1
|
Cai A, Liu L, Zhou D, Tang S, Tadic M, Schutte AE, Feng Y. Obesity and Risk of Incident Left Ventricular Hypertrophy in Community-Dwelling Populations With Hypertension: An Observational Study. J Am Heart Assoc 2024; 13:e033521. [PMID: 38842284 PMCID: PMC11255740 DOI: 10.1161/jaha.123.033521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the association between obesity and risk of incident left ventricular hypertrophy (LVH) in community-dwelling populations with hypertension and investigate whether this association would be attenuated by a lower achieved systolic blood pressure (SBP). METHODS AND RESULTS We used the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) criteria, which were derived from healthy Chinese populations to define LVH. A total of 2069 participants with hypertension and without LVH (obesity 20.4%) were included. The association between obesity and risk of incident LVH was evaluated using Cox proportional hazard models and stratified by achieved follow-up SBP levels (≥140, 130-139, and <130 mm Hg). These analyses were also assessed using the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria, which were derived from European populations to define LVH. After a median follow-up of 2.90 years, the rates of incident LVH in the normal-weight, overweight, and obese groups were 13.5%, 20.3%, and 27.8%, respectively (P<0.001). In reference to normal weight, obesity was associated with increased risk of incident LVH (adjusted hazard ratio [aHR], 2.51 [95% CI, 1.91-3.29]), which was attenuated when achieved SBP was <130 mm Hg (aHR, 1.78 [95% CI, 0.99-3.19]). This association remained significant when achieved SBP was ≥140 mm Hg (aHR, 3.45 [95% CI, 2.13-5.58]) or at 130 to 139 mm Hg (aHR, 2.32 [95% CI, 1.23-4.36]). Differences in these findings were noted when LVH was defined by the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. CONCLUSIONS Obesity was associated with incident LVH and an SBP target <130 mm Hg might be needed to attenuate this risk in patients with hypertension and obesity.
Collapse
Affiliation(s)
- Anping Cai
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Lin Liu
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Dan Zhou
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Songtao Tang
- Community Health Center of the Liaobu CountyDongguanChina
| | - Marijana Tadic
- Klinik für Innere Medizin IIUniversitätsklinikum Ulm, Albert‐Einstein Allee 23UlmGermany
| | - Aletta E. Schutte
- School of Population HealthUniversity of New South Wales, The George Institute for Global HealthSydneyAustralia
| | - Yingqing Feng
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| |
Collapse
|
2
|
Qin T, Geng Y. Echocardiographic insights into early obesity-related cardiomyopathy: Deciphering the silent distress of the heart. Asian J Surg 2024; 47:1558-1559. [PMID: 38092596 DOI: 10.1016/j.asjsur.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Tingting Qin
- Department of Ultrasound, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yaming Geng
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China.
| |
Collapse
|
3
|
Jain A, Singam A, Mudiganti VNKS. Echocardiography as a Vital Tool in Assessing Shock: A Comprehensive Review. Cureus 2024; 16:e57310. [PMID: 38690492 PMCID: PMC11059330 DOI: 10.7759/cureus.57310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Shock is a critical condition characterized by inadequate tissue perfusion, leading to cellular hypoxia and organ dysfunction. Early and accurate assessment is crucial for timely intervention and improved patient outcomes. Echocardiography has emerged as a vital tool in the assessment of shock, offering real-time visualization of cardiac anatomy, function, and hemodynamics. This comprehensive review aims to elucidate the role of echocardiography in shock assessment by providing an overview of its principles, techniques, and clinical applications. We discuss the importance of early diagnosis, identification of underlying pathology, monitoring response to therapy, and prognostic value offered by echocardiography in managing shock. Furthermore, we explore its utility in different types of shock, including hypovolemic, cardiogenic, distributive, and obstructive shock. Challenges and limitations of echocardiography, as well as future directions and innovations, are also discussed. Through a synthesis of current evidence and clinical insights, this review underscores the significance of echocardiography in optimizing shock management and highlights areas for further research and development.
Collapse
Affiliation(s)
- Abhishek Jain
- Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amol Singam
- Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - V N K Srinivas Mudiganti
- Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Abstract
Hypertrophic cardiomyopathy is one of the most frequently diagnosed primary conditions of the heart muscle. It is considered to be inherited, caused by genetic mutations encoding for sarcomere proteins. The marked heterogeneity in clinical manifestations and natural course of the disease, even among family members sharing the same genetic mutation, has raised the question of non-genetic environmental factors contributing to the phenotype. Obesity has been associated with worse cardiovascular outcomes in the general population. Its prevalence is increased in hypertrophic cardiomyopathy, and the two conditions share some similar pathophysiological and clinical characteristics. In this review, we aim to summarise the effects of obesity in the cardiac phenotype, the symptoms and management in patients with hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
| | - Konstantinos Savvatis
- Barts Health NHS Trust, London, UK; William Harvey Research Institute, Queen Mary University London, UK; Institute for Cardiovascular Science, University College London, London, UK
| |
Collapse
|
5
|
Role of Echocardiography in Diabetic Cardiomyopathy: From Mechanisms to Clinical Practice. J Cardiovasc Dev Dis 2023; 10:jcdd10020046. [PMID: 36826542 PMCID: PMC9959745 DOI: 10.3390/jcdd10020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
It has been well established that diabetes mellitus (DM) is considered as a core risk factor for the development of cardiovascular diseases. However, what is less appreciated is the fact that DM may affect cardiac function irrespective of cardiac pathologies to which it contributes, such as coronary artery disease and hypertension. Although echocardiography provides accurate and reproducible diagnostic and prognostic data in patients with DM, its use in these patients is still underappreciated, resulting in progression of DM-related heart failure in many patients. Hence, in the present review, we aimed to discuss the role of echocardiography in the contemporary management of diabetic cardiomyopathy (DCM), as well as the role of emerging echocardiographic techniques, which may contribute to earlier diagnosis and more appropriate management of this complication of DM. In order to improve outcomes, focus must be placed on early diagnosis of this condition using a combination of echocardiography and emerging biomarkers, but perhaps the more important thing is to change perspective when it comes to the clinical importance of DCM.
Collapse
|
6
|
Che Rahim MJ, Abdull Wahab SF, Fauzi MH, Nadarajan C, Ab Hamid SA. Supradiaphragmatic central venous catheter malposition detection using the parasternal long-axis echocardiographic view and dextrose 50% contrast solution: A pilot study. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:292-298. [PMID: 36969538 PMCID: PMC10034659 DOI: 10.1177/1742271x211051767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/03/2021] [Indexed: 11/15/2022]
Abstract
Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators' diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p < .0001). The RVI-PLAX CEUS was not able to detect two central venous catheter malpositions (one atrial malposition and one left brachiocephalic vein venous catheter malposition). The capillary blood sugar was significantly elevated (8.96 mmol/L vs. 9.75 mmol/L) after D50% flush (p < 0.005) with no complications reported within 30 minutes after the D50% flush. Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.
Collapse
Affiliation(s)
- Mohd Jazman Che Rahim
- School of Medical Sciences, Universiti Sains Malaysia – Kampus
Kesihatan, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Shaik Farid Abdull Wahab
- School of Medical Sciences, Universiti Sains Malaysia – Kampus
Kesihatan, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Hashairi Fauzi
- School of Medical Sciences, Universiti Sains Malaysia – Kampus
Kesihatan, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Chandran Nadarajan
- School of Medical Sciences, Universiti Sains Malaysia – Kampus
Kesihatan, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Siti Azrin Ab Hamid
- School of Medical Sciences, Universiti Sains Malaysia – Kampus
Kesihatan, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| |
Collapse
|
7
|
Muacevic A, Adler JR, Makonnen N, Kongkatong M, Thom CD. Comparison of the Quality of Echocardiography Imaging Between the Left Lateral Decubitus and Supine Positions. Cureus 2022; 14:e31835. [PMID: 36579253 PMCID: PMC9788794 DOI: 10.7759/cureus.31835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction It is commonly taught that positioning the patient in the left lateral decubitus (LLD) position will improve transthoracic echocardiography (TTE) image quality. Despite this, no previous studies have been performed that study this practice. Our goal was to quantify the difference in image quality of TTE views between the supine and LLD positions. Methods This was a prospective study in a single academic Emergency Department (ED) of a convenience sample of 30 patients. Three separate ED physicians performed TTE views in both the supine and LLD position on each patient. The order of position was randomized. Images were then reviewed on a previously validated TTE image quality scale by two blinded ED physicians with specialized training in ultrasound. The scale used a 0 to 5 (highest quality) metric for quality assessment. Interpretability of right ventricular and left ventricular function was also assessed. Results The mean image quality for the supine position was 2.85 (standard deviation {SD} 1.1) and 3.05 (SD 1.2) for the LLD position (p=0.044). In the subset of parasternal and apical windows, the mean quality for the supine position was 2.87 (SD 1.1) and 3.23 (SD 1.1) for the LLD position (p=0.003). The number of studies in which right ventricular function was interpretable was significantly higher in the LLD position (62% versus 42%, p=0.044). Conclusions There was a statistically significant increase in image quality when TTE was performed in the LLD position as compared to supine. This was especially pronounced in the apical four and parasternal windows.
Collapse
|
8
|
Moukarzel J, Guevara E, Casciaro ME, Guilenea FN, Pascaner AF, Craiem D. Echocardiographic measurements of the left heart chambers size in a large cohort of subjects: comparison of body surface area and height indexation to account for effects of obesity. J Am Soc Echocardiogr 2022; 35:1159-1167.e2. [PMID: 35953008 DOI: 10.1016/j.echo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The assessment of cardiac chamber size in the obese population is a challenging subject. Values usually indexed to body surface area (BSA) are smaller in obese subjects and prone to overcorrection. This study aimed to find reference thresholds to account for effects of obesity from a large cohort of patients and to evaluate the indexation by height as an alternative to BSA. METHODS The last 10-years records of our Echocardiography Unit were retrospectively analyzed and 14,007 subjects without known cardiac disease were included (45±15 years, 54% women, 20% obese). Measurements included left atrial diameter, area and volume (LAD, LAA and LAV), left ventricular (LV) end-diastolic (LVEDD) and end-systolic diameters (LVESD), aortic root diameter (ARD) and LV mass (LVM). Absolute, BSA and height indexed maximum thresholds (mean+1.96.SD) were calculated. An allometric indexation of the form variable/Heightβ was tested. Correlation coefficients between indexed and absolute values were calculated to evaluate their proportional association (ideally r=1). Correlations between indexed values and body size represented residual associations to be minimized (ideally r=0). RESULTS The strongest association of echocardiographic measurements with body size was observed for BSA (r=0.36-0.63), whereas the isometric and allometric height models showed lower comparable values (r=0.28-0.48). Positive correlations with BMI were mostly observed for LA size (r≈0.36) and LVM (r≈0.36) measurements. Scaling exponents β for the allometric height indexation were 1.72 for LAV and 2.33 for LVM. Correlations between indexed and absolute values were higher for height than BSA (0.80-0.98 vs 0.44-0.92). Correlations between indexed values and height were closer to zero than for BSA, particularly using the allometric model. The overcorrection observed with increasing obesity class after BSA indexation was avoided after height indexation. CONCLUSIONS Unlike BSA, height indexing provided an adequate body size scaling of left heart chambers size avoiding overcorrection using allometric models in particular.
Collapse
Affiliation(s)
- Juan Moukarzel
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Eduardo Guevara
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Mariano E Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Federico N Guilenea
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Ariel F Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Damian Craiem
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina; Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro - CONICET, Buenos Aires, Argentina.
| |
Collapse
|
9
|
Transthoracic echocardiography of patients in prone position ventilation during the COVID-19 pandemic: an observational and retrospective study. Int J Cardiovasc Imaging 2022; 38:2303-2309. [PMID: 36434340 PMCID: PMC9244514 DOI: 10.1007/s10554-022-02659-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
Mechanical ventilation in prone position is a strategy that increases oxygenation and reduces mortality in severe ARDS. The hemodynamic and cardiovascular assessment of these patients is essential. Transthoracic echocardiography (TTE) is a widely used tool to assess hemodynamics in critical care, but the prone position is thought to limit adequate TTE views and goal-oriented measurements. The aim of this study is to show the feasibility of the hemodynamic assessment by transthoracic echocardiography during prone position ventilation (PPV). This is a retrospective, observational study, carried out in the intensive care unit (ICU) of a tertiary-care center in Buenos Aires, Argentina. We included all the adult patients admitted to the ICU between March 2020 and August 2021 who had a TTE examination in PPV due to ARDS. During the study period, we evaluated by TTE a total of 35 patients requiring PPV. The vast majority of the patients had COVID-19 pneumonia (91.4%). In 33 out of 35 (94.3%) cases, it was able to achieve an adequate apical four chamber view. We assessed qualitatively the systolic function of left ventricle (LV) and right ventricle (RV) in all of the successfully evaluated patients. We measured the RV basal diameter (94.3%), RV/LV ratio (77.1%), tricuspid annular plane systolic excursion (TAPSE) (91.4%), and septal mitral annular plane systolic excursion (MAPSE) (88.5%) in most of them. Also, we quantified the left ventricle outflow tract velocity time integral (LVOT VTI) in a large part (68.5%) of the examinations. Transthoracic echocardiography is a useful tool for the hemodynamic assessment of patients in prone position under mechanical ventilation.
Collapse
|
10
|
Carlino C, Kuppuswamy S, McCray L, Aggarwal K, Alpert MA. Comparative feasibility of dobutamine stress echocardiography performed with and without intravenous contrast in patients with class III obesity. Echocardiography 2021; 39:20-27. [DOI: 10.1111/echo.15207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/10/2021] [Accepted: 08/30/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Carl Carlino
- Division of Cardiovascular Medicine University of Missouri School of Medicine Columbia Missouri USA
| | - Saravanan Kuppuswamy
- Division of Cardiovascular Medicine University of Missouri School of Medicine Columbia Missouri USA
| | - Lerin McCray
- Division of Cardiovascular Medicine University of Missouri School of Medicine Columbia Missouri USA
| | - Kul Aggarwal
- Division of Cardiovascular Medicine University of Missouri School of Medicine Columbia Missouri USA
| | - Martin A. Alpert
- Division of Cardiovascular Medicine University of Missouri School of Medicine Columbia Missouri USA
| |
Collapse
|
11
|
Hoit BD, Litwin SE. The New Normal: How Should We Assess Cardiac Chamber Sizes and Proportionality across the Full Spectrum of Body Sizes with Varying Degrees of Adiposity? J Am Soc Echocardiogr 2021; 35:151-153. [PMID: 34875314 DOI: 10.1016/j.echo.2021.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sheldon E Litwin
- Division of Cardiology Medical University of South Carolina and Ralph H. Johnson, Veterans Affairs Medical Center, Charleston, South Carolina.
| |
Collapse
|
12
|
The Influence of Obesity on Care of Adults with Cardiovascular Disease. Nurs Clin North Am 2021; 56:511-525. [PMID: 34749891 DOI: 10.1016/j.cnur.2021.07.002] [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: 11/22/2022]
Abstract
Obesity is a strong independent predictor of cardiovascular disease. In this article, we briefly review the physiologic effects of obesity on the cardiovascular system, discuss how obesity influences history taking, physical assessment, diagnostic testing, and treatment of patients with common cardiovascular conditions such as hypertension, coronary heart disease, and chronic heart failure. Implications for nursing practice will be shared with a focus on lifestyle modifications to be included in patient education.
Collapse
|