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Park SK, Oh CM, Ryoo JH, Kim E, Kang JG, Jung JY. Chinese visceral adiposity index and its relation to abnormal left ventricular remodeling assessed by relative wall thickness and left ventricular mass index. Nutr Metab Cardiovasc Dis 2024; 34:2273-2281. [PMID: 38862353 DOI: 10.1016/j.numecd.2024.05.003] [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: 01/25/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND AIMS The Chinese visceral adipose index (CVAI) is more significantly associated with cardiometabolic risk factors than other obesity indices. This study investigated the relationship between CVAI and left ventricular (LV) remodeling. METHODS AND RESULTS This study included 75,132 Koreans who underwent echocardiography during a health checkup. They were grouped according to quartile levels of the CVAI, body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). LV remodeling was defined as the presence of abnormal relative wall thickness (ARWT) and left ventricular hypertrophy (LVH). Multivariate adjusted logistic regression analysis (adjusted OR [95% confidence interval]) was used to analyze the association between ARWT and LVH according to the quartile levels of each index. Receiver operating characteristic (ROC) graphs and areas under the curve (AUC) were calculated to identify the predictive ability of the indices for ARWT and LVH. ARWT was associated proportionally with CVAI quartiles in both men (second quartile: 1.42 [1.29-1.56], third quartile: 1.61 [1.46-1.77], fourth quartile: 2.01 [1.84-2.21]), and women (second quartile: 1.06 [0.78-1.45], third quartile: 1.15 [0.86-1.55], and fourth quartile: 2.09 [1.56-2.80]). LVH was significantly associated with third (1.74 [1.07-2.83]) and fourth quartile (1.94 [1.18-3.20]) groups of CVAI in women. ROC and AUC analyses indicated that CVAI was superior to other indices in predicting ARWT in men and LVH and ARWT in women. CONCLUSION The CVAI is an effective surrogate marker of LV remodeling, particularly in women.
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Affiliation(s)
- Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Samsung Kangbuk Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Samsung Kangbuk Hospital, Sungkyunkwan University School of Medicine, South Korea
| | - Jeong Gyu Kang
- Total Healthcare Center, Samsung Kangbuk Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Ju Young Jung
- Total Healthcare Center, Samsung Kangbuk Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
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2
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Toba A, Ishikawa J, Harada K. Ambulatory blood pressure is associated with left ventricular geometry after 10 years in hypertensive patients with continuous antihypertensive treatment. Hypertens Res 2024:10.1038/s41440-024-01905-2. [PMID: 39300295 DOI: 10.1038/s41440-024-01905-2] [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: 04/01/2024] [Revised: 08/28/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
Both aging and high blood pressure (BP) are associated with a risk of left ventricular concentricity and hypertrophy. We hypothesized that optimal BP management improves left ventricular remodeling beyond aging. Among 558 hypertensive patients on continuous antihypertensive treatment and without concurrent heart disease who were referred to a cardiology clinic with echocardiography and ambulatory BP monitoring data, 142 patients' echocardiographic data was available after 10 years. Baseline BP and changes in left ventricular geometry were evaluated. Mean age at baseline was 71.0 years old. Baseline daytime BP was 129.9/72.4 ± 17.1/10.2 mmHg and nighttime BP was 122.5/67.1 ± 16.9/9.1 mmHg. After 10 years, left ventricular mass index (LVMI) and relative wall thickness (RWT) significantly decreased from 104.5 ± 26.3 to 97.9 ± 26.4 g/m2, p = 0.003 and 0.51 ± 0.09 to 0.47 ± 0.09, p < 0.001, consecutively. Among patients with hypertrophic geometry at baseline, 17.2% reverted to normal geometry at follow-up. Daytime systolic BP (136.9 ± 18.5 mmHg vs 126.2 ± 16.5 mmHg, p = 0.03), nighttime systolic BP (126.2 ± 17.7 mmHg vs 116.3 ± 16.0 mmHg, p = 0.038) and daytime pulse pressure (63.5 ± 17.3 mmHg vs 53.1 ± 14.9 mmHg, p = 0.022) at baseline were higher in patients who remained hypertrophic than those without hypertrophy at follow-up. On logistic regression analysis, daytime, nighttime systolic BP, and daytime pulse pressure were significantly related to the regression of hypertrophy adjusted for age, sex, eGFR, BMI, LVMI, and RWT at baseline. For conclusion, antihypertensive treatment for 10 years improved LV geometry despite aging. Ambulatory BP and pulse pressure at baseline predicted the change of LV geometry after 10 years.
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Affiliation(s)
- Ayumi Toba
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Japan.
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Japan
| | - Kazumasa Harada
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Japan
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3
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Czarnik K, Sablik Z, Borkowska A, Drożdż J, Cypryk K. Concentric remodeling and the metabolic-associated steatotic liver disease in patients with type 1 diabetes: an exploratory study. Acta Diabetol 2024:10.1007/s00592-024-02365-3. [PMID: 39287794 DOI: 10.1007/s00592-024-02365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Diabetic cardiomyopathy in young patients with type 1 diabetes (T1D) usually presents as asymptomatic diastolic heart dysfunction with left ventricle (LV) remodeling. Its prevalence seems to be underestimated. One of the factors seemingly influencing LV remodeling is a metabolic-associated steatotic liver disease (MASLD), which was extensively investigated in patients with type 2 diabetes but not with T1D. This study aimed to describe the correlation between MASLD risk and relative wall thickness (RWT) in young patients with T1D without heart failure symptoms or treatment. MATERIALS AND METHODS Study participants were recruited at the inpatient diabetology department, in admission order. Patients underwent a set of laboratory tests and echocardiographic examinations. The risk of MASLD was estimated using fatty liver index (FLI). Acquired data was then statistically analyzed. RESULTS The study group consisted of 55 patients. 25 participants had RWT > 0.42, suggesting LV remodeling. Study participants did not differ in HbA1c, NT-proBNP, HDL, LDL, non-HDL, and uric acid concentrations. However, patients with RWT > 0.42 had higher FLI (40.97 vs. 13.82, p < 0.01) and BMI (27.3 vs. 22.5, p < 0.01) and differed in transaminase concentrations. Moreover, patients with RWT > 0.42 had significantly higher LV mass index (85.6 vs. 68.2 g/m2) and altered mitral ring velocities. In univariable logistic regression, FLI correlated with LV remodeling risk (OR 1.028, p = 0.05). The optimal cutoff point for FLI predicting the RWT > 0.42 was 26.38 (OR 10.6, p = 0.04, sensitivity 0.857, specificity 0.657). CONCLUSIONS FLI correlates with RWT in patients with T1D independently of diabetes metabolic control and hypothetically may support recognizing T1D patients with a higher risk of LV remodeling.
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Affiliation(s)
- Klaudia Czarnik
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Central Teaching Hospital in Lodz, 251 Pomorska Street, 92-213, Lodz, Poland.
| | - Zbigniew Sablik
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Anna Borkowska
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, Central Teaching Hospital in Lodz, 251 Pomorska Street, 92-213, Lodz, Poland
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4
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Peterson TE, Lima JAC, Shah SJ, Bluemke DA, Bertoni AG, Liu Y, Ngo D, Varadarajan V, Mychaleckyj JC, Johnson CW, Psaty BM, Clish CB, Taylor KD, Durda P, Tracy RP, Gerszten RE, Rich SS, Rotter JI, Post WS, Pankow JS. Proteomics of left ventricular structure in the Multi-Ethnic Study of Atherosclerosis. ESC Heart Fail 2024. [PMID: 39263947 DOI: 10.1002/ehf2.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/13/2024] Open
Abstract
AIMS Proteomic profiling offers an expansive approach to biomarker discovery and mechanistic hypothesis generation for LV remodelling, a critical component of heart failure (HF). We sought to identify plasma proteins cross-sectionally associated with left ventricular (LV) size and geometry in a diverse population-based cohort without known cardiovascular disease (CVD). METHODS AND RESULTS Among participants of the Multi-Ethnic Study of Atherosclerosis (MESA), we quantified plasma abundances of 1305 proteins using an aptamer-based platform at exam 1 (2000-2002) and exam 5 (2010-2011) and assessed LV structure by cardiac magnetic resonance (CMR) at the same time points. We used multivariable linear regression with robust variance to assess cross-sectional associations between plasma protein abundances and LV structural characteristics at exam 1, reproduced findings in later-life at exam 5, and explored relationships of associated proteins using annotated enrichment analysis. We studied 763 participants (mean age 60 ± 10 years at exam 1; 53% female; 19% Black race; 31% Hispanic ethnicity). Following adjustment for renal function and traditional CVD risk factors, plasma levels of 3 proteins were associated with LV mass index at both time points with the same directionality (FDR < 0.05): leptin (LEP), renin (REN), and cathepsin-D (CTSD); 20 with LV end-diastolic volume index: LEP, NT-proBNP, histone-lysine N-methyltransferase (EHMT2), chordin-like protein 1 (CHRDL1), tumour necrosis factor-inducible gene 6 protein (TNFAIP6), NT-3 growth factor receptor (NTRK3), c5a anaphylatoxin (C5), neurogenic locus notch homologue protein 3 (NOTCH3), ephrin-B2 (EFNB2), osteomodulin (OMD), contactin-4 (CNTN4), gelsolin (GSN), stromal cell-derived factor 1 (CXCL12), calcineurin subunit B type 1 (PPP3R1), insulin-like growth factor 1 receptor (IGF1R), bone sialoprotein 2 (IBSP), interleukin-11 (IL-11), follistatin-related protein 1 (FSTL1), periostin (POSTN), and biglycan (BGN); and 4 with LV mass-to-volume ratio: RGM domain family member B (RGMB), transforming growth factor beta receptor type 3 (TGFBR3), ephrin-A2 (EFNA2), and cell adhesion molecule 3 (CADM3). Functional annotation implicated regulation of the PI3K-Akt pathway, bone morphogenic protein signalling, and cGMP-mediated signalling. CONCLUSIONS We report proteomic profiling of LV size and geometry, which identified novel associations and reinforced previous findings on biomarker candidates for LV remodelling and HF. If validated, these proteins may help refine risk prediction and identify novel therapeutic targets for HF.
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Grants
- 75N92020D00001 NHLBI NIH HHS
- HHSN268201500003I NHLBI NIH HHS
- N01-HC-95159 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00005 NHLBI NIH HHS
- N01-HC-95160 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00002 NHLBI NIH HHS
- N01-HC-95161 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00003 NHLBI NIH HHS
- N01-HC-95162 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00006 NHLBI NIH HHS
- N01-HC-95163 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00004 NHLBI NIH HHS
- N01-HC-95164 National Heart, Lung, and Blood Institute (NHLBI)
- 75N92020D00007 NHLBI NIH HHS
- N01-HC-95165 National Heart, Lung, and Blood Institute (NHLBI)
- N01-HC-95166 National Heart, Lung, and Blood Institute (NHLBI)
- N01-HC-95167 National Heart, Lung, and Blood Institute (NHLBI)
- N01-HC-95168 National Heart, Lung, and Blood Institute (NHLBI)
- N01-HC-95169 National Heart, Lung, and Blood Institute (NHLBI)
- UL1-TR-000040 National Heart, Lung, and Blood Institute (NHLBI)
- UL1-TR-001079 National Heart, Lung, and Blood Institute (NHLBI)
- UL1-TR-001420 National Heart, Lung, and Blood Institute (NHLBI)
- UL1TR001881 National Heart, Lung, and Blood Institute (NHLBI)
- DK063491 National Heart, Lung, and Blood Institute (NHLBI)
- R01HL105756 National Heart, Lung, and Blood Institute (NHLBI)
- T32 HL007779 NHLBI NIH HHS
- T32 HL007227 NHLBI NIH HHS
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Affiliation(s)
- Tess E Peterson
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alain G Bertoni
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yongmei Liu
- Department of Medicine, Cardiology and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Debby Ngo
- Division of Cardiovascular Medicine, Beth Israel Deaconess Hospital, Boston, Massachusetts, USA
| | - Vinithra Varadarajan
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Josyf C Mychaleckyj
- Department of Genome Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Craig W Johnson
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Clary B Clish
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Washington, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Peter Durda
- Department of Pathology & Laboratory Medicine, University of Vermont, Colchester, Vermont, USA
| | - Russell P Tracy
- Department of Pathology & Laboratory Medicine, University of Vermont, Colchester, Vermont, USA
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Hospital, Boston, Massachusetts, USA
| | - Stephen S Rich
- Department of Genome Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Wu CK, Wang M, Kao ZK, Yar N, Chuang MT, Chang TH. Left Ventricular Geometry and Inferior Vena Cava Diameter Co-Modify the Risk of Cardiovascular Outcomes in Chronic Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1140. [PMID: 39064569 PMCID: PMC11278667 DOI: 10.3390/medicina60071140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently explored. Therefore, our study aims to gain further insights into this aspect. Materials and Methods: A retrospective cohort study enrolled patients receiving CHD in a single medical center with available echocardiography from October to December 2018. They were categorized into four groups based on LVH geometry and IVCD. Cox proportional hazard models assessed the risk of major adverse cardiovascular effects (MACEs) and cardiovascular and overall mortality after multivariate adjustments. Kaplan-Meier analysis depicted MACE-free events and survival during the follow-up time. Results: Of the 175 CHD patients, 38, 42, 45, and 50 exhibited small IVCD with eccentric and concentric LVH and large IVCD with eccentric and concentric LVH, respectively. Compared to small IVCD and eccentric LVH, large IVCD and eccentric LVH had the highest risk of MACEs, followed by large IVCD and concentric LVH (aHR: 4.40, 3.60; 95% CI: 1.58-12.23, 1.28-10.12, respectively). As for cardiovascular mortality, large IVCD and concentric LVH had the highest risk, followed by large IVCD and eccentric LVH, and small IVCD and concentric LVH. (aHR: 14.34, 10.23, 8.87; 95% CI: 1.99-103.35, 1.41-74.33; 1.01-77.87). The trend in overall mortality risk among the groups was similar to that of cardiovascular mortality. Conclusions: LVH geometry and IVCD co-modify the risk of MACEs and cardiovascular and overall mortality in CHD patients. The highest risk of MACEs is associated with large IVCD and eccentric LVH, while the highest risk of cardiovascular and overall mortality is linked with large IVCD and concentric LVH.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan; (C.-K.W.); (M.W.); (N.Y.)
- School of Medicine, Fu-Jen Catholic University, New Taipei 242, Taiwan
| | - Ming Wang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan; (C.-K.W.); (M.W.); (N.Y.)
| | - Zih-Kai Kao
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Noi Yar
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan; (C.-K.W.); (M.W.); (N.Y.)
| | - Ming-Tsang Chuang
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 11031, Taiwan;
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 11031, Taiwan
- Clinical Big Data Research Center, Taipei Medical University, Taipei 11031, Taiwan
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6
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Park E, Bathon J. Cardiovascular complications of rheumatoid arthritis. Curr Opin Rheumatol 2024; 36:209-216. [PMID: 38334476 DOI: 10.1097/bor.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) patients remain at higher cardiovascular (CV) risk compared to non-RA patients, driven by accelerated atherosclerosis, leading to plaque rupture and acute CV events (CVE), including heart failure (HF). It has been hypothesized that chronic inflammation is the main driving force behind such outcomes. We summarize the current evidence supporting this hypothesis, focusing on arterial disease and myocardial disease. RECENT FINDINGS RA patients demonstrate higher prevalence of subclinical atherosclerosis (high risk plaque and arterial inflammation) compared to non-RA patients, with RA disease activity correlating independently with CVE and death. Nonischemic HF with preserved ejection fraction (HFpEF) is more common in RA compared to non-RA, with subclinical myocardial structural and functional alterations also more prevalent in RA. HFpEF and myocardial remodeling and dysfunction bear a strong and independent association with inflammatory correlates. SUMMARY All of this suggests that inflammation contributes to enhanced risk of CVE in RA. A more accurate and specific CV risk stratification tool for RA, incorporating biomarkers or imaging, is needed. Likewise, more prospective studies outlining the trajectory from preclinical to clinical HF, incorporating biomarkers and imaging, are also needed.
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Affiliation(s)
- Elizabeth Park
- Columbia University Irving Medical Center. Vagelos College of Physicians & Surgeons, New York, New York, USA
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7
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Manne M, Niebauer M, Tchou P, Varma N. LBBB and heart failure-Relationships among QRS amplitude, duration, height, LV mass, and sex. J Cardiovasc Electrophysiol 2024; 35:583-591. [PMID: 37811553 DOI: 10.1111/jce.16097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Height, left ventricular (LV) size, and sex were proposed as additional criteria for patient selection for cardiac resynchronization therapy (CRT) but their connections with the QRS complex in left bundle branch block (LBBB) are little investigated. We evaluated these. METHODS Among patients with "true" LBBB, QRS duration (QRSd) and amplitude, and LV hypertrophy indices, were correlated with patient's height and LV mass, and compared between sexes. RESULTS In this study cohort (n = 220; 60 ± 12 years; left ventricular ejection fraction [LVEF] 21 ± 7%; mostly New York Heart Association II-III, QRSd 165 ± 19 ms; 57% female; 70% responders [LVEF increased ≥5%]), LV mass was increased in all patients. QRS amplitude did not correlate with LV mass or height in any individual lead or with Sokolow-Lyon or Cornell-Lyon indices. QRSd did not correlate with height. In contrast, QRSd correlated strongly with LV mass (r = .51). CRT response rate was greater in women versus men (84% vs. 58%, p < .001) despite shorter QRSd [7% shorter (p < .0001)]. QRSd normalized for height resulted in a 2.7% and for LV mass 24% greater index in women. CONCLUSION True LBBB criteria do not exclude HF patients with increased LV mass. QRS amplitudes do not correlate with height or LV mass. Height does not affect QRSd. However, QRSd correlates with LV size. QRSd normalized for LV mass results in 24% greater value in women in the direction of sex-specific responses. LV mass may be a significant nonelectrical modifier of QRSd for CRT.
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Affiliation(s)
- Mahesh Manne
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Niebauer
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Tchou
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Niraj Varma
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Yuan WF, Yu L, Xu K, Xu R, Fu H, Song Y, Zhou ZQ, Xu T, Cai XT, Guo YK, Xu HY. Left ventricular concentric hypertrophy with cardiac magnetic resonance imaging improves risk stratification in patients with Duchenne muscular dystrophy: a prospective cohort study. Pediatr Radiol 2024; 54:208-217. [PMID: 38267713 DOI: 10.1007/s00247-024-05856-1] [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: 09/23/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The development of left ventricular (LV) remodeling has been associated with an increased cardiovascular risk and cardiogenic death, and different patterns of remodeling result in varying levels of prognosis. OBJECTIVE To investigate the association between different patterns of LV remodeling and clinical outcomes in the preclinical stage of patients with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS A total of 148 patients with DMD and 43 sex- and age-matched healthy participants were enrolled. We used the four-quadrant analysis method to investigate LV remodeling based on cardiac magnetic resonance (MR) imaging. Kaplan-Meier curves were generated to illustrate the event-free survival probability stratified by the LV remodeling pattern. Cox regression models were constructed and compared to evaluate the incremental predictive value of the LV remodeling pattern. RESULTS During the median follow-up period of 2.2 years, all-cause death, cardiomyopathy, and ventricular arrhythmia occurred in 5, 35, and 7 patients, respectively. LV concentric hypertrophy (hazard ratio 2.91, 95% confidence interval 1.47-5.75, P=0.002) was an independent predictor of composite endpoint events. Compared to the model without LV concentric hypertrophy, the model with LV concentric hypertrophy had significant incremental predictive value (chi-square value 33.5 vs. 25.2, P=0.004). CONCLUSION Age and late gadolinium enhancement positivity were positively correlated with clinical outcomes according to the prediction models. LV concentric hypertrophy was also an independent predictor for risk stratification and provided incremental value for predicting clinical outcomes in the preclinical stage of patients with DMD.
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Affiliation(s)
- Wei-Feng Yuan
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
- Department of Medical Imaging, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Li Yu
- Department of Pediatric Cardiovascular Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ke Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Yu Song
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Zi-Qi Zhou
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Ting Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Xiao-Tang Cai
- Department of Rehabilitation, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China.
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Colangelo LA, Carroll AJ, Perak AM, Gidding SS, Lima JAC, Lloyd-Jones DM. Association of 20-Year Longitudinal Depressive Symptoms With Left Ventricular Geometry Outcomes in the Coronary Artery Risk Development in Young Adults Study: A Role for Androgens? Psychosom Med 2024; 86:60-71. [PMID: 38193784 PMCID: PMC10922617 DOI: 10.1097/psy.0000000000001277] [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] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Depression is a risk factor for coronary heart disease and left ventricular hypertrophy (LVH) is a potent predictor of coronary heart disease events. Whether depression is associated with LVH has received limited investigation. This study assessed cross-sectional and 20-year longitudinal associations of depressive symptoms with LVH outcomes after accounting for important known confounders. METHODS From 5115 participants enrolled in 1985-1986 in the Coronary Artery Risk Development in Young Adults Study, 2533 had serial measures of depressive symptoms and subsequent echocardiography to measure normal LV geometry, concentric remodeling, and LVH. The primary exposure variable was trajectories of the Center for Epidemiologic Studies Depression (CES-D) scale score from 1990-1991 to 2010-2011. Multivariable polytomous logistic regression was used to assess associations of trajectories with a composite LV geometry outcome created using echocardiogram data measured in 2010-2011 and 2015-2016. Sex-specific conflicting results led to exploratory models that examined potential importance of testosterone and sex hormone-binding globulin. RESULTS Overall CES-D and Somatic subscale trajectories had significant associations with LVH for female participants only. Odds ratios for the subthreshold (mean CES-D ≈ 14) and stable (mean CES-D ≈ 19) groups were 1.49 (95% confidence interval = 1.05-2.13) and 1.88 (95% confidence interval = 1.16-3.04), respectively. For female participants, sex hormone-binding globulin was inversely associated with LVH, and for male participants, bioavailable testosterone was positively associated with concentric geometry. CONCLUSIONS Findings from cross-sectional and longitudinal regression models for female participants, but not male ones, and particularly for Somatic subscale trajectories suggested a plausible link among depression, androgens, and LVH. The role of androgens to the depression-LVH relation requires additional investigation in future studies.
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Affiliation(s)
- Laura A Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 10-132, Chicago, IL 60611
| | - Amanda M Perak
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
- Division of Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Samuel S Gidding
- Geisinger Genomic Medicine Institute, Geisinger, Danville, PA; 1631 Hale hollow Road, Bridgewater Corners, VT
| | - Joao AC Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
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10
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Vandroux D, Aboyans V, Houehanou YC, Chastaingt L, Saka D, Sonou A, Amidou S, Houinato D, Preux PM, Magne J, Lacroix P. Impact of Hypertension on Left Ventricular Geometry and Diastolic Function in Africa: Results from the Population-Based TAnve Health (TAHES) Cohort Study. Am J Cardiol 2024; 211:275-281. [PMID: 37979639 DOI: 10.1016/j.amjcard.2023.10.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
High blood pressure leads to morphologic changes and functional alterations of the myocardial structure. Transthoracic echocardiography is of great clinical interest to evaluate these alterations, using reference values proposed by the American Society of Echocardiography/European Association of Cardiovascular Imaging, largely based on studies in Caucasian Whites. We aimed to assess the impact of hypertension on echocardiographic parameters in a sub-Saharan African community, using ethnic-specific reference values. This study is part of the TAnve HEalth Study, a population-based prospective cohort study initiated in 2015 in the district of Tanve, Republic of Benin. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or currently taking antihypertensive medications. All participants had a transthoracic echocardiography. The patterns of diastolic dysfunction and left ventricular (LV) geometry were defined from 486 subjects in the cohort, free from cardiovascular disease, diabetes, and hypertension. Of all participants, 318 (65% women, median age 48 years) had hypertension. Systolic blood pressure correlated significantly (p <0.0001) with LV mass (r = 0.28), wall thickness (r = 0.25), isovolumic relaxation time (r = 0.27), E/A ratio (r = -0.35), lateral e' velocity (r= -0.41), and E/E' ratio (r = 0.39). Ventricular geometry was normal in only 22% of participants with hypertension when using the American Society of Echocardiography/European Association of Cardiovascular Imaging reference values, versus 69% with ethnic-specific reference ranges. The severity of hypertension was associated with ventricular geometry abnormalities. The prevalence of diastolic dysfunction was 14.5% (confidence interval 10.6% to 18.4%), including relaxation impairment (9%) and pseudonormal pattern (6%). Thus, correct assessment of the repercussions of hypertension on LV geometry in Black Africans requires ethnic-specific reference values.
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Affiliation(s)
- David Vandroux
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France; IRD, U270, Tropical Neuroepidemiology, GEIST, Limoges, France; Cardio-Surgical Intensive Care Unit, CHU Limoges, France.
| | - Victor Aboyans
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France; IRD, U270, Tropical Neuroepidemiology, GEIST, Limoges, France; Department of Cardiology, CHU Limoges, France
| | - Yessito Corine Houehanou
- Inserm, U1094, Limoges University, France; Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Benin; Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | | | - Dominique Saka
- Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Benin; Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Arnaud Sonou
- Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Benin; Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Salmane Amidou
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France
| | - Dismand Houinato
- Inserm, U1094, Limoges University, France; Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Benin; Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Pierre Marie Preux
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France; IRD, U270, Tropical Neuroepidemiology, GEIST, Limoges, France
| | - Julien Magne
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France; IRD, U270, Tropical Neuroepidemiology, GEIST, Limoges, France; Department of Cardiology, CHU Limoges, France
| | - Philippe Lacroix
- Inserm, U1094, Limoges University, France; Institute of Epidemiology and Tropical Neurology, Limoges University, France; IRD, U270, Tropical Neuroepidemiology, GEIST, Limoges, France; Vascular Medicine Unit, CHU Limoges, Limoges, France
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11
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Lundin M, Heiberg E, Nordlund D, Gyllenhammar T, Steding-Ehrenborg K, Engblom H, Carlsson M, Atar D, van der Pals J, Erlinge D, Borgquist R, Khoshnood A, Ekelund U, Nickander J, Themudo R, Nordin S, Kozor R, Bhuva AN, Moon JC, Maret E, Caidahl K, Sigfridsson A, Sörensson P, Schelbert EB, Arheden H, Ugander M. Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Sci Rep 2023; 13:22806. [PMID: 38129418 PMCID: PMC10740032 DOI: 10.1038/s41598-023-48173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12-1.20], p < 0.001), followed by GTI (HR 1.14[1.09-1.19], p < 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35-1.94], p < 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p < 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).
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Affiliation(s)
- Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - David Nordlund
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tom Gyllenhammar
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dan Atar
- Department of Cardiology, and Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Jesper van der Pals
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Raquel Themudo
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Institute of Medicine, University of Gothenburg and Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Peder Sörensson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Royal North Shore Hospital, University of Sydney, Kolling Building, Level 12, Room 612017, St Leonards, NSW, 2065, Australia.
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12
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Jin H, Wang X, Dai H, Tian A, Chen B, Wu C, Zhang X, Cui J, Wu Y, Li X, Zheng X. Association of Leisure-Time Physical Activity and Mortality Risk in High Cardiovascular Risk Population with and without Left Ventricular Hypertrophy. Rev Cardiovasc Med 2023; 24:285. [PMID: 39077584 PMCID: PMC11273135 DOI: 10.31083/j.rcm2410285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 07/31/2024] Open
Abstract
Background Increased leisure-time physical activity (LTPA) is linked with decreased mortality risk, while also with increased left ventricular mass, which may induce left ventricular hypertrophy (LVH). We investigated whether LVH modifies the association between higher LTPA and lower mortality risk in population at high cardiovascular risk. Methods In a prospective national cohort, we used the left ventricular mass/body surface area (LVM/BSA) method to define LVH. Baseline LTPA was self-reported and divided into: low ( < 500 metabolic equivalent of task [MET]) min/week), moderate (500-1999 MET min/week) and high ( ≥ 2000 MET-min/week). Analyses of the dose-response relationship between LTPA and left ventricular mass were performed using restricted cubic spline regression. A multivariate adjusted Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs). Results A total of 163,006 participants (55.3% females, mean [standard deviation] age, 62.4 [7.4] years) were included. During a median of 4.8 years of follow-up, 6586 (4.0%) died from all causes and 3024 (1.9%) from cardiovascular causes. Multivariate adjusted Cox proportional hazards regression analyses revealed that moderate and high LTPA were linked with less cardiovascular and all-cause mortality risk than low LTPA in the absence of LVH. In those with LVH, the association of high (0.83, 0.69-0.99) or moderate (0.72, 0.56-0.91) LTPA with cardiovascular mortality risk persisted. For all-cause mortality risk, this association was only significant in high LTPA (0.73, 0.61-0.86), while marginal in moderate LTPA (0.96, 0.84 to 1.08). Overall, the correlation patterns between LTPA and mortality risk appears distinct between those with LVH and those without LVH; the modification of LVH was not significant regarding mortality risk among the high cardiovascular risk population (all-cause: p-value for interaction = 0.074; cardiovascular cause: p-value for interaction = 0.581), except in females regarding all-cause mortality risk (p-value for interaction = 0.006). Conclusions The association between higher LTPA and lower mortality risk was not modified by LVH in high cardiovascular risk population. However, the presence of LVH altered this association in females regarding the all-cause mortality risk.
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Affiliation(s)
- Huijun Jin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Xiulin Wang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Hao Dai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Bowang Chen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Chaoqun Wu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Xiaoyan Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Jianlan Cui
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Yi Wu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Central China Sub-Center of the National Center for Cardiovascular Diseases, 450000 Zhengzhou, Henan, China
- National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, 518057 Shenzhen, Guangdong, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, 518057 Shenzhen, Guangdong, China
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13
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Ravi A, Vittinghoff E, Wu AHB, Suen LW, Coffin PO, Hsue P, Lynch KL, Win S, Kazi DS, Riley ED. Cocaine Use is Associated With Increased LVMI in Unstably Housed Women With Polysubstance Use. Subst Abus 2023; 44:323-329. [PMID: 37830512 PMCID: PMC11131938 DOI: 10.1177/08897077231199572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND While substance use is known to influence cardiovascular health, most prior studies only consider one substance at a time. We examined associations between the concurrent use of multiple substances and left ventricular mass index (LVMI) in unhoused and unstably housed women. METHODS Between 2016 and 2019, we conducted a cohort study of unstably housed women in which measurements included an interview, serum/urine collection, vital sign assessment, and a single transthoracic echocardiogram at baseline. We evaluated independent associations between 39 separate substances confirmed through toxicology and echocardiography-confirmed LVMI. RESULTS The study included 194 participants with a median age of 53.5 years and a high proportion of women of color (72.6%). Toxicology-confirmed substance use included: 69.1% nicotine, 56.2% cocaine, 28.9% methamphetamines, 28.9% alcohol, 23.2% opioid analgesics, and 9.8% opioids with catecholaminergic effects. In adjusted analysis, cocaine was independently associated with higher LVMI (Adjusted linear effect: 18%; 95% CI 9.9, 26.6). Associations with other substances did not reach levels of significance and did not significantly interact with cocaine. CONCLUSION In a population of vulnerable women where the use of multiple substances is common, cocaine stands out as having particularly detrimental influences on cardiac structure. Blood pressure did not attenuate the association appreciably, suggesting direct effects of cocaine on LVMI. Routinely evaluating stimulant use as a chronic risk factor during risk assessment and preventive clinical care planning may reduce end organ damage, particularly in highly vulnerable women.
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Affiliation(s)
- Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Alan H. B. Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leslie W. Suen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Phillip O. Coffin
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Priscilla Hsue
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Kara L. Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sithu Win
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elise D. Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
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14
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Nemtsova V, Burkard T, Vischer AS. Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities. J Clin Med 2023; 12:5723. [PMID: 37685790 PMCID: PMC10488346 DOI: 10.3390/jcm12175723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.
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Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute, National Technical University “Kharkiv Polytechnic Institute”, 61002 Kharkiv, Ukraine
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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15
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Park E, Ito K, Depender C, Giles JT, Bathon J. Left ventricular remodeling in rheumatoid arthritis patients without clinical heart failure. Arthritis Res Ther 2023; 25:124. [PMID: 37480064 PMCID: PMC10362590 DOI: 10.1186/s13075-023-03113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
Rheumatoid arthritis (RA) patients have a 1.5- to twofold higher risk of developing heart failure (HF) and a twofold increased risk of HF-associated mortality compared to those without RA. HF is preceded subclinically by left ventricular (LV) remodeling in the general population. There is a relative absence of prospective studies following RA patients from pre-clinical to clinical HF as well as prospective studies of LV remodeling in RA without clinical HF. In our study, 158 RA patients without clinical HF were enrolled and underwent transthoracic echocardiography (TTE) at baseline and on follow-up between 4 and 6 years. Extensive characterization of RA disease activity and cardiovascular risk factors were performed. LV remodeling was prevalent at 40% at baseline and increased to 60% over time. Higher levels of interleukin-6 (IL 6) were associated with concentric LV remodeling on follow-up. The use of tocilizumab was also significantly associated with baseline LV remodeling (relative wall thickness). These findings suggest a role for IL-6 as a biomarker for LV remodeling in RA patients without clinical HF. Future research should focus on prospective follow-up of LV remodeling and the effects of IL-6 inhibition on LV remodeling in RA patients.
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Affiliation(s)
- Elizabeth Park
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168Th St, P&S 3-450, New York, NY, 10032, USA.
| | - Kazato Ito
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, USA
| | - Christopher Depender
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168Th St, P&S 3-450, New York, NY, 10032, USA
| | - Jon T Giles
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168Th St, P&S 3-450, New York, NY, 10032, USA
| | - Joan Bathon
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168Th St, P&S 3-450, New York, NY, 10032, USA
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16
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Xiao H, Shu W, Li M, Xu L, Amaerjiang N, Zunong J, Vermund SH, Huang D, Chong M, Hu Y. Sex-Specific Differences in Left Ventricular Mass and Volumes with Body Mass Index among Children Aged 6 to 8: A Cross-Sectional Study in China. Nutrients 2023; 15:3066. [PMID: 37447393 PMCID: PMC10347080 DOI: 10.3390/nu15133066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Few studies have examined the sex differences in left ventricle (LV) structure and physiology from early life stages. We aimed to assess the role of sex and overweight/obesity on left ventricular mass (LVM) and LV volume in Chinese children without preexisting cardiovascular risk factors. We selected 934 healthy children aged 6-8 years from an existing cohort in Beijing, China. Linear regression models were used to regress body mass index (BMI), fat mass, systolic blood pressure, diastolic blood pressure, waist circumference, and visceral fat area (VFA) with LVM, left ventricle end-diastolic volume (LVEDV) and end-systolic volume (LVESV). Higher BMI, fat mass, waist circumference, VFA, and stroke volume (SV) predicted higher LVM, LVEDV, and LVESV in both sexes. Multivariable analysis showed that boys with an elevated BMI had greater LV hypertrophy. LVEDV and LVESV were higher among boys than among girls and increased with higher BMI in both boys and girls. LVEDV and LVESV were associated with VFA in boys. We observed sex differences in LVM, LVESV, and LVEDV among prepubertal children, independent of obesity, with higher values observed in boys. Sex differences in cardiac structure in children may help explain the higher incidence of cardiovascular disease in male adults. Whether interventions to reduce childhood obesity can improve the trajectory of cardiac dynamics is worth investigating.
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Affiliation(s)
- Huidi Xiao
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
| | - Wen Shu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
- Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Menglong Li
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
| | - Liyuan Xu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Nubiya Amaerjiang
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
| | - Jiawulan Zunong
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, CT 06510-3201, USA;
| | - Dayong Huang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
| | - Mei Chong
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (N.A.); (J.Z.)
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17
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Virk MK, Mian MUM, Bashir DA, Wilkes JK, Schlingman T, Flores S, Kennedy C, Lam F, Arikan AA, Nguyen T, Mysore K, Galvan NTN, Coss-Bu J, Karpen SJ, Harpavat S, Desai MS. Elevated bile acids are associated with left ventricular structural changes in biliary atresia. Hepatol Commun 2023; 7:e0109. [PMID: 37058680 PMCID: PMC10109457 DOI: 10.1097/hc9.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND In children with biliary atresia (BA), pathologic structural changes within the heart, which define cirrhotic cardiomyopathy, are associated with adverse perioperative outcomes. Despite their clinical relevance, little is known about the pathogenesis and triggers of pathologic remodeling. Bile acid excess causes cardiomyopathy in experimental cirrhosis, but its role in BA is poorly understood. METHODS Echocardiographic parameters of left ventricular (LV) geometry [LV mass (LVM), LVM indexed to height, left atrial volume indexed to BSA (LAVI), and LV internal diameter (LVID)] were correlated with circulating serum bile acid concentrations in 40 children (52% female) with BA listed for transplantation. A receiver-operating characteristic curve was generated to determine optimal threshold values of bile acids to detect pathologic changes in LV geometry using Youden index. Paraffin-embedded human heart tissue was separately analyzed by immunohistochemistry for the presence of bile acid-sensing Takeda G-protein-coupled membrane receptor type 5. RESULTS In the cohort, 52% (21/40) of children had abnormal LV geometry; the optimal bile acid concentration to detect this abnormality with 70% sensitivity and 64% specificity was 152 µmol/L (C-statistics=0.68). Children with bile acid concentrations >152 µmol/L had ∼8-fold increased odds of detecting abnormalities in LVM, LVM index, left atrial volume index, and LV internal diameter. Serum bile acids positively correlated with LVM, LVM index, and LV internal diameter. Separately, Takeda G-protein-coupled membrane receptor type 5 protein was detected in myocardial vasculature and cardiomyocytes on immunohistochemistry. CONCLUSION This association highlights the unique role of bile acids as one of the targetable potential triggers for myocardial structural changes in BA.
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Affiliation(s)
- Manpreet K. Virk
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | | | - Dalia A. Bashir
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - John K. Wilkes
- Pediatric Cardiology, Cook Children’s Medical Centre, Fort Worth, Texas, USA
| | - Tobias Schlingman
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Saul Flores
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Curtis Kennedy
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Fong Lam
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Ayse A. Arikan
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Section of Nephrology, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Trung Nguyen
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Krupa Mysore
- Department of Pediatrics, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jorge Coss-Bu
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
| | - Saul J. Karpen
- Department of Pediatric Gastroenterology and Hepatology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Sanjiv Harpavat
- Department of Pediatrics, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Moreshwar S. Desai
- Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital Baylor College of Medicine, Houston, Texas, USA
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18
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Valbuena-López SC, Camastra G, Cacciotti L, Nagel E, Puntmann VO, Arcari L. Cardiac Imaging Biomarkers in Chronic Kidney Disease. Biomolecules 2023; 13:biom13050773. [PMID: 37238643 DOI: 10.3390/biom13050773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Uremic cardiomyopathy (UC), the peculiar cardiac remodeling secondary to the systemic effects of renal dysfunction, is characterized by left ventricular (LV) diffuse fibrosis with hypertrophy (LVH) and stiffness and the development of heart failure and increased rates of cardiovascular mortality. Several imaging modalities can be used to obtain a non-invasive assessment of UC by different imaging biomarkers, which is the focus of the present review. Echocardiography has been largely employed in recent decades, especially for the determination of LVH by 2-dimensional imaging and diastolic dysfunction by pulsed-wave and tissue Doppler, where it retains a robust prognostic value; more recent techniques include parametric assessment of cardiac deformation by speckle tracking echocardiography and the use of 3D-imaging. Cardiac magnetic resonance (CMR) imaging allows a more accurate assessment of cardiac dimensions, including the right heart, and deformation by feature-tracking imaging; however, the most evident added value of CMR remains tissue characterization. T1 mapping demonstrated diffuse fibrosis in CKD patients, increasing with the worsening of renal disease and evident even in early stages of the disease, with few, but emerging, prognostic data. Some studies using T2 mapping highlighted the presence of subtle, diffuse myocardial edema. Finally, computed tomography, though rarely used to specifically assess UC, might provide incidental findings carrying prognostic relevance, including information on cardiac and vascular calcification. In summary, non-invasive cardiovascular imaging provides a wealth of imaging biomarkers for the characterization and risk-stratification of UC; integrating results from different imaging techniques can aid a better understanding of the physiopathology of UC and improve the clinical management of patients with CKD.
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Affiliation(s)
| | - Giovanni Camastra
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy
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19
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Balafa O, Dounousi E, Giannikouris I, Petrakis I, Georgoulidou A, Karassavidou D, Kokalis A, Stauroulopoulos A, Theodoridis M, Oikonomidis I, Triantafyllis G, Tsotsorou O, Tzannis K, Bacharaki D. Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis. Int Urol Nephrol 2023; 55:1015-1023. [PMID: 36279086 DOI: 10.1007/s11255-022-03391-2] [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: 03/14/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Left ventricular hypertrophy (LVH) represents one of the main risk factors for cardiovascular mortality in dialysis patients. Low serum magnesium Mg is related with increased mortality in general and dialysis population. Aim of our study was to evaluate the association of Mg with LVH and cardiac geometry in dialysis patients. METHODS Hemodialysis (HD) and peritoneal dialysis (PD) patients from nine nephrology departments were included. Echocardiographic LVH was defined by LV mass index > 95 g/m2 in women and > 115 g/m2 in men. Four LV geometric patterns were defined: normal, concentric remodeling, eccentric LVH and concentric LVH. Demographic and laboratory data were collected. RESULTS 133 patients (68 HD, 65 PD) with a median age of 63 years (IQR 52-74) were studied. Mg correlated positively with creatinine, HDL and negatively with CRP levels and BMI. There were no significant differences in Mg between the modality groups. 80 patients presented LVH (43 HD and 37 PD patients). Patients with LVH were older (median age 68 vs 55 years, p < 0.001), with higher BMI (median 26.9 vs 24.7 kg/m2, p = 0.009), had a history of PVD or CAD (55% vs 30.2%, p = 0.003), had higher pulse pressure (median 60 vs 50, p = 0.017), MIS score (median 5 vs 4, p = 0.011), lower albumin (median 3.5 vs 3.8 g/dl, p = 0.011) and Mg levels (median 2.1 vs 2.4 mg/dl, p < 0.001). In univariate analysis age, CVD comorbidities, pulse pressure, CRP, BMI, albumin, Mg, MIS and use of b-blockers or calcium blockers were LVH predictors. In multivariate analysis, Mg was an independent predictor of LVH, adjusted for age, MIS and b-blockers. Considering LV geometry, lower Mg levels were mainly correlated with concentric LVH. CONCLUSION Low serum magnesium levels seem to be an independent factor for LVH in hemodialysis and peritoneal dialysis patients.
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Affiliation(s)
- Olga Balafa
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece.
| | - Evangelia Dounousi
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece
| | | | - Ioannis Petrakis
- Nephrology Department, University Hospital of Heraklion, Heraklion, Greece
| | | | | | | | | | - Marios Theodoridis
- Nephrology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | - Kimon Tzannis
- Nephrology Department, Attikon University Hospital, Athens, Greece
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20
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Mauger CA, Gilbert K, Suinesiaputra A, Bluemke DA, Wu CO, Lima JAC, Young AA, Ambale-Venkatesh B. Multi-Ethnic Study of Atherosclerosis: Relationship between Left Ventricular Shape at Cardiac MRI and 10-year Outcomes. Radiology 2023; 306:e220122. [PMID: 36125376 PMCID: PMC9870985 DOI: 10.1148/radiol.220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
Background Left ventricular (LV) subclinical remodeling is associated with adverse outcomes and indicates mechanisms of disease development. Standard metrics such as LV mass and volumes may not capture the full range of remodeling. Purpose To quantify the relationship between LV three-dimensional shape at MRI and incident cardiovascular events over 10 years. Materials and Methods In this retrospective study, 5098 participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinical cardiovascular disease underwent cardiac MRI from 2000 to 2002. LV shape models were automatically generated using a machine learning workflow. Event-specific remodeling signatures were computed using partial least squares regression, and random survival forests were used to determine which features were most associated with incident heart failure (HF), coronary heart disease (CHD), and cardiovascular disease (CVD) events over a 10-year follow-up period. The discrimination improvement of adding LV shape to traditional cardiovascular risk factors, coronary artery calcium scores, and N-terminal pro-brain natriuretic peptide levels was assessed using the index of prediction accuracy and time-dependent area under the receiver operating characteristic curve (AUC). Kaplan-Meier survival curves were used to illustrate the ability of remodeling signatures to predict the end points. Results Overall, 4618 participants had sufficient three-dimensional MRI information to generate patient-specific LV models (mean age, 60.6 years ± 9.9 [SD]; 2540 women). Among these participants, 147 had HF, 317 had CHD, and 455 had CVD events. The addition of LV remodeling signatures to traditional cardiovascular risk factors improved the mean AUC for 10-year survival prediction and achieved better performance than LV mass and volumes; HF (AUC, 0.83 ± 0.01 and 0.81 ± 0.01, respectively; P < .05), CHD (AUC, 0.77 ± 0.01 and 0.75 ± 0.01, respectively; P < .05), and CVD (AUC, 0.78 ± 0.0 and 0.76 ± 0.0, respectively; P < .05). Kaplan-Meier analysis demonstrated that participants with high-risk HF remodeling signatures had a 10-year survival rate of 56% compared with 95% for those with low-risk scores. Conclusion Left ventricular event-specific remodeling signatures were more predictive of heart failure, coronary heart disease, and cardiovascular disease events over 10 years than standard mass and volume measures and enable an automatic personalized medicine approach to tracking remodeling. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Avan Suinesiaputra
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - David A. Bluemke
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Colin O. Wu
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - João A. C. Lima
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Alistair A. Young
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Bharath Ambale-Venkatesh
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
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21
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Analysing functional implications of differences in left ventricular morphology using statistical shape modelling. Sci Rep 2022; 12:19163. [PMID: 36357433 PMCID: PMC9649786 DOI: 10.1038/s41598-022-15888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/30/2022] [Indexed: 11/11/2022] Open
Abstract
Functional implications of left ventricular (LV) morphological characterization in congenital heart disease are not widely explored. This study qualitatively and quantitatively assessed LV shape associations with a) LV function and b) thoracic aortic morphology in patients with aortic coarctation (CoA) with/without bicuspid aortic valve (BAV), and healthy controls. A statistical shape modelling framework was employed to analyse three-dimensional (3D) LV shapes from cardiac magnetic resonance (CMR) data in isolated CoA (n = 25), CoA + BAV (n = 30), isolated BAV (n = 30), and healthy controls (n = 25). Average 3D templates and deformations were computed. Correlations between shape data and CMR-derived morphometric parameters (i.e., sphericity, conicity) or global and apical strain values were assessed to elucidate possible functional implications. The relationship between LV shape features and arch architecture was also explored. The LV template was shorter and more spherical in CoA patients. Sphericity was overall associated with global and apical radial (p = 0.001, R2 = 0.09; p < 0.0001, R2 = 0.17) and circumferential strain (p = 0.001, R2 = 0.10; p = 0.04, R2 = 0.04), irrespective of the presence of aortic stenosis and/or regurgitation and controlling for age and hypertension status. LV strain was not associated with arch architecture. Differences in LV morphology were observed between CoA and BAV patients. Increasing LV sphericity was associated with reduced strain, independent of aortic arch architecture and functional aortic valve disease.
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22
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Blood Pressure Trajectories for 16 Years and the Development of Left Ventricular Hypertrophy and Increased Left Atrial Size: The Korean Genome and Epidemiology Study. Int J Hypertens 2022; 2022:6750317. [PMID: 35898962 PMCID: PMC9313986 DOI: 10.1155/2022/6750317] [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: 03/05/2022] [Revised: 05/09/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Elevated single blood pressure (BP) measurement can be associated with the development of hypertension-mediated target organ damage including left ventricular hypertrophy (LVH) and left atrial (LA) enlargement (LAE). However, long-term patterns of BP and their effects on LVH and LAE are poorly understood. We evaluated the association between the BP trajectories and the presence of LVH and LAE. Methods We analyzed a total of 2,565 participants (1,267 males, 47.8 ± 6.7 years old) from the first biennial examination (2001-2002) of the Korean Genome and Epidemiology Study. The presence of LVH and LAE was identified by echocardiography performed at the 8th biennial examination (2015-2016). Latent mixture modeling was used to identify trajectories in mid-BP ((systolic BP + diastolic BP)/2) over time. Linear logistic regression was used for assessing BP trajectories with the outcomes. Results We identified 4 distinct mid-BP trajectories: group 1 (lowest, 20.9%, n = 536), group 2 (36.2%, n = 928), group 3 (32.3%, n = 828), and group 4 (highest, 10.6%, n = 273). Compared with the lowest group, trajectories with elevated mid-BP had greater odds ratios having LVH and LAE by multivariable-adjusted regression models. Adjusted odd ratios for LVH were 2.033 (95% CI = 1.462–2.827, P < 0.001) for group 2, 3.446 (95% CI = 2.475–4.797, P < 0.001) for group 3, and 4.940 (95% CI = 3.318–7.356, P < 0.001) for group 4. Adjusted odd ratios for LAE were 1.200 (95% CI = 0.814–1.769, P = 0.358) for group 2, 1.599 (95% CI = 1.084–2.360, P = 0.018) for group 3, and 1.944 (95% CI = 1.212–3.118, P = 0.006) for group 4. Conclusions Higher long-term mid-BP was an independent risk factor of cardiac structural changes such as LVH and LAE among middle-aged population.
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23
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Sayin BY, Oto A. Left Ventricular Hypertrophy: Etiology-Based Therapeutic Options. Cardiol Ther 2022; 11:203-230. [PMID: 35353354 PMCID: PMC9135932 DOI: 10.1007/s40119-022-00260-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
Determining the etiologies of left ventricular hypertrophy (LVH) can be challenging due to the similarities of the different manifestations in clinical presentation and morphological features. Depending on the underlying cause, not only left ventricular mass but also left ventricular cavity size, or both, may increase. Patients with LVH remain asymptomatic for a few years, but disease progression will lead to the development of systolic or diastolic dysfunction and end-stage heart failure. As hypertrophied cardiac muscle disrupts normal conduction, LVH predisposes to arrhythmias. Distinguishing individuals with treatable causes of LVH is important for prevention of cardiovascular events and mortality. Athletic's heart with physiological LVH does not require treatment. Frequent causes of hypertrophy include etiologies due to pressure/volume overload, such as systemic hypertension, hypertrophic cardiomyopathy, or infiltrative cardiac processes such as amyloidosis, Fabry disease, and sarcoidosis. Hypertension and aortic valve stenosis are the most common causes of LVH. Management of LVH involves lifestyle changes, medications, surgery, and implantable devices. In this review we systematically summarize treatments for the different patterns of cardiac hypertrophy and their impacts on outcomes while informing clinicians on advances in the treatment of LVH due to Fabry disease, cardiac amyloidosis, and hypertrophic cardiomyopathy.
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Affiliation(s)
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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24
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Besse S, Nadaud S, Balse E, Pavoine C. Early Protective Role of Inflammation in Cardiac Remodeling and Heart Failure: Focus on TNFα and Resident Macrophages. Cells 2022; 11:1249. [PMID: 35406812 PMCID: PMC8998130 DOI: 10.3390/cells11071249] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/24/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Cardiac hypertrophy, initiated by a variety of physiological or pathological stimuli (hemodynamic or hormonal stimulation or infarction), is a critical early adaptive compensatory response of the heart. The structural basis of the progression from compensated hypertrophy to pathological hypertrophy and heart failure is still largely unknown. In most cases, early activation of an inflammatory program reflects a reparative or protective response to other primary injurious processes. Later on, regardless of the underlying etiology, heart failure is always associated with both local and systemic activation of inflammatory signaling cascades. Cardiac macrophages are nodal regulators of inflammation. Resident macrophages mostly attenuate cardiac injury by secreting cytoprotective factors (cytokines, chemokines, and growth factors), scavenging damaged cells or mitochondrial debris, and regulating cardiac conduction, angiogenesis, lymphangiogenesis, and fibrosis. In contrast, excessive recruitment of monocyte-derived inflammatory macrophages largely contributes to the transition to heart failure. The current review examines the ambivalent role of inflammation (mainly TNFα-related) and cardiac macrophages (Mφ) in pathophysiologies from non-infarction origin, focusing on the protective signaling processes. Our objective is to illustrate how harnessing this knowledge could pave the way for innovative therapeutics in patients with heart failure.
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Affiliation(s)
| | | | | | - Catherine Pavoine
- INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, UMR_S1166, F-75013 Paris, France; (S.B.); (S.N.); (E.B.)
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25
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Influences of achieved SBP on age and sex-related left ventricular structural alteration in community hypertensive populations. J Hypertens 2022; 40:1170-1178. [PMID: 35239549 DOI: 10.1097/hjh.0000000000003127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate age and sex-related left ventricular (LV) structural alteration in community hypertensive populations, and to explore whether achieved systolic blood pressure (SBP) (<120, < 130 and <140 mmHg) would modify the association between age and sex with LV structural alteration. METHOD A total of 1419 community hypertensive people (mean age 61 years, women 50.5%) without cardiovascular disease and left ventricular hypertrophy (LVH) at baseline were included. LV structural measures were assessed using transthoracic echocardiography at baseline and at follow-up. Age and sex-related LV structural alteration was evaluated using linear and Cox regression analysis as appropriate. RESULTS Per 10 years increase in age was associated with positive alteration of LV mass (LVM) index (coefficient-β: 2.63) and LV mass-to-volume (LVMV) ratio (coefficient-β: 0.04). Female sex was associated with positive alteration of LVM index (coefficient-β: 4.87) and LVMV ratio (coefficient-β: 0.05). After a median follow-up of 4 years, compared to men, women had a higher rate of LVH (36.8% vs. 11.5%, P < 0.001). The association between age and incident LVH was nonsignificant when achieved SBP <120 mmHg. The association between female sex and LVM index alteration was nonsignificant when achieved SBP <120 mmHg and <130 mmHg. CONCLUSION Age and female sex were associated with a phenotype of LV remodeling which was featured by increased LVM index and concentric remodeling. Women had a higher risk of developing LVH. A lower achieved SBP conferred greater effects on mitigating age and sex-related LV structural alteration. VIDEO ABSTRACT http://links.lww.com/HJH/B907.
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Park E, Griffin J, Bathon JM. Myocardial Dysfunction and Heart Failure in Rheumatoid Arthritis. Arthritis Rheumatol 2022; 74:184-199. [PMID: 34523821 PMCID: PMC8795468 DOI: 10.1002/art.41979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) patients have almost twice the risk of heart failure (HF) as individuals without RA, even with adjustment for the presence of ischemic heart disease. Moreover, RA patients remain at a 2-fold higher risk of mortality from HF compared to non-RA patients. These observations suggest that RA-specific inflammatory pathways are significant contributors to this increased risk of HF. Herein we summarize the epidemiology of HF in RA patients, the differences in myocardial structure or function between RA patients and non-RA patients without clinical signs of HF, and data on the role of systemic and local inflammation in RA HF pathophysiology. We also discuss the impact of subduing inflammation through the use of RA disease-modifying therapies on HF and myocardial structure and function, emphasizing gaps in the literature and areas needing further research.
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Affiliation(s)
- Elizabeth Park
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Jan Griffin
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Joan M Bathon
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
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27
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Roca Oporto FJ, Pérez García M, Martín Gómez MA. [Use of 48-hour ABPM in specialist care. Experience in our centre]. HIPERTENSION Y RIESGO VASCULAR 2021; 39:8-13. [PMID: 34656460 DOI: 10.1016/j.hipert.2021.09.001] [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: 03/11/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is a basic tool in the diagnosis and treatment of hypertension (HT). Validity is based on the number of readings taken and their duration. Our aim was to study in our 48-hour ABPM series whether extending the duration of ABPM to 48 hours is justified. MATERIAL AND METHODS Retrospective analysis of a case series comprising 81 patients with 48-hour ABPM over a 5-year period (2013 to 2018). We analysed the differences between the first and second day. RESULTS Eighty-one patients, 44 men, mean age of 52 years (± 18). The mean blood pressure (BP) was higher on the first day (132/77 mmHg vs. 130/76 mmHg, p ≤ .01) and there was also a greater proportion of patients with HT on the first day (59 vs. 50%; p ≤ .05). The patients with chronic kidney disease (CKD) (n = 33) had higher systolic BP (SBP) on the second night (p ≤ .05), a circadian rhythm of higher risk on the second day (dipper 13.6 vs. 86.4%, non-dipper 60.7 vs. 41.7%, and riser 30.3 vs. 18.8%; p ≤ .05), more diabetes (39%, p ≤ .01) and more left ventricular hypertrophy (LVH) (74%, p ≤ .05). CONCLUSIONS 48-hour ABPM could determine BP readings and circadian rhythm better than 24-hour ABPM, especially in patients with CKD and diabetes, both diseases carrying high cardiovascular risk.
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Affiliation(s)
- F J Roca Oporto
- Servicio de Nefrología, Hospital El Poniente, Almería, España.
| | - M Pérez García
- Servicio de Enfermería Medicina Interna, Hospital Universitario Torrecárdenas, Almería, España
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Flamant M, Mougenot N, Balse E, Le Fèvre L, Atassi F, Gautier EL, Le Goff W, Keck M, Nadaud S, Combadière C, Boissonnas A, Pavoine C. Early activation of the cardiac CX3CL1/CX3CR1 axis delays β-adrenergic-induced heart failure. Sci Rep 2021; 11:17982. [PMID: 34504250 PMCID: PMC8429682 DOI: 10.1038/s41598-021-97493-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
We recently highlighted a novel potential protective paracrine role of cardiac myeloid CD11b/c cells improving resistance of adult hypertrophied cardiomyocytes to oxidative stress and potentially delaying evolution towards heart failure (HF) in response to early β-adrenergic stimulation. Here we characterized macrophages (Mφ) in hearts early infused with isoproterenol as compared to control and failing hearts and evaluated the role of upregulated CX3CL1 in cardiac remodeling. Flow cytometry, immunohistology and Mφ-depletion experiments evidenced a transient increase in Mφ number in isoproterenol-infused hearts, proportional to early concentric hypertrophy (ECH) remodeling and limiting HF. Combining transcriptomic and secretomic approaches we characterized Mφ-enriched CD45+ cells from ECH hearts as CX3CL1- and TNFα-secreting cells. In-vivo experiments, using intramyocardial injection in ECH hearts of either Cx3cl1 or Cx3cr1 siRNA, or Cx3cr1−/− knockout mice, identified the CX3CL1/CX3CR1 axis as a protective pathway delaying transition to HF. In-vitro results showed that CX3CL1 not only enhanced ECH Mφ proliferation and expansion but also supported adult cardiomyocyte hypertrophy via a synergistic action with TNFα. Our data underscore the in-vivo transient protective role of the CX3CL1/CX3CR1 axis in ECH remodeling and suggest the participation of CX3CL1-secreting Mφ and their crosstalk with CX3CR1-expressing cardiomyocytes to delay HF.
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Affiliation(s)
- M Flamant
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France
| | - N Mougenot
- Sorbonne Université, UMS28, Plateforme d'Expérimentation Cœur, Muscles, Vaisseaux (PECMV), 75013, Paris, France
| | - E Balse
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France
| | - L Le Fèvre
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France.,Medical and Infectious Intensive Care Unit, Bichat hospital, APHP, 46 rue Henri Huchard, 75018, Paris, France
| | - F Atassi
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France
| | - E L Gautier
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S ICAN 1166 Team 5, 75013, Paris, France
| | - W Le Goff
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S ICAN 1166 Team 4, 75013, Paris, France
| | - M Keck
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France.,Département Médicaments et Technologies pour la Santé (DMTS), Université Paris-Saclay, CEA, INRAE, SIMoS, 91191, Gif-sur-Yvette, France
| | - S Nadaud
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France
| | - C Combadière
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses CIMI-Paris, 75013, Paris, France
| | - A Boissonnas
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses CIMI-Paris, 75013, Paris, France
| | - C Pavoine
- Sorbonne Université, UPMC Univ Paris 06, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), Team 3, UMR_S ICAN 1166 Team 3, 91 bd de l'hôpital, 75013, Paris, France.
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Wang Q, Fu C, Xia H, Gao Y. Elevated Plasma Homocysteine Level Associated with Further Left Ventricular Structure and Function Damages in Type 2 Diabetic Patients: A Three-Dimensional Speckle Tracking Echocardiography Study. Metab Syndr Relat Disord 2021; 19:443-451. [PMID: 34227868 DOI: 10.1089/met.2020.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims: The aims of this study were to explore the left ventricular (LV) structural remodeling and its risk factors in type 2 diabetes mellitus (T2DM) patients with or without hyperhomocysteinemia (hHcy) and to detect the accompanied LV dysfunction using three-dimensional speckle tracking echocardiography (3DSTE). Methods: There were totally 80 T2DM patients with undamaged LV ejection fraction (≥55%) in this study, 40 of whom were also diagnosed with hHcy as co-morbidity. Forty age- and gender-matched controls were also recruited. The risk factors and corresponding diagnostic values for LV remodeling (LVR) were, respectively, determined using logistic regression and area under the receiver operating characteristic curves (AUC). The 3DSTE was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). Results: The constituent ratio of LV geometry showed significant differences among the study populations (P = 0.01). Compared with the controls, three types of LVR accounted for larger proportion in the two T2DM groups, whereas LV hypertrophy was most prevalent in those with T2DM and hHcy. Glycosylated hemoglobin (HbA1c), total plasma homocysteine (tHcy), and HbA1c plus tHcy were all significant risk factors associated with LVR in T2DM patients (AUC values: 0.741, 0.746 and 0.851, respectively). The patients with T2DM alone had significantly lower GLS and GAS than the controls (both P < 0.05). The patients with T2DM and hHcy had significantly lower GLS, GCS, GAS, and GRS than the controls (all P < 0.001), and also had significantly lower GLS, GCS, and GRS than the patients with T2DM alone (all P < 0.05). Conclusions: The 3DSTE plus conventional echocardiography could be used as an effective supplement for detecting early and occult cardiac damages in T2DM patients with plasma homocysteine at normal or elevated levels.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chixue Fu
- Department of Ultrasound, the Armed Police Corps Hospital of Chongqing, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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Tezuka Y, Iguchi M, Hamatani Y, Ogawa H, Esato M, Tsuji H, Wada H, Hasegawa K, Abe M, Lip GYH, Akao M. Association of relative wall thickness of left ventricle with incidence of thromboembolism in patients with non-valvular atrial fibrillation: The Fushimi AF Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:273-283. [PMID: 31977011 DOI: 10.1093/ehjqcco/qcaa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/31/2019] [Accepted: 01/10/2020] [Indexed: 12/21/2022]
Abstract
AIMS Atrial fibrillation (AF) increases the risk of thromboembolism, such as ischaemic stroke or systemic embolism (SE). The aim of this study was to investigate the relationship between left ventricular relative wall thickness (RWT) and the risk of thromboembolism in patients with non-valvular AF. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Japan. Analyses were performed on 3067 non-valvular AF patients, in which RWT values determined by transthoracic echocardiography were available at the baseline. The high-RWT group (RWT above the median) was more often female, older, and had higher systolic blood pressure, CHADS2 and CHA2DS2-VASc scores, as compared with low-RWT group. During the median follow-up period of 1309 days, there was a higher incidence of ischaemic stroke/SE in the high-RWT group [unadjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.42-2.59]. On multivariate Cox regression analysis, including the components of CHA2DS2-VASc score, left atrial diameter, oral anticoagulant prescription at baseline, and type of AF, high RWT was independently associated with ischaemic stroke/SE (adjusted HR, 1.81; 95% CI, 1.34-2.47). Stratified analysis demonstrated no significant interaction for any subgroups. In Kaplan-Meier analysis, ordinal RWT quartiles stratified the incidence of ischaemic stroke/SE. Finally, addition of RWT to CHA2DS2-VASc score increased the performance of risk stratification for the incidence of stroke/SE. CONCLUSION Relative wall thickness was independently associated with ischaemic stroke/SE among Japanese patients with non-valvular AF, suggesting the importance of left ventricular morphology in contributing to adverse outcomes, particularly thromboembolism.
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Affiliation(s)
- Yuji Tezuka
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.,Department of Diabetes and Endocrinology, Kusatsu General Hospital, 1660 Yabase, Kusatsu, Shiga 525-8585, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ijinkai Takeda General Hospital, 28-1, Moriminami-cho, Ishida, Fushimi-ku, Kyoto 601-1495, Japan
| | - Hikari Tsuji
- Tsuji Clinic, 5-8, Kogahonmachi, Fushimi-ku, Kyoto 612-8492, Japan
| | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 3BX, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Subclinical left atrial dysfunction profiles for prediction of cardiac outcome in the general population. J Hypertens 2021; 38:2465-2474. [PMID: 32649644 DOI: 10.1097/hjh.0000000000002572] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Echocardiographic definitions of subclinical left atrial dysfunction based on epidemiological data remain scarce. In this population study, we derived outcome-driven thresholds for echocardiographic left atrial function parameters discriminating between normal and abnormal values. METHODS In 1306 individuals (mean age, 50.7 years; 51.6% women), we echocardiographically assessed left atrial function and LV global longitudinal strain. We derived cut-off values for left atrial emptying fraction (LAEF), left atrial function index (LAFI) and left atrial reservoir strain (LARS) to define left atrial dysfunction using receiver-operating curve threshold analysis. Main outcome was the incidence of cardiac events and atrial fibrillation (AFib) on average 8.5 years later. RESULTS For prediction of new-onset AFib, left atrial cut-offs yielding the best balance between sensitivity and specificity (highest Youden index) were: LAEF less than 55%, LAFI less than 40.5 and LARS less than 23%. Applying these cut-offs, abnormal LAEF, LAFI and LARS were, respectively, present in 27, 37.1 and 18.1% of the cohort. Abnormal LARS (<23%) was independently associated with higher risk for cardiac events and new-onset AFib (P ≤ 0.012). Participants with both abnormal LAEF and LARS presented a significantly higher risk to develop cardiac events (hazard ratio: 2.10; P = 0.014) and AFib (hazard ratio: 6.45; P = 0.0036) than normal counterparts. The concomitant presence of an impaired LARS and LV global longitudinal strain improved prognostic accuracy beyond a clinical risk model for cardiac events and the CHARGE-AF Risk Score for AFib. CONCLUSION Left atrial dysfunction based on outcome-driven thresholds predicted cardiac events and AFib independent of conventional risk factors. Screening for subclinical left atrial and LV systolic dysfunction may enhance cardiac disease prediction in the community.
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Sahiti F, Morbach C, Cejka V, Albert J, Eichner FA, Gelbrich G, Heuschmann PU, Störk S. Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study. Front Cardiovasc Med 2021; 8:669335. [PMID: 34179134 PMCID: PMC8232934 DOI: 10.3389/fcvm.2021.669335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure. Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of Würzburg, Germany, aged 30–79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg% per mL/m2, p < 0.001) and lower global work efficiency (GWE) (−0.02% per mL/m2, p < 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg% per g/m2, p < 0.001) and global constructive work (GCW) (+2.05 mmHg% per g/m2, p < 0.01) and lower GWE (−0.015% per g/m2, p < 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension. Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease.
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Affiliation(s)
- Floran Sahiti
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
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Prognostic Significance of Echocardiographic Measures of Cardiac Remodeling in the Community. Curr Cardiol Rep 2021; 23:86. [PMID: 34081212 DOI: 10.1007/s11886-021-01512-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Echocardiography is a noninvasive tool of choice for evaluating cardiac structure and function in numerous cardiac conditions ranging from congenital heart disease, myocardial diseases, coronary artery disease (CAD), valvulopathies, arrhythmias, and pericardial disorders. We review the prognostic significance of echocardiographic indices of cardiac remodeling in the general population. RECENT FINDINGS Recent meta-analyses have confirmed the prognostic significance of echocardiographic measurements (left ventricular mass/hypertrophy, systolic and diastolic dysfunction, left atrial dimensions and function, and strain rate measures) in asymptomatic people in the community for adverse clinical outcomes including CAD, stroke, heart failure, atrial fibrillation, sudden death, and all-cause mortality. The clinical utility of screening echocardiography has been examined comprehensively in hypertensive patients, where it is challenged by measurement variability. Echocardiographic measures predict cardiovascular disease outcomes consistently in multiple community-based epidemiological studies. However, the clinical utility of screening asymptomatic individuals with echocardiography in population-based settings is limited.
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Li T, Li G, Guo X, Li Z, Sun Y. Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study. BMC Cardiovasc Disord 2021; 21:238. [PMID: 33980151 PMCID: PMC8114526 DOI: 10.1186/s12872-021-02055-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02055-w.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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Medium to Long Term Follow-Up of Treated Hypertensive Mediated Heart Disease. High Blood Press Cardiovasc Prev 2021; 28:383-391. [PMID: 33950510 PMCID: PMC8097672 DOI: 10.1007/s40292-021-00457-7] [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: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Hypertensive mediated heart disease is the consequence of anatomical and functional changes in cardiovascular system. The benefits on left ventricular (LV) diastolic impairment and remodeling of hypertension treatment are well established. Aim To evaluate LV structure, systolic and diastolic function of treated hypertensive patients on a medium to long term follow-up. Methods Prospectively observational cohort study. Hypertensive patients over 18 years, ultrasound evaluation of LV structure and diastolic and systolic function, follow-up at least once a year. Diastolic function assessed following recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Results 285 patients, mean follow up of 1731 ± 952 days. Sample mean age 56.3 ± 12.5 years, 166 patients (58.3%) were males. Baseline blood pressure 147.8 ± 19/86.8 ± 11 mm Hg, 5 years blood pressure 134.4 ± 15.7/79 ± 9 mm Hg (p < 0.005 SBP and p < 0.01 DBP). Baseline fixed dose combinations 115 patients (40.4%), follow-up 53.1% (p < 0.05). LV remodeling was detected in 88 patients (30.9%) vs. 30.1% at 5 years (p = NS). The frequency of an E/e′ ratio > 14 was reduced from 38 patients (13.3%) to 3.6% (p < 0.001), e′ septal velocity < 7 cm/sec or e′ lateral velocity < 10 cm/sec was reduced from 38.6% (110 patients) to 19.3% (p < 0.001). Baseline normal diastolic function was detected in 85.6% (244 patients) and 94% at the end of the follow-up (p < 0.02). Conclusions In this observational cohort followed by a mean of 5 years, the main benefit of hypertension treatment was the prevention or regression of diastolic dysfunction.
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Barbieri A, Albini A, Maisano A, De Mitri G, Camaioni G, Bonini N, Mantovani F, Boriani G. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8:667984. [PMID: 33987213 PMCID: PMC8110723 DOI: 10.3389/fcvm.2021.667984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maisano
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gerardo De Mitri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Camaioni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Pelà G, Tagliaferri S, Perrino F, Righelli I, Montanari R, Longobucco Y, Salvi M, Calvani R, Cesari M, Cherubini A, Bernabei R, Di Bari M, Landi F, Marzetti E, Lauretani F, Maggio M. Determinants of cardiac structure in frail and sarcopenic elderly adults. Exp Gerontol 2021; 150:111351. [PMID: 33864831 DOI: 10.1016/j.exger.2021.111351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiac structure and function change with age. The higher prevalence of left ventricular hypertrophy (LVH) with concentric remodeling is indicative of a typical geometric pattern of aging associated with a higher cardiovascular (CV) risk and diseases. The recent associations found between low left ventricular and skeletal mass in older patients with frailty and sarcopenia have raised great interest in investigating cardiac characteristics and determinants of left ventricular mass (LVM) in this population. DESIGN Cross-sectional study. METHODS We evaluated 100 sarcopenic and physically frail outpatients, 33 men (M), 67 women (F), aged ≥70 years (mean age 79 ± 5) and enrolled in the Parma site of European multicenter SPRINTT population. RESULTS All male and female participants showed LVH, assessed as indexed LVM to body surface area (LVM/BSA) (M = 128 ± 39 g/m2; F = 104 ± 26 g/m2), and were more prone to have concentric geometry, as demonstrated by relative wall thickness value (0.41 in both sexes). After backward regression analysis, including covariates such as age, sex, office or ABPM systolic blood pressure (SBP), heart rate, BSA, use of β blockers, ACE-inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, physical activity, hemoglobin level, and Mini Mental State examination - the most powerful determinants of LVM were clinical SBP (β = 1.51 ± 0.31, p = 0.0005), BSA (β = 165.9 ± 41.4, p = 0.0001), while less powerful determinants were 24 h, daily and nightly SBP (p = 0.02, p = 0.002, p = 0.004 respectively). CONCLUSIONS Older sarcopenic and physically frail patients showed LVH with a tendency towards concentric geometry. The main determinant of LVM was SBP, highlighting the key role that hemodynamic condition plays in determining LVH in this population.
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Affiliation(s)
- Giovanna Pelà
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy.
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Felice Perrino
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy
| | - Ilaria Righelli
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Rossella Montanari
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Marco Salvi
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy; Unit of Geriatrics - Geriatrics Intensive Care Unit, Department of Medicine and Geriatrics, University-Hospital Careggi, Firenze, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
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Triposkiadis F, Xanthopoulos A, Starling RC, Iliodromitis E. Obesity, inflammation, and heart failure: links and misconceptions. Heart Fail Rev 2021; 27:407-418. [PMID: 33829388 DOI: 10.1007/s10741-021-10103-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Obesity has been linked with heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF). This link has been attributed to obesity-induced metabolic and inflammatory disturbances leading to HFpEF. However, HF is a syndrome in which disease evolvement is associated with a dynamic unraveling of functional and structural changes leading to unique disease trajectories, creating a spectrum of phenotypes with overlapping distinct characteristics extending beyond the LV ejection fraction (LVEF). In this regard, despite quantitative differences between the two extremes (HFpEF and HF with reduced LVEF, HFrEF), there is important overlap between the phenotypes along the entire spectrum. In this paper, we describe the systemic pro-inflammatory state that is present throughout the HF spectrum and emphasize that obesity intertwines with HF beyond the LVEF construct.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, Larissa, Greece
| | - Randall C Starling
- Heart, Vascular, and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, OH, Cleveland, USA
| | - Efstathios Iliodromitis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Athens, Greece
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Perak AM, Khan SS, Colangelo LA, Gidding SS, Armstrong AC, Lewis CE, Reis JP, Schreiner PJ, Sidney S, Lima JAC, Lloyd-Jones DM. Age-Related Development of Cardiac Remodeling and Dysfunction in Young Black and White Adults: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2021; 34:388-400. [PMID: 33212181 PMCID: PMC8026546 DOI: 10.1016/j.echo.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the timing of preclinical heart failure (HF) development, particularly among blacks. The primary aims of this study were to delineate age-related left ventricular (LV) structure and function evolution in a biracial cohort and to test the hypothesis that young-adult LV parameters within normative ranges would be associated with incident stage B-defining LV abnormalities over 25 years, independent of cumulative risk factor burden. METHODS Data from the Coronary Artery Risk Development in Young Adults study were analyzed. Participants (n = 2,833) had a mean baseline age of 30.1 years; 45% were black, and 56% were women. Generalized estimating equation logistic regression was used to estimate age-related probabilities of stage B LV abnormalities (remodeling, hypertrophy, or dysfunction) and logistic regression to examine risk factor-adjusted associations between baseline LV parameters and incident abnormalities. Cox regression was used to assess whether baseline LV parameters associated with incident stage B LV abnormalities were also associated with incident clinical (stage C/D) HF events over >25 years' follow-up. RESULTS Probabilities of stage B LV abnormalities at ages 25 and 60 years were 10.5% (95% CI, 9.4%-11.8%) and 45.0% (95% CI, 42.0%-48.1%), with significant race-sex disparities (e.g., at age 60, black men 52.7% [95% CI, 44.9%-60.3%], black women 59.4% [95% CI, 53.6%-65.0%], white men 39.1% [95% CI, 33.4%-45.0%], and white women 39.1% [95% CI, 33.9%-44.6%]). Over 25 years, baseline LV end-systolic dimension indexed to height was associated with incident systolic dysfunction (adjusted odds ratio per 1 SD higher, 2.56; 95% CI, 1.87-3.52), eccentric hypertrophy (1.34; 95% CI, 1.02-1.75), concentric hypertrophy (0.69; 95% CI, 0.51-0.91), and concentric remodeling (0.68; 95% CI, 0.58-0.79); baseline LV mass indexed to height2.7 was associated with incident eccentric hypertrophy (1.70; 95% CI, 1.25-2.32]), concentric hypertrophy (1.63; 95% CI, 1.19-2.24), and diastolic dysfunction (1.24; 95% CI, 1.01-1.52). Among the entire cohort with baseline echocardiographic data available (n = 4,097; 72 HF events), LV end-systolic dimension indexed to height and LV mass indexed to height2.7 were significantly associated with incident clinical HF (adjusted hazard ratios per 1 SD higher, 1.56 [95% CI, 1.26-1.93] and 1.42 [95% CI, 1.14-1.75], respectively). CONCLUSIONS Stage B LV abnormalities and related racial disparities were present in young adulthood, increased with age, and were associated with baseline variation in indexed LV end-systolic dimension and mass. Baseline indexed LV end-systolic dimension and mass were also associated with incident clinical HF. Efforts to prevent the LV abnormalities underlying clinical HF should start from a young age.
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Affiliation(s)
- Amanda M Perak
- Northwestern University, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | | | | | - Samuel S Gidding
- The Familial Hypercholesterolemia Foundation, Pasadena, California
| | - Anderson C Armstrong
- Johns Hopkins University, Baltimore, Maryland; University of Sao Francisco Valley, Petrolina, Brazil
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
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Fernandes LP, Barreto ATF, Neto MG, Câmara EJN, Durães AR, Roever L, Aras-Júnior R. Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2754. [PMID: 34190849 PMCID: PMC8221562 DOI: 10.6061/clinics/2021/e2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 01/19/2023] Open
Abstract
Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.
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Affiliation(s)
- Luciana Pereira Fernandes
- Programa de Pos Graduacao em Medicina e Saude, Universidade Federal da Bahia, Salvador, BA, BR
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
- *Corresponding author. E-mail:
| | - Ana Terra Fonseca Barreto
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
| | - Mansueto Gomes Neto
- Grupo de Pesquisa em Fisioterapia, Universidade Federal da Bahia, Salvador, BA, BR
| | | | | | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Roque Aras-Júnior
- Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA, BR
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Arterial hypertension and morphologic abnormalities of cardiac chambers: results from the Copenhagen General Population Study. J Hypertens 2020; 39:703-710. [PMID: 33394866 DOI: 10.1097/hjh.0000000000002705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In patients with arterial hypertension (AH), hypertension-mediated organ damage may be manifested by cardiac chamber enlargement and/or remodeling. Cardiac computed tomography imaging has emerged as an important method for morphological assessment of cardiac chambers. We tested the hypothesis that prevalence of cardiac chamber abnormalities is specifically related to clinical categories of AH in the general population. METHODS We studied 4747 individuals, mean age was 60 years (range: 40-93), 46% were men, undergoing 320-detector computed tomography in the Copenhagen General Population Study. Clinical categories of AH were: normotensive (n = 2484), untreated hypertensive (n = 1301), treated controlled hypertensive (n = 412) and treated uncontrolled hypertensive (n = 550). Chamber abnormalities in the form of left ventricular (LV) concentric remodeling, LV eccentric hypertrophy, LV concentric hypertrophy or left atrial enlargement were assessed, in addition to LV or right ventricular enlargement. RESULTS Chamber abnormalities were present in 23% of all individuals. Combined LV and left atrial abnormalities were rare (<2%). LV concentric remodeling (10%) was the most prevalent abnormality, and most commonly found in individuals with treated hypertension. LV and right ventricular enlargements were unrelated to hypertension. The highest frequencies of chamber abnormalities were found in individuals of elevated blood pressure (BP) with (40%) or without (32%) treatment, as opposed to individuals of normal BP with (27%) or without (14%) treatment, P less than 0.0001. CONCLUSION In a general population cohort, untreated or inadequately treated AH was associated with the highest prevalence of cardiac chamber enlargement and remodeling. These observations suggest a strong link between elevated BPs and development of hypertension-mediated organ damage.
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Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study. J Hypertens 2020; 39:952-960. [PMID: 33323911 DOI: 10.1097/hjh.0000000000002746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography. RESULTS During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (-8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91-0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83-0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95-0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93-0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry. CONCLUSION The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.
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Zhang Z, Xie Y, Shen B, Nie Y, Cao X, Xiang F, Zou J. Relationship between Soluble ST2 and Left Ventricular Geometry in Maintenance Hemodialysis Patients. Blood Purif 2020; 50:84-92. [PMID: 33291107 DOI: 10.1159/000508402] [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: 03/07/2020] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Left ventricular hypertrophy (LVH) is a highly prevalent presentation of cardiac structural abnormality and a strong predictor of adverse outcomes in maintenance hemodialysis (MHD) patients. Different left ventricular geometry may provide additional clinical information. Soluble ST2 is a novel cardiac prognostic biomarker in MHD patients and is closely related to cardiac remodeling. OBJECTIVE This study sought to evaluate the association of sST2 and left ventricular structure in a cohort of MHD patients. METHODS Two hundred eighty-seven patients were enrolled. Left ventricular structure was assessed via transthoracic echocardiography. Left ventricular geometric patterns were defined according to left ventricular mass index and relative wall thickness (RWT). Serum sST2 levels were measured. RESULTS Prevalence of LVH was 44.9% in the study population. In univariate analysis, sST2 levels were correlated with interventricular septal wall thickness, posterior wall thickness, and RWT. After multivariate adjustment, sST2 was independently correlated with only RWT (p = 0.028). Comparing sST2 concentrations across different LV geometric patterns, we found sST2 levels were significantly increased in patients with concentric cardiac remodeling and concentric LVH. CONCLUSIONS The present study found that sST2 were significantly increased in patients with concentric remodeling and concentric LVH. ST2/interleukin (IL)-33 signaling might participate in the process of cardiac remodeling via its pro-fibrotic action. Future studies on the mechanism of ST2/IL-33 pathway are needed.
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Affiliation(s)
- Zhen Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Yeqing Xie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Yuxin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Fangfang Xiang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China.,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China
| | - Jianzhou Zou
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China, .,Shanghai Municipal Health Commission, Shanghai Clinical Medical Center of Kidney Disease, Shanghai, China, .,Shanghai Municipal Health Commission, Shanghai Institute for Kidney and Dialysis, Shanghai, China, .,Shanghai Municipal Health Commission, Shanghai Hemodialysis Quality Control Center, Shanghai, China,
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Georgiopoulos G, Aimo A, Barison A, Magkas N, Emdin M, Masci PG. Imaging predictors of incident heart failure: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 22:378-387. [PMID: 33136816 DOI: 10.2459/jcm.0000000000001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. METHODS This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. RESULTS Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). CONCLUSION LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto Aimo
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Division, University Hospital of Pisa
| | - Andrea Barison
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nikolaos Magkas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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45
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Blumenthal EA, Crosland BA, Senderoff D, Santurino K, Garg N, Bernstein M, Wolfe D, Hameed A. California Cardiovascular Screening Tool: Findings from Initial Implementation. AJP Rep 2020; 10:e362-e368. [PMID: 33214931 PMCID: PMC7669431 DOI: 10.1055/s-0040-1718382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023] Open
Abstract
Objective American College of Obstetricians and Gynecologists (ACOG) recently published the California (CA) cardiovascular disease (CVD) screening algorithm for pregnant and postpartum women. We aim to prospectively determine screen-positive and true-positive rates of CVD among women across two populations. Study Design This is a prospective cohort study of obstetrical patients from April 2018 to July 2019 at academic medical centers in CA and New York (NY). We attempted to screen all patients at least once during their pregnancy care (prenatal or postpartum). Women who screened positive ("Red Flags," >3-4 moderate risk factors, abnormal physical examination, and persistent symptoms) underwent further testing. The primary outcome was the screen-positive rate. Secondary outcomes included the true-positive rate and the strength of each moderate factor in predicting a positive CVD screen. Results We screened 846 women. The overall screen-positive rate was 8% (5% in CA vs. 19% in NY). The sites differed in ethnicity, that is, African American women (2.7% in CA vs. 35% in NY, p < 0.01) and substance use (2.7 vs. 5.6%, p < 0.04). The true-positive rate was 1.5% at both sites. The percentage of screen-positive patients who did not complete follow-up studies was higher in NY (70%) than in CA (27%). CVD was confirmed in 30% with positive screens with complete follow-up. Combinations of moderate factors were the main driver of screen-positive rates in both populations. Conclusion This is the first data describing the performance of the CVD screening algorithm in a general obstetric population. Factors, such as proportion of African American women affect the likelihood of a positive screen. The screening algorithm highlights patients at higher lifetime risk of CVD and may identify a group that could be targeted for more direct care transitions postpartum. Data may be used to design a larger validation study.
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Affiliation(s)
- Elizabeth A Blumenthal
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - B Adam Crosland
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Dana Senderoff
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Kathryn Santurino
- Department Obstetrics and Gynecology, Albert Einstein School of Medicine Montefiore, The Bronx, New York
| | - Nisha Garg
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Megan Bernstein
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Diana Wolfe
- Department Obstetrics and Gynecology, Albert Einstein School of Medicine Montefiore, The Bronx, New York
| | - Afshan Hameed
- Department Obstetrics and Gynecology, University of California, Irvine, Orange, California
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46
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KAYA B, PAYDAS S, SEYREK N, BALAL M, KARAYAYLALI İ. Kronik böbrek hastalarında anormal kalp geometrisi ve sol ventrikül hipertrofisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.661790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Doost A, Rangel A, Nguyen Q, Morahan G, Arnolda L. Micro-CT scan with virtual dissection of left ventricle is a non-destructive, reproducible alternative to dissection and weighing for left ventricular size. Sci Rep 2020; 10:13853. [PMID: 32807896 PMCID: PMC7431593 DOI: 10.1038/s41598-020-70734-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022] Open
Abstract
Micro-CT scan images enhanced by iodine staining provide high-resolution visualisation of soft tissues in laboratory mice. We have compared Micro-CT scan-derived left ventricular (LV) mass with dissection and weighing. Ex-vivo micro-CT scan images of the mouse hearts were obtained following staining by iodine. The LV was segmented and its volume was assessed using a semi-automated method by Drishti software. The left ventricle was then dissected in the laboratory and its actual weight was measured and compared against the estimated results. LV mass was calculated multiplying its estimated volume and myocardial specific gravity. Thirty-five iodine-stained post-natal mouse hearts were studied. Mice were of either sex and 68 to 352 days old (median age 202 days with interquartile range 103 to 245 days) at the time of sacrifice. Samples were from 20 genetically diverse strains. Median mouse body weight was 29 g with interquartile range 24 to 34 g. Left Ventricular weights ranged from 40.0 to 116.7 mg. The segmented LV mass estimated from micro-CT scan and directly measured dissected LV mass were strongly correlated (R2 = 0. 97). Segmented LV mass derived from Micro-CT images was very similar to the physically dissected LV mass (mean difference = 0.09 mg; 95% confidence interval − 3.29 mg to 3.1 mg). Micro-CT scanning provides a non-destructive, efficient and accurate visualisation tool for anatomical analysis of animal heart models of human cardiovascular conditions. Iodine-stained soft tissue imaging empowers researchers to perform qualitative and quantitative assessment of the cardiac structures with preservation of the samples for future histological analysis.
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Affiliation(s)
- Ata Doost
- Australian National University Medical School, Canberra, ACT, Australia
| | - Alejandra Rangel
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Building 32, Wollongong, NSW, 2522, Australia
| | - Quang Nguyen
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| | - Leonard Arnolda
- Australian National University Medical School, Canberra, ACT, Australia. .,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Building 32, Wollongong, NSW, 2522, Australia.
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48
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Nwabuo CC, Moreira HT, Vasconcellos HD, Mewton N, Opdahl A, Ogunyankin KO, Ambale-Venkatesh B, Schreiner PJ, Armstrong AAC, Lewis CE, Jacobs DR, Lloyd-Jones D, Gidding SS, Lima JAC. Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study. Eur Heart J Cardiovasc Imaging 2020; 20:533-540. [PMID: 30247530 DOI: 10.1093/ehjci/jey123] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 12/26/2022] Open
Abstract
AIMS Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. METHODS AND RESULTS Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume*100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). CONCLUSION LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan.
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Affiliation(s)
- Chike C Nwabuo
- Department of Medicine, Harvard Medical School, 330 Mount Auburn St, Cambridge, MA, USA.,Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Henrique T Moreira
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA.,Division of Cardiology, Universidade of Sao Paulo, Av. Bandeirantes, 3.900 Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Henrique D Vasconcellos
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Nathan Mewton
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Anders Opdahl
- Department of cardiology, Oslo University hospital, Sognsvannsveien 20, Oslo, Norway
| | - Kofo O Ogunyankin
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Anderson A C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Cora E Lewis
- Division of preventive medicine, University of Alabama, 619 19th St, Birmingham, AL, UK
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Samuel S Gidding
- Division of Pediatrics Cardiology, Nemours Cardiac Center, 1600 Rockland Road Wilmington, DE, USA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
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Li X, Lin Y, Wang S, Zhou S, Ju J, Wang X, Chen Y, Xia M. Extracellular Superoxide Dismutase Is Associated With Left Ventricular Geometry and Heart Failure in Patients With Cardiovascular Disease. J Am Heart Assoc 2020; 9:e016862. [PMID: 32750295 PMCID: PMC7792241 DOI: 10.1161/jaha.120.016862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Extracellular superoxide dismutase (Ec-SOD) is a major scavenger of reactive oxygen species. However, its relationships with abnormal left ventricular (LV) geometry patterns and heart failure (HF) are still unknown in patients with cardiovascular disease. Methods and Results A cross-sectional study was carried out to evaluate the association of serum Ec-SOD activity with LV geometry, as well as HF in 1047 patients with cardiovascular disease. All participants underwent standard echocardiography examination and measurement of serum Ec-SOD activity. Overall, we found a significantly decreased trend of serum Ec-SOD activity from subjects with normal geometry (147.96±15.94 U/mL), subjects with abnormal LV geometry without HF (140.19±20.12 U/mL), and subjects with abnormal LV geometry and overt HF (129.32±17.92 U/mL) after adjustment for potential confounders (P for trend <0.001). The downward trends remained significant in the concentric hypertrophy and eccentric hypertrophy groups after stratification by different LV geometry patterns. Multinomial logistic regression analysis showed that each 10 U/mL increase in serum Ec-SOD activity was associated with a 16.5% decrease in the odds of concentric remodeling without HF (odds ratio [OR], 0.835; 95% CI, 0.736-0.948), a 40.4% decrease in the odds of concentric hypertrophy with HF (OR, 0.596; 95% CI, 0.486-0.730), a 16.1% decrease in the odds of eccentric hypertrophy without HF (OR, 0.839; 95% CI, 0.729-0.965) and a 34.0% decrease in the odds of eccentric hypertrophy with HF (OR, 0.660; 95% CI, 0.565-0.772). Conclusions Serum Ec-SOD activity was independently associated with abnormal LV geometry patterns with and without overt HF. Our results indicate that Ec-SOD might be a potential link between LV structure remodeling and the development of subsequent HF in patients with cardiovascular disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier NCT03351907.
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Affiliation(s)
- Xiuwen Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
| | - Yingying Lin
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
| | - Shaohua Wang
- Department of CardiologySun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Shiyi Zhou
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
| | - Jingmeng Ju
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
| | - Xiaohui Wang
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
| | - Yangxin Chen
- Department of CardiologySun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouGuangdong ProvinceChina
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and HealthGuangzhouGuangdong ProvinceChina
- Department of NutritionSchool of Public HealthSun Yat‐sen University (Northern Campus)GuangzhouGuangdong ProvinceChina
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50
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Xu M, Ge Z, Huang J, Shao X, Li J, Mrcp, Yang J. Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension. J Clin Hypertens (Greenwich) 2020; 22:1239-1246. [PMID: 32639109 PMCID: PMC7497263 DOI: 10.1111/jch.13919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 01/10/2023]
Abstract
To evaluate the value of modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy (LVH) for patients with essential hypertension. A total of 381 patients with essential hypertension diagnosed in our hospital were selected. Using the left ventricle (LV) geometric patterns classified by the American Society of Echocardiography (ASE), we examined the distribution of the modified Cornell criteria of Ravl + SD (the deepest S wave in 12‐lead ECG) in different geometric patterns and analyzed the correlation of modified Cornell criteria with changes in the LV geometric patterns using multiple linear regression analysis. The distribution of modified Cornell criteria, Sokolow‐Lyon criteria (RV5/V6 + SV1), and Cornell criteria (Ravl + SV3) in gender‐specific hypertensive geometric patterns were significantly different (P ≤ .01 for all). The voltage of Ravl + SD in male patients showed an increase trend in the normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups, and this increase trend was significantly in the unadjusted model and the adjusted model. The voltages of Ravl + SV3 and RV5/V6 + SV1 of male patients in CR, CH and RH groups showed a gradual increase trend, but the increase trend in CR group has no statistical significance compared to that in NG group (P ≥ .05). The voltages of Ravl + SD, RV5/V6 + SV1, and Ravl + SV3 in female patients in CR, CH and EH groups showed a trend of increase after decrease in the adjusted model. In conclusion, the modified Cornell criteria could dynamically reflect left ventricular hypertensive geometry of male patients.
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Affiliation(s)
- Min Xu
- Department of Echocardiography of The Third Affiliated Hospital of Soochow University, Chang Zhou, China.,Department of Echocardiography of The First Affiliated Hospital of Soochow University, Su Zhou, China
| | - Zhixiang Ge
- Department of Echocardiography of The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Jun Huang
- Department of Echocardiography of The Affiliated Hospital of Nanjing Medical University, Chang Zhou, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine of The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | | | - Mrcp
- Department of General Surgery of The Third Affiliated Hospital of Soochow University, Chang Zhou, China
| | - Junhua Yang
- Department of Echocardiography of The First Affiliated Hospital of Soochow University, Su Zhou, China
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