1
|
KAYA M, ENGİNYURT Ö, KARATAŞ A, GÜL T. Evaluation of Anemia Prevalence and Concomitant Diseases in Elderly Patients Applying to Family Medicine Polyclinic. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.853666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
2
|
Kwan AC, Salto G, Demosthenes E, Lehman BT, Osypiuk E, Stantchev P, Vasan RS, Cheng S. High-throughput digitization of analog human echocardiography data. MethodsX 2020; 7:101159. [PMID: 33665148 PMCID: PMC7897705 DOI: 10.1016/j.mex.2020.101159] [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: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022] Open
Abstract
Echocardiographic imaging has been acquired in historical longitudinal cohorts of cardiovascular disease. Many cohorts were established prior to digital recording of echocardiography, and thus have preserved their archival imaging on Video Home System (VHS) tapes. These tapes require large physical storage space, are affected by physical degradation, and cannot be analyzed using modern digital techniques. We have designed and implemented a standardized methodology for digitizing analog data in historical longitudinal cohorts. The methodology creates a pipeline through critical steps of initial review, digitization, anonymization, quality control, and storage. The methodology has been implemented in the Framingham Offspring Study, a community-based epidemiological cohort study with echocardiography performed during serial examinations between 1987 and 1998. We present this method as an accessible pipeline for preserving and repurposing historical imaging data acquired from large cohort studies. The described technique:Outlines a generalizable pipeline for digitization of analog recordings of echocardiography stored on VHS tapes Addresses research concerns including quality control, anonymization, and storage Expresses the authors’ individual experience regarding observed image quality, training needs, and potential limitations to help readers understand the costs and benefits of this method
Collapse
Affiliation(s)
- Alan C Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Gerran Salto
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Emmanuella Demosthenes
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Birgitta T Lehman
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Ewa Osypiuk
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Plamen Stantchev
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| |
Collapse
|
3
|
Ward PGD, Orchard ER, Oldham S, Arnatkevičiūtė A, Sforazzini F, Fornito A, Storey E, Egan GF, Jamadar SD. Individual differences in haemoglobin concentration influence bold fMRI functional connectivity and its correlation with cognition. Neuroimage 2020; 221:117196. [PMID: 32721510 PMCID: PMC7994014 DOI: 10.1016/j.neuroimage.2020.117196] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Resting-state connectivity measures the temporal coherence of the spontaneous neural activity of spatially distinct regions, and is commonly measured using BOLD-fMRI. The BOLD response follows neuronal activity, when changes in the relative concentration of oxygenated and deoxygenated haemoglobin cause fluctuations in the MRI T2* signal. Since the BOLD signal detects changes in relative concentrations of oxy/deoxy-haemoglobin, individual differences in haemoglobin levels may influence the BOLD signal-to-noise ratio in a manner independent of the degree of neural activity. In this study, we examined whether group differences in haemoglobin may confound measures of functional connectivity. We investigated whether relationships between measures of functional connectivity and cognitive performance could be influenced by individual variability in haemoglobin. Finally, we mapped the neuroanatomical distribution of the influence of haemoglobin on functional connectivity to determine where group differences in functional connectivity are manifest. In a cohort of 518 healthy elderly subjects (259 men), each sex group was median-split into two groups with high and low haemoglobin concentration. Significant differences were obtained in functional connectivity between the high and low haemoglobin groups for both men and women (Cohen's d 0.17 and 0.03 for men and women respectively). The haemoglobin connectome in males showed a widespread systematic increase in functional connectivity correlation values, whilst the female connectome showed predominantly parietal and subcortical increases and temporo-parietal decreases. Despite the haemoglobin groups having no differences in cognitive measures, significant differences in the linear relationships between cognitive performance and functional connectivity were obtained for all 5 cognitive tests in males, and 4 out of 5 tests in females. Our findings confirm that individual variability in haemoglobin levels that give rise to group differences are an important confounding variable in BOLD-fMRI-based studies of functional connectivity. Controlling for haemoglobin variability as a potentially confounding variable is crucial to ensure the reproducibility of human brain connectome studies, especially in studies that compare groups of individuals, compare sexes, or examine connectivity-cognition relationships.
Collapse
Affiliation(s)
- Phillip G D Ward
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Melbourne, Victoria 3800, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Victoria, Australia.
| | - Edwina R Orchard
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Melbourne, Victoria 3800, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Victoria, Australia
| | - Stuart Oldham
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Aurina Arnatkevičiūtė
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Francesco Sforazzini
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Melbourne, Victoria 3800, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Melbourne, Victoria 3800, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Victoria, Australia
| | - Sharna D Jamadar
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Melbourne, Victoria 3800, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Victoria, Australia.
| |
Collapse
|
4
|
Park S, Jung J, Kang J, Hong H, Oh CM. Association of Left Ventricular Hypertrophy with Hemoglobin Levels in Nonanemic and Anemic Populations. Cardiology 2020; 145:485-491. [DOI: 10.1159/000508034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/15/2020] [Indexed: 01/19/2023]
Abstract
<b><i>Introduction:</i></b> It is established that anemia leads to adaptive changes in cardiac geometry including left ventricular hypertrophy (LVH). However, published data are still scarce regarding the association of LVH with normal-range hemoglobin levels. <b><i>Objective:</i></b> To evaluate the association between hemoglobin level and LVH in subjects with or without anemia. <b><i>Methods:</i></b> The study included 48,034 Korean men and women who received echocardiography during their medical health checkup. They were divided into 4 groups according to their hemoglobin concentration (g/dL) in men (<14, 14–14.9, 15–15.9, and ≥16) and women (<12, 12–12.9, 13–13.9, and ≥15). Multivariate logistic regression analysis was used to calculate adjusted ORs and 95% CI for LVH in each group compared with the group with the lowest hemoglobin. Subgroup analysis was conducted for subjects within normal hemoglobin levels. <b><i>Results:</i></b> There was an inverse relationship between hemoglobin levels and LVH, where unadjusted and adjusted ORs and 95% CI for LVH decreased with increasing hemoglobin levels in both men and women. In subgroup analysis, this inverse relationship was also observed in subjects with hemoglobin in the nonanemic range. <b><i>Conclusion:</i></b> The decrease in hemoglobin was significantly associated with the increased probability of LVH, and this association was found even in nonanemic subjects.
Collapse
|
5
|
Evaluation of left atrial volume and function by real time three-dimensional echocardiography in anemic patients without overt heart disease before and after anemia correction. Int J Cardiovasc Imaging 2019; 35:1619-1626. [DOI: 10.1007/s10554-019-01609-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
|
6
|
Peng DQ, Lee JS, Kim WS, Kim YS, Bae MH, Jo YH, Oh YK, Baek YC, Hwang SG, Lee HG. Effect of vitamin A restriction on carcass traits and blood metabolites in Korean native steers. ANIMAL PRODUCTION SCIENCE 2019. [DOI: 10.1071/an17733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of the present study was to determine the effect of vitamin A restriction on serum metabolites and carcass performance in Korean native steers during a fattening period. In Study 1, 61 steers were divided into three groups and supplied diets with concentrate and roughage containing 890 IU/kg of provitamin A and then supplemented with either 8000 IU (control), 3000 IU (T1) or 0 IU (T2) of premix vitamin A per kilogram of dry matter. In Study 2, 19 steers were divided into two groups and provided with the same basic diets then supplemented with 8000 IU (control) or 0 IU (T) of premix vitamin A per kilogram of dry matter. In Study 1, we found that serum vitamin A concentrations were significantly (P < 0.05) lower in the T2 group, along with significant (P < 0.05) increases in blood urea nitrogen, albumin, creatinine and non-esterified fatty acid concentrations. In Study 2, the T group had a higher (P < 0.05) skeletal muscle mRNA expression levels of myogenic factor 6 and a trend for the greater yield grade (P=0.095). However, marbling scores in the study showed no significant. Therefore, vitamin A restriction with vitamin premix during the fattening period was associated with a trend for a higher yield grade, but marbling scores that were not significantly higher. Metabolic parameters in this stage could be used as indicators in future metabolic studies and as early health status markers in Korean native steers.
Collapse
|
7
|
|
8
|
Shen J, Zhou Q, Liu Y, Luo R, Tan B, Li G. Evaluation of left atrial function in patients with iron-deficiency anemia by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2016; 14:34. [PMID: 27550185 PMCID: PMC4994319 DOI: 10.1186/s12947-016-0078-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023] Open
Abstract
Background Iron-deficiency anemia (IDA) is a global health problem and a common medical condition that can be seen in everyday clinical practice. And two-dimensional speckle tracking echocardiography (2D-STE) has been reported very useful in evaluating left atrial (LA) function, as well as left ventricular (LV) function. The aim of our study is to evaluate the LA function in patients with IDA by 2D-STE. Methods 65 patients with IDA were selected. This group of patients was then divided into two groups according to the degree of hemoglobin: group B (Hb > 90 g/L) and group C (Hb60 ~ 90 g/L). Another 30 healthy people were also selected as control group A. Conventional echocardiography parameters, such as left atrial diameter (LAD), peak E and A of mitralis (E, A), E/A, end-diastolic thickness of ventricular septum (IVST d), end-diastolic thickness of LV posterior wall (PWTd) and left ventricular end-diastolic dimension (LVDd) were obtained from these three groups. Left atrial minimum volume (LAVmin), left atrial pre-atrial contraction volume (LAVp) and left atrial maximum volume (LAVmax) were measured by Simpson’s rule, whereas left atrial active ejection fraction (LAAEF) and left atrial passive ejection fraction (LAPEF) were obtained from calculation. Two-dimensional images were acquired from apical four-chamber view and two-chamber view to store images for offline analysis. The global peak atrial longitudinal strain and strain rate of systolic LV (GLSs, GLSRs) as well as early and late diastolic LV strain rate (GLSRe, GLSRa) curves of LA were acquired in each LA segment from basal segment to top segment of LA by 2D-STE. Results Compared with group A, there were no differences between group B and group A (all P > 0.05). The LAAEF and GLSRa were significantly higher in group C compared with those of group A and group B (all P < 0.01). The LAPEF, GLSs, GLSRs and GLSRe were significantly lower in group C compared with those of group A and group B (all P < 0.01). Conclusions 2D-STE could evaluate the LA function in patients with IDA.
Collapse
Affiliation(s)
- Jiaqi Shen
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Qiao Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Yue Liu
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Runlan Luo
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Bijun Tan
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Guangsen Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China.
| |
Collapse
|
9
|
Ng AC, Kong WKF, Kamperidis V, Bertini M, Antoni ML, Leung DY, Marsan NA, Delgado V, Bax JJ. Anaemia in patients with aortic stenosis: influence on long-term prognosis. Eur J Heart Fail 2015; 17:1042-9. [DOI: 10.1002/ejhf.297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/25/2015] [Accepted: 05/04/2015] [Indexed: 12/21/2022] Open
Affiliation(s)
- Arnold C.T. Ng
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
- Department of Cardiology; Princess Alexandra Hospital, The University of Queensland; 199 Ipswich Road, Woolloongabba Brisbane Australia 4102
| | - William K. F. Kong
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Matteo Bertini
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - M. Louisa Antoni
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Dominic Y. Leung
- Department of Cardiology; Liverpool Hospital, The University of New South Wales; Australia
| | - Nina Ajmone Marsan
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Victoria Delgado
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Jeroen J. Bax
- Department of Cardiology; Leiden University Medical Centre; Leiden the Netherlands
| |
Collapse
|
10
|
Cho IJ, Mun YC, Kwon KH, Shin GJ. Effect of anemia correction on left ventricular structure and filling pressure in anemic patients without overt heart disease. Korean J Intern Med 2014; 29:445-53. [PMID: 25045292 PMCID: PMC4101591 DOI: 10.3904/kjim.2014.29.4.445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/04/2013] [Accepted: 10/28/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS There are few data on the effects of low hemoglobin levels on the left ventricle (LV) in patients without heart disease. The objective of this study was to document changes in the echocardiographic variables of LV structure and function after the correction of anemia without significant cardiovascular disease. METHODS In total, 34 iron-deficiency anemia patients (35 ± 11 years old, 32 females) without traditional cardiovascular risk factors or cardiovascular disease and 34 age- and gender-matched controls were studied. Assessments included history, physical examination, and echocardiography. Of the 34 patients with anemia enrolled, 20 were followed and underwent echocardiography after correction of the anemia. RESULTS There were significant differences between the anemia and control groups in LV diameter, left ventricular mass index (LVMI), left atrial volume index (LAVI), peak mitral early diastolic (E) velocity, peak mitral late diastolic (A) velocity, E/A ratio, the ratio of mitral to mitral annular early diastolic velocity (E/E'), stroke volume, and cardiac index. Twenty patients underwent follow-up echocardiography after treatment of anemia. The follow-up results showed significant decreases in the LV end-diastolic and end-systolic diameters and LVMI, compared with baseline levels. LAVI, E velocity, and E/E' also decreased, suggesting a decrease in LV filling pressure. CONCLUSIONS Low hemoglobin level was associated with larger cardiac chambers, increased LV, mass and higher LV filling pressure even in the subjects without cardiovascular risk factors or overt cardiovascular disease. Appropriate correction of anemia decreased LV mass, LA volume, and E/E'.
Collapse
Affiliation(s)
- In-Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeung Chul Mun
- Division of Hematology and Oncology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki Hwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Gil Ja Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Abstract
For adults with sickle cell disease (SCD), cardiac changes are well described and may account for up to one-fourth of disease-related mortality. Much less is known about heart disease in pediatric SCD patients. This retrospective study analyzed a contemporary cohort of children with SCD followed at a single tertiary care center. The study aimed to evaluate the effect of SCD on left main coronary artery (LMCA) dimensions in the contemporary pediatric population. The echocardiography database was searched for studies of children with SCD from 2000 to 2009. The LMCA diameter was remeasured offline from digital images. Digital echocardiographic studies of 68 children (35 boys) 11.7 ± 4.6 years of age with SCD were analyzed. All the patients had normal systolic function as measured by fractional shortening. The left ventricular end-diastolic dimension (LVEDD) for 34 % of the pediatric SCD patients showed a dilated LV. In 24 % of the children, a LV mass index (LVMI) greater than 50 g/m(2.7) denoted LV hypertrophy. Application of sex-specific normal values showed that 60 % of the boys and 33 % of the girls had an increased LVMI. The LMCA diameter was enlarged in 43 % of the SCD children, including 26 % with an LMCA z-score higher than 3. This study found a higher incidence of LMCA dilation in a pediatric referral population with SCD. The findings also validated an increased LVMI in the contemporary SCD patient population, which was noted previously. This study adds the need to include assessment of coronary arteries in cardiac evaluation of SCD patients, and special attention should be paid to patients with a high-normal to high coronary z-score.
Collapse
|
12
|
Wang H, Jessup JA, Lin MS, Chagas C, Lindsey SH, Groban L. Activation of GPR30 attenuates diastolic dysfunction and left ventricle remodelling in oophorectomized mRen2.Lewis rats. Cardiovasc Res 2012; 94:96-104. [PMID: 22328091 DOI: 10.1093/cvr/cvs090] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS GPR30 is a novel oestrogen receptor expressed in various tissues, including the heart. We determined the role of GPR30 in the maintenance of left ventricular (LV) structure and diastolic function after the surgical loss of ovarian hormones in the female mRen2.Lewis rat, a model emulating the cardiac phenotype of the post-menopausal woman. METHODS AND RESULTS Bilateral oophorectomy (OVX) or sham surgery was performed in study rats; the selective GPR30 agonist, G-1 (50 µg/kg/day), or vehicle was given subcutaneously to OVX rats from 13-15 weeks of age. Similar to the cardiac phenotype of sham rats, G-1 preserved diastolic function and structure relative to vehicle-treated OVX littermates independent of changes in blood pressure. G-1 limited the OVX-induced increase in LV filling pressure, LV mass, wall thickness, interstitial collagen deposition, atrial natriuretic factor and brain natriuretic peptide mRNA levels, and cardiac NAD(P)H oxidase 4 (NOX4) expression. In vitro studies showed that G-1 inhibited angiotensin II-induced hypertrophy in H9c2 cardiomyocytes, evidenced by reductions in cell size, protein content per cell, and atrial natriuretic factor mRNA levels. The GPR30 antagonist, G15, inhibited the protective effects of both oestradiol and G-1 on this hypertrophy. CONCLUSION These data show that the GPR30 agonist G-1 mitigates the adverse effects of oestrogen loss on LV remodelling and the development of diastolic dysfunction in the study rats. This expands our knowledge of the sex-specific mechanisms underlying diastolic dysfunction and provides a potential therapeutic target for reducing the progression of this cardiovascular disease process in post-menopausal women.
Collapse
Affiliation(s)
- Hao Wang
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA
| | | | | | | | | | | |
Collapse
|
13
|
Contribution of anemia and hypertension to left ventricular hypertrophy during the initial 2 years after renal transplantation. Transplant Proc 2012; 43:2199-204. [PMID: 21839233 DOI: 10.1016/j.transproceed.2011.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease is the main cause of mortality after renal transplantation. Left ventricular hypertrophy (LVH) is considered to be an independent predictor of cardiovascular events. The main risk factors for LVH after renal transplantation are anemia and hypertension. In hypertensive and renal transplant patients, ambulatory blood pressure monitoring (ABPM) has been demonstrated to be more closely related to LVH than office blood pressure. The aim of this study has to evaluate LVH after renal transplantation, particularly its association with measures derived from ABPM and cardiovascular risk factors. PATIENTS AND METHODS Between March 2005 and October 2006, we recruited 101 consecutive kidney transplant patients to calculate left ventricular mass index (LVMI) by echocardiography at 3, 12, and 24 months. Hypertension was evaluated by office blood pressure measurements at 3, 12, and 24 months and also by ABPM at 3 months. Clinical and laboratory data were recorded during the study. RESULTS From 3 to 24 months LVMI was reduced from 129 ± 29 g/m(2) to 121 ± 34 g/m(2) (P = .0089). Multivariate stepwise regression analysis showed independent predictors of LVMI at 3 months to be hemoglobin at 1 month, day systolic blood pressure (SBP) derived from ABPM and donor age (R = .50, P < .001). The independent predictors of LVMI at 12 months were day SBP derived from ABPM, hemoglobin at 1 month, and proteinuria at 12 months (R = .55, P < .001). Office SBP at 12 months, proteinuria at 24 months, patient age and night diastolic blood pressure derived from ABPM at 3 months were independent predictors of LVMI at 24 months (R = .71, P < .001). CONCLUSION We observed a significant reduction in LVMI after renal transplantation. The main contributors to LVMI were anemia and elevated blood pressures measured by ABPM.
Collapse
|
14
|
Kim YR, Pyun WB, Shin GJ. Relation of anemia to echocardiographically estimated left ventricular filling pressure in hypertensive patients over 50 year-old. J Cardiovasc Ultrasound 2010; 18:86-90. [PMID: 20967155 DOI: 10.4250/jcu.2010.18.3.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 05/27/2010] [Accepted: 08/17/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Anemia is associated with worse long term outcomes in heart failure. However, there is little evidence on the effect of low hemoglobin level to the left ventricular (LV) structure and diastolic function in hypertensive patients. This study assessed the relationship of hemoglobin level to LV filling pressure in elderly hypertensive patients. METHODS From January 2005 to January 2009, 200 newly diagnosed hypertensive patients over 50 years old (mean age 60 ± 6 years, 116 women) were analyzed. The clinical parameters and comprehensive echocardiographic data were obtained. The patients with and without anemia were compared. RESULTS There were significant differences between the anemic and non-anemic groups in the LV mass index (115.27 ± 34.95 vs. 103.75 ± 28.21 g/m(2)), left atrial (LA) volume index (29.31 ± 10.74 vs. 24.99 ± 7.43 mL/m(2)), and E/E' (11.92 ± 4.34 vs. 9.37 ± 2.51). Chronic renal failure was more prevalent in anemic group. On multivariate logistic analysis, anemia was significantly correlated with high LV filling pressure, reflected by E/E', even after controlling for LV mass index and LA volume index. Furthermore, E/E' was significantly correlated with the hemoglobin level (R(2) = 0.093, p < 0.001). CONCLUSION In newly-diagnosed hypertensive patients over 50 years old, the presence of anemia was significantly associated with elevated LV filling pressure and LV structural changes. And the hemoglobin level was negatively correlated with noninvasively estimated LV filling pressure.
Collapse
Affiliation(s)
- Yoo Ri Kim
- Division of Cardiology, Department of Internal Medicine,University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | |
Collapse
|
15
|
Anemia of aging and obstructive sleep apnea. Sleep Breath 2010; 15:29-34. [PMID: 20162370 DOI: 10.1007/s11325-010-0326-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 01/09/2010] [Indexed: 01/06/2023]
Abstract
INTRODUCTION World Health Organization defined anemia of aging (AOA) when men and women greater than 65 years, respectively, have unexplained hemoglobin (Hgb) less than 13 and 12 g/dl. Recent evidence suggests that this is likely a chronic inflammatory process involving interleukins (IL) 6, 12, and C-reactive protein. Among elderly with obstructive sleep apnea (OSA), hypoxic stimulation of erythropoiesis may obscure AOA. Treatment of OSA may paradoxically restore AOA. We sought to identify OSA and AOA coexistence and OSA treatment AOA interaction. METHODS Records of 101 successive patients older than 65 years and with OSA who were treated with continuous positive airway pressure were analyzed retrospectively. Differences among pre/post-treatment of OSA hemograms were assessed using paired two-tailed Student's t test. Hemogram changes were compared to apnea-hypopnea index (AHI), respiratory effort related arousals (RERA), and duration patients slept with oxyhemoglobin saturation <89% (hypoxic time (HT)) and were assessed for correlative significance using Pearson coefficient correlation. RESULTS Eighty-two of one hundred one patients (27 men, 55 women; average age 71 years) had charted all the study data variables cited above. Mean pre-treatment and mean 1-year post-treatment of OSA Hgb/hematocrit (Hct) for men and women, respectively, were 13 g/dl/40.7% to 12.7 g/dl/39.1% and 12.1 g/dl/38.1% to 11.9 g/dl/37.6%. Hct changed significantly among both men and women (p < 0.05). Among 56% and 30% of the 82 patient study cohort, 1-year post-treatment of OSA, Hct declined (mean 4.8%) and increased (mean 3.7%), respectively; both changes were statistically significant (p < 0.01). These changes did not correlate significantly with AHI, RERA, or HT. DISCUSSION Among the entire cohort for both men and women, we did not see AOA before OSA treatment and we did see AOA 1 year after OSA treatment. However, post-treatment of OSA Hct distributed bimodally, with significant increases and declines of Hct. While these Hct changes did not correlate significantly with selected sleep-breathing variables, we remain intrigued by a possible AOA-OSA interaction. AOA and OSA share common inflammatory processes. We believe OSA inflammatory processes interact with OSA hypoxia-induced erythropoiesis. The balance of these sets of processes determines the effect of OSA and OSA treatment on AOA.
Collapse
|
16
|
Katayama T, Fujiwara N, Tsuruya Y. Factors contributing to left atrial enlargement in adults with normal left ventricular systolic function. J Cardiol 2009; 55:196-204. [PMID: 20206072 DOI: 10.1016/j.jjcc.2009.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/08/2009] [Accepted: 10/22/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND Causes of left atrial (LA) enlargement and its gender difference in patients with normal left ventricular (LV) systolic function have not been clarified. We investigated the factors contributing to LA enlargement in patients with normal LV systolic function, addressing its gender difference. METHODS We enrolled 380 patients (175 males and 205 females; mean age: 63 + or - 15 years) with LV ejection fraction > or = 50% who underwent Doppler echocardiography and blood tests at the same time as echocardiography. Patients with arrhythmias, significant valvular heart disease, and LV asynergy were excluded. The LA volume was measured by Simpson's method from apical 2- and 4-chamber views, and LA volume index (LAVI) was calculated as LA volume/body surface area. All patients, male and female were assigned to a group with a low or a high LAVI based on the median LAVI value, respectively. RESULTS Age, female gender, hypertension, diabetes, hemoglobin concentration, LV mass index, Doppler parameters of LA contraction, and the ratio of mitral early diastolic velocity to early diastolic velocity of the mitral annulus (E/E') were significantly associated with a high LAVI in all patients. Multivariate analysis showed that LV mass index [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.06, P<0.0001], hemoglobin concentration (OR 0.76, 95% CI 0.64-0.90, P<0.01), and female gender (OR 1.92, 95% CI 1.12-3.30, P<0.05) independently contributed to a high LAVI in all patients. In addition, LV mass index and hemoglobin concentration independently contributed to a high LAVI in both genders despite the absence of overt LV hypertrophy or anemia. CONCLUSION Increased LV wall thickness and decreased hemoglobin concentration might contribute to LA enlargement in patients with normal LV systolic function irrespective of gender.
Collapse
Affiliation(s)
- Takuji Katayama
- Division of Cardiology, Tokyo-Kita Social Insurance Hospital, 4-17-56 Akabanedai, Kita-Ku, Tokyo 115-0053, Japan.
| | | | | |
Collapse
|
17
|
Abstract
Anaemia is highly prevalent in elderly populations, particularly in long term care facilities and geriatric wards. Even mild anaemia is associated with adverse health outcomes. Although senescence is considered to be a contributing factor, underlying pathology always has to be thoroughly explored. The most frequent etiologies of anaemia in the elderly are anaemia of chronic disease/inflammation; iron, folate and cobalamin deficiency; and myelodysplastic syndrome. Multiple concomitant etiologies are frequently present. The diagnostic workup is straightforward, not very invasive and should be done systematically. Nutrient deficiencies require complete workup and cure. Anaemia of chronic disease/inflammation ideally is taken care of by treating the underlying disease. If this is not possible and if glomerular filtration rate is significantly decreased, treatment with erythropoietin should be considered. Most cases of myelodysplastic syndrome will benefit from supportive care, but a specific subgroup responds particularly well to oral thalidomide analogues. Transfusions should be avoided.
Collapse
Affiliation(s)
- K Van Puyvelde
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
| | | | | | | |
Collapse
|
18
|
de Denus S, Tardif JC, White M, Bourassa MG, Racine N, Levesque S, Ducharme A. Temporal variations in hematocrit values in patients with left ventricular dysfunction: Relationship with cause-specific mortality and morbidity and optimal monitoring--further insights from SOLVD. Can J Cardiol 2008; 24:45-8. [PMID: 18209768 DOI: 10.1016/s0828-282x(08)70547-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anemia is associated with an increased risk of death in heart failure (HF) patients. Currently, the relationship between temporal variations in hematocrit and specific causes of mortality and morbidity, as well as the most appropriate way to monitor changes in hematocrit, is unknown. OBJECTIVE To evaluate the prognostic value of changes in hematocrit during follow-up on specific causes of mortality and morbidity in the Studies Of Left Ventricular Dysfunction (SOLVD). METHODS A retrospective analysis of the SOLVD trials was conducted. Changes in hematocrit were evaluated in two ways: hematocrit as an absolute value at baseline and at each visit, and relative hematocrit variations compared with baseline. RESULTS Low absolute hematocrit values during follow-up were associated with cardiovascular (CV), non-CV and HF mortality, HF and non-CV hospitalizations, and cardiac ischemic events (P<0.05 for all end points). Decreases in hematocrit during follow-up compared with baseline were associated with HF hospitalizations (P<0.05) and non-CV death in patients receiving placebo (P=0.01 for interaction). CONCLUSIONS Hematocrit values during follow-up provide independent prognostic information in patients with HF for both CV and non-CV events. Absolute values of hematocrit are more closely related with outcomes and are therefore more clinically relevant to monitor than relative variations.
Collapse
Affiliation(s)
- Simon de Denus
- Faculty of Pharmacy, University of Montreal, Montreal, Canada
| | | | | | | | | | | | | |
Collapse
|
19
|
Fukuta H, Ohte N, Mukai S, Saeki T, Kobayashi K, Kimura G. Anemia is an Independent Predictor for Elevated Plasma Levels of Natriuretic Peptides in Patients Undergoing Cardiac Catheterization for Coronary Artery Disease. Circ J 2008; 72:212-7. [DOI: 10.1253/circj.72.212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hidekatsu Fukuta
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| | - Seiji Mukai
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| | - Tomoaki Saeki
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| | - Kenji Kobayashi
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| | - Genjiro Kimura
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
| |
Collapse
|
20
|
Abstract
Current medical therapy of heart failure (HF) focuses primarily on blockade of the neurohormonal pathways. This approach appears to have reached a benefit plateau, despite the introduction of new and improved drugs. Therefore, new targets for pharmacologic intervention are now being actively sought, and anemia has emerged as a potential candidate. Anemia is a frequently occurring comorbidity in patients with HF. However, its true prevalence is difficult to determine because no uniform definition of anemia associated with HF currently exists. Therefore, reported prevalence data can vary significantly, ranging from 4% to 55%, depending on the study population and the applied definition of anemia. Data from recent observational studies and clinical trials suggest that a low hemoglobin concentration in patients with HF is associated with, and is an independent risk factor for, increased morbidity and mortality. In light of these findings, anemia is being discussed as a possible new treatment target in patients with HF. So far, however, only a few small studies have explored this possibility using erythropoiesis-stimulating proteins, which for many years have been successfully used in the treatment of anemia secondary to chronic kidney disease or cancer chemotherapy. Preliminary data from these initial HF studies have shown that increased hemoglobin concentrations in patients with anemia were associated with improvements in cardiac and renal function as well as exercise capacity and a reduced need for hospitalizations. Larger, controlled clinical trials are needed to clearly establish the benefits and safety aspects of anemia treatment on morbidity and possibly mortality in HF patients.
Collapse
Affiliation(s)
- Judith E Mitchell
- Heart Failure Program, State University of New York Health Science Center, Brooklyn, New York 11203, USA.
| |
Collapse
|
21
|
Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D. Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 2007; 38:295-310. [PMID: 16868702 DOI: 10.1007/s11255-006-0064-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2005] [Indexed: 12/31/2022]
Abstract
Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, poor quality of life (QoL), progressive chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin production and on bone marrow activity, as well as to their interference with iron absorption from the gut and their inhibiting effect on the release of iron from iron stores. Anemia itself may further worsen cardiac and renal function and make the patients resistant to standard CHF therapy. Indeed anemia in CHF has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, the need for higher doses of diuretics, progressive worsening of renal function and reduced QoL. In both controlled and uncontrolled studies of CHF, the correction of the anemia with erythropoietin (EPO) and oral or intravenous (IV) iron has been associated with improvement in many cardiac and renal parameters and an increased QoL. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia--by reducing apoptosis of cardiac and endothelial cells, increasing the number of endothelial progenitor cells, and improving endothelial cell function and neovascularization of the heart. Anemia may also play a role in the worsening of acute myocardial infarction and chronic coronary heart disease (CHD) and in the cardiovascular complications of renal transplantation. Anemia, CHF and CKD interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only adequate treatment of all three conditions can prevent the CHF and CKD from progressing.
Collapse
Affiliation(s)
- Donald S Silverberg
- Department of Nephrology, Tel Aviv Medical Center, Weizman 6, 64239, Tel Aviv, Israel.
| | | | | | | | | | | |
Collapse
|
22
|
Anderson JL, Ronnow BS, Horne BD, Carlquist JF, May HT, Bair TL, Jensen KR, Muhlestein JB. Usefulness of a complete blood count-derived risk score to predict incident mortality in patients with suspected cardiovascular disease. Am J Cardiol 2007; 99:169-74. [PMID: 17223413 DOI: 10.1016/j.amjcard.2006.08.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 08/01/2006] [Accepted: 08/01/2006] [Indexed: 11/19/2022]
Abstract
The complete blood cell (CBC) count is an inexpensive, frequently obtained blood test whose information content is potentially underused. We examined the predictive ability of the CBC count for incident death in 29,526 consecutive consenting patients who underwent coronary angiography. Subjects were randomly assigned to training (60%) and test (40%) groups and were followed for an average of 4.9 years. Computed and integer risk score models for all-cause death were developed for 30 days and 1, 5, and 10 years using multivariable logistic regressions applied to CBC metrics, age, and gender. The study cohort was an average age of 61 years, 62% were men, and had a 3.3% annual risk of mortality. An integer (scalar) risk score (range 0 to 18) successfully separated patient cohorts into subgroups at markedly different mortality risks (<1% to >14% at 30 days). Predictive fractions (area under risk curve) at 30 days for the CBC-only model and the age- and gender-adjusted CBC model were 0.76 and 0.78, respectively, in the training set and 0.71 and 0.75, respectively, in the test set (all p values <<0.001). The CBC model was markedly more informative than models based only on hematocrit, white blood cell count, or age and gender and was superior to models with all 7 traditional risk factors. In conclusion, in a large, prospectively assembled database, a CBC risk model had high predictive ability for risk of incident mortality. A total CBC score is an important new addition to risk prediction, and it can be easily generated by computer for clinical use at negligible incremental cost.
Collapse
Affiliation(s)
- Jeffrey L Anderson
- Cardiovascular Department, LDS Hospital, and University of Utah, Salt Lake City, Utah, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Tong PCY, Kong APS, So WY, Ng MHL, Yang X, Ng MCY, Ma RCW, Ho CS, Lam CWK, Chow CC, Cockram CS, Chan JCN. Hematocrit, independent of chronic kidney disease, predicts adverse cardiovascular outcomes in chinese patients with type 2 diabetes. Diabetes Care 2006; 29:2439-44. [PMID: 17065681 DOI: 10.2337/dc06-0887] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Anemia and chronic kidney disease (CKD) are risk factors for cardiovascular diseases in diabetes. We examined the association between hematocrit, stratified by the presence of CKD, and cardiovascular events in a cohort of Chinese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 3,983 patients who underwent assessment for diabetes complications were recruited. Subjects were categorized into five groups. Group I included subjects with hematocrit below the normal sex-specific range. The cutoff points for groups II-V were selected to represent the distribution of the hematocrit for each sex. CKD was defined by the estimated glomerular filtration rate <60 ml/min per 1.73 m(2). Cardiovascular events were defined as cardiovascular mortality and morbidity, including new onset of myocardial infarction, acute coronary syndrome, revascularization, heart failure, and stroke requiring hospitalization. RESULTS A total of 294 subjects (7.4%) developed cardiovascular events during the median of 36.4 months. The rate of cardiovascular events was highest in subjects with low hematocrit (group I, 18.6%) compared with group V (3.4%, P < 0.001). The multivariate-adjusted hazard ratio for cardiovascular events diminished with increasing hematocrit (group I, 1.0; group II, 0.73 [95% CI 0.51-1.04]; group III, 0.57 [0.39-0.83]; group IV, 0.61 [0.39-0.95]; and group V, 0.36 [0.17-0.79]). After stratifying by the presence of CKD, the previously observed reduction in the risk of developing cardiovascular events with increasing hematocrit was abolished in the cohort with CKD but persisted in the non-CKD cohort. CONCLUSIONS In Chinese subjects with type 2 diabetes, low levels of hematocrit and the presence of CKD are associated with increased risk of developing adverse cardiovascular events.
Collapse
Affiliation(s)
- Peter C Y Tong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Salazar-Vazquez BY, Intaglietta M, Rodríguez-Morán M, Guerrero-Romero F. Blood pressure and hematocrit in diabetes and the role of endothelial responses in the variability of blood viscosity. Diabetes Care 2006; 29:1523-8. [PMID: 16801573 DOI: 10.2337/dc06-0323] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between mean arterial blood pressure and hematocrit in a population of treated diabetic patients and a control population of healthy individuals. RESEARCH DESIGN AND METHODS Data on hematocrit and blood pressure were obtained from 129 diabetic subjects (87 women and 42 men) and 103 healthy subjects (76 women and 27 men) enrolled in a cross-sectional study. Alcohol consumption, ischemic heart disease, stroke, neoplasia, renal, hepatic, and chronic inflammatory disease were exclusion criteria. RESULTS The hematocrit of diabetic patients ranged from 0.35 to 0.52, and blood pressure had a bimodal distribution described by a second-order polynomial (P < 0.001), whereby elevated pressures correlated with low and high hematocrit, while the minimum average pressure was at hematocrit 0.43. Hematocrit of normal control subjects (range 0.28-0.55) was uncorrelated to blood pressure (averaged 99.7 +/- 9.7 mmHg). High blood pressure, low hematocrit diabetic subjects up to the minimum average hematocrit of 0.43 had a negative correlation (P < 0.0001) between these variables. CONCLUSIONS Our findings are compatible with the hypothesis that diabetic patients present normal responses to hematocrit variation and therefore blood viscosity and shear stress in mediating the release of vasodilators and lack the ability to autoregulate blood pressure relative to differences in hematocrit by comparison to nondiabetic subjects. These findings also suggest that the treatment of diabetes should target maintaining an optimal hematocrit in order to lower cardiovascular risk.
Collapse
|
25
|
Eisenstaedt R, Penninx BWJH, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev 2006; 20:213-26. [PMID: 16472893 DOI: 10.1016/j.blre.2005.12.002] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Anemia is currently defined by the World Health Organization (WHO) as a hemoglobin (Hb) level <13 g/dL in men and <12 g/dL in women. While estimates vary widely, nearly one quarter of community-based octagenerians and one half of the chronically ill elderly have Hb levels that satisfy a diagnosis of anemia according to these criteria. A growing body of evidence has linked adverse events with even "mild" anemia or low-normal Hb in the elderly. Recent studies suggest strongly that aging is associated with dysregulation of pro-inflammatory cytokines, most notably interleukin-6 (IL-6), which may negatively impact hematopoiesis, either by inhibition of erythropoietin (EPO) production or interaction with EPO receptors. Anemia in older individuals is associated with a very wide range of complications, including increased risk for mortality, cardiovascular disease, cognitive dysfunction, longer hospitalization for elective procedures and comorbid conditions, reduced bone density, and falls and fractures. Not surprisingly, anemia also has a significant effect on quality of life (QOL) in the elderly. Most anemia in older individuals results from iron deficiency, chronic inflammation, or chronic kidney disease, or it may be unexplained. Future research on anemia in the elderly should focus on the age-related physiologic changes underlying this condition and whether anemia correction can reduce anemia-associated risks, and improve QOL.
Collapse
|
26
|
Dijk JM, Wangge G, Graaf YVD, Bots ML, Grobbee DE, Algra A. Hemoglobin and atherosclerosis in patients with manifest arterial disease. The SMART-study. Atherosclerosis 2006; 188:444-9. [PMID: 16388808 DOI: 10.1016/j.atherosclerosis.2005.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Decreased hemoglobin levels are known to be associated with an increased risk of coronary mortality and morbidity. This is largely thought to result from the development of left ventricular hypertrophy. Similar remodeling mechanisms of the vessel wall that may result in atherosclerosis are likely to be present. We studied whether hemoglobin levels are related to different vascular indicators of atherosclerosis. METHODS AND RESULTS This cross-sectional study was performed in the first consecutive 2514 patients with manifest arterial disease enrolled in the SMART-study (Second Manifestations of ARTerial disease). The relation of hemoglobin levels with common carotid IMT (CIMT), presence of a>/=50% internal carotid artery stenosis (ICAS) and prevalent peripheral arterial disease (PAD) was assessed with linear and logistic regression analyses. Each mmol/l increase in hemoglobin was associated with a lower CIMT (-0.03 mm [95% CI: -0.04; -0.01]) and a lower prevalence of >/=50% ICAS (odds ratio: 0.84 [95% CI: 0.73; 0.97]) after adjustment for age, gender and potential confounders. Hemoglobin was not related to prevalence of peripheral arterial disease (1.02 [95% CI: 0.89; 1.16]). CONCLUSIONS This study shows that in patients with manifest arterial disease, increasing hemoglobin levels are associated with reduced severity of atherosclerosis.
Collapse
Affiliation(s)
- J M Dijk
- Julius Center for Health Sciences and Primary Care, University, Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
27
|
Srivastava PM, Thomas MC, Calafiore P, MacIsaac RJ, Jerums G, Burrell LM. Diastolic dysfunction is associated with anaemia in patients with Type II diabetes. Clin Sci (Lond) 2005; 110:109-16. [PMID: 16181149 DOI: 10.1042/cs20050184] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anaemia is common in patients with diabetes and associated with an increased risk of diabetic complications. Although the role of anaemia in heart failure is established, we hypothesize that anaemia also contributes to an increased risk of cardiac dysfunction in patients with Type II diabetes. In the present study, 228 consecutive adults with diabetes were investigated using transthoracic echocardiography. Echocardiographic parameters were correlated with the Hb (haemoglobin) level and adjusted for other risk factors for cardiac dysfunction using multivariate analysis. More than one in five patients (23%) had anaemia, which was an independent risk factor for cardiac dysfunction on echocardiography. Over one-third of all patients with evidence of abnormal cardiac function (diastolic and/or systolic dysfunction) on echocardiography had anaemia compared with <5% of patients with normal echocardiographic findings. Most patients with anaemia had cardiac dysfunction (94%), with the major abnormality being diastolic dysfunction associated with an increased left ventricular mass and impaired relaxation indices. A continuous association between diastolic function and Hb was also observed in patients without anaemia. In patients with a history of cardiovascular disease, systolic dysfunction was twice as common in patients with anaemia. Anaemia was also correlated with plasma markers of cardiac risk, including BNP (brain natriuretic peptide), CRP (C-reactive protein) and AVP (arginine vasopressin). Notably, the predictive utility of these markers was eliminated after adjusting for Hb. Consequently, the inexpensive measurement of Hb may be a useful tool to identify diabetic patients at increased risk of cardiac dysfunction.
Collapse
Affiliation(s)
- Piyush M Srivastava
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria 3084, Australia
| | | | | | | | | | | |
Collapse
|
28
|
Nair D, Shlipak MG, Angeja B, Liu HH, Schiller NB, Whooley MA. Association of anemia with diastolic dysfunction among patients with coronary artery disease in the Heart and Soul Study. Am J Cardiol 2005; 95:332-6. [PMID: 15670540 PMCID: PMC2776659 DOI: 10.1016/j.amjcard.2004.09.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 09/27/2004] [Accepted: 09/27/2004] [Indexed: 12/26/2022]
Abstract
We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy (LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin (Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function (left ventricular ejection fraction >/=50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m(2). Anemia (Hb <13 g/dl) was present in 24% of participants (197 of 822). The prevalence of diastolic dysfunction ranged from 8% in participants who did not have anemia (Hb >/=13 g/dl) to 13% in those who had moderate anemia (Hb 11 to 13 g/dl) to 24% in those who had severe anemia (Hb <11 g/dl, p = 0.004 for trend). After multivariable adjustment, moderate anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1 to 3.6) and severe anemia (OR 6.6, 95% CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia (OR 1.4, 95% CI 1.0 to 2.1) and severe anemia (OR 1.6, 95% CI 0.6 to 4.6) were not significantly associated with LVH. We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.
Collapse
Affiliation(s)
- Deepu Nair
- Department of Department of Medicine, University of California, San Francisco, California, USA
| | | | | | | | | | | |
Collapse
|
29
|
Nimbkar NV, Lateef F. Carotid body dysfunction: The possible etiology of non-insulin dependent diabetes mellitus and essential hypertension. Med Hypotheses 2005; 65:1067-75. [PMID: 16125867 DOI: 10.1016/j.mehy.2005.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 06/25/2005] [Accepted: 06/28/2005] [Indexed: 11/27/2022]
Abstract
Carotid bodies are monitors of oxygen and glucose delivery to the brain. Faced with the threat of hypoxia or hypoglycemia carotid bodies initiate responses to counter the threat. General corrective action is to improve the perfusion by increasing the arterial blood pressure. Specific corrective actions are to stimulate ventilation to improve oxygen availability or to induce insulin resistance to raise blood glucose levels. Inappropriateness of response caused by misreading of hypoxia as hypoglycemia and hypoglycemia as hypoxia is observed experimentally and clinically. The response to all four types of hypoxia, namely, hypoxic, anemic, histotoxic and ischemic (or stagnant) hypoxia, is stimulation of ventilation and elevation of blood pressure. Ischemia produced by narrowing of the artery to the carotid body activates the carotid bodies. The activation produces hypertension, stimulation of ventilation and insulin resistance that manifests as non-insulin dependent diabetes mellitus. There is epidemiologic and necropsy evidence for the onset of atherosclerotic changes in childhood. Early atherosclerotic changes occurring in the region of carotid arteries and their bifurcation narrows the lumen of the arteries to the carotid bodies and produce hypo-perfusion of the carotid bodies. This ischemic hypoxia is a causative, or at least a permissive factor for hypertension and/or non-insulin dependent diabetes mellitus. It is suggested that neither non-insulin dependent diabetes mellitus causes hypertension nor hypertension causes diabetes mellitus, but both are caused by dysfunctional carotid bodies.
Collapse
Affiliation(s)
- N V Nimbkar
- Uniformed Services, University of Health Sciences, Bethesda, MD, USA
| | | |
Collapse
|