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Talle MA, Doubell AF, Robbertse PPS, Lahri S, Herbst PG. Cardiac Morphology, Function, and Left Ventricular Geometric Pattern in Patients with Hypertensive Crisis: A Cardiovascular Magnetic Resonance-Based Study. J Cardiovasc Dev Dis 2023; 10:367. [PMID: 37754796 PMCID: PMC10532285 DOI: 10.3390/jcdd10090367] [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: 07/23/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: Patients with hypertensive crisis underwent CMR imaging at 1.5 Tesla to assess cardiac volume, mass, function, and contrasted study. Left ventricular (LV) function and geometry were defined according to the guideline recommendations. Late gadolinium enhancement (LGE) was qualitatively assessed and classified into ischemic and nonischemic patterns. Predictors of LGE was determined using regression analysis. (3) Results: Eighty-two patients with hypertensive crisis (aged 48.5 ± 13.4 years, and 57% males) underwent CMR imaging. Of these patients, seventy-eight percent were hypertensive emergency and twenty-two percent were urgency. Diastolic blood pressure was higher under hypertensive emergency (p = 0.032). Seventy-nine percent (92% of emergency vs. 59% of urgency, respectively; p = 0.003) had left ventricular hypertrophy (LVH). The most prevalent LV geometry was concentric hypertrophy (52%). Asymmetric LVH occurred in 13 (22%) of the participants after excluding ischemic LGE. Impaired systolic function occurred in 46% of patients, and predominantly involved hypertensive emergency. Nonischemic LGE occurred in 75% of contrasted studies (67.2% in emergency versus 44.4% in urgency, respectively; p < 0.001). Creatinine and LV mass were independently associated with nonischemic LGE. (5) Conclusion: LVH, altered geometry, asymmetric LVH, impaired LV systolic function, and LGE are common under hypertensive crisis. LVH and LGE more commonly occurred under hypertensive emergency. Longitudinal studies are required to determine the prognostic implications of asymmetric LVH and LGE in hypertensive crisis.
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Affiliation(s)
- Mohammed A. Talle
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria
| | - Anton F. Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Pieter-Paul S. Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Sa’ad Lahri
- Division of Emergency Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Philip G. Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
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2
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Ohira A, Yamakawa T, Iwahashi N, Tanaka S, Sugiyama M, Harada M, Ichikawa M, Akiyama T, Orime K, Terauchi Y. Association of continuous positive airway pressure therapy on cardiac hypertrophy in patients with sleep apnea comorbid with type 2 diabetes mellitus. Endocr J 2023; 70:47-58. [PMID: 36089339 DOI: 10.1507/endocrj.ej22-0308] [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] [Indexed: 02/01/2023] Open
Abstract
Previous reports indicated the therapeutic effect of chronic continuous positive airway pressure (CPAP) therapy on cardiac hypertrophy due to sleep apnea syndrome. However, little is known for cases involving diabetic complications. This retrospective observational study examined the effects of CPAP therapy on left ventricular hypertrophy (LVH) in patients with obstructive sleep apnea syndrome (OSAS) and type 2 diabetes mellitus (T2DM). For all cases, the observation period was 3 years from the time when the patient was introduced to CPAP therapy. Overall, 123 patients were divided into a good CPAP group (CPAP ≥4 h/day, n = 63) and non-adherence group (CPAP <4 h/day, n = 60). The mean CPAP usage times were 5.58 ± 1.23 and 1.03 ± 1.17 h/day in the good CPAP and non-adherence groups, respectively. Regression tendencies of the thickness of the left ventricular posterior (-0.30 ± 1.19 mm) and interventricular septal walls (-0.48 ± 1.22 mm) were observed in the good CPAP group. Hypertrophic tendencies of the left ventricular posterior wall (+0.59 ± 1.44 mm) and interventricular septal wall thickness (+0.59 ± 1.43) were observed in the non-adherence group. Left ventricular posterior wall thickness (coefficient: -0.254, p = 0.0376) and interventricular septal wall thickness (coefficient: -0.426, p = 0.0006) were more likely to be greater in the non-adherence group than in the good CPAP group. Patients in the non-adherence group with an apnea hypopnea index ≥30 had increased left ventricular posterior wall thickness (coefficient: -0.263, p = 0.0673) and interventricular septal wall thickness (coefficient: -0.450, p = 0.0011). In conclusion, appropriate CPAP therapy is an effective treatment for LVH in patients with T2DM and OSAS, especially for severe cases.
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Affiliation(s)
- Akeo Ohira
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tadashi Yamakawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | | | - Mai Sugiyama
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Marina Harada
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masahiro Ichikawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tomoaki Akiyama
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kazuki Orime
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
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3
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Gronningsaeter L, Skulstad H, Quattrone A, Langesaeter E, Estensen ME. Reduced left ventricular function and sustained hypertension in women seven years after severe preeclampsia. Scand Cardiovasc J Suppl 2022; 56:292-301. [PMID: 35852091 DOI: 10.1080/14017431.2022.2099012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective. To study left ventricular (LV) function and blood pressure (BP) at a long-term follow-up in women after severe pre-eclampsia. Design. In this single-centre, cross-sectional study, 96 patients were eligible for inclusion. LV function was examined by transthoracic echocardiography including tissue Doppler echocardiography and speckle tracking. BP was measured at rest using repeated non-invasive techniques. Results. We compared 36 patients with early-onset and 33 patients with late-onset pre-eclampsia with 28 healthy controls. Mean age (40 ± 3 years) and median time since delivery (7 ± 2 years) were similar across the study groups. The patients had 18% higher systolic BP (139 ± 15 mmHg) and 24% higher diastolic BP (87 ± 19 mmHg) than controls (p < .01). Hypertension was present in 23 patients (33%), where the estimated LV mass was 16% higher (p = .05) than in controls. The LV ejection fraction was 19% lower in the early-onset group (51 ± 4%; p = .01) and 14% lower in the late-onset group (54 ± 6; p = .04) compared with controls. LV global longitudinal strain was 18% lower in the patient group (-17.7 ± 2.1%) compared with controls (p = .01). Indicative of a more restrictive filling pattern, the diastolic indices showed a lower e' mean (p < .01) and subsequently higher E/e' ratio (p < .01). There were no significant differences in BP, systolic or diastolic function indices between the patient groups. Conclusion. We found sustained hypertension, higher LV mass and reduced LV systolic and diastolic function 7 y after severe pre-eclampsia. Our findings emphasize the importance of early risk stratification and clinical counselling, and follow-up for such cases.
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Affiliation(s)
- L Gronningsaeter
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Skulstad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Heart-, lung- and vessel-disease, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - A Quattrone
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Heart-, lung- and vessel-disease, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Langesaeter
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - M E Estensen
- Department of Cardiology, Division of Heart-, lung- and vessel-disease, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
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Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
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5
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Tadic M, Cuspidi C, Marwick TH. Phenotyping the hypertensive heart. Eur Heart J 2022; 43:3794-3810. [DOI: 10.1093/eurheartj/ehac393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
Abstract
Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling—especially LV hypertrophy—is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm , Albert-Einstein Allee 23, 89081 Ulm , Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca , Milano 20126 , Italy
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute , Melbourne, VIC 3004 , Australia
- Baker Department of Cardiometabolic Health, University of Melbourne , VIC 3004 , Australia
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Zhou D, Yan M, Cheng Q, Feng X, Tang S, Feng Y. Prevalence and prognosis of left ventricular diastolic dysfunction in community hypertension patients. BMC Cardiovasc Disord 2022; 22:265. [PMID: 35698035 PMCID: PMC9195252 DOI: 10.1186/s12872-022-02709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Left ventricular diastolic dysfunction (LVDD) is common in hypertension and is a predictor of increased cardiovascular risk, however the effect of LVDD, detected by new guideline, on major adverse cardiac events (MACE) is unknown in hypertensive patients without known cardiovascular disease. The present study aims to evaluate LVDD in a community hypertension cohort study and assess the effect of LVDD on MACE. we studied 283 asymptomatic nonischemic patients with hypertension who had baseline echocardiogram between 2012 and 2014. Patients were followed for MACE (myocardial infarction, coronary revascularization procedures, heart failure, stroke, all-cause mortality) with mean follow-up of 5.4 years. A Cox proportional hazards model was used to assess the association of LVDD with MACE. At baseline, 35 of the 283 hypertensions were diagnosed with LVDD (12.3%) and 25 patients were women (15.5%). Women had higher frequency of LVDD than men (8%). During follow-up, there were 26.6% patients occurring MACE in the LVDD group at baseline, 9.9% patients occurring MACE in the group with normal diastolic function. In multivariable Cox regression analyses, LVDD was a stronger predictor of MACE (HR: 2.5; 95% CI: 1.20 to 5.25; c- statistics 0.805) than E/e' ratio (HR: 1.13; 95% CI: 1.04 to 1.22). LVDD was strongly associated with MACE in hypertension patients.
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Affiliation(s)
- Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Mengqi Yan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Qi Cheng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Xiaoxuan Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Songtao Tang
- Department of Internal Medicine, Community Health Center of Liaobu Community, Dongguan, 523411, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China.
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7
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Zuo X, Xu Z, Jia H, Mu Y, Zhang M, Yuan M, Wu C. Co-simulation of hypertensive left ventricle based on computational fluid dynamics and a closed-loop network model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106649. [PMID: 35124478 DOI: 10.1016/j.cmpb.2022.106649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/03/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Hypertension is one of the most common chronic and cardiovascular diseases, with the largest number of deaths. According to clinical experience, long-term hypertension will cause cardiac hypertrophy and other complications, and heart structure remodeling will significantly change the energy characteristics of the heart chambers, and impair heart function. Research shows that, early hypertension can be diagnosed by the blood flow and energy loss in the left ventricle. Therefore, it is important to choose an appropriate method to simulate and predict the flow domain of this ventricle. METHODS This study took the left ventricular flow field of patients with hypertensive myocardial hypertrophy as the research object, used MATLAB-SIMULINK to establish a closed-loop network cardiovascular model, provided flow boundary conditions for the computational fluid dynamics (CFD) numerical simulation method, and, finally, completed a co-simulation. RESULTS This article compared the degree of agreement between the energy loss in different phases of the heart cavity and clinical experimental data and summarized the characteristics of the flow field in patients with hypertensive myocardial hypertrophy. The analysis of three simulation groups (control group, non-left ventricular hypertrophy group, and left ventricular hypertrophy [LVH] group) showed that the vortices in the LVH group were irregular and not fully developed, accompanied by significant energy loss. CONCLUSION The simulation method used in this study is basically consistent with the clinical data. Myocardial hypertrophy has a significant influence on the blood flow of the left ventricle. Changes in the blood flow make the left ventricular vortex distribution abnormal during the rapid systole and rapid ejection periods, leading to a series of dangerous factors, including increased energy loss and a low cardiac ejection fraction.
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Affiliation(s)
- Xiaowen Zuo
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China.
| | - Zhike Xu
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, China
| | - Huaping Jia
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China.
| | - Yang Mu
- Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing 100089, China
| | - Mingming Zhang
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China
| | - Manli Yuan
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China
| | - Chengwei Wu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian 106024, China
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8
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Kagiyama N, Piccirilli M, Yanamala N, Shrestha S, Farjo PD, Casaclang-Verzosa G, Tarhuni WM, Nezarat N, Budoff MJ, Narula J, Sengupta PP. Machine Learning Assessment of Left Ventricular Diastolic Function Based on Electrocardiographic Features. J Am Coll Cardiol 2021; 76:930-941. [PMID: 32819467 DOI: 10.1016/j.jacc.2020.06.061] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/25/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is recognized as playing a major role in the pathophysiology of heart failure; however, clinical tools for identifying diastolic dysfunction before echocardiography remain imprecise. OBJECTIVES This study sought to develop machine-learning models that quantitatively estimate myocardial relaxation using clinical and electrocardiography (ECG) variables as a first step in the detection of LV diastolic dysfunction. METHODS A multicenter prospective study was conducted at 4 institutions in North America enrolling a total of 1,202 subjects. Patients from 3 institutions (n = 814) formed an internal cohort and were randomly divided into training and internal test sets (80:20). Machine-learning models were developed using signal-processed ECG, traditional ECG, and clinical features and were tested using the test set. Data from the fourth institution was reserved as an external test set (n = 388) to evaluate the model generalizability. RESULTS Despite diversity in subjects, the machine-learning model predicted the quantitative values of the LV relaxation velocities (e') measured by echocardiography in both internal and external test sets (mean absolute error: 1.46 and 1.93 cm/s; adjusted R2 = 0.57 and 0.46, respectively). Analysis of the area under the receiver operating characteristic curve (AUC) revealed that the estimated e' discriminated the guideline-recommended thresholds for abnormal myocardial relaxation and diastolic and systolic dysfunction (LV ejection fraction) the internal (area under the curve [AUC]: 0.83, 0.76, and 0.75) and external test sets (0.84, 0.80, and 0.81), respectively. Moreover, the estimated e' allowed prediction of LV diastolic dysfunction based on multiple age- and sex-adjusted reference limits (AUC: 0.88 and 0.94 in the internal and external sets, respectively). CONCLUSIONS A quantitative prediction of myocardial relaxation can be performed using easily obtained clinical and ECG features. This cost-effective strategy may be a valuable first clinical step for assessing the presence of LV dysfunction and may potentially aid in the early diagnosis and management of heart failure patients.
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Affiliation(s)
- Nobuyuki Kagiyama
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia. https://twitter.com/KagiyamaNobu
| | - Marco Piccirilli
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Naveena Yanamala
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia; Institute for Software Research, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Sirish Shrestha
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Peter D Farjo
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Grace Casaclang-Verzosa
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | | | - Negin Nezarat
- Lundquist Institute, Department of Medicine, Harbor-UCLA Medical Center, Torrance California
| | - Matthew J Budoff
- Lundquist Institute, Department of Medicine, Harbor-UCLA Medical Center, Torrance California
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Partho P Sengupta
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
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9
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Park SJ. The Role of Systolic Blood Pressure Reduction in Diastolic Dysfunction: RAAS Inhibition versus Non-RAAS Blood Pressure Lowering. J Cardiovasc Imaging 2020; 28:183-185. [PMID: 32583634 PMCID: PMC7316557 DOI: 10.4250/jcvi.2020.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sung Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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10
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Papanikolaou J, Ntalapascha M, Makris D, Koukoubani T, Tsolaki V, Zakynthinos G, Gourgoulianis K, Zakynthinos E. Diastolic dysfunction in men with severe obstructive sleep apnea syndrome but without cardiovascular or oxidative stress-related comorbidities. Ther Adv Respir Dis 2020; 13:1753466619880076. [PMID: 31566076 PMCID: PMC6769220 DOI: 10.1177/1753466619880076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: We aimed to evaluate whether the severity of obstructive sleep apnea syndrome (OSAS) per se affects the prevalence of left ventricular (LV) diastolic dysfunction in patients without comorbidities. Methods: A total of 42 patients with first-diagnosed severe OSAS [apnea–hypopnea index (AHI) > 30] and 25 controls (AHI < 5), having been referred for snoring to the Sleep Laboratory Department of our tertiary Hospital, were enrolled in the study. Inclusion criteria were absence of any cardiovascular or oxidative stress-related comorbidities, and age between 20 and 70 years. Clinical, laboratory, echocardiographic, and polysomnographic data were recorded prospectively. Diastolic dysfunction diagnosis and grading was based on 2016 ASE/EACVI recommendations. Results: Severe OSAS was associated with significantly increased prevalence and degree of diastolic dysfunction (26/42; 61.9%) compared with controls (7/25; 28%) (p = 0.007). AHI ⩾ 55 (dichotomous value of severe OSAS subset) was also characterized by greater prevalence and degree of diastolic dysfunction compared with 30 < AHI < 55 patients (p = 0.015). In the severe OSAS subset, age >45 years-old, height <1.745 m, body-mass index (BMI) >27.76 kg m−2, OSAS severity (AHI > 57.35), oxidative stress (overnight reduction of reduced to oxidized glutathione ratio < 18.44%), and BMI/height ratio > 16.155 kg m−3 (an index describing ‘dense’, short-heavy patients) presented significant diagnostic utility in identifying diastolic dysfunction in ROC-curve analysis (0.697 ⩾ AUC ⩾ 0.855, 0.001 ⩽ p ⩽ 0.018). In binary logistic regression model, advanced age (OR 1.23, 95% CI 1.025–1.477; p = 0.026) and AHI (OR 1.123, 95% CI 1.007–1.253; p = 0.036) showed independent association with diastolic dysfunction in severe OSAS. Conclusions: The present prospective study may suggest that severe OSAS is significantly associated with LV diastolic dysfunction; OSAS clinical severity exerts a positive influence on (and possibly constitutes an independent risk factor of) LV diastolic dysfunction. The reviews of this paper are available via the supplementary material section.
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Affiliation(s)
- John Papanikolaou
- Department of Critical Care, University Hospital of Larissa, Biopolis, Larissa, 41110, Greece
| | | | - Demosthenes Makris
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - George Zakynthinos
- Department of Critical Care, University Hospital of Larissa, Larissa, Thessaly, Greece
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11
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Ceyhun G, Erbay G. A rare cause of erectile dysfunction: left ventricular diastolic dysfunction. Minerva Cardioangiol 2020; 68:295-301. [PMID: 32163242 DOI: 10.23736/s0026-4725.20.05149-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease. METHODS A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed. RESULTS The mean age, Body Mass Index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (P>0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r=-0.635, P<0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score. CONCLUSIONS This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.
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Affiliation(s)
- Gökhan Ceyhun
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey -
| | - Güven Erbay
- Department of Urology, Faculty of Medicine, Omer Halisdemir University, Nigde, Turkey
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12
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Johansen MC, Shah AM, Lirette ST, Griswold M, Mosley TH, Solomon SD, Gottesman RF. Associations of Echocardiography Markers and Vascular Brain Lesions: The ARIC Study. J Am Heart Assoc 2019; 7:e008992. [PMID: 30526268 PMCID: PMC6405621 DOI: 10.1161/jaha.118.008992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Associations between subtle changes in cardiac and cerebral structure and function are not well understood, with some studies suggesting that subclinical cardiac changes may be associated with markers of vascular brain insult. Methods and Results Data from the ARIC (Atherosclerosis Risk in Communities) Study (5th ARIC visit; 2011‐2013; N=1974) were used to explore relationships between abnormalities of cardiac structure/function and subclinical brain disease and to test specific associations between those cardiac and vascular brain changes that share a common mechanism. In adjusted models white matter hyperintensities were 0.66 cm3 greater (95% confidence interval [CI] 0.08‐1.25) for every 1‐mm increase in left ventricular LV wall thickness and 0.64 cm3 greater (95% CI 0.19‐1.08) for every 10 g/m2 increase in LV mass index, both markers of LV structure. Odds of brain infarction also increased with greater LV wall thickness (odds ratio 1.11, 95% CI 1.01‐1.23 per 1 mm) and larger LV mass (odds ratio 1.08, 95% CI 1.00‐1.17 per 10 g/m2). Higher ejection fraction (per 5%), a marker of systolic function, was significantly associated with decreased odds of overall infarct (odds ratio 0.85, 95% CI0.77‐0.95), but not with cortical infarction (odds ratio 0.92, 95% CI0.78‐1.08). Conclusions Among elderly participants in a large cohort study, subclinical markers of LV structure and LV systolic dysfunction were associated with increased odds of brain infarction and more white matter hyperintensities, independent of other vascular risk factors. This suggests end‐organ dysfunction occurs in the heart and brain in parallel, with further studies needed to determine causality.
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13
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Nazário Leão R, Marques da Silva P, Marques Pocinho R, Alves M, Virella D, Palma dos Reis R. Determinants of left ventricular diastolic dysfunction in hypertensive patients. HIPERTENSION Y RIESGO VASCULAR 2018; 35:160-168. [DOI: 10.1016/j.hipert.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/16/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
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14
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Świerblewska E, Wolf J, Kunicka K, Graff B, Polonis K, Hoffmann M, Chrostowska M, Szyndler A, Bandosz P, Graff B, Narkiewicz K. Prevalence and distribution of left ventricular diastolic dysfunction in treated patients with long-lasting hypertension. Blood Press 2018; 27:376-384. [PMID: 30129379 DOI: 10.1080/08037051.2018.1484661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although the presence of sub-clinical left ventricular diastolic dysfunction (LVDD) increases cardiovascular risk, the current ESH/ESC guidelines do not include the presence of this condition in the list of target organ damage or cardiovascular risk charts dedicated to the hypertensive population. Several conditions may predict the LVDD occurrence, however, clustering of these factors with hypertension makes the relationship less clear. Therefore, the aim of this study was to evaluate both the occurrence and the severity of diastolic dysfunction in a large cohort of treated hypertensives. METHODS We retrospectively analyzed records of 610 hypertensive participants of the CARE NORTH Study who consented to echocardiography and were free of overt cardiovascular disease. Mean age was 54.0 ± 13.9 years (mean ± SD), BMI 29.7 ± 4.8 kg/m2. The exclusion criteria were: established heart failure, LVEF <45%, coronary revascularization, valvular defect, atrial fibrillation, or stroke. The staging of LVDD was based on comprehensive transthoracic echocardiographic measurements. RESULTS 49.7% percent of the patients had normal diastolic function (38.8% vs. 59.0%, females (F) vs. males (M), respectively; p < .001). Grade 1 LVDD was documented in 24.4% (27.8% and 21.6%; F and M; p = .08) and grade 2 LVDD in 19.3% (24.9% and 14.6%; F and M; p = .001) of the patients. None were diagnosed with grade 3 LVDD. In the logistic regression model, female sex, advancing age, obesity status, established diabetes mellitus, higher 24-hour SBP, and increasing LVMI were identified as the independent variables increasing the odds for the presence of LVDD, whereas blood-lowering therapy attenuated the risk. CONCLUSIONS There is an unexpectedly high prevalence of different forms of diastolic dysfunction in treated hypertensive patients who are free of overt cardiovascular disease.
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Affiliation(s)
- Ewa Świerblewska
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Jacek Wolf
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Katarzyna Kunicka
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Beata Graff
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Katarzyna Polonis
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Michał Hoffmann
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Marzena Chrostowska
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Anna Szyndler
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Piotr Bandosz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Beata Graff
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
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Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. J Hypertens 2017; 35:1727-1741. [DOI: 10.1097/hjh.0000000000001396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Perrone-Filardi P, Coca A, Galderisi M, Paolillo S, Alpendurada F, de Simone G, Donal E, Kahan T, Mancia G, Redon J, Schmieder R, Williams B, Agabiti-Rosei E, Delgado V, Cosyns B, Lombardi M, Lancellotti P, Muraru D, Kauffmann P, Cardim N, Haugaa K, Hagendorff A. Non-invasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. Eur Heart J Cardiovasc Imaging 2017; 18:945-960. [DOI: 10.1093/ehjci/jex094] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Pasquale Perrone-Filardi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maurizio Galderisi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | | | - Francisco Alpendurada
- NIHR Cardiovascular BRU, Royal Brompton & Harefield NHS Trust, Imperial College London, London, UK
| | - Giovanni de Simone
- Hypertension Research Center (CIRIAPA), Federico II University of Naples, Naples, Italy
| | - Erwan Donal
- Cardiology & Cic-it 1414, CHU Rennes LTSI, Insert 1099, Université Rennes-1, Rennes, France
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Giuseppe Mancia
- IRCCS Istituto Auxologico Italiano e Istituto Clinico Universitario di Verano Brianza, Policlinico di Monza, Italy
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia and CIBERObn Carlos III Institute, Madrid, Spain
| | - Roland Schmieder
- University Hospital, Nephrology and Hypertension, Erlangen, Germany
| | - Bryan Williams
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, University College London, London, UK
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, Hypertension and Cardiovascular Risk Research Centre, University of Brescia, Spedali Civili, Brescia
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Sklyar E, Ginelli P, Barton A, Peralta R, Bella JN. Validity of electrocardiographic criteria for increased left ventricular mass in young patients in the general population. World J Cardiol 2017; 9:248-254. [PMID: 28400921 PMCID: PMC5368674 DOI: 10.4330/wjc.v9.i3.248] [Citation(s) in RCA: 3] [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] [Received: 07/27/2016] [Revised: 10/07/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate validity of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in young adults.
METHODS Retrospectively, echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old. A control group of patients without LVH was collected. Using echocardiogram as the gold standard, electrocardiograms were analyzed using common voltage criteria.
RESULTS Study included 100 subjects (52% male, mean age = 28 ± 6.8 years, 96% Hispanic or African-American) with 50% LVH prevalence. Sensitivity and specificity for Sokolow-Lyon criteria were 24% (95%CI: 13.5%-38.4%) and 88% (95%CI: 74.9%-95%). For Cornell criteria, sensitivity was 32% (95%CI: 19.9%-46.8%) and specificity 98% (95%CI: 87.9%-99.8%). For R in aVL criteria, sensitivity was 12% (95%CI: 4.9%-25%) and specificity 100% (95%CI: 91.1%-100%).
CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups. Low sensitivities preclude these ECG criteria from serving as effective screening tests.
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18
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Abstract
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals. Blood pressure lowering using antihypertensive medications can improve LVDD; however, it remains unclear whether this improvement in LV diastolic function can improve cardiovascular outcomes.
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Affiliation(s)
- Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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19
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Consequences of obstructive sleep apnoea syndrome on left ventricular geometry and diastolic function. Arch Cardiovasc Dis 2016; 109:494-503. [DOI: 10.1016/j.acvd.2016.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 11/18/2022]
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20
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Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14:915-26. [DOI: 10.1080/14779072.2016.1186542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2016; 28:727-54. [PMID: 26140936 DOI: 10.1016/j.echo.2015.05.002] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK
| | | | - Jose L Zamorano
- University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
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22
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Bodez D, Lang S, Meuleman C, Boyer-Châtenet L, Nguyen XL, Soulat-Dufour L, Boccara F, Fleury B, Cohen A. Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: An observational study. Arch Cardiovasc Dis 2015; 108:480-90. [PMID: 26068195 DOI: 10.1016/j.acvd.2015.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between obstructive sleep apnoea syndrome (OSAS), left ventricular (LV) diastolic dysfunction and LV geometry remains controversial because of coexisting disorders. AIMS To evaluate LV diastolic dysfunction and its independent predictors in a real-life cohort of OSAS patients, by a standardized approach. METHODS We consecutively included 188 OSAS patients after an overnight polysomnography to undergo clinical evaluation, ambulatory blood pressure measurement and complete echocardiography, combining M-mode, two-dimensional Doppler and tissue Doppler imaging modes. Correlations between OSAS severity and clinical and echocardiographical variables were assessed, and logistic regression models were used to identify possible determining factors of LV diastolic dysfunction. RESULTS Most patients were hypertensive (n=148, 78.7%) and already receiving treatment by continuous positive airway pressure (n=158, 84.5%). The prevalence of LV hypertrophy, defined by LV mass index (LVMi) normalized by height (2.7), was 12.4%, with a significant correlation with hypertension (P=0.004). The apnoea-hypopnoea index was correlated with body mass index (P<0.0001), 24-hour systolic blood pressure (P=0.01) and LVMi normalized by height (2.7) (P=0.03). Diastolic function assessed by a global approach was impaired for 70 patients (37.2%) and none of the OSAS severity variables was a determining factor after multivariable analysis with adjustment for age and sex. CONCLUSION Diastolic dysfunction assessed by a standardized approach is common in OSAS and should be routinely evaluated; it is independently predicted by none of the respiratory severity variables.
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Affiliation(s)
- Diane Bodez
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Sylvie Lang
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Catherine Meuleman
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Louise Boyer-Châtenet
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Xuan-Lan Nguyen
- Centre d'évaluation et traitements des troubles du sommeil, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Laurie Soulat-Dufour
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Franck Boccara
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Bernard Fleury
- Centre d'évaluation et traitements des troubles du sommeil, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, 184, rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France.
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Fitzgibbons T, Aurigemma G. Serial Changes in Diastolic Function. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003351. [DOI: 10.1161/circimaging.115.003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Timothy Fitzgibbons
- From the Division of Cardiovascular Medicine, Department of Medicine, the University of Massachusetts Medical School, Worcester, MA
| | - Gerard Aurigemma
- From the Division of Cardiovascular Medicine, Department of Medicine, the University of Massachusetts Medical School, Worcester, MA
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Lo Iudice F, Barbato A, Muscariello R, Di Nardo C, de Stefano F, Sibilio M, Strazzullo P, de Simone G, Galderisi M. Left Ventricular Diastolic Dysfunction in Type I Gaucher Disease: An Echo Doppler Study. Echocardiography 2014; 32:890-5. [DOI: 10.1111/echo.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francesco Lo Iudice
- Hypertension Research Center and Department of Medical Translational Sciences; Federico II University Hospital; Naples Italy
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Riccardo Muscariello
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Carlo Di Nardo
- Hypertension Research Center and Department of Medical Translational Sciences; Federico II University Hospital; Naples Italy
| | - Francesco de Stefano
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Michelina Sibilio
- Division of Pediatrics and Neonatology; Moscati Hospital; Aversa (CE) Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Giovanni de Simone
- Hypertension Research Center and Department of Medical Translational Sciences; Federico II University Hospital; Naples Italy
| | - Maurizio Galderisi
- Hypertension Research Center and Department of Medical Translational Sciences; Federico II University Hospital; Naples Italy
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Ruiz P, Rezaienia MA, Rahideh A, Keeble TR, Rothman MT, Korakianitis T. In vitro cardiovascular system emulator (bioreactor) for the simulation of normal and diseased conditions with and without mechanical circulatory support. Artif Organs 2013; 37:549-60. [PMID: 23758568 DOI: 10.1111/aor.12109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents a new device designed to simulate in vitro flow rates, pressures, and other parameters representing normal and diseased conditions of the human cardiovascular system. Such devices are sometimes called bioreactors or "mock" simulator of cardiovascular loops (SCVLs) in literature. Most SCVLs simulate the systemic circulation only and have inherent limitations in studying the interaction of left and right sides of circulation. Those SCVLs that include both left and right sides of the circulation utilize header reservoirs simulating cycles with constant atrial pressures. The SCVL described in this article includes models for all four chambers of the heart, and the systemic and pulmonary circulation loops. Each heart chamber is accurately activated by a separate linear motor to simulate the suction and ejection stages, thus capturing important features in the perfusion waveforms. Four mechanical heart valves corresponding to mitral, pulmonary, tricuspid, and aortic are used to control the desired unidirectional flow. This SCVL can emulate different physiological and pathological conditions of the human cardiovascular system by controlling the different parameters of blood circulation through the vascular tree (mainly the resistance, compliance, and elastance of the heart chambers). In this study, four cases were simulated: healthy, congestive heart failure, left ventricular diastolic dysfunction conditions, and left ventricular dysfunction with the addition of a mechanical circulatory support (MCS) device. Hemodynamic parameters including resistance, pressure, and flow have been investigated at aortic sinus, carotid artery, and pulmonary artery, respectively. The addition of an MCS device resulted in a significant reduction in mean blood pressure and re-establishment of cardiac output. In all cases, the experimental results are compared with human physiology and numerical simulations. The results show the capability of the SCVL to replicate various physiological and pathological conditions with and without MCS.
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Affiliation(s)
- Paula Ruiz
- School of Engineering and Materials Science, Queen Mary University of London, UK
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26
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Perzanowski C. AV delay optimization improves atrial transport in patients with restrictive diastolic dysfunction. Int J Cardiol 2013; 168:2908-9. [DOI: 10.1016/j.ijcard.2013.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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Peterson GE, de Backer T, Contreras G, Wang X, Kendrick C, Greene T, Appel LJ, Randall OS, Lea J, Smogorzewski M, Vagaonescu T, Phillips RA. Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease. Hypertension 2013; 62:518-25. [PMID: 23836799 DOI: 10.1161/hypertensionaha.111.00904] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.
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Affiliation(s)
- Gail E Peterson
- Division of Cardiology, UT Southwestern, 5909 Harry Hines Blvd, Dallas, TX 75235-9047, USA.
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Takami T, Saito Y. Azelnidipine plus olmesartan versus amlodipine plus olmesartan on arterial stiffness and cardiac function in hypertensive patients: a randomized trial. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:175-83. [PMID: 23662047 PMCID: PMC3610435 DOI: 10.2147/dddt.s42338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose To compare the long-term effects of olmesartan combined with either azelnidipine or amlodipine on central blood pressure (CBP), left ventricular (LV) mass index (LVMI), LV diastolic function (e′ velocity, E/e′ ratio, E/A ratio) and arterial stiffness (brachial-ankle pulse wave velocity [baPWV] and augmentation index normalized for a heart rate of 75 bpm [AIx]). Patients and methods Patients with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg received olmesartan monotherapy (20 mg/day) for 12 weeks. They were then randomly assigned to fixed-dose add-on therapy with azelnidipine (16 mg/day; n = 26) or amlodipine (5 mg/day; n = 26) for a further 2 years. CBP, LVMI, e′ velocity, E/e′ ratio, E/A ratio, baPWV, and AIx were measured at baseline, 6 months, and 2 years. Results Baseline characteristics of both groups were similar. The decrease in brachial BP over 2 years was similar in both groups. CBP, LVMI, E/e′ ratio, baPWV, and AIx decreased significantly, and the E/A ratio and e′ velocity increased significantly in both groups. The decreases in CBP (P < 0.001), AIx (P < 0.001), baPWV (P < 0.001), LVMI (P < 0.001), and E/e′ (P = 0.002) as well as the increase in E/A ratio (P = 0.03) over 2 years were significantly greater in the olmesartan/azelnidipine group than in the olmesartan/amlodipine group. Multivariate linear regression analyses showed that the changes in baPWV (β = 0.41, P < 0.001) and CBP (β = 0.47, P = 0.01) were independently associated with the change in LVMI, the change in baPWV (β = 0.25, P < 0.001) was independently associated with the change in E/e′ ratio, and the changes in baPWV (β = 0.21, P = 0.001) and AIx (β = 0.25, P = 0.03) were independently associated with the change in E/A ratio. Conclusion Treatment with olmesartan/azelnidipine for 2 years resulted in greater improvements in CBP, LVMI, and LV diastolic function, and arterial stiffness compared with olmesartan/amlodipine. Improvements in LV diastolic function were associated with improvements in arterial stiffness.
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Affiliation(s)
- Takeshi Takami
- Department of Internal Medicine, Clinic Jingumae, Kashihara, Nara, Japan.
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Affiliation(s)
- Michael A. Rosenberg
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Warren J. Manning
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Greve AM, Olsen MH, Bella JN, Lønnebakken MT, Gerdts E, Okin PM, Palmieri V, Boman K, Nieminen MS, Omvik P, Dahlöf B, Devereux RB, Wachtell K. Contrasting hemodynamic mechanisms of losartan- vs. atenolol-based antihypertensive treatment: a LIFE study. Am J Hypertens 2012; 25:1017-23. [PMID: 22695506 DOI: 10.1038/ajh.2012.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pharmaceutical differences in central hemodynamics might influence cardiac response to antihypertensive treatment despite similar lowering of brachial blood pressure (BP). METHODS Data from all patients with at least two echocardiographic examinations in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) echocardiographic substudy (n = 801); high-risk patients on losartan- vs. atenolol-based antihypertensive therapy. Echocardiography was performed annually for 4 years to measure stroke index (SI), heart rate, cardiac index (CI), conduit artery stiffness assessed as pulse pressure/stroke index (PP/SI) and total peripheral resistance index (TPRI). RESULTS Atenolol- and losartan-based therapy reduced BP similarly (cumulative difference in mean brachial blood pressure 0.3 mm Hg, P = 0.65). After 4 years the cumulative means of SI and heart rate were 1.8 ml/m(2) higher and 5.7 beats/min lower on atenolol-based treatment, respectively (both P < 0.001). This kept CI below baseline in atenolol-treated patients, whereas in the losartan group CI was unchanged from baseline throughout the study. TPRI was decreased more and remained lower in the losartan group (cumulative difference in mean TPRI 287 dynes/sec(-5)/cm/m(2), P < 0.001). These findings partly explained univariate differences in systolic- and diastolic function indices between the two treatments; fully adjusted losartan was only associated with a smaller left atrial diameter (cumulative mean difference 0.07 cm; 95% confidence intervals, -0.13 to -0.01, P = 0.03). CONCLUSIONS Contrasting hemodynamics impacted cardiac response to similar reductions in brachial BP on losartan- vs. atenolol-based therapy. The similar reduction of PP/SI suggests that the antihypertensive regimens used in the LIFE study had comparable effects on arterial stiffness (LIFE study; NCT00338260)
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Ginelli P, Bella JN. Treatment of diastolic dysfunction in hypertension. Nutr Metab Cardiovasc Dis 2012; 22:613-618. [PMID: 22743209 DOI: 10.1016/j.numecd.2012.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/16/2012] [Accepted: 04/25/2012] [Indexed: 11/29/2022]
Abstract
Diastolic dysfunction is present in half of patients with hypertension and has been shown to be associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure. With the high prevalence of hypertension and its associated complications, treatment of diastolic dysfunction in hypertension is an important and desirable goal. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to be effective in improvement of measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure. Beta-blockers, calcium channel blockers, and diuretics have also shown some efficacy in improved indices of diastolic filling. However, the independent impact of these pharmacologic interventions on prognosis and outcome in diastolic dysfunction has yet to be clarified. The Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) study, Candesartan in Heart Failure: Assessment in Reduction of Mortality and Morbidity (CHARM-Preserved) trial and the Losartan Intervention For End-point Reduction in Hypertension (LIFE) Study all failed to show improved morbidity and mortality with these drugs although, the LIFE study showed reduced heart failure hospitalization in hypertensive patients with normal in-treatment diastolic function. The Trial Of Preserved Cardiac function heart failure with an Aldosterone anTagonist (TOPCAT) is an on-going large, international study evaluating the effect of spironolactone on cardiovascular mortality, aborted cardiac arrest, or hospitalization for diastolic heart failure. This and other studies will provide further insight into the pathophysiology and management of patients with diastolic dysfunction.
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Affiliation(s)
- P Ginelli
- Department of Medicine, Bronx-Lebanon Hospital Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Bruno RM, Cartoni G, Taddei S. Hypertension in special populations: athletes. Future Cardiol 2012; 7:571-84. [PMID: 21797751 DOI: 10.2217/fca.11.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Physical exercise is known to lower blood pressure and reduce cardiovascular risk through a wide range of mechanisms. Nevertheless, hypertension is the most prevalent cardiovascular disease among athletes and physically active subjects. This article reviews the state of the art in practical approaches to this issue, focusing on special aspects a physician should take into account when diagnosing hypertension, such as screening of secondary causes, assessment of global cardiovascular risk and target organ damage and, in addition, the treatment choice in athletes.
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Affiliation(s)
- Rosa Maria Bruno
- Department of Internal Medicine, University of Pisa, Via Roma, 67, 56123 Pisa, Italy
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Suzuki O, Ishii H, Kobayashi S. Effects of an angiotensin 2 receptor blocker plus diuretic combination drug in chronic heart failure complicated by hypertension. J Int Med Res 2011; 39:1420-6. [PMID: 21986143 DOI: 10.1177/147323001103900429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effects of 24 weeks' treatment with an angiotensin 2 receptor blocker (ARB)/diuretic combination drug were investigated in an open-label study of 61 patients with stabilized chronic heart failure. Renin-angiotensin-aldosterone system inhibitors were replaced with a tablet containing hydrochlorothiazide 6.25 mg plus candesartan 8 mg, administered orally, once daily, in patients with systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg while under optimal treatment. Both SBP and DBP declined significantly during the ARB/diuretic combination treatment. Diuretics administered previously were discontinued during the study period in 15 patients, decreasing the number of drugs being taken. During ARB/diuretic combination treatment, the blood urea nitrogen level worsened but no significant changes were noted in potassium or estimated glomerular filtration rate, which had been a matter of concern. Additionally, the level of brain natriuretic peptide, an indicator of the severity of heart failure, was improved, indicating effectiveness and safety of the ARB/diuretic combination drug.
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Affiliation(s)
- O Suzuki
- Division of Cardiovascular Disease, Inazawa City Hospital, Inazawa City, Aichi, Japan.
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Pandis D, Grapsa J, Athanasiou T, Punjabi P, Nihoyannopoulos P. Left ventricular remodeling and mitral valve surgery: Prospective study with real-time 3-dimensional echocardiography and speckle tracking. J Thorac Cardiovasc Surg 2011; 142:641-9. [DOI: 10.1016/j.jtcvs.2010.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/04/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
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Pereira de Melo R, Venícios de Oliveira Lopes M, Leite de Araujo T, de Fatima da Silva L, Aline Arrais Sampaio Santos F, Moorhead S. Risk for decreased cardiac output: validation of a proposal for nursing diagnosis. Nurs Crit Care 2011; 16:287-94. [PMID: 21999419 DOI: 10.1111/j.1478-5153.2011.00453.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To verify the content validity of the nursing diagnosis risk for decreased cardiac output (RDCO). BACKGROUND DCO is a phenomenon that is not restricted to individuals or environments that specifically focus on cardiovascular care. It is not only prevalent in cardiovascular care units, but also in post-anaesthesia units and non-cardiac care units among individuals with non-cardiogenic disorders. A significant decrease in cardiac output is a life-threatening situation, demonstrating the need for developing a risk nursing diagnosis for early intervention. The development of this diagnosis requires the construction of a diagnosis label, a definition of the diagnostic concept and the risk factors associated with the diagnosis. METHODS The research was carried out in two methodological stages based on the Fehring diagnosis content validation model. The quantitative analysis consisted of the calculation of the weighted mean of the values attributed by experts to each risk factor, the level of agreement/disagreement between the experts regarding the operational definitions of risk factors and the index of diagnostic content validity (DCV). RESULTS The label 'risk for decreased cardiac output' was considered representative of a nursing diagnosis defined as 'at risk of developing a health status characterized by an insufficient quantity of blood pumped by the heart to meet physical metabolic demands'. Critical risk factors (DCV ≥ 0·7) were myocardial dysfunction (0·887), blood loss (0·875), increase in intrapericardial pressure (0·825), condition that leads to changes in cardiac rhythm and/or electrical conduction (0·812), deficient fluid volume (0·725), plasma loss (0·712), ineffective tissue perfusion (0·712) and electrolyte imbalance (0·7). CONCLUSIONS The research identified eight risk factors with valid content for assessment of RDCO. IMPLICATIONS FOR NURSING PRACTICE The identification of risk factors for DCO assists nurses to intervene early and minimize the consequences of a deficient cardiac function.
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Affiliation(s)
- Renata Pereira de Melo
- Federal University of Ceará/Brazil, CAPES Scholarship, Bairro Dionísio Torres, Fortaleza, Ceará, Brasil
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