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Đorđević DB, Koračević GP, Đorđević AD, Lović DB. Hypertension and left ventricular hypertrophy. J Hypertens 2024; 42:1505-1515. [PMID: 38747417 DOI: 10.1097/hjh.0000000000003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
In the initial stage, left ventricular hypertrophy (LVH) is adaptive, but in time, it transforms to maladaptive LVH which is specific for the development of various phenotypes that cause heart failure, initially with preserved, but later with reduced left ventricular ejection fraction. Pathophysiological mechanisms, which are characteristic for remodeling procedure, are numerous and extremely complex, and should be subjected to further research with the aim of making a comprehensive overview of hypertensive heart disease (HHD) and discovering new options for preventing and treating HHD. The contemporary methods, such as cardiac magnetic resonance (CMR) and computed tomography (CT) provide very accurate morphological and functional information on HHD. The objective of this review article is to summarize the available scientific information in terms of prevalence, pathophysiology, diagnostics, prevention, contemporary therapeutic options, as well as to present potential therapeutic solutions based on the research of pathological mechanisms which are at the core of HHD.
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Affiliation(s)
- Dragan B Đorđević
- Faculty of Medicine, University of Nis
- Institute for Treatment and Rehabilitation Niska Banja
| | - Goran P Koračević
- Faculty of Medicine, University of Nis
- Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia
| | | | - Dragan B Lović
- Clinic for Internal Diseases Intermedica, Singidunum University Nis, Jovana Ristica, Nis, Serbia
- Veterans Affair Medical Centre, Washington DC, USA
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2
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Pastore MC, Cavigli L, Olivoni G, Morrone F, Amati F, Imbalzano E, Rinaldi A, Liga R, Mattioli AV, Scicchitano P, Curcio A, Barillà F, Ciccarelli M, Maestrini V, Perrone Filardi P, D'Ascenzi F, Cameli M. Physical exercise in hypertensive heart disease: From the differential diagnosis to the complementary role of exercise. Int J Cardiol 2024; 410:132232. [PMID: 38844090 DOI: 10.1016/j.ijcard.2024.132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Arterial hypertension (AH) is one of the most common pathologic conditions and uncontrolled AH is a leading risk factor for cardiovascular disease and mortality. AH chronically causes myocardial and arterial remodelling with hemodynamic changes affecting the heart and other organs, with potentially irreversible consequences leading to poor outcomes. Therefore, a proper and early treatment of AH is crucial after the diagnosis. Beyond medical treatment, physical exercise also plays a therapeutic role in reducing blood pressure, given its potential effects on sympathetic tone, renin-angiotensin-aldosterone system, and endothelial function. International scientific societies recommend physical exercise among lifestyle modifications to treat AH in the first stages of the disease. Moreover, some studies have also shown its usefulness in addition to drugs to reduce blood pressure further. Therefore, an accurate, personalized exercise prescription is recommended to optimize the prevention and treatment of hypertension. On the other hand, uncontrolled AH in athletes requires proper risk stratification and careful evaluation to practice competitive sports safely. Moreover, the differential diagnosis between hypertensive heart disease and athlete's heart is sometimes challenging and requires a careful and comprehensive interpretation in order not to misinterpret the clinical findings. The present review aims to discuss the relationship between hypertensive heart disease and physical exercise, from diagnostic tools to prevention and treatment strategies.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Gabriele Olivoni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Morrone
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Riccardo Liga
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | | | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Francesco Barillà
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Italian Society of Cardiology, Federico II University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Small GR. Myocardial extracellular volume by CT: Assessing the state of the union. J Cardiovasc Comput Tomogr 2024; 18:465-466. [PMID: 39098511 DOI: 10.1016/j.jcct.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Gary R Small
- Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Liu AB, Lin YX, Meng TT, Tian P, Chen JL, Zhang XH, Xu WH, Zhang Y, Zhang D, Zheng Y, Su GH. Global prevalence and disability-adjusted life years of hypertensive heart disease: A trend analysis from the Global Burden of Disease Study 2019. J Glob Health 2024; 14:04172. [PMID: 39212657 PMCID: PMC11364089 DOI: 10.7189/jogh.14.04172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Background As hypertensive heart disease (HHD) presents a significant public health challenge globally, we analysed its global, regional, and national burdens and trends from 1990 to 2019. Methods We used data from the Global Burden of Disease (GBD) 2019 study, focussing on the age-standardised prevalence rates (ASPRs) of HHD prevalence, age-standardised disability-adjusted life year (DALY) rates, average annual percentage change (AAPC), and risk factor attributions. We compared the HHD burden across sociodemographic index (SDI) strata, gender, age groups, and 204 countries and territories. Results In 2019, the global prevalence of HHD was estimated at 18 598 thousand cases, with DALYs reaching 21 508 thousand. From 1990 to 2019, the ASPRs increased (AAPC = 0.21; 95% confidence interval (CI) = 0.17, 0.24), while the age-standardised DALY rates decreased (AAPC = -0.45; 95% CI = -1.23, -0.93). We observed the highest increase in ASPRs in high-middle SDI quantile countries, and an overall negative correlation between age-standardised DALY rates and SDI. Individuals above 70 years of age were the most affected, particularly elderly women. There has been a significant increase in HHD burden attributed to high body mass index (BMI) since 1990. The burden of HHD is concentrated in the middle SDI quintile, with population ageing and growth being major drivers for the increase in DALYs. We identified opportunities for reducing age-standardised DALY rates in the middle SDI quintile or lower. Conclusion Despite a declining trend in the age-standardised DALY rates, the ASPRs of HHD continue to rise, especially in high-middle SDI regions. Meanwhile, countries in middle and lower SDI quintiles face a higher burden of age-standardised DALY rates. Targeted attention towards elderly women and controlling high BMI, alongside enhancing hypertension and HHD management awareness, is crucial for reducing the global burden of HHD.
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Affiliation(s)
- An-Bang Liu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yan-Xia Lin
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ting-Ting Meng
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Peng Tian
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Jian-Lin Chen
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Xin-He Zhang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wei-Hong Xu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yu Zhang
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Dan Zhang
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Yan Zheng
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guo-Hai Su
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Ma ZP, Wang SW, Xue LY, Zhang XD, Zheng W, Zhao YX, Yuan SR, Li GY, Yu YN, Wang JN, Zhang TL. A study on the application of radiomics based on cardiac MR non-enhanced cine sequence in the early diagnosis of hypertensive heart disease. BMC Med Imaging 2024; 24:124. [PMID: 38802736 PMCID: PMC11129462 DOI: 10.1186/s12880-024-01301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The prevalence of hypertensive heart disease (HHD) is high and there is currently no easy way to detect early HHD. Explore the application of radiomics using cardiac magnetic resonance (CMR) non-enhanced cine sequences in diagnosing HHD and latent cardiac changes caused by hypertension. METHODS 132 patients who underwent CMR scanning were divided into groups: HHD (42), hypertension with normal cardiac structure and function (HWN) group (46), and normal control (NOR) group (44). Myocardial regions of the end-diastolic (ED) and end-systolic (ES) phases of the CMR short-axis cine sequence images were segmented into regions of interest (ROI). Three feature subsets (ED, ES, and ED combined with ES) were established after radiomic least absolute shrinkage and selection operator feature selection. Nine radiomic models were built using random forest (RF), support vector machine (SVM), and naive Bayes. Model performance was analyzed using receiver operating characteristic curves, and metrics like accuracy, area under the curve (AUC), precision, recall, and specificity. RESULTS The feature subsets included first-order, shape, and texture features. SVM of ED combined with ES achieved the highest accuracy (0.833), with a macro-average AUC of 0.941. AUCs for HHD, HWN, and NOR identification were 0.967, 0.876, and 0.963, respectively. Precisions were 0.972, 0.740, and 0.826; recalls were 0.833, 0.804, and 0.863, respectively; and specificities were 0.989, 0.863, and 0.909, respectively. CONCLUSIONS Radiomics technology using CMR non-enhanced cine sequences can detect early cardiac changes due to hypertension. It holds promise for future use in screening for latent cardiac damage in early HHD.
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Affiliation(s)
- Ze-Peng Ma
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
- Hebei Key Laboratory of Precise Imaging of Inflammation Related Tumors, Baoding, 071000, China
| | - Shi-Wei Wang
- College of Quality and Technical Supervision, Hebei University, Baoding, 071002, China
| | - Lin-Yan Xue
- College of Quality and Technical Supervision, Hebei University, Baoding, 071002, China
| | - Xiao-Dan Zhang
- Department of Ultrasound, Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, 071000, China.
| | - Wei Zheng
- College of Electronic and Information Engineering, Hebei University, Baoding, 071002, China
| | - Yong-Xia Zhao
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Shuang-Rui Yuan
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Gao-Yang Li
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Ya-Nan Yu
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Jia-Ning Wang
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Tian-Le Zhang
- Department of Radiology, Affiliated Hospital of Hebei University/ Clinical Medical College, Hebei University, Baoding, 071000, China
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Lee JH, Kim HW, Kim SA, Ju WT, Kim SR, Kim HB, Cha IS, Kim SW, Park JW, Kang SK. Modulatory Effects of the Kuwanon-Rich Fraction from Mulberry Root Bark on the Renin-Angiotensin System. Foods 2024; 13:1547. [PMID: 38790847 PMCID: PMC11121332 DOI: 10.3390/foods13101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
In this study, we investigated the anti-hypertensive properties of mulberry products by modulating the renin-angiotensin system (RAS). Comparative analysis showed that the ethyl acetate fractions, particularly from the Cheongil and Daeshim cultivars, contained the highest levels of polyphenols and flavonoids, with concentrations reaching 110 mg gallic acid equivalent (GE)/g and 471 mg catechin equivalent (CE)/g of extract, respectively. The ethyl acetate fraction showed superior angiotensin-converting enzyme (ACE) inhibitory activity, mainly because of the presence of the prenylated flavonoids kuwanon G and H. UPLC/Q-TOF-MS analysis identified kuwanon G and H as the primary active components, which significantly contributed to the pharmacological efficacy of the extract. In vivo testing of mice fed a high-salt diet showed that the ethyl acetate fraction substantially reduced the heart weight and lowered the serum renin and angiotensinogen levels by 34% and 25%, respectively, highlighting its potential to modulate the RAS. These results suggested that the ethyl acetate fraction of mulberry root bark is a promising candidate for the development of natural ACE inhibitors. This finding has significant implications for the management of hypertension through RAS regulation and the promotion of cardiovascular health in the functional food industry.
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Affiliation(s)
- Ji-Hae Lee
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Heon-Woong Kim
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - So-Ah Kim
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Wan-Taek Ju
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Seong-Ryul Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Hyun-Bok Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Ik-Seob Cha
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Seong-Wan Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Jong-Woo Park
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
| | - Sang-Kuk Kang
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea (I.-S.C.)
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Cheng Y, Yan M, He S, Xie Y, Wei L, Xuan B, Shang Z, Wu M, Zheng H, Chen Y, Yuan M, Peng J, Shen A. Baicalin alleviates angiotensin II-induced cardiomyocyte apoptosis and autophagy and modulates the AMPK/mTOR pathway. J Cell Mol Med 2024; 28:e18321. [PMID: 38712979 PMCID: PMC11075640 DOI: 10.1111/jcmm.18321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/04/2024] [Accepted: 04/03/2024] [Indexed: 05/08/2024] Open
Abstract
As a main extraction compound from Scutellaria baicalensis Georgi, Baicalin exhibits various biological activities. However, the underlying mechanism of Baicalin on hypertension-induced heart injury remains unclear. In vivo, mice were infused with angiotensin II (Ang II; 500 ng/kg/min) or saline using osmotic pumps, followed by intragastrically administrated with Baicalin (5 mg/kg/day) for 4 weeks. In vitro, H9C2 cells were stimulated with Ang II (1 μM) and treated with Baicalin (12.5, 25 and 50 μM). Baicalin treatment significantly attenuated the decrease in left ventricular ejection fraction and left ventricular fractional shortening, increase in left ventricular mass, left ventricular systolic volume and left ventricular diastolic volume of Ang II infused mice. Moreover, Baicalin treatment reversed 314 differentially expressed transcripts in the cardiac tissues of Ang II infused mice, and enriched multiple enriched signalling pathways (including apoptosis, autophagy, AMPK/mTOR signalling pathway). Consistently, Baicalin treatment significantly alleviated Ang II-induced cell apoptosis in vivo and in vitro. Baicalin treatment reversed the up-regulation of Bax, cleaved-caspase 3, cleaved-caspase 9, and the down-regulation of Bcl-2. Meanwhile, Baicalin treatment alleviated Ang II-induced increase of autophagosomes, restored autophagic flux, and down-regulated LC3II, Beclin 1, as well as up-regulated SQSTM1/p62 expression. Furthermore, autophagy inhibitor 3-methyladenine treatment alleviated the increase of autophagosomes and the up-regulation of Beclin 1, LC3II, Bax, cleaved-caspase 3, cleaved-caspase 9, down-regulation of SQSTM1/p62 and Bcl-2 expression after Ang II treated, which similar to co-treatment with Baicalin. Baicalin treatment reduced the ratio of p-AMPK/AMPK, while increased the ratio of p-mTOR/mTOR. Baicalin alleviated Ang II-induced cardiomyocyte apoptosis and autophagy, which might be related to the inhibition of the AMPK/mTOR pathway.
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Affiliation(s)
- Ying Cheng
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Mengchao Yan
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Shuyu He
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Yi Xie
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Lihui Wei
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
- Innovation and Transformation CenterFujian University of Traditional Chinese MedicineFuzhouFujianChina
| | - Bihan Xuan
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Zucheng Shang
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Meizhu Wu
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
| | - Huifang Zheng
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
- Innovation and Transformation CenterFujian University of Traditional Chinese MedicineFuzhouFujianChina
| | - Youqin Chen
- Department of PediatricsRainbow Babies and Children's Hospital and Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Meng Yuan
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
- Innovation and Transformation CenterFujian University of Traditional Chinese MedicineFuzhouFujianChina
| | - Jun Peng
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
- Innovation and Transformation CenterFujian University of Traditional Chinese MedicineFuzhouFujianChina
| | - Aling Shen
- Academy of Integrative MedicineFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Key Laboratory of Integrative Medicine on GeriatricsFujian University of Traditional Chinese MedicineFuzhouFujianChina
- Fujian Collaborative Innovation Center for Integrative Medicine in Prevention and Treatment of Major Chronic Cardiovascular DiseasesFuzhouFujianChina
- Innovation and Transformation CenterFujian University of Traditional Chinese MedicineFuzhouFujianChina
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Yang Z, Tang D, Luo Y, Xiang C, Huang L, Xia L. The relationship between epicardial adipose tissue thickness and arrhythmias in patients with hypertension: a 3.0T cardiac magnetic resonance study. Br J Radiol 2023; 96:20221030. [PMID: 36971695 PMCID: PMC10230399 DOI: 10.1259/bjr.20221030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To investigate the relationship between epicardial adipose tissue (EAT) thickness using cardiac magnetic resonance imaging (CMR) and arrhythmias in hypertensive patients. METHODS Fifty-four hypertensive patients with arrhythmias (HTN [arrhythmias+]), 79 hypertensive patients without arrhythmias (HTN [arrhythmias-]), and 39 normal controls were retrospectively enrolled. EAT thickness was measured on cine images. Analysis of covariance with Bonferroni's post hoc correction, Pearson or Spearman analysis, receiver operating characteristic curve, and intraclass correlation coefficient analysis were performed. RESULTS All hypertensive patients had impaired left ventricular (LV) and left atrial (LA) myocardial deformation, and HTN (arrhythmias+) patients displayed higher LV myocardial native T1, LA volume index, and increased EAT thickness than HTN (arrhythmias-) patients and normotensive controls. The presence of LV late gadolinium enhancement (LGE) was higher in hypertensive patients with arrhythmias than in those without arrhythmias. EAT thickness metrics significantly correlated with age, systolic blood pressure, body mass index, triglycerides and high-density lipoprotein levels, LV mass index and native T1 (all p < 0.05). EAT thickness parameters were able to differentiate hypertensive patients with arrhythmias from those without arrhythmias and normal controls, and the right ventricular free wall had the highest diagnostic performance. CONCLUSION An accumulation of EAT thickness could further induce cardiac remodeling, promote myocardial fibrosis, and exaggerate function in hypertensive patients with arrhythmias. ADVANCES IN KNOWLEDGE CMR-derived EAT thickness metrics could be a useful imaging marker for differentiating hypertensive patients with arrhythmias, which might be a potential target for the prevention of cardiac remodeling and arrhythmias.
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Affiliation(s)
- Zhaoxia Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dazong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Ismail TF, Frey S, Kaufmann BA, Winkel DJ, Boll DT, Zellweger MJ, Haaf P. Hypertensive Heart Disease-The Imaging Perspective. J Clin Med 2023; 12:jcm12093122. [PMID: 37176563 PMCID: PMC10179093 DOI: 10.3390/jcm12093122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.
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Affiliation(s)
- Tevfik F Ismail
- King's College London & Cardiology Department, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Simon Frey
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - David J Winkel
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter. Diagnostics (Basel) 2022; 13:diagnostics13010137. [PMID: 36611429 PMCID: PMC9818319 DOI: 10.3390/diagnostics13010137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease.
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Tadic M, Cuspidi C, Marwick TH. Phenotyping the hypertensive heart. Eur Heart J 2022; 43:3794-3810. [DOI: 10.1093/eurheartj/ehac393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
Abstract
Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling—especially LV hypertrophy—is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm , Albert-Einstein Allee 23, 89081 Ulm , Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca , Milano 20126 , Italy
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute , Melbourne, VIC 3004 , Australia
- Baker Department of Cardiometabolic Health, University of Melbourne , VIC 3004 , Australia
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12
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Snel GJH, van den Boomen M, Hurtado-Ortiz K, Slart RHJA, van Deursen VM, Nguyen CT, Sosnovik DE, Dierckx RAJO, Velthuis BK, Borra RJH, Prakken NHJ. Cardiac Alterations on 3T MRI in Young Adults With Sedentary Lifestyle-Related Risk Factors. Front Cardiovasc Med 2022; 9:840790. [PMID: 35274012 PMCID: PMC8902075 DOI: 10.3389/fcvm.2022.840790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Young adult populations with the sedentary lifestyle-related risk factors overweight, hypertension, and type 2 diabetes (T2D) are growing, and associated cardiac alterations could overlap early findings in non-ischemic cardiomyopathy on cardiovascular MRI. We aimed to investigate cardiac morphology, function, and tissue characteristics for these cardiovascular risk factors. Methods Non-athletic non-smoking asymptomatic adults aged 18-45 years were prospectively recruited and underwent 3Tesla cardiac MRI. Multivariate linear regression was performed to investigate independent associations of risk factor-related parameters with cardiac MRI values. Results We included 311 adults (age, 32 ± 7 years; men, 49%). Of them, 220 subjects had one or multiple risk factors, while 91 subjects were free of risk factors. For overweight, increased body mass index (per SD = 5.3 kg/m2) was associated with increased left ventricular (LV) mass (+7.3 g), biventricular higher end-diastolic (LV, +8.6 ml), and stroke volumes (SV; +5.0 ml), higher native T1 (+7.3 ms), and lower extracellular volume (ECV, -0.38%), whereas the higher waist-hip ratio was associated with lower biventricular volumes. Regarding hypertension, increased systolic blood pressure (per SD = 14 mmHg) was associated with increased LV mass (+6.9 g), higher LV ejection fraction (EF; +1.0%), and lower ECV (-0.48%), whereas increased diastolic blood pressure was associated with lower LV EF. In T2D, increased HbA1c (per SD = 9.0 mmol/mol) was associated with increased LV mass (+2.2 g), higher right ventricular end-diastolic volume (+3.2 ml), and higher ECV (+0.27%). Increased heart rate was linked with decreased LV mass, lower biventricular volumes, and lower T2 values. Conclusions Young asymptomatic adults with overweight, hypertension, and T2D show subclinical alterations in cardiac morphology, function, and tissue characteristics. These alterations should be considered in cardiac MRI-based clinical decision making.
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Affiliation(s)
- Gert J. H. Snel
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maaike van den Boomen
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Katia Hurtado-Ortiz
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Ciudad Universitaria, Mexico City, Mexico
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Vincent M. van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Christopher T. Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David E. Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Rudi A. J. O. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Ronald J. H. Borra
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Niek H. J. Prakken
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Tadic M, Cuspidi C. Can myocardial work help in the therapy of resistant hypertension? J Clin Hypertens (Greenwich) 2022; 24:309-311. [PMID: 35001507 PMCID: PMC8925003 DOI: 10.1111/jch.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Cesare Cuspidi
- Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Stacey RB, Hundley WG. Integrating Measures of Myocardial Fibrosis in the Transition from Hypertensive Heart Disease to Heart Failure. Curr Hypertens Rep 2021; 23:22. [PMID: 33881630 DOI: 10.1007/s11906-021-01135-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize recent developments in identifying and quantifying both the presence and amount of myocardial fibrosis by imaging and biomarkers. Further, this review seeks to describe in general ways how this information may be used to identify hypertension and the transition to heart failure with preserved ejection fraction. RECENT FINDINGS Recent studies using cardiac magnetic resonance imaging highlight the progressive nature of fibrosis from normal individuals to those with hypertension to those with clinical heart failure. However, separating hypertensive patients from those with heart failure remains challenging. Recent studies involving echocardiography show the subclinical myocardial strain changes between hypertensive heart disease and heart failure. Lastly, recent studies highlight the potential use of biomarkers to identify those with hypertension at the greatest risk of developing heart failure. In light of the heterogeneous nature between hypertension and heart failure with preserved ejection fraction, an integrated approach with cardiac imaging and biomarker analysis may enable clinicians and investigators to more accurately characterize, prevent, and treat heart failure in those with hypertension.
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Affiliation(s)
- R Brandon Stacey
- Division of Cardiovascular Medicine, Wake Forest University School of Medicine, Watlington Hall, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
| | - W Gregory Hundley
- Division of Cardiovascular Medicine, Wake Forest University School of Medicine, Watlington Hall, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.,Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Association of Hypertensive Intracerebral Hemorrhage with Left Ventricular Hypertrophy on Transthoracic Echocardiography. J Clin Med 2020; 9:jcm9072148. [PMID: 32650380 PMCID: PMC7408960 DOI: 10.3390/jcm9072148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Arterial hypertension is the most frequent cause for spontaneous intracerebral hemorrhage (sICH) and may also cause left ventricular hypertrophy (LVH). We sought to analyze whether hypertensive sICH etiology is associated with LVH. METHODS We analyzed consecutive patients with sICH who were admitted to our tertiary stroke center during a four-year period and underwent transthoracic echocardiography (TTE) as part of the diagnostic work-up. We defined hypertensive sICH as typical localization of hemorrhage in patients with arterial hypertension and no other identified sICH etiology. We defined an increased end-diastolic interventricular septal wall thickness of ≥11 mm on TTE as a surrogate parameter for LVH. RESULTS Among 395 patients with sICH, 260 patients (65.8%) received TTE as part of their diagnostic work-up. The median age was 71 years (interquartile range (IQR) 17), 160 patients (61.5%) were male, the median baseline National Institute of Health Stroke Scale (NIHSS) score was 8 (IQR 13). Of these, 159 (61.2%) patients had a hypertensive sICH and 156 patients (60%) had LVH. In univariable (113/159 (71.1%) vs. 43/101 (42.6%); odds ratio (OR) 3.31; 95% confidence interval (CI95%) 1.97-5.62); and multivariable (adjusted OR 2.95; CI95% 1.29-6.74) analysis, hypertensive sICH was associated with LVH. CONCLUSIONS In patients with sICH, LVH is associated with hypertensive bleeding etiology. Performing TTE is meaningful for diagnosis of comorbidities and clarification of bleeding etiology in these patients. Future studies should include long-term outcome parameters and assess left ventricular mass as main indicator for LVH.
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Becker RC, Phillip Owens A, Sadayappan S. The potential roles of Von Willebrand factor and neutrophil extracellular traps in the natural history of hypertrophic and hypertensive cardiomyopathy. Thromb Res 2020; 192:78-87. [PMID: 32460175 DOI: 10.1016/j.thromres.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/09/2023]
Abstract
Inflammation is often applied broadly to human disease. Despite its general familiarity, inflammation is highly complex. There are numerous injurious, immune and infectious determinants, functional elements and signaling pathways, ranging from genetic to epigenetic, environmental, racial, molecular and cellular that participate in disease onset and progression, phenotypic heterogeneity, and treatment selection and response. In addition, inflammation can be tissue and organ specific, adding a layer of complexity to achieving a detailed and translatable understanding of its role in health and disease. The following review takes a close look at inflammation in the context of two common heart diseases, hypertrophic cardiomyopathy and hypertensive cardiomyopathy.
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Affiliation(s)
- Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America.
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America
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