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Wang AA, Cai X, Srivastava A, Prasad PV, Sprague SM, Carr J, Wolf M, Ix JH, Block GA, Chonchol M, Raphael KL, Cheung AK, Raj DS, Gassman JJ, Rahsepar AA, Middleton JP, Fried LF, Sarnari R, Isakova T, Mehta R. Abnormalities in Cardiac Structure and Function among Individuals with CKD: The COMBINE Trial. KIDNEY360 2021; 3:258-268. [PMID: 35373122 PMCID: PMC8967624 DOI: 10.34067/kid.0005022021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023]
Abstract
Background Individuals with CKD have a high burden of cardiovascular disease (CVD). Abnormalities in cardiac structure and function represent subclinical CVD and can be assessed by cardiac magnetic resonance imaging (cMRI). Methods We investigated differences in cMRI parameters in 140 individuals with CKD stages 3b-4 who participated in the CKD Optimal Management with BInders and NicotinamidE (COMBINE) trial and in 24 age- and sex-matched healthy volunteers. Among COMBINE participants, we examined the associations of eGFR, urine albumin-creatinine ratio (UACR), phosphate, fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH) with baseline (N=140) and 12-month change (N=112) in cMRI parameters. Results Mean (SD) ages of the COMBINE participants and healthy volunteers were 64.9 (11.9) and 60.4 (7.3) years, respectively. The mean (SD) baseline eGFR values in COMBINE participants were 32.1 (8.0) and 85.9 (16.0) ml/min per 1.73 m2 in healthy volunteers. The median (interquartile range [IQR]) UACR in COMBINE participants was 154 (20.3-540.0) mg/g. Individuals with CKD had lower mitral valve E/A ratio compared with healthy volunteers (for CKD versus non-CKD, β estimate, -0.13; 95% CI, -0.24 to -0.012). Among COMBINE participants, multivariable linear regression analyses showed that higher UACR was significantly associated with lower mitral valve E/A ratio (β estimate per 1 unit increase in natural-log UACR, -0.06; 95% CI, -0.09 to -0.03). This finding was preserved among individuals without baseline CVD. UACR was not associated with 12-month change in any cMRI parameter. eGFR, phosphate, FGF23, and PTH were not associated with any cMRI parameter in cross-sectional or change analyses. Conclusions Individuals with CKD stages 3b-4 have evidence of cMRI abnormalities. Albuminuria was independently associated with diastolic dysfunction, as assessed by mitral valve E/A ratio, in individuals with CKD with and without clinical CVD. Albuminuria was not associated with change in any cMRI parameter.
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Affiliation(s)
- Ann A. Wang
- Graduate Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Xuan Cai
- Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Division of Nephrology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pottumarthi V. Prasad
- Department of Radiology, NorthShore University Health System Evanston, Evanston, Illinois
| | - Stuart M. Sprague
- Division of Nephrology and Hypertension, NorthShore University Health System, Evanston, Illinois,University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Joachim H. Ix
- Division of Nephrology, Department of Medicine, University of San Diego School of Medicine and Veterans Affairs San Diego Healthcare System, San Diego, California
| | | | - Michel Chonchol
- Division of Renal Disease/Hypertension, Department of Internal Medicine, University of Colorado Hospitals, Aurora, Colorado
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University and Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Dominic S. Raj
- Division of Kidney Diseases and Hypertension, George Washington University School of Medicine, Washington, DC
| | | | - Amir Ali Rahsepar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John P. Middleton
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Linda F. Fried
- Renal Section, Veterans Affairs Pittsburgh Healthcare System and Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Division of Nephrology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rupal Mehta
- Center for Translational Metabolism and Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Division of Nephrology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Division of Nephrology, Department of Medicine, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
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Hong Z, Jiang Y, Liu P, Zhang L. Association of microalbuminuria and adverse outcomes in hypertensive patients: a meta-analysis. Int Urol Nephrol 2021; 53:2311-2319. [PMID: 33674949 DOI: 10.1007/s11255-021-02795-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studies on the association of microalbuminuria with adverse outcomes in patients with hypertension remain controversial. This meta-analysis aimed to assess the predictive value of microalbuminuria in hypertensive patients. METHODS PubMed and Embase databases were comprehensively searched for studies that published from their inceptions to July 10, 2020. Observational studies reporting the association of microalbuminuria (defined as urinary albumin excretion 30 and 300 mg/24 h urine or albumin/creatinine ratio 30-300 mg/g from a spot urine or equivalent value) with all-cause mortality or major adverse cardiovascular events (MACEs) in hypertensive patients were selected. RESULTS Nine studies with a total of 19,893 hypertensive patients were included. When compared with those without microalbuminuria, hypertensive patients with microalbuminuria had an increased risk of all-cause mortality (risk ratio [RR] 1.68; 95% confidence interval [CI] 1.46-1.93) and MACEs (RR 1.40; 95% CI 1.22-1.62), respectively. Gender-specific analysis indicated that microalbuminuria was significantly associated with an increased risk of all-cause mortality (RR 1.61; 95% CI 1.17-2.21) in men but not in women (RR 1.18; 95% CI 0.78-1.80). CONCLUSION This meta-analysis suggests that microalbuminuria is independently associated with higher risk of MACEs and all-cause mortality in hypertensive patients. Determination of microalbuminuria has potential to improve the risk classification of hypertension.
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Affiliation(s)
- Zhibin Hong
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China.
| | - Yabao Jiang
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
| | - Peijun Liu
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
| | - Li Zhang
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
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3
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Patel RB, Colangelo LA, Reis JP, Lima JAC, Shah SJ, Lloyd-Jones DM. Association of Longitudinal Trajectory of Albuminuria in Young Adulthood With Myocardial Structure and Function in Later Life: Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Cardiol 2021; 5:184-192. [PMID: 31734692 DOI: 10.1001/jamacardio.2019.4867] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Albuminuria, as measured by single urine albumin-to-creatinine ratio (UACR) levels, is associated with cardiac remodeling and adverse clinical outcomes. The longitudinal patterns of change in UACR through young adulthood and their associations with myocardial structure and function later in life remain unclear. Objective To describe the trajectory of albuminuria as measured by UACR across a 20-year span and evaluate the association of albuminuria trajectory with echocardiographic indices of structure and function in middle age. Design, Setting, and Participants In the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort of black and white participants aged 18 to 30 years at baseline (March 1985 to June 1986) were evaluated over 30 years. Participants underwent evaluations at 4 urban US sites. Data were collected from March 1985 to May 2016, and data were analyzed from September 2018 to April 2019. Exposures Trajectories of UACR from the year 10 examination to the year 30 examination as determined by latent class modeling. Main Outcomes and Measures Echocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 30 examination. Results Of the 2647 included participants, 1441 (54.4%) were white, 1206 (45.6%) were black, and the mean (SD) age was 35.2 (3.6) years. A total of 5 trajectory groups of UACR were identified, including 1718 participants (64.9%) in the low-stable group, 682 (25.8%) in the moderate-stable group, 116 (4.4%) in the high-stable group, 88 (3.3%) in the moderate-increasing group, and 43 (1.6%) in the high-increasing group. Apart from the high-increasing cohort, the remaining 4 groups had median baseline UACR levels less than 30 mg/g. Male sex, current smoking, diabetes, and elevated blood pressure were more common in the moderate-increasing and high-increasing UACR groups. After adjustment for clinical variables and baseline UACR levels, there were significant differences in left ventricular (LV) mass by trajectory group (mean [SE] LV mass: high-increasing, 98.4 [3.4] g/m2; moderate-increasing, 91.7 [2.2] g/m2; high-stable, 86.0 [2.1] g/m2; moderate-stable, 82.3 [0.8] g/m2; low-stable, 78.6 [0.5] g/m2; P < .001). Significant differences by trajectory group were also noted in LV longitudinal strain, e' tissue velocities, and estimated LV filling pressures, even after adjustment for clinical variables and baseline UACR level. The association of trajectory group with indices of myocardial structure and function remained significant after adjustment for clinical variables and cumulative UACR from the year 10 to year 25 examinations. Conclusions and Relevance There are distinct patterns of change in albuminuria among young adults over a 20-year span, and these trajectory groups cannot be identified by baseline UACR level alone. Dynamic changes in albuminuria are independently associated with adverse alterations to cardiac structure, LV systolic function, and LV diastolic function.
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Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Associate Editor
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Jørgensen PG, Biering-Sørensen T, Mogelvang R, Fritz-Hansen T, Vilsbøll T, Rossing P, Jensen JS. Presence of micro- and macroalbuminuria and the association with cardiac mechanics in patients with type 2 diabetes. Eur Heart J Cardiovasc Imaging 2017; 19:1034-1041. [DOI: 10.1093/ehjci/jex231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/07/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peter Godsk Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
| | - Tina Vilsbøll
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Hellerup, Denmark
| | - Peter Rossing
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2-2, Gentofte, Denmark
- Faculty of Health, Aarhus University, Nordre Ringgade 1, Aarhus C, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
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5
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Seo MH, Lee JY, Ryu S, Won YS, Sung KC. The Effects of Urinary Albumin and Hypertension on All-Cause and Cardiovascular Disease Mortality in Korea. Am J Hypertens 2017; 30:799-807. [PMID: 28472229 PMCID: PMC5861583 DOI: 10.1093/ajh/hpx051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/13/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Urinary albumin levels and hypertension (HTN) are independently associated with an increased risk of all-cause mortality. The effect of albuminuria on mortality in the absence or presence of HTN is uncertain. This study aimed to evaluate the effect of albuminuria and HTN on all-cause and cardiovascular disease (CVD) mortality. METHODS Mortality outcomes for 32,653 Koreans enrolled in a health screening including measurements of the urinary albumin/creatinine ratio (UACR) at baseline and median follow-up of 5.13 years. Receiver operating characteristic curve analyses were performed in UACR and the cut-point was 5.42 mg/g. The participants for UACR at the cut-point of 5.42 μg/mg were categorized into UACR < 5.42 or UACR ≥ 5.42. HTN status was categorized as No HTN or HTN (defined as the absence or presence HTN). RESULTS The median (interquartile) baseline UACRs were higher in those who died than in survivors. Subjects with a UACR ≥ 5.42 mg/g without or with HTN showed a similar increased risk for all-cause mortality and CVD mortality, even after adjusting for known CVD risk factors compared to those with no HTN/UACR < 5.42 (reference), (all-cause mortality; hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02–2.15: HR 1.47; 95% CI 0.94–2.32, respectively), (CVD mortality; HR 5.75; 95% CI 1.54–21.47: HR 5.87; 95% CI 1.36–25.29) CONCLUSIONS The presence of urinary albumin and HTN is a significant determinant of CVD and death. Urinary albumin might be more attributable to CVD and all-cause mortality than HTN.
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Affiliation(s)
- Mi Hae Seo
- Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Yu Sam Won
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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6
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Hanna DB, Xu S, Melamed ML, Gonzalez F, Allison MA, Bilsker MS, Hurwitz BE, Kansal MM, Schneiderman N, Shah SJ, Kaplan RC, Rodriguez CJ, Kizer JR. Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos. Am J Cardiol 2017; 119:2073-2080. [PMID: 28438309 DOI: 10.1016/j.amjcard.2017.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Abstract
Higher urine albumin-to-creatinine ratio (UACR) has been associated with cardiac dysfunction in the general population. We assessed the association of UACR with cardiac structure and function in the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos across 4 US sites. Echo-SOL participants underwent standard 2-dimensional echocardiography, including speckle-tracking strain analysis. UACR was categorized as normal and high-normal (based on the midpoint of values below microalbuminuria), microalbuminuria (≥17 mg/g for men; ≥25 mg/g for women), and macroalbuminuria (≥250 mg/g; ≥355 mg/g). Simultaneous assessments were made of left ventricular (LV) mass index and hypertrophy and measures of LV systolic and diastolic dysfunction. We assessed the association of UACR with subclinical cardiac measures, adjusting for sociodemographic and cardiometabolic factors. Among 1,815 participants (median age 54, women 65%), 42% had normal UACR, 43% high-normal UACR, 13% microalbuminuria, and 2% macroalbuminuria. Prevalence of LV hypertrophy was 13%, LV systolic dysfunction (ejection fraction <50%) 3%, and diastolic dysfunction 53%. After covariate adjustment, both micro- and macroalbuminuria were significantly associated with a twofold increase in LV hypertrophy. Microalbuminuria but not macroalbuminuria was associated with worse global longitudinal strain. Elevated UACR, even at high-normal levels, was significantly associated with greater diastolic dysfunction. In conclusion, elevated UACR was associated with LV hypertrophy and diastolic dysfunction in the largest known population sample of US Hispanic/Latinos. Screening and detection of even high-normal UACR could be of value to guide cardiovascular disease prevention efforts among Hispanic/Latino Americans.
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Cornell product relates to albuminuria in hypertensive black adults independently of blood pressure: the SABPA study. ACTA ACUST UNITED AC 2015; 9:115-22. [DOI: 10.1016/j.jash.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
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Ghali JK. A new direction for albuminuria: an enigmatic multibiomarker. JACC-HEART FAILURE 2014; 2:597-9. [PMID: 25282028 DOI: 10.1016/j.jchf.2014.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jalal K Ghali
- Department of Internal Medicine, Division of Cardiology, Mercer University School of Medicine, Macon, Georgia.
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Katz DH, Burns JA, Aguilar FG, Beussink L, Shah SJ. Albuminuria is independently associated with cardiac remodeling, abnormal right and left ventricular function, and worse outcomes in heart failure with preserved ejection fraction. JACC-HEART FAILURE 2014; 2:586-96. [PMID: 25282032 DOI: 10.1016/j.jchf.2014.05.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). BACKGROUND Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular outcomes in HFpEF. However, the relationship between albuminuria and cardiac structure/function in HFpEF has not been well studied. METHODS We measured urinary albumin-to-creatinine ratio (UACR) and performed comprehensive echocardiography, including tissue Doppler imaging and right ventricular (RV) evaluation, in a prospective study of 144 patients with HFpEF. Multivariable-adjusted linear regression was used to determine the association between UACR and echocardiographic parameters. Cox proportional hazards analyses were used to determine the association between UACR and outcomes. RESULTS The mean age was 66 ± 11 years, 62% were female, and 42% were African American. Higher UACR was associated with greater left ventricular mass, lower preload-recruitable stroke work, and lower global longitudinal strain. Higher UACR was also significantly associated with RV remodeling (for each doubling of UACR, RV wall thickness was 0.9 mm higher [95% confidence interval: 0.05 to 0.14 mm; p = 0.001, adjusted p = 0.01]) and worse RV systolic function (for each doubling of UACR, RV fractional area change was 0.56% lower [95% confidence interval: 0.14 to 0.98%; p = 0.01, adjusted p = 0.03]. The association between UACR and RV parameters persisted after the exclusion of patients with macroalbuminuria (UACR >300 mg/g). Increased UACR was also independently associated with worse outcomes. CONCLUSIONS In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and left ventricular remodeling and longitudinal systolic dysfunction. (Classification of Heart Failure With Preserved Ejection Fraction; NCT01030991).
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Affiliation(s)
- Daniel H Katz
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacob A Burns
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank G Aguilar
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren Beussink
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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10
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Electrocardiographic versus echocardiographic left ventricular hypertrophy and sudden cardiac arrest in the community. Heart Rhythm 2014; 11:1040-6. [PMID: 24657425 DOI: 10.1016/j.hrthm.2014.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is associated with increased risk of sudden cardiac arrest (SCA). Whether LVH diagnosed by 12-lead ECG vs echocardiogram conveys identical or distinct risk information has not been previously evaluated. OBJECTIVE The purpose of this study was to compare the association between ECG vs echocardiographic LVH and SCA in the community. METHODS In a large, prospective population-based study (The Oregon Sudden Unexpected Death Study; population approximately 1 million), cases of SCA were compared to controls recruited from the same geographical area. The association between LVH and SCA was evaluated, specifically comparing LVH diagnosed by ECG vs echocardiogram. RESULTS Cases (n = 132, age 66.9 ± 13.5 years, 58.3% male) compared to controls (n = 211; age 66.2 ± 12 years, 59.2% male) were more likely to have both ECG LVH (12.1% vs 5.7%, P = .03) and echocardiographic LVH (35.0% vs 15.5%, P <.001). However, there was poor agreement between the tests (kappa statistic = 0.128). A large subgroup of patients with ECG LVH (57.1%) did not have echocardiographic LVH; conversely, 83.6% of patients with echocardiographic LVH did not have ECG LVH. In multivariate analysis, ECG LVH was significantly associated with SCA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-6.0, P = .04). When echocardiographic LVH was added to the model, this association was only mildly attenuated (OR 2.4, 95% CI 1.0-6.0, P= .05), and echocardiographic LVH was also independently associated with SCA (OR 2.7, 95% CI 1.5-4.9, P = .001). CONCLUSION ECG and echocardiographic LVH may convey distinct risk information in patients with SCA, reflecting electrical vs anatomic remodeling. These findings have potential implications for SCA mechanisms and risk stratification.
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11
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Katz DH, Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KYA, Peng J, Sha J, Irvin MR, Eckfeldt JH, Turner ST, Freedman BI, Arnett DK, Shah SJ. Association of low-grade albuminuria with adverse cardiac mechanics: findings from the hypertension genetic epidemiology network (HyperGEN) study. Circulation 2014; 129:42-50. [PMID: 24077169 PMCID: PMC3888488 DOI: 10.1161/circulationaha.113.003429] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/23/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Albuminuria is a marker of endothelial dysfunction and has been associated with adverse cardiovascular outcomes. The reasons for this association are unclear but may be attributable to the relationship between endothelial dysfunction and intrinsic myocardial dysfunction. METHODS AND RESULTS In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, a population- and family-based study of hypertension, we examined the relationship between urine albumin-to-creatinine ratio (UACR) and cardiac mechanics (n=1894, all of whom had normal left ventricular ejection fraction and wall motion). We performed speckle-tracking echocardiographic analysis to quantify global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities. We used E/e' ratio as a marker of increased left ventricular filling pressures. We used multivariable-adjusted linear mixed effect models to determine independent associations between UACR and cardiac mechanics. The mean age was 50±14 years, 59% were female, and 46% were black. Comorbidities were increasingly prevalent among higher UACR quartiles. Albuminuria was associated with global longitudinal strain, global circumferential strain, global radial strain, e' velocity, and E/e' ratio on unadjusted analyses. After adjustment for covariates, UACR was independently associated with lower absolute global longitudinal strain (multivariable-adjusted mean global longitudinal strain [95% confidence interval] for UACR Quartile 1 = 15.3 [15.0-15.5]% versus UACR Q4 = 14.6 [14.3-14.9]%, P for trend <0.001) and increased E/e' ratio (Q1 = 25.3 [23.5-27.1] versus Q4 = 29.0 [27.0-31.0], P=0.003). The association between UACR and global longitudinal strain was present even in participants with UACR < 30 mg/g (P<0.001 after multivariable adjustment). CONCLUSIONS Albuminuria, even at low levels, is associated with adverse cardiac mechanics and higher E/e' ratio.
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Affiliation(s)
- Daniel H. Katz
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank G. Aguilar
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eva E. Martinez
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Beussink
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jie Peng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin Sha
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Marguerite R. Irvin
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Stephen T. Turner
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Barry I. Freedman
- Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donna K. Arnett
- Departments of Epidemiology and Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Chillo P, Lwakatare J, Rieck AE, Lutale J, Gerdts E. Prevalence and covariates of abnormal left ventricular geometry in never-treated hypertensive patients in Tanzania. Blood Press 2013; 23:31-8. [PMID: 23721542 DOI: 10.3109/08037051.2013.791415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM. To assess prevalence, type and covariates of abnormal left ventricular (LV) geometry in untreated native Tanzanian patients with hypertension in relation to normotensive controls. METHODS. Echocardiography was performed in 161 untreated hypertensive outpatients and 80 normotensive controls at a tertiary hospital in Tanzania. Hypertensive heart disease was defined as presence of increased LV mass or relative wall thickness (RWT). RESULTS. The prevalence of hypertensive heart disease increased with the severity of hypertension and was on average 62.1% among patients and 12.5% in controls. In multivariate analyses, higher LV mass index was associated with higher systolic blood pressure (β = 0.28), body mass index (β = 0.20), peak early transmitral to medial mitral annulus velocity ratio (β = 0.16), and with lower stress-corrected midwall shortening (scMWS) (β = - 0.44) and estimated glomerular filtration rate (β = - 0.16), all p < 0.05. Higher RWT was associated with higher systolic blood pressure (β = 0.16), longer E-wave deceleration time (β = 0.23) and lower scMWS (β = - 0.66), irrespective of LV mass (all p < 0.05). CONCLUSION. Subclinical hypertensive heart disease is highly prevalent in untreated native hypertensive Tanzanians and associated with both systolic and diastolic LV dysfunction. Management of hypertension in Africans should include high focus on subclinical hypertensive heart disease.
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Affiliation(s)
- Pilly Chillo
- Institute of Medicine, University of Bergen , Norway
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MOUBARAK M, JABBOUR H, SMAYRA V, CHOUERY E, SALIBA Y, JEBARA V, FARÈS N. Cardiorenal Syndrome in Hypertensive Rats: Microalbuminuria, Inflammation and Ventricular Hypertrophy. Physiol Res 2012; 61:13-24. [DOI: 10.33549/physiolres.932146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to evaluate a possible association between microalbuminuria (MA), several low-grade inflammation factors and left ventricular hypertrophy (LVH) by using a pharmacological approach. This may provide new insights into the pathophysiologic mechanisms of the cardiorenal syndrome (CRS) linking early renal impairment with elevated cardiovascular risk. Two kidney-one clip (2K-1C) renovascular hypertension was induced in 24 male Wistar rats (220-250 g). After the development of hypertension, rats were divided into four groups: 2K-1C (untreated), calcium channel blocker (amlodipine-treated), angiotensin receptor blocker (losartan-treated) and peripheral vasodilator (hydralazine-treated), which were treated for 10 weeks. Rats in the 2K-1C group had all developed hypertension, a significant increase in plasma levels of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), brain natriuretic peptide (BNP) and C-reactive protein (CRP). Moreover MA and creatininaemia underwent a significant increase. Under treatment decreases were observed in systolic blood pressure (SBP), TNF-α, CRP, IL-6, BNP concentrations and creatininaemia. These results were related to the absence of MA which was significantly associated with reductions in cardiac mass and hypertrophy markers (BNP and β-MHC gene expression) as well as renal interstitial inflammation. In conclusion, our results suggest that the reduction of MA is correlated with the decrease of the inflammatory components and seems to play an important role in protecting against cardiac hypertrophy and renal injury.
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Affiliation(s)
| | | | | | | | | | | | - N. FARÈS
- Laboratoire de Physiologie et Physiopathologie, Faculté de Médecine, Université Saint Joseph, Beyrouth, Liban
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Abstract
This narrative review focuses on outcomes related to proteinuria in hypertension (HT), and also examines the role of current and future therapeutic strategies. Proteinuria is an independent marker of renal and cardiovascular (CV) disease in hypertensive populations, particularly in high-risk groups such as diabetic patients. Effective blood pressure (BP) control and proteinuria management are associated with significant improvements in the risk of key adverse outcomes, although a causative relationship needs careful assessment. Available antihypertensives have varying effects on proteinuria reduction. Drugs affecting the renin system offer antiproteinuric and renoprotective effects that are probably at least partially independent of their BP effects. Economic evaluations of these interventions confirm their cost-saving benefits relative to other antihypertensives, but outcomes-based research is needed in some settings.
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