortiz M, Flores M, Bejarano S, Dào LU, Baldwin J, Martinez-Tyson D. 'Desculturización,' urbanization, and nutrition transition among urban Kichwas Indigenous communities residing in the Andes highlands of Ecuador. Public Health 2019; 176:21-28. [PMID: 31679636 DOI: 10.1016/j.puhe.2019.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/25/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The nutrition transition continues to affect populations throughout the world. The added impact of market integration and urbanization exacerbates the impact of the nutrition transition upon Indigenous populations worldwide. OBJECTIVES This study aims to explore the nutritional concerns of the urban Kichwas community residing in the Andes highlands of Ecuador. STUDY DESIGN This is a qualitative study. METHODS Eight focus groups were conducted with Kichwas men and women in November 2015 in the Imbabura province of the Andes in Ecuador. DATA ANALYSIS Applied thematic analysis was used to analyze findings regarding nutrition. RESULTS The participants shared concerns regarding increased intake of fast food, poor meal timing, and a shift in the child's food preferences that rejects traditional foods. They attributed these concerns to urbanization resulting from an increase in dual-income households and a loss of cultural identity. CONCLUSIONS Synergistic cultural factors are related to nutritional concerns voiced by the urban Kichwas community. PUBLIC HEALTH IMPLICATIONS Syndemic theory is a useful interpretive lens regarding nutritional trends within the Kichwas communities as they relate to the increased risk of chronic disease.
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Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick TH. 3224Incremental benefit of left ventricular global longitudinal strain over clinical and left atrial parameters for predicting new-onset atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although LV hypertrophy and dysfunction are associated with atrial fibrillation (AF), AF often occurs in the absence of LV hypertrophy or reduced ejection fraction. The effect of subclinical LV dysfunction on AF has not been fully studied.
Purpose
We sought the association between subclinical LV dysfunction (measured with global longitudinal strain, GLS) and new-onset AF.
Methods
This observational study evaluated 531 consecutive patients (median age, 67 years [interquartile range, 56 to 78]; 56% male), without a history of AF who underwent strain echocardiography after cryptogenic stroke. The CHARGE-AF score was used to calculate the 5-year risk of developing AF. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir strain, pump strain, and conduit strain) and LV strain (GLS). A strain analysis was conducted using a dedicated software package, using R-R gating. The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared.
Results
Over 2.5 years of follow-up, 61 patients (11%) had new-onset AF. Patients who developed AF were older, had a higher CHARGE-AF score, larger LA volume, worse LA strain, and worse GLS than those who did not. Areas under the receiver-operating curve for GLS (0.84) was comparable to CHARGE-AF (0.79), LA pump strain (0.83), and LA reservoir strain (0.85). In the nested Cox models, GLS demonstrated an independent and incremental predictive value over the clinical and LA parameters (Figure). Moreover, adding GLS to the combined clinical and LA parameters model resulted in a significantly improved reclassification (net reclassification improvement, 0.32; p=0.016). Importantly, the predictive value of GLS was confirmed in patients with abnormal LA volumes (LA volume index≥34ml/m2) but not in patients with normal LA volumes.
Figure 1
Conclusion
GLS is associated with new-onset AF, especially in patients with abnormal LA volumes. This effect is independent of and incremental to the clinical and LA parameters.
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Haji K, Marwick T, Neil C, Stewart S, Carrington M, Wright L, Chan Y, Simons K, Wong C. P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF.
Method
Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage.
Results
63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure.
HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04
Conclusion
GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.
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Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick T. Incremental Benefit of Left Ventricular Global Longitudinal Strain over Clinical and Left Atrial Parameters for Predicting New-Onset Atrial Fibrillation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gutman S, Costello B, Van Leeuwen M, Wright L, Varghese S, Brady S, Wong C, Naughton W, Woods C, Maguire G, Marwick T, Taylor A. Identification of Carditis in Acute Rheumatic Fever with Myocardial T1 Mapping. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wright L. Food Fighters - A Food Recovery Program to Fight Hunger. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elmore M, Wright L, Yu Z, Arikawa A. Prevalence of Food Insecurity, Anxiety and Depression in LGBT Young Adults. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rodrigo A, Wright L, Ruocco A. B - 61Can a Neural Marker of Impulsivity Better Predict Interpersonal Problems than a Performance-Based Test? Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Haji K, Marwick T, Neil C, Carrington M, Stewart S, Chan Y, Simons K, Wright L, Wong C. P2745Use of left ventricular deformation imaging to predict heart failure risk in cardiac inpatients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Haji K, Pathan F, Wong C, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. P5633Handheld ultrasound: a way to reduce requests for inappropriate echocardiograms. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Przewlocka-Kosmala M, Kosmala W, Yang H, Wright L, Negishi K, Marwick TH. P901Association of reduced LV apical untwisting with adverse outcome in asymptomatic patients with heart failure risk factors. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hasan R, van den Bogaerde J, Forty J, Wright L, Wallwork J, White DJG. Inhibition of rejection of hamster-to-rat heart xenografts. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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White D, Oglesby T, Liszewski M, Tedja I, Hourcade D, Wang MW, Wright L, Wallwork J, Atkinson J. Expression of human decay accelerating factor or membrane cofactor protein genes on mouse cells inhibits lysis by human complement. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.648] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Kuper LE, Wright L, Mustanski B. Gender identity development among transgender and gender nonconforming emerging adults: An intersectional approach. Int J Transgend 2018. [DOI: 10.1080/15532739.2018.1443869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Wright L, Kochilas L, Knight J, Thomas A. LONG-TERM OUTCOMES AFTER INTERVENTION FOR PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM: A STUDY FROM THE PEDIATRIC CARDIAC CARE CONSORTIUM. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haji K, Wong C, Pathan F, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. Using Handheld Ultrasound to Reduce Rarely Appropriate Echocardiograms. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Costello B, Howden E, Bigaran A, Beaudry R, Foulkes S, Wright L, Janssens K, Haykowsky M, Antill Y, Nightingale S, Loi S, La Gerche A. Exercise Training Attenuates Chemotherapy-Induced Systolic Dysfunction Measured by Novel Cardiac Magnetic Resonance-Derived Global Longitudinal Strain. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Costello B, Howden E, Bigaran A, Beaudry R, Wright L, Foulkes S, Janssens K, Haykowsky M, Antill Y, Nightingale S, Loi S, La Gerche A. Native T1 Times Increase After 3 Months of Anthracycline-Based Chemotherapy for Breast Cancer. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wright L, Dwyer N, Wahi S, Marwick T. P2592Incremental predictive ability of baseline and sequential pulmonary artery pressure, RV free wall strain and 6MW in predicting outcome of pulmonary arterial hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Wright L. QUALITY CARE: BETTER TRAINING FOR BETTER DIRECT CARE WORKERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Doost A, Wong L, Harding E, Robbie Y, Wright L, Smith F, Nair A, Tan R. 12-Lead ECG Transmission for STEMI Management for Regional Patients. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The concept of mentoring has been used successfully in numerous settings, but only in the past decade have mentoring programs been used with organ transplant recipients. This paper describes how the Toronto Multi Organ Transplant Mentor Programme works, is administered, augments patient care, is evaluated, and has been adapted to meet the needs of various transplant patient populations.
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