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Li Y, Liu Z, Liu T, Li J, Mei Z, Fan H, Cao C. Risk Prediction for Sudden Cardiac Death in the General Population: A Systematic Review and Meta-Analysis. Int J Public Health 2024; 69:1606913. [PMID: 38572495 PMCID: PMC10988292 DOI: 10.3389/ijph.2024.1606913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Objective: Identification of SCD risk is important in the general population from a public health perspective. The objective is to summarize and appraise the available prediction models for the risk of SCD among the general population. Methods: Data were obtained searching six electronic databases and reporting prediction models of SCD risk in the general population. Studies with duplicate cohorts and missing information were excluded from the meta-analysis. Results: Out of 8,407 studies identified, fifteen studies were included in the systematic review, while five studies were included in the meta-analysis. The Cox proportional hazards model was used in thirteen studies (96.67%). Study locations were limited to Europe and the United States. Our pooled meta-analyses included four predictors: diabetes mellitus (ES = 2.69, 95%CI: 1.93, 3.76), QRS duration (ES = 1.16, 95%CI: 1.06, 1.26), spatial QRS-T angle (ES = 1.46, 95%CI: 1.27, 1.69) and factional shortening (ES = 1.37, 95%CI: 1.15, 1.64). Conclusion: Risk prediction model may be useful as an adjunct for risk stratification strategies for SCD in the general population. Further studies among people except for white participants and more accessible factors are necessary to explore.
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Affiliation(s)
- Yue Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Zhengkun Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Zihan Mei
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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Averina M, Stylidis M, Brox J, Schirmer H. NT-ProBNP and high-sensitivity troponin T as screening tests for subclinical chronic heart failure in a general population. ESC Heart Fail 2022; 9:1954-1962. [PMID: 35322586 PMCID: PMC9065856 DOI: 10.1002/ehf2.13906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Aims The aim of this study was to establish age‐specific and sex‐specific cut‐off values for N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐troponin T) in healthy subjects and assess cardiac biomarkers as screening tools for subclinical heart failure (HF) in a general population. Methods and results Altogether, 1936 participants were randomly selected from the general population Tromsø 7 study in Northern Norway. Diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) of cardiac markers for echocardiographically defined subclinical HF was evaluated. The receiver‐operating characteristic analysis showed that areas under the curve were relatively low (under 0.75) for both NT‐proBNP and hs‐troponin T, suggesting that the diagnostic accuracy of these biomarkers for subclinical HF was not excellent, especially for mild forms of HF and younger age group 40–49 years. Sex‐specific and age‐specific cut‐offs for hs‐troponin T (99th percentiles) and NT‐proBNP (97.5th percentiles) were established in healthy subjects from the same general population. The sex‐specific and age‐specific cut‐offs for NT‐proBNP had higher specificity for subclinical HF compared with the previously established single cut‐off 125 pg/mL. Age‐specific cut‐off for hs‐troponin T (18 ng/L) for men ≥60 years had also higher specificity than the single cut‐off 14 ng/L. These cut‐offs had high specificity, but low sensitivity, that makes hs‐troponin T and NT‐proBNP good biomarkers to rule in HF in case of a positive test, but not good enough to rule out all unrecognized HF due to false negative results. Conclusions N‐terminal pro‐brain natriuretic peptide and hs‐troponin T are suboptimal screening tools for subclinical HF in a general population due to low sensitivity.
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Affiliation(s)
- Maria Averina
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, 9038, Norway.,Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Jan Brox
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, 9038, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Cardiovascular Research Group, Campus Ahus, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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3
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Short stature is associated with incident sudden cardiac death in a large Asian cohort. Heart Rhythm 2020; 17:931-936. [DOI: 10.1016/j.hrthm.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/24/2020] [Indexed: 12/28/2022]
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Pichler G, Grau-Perez M, Tellez-Plaza M, Umans J, Best L, Cole S, Goessler W, Francesconi K, Newman J, Redon J, Devereux R, Navas-Acien A. Association of Arsenic Exposure With Cardiac Geometry and Left Ventricular Function in Young Adults. Circ Cardiovasc Imaging 2020; 12:e009018. [PMID: 31060373 DOI: 10.1161/circimaging.119.009018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Arsenic exposure has been related to numerous adverse cardiovascular outcomes. The aim of this study was to investigate the cross-sectional and prospective association between arsenic exposure with echocardiographic measures of left ventricular (LV) geometry and functioning. METHODS A total of 1337 young adult participants free of diabetes mellitus and cardiovascular disease were recruited from the SHFS (Strong Heart Family Study). The sum of inorganic and methylated arsenic concentrations in urine (ΣAs) at baseline was used as a biomarker of arsenic exposure. LV geometry and functioning were assessed using transthoracic echocardiography at baseline and follow-up. RESULTS Mean follow-up was 5.6 years, and median (interquartile range) of ΣAs was 4.2 (2.8-6.9) µg/g creatinine. Increased arsenic exposure was associated with prevalent LV hypertrophy, with an odds ratio (95% CI) per a 2-fold increase in ΣAs of 1.47 (1.05-2.08) in all participants and of 1.58 (1.04-2.41) among prehypertensive or hypertensive individuals. Measures of LV geometry, including LV mass index, left atrial systolic diameter, interventricular septum, and LV posterior wall thickness, were positively and significantly related to arsenic exposure. Among measures of LV functioning, stroke volume, and ejection fraction were associated with arsenic exposure. CONCLUSIONS Arsenic exposure was related to an increase in LV wall thickness and LV hypertrophy in young American Indians with a low burden of cardiovascular risk factors. The relationship was stronger in participants with prehypertension or hypertension, suggesting that potential cardiotoxic effects of arsenic might be more pronounced in individuals already undergoing cardiovascular adaptive mechanisms following elevated systemic blood pressure.
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Affiliation(s)
- Gernot Pichler
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY (G.P., M.G.-P., A.N.-A.).,Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain (G.P., M.G.-P., M.T.-P., J.R.).,Division of Cardiology, Department of Internal Medicine, Hospital Hietzing, Vienna, Austria (G.P.)
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY (G.P., M.G.-P., A.N.-A.).,Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain (G.P., M.G.-P., M.T.-P., J.R.).,Department of Statistics and Operational Research, University of Valencia, Spain (M.G.-P.)
| | - Maria Tellez-Plaza
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain (G.P., M.G.-P., M.T.-P., J.R.).,Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.T.-P.).,Department of Chronic Diseases Epidemiology, National Center for Epidemiology, National Institutes for Health Carlos III, Madrid, Spain (M.T.-P.)
| | - Jason Umans
- MedStar Health Research Institute, and Georgetown University (J.U.).,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC (J.U.)
| | - Lyle Best
- Missouri Breaks Industries Research, Inc, Timber Lake (L.B.)
| | - Shelley Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.C.)
| | - Walter Goessler
- Institute of Chemistry-Analytical Chemistry, University of Graz, Austria (W.G., K.F.)
| | - Kevin Francesconi
- Institute of Chemistry-Analytical Chemistry, University of Graz, Austria (W.G., K.F.)
| | - Jonathan Newman
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, NY (J.N.)
| | - Josep Redon
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain (G.P., M.G.-P., M.T.-P., J.R.).,CIBER 03/06 Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain (J.R.)
| | | | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY (G.P., M.G.-P., A.N.-A.)
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Joodi G, Maradey JA, Bogle B, Mirzaei M, Sadaf MI, Pursell I, Henderson C, Mounsey JP, Simpson RJ. Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death. J Gen Intern Med 2020; 35:531-537. [PMID: 31808130 PMCID: PMC7018927 DOI: 10.1007/s11606-019-05486-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high. OBJECTIVE We aimed to assess the prevalence of CAD and its risk factors among 18-64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area. DESIGN From 2013 to 2015, all sudden deaths among 18-64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218). MAIN MEASURES Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities. KEY RESULTS CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD. CONCLUSIONS Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.
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Affiliation(s)
- Golsa Joodi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joan A Maradey
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brittany Bogle
- Senior Data Scientist, Data Science Elite Team, IBM Corporation, Durham, NC, USA
| | - Mojtaba Mirzaei
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - Murrium I Sadaf
- Department of Internal Medicine, Yale University School of Medicine, Waterbury, CT, USA
| | - Irion Pursell
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Cory Henderson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - John Paul Mounsey
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA.
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Bozkurt S. Mathematical modeling of cardiac function to evaluate clinical cases in adults and children. PLoS One 2019; 14:e0224663. [PMID: 31671136 PMCID: PMC6822734 DOI: 10.1371/journal.pone.0224663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022] Open
Abstract
Time-varying elastance models can simulate only the pressure and volume signals in the heart chambers while the diagnosis of clinical cases and evaluation of different treatment techniques require more information. In this study, an extended model utilizing the geometric dimensions of the heart chambers was developed to describe the cardiac function. The new cardiac model was evaluated by simulating a healthy and dilated cardiomyopathy (DCM) condition for adults and children. The left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 53.60%, 125 mL, 5.08 cm and 1.82 in the healthy adult cardiovascular system model and 23.70%, 173 mL, 6.60 cm and 1.40 in the DCM adult cardiovascular system model. In the healthy child cardiovascular system model, the left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 59.70%, 92 mL, 4.10 cm and 2.26 respectively and 30.70%, 125 mL, 4.94 cm and 1.87 in the DCM child cardiovascular system model. The developed cardiovascular system model simulates the hemodynamic variables and clinical diagnostic indicators within the physiological range for healthy and DCM conditions proving the feasibility of this new model to evaluate clinical cases in adults and children.
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Affiliation(s)
- Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- * E-mail:
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7
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Medina‐Lezama J, Narvaez‐Guerra O, Herrera‐Enriquez K, Morey‐Vargas OL, Bolaños‐Salazar JF, Abugattas JP, Zea‐Diaz H, Chirinos‐Revilla JL, Fernandez‐Sivincha JG, Delgado‐Lazo V, Chirinos DA, Townsend RR, Chirinos JA. Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study. J Am Heart Assoc 2018; 7:e009259. [PMID: 30371205 PMCID: PMC6222967 DOI: 10.1161/jaha.118.009259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
Background Blood pressure is determined by the interactions between the heart and arterial properties, and subjects with identical blood pressure may have substantially different hemodynamic determinants. Whether arterial hemodynamic indices quantified by impedance cardiography ( ICG ), a simple operator-independent office procedure, independently predict all-cause mortality in adults from the general population, and specifically among those who do not meet criteria for American College of Cardiology/American Heart Association stage 2 hypertension, is currently unknown. Methods and Results We studied 1639 adults aged 18 to 80 years from the general population. We used ICG to measure hemodynamic parameters and metrics of cardiac function. We assessed the relationship between hemodynamic parameters measured at baseline and all-cause mortality over a mean follow-up of 10.9 years. Several ICG parameters predicted death. The strongest predictors were total arterial compliance index (standardized hazard ratio=0.38; 95% confidence interval=0.31-0.46; P<0.0001) and indices of cardiac contractility: velocity index (standardized hazard ratio=0.45; 95% confidence interval=0.37-0.55; P<0.0001) and acceleration index (standardized hazard ratio=0.44; 95% confidence interval=0.35-0.55; P<0.0001). These remained independently predictive of death after adjustment for multiple confounders, as well as systolic and diastolic blood pressure. Among subjects without stage 2 hypertension (n=1563), indices of cardiac contractility were independently predictive of death and identified a subpopulation (25% of non-stage-2 hypertensives) that demonstrated a high 10-year mortality risk, equivalent to that of stage 2 hypertensives. Conclusions Hemodynamic patterns identified by ICG independently predict mortality in the general population. The predictive value of ICG applies even in the absence of American College of Cardiology/American Heart Association stage 2 hypertension and identifies higher-risk individuals who are in earlier stages of the hypertension continuum.
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Affiliation(s)
- Josefina Medina‐Lezama
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Offdan Narvaez‐Guerra
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Karela Herrera‐Enriquez
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Oscar L. Morey‐Vargas
- Department of MedicineSanford University of South Dakota
Medical CenterBrusselsBelgium
| | - Juan Francisco Bolaños‐Salazar
- Department of Cardiology, Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel‐Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 JetteBrusselsBelgium
| | - Juan P. Abugattas
- Department of Cardiology, Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel‐Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 JetteBrusselsBelgium
| | | | | | | | | | | | - Raymond R. Townsend
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of PennsylvaniaPhiladelphiaPA
| | - Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of PennsylvaniaPhiladelphiaPA
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Heidenreich PA. Should We Start Community Screening for Left Ventricular Dysfunction? J Card Fail 2016; 22:24-5. [DOI: 10.1016/j.cardfail.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/27/2022]
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