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Haapala EA, Leppänen MH, Lee E, Savonen K, Laukkanen JA, Kähönen M, Brage S, Lakka TA. Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence. J Am Heart Assoc 2024; 13:e031837. [PMID: 38497441 PMCID: PMC11010014 DOI: 10.1161/jaha.123.031837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence. METHODS AND RESULTS Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (β=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (β=-0.218 [95% CI, -0.436 to 0.000]). CONCLUSIONS Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.
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Affiliation(s)
- Eero A. Haapala
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Marja H. Leppänen
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
- Faculty of MedicineUniversity of HelsinkiFinland
| | - Earric Lee
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Kai Savonen
- Foundation for Research in Health Exercise and NutritionKuopio Research Institute of Exercise MedicineKuopioFinland
| | - Jari A. Laukkanen
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Department of MedicineWellbeing Services County of Central FinlandJyväskyläFinland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Soren Brage
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Timo A. Lakka
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
- Foundation for Research in Health Exercise and NutritionKuopio Research Institute of Exercise MedicineKuopioFinland
- Department of Clinical Physiology and Nuclear ImagingUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
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Zhao X, Xiao C, Sun L, Zhang F. Assessment of left atrial function in patients with metabolic syndrome by four-dimensional automatic left atrial quantification. Diabetes Res Clin Pract 2024; 207:111080. [PMID: 38145827 DOI: 10.1016/j.diabres.2023.111080] [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: 07/04/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study aimed at assessing the changes of left atrial (LA) volume and strain function in metabolic syndrome (MS) patients using four-dimensional automatic left atrial quantification (4D-LAQ) and exploring independent correlative factors for LA function. METHODS A total of 110 MS patients and 70 normal controls were selected and assigned into the MS group and the control group, respectively. Echocardiogram parameters were routinely examined and the thickness of epicardial adipose tissue (EAT) were measured with a parasternal long axis of left ventricle(LV). The LA volume and strain parameters were determined using 4D-LAQ. The independent correlation factors for LA strain parameters in MS patients were investigated through linear regression analysis. RESULTS Compared with the control group, LA volume parameters were increased in the MS group, LA strain parameters and LA emptying fraction (LAEF) were decreased (all P < 0.05). EAT thickness is associated with LA reservoir longitudinal strain (LASr), conduit longitudinal strain (LAScd), reservoir circumferential strain (LASr-c), and conduit circumferential strain (LAScd-c) (all P < 0.05). LA contraction longitudinal (LASct) and circumferential strain (LASct-c) were not statistically significant. Regression analysis results show that systolic blood pressure (SBP) and triglyceride (TG) are independent correlative factors. Intra-observer and inter-observer repeatability test showed that the LA parameters examined by 4D-LAQ had good agreement. CONCLUSIONS 4D-LAQ is capable of effectively assessing the LA function in MS patients and providing a useful reference for clinical diagnosis. SBP and TG serve as the independent correlative factors for LA function.
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Affiliation(s)
- Xuebing Zhao
- Hebei Medical University, Shijiazhuang, Hebei, China; Department of Ultrasound, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Chengwei Xiao
- Hebei Medical University, Shijiazhuang, Hebei, China; Department of Ultrasound, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Lijuan Sun
- Department of Ultrasound, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
| | - Fang Zhang
- Department of Ultrasound, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
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de Waal K, Phad N, Crendal E. Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants. Echocardiography 2023; 40:1099-1106. [PMID: 37658834 DOI: 10.1111/echo.15686] [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: 03/28/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Relaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP). METHODS Preterm infants received an echocardiogram 1 week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis. RESULTS We studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm. CONCLUSION Various grades of diastolic dysfunction could be appreciated in preterm infants using a multi-parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Edward Crendal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
- Department of Cardiology, John Hunter Hospital Department of Cardiology, Newcastle NSW, Australia
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Zhang M, Chen X, Yang F, Song Y, Zhang D, Chen Q, Ma Y, Wang S, Ji D, Duan Z, Zhang L, Wang Q. Evaluation of Left Ventricular Mass in Different Cardiac Geometry Using Three-Dimensional Contrast-Enhanced Echocardiography. Int Heart J 2023; 64:885-893. [PMID: 37778991 DOI: 10.1536/ihj.22-663] [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: 10/03/2023]
Abstract
A total of 69 patients were enrolled in the study, including 23 patients with hypertrophic cardiomyopathy (HCM), 26 patients with Left Ventricle (LV) enlargement comprising 16 dilated cardiomyopathy (DCM) patients and 10 ischemic cardiomyopathy (ICM) patients, and 20 control subjects. All patients underwent 2DE, contrast-enhanced 2DE (Contrast-2DE), 3DE, Contrast-3DE, and single photon emission computed tomography (SPECT) examinations. The 2DE-AL and 3DE methods measured the left ventricular mass (LVM). The results were compared with those measured by SPECT. The measured LVM of the 69 patients was systematically overestimated by 2DE-AL (177.4 ± 56.2 g), Contrast-2DE-AL (174.5 ± 55.5 g), 3DE (167.3 ± 59.2 g), and Contrast-3DE (154.2 ± 46.7 g) when compared with SPECT (148.5 ± 52.4 g) (P < 0.05), while Contrast-3DE provided the best agreement with SPECT in LVM measurement (r = 0.898, P < 0.001) and had the smallest deviation (5.7 ± 23.1 g). 3DE overestimated LVM more compared to Contrast-3DE in LV hypertrophy group (165.5 ± 37.9 g versus 153.5 ± 27.6 g, P = 0.003) and LV enlargement group (204.5 ± 69.3 g versus 183.5 ± 53.5 g, P = 0.006). For 2DE methods, there was no significant difference between the LVM obtained with or without contrast enhancement in control group (132.3 ± 23.6 g versus 128.4 ± 23.3 g), LV hypertrophy group (177.7 ± 38.6 versus 178.3 ± 30.9 g, P = 0.889), and LV enlargement group (211.9 ± 63.2 g versus 206.5 ± 66.0 g, P = 0.386). The difference between LVM measured by 2DE-AL and SPECT was the greatest (27.9 ± 34.0 g), especially in LV hypertrophy group and LV enlargement group (LV hypertrophy group 39.7 ± 26.0 g; LV enlargement group 24.2 ± 42.8 g). To conclude, Contrast-3DE and SPECT show greater consistency in LVM measurement, especially in cardiomyopathy, when compared with 2DE. Administering contrast can effectively reduce the overestimation of LVM by non-contrast DE.
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Affiliation(s)
- Meiqing Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Xu Chen
- Medical School of Chinese PLA
| | - Feifei Yang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Yanjie Song
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dai Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Qiang Chen
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Yongjiang Ma
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Shuhua Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dongdong Ji
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Zhongxiang Duan
- Department of Nuclear Medicine, Fourth Medical Center of Chinese PLA General Hospital
| | - Liwei Zhang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Qiushuang Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
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Zan Y, Wang J, Wang W, Cui T, Xu K, Li Y, Huang X, Zhang Y, Wei N, Xing X. Inflammatory cytokines and their correlations with different left ventricular geometries and functions in PHT patients. Echocardiography 2022; 39:1589-1600. [PMID: 36376258 DOI: 10.1111/echo.15495] [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: 06/21/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate relationships between hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor -α (TNF-α), interleukin-17A (IL-17A), and interferon -γ (IFN-γ), with left ventricular geometry (LVG) and function in patients with primary hypertension (PHT). METHODS A total of 396 PHT patients were assigned into four groups: Normal Geometry (NG), Concentric Remodeling (CR), Eccentric Hypertrophy (EH), and Concentric Hypertrophy (CH). The correlation between hs-CRP, TNF-α, IL-17A, IFN-γ, and clinical, biochemical parameters were analyzed by Pearson correlation analysis and Logistic regression. Receiver Operating Characteristic (ROC) curve was used to analyze the clinical values of hs-CRP, TNF-α, IL-17A, and IFN-γ for abnormal LVG prediction. RESULTS NG, CR, EH, and CH group all presented increasingly higher levels of Hs-CRP, TNF-α, IL-17A, and IFN-γ, and the increase was the most prominent in the CH group. Pearson correlation analysis showed that hs-CRP, IL-17A, and IFN-γ were all positively correlated with LASct. Hs-CRP, TNF-α, and IL-17A were all negatively correlated with GLS, LASr, and LAScd. However, IFN-γ was only negatively correlated with GLS and LAScd. Logistic regression analysis showed that hs-CRP and IL-17A were independently correlated with CR; hs-CRP, TNF-α, IFN-γ, and IL-17A were independently correlated with EH and CH. ROC curve analysis showed that the area under the curve (AUC) of hs-CRP was 0.816. When the optimal diagnostic threshold of hs-CRP was 3.04 mg/L, the sensitivity and specificity of the abnormal LVG were 72.1% and 81.5%, respectively. CONCLUSION In PHT patients, hs-CRP, TNF-α, IL-17A, and IFN-γ were correlated with abnormal LVG and left ventricular function, suggesting that inflammatory cytokines may be involved in the process of PHT-induced abnormal left ventricular structure and function. In addition, hs-CRP can be used as a health screening index for patients at high risk of abnormal LVG.
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Affiliation(s)
- Yu Zan
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Wang
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenjuan Wang
- Department of Integrated, Shanxi International Travel Health Care Center, Taiyuan, China
| | - Tong Cui
- Department of Ultrasound, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Kun Xu
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yiying Li
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaochun Huang
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanjing Zhang
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Na Wei
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueqing Xing
- Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan, China
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Optimization of the method of measuring left ventricular end-diastolic diameter in cardiac magnetic resonance as a predictor of left ventricular enlargement. Sci Rep 2022; 12:8425. [PMID: 35589833 PMCID: PMC9120015 DOI: 10.1038/s41598-022-12359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of the study was to optimize the method of measuring left ventricular end-diastolic diameter (LVEDD) in cardiac magnetic resonance (CMR) as a predictor of left ventricular end-diastolic volume (LVEDV). The study group consisted of 78 patients (age 55.28 ± 17.18) who underwent 1.5 T CMR examination. LVEDD measurements in the short axis, in the long axis in the 2-chamber, 3-chamber and 4-chamber views were made by 2 radiologists. The repeatability of LVEDD measurements was assessed. The sensitivity and specificity of various methods of measuring LVEDD as a predictor of left ventricular enlargement (diagnosed based on LVEDV) were assessed. The correlation coefficients between LVEDD measurements made by researcher A and B were 0.98 for the long axis measurements in the 2-chamber and 3-chamber view, and 0.99 for measurements made in the short axis and in the long axis in the 4-chamber view. The lowest LVEDD measurements variability was recorded for the short axis measurements (RD 0.02, CV 1.38%), and the highest for the long axis measurements in the 3-chamber view (RD 0.04, CV 2.53%). In the male subgroup, the highest accuracy in predicting left ventricular enlargement was characterized by the criterion “LVEDD measured in the long axis in the 2-chamber view > 68.0 mm” (accuracy 94.1%). In the female subgroup, the highest accuracy in predicting left ventricular enlargement was achieved by the criterion “LVEDD measured in the short axis > 63.5 mm” (96.3%). In summary, the measurement made in the short axis should be considered the optimal method to LVEDD measure in CMR, considering the repeatability of measurements and the accuracy of left ventricular enlargement prediction.
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Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test. High Blood Press Cardiovasc Prev 2022; 29:145-154. [PMID: 35107808 PMCID: PMC8942964 DOI: 10.1007/s40292-021-00494-2] [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: 09/23/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear. The combined cardiopulmonary-echocardiography stress test (CPET-ESE) represents a precious non-invasive aid to detect alterations in patients at the earliest stages of HF. The opportunity to study the response of the cardiovascular system to exercise, and to differentiate central from peripheral cardiovascular maladaptations, makes the CPET-ESE an ideal technique to gain insights into the mechanisms involved in the transition from AH to HF, by recognizing alterations that might be silent at rest but influence the response to exercise. Identifications of these subclinical alterations might allow for a better risk stratification in hypertensive patients, facilitating the recognition of those at higher risk of evolution towards established HF. This may also lead to the development of novel preventive strategies and help tailor medical treatment. The purpose of this review is to summarise the potential advantages of using CPET-ESE in the characterisation of hypertensive patients in the cardiovascular continuum.
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Chen Y, Cheng X, Li S, Yin Y, Xing S, Guo Y. Insulin-like growth factor-1 levels are associated with interventricular septal thickening. Front Endocrinol (Lausanne) 2022; 13:997023. [PMID: 36568107 PMCID: PMC9768022 DOI: 10.3389/fendo.2022.997023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Insulin-like growth factor-1 (IGF-1) regulates cardiomyocyte survival, hypertrophy, and ageing. We aimed to investigate the potential correlation between IGF-1 and interventricular septal (IVS) thickening. METHODS Medical record data were obtained from patients hospitalized between May 1, 2012 and April 30, 2022. All patients underwent echocardiography and had laboratory data on plasma IGF-1. We analyzed the relationship between IGF-1 levels and IVS thickening based on logistic regression models. RESULTS Propensity score matching at 1:4 ratio was performed for 180 patients with IVS thickening and 1,964 patients without IVS thickening. Finally, 180 (case group) and 623 (control group) patients were enrolled. Of the total 803 patients, the mean age was 59 years, and 59.7% were male. In multivariate-adjusted models that adjusted for propensity scores, the risk of IVS thickening increased with increasing IGF-1 levels; specifically, the risk of IVS thickening increased per 1 ng/mL [odds ratio (OR) 1.003; 95% confidence interval (CI): 1.002-1.004; P < 0.001], per 5 ng/mL (OR, 1.016; 95% CI, 1.010-1.022; P < 0.001), and per 10 ng/mL(OR, 1.032; 95% CI, 1.019-1.045; P < 0.001) increase in IGF-1 levels. When the IGF-1 levels were expressed as a categorical variable, the increased levels of IGF-1 led to an increased risk of IVS thickening; specifically, the OR of IVS thickening for T3 >152.00 ng/mL was 2.020 (95% CI: 1.310-3.115, P < 0.01) compared with T1 <102.00 ng/mL. We performed restricted cubic splines, and it showed a linear association between IGF-1 levels and the risk of IVS thickening. In splines for the age and sex subgroups, different IGF-1 levels increased the risk of IVS thickening among different age groups in male patients: 18-44 years when IGF-1 value >164.00 ng/mL, 45-60 years when IGF-1 value > 140.34 ng/mL and ≥ 60 years when IGF-1 value >108.20 ng/mL. In female patients aged 45-60 years, the risk of IVS thickening increased when the IGF-1 levels were >207.45 ng/mL. However, IGF-1 was not significantly correlated with IVS thickening in female patients aged 18-45 and ≥60 years. Sensitivity analysis by excluding those with acromegaly did not change the relationship between IGF-1 and the risk of IVS thickening. CONCLUSION The plasma IGF-1 levels were related to the risk of IVS thickening irrespective of blood pressure.
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Affiliation(s)
- Yuan Chen
- Graduate School of Xinjiang Medical University, Urumqi, China
| | - Xinchun Cheng
- Geriatrics Center, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Suli Li
- Department of Endocrinology and Metabolic Diseases, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Diabetes, Urumqi, China
| | - Yuting Yin
- Department of Endocrinology and Metabolic Diseases, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Diabetes, Urumqi, China
| | - Shuqing Xing
- Department of Endocrinology and Metabolic Diseases, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Diabetes, Urumqi, China
| | - Yanying Guo
- Department of Endocrinology and Metabolic Diseases, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Research Center for Diabetes, Urumqi, China
- *Correspondence: Yanying Guo,
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Impact of diabetes on cardiopulmonary function: the added value of a combined cardiopulmonary and echocardiography stress test. Heart Fail Rev 2021; 28:645-655. [PMID: 34820732 DOI: 10.1007/s10741-021-10194-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) represents a major health issue worldwide, as patients with T2DM show an excess risk of death for cardiovascular causes, twice as high as the general population. Among the many complications of T2DM, heart failure (HF) deserves special consideration as one of the leading causes of morbidity and reduced life expectancy. T2DM has been associated with different phenotypes of HF, including HF with reduced and preserved ejection fraction. Cardiopulmonary exercise testing (CPET) can evaluate the metabolic and ventilatory alterations related to myocardial dysfunction and/or peripheral impairment, representing a unique tool for the clinician to study the whole HF spectrum. While CPET allows for a thorough evaluation of functional capacity, it cannot directly differentiate central and peripheral determinants of effort intolerance. Combining CPET with imaging techniques could provide even higher accuracy and further insights into the progression of the disease since signs of left ventricular systolic and diastolic dysfunction can be detected during exercise, even in asymptomatic diabetic individuals. This review aims to dissect the alterations in cardiopulmonary function characterising patients with T2DM and HF to improve patient risk stratification.
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Pohl A, Schünemann F, Bersiner K, Gehlert S. The Impact of Vegan and Vegetarian Diets on Physical Performance and Molecular Signaling in Skeletal Muscle. Nutrients 2021; 13:3884. [PMID: 34836139 PMCID: PMC8623732 DOI: 10.3390/nu13113884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Muscular adaptations can be triggered by exercise and diet. As vegan and vegetarian diets differ in nutrient composition compared to an omnivorous diet, a change in dietary regimen might alter physiological responses to physical exercise and influence physical performance. Mitochondria abundance, muscle capillary density, hemoglobin concentration, endothelial function, functional heart morphology and availability of carbohydrates affect endurance performance and can be influenced by diet. Based on these factors, a vegan and vegetarian diet possesses potentially advantageous properties for endurance performance. Properties of the contractile elements, muscle protein synthesis, the neuromuscular system and phosphagen availability affect strength performance and can also be influenced by diet. However, a vegan and vegetarian diet possesses potentially disadvantageous properties for strength performance. Current research has failed to demonstrate consistent differences of performance between diets but a trend towards improved performance after vegetarian and vegan diets for both endurance and strength exercise has been shown. Importantly, diet alters molecular signaling via leucine, creatine, DHA and EPA that directly modulates skeletal muscle adaptation. By changing the gut microbiome, diet can modulate signaling through the production of SFCA.
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Affiliation(s)
- Alexander Pohl
- Department of Biosciences of Sport Science, Institute of Sport Science, University of Hildesheim, 31141 Hildesheim, Germany; (F.S.); (K.B.); (S.G.)
| | - Frederik Schünemann
- Department of Biosciences of Sport Science, Institute of Sport Science, University of Hildesheim, 31141 Hildesheim, Germany; (F.S.); (K.B.); (S.G.)
| | - Käthe Bersiner
- Department of Biosciences of Sport Science, Institute of Sport Science, University of Hildesheim, 31141 Hildesheim, Germany; (F.S.); (K.B.); (S.G.)
| | - Sebastian Gehlert
- Department of Biosciences of Sport Science, Institute of Sport Science, University of Hildesheim, 31141 Hildesheim, Germany; (F.S.); (K.B.); (S.G.)
- Department for Molecular and Cellular Sports Medicine, German Sports University Cologne, 50933 Cologne, Germany
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Dos Santos PB, Simões RP, Goulart CDL, Roscani MG, Marinho RS, Camargo PF, Arbex RF, Casale G, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance. Int J Chron Obstruct Pulmon Dis 2021; 16:203-214. [PMID: 33568904 PMCID: PMC7868200 DOI: 10.2147/copd.s285812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. Methods The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Results Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. Conclusion Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil.,Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil
| | - Cássia da L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Patrícia Faria Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Guilherme Casale
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Cláudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
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12
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Joseph G, Marott JL, Biering-Sørensen T, Johansen MN, Saevereid HA, Nielsen G, Schnohr P, Prescott E, Søgaard P, Mogelvang R. Level of Physical Activity, Left Ventricular Mass, Hypertension, and Prognosis. Hypertension 2020; 75:693-701. [DOI: 10.1161/hypertensionaha.119.14287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular hypertrophy is a strong predictor of prognosis in hypertension. Physical activity is associated with higher left ventricular mass but also reduced risk of cardiovascular outcomes. The aims were to explore whether (1) presence of hypertension modifies the association between physical activity and left ventricular mass; (2) the beneficial association between physical activity and prognostic outcome is modified by left ventricular hypertrophy. Randomly selected number of 3078 persons from the general population underwent echocardiogram. Left ventricular mass was indexed to body surface area. Level of physical activity was self-reported: inactivity, light activity, and moderate/high activity. Blood pressure was measured in rest: normal BP (<140/90 mm Hg) and hypertension (≥140/90 mm Hg or in pharmacological treatment for hypertension). Presence of hypertension modified the association between physical activity and left ventricular mass index significantly (test for interaction:
P
=0.01): in normal BP, higher levels of physical activity were associated with significantly higher left ventricular mass index (
P
<0.001), but this was not present in hypertension (
P
=0.90). Level of physical activity was associated with reduction in mortality and cardiovascular outcome independent of the presence of LVH (Persons with LVH: light activity HR, 0.77 [0.52–1.15], moderate/high activity HR, 0.61 [0.38–0.97]; test for interaction between LVH and level of physical activity
P
=0.71). In conclusion, persons with normal BP had higher left ventricular mass index at increased levels of physical activity, whereas this association was not present among persons with hypertension. Level of physical activity was associated with better prognosis independent of whether left ventricular hypertrophy was present or not.
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Affiliation(s)
- Gowsini Joseph
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Clinical Medicine, Aalborg University, Denmark (G.J., P. Søgaard)
- Department of Cardiology and Centre for Clinical Research, North Denmark Regional Hospital, Hjorring, Denmark (G.J., G.N.)
- Department of Cardiology, Rigshospitalet (G.J., R.M.), University of Copenhagen, Denmark
| | - Jacob Louis Marott
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
| | - Tor Biering-Sørensen
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences (T.B.-S.), University of Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (T.B.-S.)
| | | | - Hans A. Saevereid
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital (H.A.S., E.P.), University of Copenhagen, Denmark
| | - Gitte Nielsen
- Department of Cardiology and Centre for Clinical Research, North Denmark Regional Hospital, Hjorring, Denmark (G.J., G.N.)
| | - Peter Schnohr
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Aalborg University Hospital, Denmark (M.N.J, P.S.)
| | - Eva Prescott
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital (H.A.S., E.P.), University of Copenhagen, Denmark
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Denmark (G.J., P. Søgaard)
| | - Rasmus Mogelvang
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Rigshospitalet (G.J., R.M.), University of Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Svendborg, Denmark (R.M.)
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13
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Chen Y, Beng H, Su H, Han F, Fan Z, Lv N, Jovanović A, Tan W. Isosteviol prevents the development of isoprenaline‑induced myocardial hypertrophy. Int J Mol Med 2019; 44:1932-1942. [PMID: 31545484 PMCID: PMC6777692 DOI: 10.3892/ijmm.2019.4342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/30/2019] [Indexed: 11/06/2022] Open
Abstract
Isosteviol sodium (STVNa), which is a derivate of the natural sweet-tasting glycoside stevioside, has recently been developed and it has been determined that this compound exhibits neuro- and cardio-protective properties. In the current study, whether STVNa interferes with the development of cardiac hypertrophy, which is induced by isoprenaline (Iso), was investigated in an experimental rat model. Rats were treated with a vehicle (0.9% NaCl; control), isoprenaline (Iso; 5 mg/kg) or Iso (5 mg/kg) with STVNa (4 mg/kg; Iso + STVNa). Cardiomyocytes were isolated using enzymatic dissociation and were treated with 5 µM Iso for 24 h and co-treated with 5 µM STVNa. Brain natriuretic peptide (BNP) mRNA expression was determined using PCR analysis. Cell surface area, intracellular reactive oxygen species (ROS), mitochondrial transmembrane potential (ΔΨm), cytoplasmic Ca2+ and Ca2+ and contractile function were examined using a laser scanning confocal microscope. The current study demonstrated that STVNa inhibited Iso-induced cardiac hypertrophy by inhibiting cardiomyocyte size. STVNa significantly reduced cell surface area and decreased BNP mRNA expression in ventricular cardiomyocyte Iso-induced hypertrophy. STVNa was also revealed to restore ΔΨm and reduce ROS generation and intracellular Ca2+ concentration when compared with the Iso-treated group. Additionally, STVNa preserved Ca2+ transients in hypertrophic cardiomyocytes. In conclusion, the present study demonstrated that STVNa protects against Iso-induced myocardial hypertrophy by reducing oxidative stress, restoring ΔΨm and maintaining Ca2+ homeostasis.
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Affiliation(s)
- Yaoxu Chen
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Huimin Beng
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Hao Su
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Fuping Han
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Zhuo Fan
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Nanying Lv
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
| | - Aleksandar Jovanović
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Cyprus
| | - Wen Tan
- Department of Innovative Drugs and Medicine, School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, Guangdong 510641, P.R. China
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14
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Fabiani I, Pugliese NR, Santini C, Miccoli M, D'Agostino A, Rovai I, Mazzola M, Pedrinelli R, Dini FL. The assessment of pressure-volume relationship during exercise stress echocardiography predicts left ventricular remodeling and eccentric hypertrophy in patients with chronic heart failure. Cardiovasc Ultrasound 2019; 17:6. [PMID: 30954080 PMCID: PMC6451304 DOI: 10.1186/s12947-019-0157-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The contractile response of patients with heart failure (HF) may be assessed by exercise stress echocardiography (ESE)-derived indexes. We sought to test whether ESE parameters are useful to identify the risk of adverse left ventricular (LV) remodeling in patients with chronic HF and reduced or mildly reduced LV ejection fraction (EF). METHODS We enrolled 155 stabilized patients (age: 62 ± 11 years, 17% female, coronary artery disease 47%) with chronic HF, LV EF ≤50% and LV end-diastolic volume index > 75 ml/m2. All patients underwent a symptom-limited graded bicycle semi-supine ESE, with evaluation of peak stress LV EF, end-systolic pressure-volume relation (ESPVR, i.e. LV elastance) and cardiac power output to LV mass (CPOM). A complete echocardiographic study was performed at baseline and after 6 ± 3 months. Adverse LV remodeling was defined as the association of eccentric LV hypertrophy (LV mass: ≥115 g/m2 for male and ≥ 95 g/m2 for women, and relative wall thickness < 0.32) with an increase in LV end-systolic volume index ≥10% at six months. RESULTS Adverse LV remodeling was detected in 34 (22%) patients. After adjustment for clinical, biochemical and echocardiographic data, peak ESPVR resulted in the most powerful independent predictor of adverse LV remodeling (OR: 12.5 [95% CI 4.5-33]; p < 0.0001) followed by ischemic aetiology (OR: 2.64 [95% 1.04-6.73]; p = 0.04). CONCLUSION In patients with HF and reduced or mildly reduced EF, a compromised ESE-derived peak ESPVR, that reflects impaired LV contractility, resulted to be the most powerful predictor of adverse LV remodeling.
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Affiliation(s)
- Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
- Department of Surgical, Medical, Molecular and Critical Care Pathology, Fresno, USA
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Claudia Santini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ilaria Rovai
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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