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HDL mimetic peptide CER-522 treatment regresses left ventricular diastolic dysfunction in cholesterol-fed rabbits. Int J Cardiol 2016; 215:364-71. [PMID: 27128563 DOI: 10.1016/j.ijcard.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES High-density lipoprotein (HDL) infusions induce rapid improvement of experimental atherosclerosis in rabbits but their effect on ventricular function remains unknown. We aimed to evaluate the effects of the HDL mimetic peptide CER-522 on left ventricular diastolic dysfunction (LVDD). METHODS Rabbits were fed with a cholesterol- and vitamin D2-enriched diet until mild aortic valve stenosis and hypercholesterolemia-induced LV hypertrophy and LVDD developed. Animals then received saline or 10 or 30mg/kg CER-522 infusions 6 times over 2weeks. We performed serial echocardiograms and LV histology to evaluate the effects of CER-522 therapy on LVDD. RESULTS LVDD was reduced by CER-522 as shown by multiple parameters including early filling mitral deceleration time, deceleration rate, Em/Am ratio, E/Em ratio, pulmonary venous velocities, and LVDD score. These findings were associated with reduced macrophages (RAM-11 positive cells) in the pericoronary area and LV, and decreased levels of apoptotic cardiomyocytes in CER-522-treated rabbits. CER-522 treatment also resulted in decreased atheromatous plaques and internal elastic lamina area in coronary arteries. CONCLUSIONS CER-522 improves LVDD in rabbits, with reductions of LV macrophage accumulation, cardiomyocyte apoptosis, coronary atherosclerosis and remodelling.
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Mehta H, Armstrong A, Swett K, Shah SJ, Allison MA, Hurwitz B, Bangdiwala S, Dadhania R, Kitzman DW, Arguelles W, Lima J, Youngblood M, Schneiderman N, Daviglus ML, Spevack D, Talavera GA, Raisinghani A, Kaplan R, Rodriguez CJ. Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos. Circ Heart Fail 2016; 9:e002733. [PMID: 27048764 PMCID: PMC4826756 DOI: 10.1161/circheartfailure.115.002733] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults. METHODS AND RESULTS Participants of Hispanic/Latino origin across the United States aged 45 to 74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography examination to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report, and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1818 ECHO-SOL participants (mean age 56.4 years; 42.6% male), 49.7% had LVSD or LVDD or both. LVSD prevalence was 3.6%, whereas LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all P<0.05). Female sex, hypertension, diabetes mellitus, higher body mass index, and renal dysfunction were more common among those with LVDD (all P<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost 2-fold more likely to have LVDD compared with those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared with those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4). CONCLUSIONS Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.
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Affiliation(s)
- Hardik Mehta
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Anderson Armstrong
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Katrina Swett
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Sanjiv J Shah
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Matthew A Allison
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Barry Hurwitz
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Shrikant Bangdiwala
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Rupal Dadhania
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Dalane W Kitzman
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - William Arguelles
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Joao Lima
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Marston Youngblood
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Neil Schneiderman
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Martha L Daviglus
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Daniel Spevack
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Greg A Talavera
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Ajit Raisinghani
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Robert Kaplan
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Carlos J Rodriguez
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
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Murray ET, Jones R, Thomas C, Ghosh AK, Sattar N, Deanfield J, Hardy R, Kuh D, Hughes AD, Whincup P. Life Course Socioeconomic Position: Associations with Cardiac Structure and Function at Age 60-64 Years in the 1946 British Birth Cohort. PLoS One 2016; 11:e0152691. [PMID: 27031846 PMCID: PMC4816291 DOI: 10.1371/journal.pone.0152691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/17/2016] [Indexed: 12/23/2022] Open
Abstract
Although it is recognized that risks of cardiovascular diseases associated with heart failure develop over the life course, no studies have reported whether life course socioeconomic inequalities exist for heart failure risk. The Medical Research Council’s National Survey of Health and Development was used to investigate associations between occupational socioeconomic position during childhood, early adulthood and middle age and measures of cardiac structure [left ventricular (LV) mass index and relative wall thickness (RWT)] and function [systolic: ejection fraction (EF) and midwall fractional shortening (mFS); diastolic: left atrial (LA) volume, E/A ratio and E/e’ ratio)]. Different life course models were compared with a saturated model to ascertain the nature of the relationship between socioeconomic position across the life course and each cardiac marker. Findings showed that models where socioeconomic position accumulated over multiple time points in life provided the best fit for 3 of the 7 cardiac markers: childhood and early adulthood periods for the E/A ratio and E/e’ ratio, and all three life periods for LV mass index. These associations were attenuated by adjustment for adiposity, but were little affected by adjustment for other established or novel cardio-metabolic risk factors. There was no evidence of a relationship between socioeconomic position at any time point and RWT, EF, mFS or LA volume index. In conclusion, socioeconomic position across multiple points of the lifecourse, particularly earlier in life, is an important determinant of some measures of LV structure and function. BMI may be an important mediator of these associations.
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Affiliation(s)
- Emily T. Murray
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom
- * E-mail:
| | - Rebecca Jones
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom
| | - Claudia Thomas
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom
| | - Arjun K. Ghosh
- National Heart and Lung Institute, Imperial College Academic Health Sciences Centre, London, United Kingdom
- MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John Deanfield
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, at University College London, London, United Kingdom
| | - Alun D. Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Peter Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom
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104
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Ohlwein S, Klümper C, Vossoughi M, Sugiri D, Stolz S, Vierkötter A, Schikowski T, Kara K, Germing A, Quass U, Krämer U, Hoffmann B. Air pollution and diastolic function in elderly women - Results from the SALIA study cohort. Int J Hyg Environ Health 2016; 219:356-63. [PMID: 27009693 DOI: 10.1016/j.ijheh.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies linking particulate matter (PM) with heart failure (HF) show inconsistent results. However, the association of air pollution with diastolic function, an important determinant of heart failure, has not been studied yet and is addressed in the presented study. METHODS 402 women (69-79 years) of the clinical follow-up (2007-2010) of the ongoing population-based prospective SALIA (Study on the influence of Air pollution on Lung function, Inflammation and Ageing) cohort were examined using Doppler echocardiography: Of the 291 women with preserved ejection fraction, the ratio of peak early diastolic filling velocity and peak early diastolic mitral annulus velocity (E/E') was collected in 264 and left atrial volume index (LAVI) in 262 women. Residential long-term air pollution exposure (nitrogen oxides, size-fractioned PM) was modeled at baseline and at follow-up, applying land use regression models. We used linear regression to model the cross-sectional associations of air pollutants per interquartile range (IQR) with different measures of diastolic function, adjusting for personal risk factors. RESULTS Median concentrations of annual NOx, NO2, PM2.5, and PM10 at follow-up were 37.7, 25.9, 17.4 and 26.4μg/m(3), respectively. In the fully adjusted models, LAVI was associated with an IQR increase in PM2.5 (1.05 [0.99; 1.12]) and NOx (1.04 [1.00; 1.09]) at follow-up, and with NOx and NO2 (both 1.05 [1.00; 1.11]) at baseline. None of the pollutants were clearly associated with E/E'. CONCLUSIONS In this analysis of elderly women, we found suggestive evidence for an association of air pollution with impaired diastolic function.
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Affiliation(s)
- Simone Ohlwein
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
| | - Claudia Klümper
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Mohammad Vossoughi
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Dorothea Sugiri
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Sabine Stolz
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Andrea Vierkötter
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Kaffer Kara
- Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Germany
| | - Alfried Germing
- Medizinische II (Kardiologie & Angiologie), Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
| | - Ulrich Quass
- IUTA - Institute of Energy and Environmental Technology, Duisburg, Germany
| | - Ursula Krämer
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Barbara Hoffmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany; Heinrich-Heine University, Medical Faculty, Deanery of Medicine, Düsseldorf, Germany
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105
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An effect of left ventricular hypertrophy on mild-to-moderate left ventricular diastolic dysfunction. Hellenic J Cardiol 2016; 57:92-8. [DOI: 10.1016/j.hjc.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/18/2015] [Indexed: 11/20/2022] Open
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Abstract
Multimorbidity is common among older adults with heart failure and creates diagnostic and management challenges. Diagnosis of heart failure may be difficult, as many conditions commonly found in older persons produce dyspnea, exercise intolerance, fatigue, and weakness; no singular pathognomonic finding or diagnostic test differentiates them from one another. Treatment may also be complicated, as multimorbidity creates high potential for drug-disease and drug-drug interactions in settings of polypharmacy. The authors suggest that management of multimorbid older persons with heart failure be patient, rather than disease-focused, to best meet patients' unique health goals and minimize risk from excessive or poorly-coordinated treatments.
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107
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Wright SP, Esfandiari S, Gray T, Fuchs FC, Chelvanathan A, Chan W, Sasson Z, Granton JT, Goodman JM, Mak S. The pulmonary artery wedge pressure response to sustained exercise is time-variant in healthy adults. Heart 2016; 102:438-43. [PMID: 26762239 DOI: 10.1136/heartjnl-2015-308592] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/15/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The clinical and prognostic significance of 'exaggerated' elevations in pulmonary artery wedge pressure (PAWP) during symptom-limited exercise testing is increasingly recognised. However, the paucity of normative data makes the identification of abnormal responses challenging. Our objectives was to describe haemodynamic responses that reflect normal adaptation to submaximal exercise in a group of community-dwelling, older, non-dyspnoeic adults. METHODS Twenty-eight healthy volunteers (16 men/12 women; 55±6 years) were studied during rest and two consecutive stages of cycle ergometry, at targeted heart rates of 100 bpm (light exercise) and 120 bpm (moderate exercise). Right-heart catheterisation was performed to measure pulmonary artery pressures, both early (2 min) and after sustained (7 min) exercise at each intensity. RESULTS End-expiratory PAWP at baseline was 11±3 mm Hg and increased to 22±5 mm Hg at early-light exercise (p<0.01). At sustained-light exercise, PAWP declined to 17±5 mm Hg, remaining elevated versus baseline (p<0.01). PAWP increased again at early-moderate exercise to 20±6 mm Hg but did not exceed the values observed at early-light exercise, and declined further to 15±5 mm Hg at sustained-moderate exercise (p<0.01 vs baseline). When analysed at 30 s intervals, mean and diastolic pulmonary artery pressures peaked at 180 (IQR=30) s and 130 (IQR=90) s, respectively, and both declined significantly by 420 (IQR=30) s (both p<0.01) of light exercise. Similar temporal patterns were observed at moderate exercise. CONCLUSIONS The range of PAWP responses to submaximal exercise is broad in health, but also time-variant. PAWP may routinely exceed 20 mm Hg early in exercise. Initial increases in PAWP and mean pulmonary artery pressures do not necessarily reflect abnormal cardiopulmonary physiology, as pressures may normalise within a period of minutes.
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Affiliation(s)
- Stephen P Wright
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Sam Esfandiari
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Taylor Gray
- Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Felipe C Fuchs
- Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Anjala Chelvanathan
- Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - William Chan
- Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - Zion Sasson
- Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
| | - John T Granton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Jack M Goodman
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada
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108
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van Riet EES, Hoes AW, Wagenaar KP, Limburg A, Landman MAJ, Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail 2016; 18:242-52. [PMID: 26727047 DOI: 10.1002/ejhf.483] [Citation(s) in RCA: 459] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/08/2015] [Accepted: 11/29/2015] [Indexed: 12/31/2022] Open
Abstract
The 'epidemic' of heart failure seems to be changing, but precise prevalence estimates of heart failure and left ventricular dysfunction (LVD) in older adults, based on adequate echocardiographic assessment, are scarce. Systematic reviews including recent studies on the prevalence of heart failure and LVD are lacking. We aimed to assess the trends in the prevalence of LVD, and heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) in the older population at large. A systematic electronic search of the databases Medline and Embase was performed. Studies that reported prevalence estimates in community-dwelling people ≥60 years old were included if echocardiography was used to establish the diagnosis. In total, 28 articles from 25 different study populations were included. The median prevalence of systolic and 'isolated' diastolic LVD was 5.5% (range 3.3-9.2%) and 36.0% (range 15.8-52.8%), respectively. A peak in systolic dysfunction prevalence seems to have occurred between 1995 and 2000. 'All type' heart failure had a median prevalence rate of 11.8% (range 4.7-13.3%), with fairly stable rates in the last decade and with HFpEF being more common than HFrEF [median prevalence 4.9% (range 3.8-7.4%) and 3.3% (range 2.4-5.8%), respectively]. Both LVD and heart failure remain common in the older population at large. The prevalence of diastolic dysfunction is on the rise and currently higher than that of systolic dysfunction. The prevalence of the latter seems to have decreased in the 21st century.
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Affiliation(s)
- Evelien E S van Riet
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | - Kim P Wagenaar
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
| | | | - Marcel A J Landman
- Former Institution (retired) Meander Medical Centre, Amersfoort, the Netherlands
| | - Frans H Rutten
- Julius Centre for Health Sciences and Primary care, University Medical Centre Utrecht, PO Box 85500, 3508 AB Utrecht, the Netherlands
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109
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Lim SL, Lam CSP. Breakthrough in heart failure with preserved ejection fraction: are we there yet? Korean J Intern Med 2016; 31:1-14. [PMID: 26767852 PMCID: PMC4712413 DOI: 10.3904/kjim.2016.31.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/13/2015] [Indexed: 01/09/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFPEF) is a global health problem of considerable socioeconomic burden. It is projected to worsen with the aging population worldwide. The lack of effective therapies underscores our incomplete understanding of this complex heterogeneous syndrome. A novel paradigm has recently emerged, in which central roles are ascribed to systemic inflammation and generalized endothelial dysfunction in the pathophysiology of HFPEF. In this review, we discuss the role of the endothelium in cardiovascular homeostasis and how deranged endothelial-related signaling pathways contribute to the development of HFPEF. We also review the novel therapies in various stages of research and development that target different components of this signaling pathway.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Carolyn Su Ping Lam
- Department of Cardiology, National Heart Center Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School, Singapore
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110
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Rosin NL, Sopel MJ, Falkenham A, Lee TDG, Légaré JF. Disruption of collagen homeostasis can reverse established age-related myocardial fibrosis. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:631-42. [PMID: 25701883 DOI: 10.1016/j.ajpath.2014.11.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/29/2014] [Accepted: 11/06/2014] [Indexed: 02/06/2023]
Abstract
Heart failure, the leading cause of hospitalization of elderly patients, is correlated with myocardial fibrosis (ie, deposition of excess extracellular matrix proteins such as collagen). A key regulator of collagen homeostasis is lysyl oxidase (LOX), an enzyme responsible for cross-linking collagen fibers. Our objective was to ameliorate age-related myocardial fibrosis by disrupting collagen cross-linking through inhibition of LOX. The nonreversible LOX inhibitor β-aminopropionitrile (BAPN) was administered by osmotic minipump to 38-week-old C57BL/6J male mice for 2 weeks. Sirius Red staining of myocardial cross sections revealed a reduction in fibrosis, compared with age-matched controls (5.84 ± 0.30% versus 10.17 ± 1.34%) (P < 0.05), to a level similar to that of young mice at 8 weeks (4.9 ± 1.2%). BAPN significantly reduced COL1A1 mRNA, compared with age-matched mice (3.5 ± 0.3-fold versus 15.2 ± 4.9-fold) (P < 0.05), suggesting that LOX is involved in regulation of collagen synthesis. In accord, fibrotic factor mRNA expression was reduced after BAPN. There was also a novel increase in Ly6C expression by resident macrophages. By interrupting collagen cross-linking by LOX, the BAPN treatment reduced myocardial fibrosis. A novel observation is that BAPN treatment modulated the transforming growth factor-β pathway, collagen synthesis, and the resident macrophage population. This is especially valuable in terms of potential therapeutic targeting of collagen regulation and thereby age-related myocardial fibrosis.
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Affiliation(s)
- Nicole L Rosin
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mryanda J Sopel
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alec Falkenham
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timothy D G Lee
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-Francois Légaré
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.
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111
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Dyspnea predicts mortality among patients undergoing coronary computed tomographic angiography. Int J Cardiovasc Imaging 2015; 32:329-337. [DOI: 10.1007/s10554-015-0769-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
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112
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Affiliation(s)
- Henrik Watz
- 1 Pulmonary Research Institute at LungenClinic Grosshansdorf Grosshansdorf, Germany
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113
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Chivite D, Franco J, Formiga F. [Chronic heart failure in the elderly patient]. Rev Esp Geriatr Gerontol 2015; 50:237-246. [PMID: 25962334 DOI: 10.1016/j.regg.2015.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
The prevalence and incidence of heart failure (HF) is increasing, especially in the elderly population, and is becoming a major geriatric problem. Elderly patients with HF usually show etiopathogenic, epidemiological, and even clinical characteristics significantly different from those present in younger patients. Their treatment, however, derives from clinical trials performed with only a few elderly subjects. Moreover, beyond the cardiovascular disease itself, it is essential to evaluate the patient as a whole, given the interrelationship between HF and the characteristic geriatric syndromes of the elderly patient. This review examines the peculiarities in the most prevalent "real world" HF patient.
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Affiliation(s)
- David Chivite
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Jhonatan Franco
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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114
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Catena C, Verheyen N, Pilz S, Kraigher-Krainer E, Tomaschitz A, Sechi LA, Pieske B. Plasma Aldosterone and Left Ventricular Diastolic Function in Treatment-Naïve Patients With Hypertension. Hypertension 2015; 65:1231-7. [DOI: 10.1161/hypertensionaha.115.05285] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/05/2015] [Indexed: 01/19/2023]
Abstract
Aldosterone has hypertrophic and profibrotic effects on the heart. The relationship between plasma aldosterone levels and left ventricular diastolic function in hypertension, however, is unclear. The aim of this study was to examine this relationship in treatment-naïve hypertensive patients free of comorbidities that could affect left ventricular diastolic filling properties. In 115 patients with primary hypertension who were eating a standard diet and 100 matched normotensive controls, we measured plasma aldosterone and active renin levels and performed both conventional echocardiography and tissue-Doppler imaging for assessment of left ventricular diastolic function. Left ventricular hypertrophy was found in 21% of hypertensive patients, and diastolic dysfunction was detected in 20% by conventional echocardiography and in 58% by tissue-Doppler imaging. Patients with left ventricular diastolic dysfunction at tissue-Doppler imaging were older and more frequently men, had greater body mass index, blood pressure, alcohol intake, left ventricular mass index, relative wall thickness, and lower plasma aldosterone levels than patients with preserved diastolic function. Plasma aldosterone correlated directly with left ventricular mass index in addition to age, body mass index, and systolic blood pressure. Plasma aldosterone was also directly related to
e
′ velocity at tissue-Doppler imaging, but this relationship was lost after multivariate adjustment. In conclusion, plasma aldosterone levels are associated with left ventricular hypertrophy but have no independent relationship with left ventricular diastolic properties in hypertensive patients.
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Affiliation(s)
- Cristiana Catena
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Nicolas Verheyen
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Stefan Pilz
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Elisabeth Kraigher-Krainer
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Andreas Tomaschitz
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Leonardo A. Sechi
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
| | - Burkert Pieske
- From the Divisions of Cardiology (C.C., N.V.) and Endocrinology and Metabolism (S.P., A.T.), Department of Medicine, Medical University of Graz, Graz, Austria; Department of Internal Medicine and Cardiology, Charitè University Medicine, Campus Virchow Klinikum and German Heart Center, Berlin, Germany (E.K.-K., B.P.); and Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy (L.A.S.)
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115
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Left ventricular subclinical dysfunction associated with myocardial deformation changes in obstructive sleep apnea patients estimated by real-time 3D speckle-tracking echocardiography. Sleep Breath 2015; 20:135-44. [PMID: 26003787 DOI: 10.1007/s11325-015-1197-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/20/2015] [Accepted: 05/13/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE). METHODS Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea-hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender-age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE. RESULTS LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E' was 9.6 ± 2.8 and 10.4 ± 2.5, respectively, p < 0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9 ± 1.4 % and 14.8 ± 1.5 % vs 18.2 ± 1.7 % and 17.8 ± 1.5 %; AS 27.4 ± 1.8 % and 24.9 ± 2.3 % vs 33.4 ± 2.2 % and 32.7 ± 2.9 %, respectively, p < 0.0001), but the global CS and RS were significantly reduced only in group III (17.3 ± 1.4 % and 43.1 ± 6.5 % vs 19.6 ± 1.6 % and 55.4 ± 4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r = -0.80, p < 0.0001), LS (r = -0.64, p < 0.0001), CS (r = -0.51, p < 0.0001), and RS (r = -0.62, p < 0.0001). CONCLUSIONS Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.
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116
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Progression of left ventricular diastolic dysfunction in ethnic minorities. High Blood Press Cardiovasc Prev 2015; 21:205-11. [PMID: 24235072 DOI: 10.1007/s40292-013-0031-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Approximately 50 % of heart failure cases are due to diastolic failure. Generally, it is thought that asymptomatic diastolic dysfunction precedes the development of diastolic heart failure, representing an ideal time for intervention. Previous studies have examined progression rates in non-minority populations only. OBJECTIVE To determine the rate of diastolic dysfunction progression and the associated risk factors in a predominately ethnic minority population. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of participants drawn from the echocardiogram database and Electronic Health Record (EHR) for an academic medical center. Individuals with 2 or more echocardiograms showing diastolic dysfunction during a six year study period (2006–2012) were selected. MAIN OUTCOME MEASURES Change in diastolic function grade over time and risk factors associated with this change. RESULTS During the six-year retrospective study period, 154 patients with 2 or more echocardiograms demonstrating diastolic dysfunction were reviewed; these represented 496 echocardiograms. The mean time between echocardiograms was 1.9 years. Mean age was 64.6 (±10.1) years,81 % were female, and average BMI was 30.5(±7.4). The majority of subjects had Grade I diastolic dysfunction at the initial examination (87.7 % (n = 135)); 9 % (n = 14) had Grade II, and 3 % (n = 5) had Grade III. Approximately 27.9 % (n = 43) of the study cohort demonstrated overall worsening grade of diastolic dysfunction over time. Diastolic dysfunction grade was unchanged in 62 %(n = 96), improved in 9.7 % (n = 14), and worsened then improved in 0.7 % (n = 1). CONCLUSIONS Our study showed a slightly higher rate of diastolic dysfunction progression in this predominately ethnic minority population. This is consistent with a previous study in a non-minority population demonstrating the progressive nature of diastolic dysfunction over time.Understanding the role of cardiovascular disease risk factors in accelerating progression rates from asymptomatic diastolic dysfunction to symptomatic stages is paramount to optimize intervention strategies.
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117
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Moilanen AM, Rysä J, Kaikkonen L, Karvonen T, Mustonen E, Serpi R, Szabó Z, Tenhunen O, Bagyura Z, Näpänkangas J, Ohukainen P, Tavi P, Kerkelä R, Leósdóttir M, Wahlstrand B, Hedner T, Melander O, Ruskoaho H. WDR12, a Member of Nucleolar PeBoW-Complex, Is Up-Regulated in Failing Hearts and Causes Deterioration of Cardiac Function. PLoS One 2015; 10:e0124907. [PMID: 25915632 PMCID: PMC4411154 DOI: 10.1371/journal.pone.0124907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/09/2015] [Indexed: 01/13/2023] Open
Abstract
Aims In a recent genome-wide association study, WD-repeat domain 12 (WDR12) was associated with early-onset myocardial infarction (MI). However, the function of WDR12 in the heart is unknown. Methods and Results We characterized cardiac expression of WDR12, used adenovirus-mediated WDR12 gene delivery to examine effects of WDR12 on left ventricular (LV) remodeling, and analyzed relationship between MI associated WDR12 allele and cardiac function in human subjects. LV WDR12 protein levels were increased in patients with dilated cardiomyopathy and rats post-infarction. In normal adult rat hearts, WDR12 gene delivery into the anterior wall of the LV decreased interventricular septum diastolic and systolic thickness and increased the diastolic and systolic diameters of the LV. Moreover, LV ejection fraction (9.1%, P<0.05) and fractional shortening (12.2%, P<0.05) were declined. The adverse effects of WDR12 gene delivery on cardiac function were associated with decreased cellular proliferation, activation of p38 mitogen–activated protein kinase (MAPK)/heat shock protein (HSP) 27 pathway, and increased protein levels of Block of proliferation 1 (BOP1), essential for ribosome biogenesis. Post-infarction WDR12 gene delivery decreased E/A ratio (32%, P<0.05) suggesting worsening of diastolic function. In human subjects, MI associated WDR12 allele was associated significantly with diastolic dysfunction and left atrial size. Conclusions WDR12 triggers distinct deterioration of cardiac function in adult rat heart and the MI associated WDR12 variant is associated with diastolic dysfunction in human subjects.
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Affiliation(s)
- Anne-Mari Moilanen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
- Department of Pathology, The Institute of Diagnostics, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaana Rysä
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Leena Kaikkonen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Teemu Karvonen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Erja Mustonen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Raisa Serpi
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Zoltán Szabó
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Olli Tenhunen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Zsolt Bagyura
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Juha Näpänkangas
- Department of Pathology, The Institute of Diagnostics, University of Oulu, Oulu, Finland
| | - Pauli Ohukainen
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Pasi Tavi
- Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Risto Kerkelä
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Margrét Leósdóttir
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Björn Wahlstrand
- Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Hedner
- Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Heikki Ruskoaho
- The Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
- Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland
- * E-mail:
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Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study. J Emerg Med 2015; 48:756-61. [PMID: 25802165 DOI: 10.1016/j.jemermed.2014.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 10/14/2014] [Accepted: 12/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications. OBJECTIVE Determine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles. METHODS A convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE). Subclinical hypertensive heart disease was classified as the presence of: LVH, abnormal ejection fraction (EF), or diastolic dysfunction. RESULTS Thirty-nine patients with EBP were enrolled. The mean age was 46 years (SD = 10.9), 59% were women, 21% were smokers, and 92% had a history of hypertension. The average body mass index was 30.7 (SD = 8.7). Patients were 67% African American, 23% Latino, 5% Caucasian, 3% Asian, and 3% Native American. Subclinical disease was found in 39%: 31% had LVH, 15% had diastolic dysfunction, and 8% had abnormal EF. On bivariate analysis, elevated BP (p = 0.039) and blood urea nitrogen (p = 0.016) were correlated with subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p = 0.005) was associated with subclinical heart disease. CONCLUSIONS We found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.
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119
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Pawlak A, Gil RJ, Nasierowska-Guttmejer AM, Kasprzak JD. Changes in desmin expression in patients with cardiac diastolic dysfunction and preserved or reduced ejection fraction. Adv Med Sci 2015; 60:148-55. [PMID: 25732530 DOI: 10.1016/j.advms.2015.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Desmin regulates function of mitochondria, T-tubular system and cytosolic Ca(2+) transients. We investigated whether desmin remodeling correlates with diastolic dysfunction and whether progressive desmin abnormalities are accompanied by increasing diastolic dysfunction stages. PATIENTS AND METHODS Eighty five patients with idiopathic dilated cardiomyopathy and suspected myocarditis without confirmed cardiac tissue inflammation in histopathology assays were included and divided into groups: with preserved EF and reduced EF. After echocardiographic analysis of diastolic dysfunction we identified 2 preserved EF subgroups (normal diastolic function (NDF) and impaired relaxation (IR)) and 3 reduced EF subgroups (NDF, IR, and pseudonormalization). Patients with preserved EF and NDF formed the control group. Tissue desmin staining revealed 4 types of desmin expression: I - normal, with regular pattern of cross-section, IIA - increased with regular pattern, IIB - increased, with irregular pattern and presence of aggregates, III - decreased/lack desmin. RESULTS Desmin I was observed only in patients with NDF n=8 (100%) in preserved EF and reduced EF, desmin IIA in NDF n=8 (33%) in preserved EF and n=5 (33%) in reduced EF and IR n=16 (66%) in preserved EF and n=10 (66%) in reduced EF. Desmin IIB and III were observed in patients with reduced EF and diastolic dysfunction: IR and pseudonormalization n=9 (39%) and n=2 (29%); n=14 (61%) and n=5 (71%), respectively. Desmin was found to be an independent predictor of diastolic function parameters β=-0.63, R(2)=0.52 for E'; β=0.54, R(2)=0.42 for E/E'. CONCLUSIONS Increasing desmin abnormalities were correlated with diastolic dysfunction progression. Desmin expression represents a novel factor contributing or paralleling the development of diastolic dysfunction.
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Affiliation(s)
- Agnieszka Pawlak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland.
| | - Robert Julian Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland; Mossakowski Medical Research Centre, Academy of Science, Warsaw, Poland
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Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, Nathan PC, Tissing WJE, Shankar S, Sieswerda E, Skinner R, Steinberger J, van Dalen EC, van der Pal H, Wallace WH, Levitt G, Kremer LCM. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2015; 16:e123-36. [PMID: 25752563 PMCID: PMC4485458 DOI: 10.1016/s1470-2045(14)70409-7] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Survivors of childhood cancer treated with anthracycline chemotherapy or chest radiation are at an increased risk of developing congestive heart failure. In this population, congestive heart failure is well recognised as a progressive disorder, with a variable period of asymptomatic cardiomyopathy that precedes signs and symptoms. As a result, several clinical practice guidelines have been developed independently to help with detection and treatment of asymptomatic cardiomyopathy. These guidelines differ with regards to definitions of at-risk populations, surveillance modality and frequency, and recommendations for interventions. Differences between these guidelines could hinder the effective implementation of these recommendations. We report on the results of an international collaboration to harmonise existing cardiomyopathy surveillance recommendations using an evidence-based approach that relied on standardised definitions for outcomes of interest and transparent presentation of the quality of the evidence. The resultant recommendations were graded according to the quality of the evidence and the potential benefit gained from early detection and intervention.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, USA.
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Ming Hui Chen
- Department of Pediatrics, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Mary Dwyer
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Paul C Nathan
- The Hospital for Sick Children and the University of Toronto, Department of Pediatrics and Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Wim J E Tissing
- Division of Pediatric Oncology and Pediatric Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sadhna Shankar
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Elske Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Rod Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and University of Newcastle, Newcastle upon Tyne, UK
| | - Julia Steinberger
- Department of Pediatrics, Division of Cardiology, University of Minnesota Amplatz Childrens' Hospital, Minneapolis, MN, USA
| | - Elvira C van Dalen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Helena van der Pal
- Department of Pediatric Oncology and Medical Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Hematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Gill Levitt
- Department of Oncology/Haematology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
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Fenk S, Fischer M, Strack C, Schmitz G, Loew T, Lahmann C, Baessler A. Successful weight reduction improves left ventricular diastolic function and physical performance in severe obesity. Int Heart J 2015; 56:196-202. [PMID: 25740581 DOI: 10.1536/ihj.14-261] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obesity and the metabolic syndrome (MetS) are risk factors for left ventricular diastolic dysfunction (LVDD). However, little is known about the impact of successful weight reduction (WR) on diastolic function and physical performance.Obese subjects (øBMI 40.2 ± 8.6 kg/m(2)) underwent a 1-year WR program comprising diet and lifestyle components. Echocardiography and exercise capacity (6-minute walk) were performed at baseline and after 1 year. The distribution of weight reduction was split at the sample median and subjects were dichotomized in "successful WR" (% WR ≥ median, corresponding to a weight loss of 8%) and "failed-WR" (% WR < median).From a total of 188 obese subjects, 71 had LVDD at baseline. Obese patients with successful WR improved their MetS alterations, including fasting glucose, insulin, lipids, adipokines, blood pressure levels, and epicardial fat thickness. The same was not true for obesity with failed WR. Subjects with successful WR demonstrated significant improvement in echocardiographic LVDD parameters (median [interquartile range]): Δe' (2,5 [-1.0, 4.7], P < 0.01), Δe'/a' (0.34 [0.07, 079], P < 0.01), ΔE/e' (-1.14 [-2.72, -0.54], P < 0.05), ΔE/A (0.08 [-0.04, 0.26], P < 0.05), ΔArd-Ad (-28 [-54, -4], P < 0.01), and 6-minute walk distance (65 [19, 135], P < 0.01). Improvement of ≥ 2 LVDD criteria was accomplished in 30% of subjects with WR versus 10% without (P = 0.009). Using multivariable regression analysis, reduction of epicardial fat thickness was particularly predictive for the improvement of diastolic function.In summary, in severe obesity, successful long-term WR was associated with improved LV diastolic function and exercise capacity.
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Affiliation(s)
- Sabine Fenk
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
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Osawa K, Miyoshi T, Oe H, Sato S, Nakamura K, Kohno K, Morita H, Kanazawa S, Ito H. Association between coronary artery calcification and left ventricular diastolic dysfunction in elderly people. Heart Vessels 2015; 31:499-507. [PMID: 25673497 DOI: 10.1007/s00380-015-0645-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/30/2015] [Indexed: 01/08/2023]
Abstract
Coronary artery calcification (CAC) is associated with the incidence of congestive heart failure. We evaluated the association between CAC and left ventricular diastolic dysfunction (LVDD) in elderly patients without coronary artery disease. Coronary computed tomography was performed in 1,021 consecutive patients >55 years of age who were suspected of having coronary artery disease. A total of 530 patients (age, 70 ± 8 years; 56 % men) with a LV ejection fraction >50 % and without obstructive coronary artery disease and a history of coronary artery disease were included in the analysis. LVDD was defined according to a standard algorithm by echocardiography (septal e' <8, lateral e' <10, and left atrial volume index ≥34 mL/m(2)). A total of 224 of 530 patients had LVDD. CAC scores in patients with LVDD were higher than those in patients without LVDD (p < 0.01). The prevalence of LVDD in patients with CAC scores ≥400 was greater than that in patients with CAC scores of 0-9 (58 vs. 34 %, p < 0.01). After adjustment for confounding factors, the CAC score was associated with LVDD, with an odds ratio of 1.96 (95 % confidence interval: 1.11-3.43, p = 0.02) for a CAC score ≥400 compared with a CAC score of 0-9. A CAC score ≥400 was associated with LVDD in elderly patients without CAD in this population. Further prospective studies are needed to evaluate the clinical relevance of CAC as a risk of heart failure with preserved ejection fraction.
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Affiliation(s)
- Kazuhiro Osawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Hiroki Oe
- Center of Ultrasound, Okayama University Hospital, Okayama, Japan
| | - Shuhei Sato
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kunihisa Kohno
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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Abstract
Hypertension is an important risk factor implicated in the development of multiple common cardiac conditions, including coronary atherosclerosis, heart failure, and atrial fibrillation. Epidemiologic studies have provided insights into the shared pathogenesis of hypertension and subclinical as well as clinically evident cardiac diseases. The mechanistic common ground between chronic blood pressure elevation and cardiac disease likely begins early in life. Understanding these connections will aid ongoing efforts to identify individuals at risk, develop targeted therapeutics, and improve overall outcomes for individuals with elevated blood pressure in the population at large.
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124
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Jin Q, Lou Y, Chen H, Li T, Bao X, Liu Q, He X. Lower free testosterone level is correlated with left ventricular diastolic dysfunction in asymptomatic middle-aged men with type 2 diabetes mellitus. Int J Clin Pract 2014; 68:1454-61. [PMID: 25040479 DOI: 10.1111/ijcp.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Low testosterone (T) level is associated with cardiovascular risk factors. However, the relationship between T level and heart function in asymptomatic men with type 2 diabetes mellitus (T2DM) is unknown. METHODS A total of 325 men were recruited who had no history, symptoms, or signs of heart disease. RESULTS T2DM had significantly lower free T (FT) levels than those with normal glucose metabolism (NGM) (428 ± 38 pmol/l vs. 444 ± 38 pmol/l, p = 0.0002), and had an increased risk of LVDD (66.1% vs. 31.8%). There was a significant difference in FT level between subjects with and without LVDD among those with T2DM (421 ± 37 pmol/l vs. 442 ± 40 pmol/l, p = 0.0007), but not among those with NGM (439 ± 37 pmol/l vs. 447 ± 39 pmol/l, p = 0.247) or in the group overall (426 ± 38 pmol/l vs. 445 ± 38 pmol/l, p = 0.156). Lower FT level was significantly associated with LVDD [univariate odds ratio (OR) = 0.63, p = 0.032; multivariate OR = 0.71, p = 0.039]. Receiver operating characteristic curve analysis of the usefulness of FT level for predicting LVDD showed an area under the curve (AUC) of 0.85 for T2DM (p < 0.001) and 0.66 for NGM (p < 0.05). FT level had a high predictive value for LVDD in T2DM (83% for FT < 414 pmol/l), but a low predictive value in NGM (61% for FT < 423 pmol/l). Comparison of the AUCs showed that FT level was more strongly correlated with LVDD in T2DM than in NGM. CONCLUSIONS Lower FT level is correlated with LVDD in asymptomatic middle-aged men with T2DM.
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Affiliation(s)
- Q Jin
- Department of Geriatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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125
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Venskutonyte L, Jarnert C, Rydén L, Kjellström B. Longitudinal development of left ventricular diastolic function in patients with type 2 diabetes. Diabetes Care 2014; 37:3092-7. [PMID: 25193530 DOI: 10.2337/dc14-0779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Left ventricular diastolic dysfunction (LVDD) is considered to be common in patients with type 2 diabetes mellitus (T2DM), but information on its progression over time is lacking. We studied the longitudinal development of left ventricular diastolic function (LVDF) and myocardial blood flow reserve in patients with T2DM who were free from clinically detectable cardiovascular disease. RESEARCH DESIGN AND METHODS The LVDF was assessed in 73 patients with T2DM (mean age 67 ± 7 years; males 51%) on two occasions separated by 6.4 ± 0.8 years. RESULTS At baseline, LVDD was observed in 23 of the patients (32%). During follow-up, the LVDF normalized in 10 of these patients (43%) and remained unchanged in 13 of them (57%). Of the 50 patients (68%) with normal LVDF at baseline, LVDD developed in 9 (18%). Paired evaluation of myocardial blood volume index was available from 22 patients with LVDD and remained unchanged over time. CONCLUSIONS The condition of the majority of the investigated patients with LVDD improved or remained stable over a period of 6 years.
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Affiliation(s)
- Laura Venskutonyte
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Jarnert
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Kjellström
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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126
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Three-Dimensional Principal Strain Analysis for Characterizing Subclinical Changes in Left Ventricular Function. J Am Soc Echocardiogr 2014; 27:1041-1050.e1. [DOI: 10.1016/j.echo.2014.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Indexed: 01/11/2023]
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127
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Wu V, Chyou JY, Chung S, Bhagavatula S, Axel L. Evaluation of diastolic function by three-dimensional volume tracking of the mitral annulus with cardiovascular magnetic resonance: comparison with tissue Doppler imaging. J Cardiovasc Magn Reson 2014; 16:71. [PMID: 25242199 PMCID: PMC4169226 DOI: 10.1186/s12968-014-0071-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/26/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Measurement of mitral annulus (MA) dynamics is an important component of the evaluation of left ventricular (LV) diastolic function; MA velocities are commonly measured using tissue Doppler imaging (TDI). This study aimed to examine the clinical potential of a semi-automated cardiovascular magnetic resonance (CMR) technique for quantifying global LV diastolic function, using 3D volume tracking of the MA with conventional cine-CMR images. METHODS 124 consecutive patients with normal ejection fraction underwent both clinically indicated transthoracic echocardiography (TTE) and CMR within 2 months. Interpolated 3D reconstruction of the MA over time was performed with semi-automated atrioventricular junction (AVJ) tracking in long-axis cine-CMR images, producing an MA sweep volume over the cardiac cycle. CMR-based diastolic function was evaluated, using the following parameters: peak volume sweep rates in early diastole (PSRE) and atrial systole (PSRA), PSRE/PSRA ratio, deceleration time of sweep volume (DTSV), and 50% diastolic sweep volume recovery time (DSVRT50); these were compared with TTE diastolic measurements. RESULTS Patients with TTE-based diastolic dysfunction (n = 62) showed significantly different normalized MA sweep volume profiles compared to those with TTE-based normal diastolic function (n = 62), including a lower PSRE (5.25 ± 1.38 s-1 vs. 7.72 ± 1.7 s-1), a higher PSRA (6.56 ± 1.99 s-1 vs. 4.67 ± 1.38 s-1), a lower PSRE/PSRA ratio (0.9 ± 0.44 vs. 1.82 ± 0.69), a longer DTSV (144 ± 55 ms vs. 96 ± 37 ms), and a longer DSVRT50 (25.0 ± 11.0% vs. 15.6 ± 4.0%) (all p < 0.05). CMR diastolic parameters were independent predictors of TTE-based diastolic dysfunction after adjusting for left ventricular hypertrophy, hypertension, and coronary artery disease. Good correlations were observed between CMR PSRE/PSRA and early-to-late diastolic annular velocity ratios (e'/a') measured by TDI (r = 0.756 to 0.828, p < 0.001). CONCLUSIONS 3D MA sweep volumes generated by semi-automated AVJ tracking in routinely acquired CMR images yielded diastolic parameters that were effective in identifying patients with diastolic dysfunction when correlated with TTE-based variables.
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Affiliation(s)
- Vincent Wu
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Janice Y Chyou
- />Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY USA
| | - Sohae Chung
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Sharath Bhagavatula
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Leon Axel
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
- />Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY USA
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Hasegawa T, Asakura M, Eguchi K, Asanuma H, Ohara T, Kanzaki H, Hashimura K, Tomoike H, Kim J, Kitakaze M. Plasma B-type natriuretic peptide is a useful tool for assessing coronary heart disease risk in a Japanese general population. Hypertens Res 2014; 38:74-9. [PMID: 25119474 DOI: 10.1038/hr.2014.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/08/2014] [Accepted: 06/15/2014] [Indexed: 11/09/2022]
Abstract
B-type natriuretic peptide (BNP) has been reported to be associated with cardiovascular prognosis in a community-based population. In addition, accumulation of individual cardiovascular risk factors is important in predicting an individual's risk of future cardiovascular disease. However, there have been few reports showing that BNP is a comprehensive marker of the accumulation of cardiovascular risk factors. We studied 1530 community-dwelling subjects without obvious heart diseases or renal dysfunction (mean age 62 ± 15 years; 569 men and 961 women) who participated in an annual health checkup in a rural Japanese community. Coronary heart disease (CHD) risk was estimated, and patients were placed into the following three groups based on the Framingham function: low risk, moderate risk and high risk. The prevalence of moderate- and high-risk subjects for CHD rose in both genders with increasing plasma BNP levels. The area under the receiver operating characteristic curve showed a modest ability of plasma BNP levels to detect these subjects (0.755 and 0.700 for men and women, respectively). The optimal thresholds for the identification of subjects with moderate- and high-risk disease were BNP concentrations of 12.0 and 22.0 pg ml(-1), with sensitivities of 70% and 66% and specificities of 71% and 63% for men and women, respectively. In conclusion, subjects with high plasma BNP levels were at higher risk for CHD in a population without obvious heart disease or renal dysfunction.
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Affiliation(s)
- Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masanori Asakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Eguchi
- Department of Cardiology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Hiroshi Asanuma
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Ohara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuhiko Hashimura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hitonobu Tomoike
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jiyoong Kim
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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129
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Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function. J Hypertens 2014; 32:174-80. [PMID: 24309488 DOI: 10.1097/hjh.0b013e32836586da] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown. METHODS In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140 mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction. RESULTS Antihypertensive therapy reduced SBP by 28 ± 19 mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10 mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10 mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10 mmHg reduction in SBP was not influenced by age (P = 0.89). CONCLUSIONS In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.
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130
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Acar RD, Bulut M, Ergün S, Yesin M, Akçakoyun M. Evaluation of the Effect of Cardiac Rehabilitation on Left Atrial and Left Ventricular Function and Its Relationship with Changes in Arterial Stiffness in Patients with Acute Myocardial Infarction. Echocardiography 2014; 32:443-7. [DOI: 10.1111/echo.12701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rezzan Deniz Acar
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; Istanbul Turkey
| | - Mustafa Bulut
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; Istanbul Turkey
| | - Sunay Ergün
- Department of Physical Therapy and Rehabilitation; Kartal Kosuyolu Education and Research Hospital; Istanbul Turkey
| | - Mahmut Yesin
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; Istanbul Turkey
| | - Mustafa Akçakoyun
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; Istanbul Turkey
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Hee L, Nguyen T, Whatmough M, Descallar J, Chen J, Kapila S, French JK, Thomas L. Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD. Clin J Am Soc Nephrol 2014; 9:1369-76. [PMID: 24923578 DOI: 10.2215/cjn.06700613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR≥60 ml/min per 1.73 m(2), n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure. RESULTS Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI>32 ml/m(2) had significantly lower event-free survival than patients with normal (<28 ml/m(2)) or mildly dilated LAVI (28-32 ml/m(2)) (P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P<0.001) were independently associated with LAVI>32 ml/m(2). Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint. CONCLUSIONS Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.
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Affiliation(s)
- Leia Hee
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Tuan Nguyen
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Melinda Whatmough
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia; and
| | - Jack Chen
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Shruti Kapila
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John K French
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Liza Thomas
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
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132
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Vogel T, Lang PO, Schmitt E, Lepretre PM, Kaltenbach G, Goette-Di Marco P, Talha S, Lonsdorfer J, Geny B. Effects of a personalized nine weeks intermittent exercise working program on left ventricle filling function in middle-aged women with mild diastolic dysfunction. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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133
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Mitochondrial reactive oxygen species production and elimination. J Mol Cell Cardiol 2014; 73:26-33. [PMID: 24657720 DOI: 10.1016/j.yjmcc.2014.03.011] [Citation(s) in RCA: 213] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/24/2014] [Accepted: 03/14/2014] [Indexed: 12/31/2022]
Abstract
Reactive oxygen species (ROS) play an important role in cardiovascular diseases, and one important source for ROS are mitochondria. Emission of ROS from mitochondria is the net result of ROS production at the electron transport chain (ETC) and their elimination by antioxidative enzymes. Both of these processes are highly dependent on the mitochondrial redox state, which is dynamically altered under different physiological and pathological conditions. The concept of "redox-optimized ROS balance" integrates these aspects and implies that oxidative stress occurs when the optimal equilibrium of an intermediate redox state is disturbed towards either strong oxidation or reduction. Furthermore, mitochondria integrate ROS signals from other cellular sources, presumably through a process termed "ROS-induced ROS release" that involves mitochondrial ion channels. Here, we attempt to integrate these recent advances in our understanding of the control of mitochondrial ROS emission and develop a concept of how in heart failure, defects in ion handling can lead to mitochondrial oxidative stress. This article is part of a Special Issue entitled "Redox Signalling in the Cardiovascular System".
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134
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Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Influence of comorbid cardiovascular risk factors on left atrial-left ventricular interaction in asymptomatic patients: clinical application of two-dimensional speckle-tracking echocardiography. Int Heart J 2014; 55:138-45. [PMID: 24632964 DOI: 10.1536/ihj.13-220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies have examined the negative impacts of individual cardiovascular risk (CVR) factors on left atrial (LA)-left ventricular (LV) interaction, whereas the combined effects of these risk factors are insufficiently elucidated. We studied 176 asymptomatic patients with CVR factors and age-matched 50 healthy individuals by conventional and 2-dimensional speckle-tracking echocardiography. The patients were classified into 2 groups according to the number of CVR factors: one risk factor (single) group (n = 79) and 2 or more risk factors (comorbid) group (n = 97). The peak early diastolic transmitral flow velocity (E)/peak early diastolic mitral annular motion velocity (e')/peak systolic LA strain (S-LAs) was used as a surrogate for LA stiffness during ventricular systole. The E/e'/S-LAs was greatest in the comorbid group. The peak systolic LV circumferential and radial strains, peak early diastolic LV radial strain rate, and peak early diastolic LA strain and strain rate were lower in the comorbid group than in the single group. Multivariate regression analysis identified age, body mass index, systolic blood pressure, end-systolic LV diameter, peak systolic mitral annular motion velocity (s'), and peak systolic LV radial strain in the comorbid group, and peak atrial systolic transmitral fl ow velocity and s' in the single group, as independent predictors of E/e'/S-LAs. Subtle LA and LV dysfunction with individual CVR factors were more aggravated with the comorbid conditions in asymptomatic patients.
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Affiliation(s)
- Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization
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135
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Haq MAU, Wong C, Mutha V, Anavekar N, Lim K, Barlis P, Hare DL. Therapeutic interventions for heart failure with preserved ejection fraction: A summary of current evidence. World J Cardiol 2014; 6:67-76. [PMID: 24575173 PMCID: PMC3935061 DOI: 10.4330/wjc.v6.i2.67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/13/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFPEF) is common and represents a major challenge in cardiovascular medicine. Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction. Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF. Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF. We present a brief overview of the currently recommended therapeutic options with available evidence.
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136
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Castro CER, Lyapin A, Pattathan M, Negrin J, Mukherjee D. Prevalence and predictors of left ventricular diastolic dysfunction in a Hispanic patient population. Int J Angiol 2014; 22:229-34. [PMID: 24436617 DOI: 10.1055/s-0033-1353240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Minimal data exist on attributes of diastolic dysfunction in the Hispanic population. The purpose of this study was to evaluate the prevalence and predictors of diastolic dysfunction in a Hispanic patient population. We performed a retrospective review of 166 consecutive echocardiograms in a southwestern Texas Hospital that caters to a large Hispanic patient population. We identified all echocardiograms that met criteria for diastolic dysfunction and assessed baseline demographics and comorbidities in the cohort of Hispanic patients. A multivariate analysis was performed to identify the independent predictors of diastolic dysfunction. A total of 129 out of 166 patients (77.8%) were of Hispanic origin. Out of the 129 patients, 87 (67.4%) had some degree of diastolic dysfunction in this population suggesting a high prevalence in the study cohort. In the diastolic dysfunction group, the mean age was 64.5 ± 13.9, 37% were male and 63% female, 78% had diabetes, 85% had hypertension, and 49% had some degree of renal insufficiency (stages 3-5). A logistic multivariate analysis showed that diabetes was an independent predictor of diastolic dysfunction with odds ratio of 2.69 (95% confidence interval [CI], 1.06-6.28; p = 0.038). Similarly age (per year increase) and chronic kidney disease were independent predictors of diastolic dysfunction. We demonstrated that older age, presence of diabetes, and renal dysfunction are independent predictors of diastolic dysfunction in the Hispanic patient population. Strategies geared toward reducing diabetes and preventing renal dysfunction are likely to decrease prevalence of diastolic dysfunction and heart failure in this community.
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Affiliation(s)
| | - Alexander Lyapin
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas
| | - Mithun Pattathan
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas
| | - José Negrin
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas
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137
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Butrous H, Pai RG. Heart failure with normal ejection fraction: current diagnostic and management strategies. Expert Rev Cardiovasc Ther 2014; 11:1179-93. [DOI: 10.1586/14779072.2013.827468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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138
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Hansdottir S, Groskreutz DJ, Gehlbach BK. WHO's in second?: A practical review of World Health Organization group 2 pulmonary hypertension. Chest 2014; 144:638-650. [PMID: 23918108 DOI: 10.1378/chest.12-2114] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
World Health Organization (WHO) group 2 pulmonary hypertension (PH) due to left-side heart disease (ie, heart failure or left-sided valvular heart disease) is the most common form of PH in western countries. Distinguishing patients with WHO group 2 PH, particularly the subset of patients with PH due to heart failure with preserved ejection fraction (HFpEF), from those with WHO group 1 pulmonary arterial hypertension (PAH) is challenging. Separating the two conditions is of vital importance because treatment strategies differ completely. Furthermore, therapies that are indicated for WHO group 1 PAH may be harmful in patients with WHO group 2 PH. We review the somewhat confusing PH nomenclature and the WHO classification system and rationale behind it. We then focus on left-side heart disorders that cause PH. An aging population and advances in the medical management of common cardiovascular disorders have caused the prevalence of heart failure to rise significantly, with more than one-half of patients having HFpEF. We review contemporary studies that focus on clinical and echocardiographic findings that help to distinguish HFpEF from PAH in the patient with PH. We discuss the typical, and sometimes atypical, hemodynamic profiles that characterize these two groups, review challenges in the interpretation of data obtained by right-sided heart catheterization, and highlight special maneuvers that may be required for accurate diagnosis. Finally, we review the largely disappointing studies on the use of PAH-specific therapies in patients with WHO group 2 PH, including the use of prostacyclins, endothelin receptor antagonists, and the more promising phosphodiesterase-5 inhibitors.
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Affiliation(s)
- Sif Hansdottir
- University of Iowa Carver College of Medicine, Iowa City, IA.
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139
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Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction. J Am Coll Cardiol 2013; 63:407-16. [PMID: 24291270 DOI: 10.1016/j.jacc.2013.10.063] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/08/2013] [Accepted: 10/15/2013] [Indexed: 12/30/2022]
Abstract
Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed.
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Affiliation(s)
- Siu-Hin Wan
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Mark W Vogel
- Division of Cardiovascular Diseases, Washington University, St. Louis, Missouri
| | - Horng H Chen
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.
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140
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Barron AJ, Hughes AD, Sharp A, Baksi AJ, Surendran P, Jabbour RJ, Stanton A, Poulter N, Fitzgerald D, Sever P, O'Brien E, Thom S, Mayet J. Long-term antihypertensive treatment fails to improve E/e' despite regression of left ventricular mass: an Anglo-Scandinavian cardiac outcomes trial substudy. Hypertension 2013; 63:252-8. [PMID: 24218432 DOI: 10.1161/hypertensionaha.113.01360] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the short term, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5-116.8; atenolol: 122.9-117.5; P<0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e', 7.5-7.6 cm/s; P=not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e', 8.0-8.5 cm/s; P<0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e'. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol±bendroflumethiazide compared with amlodipine±perindopril.
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Affiliation(s)
- Anthony J Barron
- Imperial College London, 59 North Wharf Rd, London W2 1LA, United Kingdom.
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141
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142
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Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study. ACTA ACUST UNITED AC 2013; 8:54-63. [PMID: 24131668 DOI: 10.1016/j.jash.2013.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/20/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] <25 kg/m(2)] and obese (n = 54; BMI ≥25 kg/m(2)). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e'), peak systolic LV circumferential strain rate, and E/e'/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e'/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s'), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e'/S-LAs in the obese patients, whereas only s' contributes to the E/e'/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms.
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Affiliation(s)
- Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan.
| | - Yoshifumi Oishi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Arata Iuchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Norio Nagase
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Nusrat Ara
- Department of Cardiology, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Takashi Oki
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
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143
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Association of a prothrombotic state with left-ventricular diastolic dysfunction in hypertension. J Hypertens 2013; 31:2077-84. [DOI: 10.1097/hjh.0b013e328362d951] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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144
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Campens L, Vanakker OM, Trachet B, Segers P, Leroy BP, De Zaeytijd J, Voet D, De Paepe A, De Backer T, De Backer J. Characterization of cardiovascular involvement in pseudoxanthoma elasticum families. Arterioscler Thromb Vasc Biol 2013; 33:2646-52. [PMID: 23968982 DOI: 10.1161/atvbaha.113.301901] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Pseudoxanthoma elasticum (PXE) is an autosomal recessive connective tissue disorder with involvement of the skin, the retina, and the cardiovascular system. Cardiovascular involvement is mainly characterized by mineralization and fragmentation of elastic fibers of blood vessels and premature atherosclerosis. We conducted an ultrasound study to investigate the cardiovascular phenotype and to propose recommendations for the management of patients with PXE and heterozygous ABCC6 mutation carriers. APPROACH AND RESULTS Thirty-two patients, 23 carriers, and 28 healthy volunteers underwent cardiac and vascular ultrasound studies. Cardiac imaging revealed left ventricular diastolic dysfunction in patients with PXE with a significantly prolonged deceleration time and lower septal early diastolic velocities of the mitral annulus compared with controls. Carriers also demonstrated significantly prolonged deceleration time. Carotid-to-femoral pulse wave velocity was significantly increased in patients with PXE when compared with carriers and controls. Vascular imaging revealed a high prevalence of peripheral artery disease in both patients and carriers and a significantly higher carotid intima-media thickness compared with controls. CONCLUSIONS The results of this study clearly demonstrate impaired left ventricular diastolic function, impairment of the elastic properties of the aorta, and a high prevalence of peripheral artery disease in patients with PXE. Carriers also seem to exhibit a cardiovascular phenotype with mainly mild diastolic dysfunction and accelerated atherosclerosis. Increased awareness for cardiovascular events in both patients and heterozygous carriers is warranted.
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Affiliation(s)
- Laurence Campens
- From the Center for Medical Genetics (L.C., O.M.V., B.P.L., A.D.P., J.D.B.), Department of Cardiology (T.D.B., J.D.B.), Department of Ophthalmology (B.P.L., J.D.Z.), and Department of Internal Medicine (D.V.), Ghent University Hospital, Ghent, Belgium; and Institute of Biomedical Technology, Ghent University, Ghent, Belgium (B.T., P.S.)
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145
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Graça B, Ferreira MJ, Donato P, Castelo-Branco M, Caseiro-Alves F. Cardiovascular magnetic resonance imaging assessment of diastolic dysfunction in a population without heart disease: a gender-based study. Eur Radiol 2013; 24:52-9. [DOI: 10.1007/s00330-013-2976-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/27/2013] [Indexed: 12/30/2022]
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146
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de Souza SBC, Rocha JA, Cuoco MAR, Guerra GM, Ferreira-Filho JC, Borile S, Krieger EM, Bortolotto LA, Consolim-Colombo FM. High muscle sympathetic nerve activity is associated with left ventricular dysfunction in treated hypertensive patients. Am J Hypertens 2013; 26:912-7. [PMID: 23475700 DOI: 10.1093/ajh/hpt032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity. METHODS After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n = 15), impaired relaxation (LV-IR, n = 15), and pseudonormal or restrictive (LV-P/R, n = 15). An age-, sex-, and body mass index-matched control group of normotensive volunteers (N, n = 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position. RESULTS Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (33±1 and 32±1 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (26±3 and 15±2 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group. CONCLUSIONS The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
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147
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López-Sánchez M, Muñoz-Esquerre M, Huertas D, Gonzalez-Costello J, Ribas J, Manresa F, Dorca J, Santos S. High Prevalence of Left Ventricle Diastolic Dysfunction in Severe COPD Associated with A Low Exercise Capacity: A Cross-Sectional Study. PLoS One 2013; 8:e68034. [PMID: 23826360 PMCID: PMC3694927 DOI: 10.1371/journal.pone.0068034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/24/2013] [Indexed: 01/28/2023] Open
Abstract
Background A subclinical left ventricle diastolic dysfunction (LVDD) has been described in patients with chronic obstructive pulmonary disease (COPD). Objectives To evaluate the prevalence of LVDD in stable severe COPD patients, to analyze its relationship with exercise capacity and to look for its possible causes (lung hyperinflation, ventricular interdependence or inflammatory mechanisms). Methods We evaluated 106 consecutive outpatients with severe COPD (FEV1 between 30–50%). Thirty-three (31%) were excluded because of previous heart disease. A pulmonary function test, a 6-minute walking test (6MWT), a Doppler echocardiography test, including diastolic dysfunction parameters, and an analysis of arterial blood gases, NT-proBNP and serum inflammatory markers (CRP, leucocytes), were performed in all patients. Results The prevalence of LVDD in severe stable COPD patients was 90% (80% type I, n=57, and 10% type II, n=7). A significant association between a lower E/A ratio (higher LVDD type I) and a lower exercise tolerance (6-minute walked distance (6MWD)) was found (r=0.29, p<0.05). The fully adjusted multivariable linear regression model demonstrated that a lower E/A ratio, a DLCO in the quartile 4th and a higher tobacco consumption were associated with a lower 6MWD (76, 57 and 0.7 metres, respectively, p<0.05). A significant correlation between E/A ratio and PaO2 was observed (r=0.26, p<0.05), but not with static lung hyperinflation, inflammation or right ventricle overload parameters. Conclusion In stable severe COPD patients, the prevalence of LVDD is high and this condition might contribute in their lower exercise tolerance. Hypoxemia could have a concomitant role in their pathogenesis.
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Affiliation(s)
- Marta López-Sánchez
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Daniel Huertas
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - José Gonzalez-Costello
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Jesús Ribas
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Federico Manresa
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Salud Santos
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
- * E-mail:
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148
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Albu A, Fodor D, Bondor C, Poantă L. Arterial stiffness, carotid atherosclerosis and left ventricular diastolic dysfunction in postmenopausal women. Eur J Intern Med 2013; 24:250-4. [PMID: 23276453 DOI: 10.1016/j.ejim.2012.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 11/04/2012] [Accepted: 11/28/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postmenopausal women have an increased cardiovascular morbidity that may be due to the increase in classical cardiovascular risk factors and also to the arterial structure and function alterations. The aim of our study was to evaluate the association of aortic pulse wave velocity (PWV), and carotid intima-media thickness (IMT), with left ventricular diastolic dysfunction (LVDD) in postmenopausal women. PATIENTS AND METHODS In 96 women without overt cardiovascular disease (age 62±7.7 years), and with normal left ventricular systolic function, aortic PWV was assessed by using an oscillometric device, intima-media thickness was measured by B-mode ultrasonography and the parameters of left ventricular diastolic function were evaluated by a transthoracic echocardiographic study. RESULTS LVDD, defined as an E/A ratio≤1 was found in 50 patients (52%). All of them had mild LVDD. In these patients we found significant increase in age (p<0.001), aortic PWV (p<0.001), carotid IMT (p=0.002) and plaque score (p=0.004) when compared with patients without LVDD. In a logistic regression analyzed, after adjusting for age, only aortic PWV was a significant predictor of LVDD (2.15, 95% CI 1.39-3.31, p=0.0006). CONCLUSIONS This study among postmenopausal women provides evidence that increased arterial stiffness as measured by aortic PWV and not carotid IMT may be a marker or a risk factor for LVDD, independent of other classical risk factors.
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Affiliation(s)
- A Albu
- 2nd Internal Medicine Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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149
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Georgiopoulou VV, Kalogeropoulos AP, Borlaug BA, Gheorghiade M, Butler J. Left Ventricular Dysfunction With Pulmonary Hypertension. Circ Heart Fail 2013; 6:344-54. [DOI: 10.1161/circheartfailure.112.000095] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vasiliki V. Georgiopoulou
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Andreas P. Kalogeropoulos
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Barry A. Borlaug
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Mihai Gheorghiade
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Javed Butler
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
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150
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Sahin T, Celikyurt U, Kilic T, Kahraman G, Kozdag G, Agacdiken A, Ural E, Ural D. Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: an echocardiographic long-term follow-up study. Med Sci Monit 2013; 18:MT79-84. [PMID: 23018362 PMCID: PMC3560558 DOI: 10.12659/msm.883472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period. MATERIAL/METHODS Our study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined. RESULTS Relaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E' ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver. CONCLUSIONS Respiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.
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Affiliation(s)
- Tayfun Sahin
- Kocaeli University, Medical Faculty, Department of Cardiology, Kocaeli, Turkey.
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