1
|
Chen C, Zhu Y, Liu L, Ke J, Yu W, Song Q, Li M, Tang Y, Wang C. Associations of 24-Hour Central Systolic Blood Pressure With Multiorgan Damage in Nondialysis Patients With Chronic Kidney Disease. J Am Heart Assoc 2024; 13:e034469. [PMID: 39158576 DOI: 10.1161/jaha.124.034469] [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: 01/14/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Multiple target-organ damages (TODs) in the same patient are common and further increase the risk of cardiovascular disease. However, the relationship between ambulatory central systolic blood pressure (SBP) and multiple TODs has yet to be explored. METHODS AND RESULTS MobilO-Graph PWA was used to monitor the participants' ambulatory blood pressure, and the presence of left ventricular hypertrophy, carotid hypertrophy, and kidney injury were used to define TOD. Logistic regression analyses and receiver operating characteristic analyses were used to explore the correlation between SBP and TOD. Overall, 2018 nondialysis patients with chronic kidney disease were included and 580 (28.74%) had multiple TODs. Twenty-four-hour central SBP with c2 calibration exhibited a stronger correlation with the increasing number of TOD compared with 24-hour brachial SBP in ordinal logistic regression analyses. In the multivariable analyses with the presence of multiple TODs, the odds ratios were 1.786 (95% CI, 1.474-2.165; P<0.001) for 24-hour brachial SBP and 1.949 (95% CI, 1.605-2.366; P<0.001) for 24-hour central SBP with c2 calibration. The receiver operating characteristic analyses also showed that 24-hour central SBP with c2 calibration had higher discrimination than 24-hour brachial SBP regarding multiple TODs (P<0.001). In addition, using 130/135 mm Hg as the threshold for 24-hour brachial SBP/central SBP with c2 calibration to cross-classify, the prevalence of multiple TODs was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension, with no difference between the latter 2 conditions. CONCLUSIONS Twenty-four-hour central SBP with c2 calibration was more associated with the presence of multiple TODs compared with 24-hour brachial SBP and was helpful in risk classification of multiple TODs among nondialysis patients with chronic kidney disease.
Collapse
Affiliation(s)
- Cheng Chen
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ye Zhu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Lingling Liu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Jianting Ke
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Wenjuan Yu
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Qirong Song
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ying Tang
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Cheng Wang
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| |
Collapse
|
2
|
Li S, Huang J, Zhu C, Ng M, Lin Q, Wu M, Liu M, Wang R, Cao G, Chen C, Wu M, Ren Q, Tse H, Yiu K. Target organ damage in untreated hypertensive patients with primary aldosteronism. J Clin Hypertens (Greenwich) 2024; 26:789-796. [PMID: 38715256 PMCID: PMC11232450 DOI: 10.1111/jch.14794] [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: 12/03/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 07/10/2024]
Abstract
An increased risk of target organ damage (TOD) has been reported in patients with primary aldosteronism (PA). However, there is relatively little related research on the correlation between the degree of TOD and those with and without PA in newly diagnosed hypertensive patients. The aim of this study was to assess the association between PA and TOD among patients with newly diagnosed hypertension. Newly diagnosed hypertensive patients were consecutively recruited from January 2015 to June 2020 at the University of Hong Kong-Shenzhen Hospital. Patients were stratified into those with and without PA. Data for left ventricular mass index (LVMI), carotid intima-media thickness (CIMT) and plaque, and microalbuminuria were systematically collected. A total of 1044 patients with newly diagnosed hypertension were recruited, 57 (5.5%) of whom were diagnosed with PA. Patients with PA had lower blood pressure, serum lipids, body mass index, and plasma renin activity and a higher incidence of hypokalemia than those without PA. In contrast, the prevalence of left ventricular hypertrophy, increased CIMT, and microalbuminuria was higher in patients with PA than in those without PA. Multivariable regression analysis demonstrated that PA was independently associated with increased LVMI, CIMT and microalbuminuria. Among patients with newly diagnosed hypertension, those with PA had more severe TOD, including a higher LVMI, CIMT and microalbuminuria, than those without PA. These findings emphasize the need for screening TOD in newly diagnosed hypertension due to underlying PA.
Collapse
Affiliation(s)
- Shi‐Min Li
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Jia‐Yi Huang
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| | - Ching‐Yan Zhu
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| | - Ming‐Yen Ng
- Division of RadiologyDepartment of MedicineThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Qing‐Shan Lin
- Division of RadiologyDepartment of MedicineThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Min Wu
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Ming‐Ya Liu
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Run Wang
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Gao‐Zhen Cao
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Cong Chen
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
| | - Mei‐Zhen Wu
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| | - Qing‐Wen Ren
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| | - Hung‐Fat Tse
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| | - Kai‐Hang Yiu
- Division of CardiologyDepartment of MedicineThe University of Hong Kong‐ Shenzhen HospitalShenzhenChina
- Division of CardiologyDepartment of MedicineThe University of Hong KongQueen Mary HospitalHong KongChina
| |
Collapse
|
3
|
Lembo M, Pacella D, Manzi MV, Morisco C, La Mura L, Mancusi C, Bardi L, Trimarco V, Trimarco B, Izzo R, Esposito G. Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead102. [PMID: 37881599 PMCID: PMC10597657 DOI: 10.1093/ehjopen/oead102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/15/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Aims Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of the absence vs. presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. Methods and results The study included 7237 hypertensive patients from the Campania Salute Network Registry, followed up for 5.3 ± 4.5 years. As HMOD, we analysed the presence of left ventricular hypertrophy, carotid plaques, and chronic kidney disease (CKD-EPI ≥3 stage) and evaluated the impact of zero vs. one vs. two vs. three sites of HMOD on the occurrence of major adverse cardiovascular events (MACEs). Blood pressure control and Metabolic Score for Insulin Resistance (METS-IR) were also considered. Optimal BP control was achieved in 57.3% patients. Major adverse cardiovascular events occurred in 351 (4.8%) patients. The MACE rate in patients without HMOD was 2.7%, whereas it was 4.7, 7.9, and 9.8% in patients with one, two, and three sites with HMOD, respectively. By using Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites, and drugs, MACE was found to be significantly associated with ageing, mean METS-IR, anti-platelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin system inhibitor drugs. Conclusion In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independent of BP control and despite the significant impact of metabolic dysregulation. Hypertension-mediated organ damage involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Daniela Pacella
- Department of Public Health, ‘Federico II’ University, Via S. Pansini 5, 80131 Napoli, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, ‘Federico II’ University, Via S. Pansini 5, 80131 Napoli, Italy
| | - Bruno Trimarco
- International Translational Research and Medical Education (ITME) Consortium, 80131 Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| |
Collapse
|
4
|
Nemtsova V, Burkard T, Vischer AS. Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities. J Clin Med 2023; 12:5723. [PMID: 37685790 PMCID: PMC10488346 DOI: 10.3390/jcm12175723] [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: 07/10/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.
Collapse
Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute, National Technical University “Kharkiv Polytechnic Institute”, 61002 Kharkiv, Ukraine
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| |
Collapse
|
5
|
Heshmat-Ghahdarijani K, Dabaghi GG, Rad MR, Najafi MB. The relation between inter arm blood pressure difference and presence of cardiovascular disease: a review of current findings. Curr Probl Cardiol 2021; 47:101087. [PMID: 34936907 DOI: 10.1016/j.cpcardiol.2021.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
Raised inter arm blood pressure difference (IABPD) is already well-known as a clinical sign of peripheral arterial diseases including aortic dissection and subclavian stenosis. However, there are several other diseases associated with high IABPD. Therefore, this study aimed to review the association between increased IABPD and the presence of lethal health conditions, the possible mechanisms behind this relationship, and its contributing risk factors. Significant IABPD has been observed in patients with atherosclerotic plaques, peripheral artery disease, coronary artery disease, and chronic kidney disease. Patients with high IABPD are also at more risk of left ventricular hypertrophy that may affect long-term cardiac function. Besides, brain injuries such as stroke, dementia, and Alzheimer's disease has been related to increased IABPD. Considering that raised IABPD is associated with multiple cardiovascular diseases and other organ damage, IABPD detection may be accurate for the early diagnosis and screening of these life-threatening diseases and help manage them better.
Collapse
Affiliation(s)
- Kiyan Heshmat-Ghahdarijani
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehrdad Rabiee Rad
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.
| | - Majed Bahri Najafi
- Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Smith DF, Schuler CL, Hossain MM, Huang G, McConnell K, Urbina EM, Amin RS. Early Atherosclerotic Inflammatory Pathways in Children with Obstructive Sleep Apnea. J Pediatr 2021; 239:168-174. [PMID: 34450122 PMCID: PMC9020582 DOI: 10.1016/j.jpeds.2021.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate structural and functional carotid changes and inflammatory profiles in children with obstructive sleep apnea (OSA) and healthy controls. STUDY DESIGN Patients with OSA and matched controls (ages 5-13 years) were recruited. Proinflammatory cytokines and acute phase reactants were measured at 6:00 p.m. Common carotid artery measures were determined using ultrasound. Confirmatory factor analysis was used to determine subgroups of cytokines and their effects on carotid measures. RESULTS Ninety-six patients participated (53 healthy controls, 43 patients with OSA). OSA was associated with increased proinflammatory cytokines (cluster of differentiation-40 ligand [CD40-L], interleukin [IL]-6, and IL-8) and high sensitivity C-reactive protein (P < .05 for all). One cytokine subgroup (IL-6 and IL-8) was negatively associated with markers of carotid function, indicating reduced arterial distensibility and increased stiffness (P < .05 for 3 ultrasound measures); and tumor necrosis factor-α had an opposing effect on carotid function compared with this cytokine subgroup (P < .05 for 2 ultrasound measures). Linear regression demonstrated significant associations between and tumor necrosis factor- α and 2 measures of carotid function (P < .05 for each). Children with OSA did not have functional or structural carotid changes compared with controls. CONCLUSION OSA was not directly associated with structural and functional carotid changes but was associated with upregulation of key proinflammatory cytokines (sCD40-L, IL-6, and IL-8). Together, IL-6 and IL-8 were associated with changes in carotid function. Longitudinal studies are needed to demonstrate that the inflammatory milieu observed in our population is a precursor of atherosclerosis in children.
Collapse
Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; The Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christine L Schuler
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Md M Hossain
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Keith McConnell
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
| |
Collapse
|
7
|
Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, Hameed W, Cooper AC, Jean-Charles G. Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy. Cureus 2021; 13:e17550. [PMID: 34646607 PMCID: PMC8479854 DOI: 10.7759/cureus.17550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
Collapse
Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Dina Ismail
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Dhriti Gupta
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Roshini Pradeep
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Warda Hameed
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
| |
Collapse
|
8
|
Guide de Pratique Clinique. Prise en charge de l’hypertension artérielle chez l’adulte en Tunisie. LA TUNISIE MÉDICALE 2021. [PMCID: PMC9003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ce document a été réalisé dans le cadre d'une collaboration entre l'Instance Nationale de l’Évaluation et de l'Accréditation en Santé (INEAS), la Société Tunisienne de Cardiologie et de Chirurgie Cardiovasculaire (STCCCV) et la Caisse Nationale d’Assurance Maladie (CNAM).
Collapse
|
9
|
Blunden CE, Urbina EM, Lawson SA, Gutmark-Little I, Shah AS, Khoury PR, Backeljauw PF. Progression of Vasculopathy in Young Individuals with Turner Syndrome. Pediatr Cardiol 2021; 42:481-491. [PMID: 33242100 DOI: 10.1007/s00246-020-02505-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Vasculopathy has been identified in young individuals with Turner syndrome (TS). No studies in young individuals with TS have investigated whether this vasculopathy progresses over time. The objective of this study is to describe the changes in vasculopathy over time in a cohort of young individuals with TS. Repeat ultrasound and SphygmoCor CPV® (AtCor Medical) measurements of carotid thickness and peripheral arterial stiffness were performed. Vascular measurements were compared at baseline and follow-up. Follow-up measurements were also compared to historical lean (L) and obese (O) age-, race-, and sex-matched non-TS controls. Thirty-five individuals with TS were studied at a mean age of 19.4 years (range, 13.9-27.5). Mean time to follow-up was 7.2 years (range, 7.1-7.8). Carotid intima media thickness increased by 0.03 ± 0.07 mm (p < 0.01) over time, but was less than L and O controls at follow-up. Pulse wave velocity carotid-femoral increased by 0.51 ± 0.86 m/s (p < 0.01) over time, but was similar to L and less than O controls at follow-up. Augmentation index (AIx) remained unchanged (p = 0.09) over time, but was significantly higher at follow-up than both control groups (p < 0.01 for both). There were no identified differences between 45,X and other TS genotypes. We demonstrate evidence of vascular thickening and stiffening over 7 years in a cohort of young individuals with TS, as well as a persistently increased augmentation index compared to L and O non-TS controls. It is unclear whether the increase in vascular structure and function are related to normal aging or if TS is a risk factor. Higher body mass index seems to be a risk factor. Early estrogen replacement and longer exposure to growth hormone therapy need to be further explored as potential protective factors.
Collapse
Affiliation(s)
- Christopher E Blunden
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Section of Pediatric Endocrinology, Ochsner Health, 1315 Jefferson Hwy, New Orleans, LA, 70121, USA.
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sarah A Lawson
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amy S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philip R Khoury
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philippe F Backeljauw
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
10
|
Oh JS, Lee CH, Park JI, Park HK, Hwang JK. Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease. J Korean Med Sci 2020; 35:e400. [PMID: 33316856 PMCID: PMC7735919 DOI: 10.3346/jkms.2020.35.e400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/27/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease. However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients. METHODS From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death. RESULTS Median age was 63.3 years (interquartile range [IQR], 61.4-65.4), and median follow-up was 6.6 years (IQR, 5.9-7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05). The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs. 9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01-2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52-3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001). CONCLUSION HMOD was associated with increased risk of mortality and CV events. Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.
Collapse
Affiliation(s)
- Jung Sun Oh
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Chang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Joong Il Park
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hoon Ki Park
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.
| |
Collapse
|
11
|
Ryder JR, Northrop E, Rudser KD, Kelly AS, Gao Z, Khoury PR, Kimball TR, Dolan LM, Urbina EM. Accelerated Early Vascular Aging Among Adolescents With Obesity and/or Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 9:e014891. [PMID: 32370578 PMCID: PMC7660865 DOI: 10.1161/jaha.119.014891] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
Background The normal rate of subclinical vascular aging from adolescence to young adulthood has not been well-characterized. We conducted a 5-year longitudinal study among adolescents with normal-weight, obesity, and/or type 2 diabetes mellitus to examine trajectories of early vascular aging. Methods and Results Adolescents (mean [SD] age 17.6 [3.5]; 35.3% male) had either normal weight (n=141), obesity (n=156), or type 2 diabetes mellitus (n=151) at baseline. Primary metrics used for early vascular aging included measures of vascular structure (carotid intima-media thickness [cIMT]; common, internal, and bulb) and arterial stiffness (carotid-femoral pulse wave velocity, and augmentation index). Longitudinal (5-year) outcomes were examined using generalized estimating equations adjusting for baseline value, sex, race, and age. Compared with participants with normal weight, those with obesity had greater positive change in common cIMT (0.05 mm [0.03, 0.06]; P<0.001), bulb cIMT (0.02 mm [0.00, 0.05]; P=0.033), internal cIMT (0.03 mm [0.01, 0.05]; P<0.001), and pulse wave velocity carotid-femoral (0.38 m/sec [0.14, 0.61]; P=0.001), and those with type 2 diabetes mellitus had greater positive change in common cIMT (0.05 mm [0.04, 0.07]; P<0.001), bulb cIMT (0.06 mm [0.04, 0.09]; P<0.001), internal cIMT (0.04 mm [0.02, 0.07]; P<0.001), augmentation index (4.67% [2.20, 7.13]; P<0.001), and pulse wave velocity carotid-femoral (0.74 m/sec [0.46, 1.02]; P<0.001). Higher baseline systolic blood pressure was associated with greater positive change in common cIMT (0.007 mm [0.003, 0.011]; P<0.001), bulb cIMT (0.009 mm [0.002, 0.016]; P=0.01), internal cIMT (0.008 mm [0.003, 0.013]; P=0.001), and pulse wave velocity carotid-femoral (0.066 m/sec [0.002, 0.130]; P=0.042). Conclusions These longitudinal data support the hypothesis that the presence of obesity, type 2 diabetes mellitus, and elevated baseline systolic blood pressure in early life accelerates the progression of risk factors key in the development of early vascular aging.
Collapse
Affiliation(s)
- Justin R. Ryder
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMN
- Center for Pediatric Obesity MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Elise Northrop
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMN
| | - Kyle D. Rudser
- Center for Pediatric Obesity MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMN
| | - Aaron S. Kelly
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMN
- Center for Pediatric Obesity MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Zhiqian Gao
- Cincinnati Children's Hospital Medical CenterUniversity of CincinnatiOH
| | - Philip R. Khoury
- Cincinnati Children's Hospital Medical CenterUniversity of CincinnatiOH
| | - Thomas R. Kimball
- Children's Hospital of New Orleans and Louisiana State University Health Sciences CenterNew OrleansLAUSA
| | - Lawrence M. Dolan
- Cincinnati Children's Hospital Medical CenterUniversity of CincinnatiOH
| | - Elaine M. Urbina
- Cincinnati Children's Hospital Medical CenterUniversity of CincinnatiOH
| |
Collapse
|
12
|
Oscillometrically Measured Aortic Pulse Wave Velocity Reveals Asymptomatic Carotid Atherosclerosis in a Middle-Aged, Apparently Healthy Population. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8571062. [PMID: 32025521 PMCID: PMC6991166 DOI: 10.1155/2020/8571062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/24/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022]
Abstract
Background Asymptomatic atherosclerosis is a common entity even at young age. Studies have suggested a strong relationship between increased arterial stiffness and asymptomatic carotid atherosclerosis (ACA) in general population, particularly in those with high cardiovascular risk, but no data exist from a younger population free from recognized cardiovascular disease. Hypothesis. We hypothesized there is an association between ACA and aortic pulse wave velocity (PWVao) in middle-aged, apparently healthy, normotensive population to reveal increased cardiovascular risk. Methods We examined the relationship between ACA and PWVao in 236 apparently healthy, asymptomatic, normotensive, middle-aged subjects (age 47 ± 8 years; 52% women). PWVao was measured with the oscillometric method (Arteriograph). ACA was assessed by carotid artery ultrasonography. Results ACA was present in 51 subjects. Subjects with ACA were older (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (. Conclusions PWVao measured by the Arteriograph proved to be an independent marker of ACA. Our study may reveal high CV risk, detected as increased PWVao, which according to our study is related in a very high probability to asymptomatic carotid atherosclerosis in apparently healthy, young, and middle-aged subjects.
Collapse
|
13
|
Chang CT, Lee WH, Hsu PC, Chen YC, Lee MK, Tsai WC, Chu CY, Lee CS, Lin TH, Voon WC, Su HM. Association of 4-limb systolic blood pressure heterogeneity with peripheral artery disease and left ventricular mass index. Medicine (Baltimore) 2020; 99:e18598. [PMID: 32011439 PMCID: PMC7220312 DOI: 10.1097/md.0000000000018598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A large interarm and interleg systolic blood pressure (SBP) difference and ankle-brachial index (ABI) <0.9 were associated with peripheral artery disease and left ventricular hypertrophy. These 3 parameters were derived from 4-limb SBP data. However, there is no study to assess clinical significance of SBP heterogeneity in 4 limbs. The aim of this study was to evaluate the association of 4-limb SBP standard deviation (SD) with peripheral vascular parameters and echocardiographic data in patients with or without clinical findings of peripheral artery disease.A total of 1240 patients were included, of whom 1020 had no clinical evidence of overt peripheral artery disease. The 4-limb blood pressures, brachial-ankle pulse wave velocity, and ABI were measured simultaneously by an ABI-form device.In the multivariable linear regression analysis, increased left ventricular mass index (LVMI), ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg (P ≤ .030) were associated with increased 4-limb SBP SD. Additionally, a subgroup multivariable linear regression analysis in 1020 patients without ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg found 4-limb SBP SD still had a positive correlation with LVMI (P < .001).In addition to significant association with ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg, 4-limb SBP SD was positively correlated with LVMI in the multivariable linear regression analysis in all study patients. Furthermore, in the subgroup of patients without clinical evidence of peripheral artery disease, 4-limb SBP SD still had a positive correlation with LVMI. Hence, assessment of 4-limb SBP heterogeneity is useful in identification of high-risk group of peripheral artery disease and/or increased LVMI, irrespective of the presence of overt peripheral artery disease.
Collapse
Affiliation(s)
- Ching-Tang Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital
| | - Wen-Hsien Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
- Faculty of Medicine, College of Medicine
| | - Po-Chao Hsu
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
| | - Meng-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Faculty of Medicine, College of Medicine
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital
- Faculty of Medicine, College of Medicine
| |
Collapse
|
14
|
Investigation of Acoustic Cardiographic Parameters before and after Hemodialysis. DISEASE MARKERS 2019; 2019:5270159. [PMID: 31781303 PMCID: PMC6874870 DOI: 10.1155/2019/5270159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/22/2019] [Indexed: 01/20/2023]
Abstract
Patients with end-stage renal disease are at an increased risk of cardiovascular diseases and associated mortality. Acoustic cardiography is a technique in which cardiac acoustic data is synchronized with electric information to detect and characterize heart sounds and detect heart failure early. The aim of this study was to investigate acoustic cardiographic parameters before and after hemodialysis (HD) and their correlations with ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and ratio of brachial preejection period to ejection time (bPEP/bET) obtained from an ABI-form device in HD patients. This study enrolled 162 HD patients between October 2016 and April 2018. Demographic, medical, and laboratory data were collected. Acoustic cardiography was performed before and after HD to assess parameters including third heart sound (S3), fourth heart sound (S4), systolic dysfunction index (SDI), electromechanical activation time (EMAT), and left ventricular systolic time (LVST). The mean age of the enrolled patients was 60.4 ± 10.9 years, and 86 (53.1%) patients were male. S4 (p < 0.001) and LVST (p < 0.001) significantly decreased after HD, but EMAT (p < 0.001) increased. Multivariate forward linear regression analysis showed that EMAT/LVST before HD was negatively associated with albumin (unstandardized coefficient β = ‐0.076; p = 0.004) and ABI (unstandardized coefficient β = ‐0.115; p = 0.011) and positively associated with bPEP/bET (unstandardized coefficient β = 0.278; p = 0.003). Screening HD patients with acoustic cardiography may help to identify patients at a high risk of malnutrition, peripheral artery disease, and left ventricular systolic dysfunction.
Collapse
|
15
|
Endothelial dysfunction, subclinical atherosclerosis and LDL cholesterol are the independent predictors of left atrial functions in hypertension. Int J Cardiovasc Imaging 2019; 36:69-77. [PMID: 31586295 DOI: 10.1007/s10554-019-01699-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
|
16
|
Hong L, Xing L, Li R, Zhang L, Ma C, An J, Zhao L, Yang J, Liu S. Subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking echocardiography in asymptomatic patients with carotid stenosis. Int J Cardiovasc Imaging 2019; 35:2205-2212. [PMID: 31342237 DOI: 10.1007/s10554-019-01677-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
The relationship between subclinical left ventricular (LV) dysfunction and atherosclerosis may have been underestimated in the past, which might be responsible for the high incidence of premature death in individuals with carotid stenosis. We sought to evaluate the underlying myocardial dysfunction in asymptomatic carotid stenosis patients using speckle tracking echocardiography (STE). Fifty patients with carotid stenosis ≥ 50% and a preserved LV ejection fraction (LVEF), and 45 controls without carotid stenosis who were matched in terms of vascular comorbidities were enrolled. All participants underwent carotid ultrasound and echocardiographic examination. The global LV longitudinal strain (GLS) was measured using STE. Compared with the control group, the e' of the mitral annular velocity and GLS were decreased in asymptomatic carotid stenosis patients (p < 0.05), however, the LVEF was well preserved. Based on a predefined cutoff for subclinical LV systolic dysfunction that was defined at a GLS < - 18%, this dysfunction was detected in 22 patients with carotid stenosis (44%) and in 10 patients in the control group (22%) (p < 0.05). The GLS was negatively correlated with the levels of low-density lipoprotein cholesterol (r = - 0.356, p < 0.05) and triglyceride (r = - 0.396, p < 0.05). In conclusion, LV diastolic and systolic functioning were significantly decreased in patients with asymptomatic carotid stenosis, and dyslipidemia likely contributed to the subclinical LV dysfunction in these patients. Our findings indicated the importance of detecting LV subclinical dysfunction and early intervention in this patient population.
Collapse
Affiliation(s)
- Linwei Hong
- Department of Ultrasound, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, People's Republic of China
| | - Liying Xing
- Department of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, 110005, People's Republic of China
| | - Ru Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Limin Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jing An
- Department of Ultrasound, Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110034, People's Republic of China
| | - Lanting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
| |
Collapse
|
17
|
Adeoye AM, Ovbiagele B, Akinyemi JO, Ogah OS, Akinyemi R, Gebregziabher M, Wahab K, Fakunle AG, Akintunde A, Adebayo O, Aje A, Tiwari HK, Arnett D, Agyekum F, Appiah LT, Amusa G, Olunuga TO, Onoja A, Sarfo FS, Akpalu A, Jenkins C, Lackland D, Owolabi L, Komolafe M, Faniyan MM, Arulogun O, Obiako R, Owolabi M. Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study. J Am Heart Assoc 2019; 8:e010814. [PMID: 31142178 PMCID: PMC6585359 DOI: 10.1161/jaha.118.010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1‐month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1‐month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
Collapse
Affiliation(s)
- Abiodun M Adeoye
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- 2 Department of Neurology University of California San Francisco CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mayowa Owolabi
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| |
Collapse
|
18
|
2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1834] [Impact Index Per Article: 305.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
Collapse
|
19
|
Wang H, Wang S, Yi X, Tao Y, Qian H, Jia P, Chen Y, Sun Y. Estimate of ischemic stroke prevalence according to a novel 4-tiered classification of left ventricular hypertrophy: insights from the general Chinese population. Ann Med 2018; 50:519-528. [PMID: 30001637 DOI: 10.1080/07853890.2018.1500702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population. METHODS We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data were available to subdivide patients with LVH into four geometric patterns: indeterminate, dilated, thick and both thick and dilated hypertrophy. RESULTS Compared with normal LV geometry, indeterminate and thick hypertrophy showed a higher prevalence of ischemic stroke (p < .05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115-2.398) and thick (2.143 [1.329-3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803-1.950]) and both thick and dilated hypertrophy (0.926 [0.435-1.971]) compared with normal geometry in multivariable analysis. CONCLUSIONS Indeterminate and thick hypertrophy were significantly associated with the presence of ischemic stroke in the general Chinese population. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy. Key messages This was the first study to investigate whether a 4-tiered classification of LVH defines subgroups in the general population that are at variable risks of ischemic stroke. We identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH emerged as a valuable operational approach, a potential alternative to LVM, to refine ischemic stroke stratification in general population.
Collapse
Affiliation(s)
- Haoyu Wang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Shuze Wang
- b Department of Computational Medicine and Bioinformatics , University of Michigan , Ann Arbor , MI , USA
| | - Xin Yi
- c Department of Cardiovascular Medicine , Beijing Moslem Hospital , Beijing , China
| | - Yining Tao
- d Department of Radiology , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Hao Qian
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Pengyu Jia
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Yintao Chen
- e Department of Cardiovascular Medicine , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yingxian Sun
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| |
Collapse
|
20
|
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5734] [Impact Index Per Article: 955.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
21
|
Tziomalos K, Sofogianni A, Angelopoulou SM, Christou K, Kostaki S, Papagianni M, Satsoglou S, Spanou M, Savopoulos C, Hatzitolios AI. Left ventricular hypertrophy assessed by electrocardiogram is associated with more severe stroke and with higher in-hospital mortality in patients with acute ischemic stroke. Atherosclerosis 2018; 274:206-211. [DOI: 10.1016/j.atherosclerosis.2018.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
|
22
|
Wang H, Li Z, Guo X, Chen Y, Chang Y, Chen S, Sun Y. The impact of nontraditional lipid profiles on left ventricular geometric abnormalities in general Chinese population. BMC Cardiovasc Disord 2018; 18:88. [PMID: 29739326 PMCID: PMC5941470 DOI: 10.1186/s12872-018-0829-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/03/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite current interest in the unfavorable impact of nontraditional lipid profiles on cardiovascular disease, information regarding its relations to abnormal left ventricular (LV) geometry has not been systemically elucidated. This study sought to understand predictive implication of nontraditional lipid profiles in specific LV geometric patterns in the general population of rural China. METHODS Analyses were based upon a cross-sectional study of 10,756 participants (mean age 53.8 years; 54.0% females) who underwent assessment of biochemical, anthropometric, and blood pressure variables in rural areas of China. Participants were classified into four groups of LV morphologic pattern according to left ventricular mass index (LVMI) and relative wall thickness with quantitative echocardiographic data. RESULTS By multivariable-adjusted linear regression models, nontraditional lipid profiles were positive determinants of concentricity index and LV wall thickness (all P < 0.05), with modest effects on LVMI. Non-high-density lipoprotein cholesterol (non-HDL-C) emerged as an independent correlate of concentric LV hypertrophy (LVH) (adjusted odds ratio [OR]: 1.174 per 1 SD increment in non-HDL-C, 95% confidence interval [CI]: 1.075-1.281), followed by low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio (1.158 [1.059-1.266]), total cholesterol (TC)/HDL-C ratio (1.150 [1.050-1.260]), and triglyceride (TG)/HDL-C ratio (1.134 [1.030-1.249]). The ORs for concentric LVH by tertiles further provided insight into that excess risk was associated with the highest tertile of nontraditional lipid profiles. The areas under the ROC curves to predict concentric LVH were statistically identical among nontraditional lipid parameters. CONCLUSION Nontraditional lipid profiles, easily measured in the everyday routine examination, were responsible for increased risk of concentric LVH, potentially providing enhanced clinical utility at no additional cost, which emphasized the beneficial effect of these markers to supplement and improve CVD risk stratification.
Collapse
Affiliation(s)
- Haoyu Wang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Yintao Chen
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Ye Chang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Shuang Chen
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning People’s Republic of China
| |
Collapse
|
23
|
Mehta S, Khoury PR, Madsen NL, Dolan LM, Kimball TR, Urbina EM. Arterial Thickness and Stiffness Are Independently Associated with Left Ventricular Strain. J Am Soc Echocardiogr 2018; 31:99-104. [PMID: 29174337 PMCID: PMC5756686 DOI: 10.1016/j.echo.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to examine the association between myocardial strain and arterial thickness and stiffness in young adults. Increased common carotid artery intima media thickness and peripheral arterial stiffness are known to precede coronary artery disease and cardiovascular (CV) events such as myocardial infarction and congestive heart failure. However, subclinical cardiac dysfunction can be detected in high-risk adults by myocardial strain echocardiography. The authors hypothesized that increased carotid artery intima media thickness would be associated with abnormal myocardial strain in young subjects who had obesity and type 2 diabetes mellitus. METHODS CV risk factors were collected in 338 young adults participating in a prospective, cross-sectional study. The CV parameters collected included intima-media thickness, peripheral arterial stiffness by brachial distensibility, and myocardial strain and strain rate. General linear models were constructed to determine if vascular structure and function measures were independently associated with myocardial strain and strain rate. RESULTS A linear relationship was found between global longitudinal strain obtained from the four-chamber view and global strain rate in systole and carotid intima-media thickness (four-chamber global longitudinal strain: β = 3.0, CV risk factor-adjusted R2 = 0.34; global strain rate in systole: β = 0.0053, R2 = 0.21; P ≤ .0001) and between four-chamber global longitudinal strain and lower brachial distensibility (β = -0.42, R2 = 0.22; P < .001). CONCLUSIONS Adverse changes in vascular structure and function are simultaneously present with reduced myocardial systolic function.
Collapse
Affiliation(s)
- Smita Mehta
- Preventive Cardiology, Dayton Children's Hospital, Dayton, Ohio
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicolas L Madsen
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence M Dolan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas R Kimball
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
24
|
Chang Y, Choi GS, Lim SM, Kim YJ, Song TJ. Interarm Systolic and Diastolic Blood Pressure Difference Is Diversely Associated With Cerebral Atherosclerosis in Noncardioembolic Stroke Patients. Am J Hypertens 2017; 31:35-42. [PMID: 28985258 DOI: 10.1093/ajh/hpx126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/11/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interarm systolic and diastolic blood pressure differences (IASBD, IADBD) are not infrequent in various populations. Cerebral atherosclerosis, including extracranial cerebral atherosclerosis (ECAS) and intracranial cerebral atherosclerosis (ICAS), is an important risk factor for stroke. In this study, we aimed to investigate the relationship of IASBD, IADBD with presence and burden of ICAS and ECAS. METHODS This was a retrospective hospital-based cross-sectional study. In total, 1,063 consecutive noncardioembolic ischemic stroke patients, who were checked for bi-brachial blood pressures from ankle-brachial index and brain magnetic resonance angiographic images of cerebral arteries, were included. The IASBD and IADBD were defined as absolute value of the blood pressure difference in both arms. RESULTS In all included patients, patients with IASBD ≥10 and IADBD ≥10 were noted in 9.4% (100/1,063) and 5.3% (56/1,063). The patients with IASBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.001) and ECAS (P = 0.027) and patients with IADBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.042) but not ECAS (P = 0.187). Multivariate analysis after adjusting gender, age, and a P value <0.1 in univariate analysis showed IASBD ≥10 mm Hg was associated with the presence of both ECAS and ICAS [odds ratio (OR): 2.96, 95% confidence interval (CI): 1.65-5.31]. The IADBD ≥10 mm Hg was related with presence of ICAS only (OR: 1.87, 95% CI: 1.05-3.37) but not with ECAS only (OR: 1.50, 95% CI: 0.73-3.06). CONCLUSIONS Our study showed IASBD and IADBD were diversely associated with cerebral atherosclerosis. In noncardioembolic stroke patients with IASBD ≥10 or IADBD ≥10, the possibility of accompanying cerebral atherosclerosis should be considered.
Collapse
Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Gyeong Seon Choi
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Soo Mee Lim
- Department of Radiology, College of Medicine, Ewha Womans University, Korea
| | - Yong-Jae Kim
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| |
Collapse
|
25
|
Association of Habitual Physical Activity With Cardiovascular Risk Factors and Target Organ Damage in Adolescents and Young Adults. J Phys Act Health 2017; 15:176-182. [PMID: 29172989 DOI: 10.1123/jpah.2017-0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to (1) compare a subjective and objective measure of habitual physical activity (PA), (2) determine the association of PA and cardiovascular risk factors, and (3) test the hypothesis that PA is an independent determinant of target organ damage in youth. METHODS Cross-sectional analysis of youth with and without type 2 diabetes [mean age = 22 (3.9) y]. PA was measured with International Physical Activity Questionnaire and Actical accelerometer. Target organ damage was assessed with echocardiography and peripheral arterial testing. Subjects were stratified into tertiles of total PA, and differences were tested by analysis of variance and χ2 tests. General linear models tested for independent associations. RESULTS The correlation between International Physical Activity Questionnaire and accelerometry was weak (r = .23, P = .0003). Less active subjects had worse cardiovascular risk profiles and target organ damage, including stiffer arteries (P < .01). These outcome differences did not reach statistical significance when adjusted for covariates, such as lipid levels and glycemic control. CONCLUSION Survey assessment of PA is complicated by inaccurate reporting. There is a strong association of habitual PA with cardiovascular risk factor clustering. PA may exert its beneficial effect on arterial stiffness in obese youth through improved glycemic control.
Collapse
|
26
|
Khutan H, Aggarwal S, Kajal KS, Garg R, Kaur R, Kaur A. Study of carotid intimal medial thickness in essential hypertension with or without left ventricular hypertrophy. Ann Afr Med 2017; 16:192-195. [PMID: 29063904 PMCID: PMC5676410 DOI: 10.4103/aam.aam_9_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hypertension and atherosclerosis though separate entities, are interrelated as hypertension plays an important role in the pathogenesis of atherosclerosis. This study was undertaken to study the association of carotid intimal medial thickness with left ventricular hypertrophy (LVH) in hypertensive patients. Materials and Methods: Hundred hypertensives (JNC-7, Stage 1 and 2) between 30 and 55 years were enrolled in this prospective observational study conducted at a tertiary care teaching institute of Punjab, India. Electrocardiogram, Carotid Doppler, and Echocardiography were carried out in addition to routine biochemical investigations. Results: Increased carotid intimal medial thickness (CIMT) had statistically significant association with age, duration of hypertension, high systolic and diastolic blood pressure (BP), left ventricular hypertrophy and left ventricular mass index but was not associated with body mass index, low-density lipoproteins, and total cholesterol. Conclusions: LVH and arterial wall changes occur concurrently, and therefore, management of hypertension should not be limited just to control of BP but should also include therapy for carotid plaques and increased CIMT.
Collapse
Affiliation(s)
- Himanshu Khutan
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Simmi Aggarwal
- Department of Radiodaignosis, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - K S Kajal
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Rupinderjeet Kaur
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Amanpreet Kaur
- Department of Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
| |
Collapse
|
27
|
Fan X, Zhu M, Chi C, Yu S, Xiong J, Lu Y, Bai B, Xu Y, Zhang Y. Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study. Clin Interv Aging 2017; 12:929-936. [PMID: 28652715 PMCID: PMC5472426 DOI: 10.2147/cia.s133691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective Vascular abnormality includes two forms, arteriosclerosis (ARS) and atherosclerosis (ATS), which coexist in patients with cardiovascular (CV) diseases. However, whether their combination may lead to a worsening status in those patients remains unclear. We therefore aimed to investigate the association of ARS and/or ATS with hypertensive target organ damage (TOD). Methods From June 2014 to August 2015, a total of 1,599 community-dwelling elderly subjects (aged >65 years) from northern Shanghai were recruited. Vascular measurements, such as carotid–femoral pulse wave velocity (cf-PWV), ankle–brachial index (ABI) and carotid plaque, were conducted on each participant, and ARS was defined as cf-PWV >12 m/s, while ATS was defined as participants who have carotid plaque or ABI <0.9. Within the framework of comprehensive CV examinations, CV risk factors were assessed, and asymptomatic TOD was evaluated by measuring participants’ left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), urinary albumin–creatinine rate (UACR) and estimated glomerular filtration rate (eGFR). Results Although LVMI, E/Ea and eGFR were significantly different among subjects with or without ARS and/or ATS (P<0.02), in full adjustment model, only E/Ea showed the independent and significant difference (P=0.023). Moreover, E/Ea was significantly different between participants with ARS or ATS and those without ARS or ATS (P=0.045), while there was no significant difference between participants with ARS and ATS and those without ARS or ATS (P=0.28). Similar results were obtained in the multivariate logistic regression of left ventricular diastolic dysfunction (LVDD). With similar adjustment, LVDD was significantly associated with ATS (P=0.01) but not with ARS (P=0.99). Conclusion In the community-dwelling elderly Chinese, among hypertensive TOD, LVDD was significantly associated with ATS but not with ARS. The proportion of patients with LVDD was not significantly different despite the presence of both ATS and ARS, when compared to patients with ATS alone.
Collapse
Affiliation(s)
- Ximin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mengyun Zhu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yuyan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Bin Bai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
28
|
Kim NH, Shin MH, Kweon SS, Ko JS, Lee YH. Carotid Atherosclerosis and Electrocardiographic Left Ventricular Hypertrophy in the General Population: The Namwon Study. Chonnam Med J 2017; 53:153-160. [PMID: 28584795 PMCID: PMC5457951 DOI: 10.4068/cmj.2017.53.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 01/18/2023] Open
Abstract
This study aimed to investigate the relationship between carotid atherosclerosis and left ventricular hypertrophy on electrocardiogram (ECG-LVH) on adults living in the community. A total of 9,266 adults who participated in the Namwon Study were included in this analysis. Carotid atherosclerosis, including intima-media thickness (IMT) and plaques, were assessed using high-resolution B-mode ultrasound. ECG-LVH was determined using the Sokolow-Lyon voltage (SokV) and Cornell voltage (CorV) criteria. The prevalence of ECG-LVH was 12.7% using the SokV criteria and 9.7% using the CorV criteria. After full adjustment, compared to the lowest quartile of common carotid artery IMT (CCA-IMT), the odds ratios and 95% confidence intervals for ECG-LVH of the carotid IMT quartiles 2, 3, and 4 increased linearly as follows: 1.54 (1.24-1.90), 1.62 (1.31-2.02), and 1.91 (1.54-2.38), respectively, for the SokV criteria (p<0.001); and 1.33 (1.05-1.68), 1.41 (1.11-1.78), and 1.48 (1.16-1.88), respectively, for the CorV criteria (p=0.003). Positive associations between the carotid bulb IMT (CB-IMT) quartiles and the ECG-LVH were also observed, although the magnitudes of association between CB-IMT and ECG-LVH were slightly lower than those of CCA-IMT. However, no significant association between carotid plaques and ECG-LVH as defined by the SokV or CorV criteria was found. The present study demonstrated that increased carotid IMT, but not carotid plaques, is significantly associated with LVH defined by various ECG criteria in a large population.
Collapse
Affiliation(s)
- Nam-Ho Kim
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.,Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.,Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jum Suk Ko
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.,Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Young-Hoon Lee
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.,Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
Chen SC, Lee MY, Huang JC, Shih MCP, Chang JM, Chen HC. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis. Sci Rep 2016; 6:33164. [PMID: 27608939 PMCID: PMC5016837 DOI: 10.1038/srep33164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/16/2016] [Indexed: 12/31/2022] Open
Abstract
Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI < 0.95 or ≥0.95 and an AoAC score of >4 or ≤4 according to receiver operating characteristic curve. Those with an ABI < 0.95 and AoAC > 4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD.
Collapse
Affiliation(s)
- Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Department of Radiology, Faculty of Medicine, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
31
|
Jansen van Vuren E, Malan L, Cockeran M, Scheepers JD, Oosthuizen W, Malan NT. Fibrosis and coronary perfusion - a cardiovascular disease risk in an African male cohort: The SABPA study. Clin Exp Hypertens 2016; 38:482-8. [PMID: 27380493 DOI: 10.3109/10641963.2016.1151524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Low-grade inflammation has been correlated with risk factors of cardiovascular diseases (CVD). Whether the pro-inflammatory and thrombotic ratio (fibrosis) may contribute to CVD is not known. We therefore aimed to assess whether Cornell Product left ventricular hypertrophy (LVH) is associated with fibrosis and coronary perfusion (silent ischemia) in a bi-ethnic male cohort from South Africa. A cross sectional study was conducted including 165 African and Caucasian men between the ages of 20-65. Fasting blood samples were obtained to measure fibrinogen, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α). Ambulatory blood pressure, ECG and 12 lead ECG measures were obtained to determine silent ischemic events (ST events) and LVH, respectively. Africans revealed more silent ischemia, higher 24 h blood pressure, inflammatory, coagulation as well as fibrosis levels than Caucasians. In a low-grade inflammatory state (CRP > 3 mg/l), Africans revealed higher fibrosis (p ≤ 0.01) values, but lower IL-6 and TNF-α values than Caucasians. Linear regression analyses in several models demonstrated positive associations between silent ischemia and fibrosis [Adj. R(2) 0.23; ß 0.35 (95% CI 0.13, 0.58), p ≤ 0.01]. In a low-grade inflammatory state (CRP>3mg/l), fibrinogen predicted AV-block in African men [OR 3.38 (95% CI 2.24, 4.53); p = 0.04]. Low-grade inflammation may induce AV-block through mechanisms involving fibrosis and ischemia to increase the burden on the heart in African men.
Collapse
Affiliation(s)
- Esmé Jansen van Vuren
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Leoné Malan
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Marike Cockeran
- b Medicine Usage in South Africa (MUSA) , North-West University , Potchefstroom Campus, South Africa
| | - Jacobus D Scheepers
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Woudri Oosthuizen
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Nicolaas T Malan
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| |
Collapse
|
32
|
Chen SC, Lee WH, Hsu PC, Huang JC, Lee CS, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Association of body mass index and left ventricular mass index with abnormally low and high ankle-brachial indices in chronic kidney disease. Hypertens Res 2015; 39:166-70. [DOI: 10.1038/hr.2015.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/15/2015] [Accepted: 10/06/2015] [Indexed: 12/28/2022]
|
33
|
Devereux RB, Bang CN, Roman MJ, Palmieri V, Boman K, Gerdts E, Nieminen MS, Papademetriou V, Wachtell K, Hille DA, Dahlöf B. Left Ventricular Wall Stress-Mass-Heart Rate Product and Cardiovascular Events in Treated Hypertensive Patients: LIFE Study. Hypertension 2015; 66:945-53. [PMID: 26418019 DOI: 10.1161/hypertensionaha.114.05582] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
In the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, 4.8 years' losartan- versus atenolol-based antihypertensive treatment reduced left ventricular hypertrophy and cardiovascular end points, including cardiovascular death and stroke. However, there was no difference in myocardial infarction (MI), possibly related to greater reduction in myocardial oxygen demand by atenolol-based treatment. Myocardial oxygen demand was assessed indirectly by the left ventricular mass×wall stress×heart rate (triple product) in 905 LIFE participants. The triple product was included as time-varying covariate in Cox models assessing predictors of the LIFE primary composite end point (cardiovascular death, MI, or stroke), its individual components, and all-cause mortality. At baseline, the triple product in both treatment groups was, compared with normal adults, elevated in 70% of patients. During randomized treatment, the triple product was reduced more by atenolol, with prevalences of elevated triple product of 39% versus 51% on losartan (both P≤0.001). In Cox regression analyses adjusting for age, smoking, diabetes mellitus, and prior stroke, MI, and heart failure, 1 SD lower triple product was associated with 23% (95% confidence interval 13%-32%) fewer composite end points, 31% (18%-41%) less cardiovascular mortality, 30% (15%-41%) lower MI, and 22% (11%-33%) lower all-cause mortality (all P≤0.001), without association with stroke (P=0.34). Although losartan-based therapy reduced ventricular mass more, greater heart rate reduction with atenolol resulted in larger reduction of the triple product. Lower triple product during antihypertensive treatment was strongly, independently associated with lower rates of the LIFE primary composite end point, cardiovascular death, and MI, but not stroke.
Collapse
Affiliation(s)
- Richard B Devereux
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.).
| | - Casper N Bang
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Mary J Roman
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Vittorio Palmieri
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Kurt Boman
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Eva Gerdts
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Markku S Nieminen
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Vasilios Papademetriou
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Kristian Wachtell
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Darcy A Hille
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Björn Dahlöf
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| |
Collapse
|
34
|
Field TS, Pearce LA, Asinger RW, Smyth NGC, De SK, Hart RG, Benavente OR. Left Ventricular Geometry on Transthoracic Echocardiogram and Prognosis after Lacunar Stroke: The SPS3 Trial. J Stroke Cerebrovasc Dis 2015; 24:1423-9. [PMID: 25840952 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/03/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The spectrum, prevalence, and prognostic implications of abnormal left ventricular geometry (LVG) in patients with lacunar stroke are unknown. We examined the spectrum of LVG and its relationship with vascular risk factors and outcomes after lacunar stroke. METHODS LVG was determined with transthoracic echocardiography for 1961 patients with magnetic resonance imaging-verified recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes trial. Multivariable logistic regression and Cox proportional hazards models were used to identify characteristics independently associated with LVG and to estimate risk from abnormal LVG for recurrent stroke and death. RESULTS Abnormal LVG was present in 77%. Hispanic (odds ratio [OR], 1.4; 95% confidence interval, 1.1-1.8) or black (OR, 2.0; 1.3-2.9) race-ethnicity, diabetes (OR, 1.3; 1.0-1.7), hypertension, impaired renal function (OR, 1.8; 1.2-2.5), intracranial stenosis (OR, 1.5; 1.1-2.1), and abnormal left ventricular function (OR, 2.0; 1.4-3.0) were independently associated with abnormal LVG. Subjects with abnormal LVG also more frequently had advanced manifestations of small-vessel disease specifically previous subcortical infarcts and white matter hyperintensities. After adjusting for assigned treatments, clinical risk factors, and advanced manifestations of small-vessel disease, subjects with abnormal LVG remained at increased risk of stroke recurrence (hazard ratio, 1.5; confidence interval, 1.0-2.4). There was no interaction between LVG and assigned antiplatelet or blood pressure target. Abnormal LVG was not associated with mortality. CONCLUSIONS LVG consistent with chronic hypertensive changes was highly prevalent and correlated with neuroradiologic manifestations of small-vessel disease in lacunar stroke patients. These results support the constructs that both cerebral small-vessel disease and LVG represent end-organ consequences of chronic hypertension.
Collapse
Affiliation(s)
- Thalia S Field
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - Richard W Asinger
- Department of Medicine, Hennepin Heart Center, University of Minnesota, Minneapolis, Minnesota
| | - Nathan G Chan Smyth
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabe K De
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert G Hart
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Oscar R Benavente
- Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
35
|
Ogah OS, Sliwa K, Akinyemi JO, Falase AO, Stewart S. Hypertensive heart failure in Nigerian Africans: insights from the Abeokuta Heart Failure Registry. J Clin Hypertens (Greenwich) 2015; 17:263-72. [PMID: 25688932 PMCID: PMC8031496 DOI: 10.1111/jch.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short- and medium-term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5-21) while intra-hospital mortality was 3.4%. The 30-day, 90-day, and 180-day mortality rates were 0.9% (95% confidence interval, -0.2 to 3.5), 3.5% (95% confidence interval, -1.7 to 7.3), and 11.7% (95% confidence interval, -7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, -1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in-hospital mortality.
Collapse
Affiliation(s)
- Okechukwu S. Ogah
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
- Department of MedicineFaculty of Health SciencesHatter Institute for Cardiovascular Research in Africa & IIDMMUniversity of Cape TownCape TownSouth Africa
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical StatisticsCollege of MedicineUniversity of IbadanIbadanNigeria
| | - Ayodele O. Falase
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
| | - Simon Stewart
- Mary MacKillop Institute for Health Research/NHMRC CRE to Reduce Inequality in Heart DiseaseAustralian Catholic UniversityMelbourneVictoriaAustralia
| |
Collapse
|
36
|
Uçar H, Gür M, Börekçi A, Yıldırım A, Baykan AO, Yüksel Kalkan G, Koç M, Şeker T, Coşkun M, Şen Ö, Çaylı M. Relationship between extent and complexity of coronary artery disease and different left ventricular geometric patterns in patients with coronary artery disease and hypertension. Anatol J Cardiol 2015; 15:789-94. [PMID: 25592099 PMCID: PMC5336963 DOI: 10.5152/akd.2014.5747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The relationship between severity of coronary artery disease (CAD) and left ventricler (LV) hypertrophy in hypertensive patients is well known. However, the association between the extent and complexity of CAD assessed with SYNTAX score (SS) and different LV geometric patterns has not been investigated. We aimed to investigate the association between SYNTAX score and different LV geometric patterns in hypertensive patients. METHODS The study had been made in our clinic between January 2013 and August 2013. We studied 251 CAD patients who had hypertension and who underwent coronary angiography (147 males, 104 females; mean age 61.61±9.9 years). Coronary angiography was performed based on clinical indications. SS was determined in all patients. Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in patients according to LV mass index (LVMI) and relative wall thickness (RWT) (Groups: NG- normal geometry, CR- concentric remodeling, EH- eccentric hypertrophy, and CH- concentric hypertrophy). Biochemical markers were measured in all participants. RESULTS The highest SS values were observed in the CH group compared with the NG, CR, and EH groups (p<0.05 for all). Also, the SS values of the EH group were higher than in the NG and CR groups (p<0.05 for all). Multivariate linear regression analysis showed that SS was independently associated with LV geometry (β=0.316, p=0.001), as well as age (β=0.163, p=0.007) and diabetes (β=-0.134, p=0.022). CONCLUSION SYNTAX score is independently related with LV geometry in hypertensive patients. This result shows that LV remodeling is parallel to the increase in the extent and complexity of CAD in our study patients.
Collapse
Affiliation(s)
- Hakan Uçar
- Department of Cardiology, Adana Numune Training and Research Hospital; Adana-Turkey.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Lawson SA, Urbina EM, Gutmark-Little I, Khoury PR, Gao Z, Backeljauw PF. Vasculopathy in the young Turner syndrome population. J Clin Endocrinol Metab 2014; 99:E2039-45. [PMID: 24960543 PMCID: PMC5393494 DOI: 10.1210/jc.2014-1140] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Turner syndrome (TS) carries an increased risk for vascular disease, or vasculopathy. OBJECTIVE Vasculopathy can be detected in young TS patients. DESIGN AND PATIENTS Vasculopathy was prospectively assessed by measuring vascular function and structure in TS patients (n = 49) and lean (L) (n = 76) and obese (O) controls (n = 52) through noninvasive techniques. Controls were drawn from previously known adolescents who were age-matched and disease-free. DATA COLLECTED Pulse wave velocity femoral (PWVf), augmentation index (AIx), carotid intima media thickness (cIMT), and Young's Elastic Modulus (YEM). RESULTS Mean age and body mass index (BMI) for TS, L, and O subjects were 11.89 years and 21.2 kg/m(2), 17.93 years and 20.9 kg/m(2), and 18.35 years 36.5 kg/m(2), respectively. Blood pressure means (mmHg) in TS, L, and O subjects were 112/65, 103/59, and 113/67, respectively. A greater AIx and YEM were seen in TS patients after adjusting for age plus BMI: AIx = 12.3% ± 2 (TS), -2% ± 1.7 (L), 5.8% ± 2.2 (O); YEM = 544.4 mmHg/mm ± 26.75 (TS), 258.1 mmHg/mm ± 22.7 (L), 343.5 mmHg/mm ± 30.6 (O). After adjustment for age and BMI, a greater PWVf was seen in TS vs L controls (P < .0001). The cIMT was lowest in the TS group: 0.35 mm ± 0.06 vs 0.43 mm ± 0.06 (L) and 0.45 mm ± 0.06 (O) (P < .001). CONCLUSIONS Vasculopathy, a marker of cardiovascular morbidity in adult TS, is detected in childhood. The findings remained after adjusting for age, demonstrating stiffer arterial vessels in young TS patients.
Collapse
Affiliation(s)
- Sarah A Lawson
- Division of Endocrinology (S.A.L., I.G-L., P.F.B.) and Division of Cardiology (E.M.U., P.R.K., Z.G.), Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229
| | | | | | | | | | | |
Collapse
|
38
|
Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Durodola A, Ajani AA, Sliwa K. Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: data from the Abeokuta Heart Failure Registry. Cardiovasc J Afr 2014; 25:217-23. [PMID: 25210973 PMCID: PMC4241595 DOI: 10.5830/cvja-2014-040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/20/2023] Open
Abstract
Background Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria. Methods The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%). Results There were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once. Conclusions The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
Collapse
Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Gali D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
39
|
Yeh F, Dixon AE, Best LG, Marion SM, Lee ET, Ali T, Yeh J, Rhoades ER, Howard BV, Devereux RB. Lung function and heart disease in American Indian adults with high frequency of metabolic abnormalities (from the Strong Heart Study). Am J Cardiol 2014; 114:312-9. [PMID: 24878118 DOI: 10.1016/j.amjcard.2014.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 01/20/2023]
Abstract
The associations of pulmonary function with cardiovascular disease (CVD) independent of diabetes mellitus (DM) and metabolic syndrome have not been examined in a population-based setting. We examined prevalence and incidence CVD in relation to lower pulmonary function in the Strong Heart Study second examination (1993 to 1995) in 352 CVD and 2,873 non-CVD adults free of overt lung disease (mean age 60 years). Lung function was assessed by standard spirometry. Participants with metabolic syndrome or DM with or without CVD had lower pulmonary function than participants without these conditions after adjustment for hypertension, age, gender, abdominal obesity, smoking, physical activity index, and study field center. CVD participants with DM had significantly lower forced vital capacity than participants with CVD alone. Significant associations were observed between reduced pulmonary function, preclinical CVD, and prevalent CVD after adjustment for multiple CVD risk factors. During follow-up (median 13.3 years), pulmonary function did not predict CVD incidence, it predicted CVD mortality. Among 3,225 participants, 412 (298 without baseline CVD) died from CVD by the end of 2008. In models adjusted for multiple CVD risk factors, DM, metabolic syndrome, and baseline CVD, compared with highest quartile of lung function, lower lung function predicted CVD mortality (relative risk up to 1.5, 95% confidence interval 1.1 to 2.0, p<0.05). In conclusion, a population with a high prevalence of DM and metabolic syndrome and lower lung function was independently associated with prevalent clinical and preclinical CVD, and its impairment predicted CVD mortality. Additional research is needed to identify mechanisms linking metabolic abnormalities, low lung function, and CVD.
Collapse
|
40
|
Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2014; 31:2060-8. [PMID: 23838656 DOI: 10.1097/hjh.0b013e328362bbd6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients. METHODS AND RESULTS Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05). CONCLUSION The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
Collapse
|
41
|
Left ventricular hypertrophy, abnormal ventricular geometry and relative wall thickness are associated with increased risk of stroke in hypertensive patients among the Han Chinese. Hypertens Res 2014; 37:870-4. [DOI: 10.1038/hr.2014.88] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 01/24/2014] [Accepted: 03/11/2014] [Indexed: 11/08/2022]
|
42
|
Association of brachial-ankle pulse wave velocity, ankle-brachial index and ratio of brachial pre-ejection period to ejection time with left ventricular hypertrophy. Am J Med Sci 2014; 347:289-94. [PMID: 23588262 DOI: 10.1097/maj.0b013e31828c5bee] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Arterial stiffness, peripheral artery disease and left ventricular systolic dysfunction contributed to left ventricular hypertrophy (LVH). Using an ABI-form device, we can obtain brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and the ratio of brachial pre-ejection period to ejection time (bPEP/bET), which are markers for arterial stiffness, peripheral artery disease and left ventricular systolic function, respectively. The aim of this study was to assess whether "BAP score" calculated from the 3 measures of baPWV, ABI and bPEP/bET is associated with LVH. METHODS A total of 1,146 patients were included in the study. BAP score was calculated based on a point system in which 1 point was assigned for baPWV above the median value of 1670 cm/s, ABI < 0.9 or ≥ 1.3 in either leg and bPEP/bET > 0.38. RESULTS There was a significant trend for a stepwise increase in the left atrial diameter, left ventricular mass index (LVMI) and the prevalence of LVH and a stepwise decrease in the left ventricular ejection fraction corresponding to advancement in BAP score from 0 to 3. In addition, increased BAP score is significantly associated with increased LVMI and LVH. CONCLUSIONS Our results demonstrated increased BAP score was related to increased LVMI and LVH independent of traditional risk factors such as old age, diabetes, hypertension, obesity, anemia, hyperlipidemia and chronic kidney disease. Therefore, the BAP score obtained from the same examination might be useful and convenient in identifying patients with increased LVMI and LVH.
Collapse
|
43
|
Okamoto K, Sato A, Matsukawa K, Kasuga T, Uchigata Y. Impact of eicosapentaenoic acid/arachidonic acid ratio on left ventricular structure in patients with diabetes. Diabetol Int 2014. [DOI: 10.1007/s13340-014-0172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Bang CN, Gerdts E, Aurigemma GP, Boman K, de Simone G, Dahlöf B, Køber L, Wachtell K, Devereux RB. Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low-risk subset of eccentric hypertrophy in hypertensive patients. Circ Cardiovasc Imaging 2014; 7:422-9. [PMID: 24723582 DOI: 10.1161/circimaging.113.001275] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients. METHODS AND RESULTS In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/body surface area ≥116 and ≥96 g/m(2) in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not. CONCLUSIONS Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
Collapse
Affiliation(s)
- Casper N Bang
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
| | - Eva Gerdts
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Gerard P Aurigemma
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Kurt Boman
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Giovanni de Simone
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Björn Dahlöf
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Lars Køber
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Kristian Wachtell
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Richard B Devereux
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| |
Collapse
|
45
|
Association of bilateral brachial-ankle pulse wave velocity difference with peripheral vascular disease and left ventricular mass index. PLoS One 2014; 9:e88331. [PMID: 24551090 PMCID: PMC3923774 DOI: 10.1371/journal.pone.0088331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/07/2014] [Indexed: 01/20/2023] Open
Abstract
Unequal arterial stiffness had been associated with cardiovascular risks. We investigated whether an association existed between unequal arterial stiffness indicated by bilateral brachial-ankle pulse wave velocity (baPWV) difference and ankle-brachial index (ABI), baPWV, echocardiographic parameters and interarm and interankle systolic blood pressure (BP) differences. A total of 1111 patients referred for echocardiographic examination were included in this study. The BPs, ABI and baPWV were measured simultaneously by an ABI-form device. The ΔbaPWV was defined as absolute value of difference between bilateral baPWV. We performed three multivariate analyses for determining the factors associated with a ΔbaPWV ≧ 185 cm/s (90 percentile of ΔbaPWV) (model 1: significant variables in univariate analysis and ABI <0.9 and baPWV; model 2: significant variables in univariate analysis and left ventricular mass index [LVMI]; model 3: significant variables in univariate analysis and interankle systolic BP difference ≧ 15 mmHg). The ABI <0.9 and high baPWV (both P<0.001) in model 1, high LVMI (P = 0.021) in model 2 and an interankle systolic BP difference ≧ 15 mmHg (P = 0.026) in model 3 were associated with a ΔbaPWV ≧ 185 cm/s, but the interarm systolic BP difference ≧ 10 mmHg was not (P = NS). Our study demonstrated ABI <0.9, high baPWV, high LVMI and an interankle systolic BP difference ≧ 15 mmHg were associated with unequal arterial stiffness.
Collapse
|
46
|
van der Walt C, Malan L, Uys AS, Malan NT. Low Grade Inflammation and ECG Left Ventricular Hypertrophy in Urban African Males: The SABPA Study. Heart Lung Circ 2013; 22:924-9. [DOI: 10.1016/j.hlc.2013.03.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 01/25/2013] [Accepted: 03/19/2013] [Indexed: 12/16/2022]
|
47
|
Su HM, Lin TH, Hsu PC, Lee CS, Lee WH, Chen SC, Voon WC, Lai WT, Sheu SH. Association of chronic kidney disease and peripheral artery disease with inappropriate left ventricular mass. PLoS One 2012; 7:e48422. [PMID: 23119010 PMCID: PMC3485213 DOI: 10.1371/journal.pone.0048422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/25/2012] [Indexed: 01/20/2023] Open
Abstract
Inappropriate left ventricular mass index (LVM) may develop as a response to particular hemodynamic and metabolic alterations. Inappropriate LVM and peripheral artery disease (PAD) characterized by abnormally low or high ankle-brachial index (ABI) are common in chronic kidney disease (CKD) patients, in whom there may be a close and cause-effect relationship. The aim of this study is to assess whether CKD and abnormal ABI has an independent and additive association with inappropriate LVM. A total of 1110 patients were included in the study. Inappropriate LVM was defined as observed LVM more than 28% of the predicted value. The ABI was measured using an ABI-form device. PAD was defined as ABI <0.9 or >1.3 in either leg. Multivariate analysis showed that patients with estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m2 (odds ratio [OR], 1.644; P = 0.011) and PAD (OR, 2.082; P = 0.002) were independently associated with inappropriate LVM. The interaction between eGFR <45 ml/min/1.73 m2 and PAD on inappropriate LVM was statistically significant (P = 0.044). Besides, eGFR<45 ml/min/1.73 m2 (change in observed/predicted LVM, 19.949; P<0.001) and PAD (change in observed/predicted LVM, 11.818; P = 0.003) were also significantly associated with observed/predicted LVM. Our findings show that eGFR <45 ml/min/1.73 m2 and PAD are independently and additively associated with inappropriate LVM and observed/predicted LVM. Assessments of eGFR and ABI may be useful in identifying patients with inappropriate LVM.
Collapse
Affiliation(s)
- Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
48
|
Strand A, Gudmundsdottir H, Høieggen A, Fossum E, Bjørnerheim R, Os I, Kjeldsen SE. Increased hematocrit before blood pressure in men who develop hypertension over 20 years. ACTA ACUST UNITED AC 2012; 1:400-6. [PMID: 20409872 DOI: 10.1016/j.jash.2007.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/02/2007] [Accepted: 07/09/2007] [Indexed: 12/01/2022]
Abstract
We have previously demonstrated that neurohormonal activity can predict left ventricular (LV) mass in men who developed hypertension over 20 years. The aim of the study was to investigate early markers of cardiac and hemorheological changes at baseline in these men, i.e., before a rise in blood pressure. Fifty-six middle-aged men were followed for 20 years; 22 were sustained hypertensives, 17 developed hypertension, and 17 were sustained normotensives. They were compared at baseline (42 years) and follow-up (62 years). We investigated Cornell voltage product and Sokolow-Lyon voltage, hematocrit (Hct), and echocardiographic LV parameters. There was no sign of LV hypertrophy by electrocardiography (ECG) at baseline. Baseline Hct discriminated between the groups (P= .015) and correlated to diastolic blood pressure (DBP) at baseline (r = 0.37, P= .006) and follow-up (r = 0.31, P= .020). Regression analysis identified baseline Hct as an independent correlate of DBP in the cohort at baseline when they were untreated (beta = .33, P= .013, R(2) = 0.25), and of borderline significance at follow-up (beta = .26, P= .060, R(2) = 0.12) despite possible interference by antihypertensive drugs. Hct was elevated at baseline compatible with the hypothesis that pathogenic hemorheological processes could be activated at the outset and prior to cardiac changes in men who later develop hypertension.
Collapse
Affiliation(s)
- Arne Strand
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | | | | | | | | | | | | |
Collapse
|
49
|
Su HM, Lin TH, Hsu PC, Chu CY, Lee WH, Chen SC, Lee CS, Voon WC, Lai WT, Sheu SH. Abnormally low and high ankle-brachial indices are independently associated with increased left ventricular mass index in chronic kidney disease. PLoS One 2012; 7:e44732. [PMID: 22957102 PMCID: PMC3434147 DOI: 10.1371/journal.pone.0044732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/07/2012] [Indexed: 01/20/2023] Open
Abstract
Abnormally low and high ankle-brachial indices (ABIs) are associated with high cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD), but the mechanisms responsible for the association are not fully known. This study is designed to assess whether there is a significant correlation between abnormal ABI and echocariographic parameters in patients with CKD stages 3-5. A total of 684 pre-dialysis CKD patients were included in the study. The ABI was measured using an ABI-form device. Patients were classified into ABI <0.9, ≥ 0.9 to <1.3, and ≥ 1.3. Clinical and echocariographic parameters were compared and analyzed. Compared with patients with ABI of ≥ 0.9 to <1.3, the values of left ventricular mass index (LVMI) were higher in patients with ABI <0.9 and ABI ≥ 1.3 (P ≤ 0.004). After the multivariate analysis, patients with ABI <0.9 (β = 0.099, P = 0.004) and ABI ≥ 1.3 (β = 0.143, P<0.001) were independently associated with increased LVMI. Besides, increased LVMI (odds ratio, 1.017; 95% confidence interval, 1.002 to 1.033; P = 0.031) was also significantly associated with ABI <0.9 or ABI ≥1.3. Our study in patients of CKD stages 3-5 demonstrated abnormally low and high ABIs were positively associated with LVMI. Future studies are required to determine whether increased LVMI is a causal intermediary between abnormal ABI and adverse cardiovascular outcomes in CKD.
Collapse
Affiliation(s)
- Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Mecicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
50
|
Su HM, Lin TH, Hsu PC, Chu CY, Lee WH, Chen SC, Lee CS, Voon WC, Lai WT, Sheu SH. Association of interarm systolic blood pressure difference with atherosclerosis and left ventricular hypertrophy. PLoS One 2012; 7:e41173. [PMID: 22927905 PMCID: PMC3426512 DOI: 10.1371/journal.pone.0041173] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/18/2012] [Indexed: 01/20/2023] Open
Abstract
An interarm systolic blood pressure (SBP) difference of 10 mmHg or more have been associated with peripheral artery disease and adverse cardiovascular outcomes. We investigated whether an association exists between this difference and ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and echocardiographic parameters. A total of 1120 patients were included in the study. The bilateral arm blood pressures were measured simultaneously by an ABI-form device. The values of ABI and baPWV were also obtained from the same device. Clinical data, ABI<0.9, baPWV, echocariographic parameters, and an interarm SBP difference ≥10 mmHg were compared and analyzed. We performed two multivariate forward analyses for determining the factors associated with an interarm SBP difference ≥10 mmHg [model 1: significant variables in univariate analysis except left ventricular mass index (LVMI); model 2: significant variables in univariate analysis except ABI<0.9 and baPWV]. The ABI<0.9 and high baPWV in model 1 and high LVMI in model 2 were independently associated with an interarm SBP difference ≥10 mmHg. Female, hypertension, and high body mass index were also associated with an interarm SBP difference ≥10 mmHg. Our study demonstrated that ABI<0.9, high baPWV, and high LVMI were independently associated with an interarm SBP difference of 10 mmHg or more. Detection of an interarm SBP difference may provide a simple method of detecting patients at increased risk of atherosclerosis and left ventricular hypertrophy.
Collapse
Affiliation(s)
- Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|