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Bradley CR, Cox EF, Scott RA, James MW, Kaye P, Aithal GP, Francis ST, Guha IN. Multi-organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging. J Hepatol 2018; 69:1015-1024. [PMID: 29886155 DOI: 10.1016/j.jhep.2018.05.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit vs. harm for therapies. Our aim was to establish the feasibility of magnetic resonance imaging (MRI) to assess changes in Compensated Cirrhosis (CC), and relate this to disease severity and future liver-related outcomes (LROs). METHODS A total of 60 patients with CC, 40 healthy volunteers and 7 patients with decompensated cirrhosis were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time, heart rate, cardiac index, and volume assessment of the liver, spleen and kidneys. We explored the association between MRI parameters and disease severity, analysing differences in baseline MRI parameters in the 11 (18%) patients with CC who experienced future LROs. RESULTS In the liver, compositional changes were reflected by increased T1 in progressive disease (p <0.001) and an increase in liver volume in CC (p = 0.006), with associated progressive reduction in liver (p <0.001) and splenic (p <0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial blood flow was seen with increasing disease severity. Baseline liver T1 (p = 0.01), liver perfusion (p <0.01), and renal cortex T1 (p <0.01) were significantly different in patients with CC who subsequently developed negative LROs. CONCLUSIONS MRI enables the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement for a contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and superior mesenteric arterial blood flow were related to the risk of LROs. LAY SUMMARY This study assesses the changes to structure, blood flow and perfusion that occur in the key organs (liver, spleen and kidney) associated with severe liver disease (Compensated Cirrhosis), using magnetic resonance imaging. The magnetic resonance imaging measures which changed with disease severity and were related to negative liver-related clinical outcomes are described.
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Affiliation(s)
- Christopher R Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK; NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK; NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Robert A Scott
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Martin W James
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Phillip Kaye
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK; NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Indra Neil Guha
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
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102
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Parashar A, Hundley WG. The Role of Cardiovascular Magnetic Resonance for Surveillance of Cardiac Performance upon Receipt of Potentially Cardiotoxic Cancer Therapeutics. Curr Cardiol Rep 2018; 20:142. [PMID: 30367282 DOI: 10.1007/s11886-018-1075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Advancements in cancer treatment have resulted in improved cancer-related survival and consequently an increase in the number of cancer survivors. Unfortunately, associated with this increase in cancer-related survivorship, cardiac events have occurred with increasing frequency in cancer survivors. Recognition that cancer survivors are at increased risk for cardiovascular (CV) morbidity has generated interest to develop cardiac imaging techniques that identify subclinical CV disease during receipt of potentially cardiotoxic cancer treatment. Since subclinical cardiovascular disease precedes future cardiac events, early recognition of subclinical CV disease during receipt of potentially cardiotoxic cancer treatment offers the opportunity to initiate strategies that prevent further evolution of subclinical CV disease as well as cardiac events. RECENT FINDINGS Cardiovascular magnetic resonance imaging (CMR) is an advanced imaging technique that identifies imaging markers of subclinical cardiovascular disease in patients receiving potentially cardiotoxic cancer treatment regimens. In this article, we review the use of CMR for identifying subclinical cardiac disease in patients receiving potentially cardiotoxic cancer treatment regimens. The ability of contemporary CMR to accurately define cardiac anatomy, function, and tissue characteristics may represent a critical tool to assess patients with cancer.
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Affiliation(s)
- Amitabh Parashar
- Section of Cardiology, Veterans Affairs Medical Center, Salem, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - W Gregory Hundley
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Radiological Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Internal Medicine, Virginia Commonwealth Health Sciences, Richmond, VA, USA. .,Department of Radiological Sciences, Virginia Commonwealth Health Sciences, Richmond, VA, USA. .,Department of Internal Medicine, Section on Cardiovascular Medicine, VCU Health Pauley Heart Center, Virginia Commonwealth University, Gateway bldg. 1200 E Marshall St, Richmond, VA, 23298, USA.
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103
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Chacko S, Redfearn D. One Size Fits All? Ethnicity and Electrocardiographic Criteria for Cardiac Hypertrophy. Can J Cardiol 2018; 34:1104-1107. [PMID: 30170665 DOI: 10.1016/j.cjca.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sanoj Chacko
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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104
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Winau L, Hinojar Baydes R, Braner A, Drott U, Burkhardt H, Sangle S, D'Cruz DP, Carr-White G, Marber M, Schnoes K, Arendt C, Klingel K, Vogl TJ, Zeiher AM, Nagel E, Puntmann VO. High-sensitive troponin is associated with subclinical imaging biosignature of inflammatory cardiovascular involvement in systemic lupus erythematosus. Ann Rheum Dis 2018; 77:1590-1598. [PMID: 30077990 DOI: 10.1136/annrheumdis-2018-213661] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiovascular (CV) involvement in patients with systemic lupus erythematosus (SLE) is presumably subclinical for the major part of its evolution. We evaluated the associations between high-sensitive troponin T (hs-TropT), a sensitive marker of myocardial injury, and CV involvement using cardiac magnetic resonance (CMR). METHODS AND RESULTS This is a two-centre (London and Frankfurt) CMR imaging study at 3.0 Tesla of consecutive 92 patients with SLE free of cardiac symptoms, undergoing screening for cardiac involvement. Venous samples were drawn and analysed post-hoc for cardiac biomarkers, including hs-TropT, high-sensitive C reactive protein and N-terminal pro brain natriuretic peptide. Compared with age-matched/gender-matched non-SLE controls (n=78), patients had significantly raised cardiac biomarker levels, native T1 and T2, aortic and ventricular stiffness, and reduced global longitudinal strain (p<0.01). In SLE, hs-TropT was significantly and independently associated with native T2, followed by the models including native T1 and aortic stiffness (Χ2 0.462, p<0.01). There were no relationships between hs-TropT and age, gender, CV risk factors, duration of systemic disease, cardiac structure or function, or late gadolinium enhancement. CONCLUSIONS Patients with SLE have a high prevalence of subclinical myocardial injury as demonstrated by raised high-sensitive troponin levels. CMR with T2 mapping reveals myocardial oedema as the strongest predictor of hs-TropT release, underscoring the inflammatory interstitial remodelling as the main mechanism of injury. Patients without active myocardial inflammation demonstrate diffuse interstitial remodelling and increased vascular stiffness. These findings substantiate the role of CMR in screening of subclinical cardiac involvement. TRIAL REGISTRATION NUMER NCT02407197; Results.
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Affiliation(s)
- Lea Winau
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Rocio Hinojar Baydes
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - Axel Braner
- Department of Rheumatology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrich Drott
- Department of Rheumatology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Harald Burkhardt
- Department of Rheumatology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Shirish Sangle
- The Louise Coote Lupus Unit, St Thomas' Hospital, London, UK
| | - David P D'Cruz
- The Louise Coote Lupus Unit, St Thomas' Hospital, London, UK
| | | | - Mike Marber
- Cardiovascular Sciences, King's College London, London, UK
| | - Katrin Schnoes
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christophe Arendt
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Thomas J Vogl
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, St Thomas' Hospital, London, UK.,Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
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105
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Kwon Y, Jacobs DR, Lutsey PL, Brumback L, Chirinos JA, Mariani S, Redline S, Duprez DA. "Sleep disordered breathing and ECG R-wave to radial artery pulse delay, The Multi-Ethnic Study of Atherosclerosis". Sleep Med 2018; 48:172-179. [PMID: 29960211 PMCID: PMC6051731 DOI: 10.1016/j.sleep.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrocardiography R-wave to radial artery pulse delay (RRD) represents pulse transit time inclusive of pre-ejection period (PEP) and arterial pulse propagation time. RRD is proposed to largely reflect arterial stiffness when PEP is accounted for (shorter RRD = higher arterial stiffness). Sleep disordered breathing (SDB) causes intermittent hypoxemia and sympathetic activation, which negatively influences vascular function. We aimed to examine the association of measures of SDB with RRD. METHODS Our sample consisted of participants in the Multi-Ethnic Study of Atherosclerosis without prevalent cardiovascular disease who underwent a daytime arterial elasticity exam, cardiac magnetic resonance imaging (MRI), and overnight polysomnography. SDB measures of interest included apnea hypopnea index (AHI) and oxygen desaturation index (ODI) (N = 1173). RRD was regressed on each measure of SDB separately, with adjustment for other cardiovascular risk factors as well as for correlates of the PEP, another component of RRD, by including cardiac MRI measures of contractility and preload. RESULTS In multivariate analysis, among measures of SDB, ODI, a marker of intermittent hypoxemia, was inversely associated with RRD (β = -60.2 msec per SD [15.5/hr], p = 0.04). No significant association was found with AHI. In gender stratified analyses, ODI and AHI were predictive of RRD in men only (β = -111.3 msec per SD [15.5/hr], p = 0.01 and β = -100.3 msec per SD [16.1/hr], p = 0.02 respectively). CONCLUSION Severity of SDB as measured by ODI was associated with RRD, a marker of arterial stiffness. Thus, association of RRD with measures of SDB appears to be gender-dependent.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Lyndia Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sara Mariani
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Daniel A. Duprez
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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106
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Yoneyama K, Venkatesh BA, Wu CO, Mewton N, Gjesdal O, Kishi S, McClelland RL, Bluemke DA, Lima JAC. Diabetes mellitus and insulin resistance associate with left ventricular shape and torsion by cardiovascular magnetic resonance imaging in asymptomatic individuals from the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson 2018; 20:53. [PMID: 30064457 PMCID: PMC6069876 DOI: 10.1186/s12968-018-0472-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although diabetes mellitus (DM) and insulin resistance associate with adverse cardiac events, the associations of left ventricular (LV) remodeling and function with compromised glucose metabolism have not been fully evaluated in a general population. We used cardiovascular magnetic resonance (CMR) to evaluate how CMR indices are associated with DM or insulin resistance among participants before developing cardiac events. METHODS We studied 1476 participants who were free of clinical cardiovascular disease and who underwent tagged CMR in the Multi-Ethnic Study of Atherosclerosis (MESA). LV shape and longitudinal myocardial shortening and torsion were assessed by CMR. A higher sphericity index represents a more spherical LV shape. Multivariable linear regression was used to evaluate the associations of DM or homeostasis model assessment-estimated insulin resistance (HOMA-IR) with CMR indices. RESULTS In multiple linear regression, longitudinal shortening was lower in impaired fasting glucose than normal fasting glucose (NFG) (0.36% lower vs. NFG, p < 0.05); torsion was greater in treated DM (0.24 °/cm greater vs. NFG, p < 0.05) after full adjustments. Among participants without DM, greater log-HOMA-IR was correlated with greater LV mass (3.92 g/index, p < 0.05) and LV mass-to-volume ratio (0.05 /index, p < 0.01), and lower sphericity index (- 1.26/index, p < 0.01). Greater log-HOMA IR was associated with lower longitudinal shortening (- 0.26%/index, p < 0.05) and circumferential shortening (- 0.30%/index, p < 0.05). Torsion was positively correlated with log-HOMA-IR until 1.5 of log-HOMA-IR (0.16 °/cm/index, p = 0.030).), and tended to fall once above 1.5 of log-HOMA-IR (- 0.50 °/cm/index, p = 0.203). The sphericity index was associated negatively with LV mass-to-volume ratio (- 0.02/%, p < 0.001) and torsion (- 0.03°/cm/%, p < 0.001). CONCLUSIONS Glucose metabolism disorders are associated with LV concentric remodeling, less spherical shape, and reduced systolic myocardial shortening in the general population. Although torsion is higher in participants who are treated for DM and impaired insulin resistance, myocardial shortening was progressively decreased with higher HOMA-IR and torsion was increased only with less severe insulin resistance. CLINICAL TRIAL REGISTRATION Multi-Ethnic Study of Atherosclerosis (MESA): A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org/ . Study Start Date: January 1999 ( NCT00005487 ).
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Affiliation(s)
- Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Colin O. Wu
- Offices of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Nathan Mewton
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | - Ola Gjesdal
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | - Satoru Kishi
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | | | - David A. Bluemke
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD USA
| | - João A. C. Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
- Radiology and Epidemiology, Johns Hopkins University, Blalock 524D1, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 USA
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107
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Kotha VK, Deva DP, Connelly KA, Freeman MR, Yan RT, Mangat I, Kirpalani A, Barfett JJ, Sloninko J, Lin HM, Graham JJ, Crean AM, Jimenez-Juan L, Dorian P, Yan AT. Cardiac MRI and radionuclide ventriculography for measurement of left ventricular ejection fraction in ICD candidates. Magn Reson Imaging 2018; 52:69-74. [PMID: 29859946 DOI: 10.1016/j.mri.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/26/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Current guidelines provide left ventricular ejection fraction (LVEF) criterion for use of implantable cardioverter defibrillators (ICD) but do not specify which modality to use for measurement. We compared LVEF measurements by radionuclide ventriculography (RNV) vs cardiac MRI (CMR) in ICD candidates to assess impact on clinical decision making. METHODS This single-centre study included 124 consecutive patients referred for assessment of ICD implantation who underwent RNV and CMR within 30 days for LVEF measurement. RNV and CMR were interpreted independently by experienced readers. RESULTS Among 124 patients (age 64 ± 11 years, 77% male), median interval between CMR and RNV was 1 day; mean LVEF was 32 ± 12% by CMR and 33 ± 11% by RNV (p = 0.60). LVEF by CMR and RNV showed good correlation, but Bland-Altman analysis showed relatively wide limits of agreement (-12.1 to 11.4). CMR LVEF reclassified 26 (21%) patients compared to RNV LVEF (kappa = 0.58). LVEF by both modalities showed good interobserver reproducibility (ICC 0.96 and 0.94, respectively) (limits of agreement -7.27 to 5.75 and -8.63 to 6.34, respectively). CONCLUSION Although LVEF measurements by CMR and RNV show moderate agreement, there is frequent reclassification of patients for ICD placement based on LVEF between these modalities. Future studies should determine if a particular imaging modality for LVEF measurement may enhance ICD decision making and treatment benefit.
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Affiliation(s)
- Vamshi K Kotha
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Djeven P Deva
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Kim A Connelly
- University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Michael R Freeman
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Iqwal Mangat
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Anish Kirpalani
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Joseph J Barfett
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Joanna Sloninko
- Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Hui Ming Lin
- Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - John J Graham
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Andrew M Crean
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging and Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Paul Dorian
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Strand LN, Young RL, Bertoni AG, Bluemke DA, Burke GL, Lima JA, Sotoodehnia N, Psaty BM, McClelland RL, Heckbert SR, Delaney JA. New statin use and left ventricular structure: Estimating long-term associations in the Multi-Ethnic Study of Atherosclerosis (MESA). Pharmacoepidemiol Drug Saf 2018; 27:570-580. [PMID: 29380457 PMCID: PMC5984180 DOI: 10.1002/pds.4389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Only small and short-term studies have evaluated statins in relation to changes in heart structure. We estimated the association between new statin use and 10-year remodeling of the left ventricle. METHODS The Multi-Ethnic Study of Atherosclerosis collected data on statin use over approximately 10 years, conducting cardiac magnetic resonance (CMR) imaging at baseline and the 10-year exam. Participants were free of baseline cardiovascular disease, and we excluded users of statins at baseline. Statin initiation was defined as a report of current use at any of the 4 subsequent exams. Primary outcomes were the change in left ventricular mass index (LVMI; % predicted by height, weight, and sex) and mass-to-volume ratio. Associations were estimated in a propensity score-matched analysis. RESULTS A total of 3113 participants (53% female; 40% European-American, 25% African-American, 22% Hispanic-American, and 13% Chinese-American) were eligible; 2431 returned for follow-up CMR imaging after a median of 9.4 years. Statin therapy (moderate dose, 76%) was started by 36% of participants (N = 872). We excluded 42 participants with incident myocardial infarction. Compared with nonuse, statin use was associated with less 10-year progression in LVMI (-2.35 percentage points; 95% CI, -4.24 to -0.47; P = .01) and mass-to-volume ratio (-0.03 absolute difference; 95% CI, -0.07 to -0.00; P = .02); effects were small in magnitude. A dose response was observed: Higher statin dose was associated with less LVMI progression. CONCLUSIONS In contrast to previous small studies, we found very modest associations between statin use and indices of left ventricular remodeling over 10 years in this prospective study of a diverse cohort.
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Affiliation(s)
| | - Rebekah L Young
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alain G Bertoni
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, Bethesda, MD, USA
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Gregory L Burke
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joao A Lima
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Cardiology, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Robyn L McClelland
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joseph A Delaney
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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109
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Jagsi R, Griffith KA, Moran JM, Ficaro E, Marsh R, Dess RT, Chung E, Liss AL, Hayman JA, Mayo CS, Flaherty K, Corbett J, Pierce L. A Randomized Comparison of Radiation Therapy Techniques in the Management of Node-Positive Breast Cancer: Primary Outcomes Analysis. Int J Radiat Oncol Biol Phys 2018; 101:1149-1158. [PMID: 30012527 DOI: 10.1016/j.ijrobp.2018.04.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Edward Ficaro
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Eugene Chung
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Adam L Liss
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kevin Flaherty
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - James Corbett
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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110
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Eyeington CT, Ancona P, Cioccari L, Luethi N, Glassford NJ, Eastwood GM, Proimos HK, Franceschi F, Chan MJ, Jones D, Bellomo R. Non-Invasive Estimation of Cardiac Index in Healthy Volunteers. Anaesth Intensive Care 2018; 46:290-296. [DOI: 10.1177/0310057x1804600306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The primary objective was to non-invasively measure the cardiac index (CI) and associated haemodynamic parameters of healthy volunteers and their changes with age. This was a single centre, prospective, observational study of healthy volunteers aged between 20 and 59 years, using the ClearSight™ (Edwards Life Sciences, Irvine, CA, USA) device. We recorded 514 observations in 97 participants. The mean CI was 3.5 l/min/m2 (95% confidence interval [95% CI] 3.4 to 3.7 l/min/m2). The mean stroke volume index (SVI) was 47 ml/m2 (95% CI 45 to 49 ml/m2) and the mean systemic vascular resistance index was 2,242 dyne·s/cm5/m2 (95% CI 2,124 to 2,365 dyne·s/cm5/m2). There was an inverse linear relationship between increasing age and CI (P <0.0001), which decreased by 0.044 l/min/m2 (95% CI −0.032 to −0.056 l/min/m2) per year. This change was mostly due to a decrease in SVI of 0.45 ml/m2 (95% CI 0.32 to 0.57 ml/m2) per year (P <0.0001). The mean CI of young healthy humans is approximately 3.5 l/min/m2 and declines by approximately 40 ml/min/m2 per year, mostly due to a decline in stroke volume (SV). These findings have significant implications regarding the clinical interpretation of haemodynamic parameters and the application of these results to individual patients.
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Affiliation(s)
- C. T. Eyeington
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - P. Ancona
- Intensive Care, Austin Hospital, Melbourne, Victoria
| | - L. Cioccari
- Intensive Care, Austin Hospital, Melbourne, Victoria
| | - N. Luethi
- Intensive Care, Austin Hospital, Melbourne, Victoria
| | - N. J. Glassford
- Department of Anaesthesia, Austin Hospital; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University; Melbourne, Victoria
| | | | - H. K. Proimos
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - F. Franceschi
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - M. J. Chan
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - D. Jones
- Consultant Intensivist, Associate Professor of Intensive Care, Department of Intensive Care, Austin Hospital; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University; Melbourne, Victoria
| | - R. Bellomo
- Consultant Intensivist, Professor of Intensive Care, Director of Intensive Care Research, Department of Intensive Care, Austin Hospital; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University; Department of Medicine, Melbourne University; Melbourne, Victoria
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111
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Seng MC, Shen X, Wang K, Chong DT, Fam JM, Hamid N, Amanullah MR, Yeo KK, Ewe SH, Chua TS, Ding ZP, Sahlén A. Allometric Relationships for Cardiac Size and Longitudinal Function in Healthy Chinese Adults - Normal Ranges and Clinical Correlates. Circ J 2018; 82:1836-1843. [PMID: 29695648 DOI: 10.1253/circj.cj-18-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac size measurements require indexing to body size. Allometric indexing has been investigated in Caucasian populations but a range of different values for the so-called allometric power exponent (b) have been proposed, with uncertainty as to whether allometry offers clinical utility above body surface area (BSA)-based indexing. We derived optimal values for b in normal echocardiograms and validated them externally in cardiac patients. METHODS AND RESULTS Values for b were derived in healthy adult Chinese males (n=1,541), with optimal b for left ventricular mass (LVM) of 1.66 (95% confidence interval 1.41-1.92). LV hypertrophy (LVH) defined as indexed LVM >75 g/m1.66 was associated with adverse outcomes in an external validation cohort (n=738) of patients with acute coronary syndrome (odds ratio for reinfarction: 2.4 (1.1-5.4)). In contrast, LVH defined by BSA-based indexing or allometry using exponent 2.7 exhibited no significant association with outcomes (P=NS for both). Cardiac longitudinal function also varied with body size: septal and RV free wall s', TAPSE and lateral e' all scaled allometrically (b=0.3-0.9). CONCLUSIONS An optimal b of 1.66 for LVM in healthy Chinese was found to validate well, with superior clinical utility both to that of BSA-based indexing and to b=2.7. The effect of allometric indexing of cardiac function requires further study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anders Sahlén
- National Heart Centre Singapore.,Karolinska Institutet
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112
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Akintoye E, Mahmoud K, Shokr M, Sandio A, Mallikethi-Reddy S, Sheikh M, Adegbala O, Egbe A, Briasoulis A, Afonso L. Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease. Clin Cardiol 2018; 41:502-509. [PMID: 29663526 DOI: 10.1002/clc.22914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/07/2018] [Accepted: 01/30/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Evidence exists for racial/ethnic differences in left ventricular mass index (LVMI). How this translates to future cardiovascular disease (CVD) events is unknown. HYPOTHESIS The impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes could have potential implications for the optimization of risk stratification strategies. METHODS Using the prospectively collected database of the Multi-Ethnic Study of Atherosclerosis (MESA) involving 4 racial/ethnic groups (non-Hispanic Whites, Chinese, Blacks, and Hispanics) free of CVD at baseline, we assessed for racial/ethnic differences in the relationship between LVMI and incident CVD using a Cox model. RESULTS 5004 participants (mean age, 62 ± 10 years; 48% male) were included in this study. After an average follow-up of 10.2 years, 369 (7.4%) CVD events occurred. Significant racial/ethnic differences existed in the relationship between LVMI and incident CVD (P for interaction = 0.04). Notably, the relationship was strongest for Chinese (HR per 10-unit increase in LVMI: 1.7, 95% CI: 1.1-2.8) and Hispanics (HR per 10-unit increase in LVMI: 1.9, 95% CI: 1.5-2.2). Non-Hispanic Whites demonstrated the lowest relationship (HR: 1.3, 95% CI: 1.1-1.5). LVMI values of 36.9 g/m2.7 , 31.8 g/m2.7 , 39.9 g/m2.7 , and 41.7 g/m2.7 were identified as optimal cutpoints for defining left ventricular hypertrophy (LVH) for non-Hispanic Whites, Chinese, Blacks, and Hispanics, respectively. In secondary analysis of LVH (vs no LVH) using these optimal cutpoints, we found a similar pattern of association as above (P for interaction = 0.04). For example, compared with those without LVH, Chinese with LVH had HR: 5.3, 95% CI: 1.6-17, whereas non-Hispanic Whites with LVH had HR: 1.6, 95% CI: 1.2-2.1 for CVD events. CONCLUSIONS Among 4 races/ethnicities studied, LVMI has more prognostic utility predicting future CVD events for Chinese and Hispanics and is least significant for non-Hispanic Whites.
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Affiliation(s)
- Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Karim Mahmoud
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohamed Shokr
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Aubin Sandio
- Wayne State University School of Medicine, Detroit, Michigan
| | | | - Muhammad Sheikh
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Oluwole Adegbala
- Englewood Hospital and Medical Center/Seton Hall University, Englewood, New Jersey
| | - Alexander Egbe
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplant, University of Iowa, Iowa City, Iowa
| | - Luis Afonso
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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113
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Bülow R, Ittermann T, Dörr M, Poesch A, Langner S, Völzke H, Hosten N, Dewey M. Reference ranges of left ventricular structure and function assessed by contrast-enhanced cardiac MR and changes related to ageing and hypertension in a population-based study. Eur Radiol 2018. [PMID: 29541910 DOI: 10.1007/s00330-018-5345-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Reference ranges of left ventricular (LV) parameters from cardiac magnetic resonance (CMR) were established to investigate the impact of ageing and hypertension as important determinants of cardiac structure and function. METHODS One thousand five hundred twenty-five contrast-enhanced CMRs were conducted in the Study of Health in Pomerania. LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), ejection fraction (LVEF), and myocardial mass (LVMM) were determined using long- and short-axis steady-state free-precession sequences. The reference population was defined as participants without late enhancement, hypertension, and prior cardiovascular diseases. Reference ranges were established by quantile regression (5th and 95th percentile) and compared with an additional sample of treated and untreated hypertensives. RESULTS LV volumes in the reference population (n = 634, 300 males, 334 females, 52.1 ± 13.3 years) aged between 20-69 years were lower with higher age (p = 0.001), whereas LVEFs were higher (p ≤ 0.020). LVMM was lower only in males (p = 0.002). Compared with the reference population, hypertension was associated with lower LVEDV in males (n = 258, p ≤ 0.032). Antihypertensive therapy was associated with higher LVEF in males (n = 258, +2.5%, p = 0.002) and females (n = 180, +2.1%, p = 0.001). CONCLUSIONS Population-based LV reference ranges were derived from contrast-enhanced CMR. Hypertension-related changes were identified by comparing these values with those of hypertensives, and they might be used to monitor cardiac function in these patients. KEY POINTS • Left ventricular function changed slightly but significantly between 20-69 years. • Reference values of BSA-indexed myocardial mass decreased with age in males. • Hypertension was associated with lower LV end-diastolic volume only in males. • CMR may allow assessing remodelling related to hypertension or antihypertensive treatment.
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Affiliation(s)
- Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany.
| | - Till Ittermann
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine, Ernst Moritz Arndt University Greifswald, Walther Rathenau Str. 48, 17475, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine, Ernst Moritz Arndt University, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Greifswald, Germany
| | - Axel Poesch
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine, Ernst Moritz Arndt University, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - Sönke Langner
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine, Ernst Moritz Arndt University Greifswald, Walther Rathenau Str. 48, 17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Greifswald, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany
| | - Marc Dewey
- Institute for Radiology, Charité Medical School, Charitéplatz 1, 10117, Berlin, Germany
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114
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Lolli L, Batterham AM, Atkinson G. Ejection fraction as a statistical index of left ventricular systolic function: the first full allometric scrutiny of its appropriateness and accuracy. Clin Physiol Funct Imaging 2018; 38:976-985. [PMID: 29460366 DOI: 10.1111/cpf.12510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/15/2018] [Indexed: 11/28/2022]
Abstract
Left ventricular ejection fraction (EF) is a ratio that is deemed to accurately normalize stroke volume (SV) to end-diastolic volume (EDV). Ratios are now well-recognized for not normalizing the numerator, in this case SV, consistently for the denominator, EDV. We aimed to provide the first allometric-based scrutiny of the conventional assumptions that underpin the EF ratio. We allometrically modelled untransformed SV and EDV measurements from 112 preclinical heart failure patients in the Multi-Ethnic Study of Atherosclerosis (MESA), and 864 chronic heart failure patients in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. An information-theoretic approach was adopted to assess the relative quality of twelve candidate models for normalizing SV to EDV. None of the conventional underlying assumptions for accurate ratio normalization, for example an allometric exponent ≈1, were upheld for EF. A two-parameter power function with normal, heteroscedastic error was the best model for scaling SV to EDV in both samples. The allometric exponent (95% confidence interval) was 0·776 (0·682 to 0·869) in MESA, and 0·860 (0·857 to 0·864) in TOPCAT. EF was inversely correlated with EDV in MESA (r = -0·67, 95% CI: -0·76 to -0·55) and TOPCAT (r = -0·41, 95% CI: -0·46 to -0·35). Consequently, for fundamental statistical reasons, EF was biased low for people with generally larger EDVs, and vice versa. For the first time, we have demonstrated that EF is an inaccurate statistic for scaling SV to EDV, leading to potential biased inferences for research and individual patients.
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Affiliation(s)
- Lorenzo Lolli
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Alan M Batterham
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
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115
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Moazzami K, Ostovaneh MR, Ambale Venkatesh B, Habibi M, Yoneyama K, Wu C, Liu K, Pimenta I, Fitzpatrick A, Shea S, McClelland RL, Heckbert S, Gottesman RF, Bluemke DA, Hughes TM, Lima JAC. Left Ventricular Hypertrophy and Remodeling and Risk of Cognitive Impairment and Dementia: MESA (Multi-Ethnic Study of Atherosclerosis). Hypertension 2018; 71:429-436. [PMID: 29378853 DOI: 10.1161/hypertensionaha.117.10289] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/18/2017] [Accepted: 12/19/2017] [Indexed: 12/20/2022]
Abstract
Limited information exists on the longitudinal association between the left ventricular (LV) structure and function and future cognitive impairment and dementia in a large population without clinically recognized cardiovascular disease at baseline. The aim of the present study was to investigate the association between cardiac structure and function and risk of dementia and cognitive impairment in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. Measures of LV structure and function were determined using magnetic resonance imaging at baseline in 4999 participants free of clinically diagnosed cardiovascular disease and dementia. Probable incident clinical dementia was ascertained from hospitalization discharge records. Cognitive function was evaluated using tests addressing global cognitive function, processing speed, and memory. Associations of measures of LV structure and function with the incidence of clinically diagnosed dementia and cognitive performance were evaluated using Cox proportional hazard regression models adjusted for demographics, cardiovascular risk factors, and cardiovascular events. During a median follow-up of 12 years, 130 probable incident dementia cases were documented. Higher LV mass index (hazard ratio, 1.01; 95% confidence interval, 1.00-1.02) and LV mass-to-volume ratio (hazard ratio, 2.37; 95% confidence interval, 1.25-4.43) were independently associated with incident dementia and impaired cognitive function. Measures of LV function were not associated with risk of dementia or cognitive impairment. In conclusion, in a multiethnic cohort of participants without clinically detected cardiovascular disease and dementia at baseline, LV hypertrophy and concentric remodeling were independently associated with incident dementia and cognitive impairment.
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Affiliation(s)
- Kasra Moazzami
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Mohammad Reza Ostovaneh
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Bharath Ambale Venkatesh
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Mohammadali Habibi
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Kihei Yoneyama
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Colin Wu
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Kiang Liu
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Isabel Pimenta
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Annette Fitzpatrick
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Steven Shea
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Robyn L McClelland
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Susan Heckbert
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Rebecca F Gottesman
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - David A Bluemke
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - Timothy M Hughes
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.)
| | - João A C Lima
- From the Department of Cardiology (K.M., M.R.O., B.A.V., M.H., K.Y., I.P., J.A.C.L.) and Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Department of Medicine, Rutgers New Jersey Medical School, State University of New Jersey, Newark (K.M.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.L.); Department of Family Medicine, School of Medicine (A.F.), Department of Epidemiology, School of Medicine (A.F.), Department of Global Health, School of Public Health (A.F.), Department of Biostatistics (R.L.M.), and Department of Epidemiology (S.H.), University of Washington, Seattle; Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY (S.S.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (T.M.H.).
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116
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Hui TH, McClelland RL, Allison MA, Rodriguez CJ, Kronmal RA, Heckbert SR, Michos ED, Barter PJ, Rye KA, Ong KL. The relationship of circulating fibroblast growth factor 21 levels with incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2017; 269:86-91. [PMID: 29351855 DOI: 10.1016/j.atherosclerosis.2017.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Elevated circulating levels of fibroblast growth factor 21 (FGF21) are associated with multiple cardiovascular disease (CVD) risk factors and incident events. Previous small cross-sectional studies, mainly in Chinese populations, have suggested FGF21 may play a role in the development of atrial fibrillation (AF). We therefore investigated the relationship of FGF21 levels with incident AF in participants free of clinically apparent CVD at baseline in a large, multi-ethnic cohort. METHODS A total of 5729 participants of four major ethnic groups (Caucasian, African American, Hispanic American, and Chinese American) from the Multi-Ethnic Study of Atherosclerosis (MESA), who were free of AF and had plasma FGF21 levels measured by ELISA at the baseline exam, were included in the analysis. Participants were followed up for incident AF over a median period of 12.9 years. Cox proportional hazards regression analysis was used. RESULTS Among the 5729 participants, 778 participants developed incident AF. Participants with incident AF had significantly higher baseline FGF21 levels than those without incident AF (median = 166.0 and 142.8 pg/mL, p < 0.001). After adjusting for possible confounders, including demographic, socioeconomic and lifestyle factors, traditional CVD risk factors and circulating inflammatory markers, higher baseline FGF21 levels did not predict incident AF over the follow up period. There was no effect modification by sex or ethnicity. CONCLUSIONS Baseline FGF21 levels were not associated with the development of AF in an ethnically diverse population followed long-term. Our findings do not support an important role of FGF21 in AF development.
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Affiliation(s)
- Tsz Him Hui
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Susan R Heckbert
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kwok Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
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117
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Chen TK, Katz R, Estrella MM, Gutierrez OM, Kramer H, Post WS, Shlipak MG, Wassel CL, Peralta CA. Association Between APOL1 Genotypes and Risk of Cardiovascular Disease in MESA (Multi-Ethnic Study of Atherosclerosis). J Am Heart Assoc 2017; 6:JAHA.117.007199. [PMID: 29269352 PMCID: PMC5779033 DOI: 10.1161/jaha.117.007199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background APOL1 genetic variants confer an increased risk for kidney disease. Their associations with cardiovascular disease (CVD) are less certain. We aimed to compare the prevalence of subclinical CVD and incidence of atherosclerotic CVD and heart failure by APOL1 genotypes among self‐identified black participants of MESA (Multi‐Ethnic Study of Atherosclerosis). Methods and Results Cross‐sectional associations of APOL1 genotypes (high‐risk=2 alleles; low‐risk=0 or 1 allele) with coronary artery calcification, carotid‐intimal media thickness, and left ventricular mass were evaluated using logistic and linear regression. Longitudinal associations of APOL1 genotypes with incident myocardial infarction, stroke, coronary heart disease, and congestive heart failure were examined using Cox regression. We adjusted for African ancestry, age, and sex. We also evaluated whether hypertension or kidney function markers explained the observed associations. Among 1746 participants with APOL1 genotyping (mean age 62 years, 55% women, mean cystatin C–based estimated glomerular filtration rate 89 mL/min per 1.73 m2, 12% with albuminuria), 12% had the high‐risk genotypes. We found no difference in prevalence or severity of coronary artery calcification, carotid‐intimal media thickness, or left ventricular mass by APOL1 genotypes. The APOL1 high‐risk group was 82% more likely to develop incident heart failure compared with the low‐risk group (95% confidence interval, 1.01–3.28). Adjusting for hypertension (hazard ratio, 1.80; 95% confidence interval, 1.00–3.24) but not markers of kidney function (hazard ratio, 1.86; 95% confidence interval, 1.03–3.35) slightly attenuated this association. The APOL1 high‐risk genotypes were not significantly associated with other clinical CVD outcomes. Conclusions Among blacks without baseline CVD, the APOL1 high‐risk variants may be associated with increased risk for incident heart failure but not subclinical CVD or incident clinical atherosclerotic CVD.
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Affiliation(s)
- Teresa K Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronit Katz
- Department of Medicine, Kidney Research Institute, University of Washington, Seattle, WA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Orlando M Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, AL
| | - Holly Kramer
- Division of Nephrology, Departments of Medicine and Public Health Sciences, Loyola University, Maywood, IL
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Colchester, VT
| | - Carmen A Peralta
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
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118
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MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK, Ford I, Sever P, Mackenzie IS, Padmanabhan S, McCann GP, Salsbury J, McInnes G, Brown MJ. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial. J Am Heart Assoc 2017; 6:e006986. [PMID: 29151036 PMCID: PMC5721778 DOI: 10.1161/jaha.117.006986] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Guidelines for hypertension vary in their preference for initial combination therapy or initial monotherapy, stratified by patient profile; therefore, we compared the efficacy and tolerability of these approaches. METHODS AND RESULTS We performed a 1-year, double-blind, randomized controlled trial in 605 untreated patients aged 18 to 79 years with systolic blood pressure (BP) ≥150 mm Hg or diastolic BP ≥95 mm Hg. In phase 1 (weeks 0-16), patients were randomly assigned to initial monotherapy (losartan 50-100 mg or hydrochlorothiazide 12.5-25 mg crossing over at 8 weeks), or initial combination (losartan 50-100 mg plus hydrochlorothiazide 12.5-25 mg). In phase 2 (weeks 17-32), all patients received losartan 100 mg and hydrochlorothiazide 12.5 to 25 mg. In phase 3 (weeks 33-52), amlodipine with or without doxazosin could be added to achieve target BP. Hierarchical primary outcomes were the difference from baseline in home systolic BP, averaged over phases 1 and 2 and, if significant, at 32 weeks. Secondary outcomes included adverse events, and difference in home systolic BP responses between tertiles of plasma renin. Home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7-6.0 mm Hg) less over 32 weeks (P<0.001) than after initial combination but caught up at 32 weeks (difference 1.2 mm Hg [range: -0.4 to 2.8 mm Hg], P=0.13). In phase 1, home systolic BP response to each monotherapy differed substantially between renin tertiles, whereas response to combination therapy was uniform and at least 5 mm Hg more than to monotherapy. There were no differences in withdrawals due to adverse events. CONCLUSIONS Initial combination therapy can be recommended for patients with BP >150/95 mm Hg. CLINICAL TRIAL REGISTRATION URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00994617.
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Affiliation(s)
- Thomas M MacDonald
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL), London, United Kingdom
- National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, London, United Kingdom
| | - David J Webb
- Clinical Pharmacology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Steve Morant
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Mark Caulfield
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom
| | - Peter Sever
- International Institute for Circulatory Health, Imperial College London, London, United Kingdom
| | - Isla S Mackenzie
- Medicines Monitoring Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular Medical Sciences, University of Glasgow, United Kingdom
| | - Gerald P McCann
- NIHR Leicester Cardiovascular Biomedical Research Centre Glenfield Hospital, Leicester, United Kingdom
| | - Jackie Salsbury
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
| | - Gordon McInnes
- Institute of Cardiovascular Medical Sciences, University of Glasgow, United Kingdom
| | - Morris J Brown
- Research Nurse William Harvey Institute, QMUL, London, United Kingdom
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119
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Subramanya V, Zhao D, Ouyang P, Lima JA, Vaidya D, Ndumele CE, Bluemke DA, Shah SJ, Guallar E, Nwabuo CC, Allison MA, Heckbert SR, Post WS, Michos ED. Sex hormone levels and change in left ventricular structure among men and post-menopausal women: The Multi-Ethnic Study of Atherosclerosis (MESA). Maturitas 2017; 108:37-44. [PMID: 29290213 DOI: 10.1016/j.maturitas.2017.11.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sex hormone (SH) levels may contribute to sex differences in the risk of heart failure with preserved ejection fraction (HFpEF). We examined the associations of SH levels with left ventricular mass (LVM) and mass (M):volume (V) ratio, which are risk markers for HFpEF. STUDY DESIGN We studied 1941 post-menopausal women and 2221 men, aged 45-84 years, participating in the Multi-Ethnic Study of Atherosclerosis (MESA). Serum SH levels, cardiac magnetic resonance imaging (MRI) and ejection fraction (EF) ≥50% had been recorded at baseline (2000-2002). Of these participants, 2810 underwent repeat MRI at Exam 5 (2010-2012). Stratified by sex, linear mixed-effect models were used to test associations between SH and sex hormone binding globulin (SHBG) level [per 1 SD greater log-transformed (SH)] with baseline and change in LV structure. Models were adjusted for age, race/ethnicity, center, height, weight, education, physical activity and smoking, and, in women, for hormone therapy and years since menopause. MAIN OUTCOME MEASURES LVM and M:V ratio. RESULTS After a median of 9.1 years, higher free testosterone levels were independently associated with a modest increase in LVM (g/yr) in women [0.05 (95% CI 0.01, 0.10)] and men [0.16 (0.03, 0.28)], while higher SHBG levels were associated with less LVM change (g/yr) in women [-0.07 (-0.13, -0.01)] and men [-0.15 (-0.27, -0.02)]. In men, higher dehydroepiandrosterone and estradiol levels were associated with increased LVM. Among women, free testosterone levels were positively and SHBG levels inversely associated with change in M:V ratio. CONCLUSION A more androgenic profile (higher free testosterone and lower SHBG levels) is associated with a greater increase in LVM in men and women and greater increase in M:V ratio in women over the course of 9 years.
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Affiliation(s)
- Vinita Subramanya
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Joao A Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Chiadi E Ndumele
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern School of Medicine, Chicago, IL, USA.
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chike C Nwabuo
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - Matthew A Allison
- Division of Preventive Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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120
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Markman TM, Habibi M, Venkatesh BA, Zareian M, Wu C, Heckbert SR, Bluemke DA, Lima JAC. Association of left atrial structure and function and incident cardiovascular disease in patients with diabetes mellitus: results from multi-ethnic study of atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2017; 18:1138-1144. [PMID: 28329137 PMCID: PMC5837690 DOI: 10.1093/ehjci/jew332] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 01/17/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS Diabetes mellitus (DM) is associated with the development of cardiovascular disease (CVD). Morphological changes in the left atrium (LA) may appear before symptoms. We aimed to investigate the association between cardiac magnetic resonance imaging (CMR) measured LA structure and function and incident CVD in asymptomatic individuals with DM. METHODS AND RESULTS Tissue tracking CMR was used to measure LA size and phasic function (emptying fractions and strain) on all 536 Multi-Ethnic Study of Atherosclerosis (MESA) participants with DM and available CMR at baseline in 2000-2002. At the time of enrolment, all participants were free of clinically recognized CVD, which was defined as MI, resuscitated cardiac arrest, angina, stroke, heart failure, and atrial fibrillation. Cox regression was used to assess the association of LA parameters with incident CVD adjusted for traditional cardiovascular risk factors, LV mass, NT Pro-BNP and maximum LA volume. Kaplan-Meier curves, adjusted for traditional risk factors, were generated for each LA measurement for the 25% of participants with the most abnormal values versus the remaining 75%. After a mean follow up of 11.4 ± 3.4 years, 141 individuals developed CVD. Individuals with incident CVD (mean age 66 years, 66% male vs. mean age 64 years, 50% male) had larger maximum and minimum LA volume index (LAVI) (32.1 vs. 26.8 mm3/m2; 19.4 vs. 14.2 mm3/m2 respectively, P < 0.001 for both), and lower total, passive, and active EF than those without CVD (P < 0.01 for all). In the fully adjusted model, there was a significant association of minimum LAVI, LA total EF, LA passive EF and LA active EF with incident CVD (HR 1.12 per mm3/m2, P < 0.001; HR 0.95 per %, P < 0.001; HR 0.97 per %, P = 0.021; HR 0.98 per %, P < 0.027, respectively). CONCLUSIONS CMR measured LA minimum volume and LA function as measured by emptying fraction are predictive of CVD in a diabetic multi-ethnic population free of any clinically recognized CVD at baseline.
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Affiliation(s)
- Timothy M Markman
- Department of Medicine, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Baltimore, USA
| | - Mohammadali Habibi
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, New York, USA
| | - Bharath Ambale Venkatesh
- Department of Radiology, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Blalock 524, Baltimore, USA
| | - Mytra Zareian
- Department of Radiology, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Blalock 524, Baltimore, USA
| | - Colin Wu
- National Heart, Lung, and Blood Institute, 31 Center St, MD 20892, Bethesda, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, WA 98195, Seattle, USA
| | - David A Bluemke
- National Institutes of Health, Radiology and Imaging Sciences, 10 Center St, MD 20892, Bethesda, USA
| | - Joao A C Lima
- Department of Medicine, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Baltimore, USA
- Department of Radiology, The Johns Hopkins University, 600 North Wolfe Street, MD 21287, Blalock 524, Baltimore, USA
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121
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Inoue YY, Soliman EZ, Yoneyama K, Ambale-Venkatesh B, Wu CO, Sparapani R, Bluemke DA, Lima JAC, Ashikaga H. Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.117.006624. [PMID: 28931529 PMCID: PMC5634304 DOI: 10.1161/jaha.117.006624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Both ECG strain pattern and QRS measured left ventricular (LV) hypertrophy criteria are associated with LV hypertrophy and have been used for risk stratification. However, the independent predictive value of ECG strain in apparently healthy individuals in predicting mortality and adverse cardiovascular events is unclear. Methods and Results MESA (Multi‐Ethnic Study of Atherosclerosis) is a multicenter, prospective cohort of 6441 participants (mean age, 62 years; 54% women). In 2847 of these participants, cardiac magnetic resonance imaging was repeated ≈10 years later (Year‐10). At Year‐10, 1759 participants underwent cardiac magnetic resonance imaging with gadolinium to detect myocardial scar. During a median follow‐up of 11.7 years, ECG strain (n=168, 2.6%) was significantly associated with all‐cause death (adjusted hazard ratio, 1.33; 95% confidence interval, 1.01–1.77; P=0.045), heart failure (2.62; 1.73–3.97; P<0.001), myocardial infarction (1.86; 1.09–3.18; P=0.024), and incident cardiovascular disease (1.45; 1.06–2.00; P=0.022). ECG strain was also associated with an increase in LV mass (β=9.29 g; P<0.001) and LV mass‐to‐volume ratio (β=0.07 g/mL; P=0.007) and a decline in LV ejection fraction (β=−3.30%; P<0.001). Moreover, ECG strain either at baseline and Year‐10 was associated with LV scar (odds ratio, 4.93 and 5.22; P=0.002 and <0.001, respectively), whereas these associations were not observed in ECG LV hypertrophy. Conclusions ECG strain is independently associated with all‐cause mortality, adverse cardiovascular events, development of LV concentric remodeling and systolic dysfunction, and myocardial scar over 10 years in multiethnic participants without past cardiovascular disease. ECG strain may be an early marker of LV structural remodeling that contributes to development of adverse cardiovascular events. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.
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Affiliation(s)
- Yuko Y Inoue
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC.,Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC
| | - Kihei Yoneyama
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD
| | - Rodney Sparapani
- Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
| | - David A Bluemke
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Radiology, School of Medicine and Public Health University of Wisconsin, Madison, WI
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiroshi Ashikaga
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD .,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD
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122
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Bansal N, Zelnick LR, Alonso A, Benjamin EJ, de Boer IH, Deo R, Katz R, Kestenbaum B, Mathew J, Robinson-Cohen C, Sarnak MJ, Shlipak MG, Sotoodehnia N, Young B, Heckbert SR. eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clin J Am Soc Nephrol 2017; 12:1386-1398. [PMID: 28798221 PMCID: PMC5586568 DOI: 10.2215/cjn.01860217] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of atrial fibrillation is high in ESRD, but limited data are available on the incidence of atrial fibrillation across a broad range of kidney function. Thus, we examined the association of eGFR and urine albumin-to-creatinine ratio with risk of incident atrial fibrillation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We meta-analyzed three prospective cohorts: the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Cox regression models were performed examining the association of eGFR and urine albumin-to-creatinine ratio with incident atrial fibrillation adjusting for demographics and comorbidity. In additional analyses, we adjusted for measures of subclinical cardiovascular disease (by electrocardiogram and cardiac imaging) and interim heart failure and myocardial infarction events. RESULTS In the meta-analyzed study population of 16,769 participants without prevalent atrial fibrillation, across categories of decreasing eGFR (eGFR>90 [reference], 60-89, 45-59, 30-44, and <30 ml/min per 1.73 m2), there was a stepwise increase in the adjusted risk of incident atrial fibrillation: hazard ratios (95% confidence intervals) were 1.00, 1.09 (0.97 to 1.24), 1.17 (1.00 to 1.38), 1.59 (1.28 to 1.98), and 2.03 (1.40 to 2.96), respectively. There was a stepwise increase in the adjusted risk of incident atrial fibrillation across categories of increasing urine albumin-to-creatinine ratio (urine albumin-to-creatinine ratio <15 [reference], 15-29, 30-299, and ≥300 mg/g): hazard ratios (95% confidence intervals) were 1.00, 1.04 (0.83 to 1.30), 1.47 (1.20 to 1.79), and 1.76 (1.18 to 2.62), respectively. The associations were consistent after adjustment for subclinical cardiovascular disease measures and interim heart failure and myocardial infarction events. CONCLUSIONS In this meta-analysis of three cohorts, reduced eGFR and elevated urine albumin-to-creatinine ratio were significantly associated with greater risk of incident atrial fibrillation, highlighting the need for further studies to understand mechanisms linking kidney disease with atrial fibrillation.
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Affiliation(s)
- Nisha Bansal
- Division of Nephrology, Kidney Research Institute
| | | | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emelia J. Benjamin
- Department of Medicine, Boston University School of Medicine and School of Public Health, Boston, Massachusetts
| | - Ian H. de Boer
- Division of Nephrology, Kidney Research Institute
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Rajat Deo
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ronit Katz
- Division of Nephrology, Kidney Research Institute
| | | | - Jehu Mathew
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Mark J. Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California
| | | | - Bessie Young
- Division of Nephrology, Kidney Research Institute
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, and
- Department of Epidemiology, University of Washington, Seattle, Washington
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123
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Medrek SK, Sahay S. Ethnicity in Pulmonary Arterial Hypertension: Possibilities for Novel Phenotypes in the Age of Personalized Medicine. Chest 2017; 153:310-320. [PMID: 28887060 DOI: 10.1016/j.chest.2017.08.1159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 12/18/2022] Open
Abstract
In the past decade and a half, the introduction of new therapeutic agents has revolutionized the management of pulmonary arterial hypertension (PAH). These new treatment options have improved the quality of life and survival in PAH. With an armamentarium of options available, the identification of unique phenotypes can help practitioners choose tailored treatment regimens. Experts in other cardiovascular diseases, such as congestive heart failure and hypertension, have recommended race-specific treatments in their fields based on data highlighting variations in response to therapies. With this perspective, we review evidence supporting the hypothesis that ethnicity or race plays an important role in the management of PAH. Preliminary research suggests that races/ethnicities have differences in the presentation and outcome of PAH and could respond to PAH-specific medications with varying efficacy. Genetic, physiological, and anatomic differences exist between races, particularly regarding the structure and function of the right ventricle. Unfortunately, clinical trials have not adequately included minorities, and registry data often omit inclusion of this demographic information. Further studies are needed to characterize the role that ethnicity plays in the prevalence, presentation, outcomes, and optimal treatment of PAH.
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Affiliation(s)
- Sarah K Medrek
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Sandeep Sahay
- Department of Medicine, Weill Cornell Medical College and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX.
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124
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Nio AQX, Stöhr EJ, Shave RE. Age-related differences in left ventricular structure and function between healthy men and women. Climacteric 2017; 20:476-483. [DOI: 10.1080/13697137.2017.1356814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A. Q. X. Nio
- Department of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - E. J. Stöhr
- Department of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - R. E. Shave
- Department of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
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125
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Zelnick LR, Katz R, Young BA, Correa A, Kestenbaum BR, de Boer IH, Bansal N. Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study. Am J Kidney Dis 2017; 70:199-206. [PMID: 28143672 PMCID: PMC5848095 DOI: 10.1053/j.ajkd.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/27/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cardiac structural abnormalities, common in African Americans, are associated with adverse clinical outcomes. Associations between echocardiography-measured subclinical heart failure and kidney function decline are unknown and may identify novel risk factors for kidney disease in this population. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,418 Jackson Heart Study participants with baseline echocardiograms and longitudinal measures of estimated glomerular filtration rate (eGFR) calculated from the CKD-EPI creatinine equation. 2,219 participants had baseline eGFRs≥60mL/min/1.73m2. PREDICTORS Left ventricular mass (LVM) and ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) quantified from baseline echocardiograms. OUTCOMES Primary outcome was >30% eGFR decline or progression to end-stage renal disease (ESRD; need for dialysis therapy) over a mean of 8 years. Secondary outcome, eGFR<60mL/min/1.73m2 or progression to ESRD and eGFR decline >1mL/min/1.73m2 per year among those with baseline eGFRs≥60mL/min/1.73m2. MEASUREMENTS Logistic regression models, adjusted for demographics, physical characteristics, comorbid conditions, and medication use. RESULTS Mean age was 52.2±11.9 (SD) years, 37% of participants were men; mean baseline eGFR was 87.3±17.3mL/min/1.73m2. The primary and secondary outcomes occurred in 148 (6.1%) and 162 (7.1%) participants, respectively. In unadjusted models, every 25-g greater LVM was significantly associated with greater odds of eGFR decline > 30% or ESRD (OR, 1.38; 95% CI, 1.26-1.51) and incident eGFR<60mL/min/1.73m2 or ESRD (OR, 1.30; 95% CI, 1.20-1.42); only the former remained statistically significant after adjustment. There was no association of LVEF or PASP with either eGFR decline > 30% or ESRD (LVEF: adjusted OR, 0.95 [95% CI, 0.84-1.07]; PASP: adjusted OR, 0.98 [95% CI, 0.87-1.11]) or incident eGFR<60mL/min/1.73m2 or ESRD (LVEF: adjusted OR, 0.98 [95% CI, 0.86-1.11]; PASP: adjusted OR, 1.05 [95% CI, 0.94-1.18]) in multivariable models. LIMITATIONS No midstudy creatinine measurement at examination 2. CONCLUSIONS Greater LVM was significantly associated with eGFR decline > 30% or ESRD among African Americans in a community-based cohort. Treating and reversing elevated LVM may reduce the burden and progression of kidney disease in this high-risk population.
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Affiliation(s)
- Leila R Zelnick
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
| | - Bessie A Young
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA; Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Hospital and Specialty Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Bryan R Kestenbaum
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
| | - Nisha Bansal
- Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA
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126
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D'Souza JC, Kawut SM, Elkayam LR, Sheppard L, Thorne PS, Jacobs DR, Bluemke DA, Lima JAC, Kaufman JD, Larson TV, Adar SD. Ambient Coarse Particulate Matter and the Right Ventricle: The Multi-Ethnic Study of Atherosclerosis. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:077019. [PMID: 28760719 PMCID: PMC5744657 DOI: 10.1289/ehp658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 02/24/2017] [Accepted: 03/16/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Coarse particulate matter (P10-2.5) is primarily mechanically generated and includes crustal material, brake and tire wear, and biological particles. PM10-2.5 is associated with pulmonary disease, which can lead to right ventricular (RV) dysfunction. Although RV characteristics have been associated with combustion-related pollutants, relationships with PM10-2.5 remain unknown. OBJECTIVES To quantify cross-sectional associations between RV dysfunction and PM10-2.5 mass and components among older adults and susceptible populations. METHODS We used baseline cardiac magnetic resonance images from 1,490 participants (45-84 y old) from the Multi-Ethnic Study of Atherosclerosis and assigned 5-y residential concentrations of PM10-2.5 mass, copper, zinc, phosphorus, silicon, and endotoxin, using land-use regression models. We quantified associations with RV mass, end-diastolic volume, and ejection fraction after control for risk factors and copollutants using linear regression. We further examined personal susceptibility. RESULTS We found positive associations of RV mass and, to a lesser extent, end diastolic volume with PM10-2.5 mass among susceptible populations including smokers and persons with emphysema. After adjustment for copollutants, an interquartile range increase in PM10-2.5 mass (2.2 μg/m3) was associated with 0.5 g (95% CI: 0.0, 1.0), 0.9 g (95% CI: 0.1, 1.7), and 1.4 g (95% CI: 0.4, 2.5) larger RV mass among former smokers, current smokers, and persons with emphysema, respectively. No associations were found with healthy individuals or with ejection fraction. CONCLUSIONS Alterations to RV structure may represent a mechanism by which long-term PM10-2.5 exposure increases risks for adverse respiratory and cardiovascular outcomes, especially among certain susceptible populations. https://doi.org/10.1289/EHP658.
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Affiliation(s)
- Jennifer C D'Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Steven M Kawut
- Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura R Elkayam
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - David R Jacobs
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Timothy V Larson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Civil and Environmental Engineering, University of Washington College of Engineering, Seattle, Washington, USA
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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127
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Yoneyama K, Venkatesh BA, Bluemke DA, McClelland RL, Lima JAC. Cardiovascular magnetic resonance in an adult human population: serial observations from the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson 2017; 19:52. [PMID: 28720123 PMCID: PMC5514469 DOI: 10.1186/s12968-017-0367-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
The Multi-Ethnic Study of Atherosclerosis (MESA) is the first large-scale multi-ethnic population study in the U.S. to use advanced cardiovascular magnetic resonance (CMR) imaging. MESA participants were free of cardiovascular disease at baseline between 2000 and 2002, and were followed up between 2009 and 2011 with repeated CMR examinations as part of MESA. CMR allows the clinician to visualize and accurately quantify volume and dimensions of all four cardiac chambers; measure systolic and diastolic ventricular function; assess myocardial fibrosis; assess vessel lumen size, vessel wall morphology, and vessel stiffness. CMR has a number of advantages over other imaging modalities such as echocardiography, computed tomography, and invasive angiography, and has been proposed as a diagnostic strategy for high-risk populations. MESA has been extensively evaluating CMR imaging biomarkers, as markers of subclinical disease, in the last 15 years for low-risk populations. On a more practical level, some of the imaging biomarkers developed and studied are translatable to at-risk populations. In this review, we discuss the progression of subclinical cardiovascular disease and the mechanisms responsible for the transition to symptomatic clinical outcomes based on our findings from MESA.
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Grants
- N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169, UL1-TR-000040 and UL1-TR-001079
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Affiliation(s)
- Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - João A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
- Professor of Medicine, Radiology and Epidemiology, Johns Hopkins Hospital, Johns Hopkins University, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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128
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Spahillari A, Talegawkar S, Correa A, Carr JJ, Terry JG, Lima J, Freedman JE, Das S, Kociol R, de Ferranti S, Mohebali D, Mwasongwe S, Tucker KL, Murthy VL, Shah RV. Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003682. [PMID: 28209767 DOI: 10.1161/circheartfailure.116.003682] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States. METHODS AND RESULTS We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance. CONCLUSIONS Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
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Affiliation(s)
- Aferdita Spahillari
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Sameera Talegawkar
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Adolfo Correa
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - J Jeffrey Carr
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - James G Terry
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - João Lima
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Jane E Freedman
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Saumya Das
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Robb Kociol
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Sarah de Ferranti
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Donya Mohebali
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Stanford Mwasongwe
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Katherine L Tucker
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.)
| | - Venkatesh L Murthy
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
| | - Ravi V Shah
- From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
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Chatterjee NA, Shah RV, Murthy VL, Praestgaard A, Shah SJ, Ventetuolo CE, Barr RG, Kronmal R, Lima JAC, Bluemke DA, Jerosch-Herold M, Alonso A, Kawut SM. Right Ventricular Structure and Function Are Associated With Incident Atrial Fibrillation: MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle). Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004738. [PMID: 28082528 DOI: 10.1161/circep.116.004738] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular (RV) morphology has been associated with drivers of atrial fibrillation (AF) risk, including left ventricular and pulmonary pathology, systemic inflammation, and neurohormonal activation. The aim of this study was to investigate the association between RV morphology and risk of incident AF. METHODS AND RESULTS We interpreted cardiac magnetic resonance imaging in 4204 participants free of clinical cardiovascular disease in the MESA (Multi-Ethnic Study of Atherosclerosis). Incident AF was determined using hospital discharge records, study electrocardiograms, and Medicare claims data. The study sample (n=3819) was 61±10 years old and 47% male with 47.2% current/former smokers. After adjustment for demographics and clinical factors, including incident heart failure, higher RV ejection fraction (hazard ratio, 1.16 per SD; 95% confidence interval, 1.03-1.32; P=0.02) and greater RV mass (hazard ratio, 1.25 per SD; 95% confidence interval, 1.08-1.44; P=0.002) were significantly associated with incident AF. After additional adjustment for the respective left ventricular parameter, higher RV ejection fraction remained significantly associated with incident AF (hazard ratio, 1.15 per SD; 95% confidence interval, 1.01-1.32; P=0.04), whereas the association was attenuated for RV mass (hazard ratio, 1.16 per SD; 95% confidence interval, 0.99-1.35; P=0.07). In a subset of patients with available spirometry (n=2540), higher RV ejection fraction and mass remained significantly associated with incident AF after additional adjustment for lung function (P=0.02 for both). CONCLUSIONS Higher RV ejection fraction and greater RV mass were associated with an increased risk of AF in a multiethnic population free of clinical cardiovascular disease at baseline.
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Affiliation(s)
| | - Ravi V Shah
- For the author affiliations, please see the Appendix
| | | | | | - Sanjiv J Shah
- For the author affiliations, please see the Appendix
| | | | - R Graham Barr
- For the author affiliations, please see the Appendix
| | | | - Joao A C Lima
- For the author affiliations, please see the Appendix
| | | | | | - Alvaro Alonso
- For the author affiliations, please see the Appendix
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130
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Kang EJ, Lee KN, Choi WJ, Kim YD, Shin KM, Lim JK, Lee J. Left Ventricular Functional Parameters and Geometric Patterns in Korean Adults on Coronary CT Angiography with a 320-Detector-Row CT Scanner. Korean J Radiol 2017; 18:664-673. [PMID: 28670161 PMCID: PMC5447642 DOI: 10.3348/kjr.2017.18.4.664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/29/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the normal reference values of left ventricle (LV) functional parameters in Korean adults on coronary CT angiography (CCTA) with a 320-detector-row CT scanner, and to analyze sex-related differences and correlations with various clinical characteristics. MATERIALS AND METHODS This study retrospectively enrolled 172 subjects (107 men and 65 women; age, 58 ± 10.9 years; body surface area [BSA], 1.75 ± 0.2 m2) who underwent CCTA without any prior history of cardiac disease. The following parameters were measured by post-processing the CT data: LV volume, LV functional parameters (ejection fraction, stroke volume, cardiac output, etc.), LV myocardial mass, LV inner diameter, and LV myocardial thickness (including septal wall thickness [SWT], posterior wall thickness [PWT], and relative wall thickness [RWT = 2 × PWT / LV inner diameter]). All of the functional or volumetric parameters were normalized using the BSA. The general characteristics and co-morbidities for the enrolled subjects were recorded, and the correlations between these factors and the LV parameters were then evaluated. RESULTS The LV myocardial thickness (SWT, 1.08 ± 0.18 cm vs. 0.90 ± 0.17 cm, p < 0.001; PWT, 0.91 ± 0.15 cm vs. 0.78 ± 0.10 cm, p < 0.001; RWT, 0.38 ± 0.08 cm vs. 0.33 ± 0.05 cm, p < 0.001), LV volume (LV end-diastolic volume, 112.9 ± 26.1 mL vs. 98.2 ± 21.0 mL, p < 0.001; LV end-systolic volume, 41.7 ± 14.7 mL vs. 33.7 ± 12.2 mL, p = 0.001) and mass (145.0 ± 29.1 g vs. 107.9 ± 20.0 g, p < 0.001) were significantly greater in men than in women. However, these differences were not significant after normalization using BSA, except for the LV mass (LV mass index, 79.6 ± 14.0 g/m2 vs. 66.2 ± 11.0 g/m2, p < 0.001). The cardiac output and ejection fraction were not significantly different between the men and women (cardiac output, 4.3 ± 1.0 L/min vs. 4.2 ± 0.9 L/min, p = 0.452; ejection fraction, 63.4 ± 7.7% vs. 66.4 ± 7.6%, p = 0.079). Most of the LV parameters were positively correlated with BSA, body weight, and total Agatston score. CONCLUSION This study provides sex-related reference values and percentiles for LV on cardiac CT and should assist in interpreting results.
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Affiliation(s)
- Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Ki-Nam Lee
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Won Jin Choi
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Young-Dae Kim
- Department of Cardiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jae-Kwang Lim
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
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131
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Ventetuolo CE, Baird GL, Barr RG, Bluemke DA, Fritz JS, Hill NS, Klinger JR, Lima JAC, Ouyang P, Palevsky HI, Palmisciano AJ, Krishnan I, Pinder D, Preston IR, Roberts KE, Kawut SM. Higher Estradiol and Lower Dehydroepiandrosterone-Sulfate Levels Are Associated with Pulmonary Arterial Hypertension in Men. Am J Respir Crit Care Med 2017; 193:1168-75. [PMID: 26651504 DOI: 10.1164/rccm.201509-1785oc] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RATIONALE Recent studies have focused on the role of female sex and estradiol (E2) in pulmonary arterial hypertension (PAH), but it is not known whether sex hormones are risk factors for PAH in men. OBJECTIVES We performed a case-control study to determine whether hormone levels (E2, dehydroepiandrosterone-sulfate [DHEA-S], and testosterone) are associated with PAH in men. METHODS Plasma sex hormone levels in men with idiopathic, heritable, or connective tissue disease-associated PAH were compared with those from age- and body mass index-matched men without clinical cardiovascular disease. MEASUREMENTS AND MAIN RESULTS There were 23 cases with PAH (70% had idiopathic PAH, 65% were functional class III/IV) and 67 control subjects. Higher E2 and E2/testosterone levels were associated with the risk of PAH (odds ratio per 1 ln[E2:testosterone], 6.0; 95% confidence interval, 2.2-16.4; P = 0.001), whereas higher levels of DHEA-S were associated with a reduced risk (odds ratio per 1 ln[DHEA-S], 0.1; 95% confidence interval, 0.0-0.3; P = 0.001). E2 and DHEA-S levels were strong predictors of case status (C statistic for both, 0.82) but testosterone was not (C statistic, 0.53). Higher levels of E2 were associated with shorter 6-minute-walk distances (P = 0.03), whereas higher levels of DHEA-S were associated with lower right atrial pressure (P = 0.02) and pulmonary vascular resistance (P = 0.01) in men with PAH. CONCLUSIONS Higher levels of E2 and lower levels of DHEA-S were associated with PAH in men. Sex-based differences in sex hormone processing and signaling may contribute to unique phenotypes in pulmonary vascular disease.
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Affiliation(s)
- Corey E Ventetuolo
- 1 Department of Medicine and.,2 Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, Rhode Island.,3 Lifespan Hospital System, Providence, Rhode Island
| | | | - R Graham Barr
- 4 Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A Bluemke
- 5 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | | | - Nicholas S Hill
- 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and
| | - James R Klinger
- 1 Department of Medicine and.,3 Lifespan Hospital System, Providence, Rhode Island
| | - Joao A C Lima
- 8 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- 8 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Ioana R Preston
- 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and
| | - Kari E Roberts
- 7 Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and
| | - Steven M Kawut
- 6 Department of Medicine.,9 Center for Clinical Epidemiology and Biostatistics, and.,10 Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Habibi M, Samiei S, Ambale Venkatesh B, Opdahl A, Helle-Valle TM, Zareian M, Almeida ALC, Choi EY, Wu C, Alonso A, Heckbert SR, Bluemke DA, Lima JAC. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004299. [PMID: 27511974 DOI: 10.1161/circimaging.115.004299] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early detection of structural changes in left atrium (LA) before atrial fibrillation (AF) development could be helpful in identification of those at higher risk for AF. Using cardiac magnetic resonance imaging, we examined the association of LA volume and function, and incident AF in a multiethnic population free of clinical cardiovascular diseases. METHODS AND RESULTS In a case-cohort study embedded in MESA (Multi-Ethnic Study of Atherosclerosis), baseline LA size and function assessed by cardiac magnetic resonance feature-tracking were compared between 197 participants with incident AF and 322 participants randomly selected from the whole MESA cohort. Participants were followed up for 8 years. Incident AF cases had a larger LA volume and decreased passive, active, and total LA emptying fractions and peak global LA longitudinal strain (peak LA strain) at baseline. In multivariable analysis, elevated LA maximum volume index (hazard ratio, 1.38 per SD; 95% confidence interval, 1.01-1.89) and decreased peak LA strain (hazard ratio, 0.68 per SD; 95% confidence interval, 0.48-0.96), and passive and total LA emptying fractions (hazard ratio for passive LA emptying fractions, 0.55 per SD; 95% confidence interval, 0.40-0.75 and hazard ratio for active LA emptying fractions, 0.70 per SD; 95% confidence interval, 0.52-0.95), but not active LA emptying fraction, were associated with incident AF. CONCLUSIONS Elevated LA volumes and decreased passive and total LA emptying fractions were independently associated with incident AF in an asymptomatic multiethnic population. Including LA functional variables along with other risk factors of AF may help to better risk stratify individuals at risk of AF development.
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Affiliation(s)
- Mohammadali Habibi
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Sanaz Samiei
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Bharath Ambale Venkatesh
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Anders Opdahl
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Thomas M Helle-Valle
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Mytra Zareian
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Andre L C Almeida
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Eui-Young Choi
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Colin Wu
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Alvaro Alonso
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Susan R Heckbert
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - David A Bluemke
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - João A C Lima
- From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
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Jordan JH, Vasu S, Morgan TM, D'Agostino RB, Meléndez GC, Hamilton CA, Arai AE, Liu S, Liu CY, Lima JAC, Bluemke DA, Burke GL, Hundley WG. Anthracycline-Associated T1 Mapping Characteristics Are Elevated Independent of the Presence of Cardiovascular Comorbidities in Cancer Survivors. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004325. [PMID: 27502058 DOI: 10.1161/circimaging.115.004325] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/24/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiovascular magnetic resonance T1 mapping characteristics are elevated in adult cancer survivors; however, it remains unknown whether these elevations are related to age or presence of coincident cardiovascular comorbidities. METHODS AND RESULTS We performed blinded cardiovascular magnetic resonance analyses of left ventricular T1 and extracellular volume (ECV) fraction in 327 individuals (65% women, aged 64±12 years). Thirty-seven individuals had breast cancer or a hematologic malignancy but had not yet initiated their treatment, and 54 cancer survivors who received either anthracycline-based (n=37) or nonanthracycline-based (n=17) chemotherapy 2.8±1.3 years earlier were compared with 236 cancer-free participants. Multivariable analyses were performed to determine the association between T1/ECV measures and variables associated with myocardial fibrosis. Age-adjusted native T1 was elevated pre- (1058±7 ms) and post- (1040±7 ms) receipt of anthracycline chemotherapy versus comparators (965±3 ms; P<0.0001 for both). Age-adjusted ECV, a marker of myocardial fibrosis, was elevated in anthracycline-treated cancer participants (30.4±0.7%) compared with either pretreatment cancer (27.8±0.7%; P<0.01) or cancer-free comparators (26.9±0.2%; P<0.0001). T1 and ECV of nonanthracycline survivors were no different than pretreatment survivors (P=0.17 and P=0.16, respectively). Native T1 and ECV remained elevated in cancer survivors after accounting for demographics (including age), myocardial fibrosis risk factors, and left ventricular ejection fraction or myocardial mass index (P<0.0001 for all). CONCLUSIONS Three years after anthracycline-based chemotherapy, elevations in myocardial T1 and ECV occur independent of underlying cancer or cardiovascular comorbidities, suggesting that imaging biomarkers of interstitial fibrosis in cancer survivors are related to prior receipt of a potentially cardiotoxic cancer treatment regimen.
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Affiliation(s)
- Jennifer H Jordan
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Sujethra Vasu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Timothy M Morgan
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Ralph B D'Agostino
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Giselle C Meléndez
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Craig A Hamilton
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Andrew E Arai
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Songtao Liu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Chia-Ying Liu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - João A C Lima
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - David A Bluemke
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Gregory L Burke
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - W Gregory Hundley
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.).
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Bakhshi H, Ambale-Venkatesh B, Yang X, Ostovaneh MR, Wu CO, Budoff M, Bahrami H, Wong ND, Bluemke DA, Lima JAC. Progression of Coronary Artery Calcium and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.116.005253. [PMID: 28428195 PMCID: PMC5533017 DOI: 10.1161/jaha.116.005253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Although the association between coronary artery calcium (CAC) and future heart failure (HF) has been shown previously, the value of CAC progression in the prediction of HF has not been investigated. In this study, we investigated the association of CAC progression with subclinical left ventricular (LV) dysfunction and incident HF in the Multi‐Ethnic Study of Atherosclerosis. Methods and Results The Multi‐Ethnic Study of Atherosclerosis is a population‐based study consisting of 6814 men and women aged 45 to 84, free of overt cardiovascular disease at enrollment, who were recruited from 4 ethnicities. We included 5644 Multi‐Ethnic Study of Atherosclerosis participants who had baseline and follow‐up cardiac computed tomography and were free of HF and coronary heart disease before the second cardiac computed tomography. Mean (±SD) age was 61.7±10.2 years and 47.2% were male. The Cox proportional hazard models and multivariable linear regression models were deployed to determine the association of CAC progression with incident HF and subclinical LV dysfunction, respectively. Over a median follow‐up of 9.6 (interquartile range: 8.8–10.6) years, 182 participants developed incident HF. CAC progression of 10 units per year was associated with 3% of increased risk of HF independent of overt coronary heart disease (P=0.008). In 2818 participants with available cardiac magnetic resonance images, CAC progression was associated with increased LV end diastolic volume (β=0.16; P=0.03) and LV end systolic volume (β=0.12; P=0.006) after excluding participants with any coronary heart disease. Conclusions CAC progression was associated with incident HF and modestly increased LV end diastolic volume and LV end systolic volume at follow‐up exam independent of overt coronary heart disease.
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Affiliation(s)
- Hooman Bakhshi
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | | | | | - Mohammad R Ostovaneh
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD
| | - Matthew Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, Irvine, CA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
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Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
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Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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136
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Polonsky TS, Ning H, Daviglus ML, Liu K, Burke GL, Cushman M, Eng J, Folsom AR, Lutsey PL, Nettleton JA, Post WS, Sacco RL, Szklo M, Lloyd-Jones DM. Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.116.004894. [PMID: 28320747 PMCID: PMC5524019 DOI: 10.1161/jaha.116.004894] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few adults have ideal cardiovascular health (CVH). We studied associations of an overall CVH score with subclinical cardiovascular disease and events. We assessed whether associations varied by race/ethnicity. Methods and Results Among 5961 participants in the Multi‐Ethnic Study of Atherosclerosis, components of CVH were measured at baseline, 2000‐2002: systolic blood pressure, total cholesterol, fasting glucose, smoking, physical activity, diet, and body mass index. Levels were classified as ideal (2 points), intermediate (1 point), and poor (0 points) according to American Heart Association definitions. Points were summed to produce a CVH score (0‐7 low, 8‐11 moderate, 12‐14 high). Coronary artery calcium, carotid intima‐media thickness, and left ventricular mass were measured at baseline. Cardiovascular disease was defined as myocardial infarction, coronary heart disease death, resuscitated cardiac arrest, stroke, heart failure, or peripheral artery disease. Follow‐up was 10.3 years. Regression models were used to examine associations of the CVH score with subclinical disease and events, adjusting for age, sex, and education. Analyses were stratified by race/ethnicity. Adults with high or moderate CVH scores had significantly lower odds of coronary artery calcium and lower carotid intima‐media thickness and left ventricular mass than adults with low CVH scores. Adults with high or moderate CVH scores were 67% (95%CI 41% to 82%) and 37% (95%CI 22% to 49%) less likely, respectively, to experience a cardiovascular disease event than adults with low scores. There was no interaction with race/ethnicity. Conclusions There is a graded inverse association between CVH scores and measures of subclinical and overt cardiovascular disease that is similar across race/ethnic groups.
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Affiliation(s)
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Gregory L Burke
- Department of Public Health Sciences, Wake Forest University, Winston Salem, NC
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory Medicine, University of Vermont, Colchester, VT
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron R Folsom
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Jennifer A Nettleton
- Health Science Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas, Houston, TX
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Petersen SE, Aung N, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Francis JM, Khanji MY, Lukaschuk E, Lee AM, Carapella V, Kim YJ, Leeson P, Piechnik SK, Neubauer S. Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort. J Cardiovasc Magn Reson 2017; 19:18. [PMID: 28178995 PMCID: PMC5304550 DOI: 10.1186/s12968-017-0327-9] [Citation(s) in RCA: 360] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45-74. METHODS Five thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45-54, 55-64, 65-74). RESULTS After applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2 vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females. CONCLUSIONS We describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.
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Affiliation(s)
- Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Nay Aung
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Young Jin Kim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
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138
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Seliger SL, Hong SN, Christenson RH, Kronmal R, Daniels LB, Lima JAC, de Lemos JA, Bertoni A, deFilippi CR. High-Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure: MESA (Multi-Ethnic Study of Atherosclerosis). Circulation 2017; 135:1494-1505. [PMID: 28159799 DOI: 10.1161/circulationaha.116.025505] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although small elevations of high-sensitive cardiac troponin T (hs-cTnT) are associated with incident heart failure (HF) in the general population, the underlying mechanisms are not well defined. Evaluating the association of hs-cTnT with replacement fibrosis and progression of structural heart disease before symptoms is fundamental to understanding the potential of this biomarker in a HF prevention strategy. METHODS We measured hs-cTnT at baseline among 4986 participants in MESA (Multi-Ethnic Study of Atherosclerosis), a cohort initially free of overt cardiovascular disease (CVD). Cardiac magnetic resonance imaging was performed at baseline. Repeat cardiac magnetic resonance was performed 10 years later among 2831 participants who remained free of interim CVD events; of these, 1723 received gadolinium-enhanced cardiac magnetic resonance for characterization of replacement fibrosis by late gadolinium enhancement. Progression of subclinical CVD was defined by 10-year change in left ventricular structure and function. Associations of hs-cTnT with incident HF, CV-related mortality, and coronary heart disease were estimated using Cox regression models. RESULTS Late gadolinium enhancement for replacement fibrosis was detectable in 6.3% participants without interim CVD events by follow-up cardiac magnetic resonance. A graded association was observed between higher baseline hs-cTnT categories and late gadolinium enhancement (≥7.42 ng/L versus <limit of detection [<3 ng/L]; adjusted odds ratio, 2.87; 95% confidence interval, 1.38-5.94). Higher hs-cTnT was also associated with a greater probability of an increase in LV mass >12% (highest category versus <limit of detection; odds ratio, 1.50; 95% confidence interval, 1.09-2.07), but not with decline in left ventricular ejection fraction. The risk of incident HF was greater for higher hs-cTnT (≥8.81 ng/L versus <limit of detection; adjusted hazards ratio, 5.59; 95% CI, 2.97-10.68). CONCLUSIONS hs-cTnT levels are associated with replacement fibrosis and progressive changes in left ventricular structure in CVD-free adults, findings that may precede HF symptoms by years. Minor elevations of hs-cTnT may represent a biochemical signature of early subclinical cardiac disease, providing an opportunity for targeted preventive interventions.
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Affiliation(s)
- Stephen L Seliger
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Susie N Hong
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Robert H Christenson
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Richard Kronmal
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Lori B Daniels
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Joao A C Lima
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - James A de Lemos
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Alain Bertoni
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.)
| | - Christopher R deFilippi
- From Division of Nephrology (S.L.S.), Division of Cardiovascular Medicine (S.N.H.), and Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore; University of Washington, Department of Biostatistics, Seattle (R.K.); University of California at San Diego, Division of Cardiology, La Jolla (L.B.D.); Johns Hopkins University, Division of Cardiology, Baltimore, MD (J.A.C.L.); University of Texas Southwestern Medical Center, Division of Cardiology, Dallas (J.A.d.L.); Wake Forest School of Medicine, Department of Epidemiology and Prevention, Winston-Salem, NC (A.B.); and Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.).
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139
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Zemrak F, Ambale-Venkatesh B, Captur G, Chrispin J, Chamera E, Habibi M, Nazarian S, Mohiddin SA, Moon JC, Petersen SE, Lima JAC, Bluemke DA. Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 10:e005379. [PMID: 28196797 PMCID: PMC5319802 DOI: 10.1161/circimaging.116.005379] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial (LA) size is a marker of diastolic function and is associated with atrial fibrillation and cardiovascular outcomes. However, there are no large population studies measuring LA structure. The relationship of demographics and cardiovascular risk factors to LA size is largely unknown. This study aimed to determine associations of LA size with demographic factors, cardiac structure and function, and cardiovascular risk factors. METHODS AND RESULTS LA volume indexed to body surface area was measured by cardiovascular magnetic resonance steady-state free precession and fast gradient echo cine long- and short-axis images in 2576 asymptomatic participants of MESA ([Multi-Ethnic Study of Atherosclerosis] 68.7 years, 53.0% women, white 42.2%, Chinese American 12.0%, black 24.5%, and Hispanic 21.2%) using biplane and short-axis images. The mean LA volume index was 36.5±11.4 mL/m2 in the entire cohort and 35.5±10.1 mL/m2 in subjects free of cardiovascular risk factors (n=283). Multivariable analysis included adjustment for demographics, ethnicity, cardiovascular risk factors, serological studies, socioeconomic status, left ventricular structure, and medications. In the adjusted analysis, age (β=0.2 mL/m2 per year, P<0.0001), male sex (β=-4.2 mL/m2, P<0.0001), obesity (β=1.3 mL/m2, P<0.01), end-diastolic volume index (β=0.4 mL/m2, P<0.0001), Chinese American (β=-2.6 mL/m2, P<0.0001), and Hispanic (β=1.1 mL/m2, P<0.05) ethnicities were associated with LA volume index. Diabetes mellitus and smoking were not associated with LA volume index. LA volumes measured by steady-state free precession were 3% larger than by fast gradient echo cine cardiovascular magnetic resonance (P<0.001). CONCLUSIONS Age, sex, ethnicity and left ventricular structural parameters were associated with LA size. Importantly, the study provides reference values of normal LA volume index.
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Affiliation(s)
- Filip Zemrak
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Bharath Ambale-Venkatesh
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Gabriella Captur
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Jonathan Chrispin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Ela Chamera
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Mohammadali Habibi
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saman Nazarian
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saidi A Mohiddin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - James C Moon
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Steffen E Petersen
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - João A C Lima
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - David A Bluemke
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.).
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140
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Chaturvedi A, Whitnah J, Maki JH, Baran T, Mitsumori LM. Horizontal Long Axis Imaging Plane for Evaluation of Right Ventricular Function on Cardiac Magnetic Resonance Imaging. J Clin Imaging Sci 2017; 6:52. [PMID: 28123842 PMCID: PMC5209858 DOI: 10.4103/2156-7514.197076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate a horizontal long axis (HLA) magnetic resonance imaging (MRI) plane aligned to the long axis of the right ventricular (RV) cavity for functional analysis by comparing the measurement variability and time required for the analysis with that using a short-axis (SAX) image orientation. Materials and Methods: Thirty-four cardiac MRI exams with cine balanced steady-state free precession image stacks in both the SAX and the HLA of the RV (RHLA) were evaluated. Two reviewers independently traced RV endocardial borders on each image of the cine stacks. The time required to complete each set of traces was recorded, and the RV end-diastolic volume, end-systolic volume, and ejection fraction were calculated. Analysis times and RV measurements were compared between the two orientations. Results: Analysis time for each reviewer was significantly shorter for the RHLA stack (reviewer 1 = 6.4 ± 1.8 min, reviewer 2 = 6.0 ± 3.3 min) than for the SAX stack (7.5 ± 2.1 and 6.9 ± 3.6 min, respectively; P < 0.002). Bland–Altman analysis revealed lower mean differences, limits of agreement, and coefficients of variation for RV measurements obtained with the RHLA stack. Conclusions: RV functional analysis using a RHLA stack resulted in shorter analysis times and lower measurement variability than for a SAX stack orientation.
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Affiliation(s)
- Abhishek Chaturvedi
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA; Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, USA
| | - Joseph Whitnah
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA
| | - Jeffrey H Maki
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA
| | - Timothy Baran
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, USA
| | - Lee M Mitsumori
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA; Department of Radiology, Straub Clinic and Hospital, Honolulu, HI, NY, USA
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141
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Wu J, Wu C, Fan W, Zhou J, Xu L. Incidence and predictors of left ventricular remodeling among elderly Asian women: a community-based cohort study. BMC Geriatr 2017; 17:21. [PMID: 28088188 PMCID: PMC5237527 DOI: 10.1186/s12877-017-0411-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/03/2017] [Indexed: 12/02/2022] Open
Abstract
Background Left ventricular (LV) remodeling is closely linked to the progression of heart failure. There are limited data on the epidemiology of new onset LV remodeling among elderly women, which requires further investigation. Method We examined data from a community-based cohort of women aged > 65 years, who had received > 2 echocardiography scans from 2009 to 2014. Exclusion criteria for patients included prior echocardiographic evidence of left ventricular enlargement (LVE) or hypertrophy (LVH). LVE was defined as the index of left ventricular internal diameter at end-diastole to height, and LVH was defined as the left ventricular mass and thickness index which indicate hypertrophy. Results Of the 474 subjects (age 71.85 ± 6.47 years), 49 (10.3%) developed LVH, while 55 (11.6%) developed LVE during the mean follow-up period of 5 years. Independent predictors of LVH included: central blood pressure (CBP, per 10 mmHg) [HR 1.094, 95% CI 1.011–1.202], BMI˃25(kg/m 2)[HR 1.306, 95% CI 1.175–1.434], B-type natriuretic peptide (BNP) ≥ 100 (pg/mL) [HR 1.635, 95% CI 1.107–3.311] and brachial-ankle pulse wave velocity (baPWV) ≥16 m/s [HR 1.605, 95% CI 1.474–2.039]. Predictors of LVE were CBP (per 10 mmHg) [HR 1.121, 95% CI 1.027–1.238], BMI˃25(kg/m 2)[HR 1.302, 95% CI 1.173–1.444], Low-density lipoprotein cholesterol (LDL-C) [HR 1.193, 95%CI 1.013–1.405] and E/e’ ratio [HR 1.077, 95% CI 1.017–1.140]. Conclusion CBP and BMI were demonstrated to be independent and robust predictors of left ventricular remodeling among elderly women, including both LVE and LVH. BNP and baPWV were specifically related to the development of LVH, whereas LDL-C and E/e’ ratio were related to LVE.
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Affiliation(s)
- Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cai Lun Road, Shanghai, People's Republic of China
| | - Caiqin Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cai Lun Road, Shanghai, People's Republic of China
| | - Wenjing Fan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cai Lun Road, Shanghai, People's Republic of China
| | - Jie Zhou
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cai Lun Road, Shanghai, People's Republic of China.
| | - Ling Xu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, People's Republic of China.
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Kendrick J, Zelnick L, Chonchol M, Siscovick D, Hoofnagle AN, Ix JH, Sarnak M, Shlipak M, Kestenbaum B, de Boer IH. Serum Bicarbonate Is Associated with Heart Failure in the Multi-Ethnic Study of Atherosclerosis. Am J Nephrol 2016; 45:118-126. [PMID: 27941322 PMCID: PMC5296282 DOI: 10.1159/000454783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low serum bicarbonate concentrations are associated with mortality and kidney disease progression. Data regarding associations between bicarbonate and cardiovascular disease (CVD) are scarce. METHODS We performed a cohort study of 6,229 adult participants from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort free of CVD at baseline. Serum bicarbonate was measured at baseline. Cardiovascular outcomes were defined as: (1) subclinical CVD (left ventricular mass [LVM] and aortic pulse pressure [PP] measured at baseline), (2) incident atherosclerotic cardiovascular events (CVE; composite of myocardial infarction, resuscitated cardiac arrest, stroke, coronary heart disease death, and stroke death), and (3) incident heart failure. RESULTS During a median (interquartile range) follow-up of 8.5 (7.7-8.6) years, 331 (5.3%) participants had an incident CVE and 174 (2.8%) developed incident heart failure. We stratified analyses by use of diuretics because we observed a significant interaction between diuretic use and bicarbonate with study outcomes. Among diuretic nonusers, with adjustment, bicarbonate ≥25 mEq/L was associated with an estimated 3.0 g greater LVM (95% CI 0.5-5.0) and 1.0 mm Hg higher aortic PP (95% CI 0.4-2.0) compared to bicarbonate 23-24 mEq/L. Each 1 mEq/L of bicarbonate increase was associated with a 13% higher risk of incident heart failure (hazards ratio 1.13, 95% CI 1.01-2.11). Among diuretic users, higher bicarbonate was not associated with CVD. Bicarbonate was not associated with incident atherosclerotic CVE irrespective of diuretic use. CONCLUSION Among nonusers of diuretics in a large community-based study, higher serum bicarbonate concentrations are associated with subclinical CVD and new heart failure.
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Affiliation(s)
- Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
- Denver Health Medical Center, Denver, CO
| | - Leila Zelnick
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle WA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | | | | | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA
| | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Michael Shlipak
- Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA
| | - Bryan Kestenbaum
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle WA
| | - Ian H. de Boer
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle WA
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Shah AM, Claggett B, Kitzman D, Biering-Sørensen T, Jensen JS, Cheng S, Matsushita K, Konety S, Folsom AR, Mosley TH, Wright JD, Heiss G, Solomon SD. Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults: The Atherosclerosis Risk in Communities Study. Circulation 2016; 135:426-439. [PMID: 27927714 DOI: 10.1161/circulationaha.116.024825] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although age-associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values for incident heart failure (HF), as well as their associations with circulating biomarkers of HF risk. METHODS Among 5801 elderly participants in the ARIC study (Atherosclerosis Risk in Communities; age range, 67-90 years; mean age, 76±5 years; 42% male; 21% black), we determined the continuous association of diastolic measures (tissue Doppler imaging [TDI] e', E/e', and left atrial size) with concomitant N-terminal pro-brain natriuretic peptide and subsequent HF hospitalization or death. We also determined sex-specific 10th and 90th percentile limits for these measures using quantile regression in 401 participants free of prevalent cardiovascular disease and risk factors. RESULTS Each measure of diastolic function was robustly associated with N-terminal pro-brain natriuretic peptide and incident HF or death. ARIC-based reference limits for TDI e' (4.6 and 5.2 cm/s for septal and lateral TDI e', respectively) were substantially lower than guideline cut points (7 and 10 cm/s, respectively), whereas E/e' and left atrial size demonstrated good agreement with guideline cut points. TDI e' was nonlinearly associated with incident HF or death, with inflection points for risk supportive of ARIC-based limits. ARIC-based limits for diastolic function improved risk discrimination over guideline-based cut points based on the integrated discrimination improvement (P<0.001) and continuous net reclassification improvement (P<0.001), reclassifying 42% of the study population as having normal diastolic function. We replicate these findings in the Copenhagen City Heart Study. With these limits, 46% had normal diastolic function and were at low risk of HF hospitalization or death (1%/y over a mean 1.7-year follow-up), 49% had 1 or 2 abnormal measures and were at intermediate risk (2.4%/y), and all 3 diastolic measures were abnormal in 5% who were at high risk (7.5%/y). CONCLUSIONS Our findings suggest that left ventricular longitudinal relaxation velocity declines as a part of healthy aging and is largely prognostically benign. The use of age-based normative values when considering an elderly population improves the risk discrimination of diastolic measures for incident HF or death.
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Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Dalane Kitzman
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Tor Biering-Sørensen
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Jan Skov Jensen
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Susan Cheng
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Kunihiro Matsushita
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Suma Konety
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Aaron R Folsom
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Thomas H Mosley
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Jacqueline D Wright
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Gerardo Heiss
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
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Yeboah J, Bertoni A, Qureshi W, Aggarwal S, Lima JAC, Kawel-Boehm N, Bluemke DA, Shah SJ. Pedal Edema as an Indicator of Early Heart Failure in the Community: Prevalence and Associations With Cardiac Structure/Function and Natriuretic Peptides (MESA [Multiethnic Study of Atherosclerosis]). Circ Heart Fail 2016; 9:e003415. [PMID: 27923806 PMCID: PMC5147536 DOI: 10.1161/circheartfailure.116.003415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of pedal edema (PE) and its associations with abnormal cardiac structure/function, natriuretic peptides, and incident heart failure (HF) is unknown, especially in community-dwelling adults without a history of cardiovascular disease. METHODS AND RESULTS Out of 5004 MESA (Multiethnic Study of Atherosclerosis) participants who had cardiac magnetic resonance imaging, 4196 had complete data and were included in this analysis (3501 for the right ventricle analysis). Logistic regression and Cox proportional hazard analyses were used to assess the associations among self-reported PE, 2-pillow orthopnea, paroxysmal nocturnal dyspnea, left and right ventricular structure and function, natriuretic peptide levels, and incident HF. PE was present in 28% of the participants. PE was not associated with overt left or right ventricular systolic dysfunction (ejection fraction <50%). PE was associated with 2-pillow orthopnea (odds ratio 1.66; 95% confidence interval [CI], 1.30-2.12), paroxysmal nocturnal dyspnea (odds ratio 1.95; 95% CI, 1.55-2.44), and abnormal N-terminal pro-B-type natriuretic peptide levels (defined as >400 pg/mL; odds ratio 1.80; 95% CI, 1.21-2.68) in adjusted models. After a mean of 10.2 years of follow-up, 184/4196 (4.4%) participants had an adjudicated incident HF hospitalization. PE was associated with incident HF hospitalization in models adjusted for age, sex, and race (hazard ratio 1.44; 95% CI, 1.05-1.97). This association persisted after adding additional covariates, including comorbidities, baseline left ventricular ejection fraction, and antecedent myocardial infarction (hazard ratio 1.43; 95% CI, 1.02-1.99). The association of PE with incident HF was attenuated by further adjustment for N-terminal pro-B-type natriuretic peptide. CONCLUSIONS PE is prevalent in community-dwelling adults without clinically recognized cardiovascular disease and associated with future hospitalized HF.
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Affiliation(s)
- Joseph Yeboah
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
| | - Alain Bertoni
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Waqas Qureshi
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Shivani Aggarwal
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Joao A C Lima
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Nadine Kawel-Boehm
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - David A Bluemke
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Sanjiv J Shah
- From the Heart and Vascular Center of Excellence (J.Y., W.Q., S.A.) and Department of Epidemiology (A.B.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Cardiology and Radiology, Johns Hopkins University, Baltimore, MD (J.A.C.L.); Kantonsspital Graubuenden Clinic of Radiology, Loestrasse 170, 7000 Chur, Switzerland (N.K.-B.); National Institutes of Health Clinical Center, Bethesda, MD (D.A.B.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
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Shah AM, Claggett B, Loehr LR, Chang PP, Matsushita K, Kitzman D, Konety S, Kucharska-Newton A, Sueta CA, Mosley TH, Wright JD, Coresh J, Heiss G, Folsom AR, Solomon SD. Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study. Circulation 2016; 135:224-240. [PMID: 27881564 DOI: 10.1161/circulationaha.116.023361] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although heart failure (HF) disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association HF stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain and diastolic dysfunction in defining HF stages is unclear. METHODS HF stages were classified in 6118 participants in the Atherosclerosis Risk in Communities study (67-91 years of age) at the fifth study visit as follows: A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with earlier hospitalization). RESULTS Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. Left ventricular (LV) ejection fraction was preserved in 77% and 65% in Stages C1 and C2, respectively. Incorporation of longitudinal strain and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (P=0.028) and integrated discrimination index (P=0.016). Abnormal LV structure, systolic function (based on LV ejection fraction and longitudinal strain), and diastolic function (based on e', E/e', and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants. CONCLUSIONS The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared with previous reports in younger community-based samples. LV ejection fraction is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HF with preserved LV ejection fraction in the elderly. LV diastolic function and longitudinal strain provide incremental prognostic value beyond conventional measures of LV structure and LV ejection fraction in identifying persons at risk for HF hospitalization or death.
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Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Laura R Loehr
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Patricia P Chang
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Kunihiro Matsushita
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Dalane Kitzman
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Suma Konety
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Anna Kucharska-Newton
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Carla A Sueta
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Thomas H Mosley
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Jacqueline D Wright
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Joseph Coresh
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Gerardo Heiss
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Aaron R Folsom
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
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Lei X, Liu H, Han Y, Cheng W, Sun J, Luo Y, Yang D, Dong Y, Chung Y, Chen Y. Reference values of cardiac ventricular structure and function by steady-state free-procession MRI at 3.0T in healthy adult chinese volunteers. J Magn Reson Imaging 2016; 45:1684-1692. [PMID: 27862557 DOI: 10.1002/jmri.25520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/07/2016] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xiaolin Lei
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Hong Liu
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - Wei Cheng
- Radiology Department, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Jiayu Sun
- Radiology Department, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yong Luo
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Dan Yang
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yang Dong
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
| | - Yiochu Chung
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Key Laboratory for MRI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences; Shenzhen Guangdong China
| | - Yucheng Chen
- Cardiology Division, West China Hospital; Sichuan University; Chengdu Sichuan Province China
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147
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Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain. Eur J Radiol 2016; 86:163-168. [PMID: 28027742 DOI: 10.1016/j.ejrad.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/18/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. MATERIALS AND METHODS This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. RESULTS 225 subjects (age, 56.2±11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01-1.13permm) and LV mass (HR:1.05, 95%CI:1.00-1.10perg) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. CONCLUSION CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and obstructive coronary artery disease.
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148
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Assessment of the accuracy of common clinical thresholds for cardiac morphology and function by transthoracic echocardiography. J Echocardiogr 2016; 15:27-36. [PMID: 27817093 DOI: 10.1007/s12574-016-0322-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the ability of transthoracic echocardiography (TTE) to correctly identify abnormal left ventricular (LV) size, function, and mass when compared to cardiac magnetic resonance (CMR). Whilst numerous studies have compared TTE and CMR with respect to correlation between measurements and study reproducibility, few have employed categorical analysis relevant to clinical practice. METHODS Two hundred and fifteen consecutive patients who underwent both TTE and CMR were evaluated for the presence of abnormal LV size, systolic function, and mass. Abnormal LV systolic function was further categorized into grades (mild, moderate, and severe). Quantification of LV morphology and function was performed on TTE and CMR according to published guidelines. The level of agreement between TTE and CMR was compared across binary and categorical variables using Cohen's kappa. RESULTS Compared to CMR, TTE demonstrated excellent agreement in identification of abnormal versus normal function (κ = 0.87). However, agreement across grades of LV function was less strong (κ = 0.63). Whilst agreement for identification of severe LV dysfunction was good (κ = 0.68), this would still lead to misclassification of severe dysfunction in approximately one in seven cases. Agreement between TTE and CMR was moderate to good for identification of LV dilation (κ = 0.43-0.63), but poor for identification of increased mass (κ = 0.04). CONCLUSIONS Whilst in clinical practice TTE performs well in identification of normal versus abnormal systolic function, it has substantial limitations across grades of dysfunction and in the assessment of LV size and mass. These limitations have important implications when considering management decisions for patients based on thresholds of LV morphology or function.
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149
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Gandy SJ, Lambert M, Belch J, Cavin I, Crowe E, Littleford R, MacFarlane JA, Matthew SZ, Martin P, Nicholas RS, Struthers A, Sullivan F, Waugh SA, White RD, Weir-McCall JR, Houston JG. 3T MRI investigation of cardiac left ventricular structure and function in a UK population: The tayside screening for the prevention of cardiac events (TASCFORCE) study. J Magn Reson Imaging 2016; 44:1186-1196. [PMID: 27143317 PMCID: PMC5082537 DOI: 10.1002/jmri.25267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/28/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To scan a volunteer population using 3.0T magnetic resonance imaging (MRI). MRI of the left ventricular (LV) structure and function in healthy volunteers has been reported extensively at 1.5T. MATERIALS AND METHODS A population of 1528 volunteers was scanned. A standardized approach was taken to acquire steady-state free precession (SSFP) LV data in the short-axis plane, and images were quantified using commercial software. Six observers undertook the segmentation analysis. RESULTS Mean values (±standard deviation, SD) were: ejection fraction (EF) = 69 ± 6%, end diastolic volume index (EDVI) = 71 ± 13 ml/m2 , end systolic volume index (ESVI) = 22 ± 7 ml/m2 , stroke volume index (SVI) = 49 ± 8 ml/m2 , and LV mass index (LVMI) = 55 ± 12 g/m2 . The mean EF was slightly larger for females (69%) than for males (68%), but all other variables were smaller for females (EDVI 68v77 ml/m2 , ESVI 21v25 ml/m2 , SVI 46v52 ml/m2 , LVMI 49v64 g/m2 , all P < 0.05). The mean LV volume data mostly decreased with each age decade (EDVI males: -2.9 ± 1.3 ml/m2 , females: -3.1 ± 0.8 ml/m2 ; ESVI males: -1.3 ± 0.7 ml/m2 , females: -1.7 ± 0.5 ml/m2 ; SVI males: -1.7 ± 0.9 ml/m2 , females: -1.4 ± 0.6 ml/m2 ; LVMI males: -1.6 ± 1.1 g/m2 , females: -0.2 ± 0.6 g/m2 ) but the mean EF was virtually stable in males (0.6 ± 0.6%) and rose slightly in females (1.2 ± 0.5%) with age. CONCLUSION LV reference ranges are provided in this population-based MR study at 3.0T. The variables are similar to those described at 1.5T, including variations with age and gender. These data may help to support future population-based MR research studies that involve the use of 3.0T MRI scanners. J. Magn. Reson. Imaging 2016;44:1186-1196.
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Affiliation(s)
- Stephen J Gandy
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Jill Belch
- University of Dundee School of Medicine, Dundee, UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - Elena Crowe
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | | | | | | | - Patricia Martin
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | - R Stephen Nicholas
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Frank Sullivan
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Canada
| | | | - Richard D White
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
- Department of Clinical Radiology, University Hospital of Wales, UK
| | | | - J Graeme Houston
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK.
- University of Dundee School of Medicine, Dundee, UK.
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Hinojar R, Foote L, Sangle S, Marber M, Mayr M, Carr-White G, D'Cruz D, Nagel E, Puntmann VO. Native T1 and T2 mapping by CMR in lupus myocarditis: Disease recognition and response to treatment. Int J Cardiol 2016; 222:717-726. [DOI: 10.1016/j.ijcard.2016.07.182] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022]
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