1
|
Condurache DG, D’Angelo S, Salih AM, Szabo L, McCracken C, Mahmood A, Curtis EM, Altmann A, Petersen SE, Harvey NC, Raisi-Estabragh Z. Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis. JBMR Plus 2024; 8:ziae058. [PMID: 38784722 PMCID: PMC11114472 DOI: 10.1093/jbmrpl/ziae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
This study examined the association of estimated heel bone mineral density (eBMD, derived from quantitative ultrasound) with: (1) prevalent and incident cardiovascular diseases (CVDs: ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), non-ischemic cardiomyopathy (NICM), arrhythmia), (2) mortality (all-cause, CVD, IHD), and (3) cardiovascular magnetic resonance (CMR) measures of left ventricular and atrial structure and function and aortic distensibility, in the UK Biobank. Clinical outcomes were ascertained using health record linkage over 12.3 yr of prospective follow-up. Two-sample Mendelian randomization (MR) was conducted to assess causal associations between BMD and CMR metrics using genetic instrumental variables identified from published genome-wide association studies. The analysis included 485 257 participants (55% women, mean age 56.5 ± 8.1 yr). Higher heel eBMD was associated with lower odds of all prevalent CVDs considered. The greatest magnitude of effect was seen in association with HF and NICM, where 1-SD increase in eBMD was associated with 15% lower odds of HF and 16% lower odds of NICM. Association between eBMD and incident IHD and MI was non-significant; the strongest relationship was with incident HF (SHR: 0.90 [95% CI, 0.89-0.92]). Higher eBMD was associated with a decreased risk in all-cause, CVD, and IHD mortality, in the fully adjusted model. Higher eBMD was associated with greater aortic distensibility; associations with other CMR metrics were null. Higher heel eBMD is linked to reduced risk of a range of prevalent and incident CVD and mortality outcomes. Although observational analyses suggest associations between higher eBMD and greater aortic compliance, MR analysis did not support a causal relationship between genetically predicted BMD and CMR phenotypes. These findings support the notion that bone-cardiovascular associations reflect shared risk factors/mechanisms rather than direct causal pathways.
Collapse
Affiliation(s)
- Dorina-Gabriela Condurache
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
| | - Stefania D’Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
| | - Ahmed M Salih
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, England, United Kingdom
- Department of Computer Science, Faculty of Science, University of Zakho, Zakho 42002, Kurdistan Region, Iraq
| | - Liliana Szabo
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, England, United Kingdom
| | - Adil Mahmood
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, England, United Kingdom
| | - Andre Altmann
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London, London WC1E 6BT, England, United Kingdom
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
- Health Data Research UK, British Heart Foundation Data Science Centre, London NW1 2BE, England, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton SO16 6YD, England,United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, England, United Kingdom
| | - Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service (NHS) Trust, West Smithfield, London EC1A 7BE, England, United Kingdom
| |
Collapse
|
2
|
Tachibana T, Shiga Y, Tashiro K, Higashi S, Shibata Y, Kawahira Y, Kato Y, Kuwano T, Sugihara M, Miura SI. Association Between Major Adverse Cardiovascular Events and Left Ventricular Mass Index in Patients Who Have Undergone Coronary Computed Tomography Angiography: From the FU-CCTA Registry. Cardiol Res 2024; 15:134-143. [PMID: 38994229 PMCID: PMC11236349 DOI: 10.14740/cr1655] [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: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Background Left ventricular mass (LVM) is a predictor of future cardiovascular risk. We determined the association between LVM measured by coronary computed tomography angiography (CCTA) and the prognosis in patients who have undergone CCTA for screening of coronary artery disease (CAD). Methods We performed a prospective cohort study. Five hundred twenty consecutive patients who underwent CCTA at Fukuoka University Hospital (FU-CCTA registry) were enrolled. They were clinically suspected of having CAD or had at least one cardiovascular risk factor, and were a follow-up of up to 5 years. Equal to more than 50% of coronary stenosis as assessed by CCTA was diagnosed as CAD. Using CCTA, LVM index (LVMI), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and LV end-systolic volume were measured. The primary endpoint was major adverse cardiovascular events (MACEs: including all causes of death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into non-MACEs and MACEs groups. Results The non-MACEs and MACEs groups consisted of 478 and 42 patients, respectively. Percent of CAD in the MACEs group was significantly higher than that in the non-MACEs group. The MACEs group showed significantly higher LVMI and tended to have a lower LVEF and LVEDV than the non-MACEs group. Although LVMI was not associated with MACEs in all patients, LVMI was independently associated with MACEs in males (odd ratio: 1.018, 95% confidence interval: 1.002 - 1.035, P = 0.030), but not females. Conclusions Evaluation of LVMI by CCTA may be useful for predicting MACEs in males.
Collapse
Affiliation(s)
- Tetsuro Tachibana
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Sara Higashi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuka Shibata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| |
Collapse
|
3
|
Rabkin SW. Searching for the Best Machine Learning Algorithm for the Detection of Left Ventricular Hypertrophy from the ECG: A Review. Bioengineering (Basel) 2024; 11:489. [PMID: 38790356 PMCID: PMC11117908 DOI: 10.3390/bioengineering11050489] [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: 04/02/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Left ventricular hypertrophy (LVH) is a powerful predictor of future cardiovascular events. Objectives: The objectives of this study were to conduct a systematic review of machine learning (ML) algorithms for the identification of LVH and compare them with respect to the classical features of test sensitivity, specificity, accuracy, ROC and the traditional ECG criteria for LVH. Methods: A search string was constructed with the operators "left ventricular hypertrophy, electrocardiogram" AND machine learning; then, Medline and PubMed were systematically searched. Results: There were 14 studies that examined the detection of LVH utilizing the ECG and utilized at least one ML approach. ML approaches encompassed support vector machines, logistic regression, Random Forest, GLMNet, Gradient Boosting Machine, XGBoost, AdaBoost, ensemble neural networks, convolutional neural networks, deep neural networks and a back-propagation neural network. Sensitivity ranged from 0.29 to 0.966 and specificity ranged from 0.53 to 0.99. A comparison with the classical ECG criteria for LVH was performed in nine studies. ML algorithms were universally more sensitive than the Cornell voltage, Cornell product, Sokolow-Lyons or Romhilt-Estes criteria. However, none of the ML algorithms had meaningfully better specificity, and four were worse. Many of the ML algorithms included a large number of clinical (age, sex, height, weight), laboratory and detailed ECG waveform data (P, QRS and T wave), making them difficult to utilize in a clinical screening situation. Conclusions: There are over a dozen different ML algorithms for the detection of LVH on a 12-lead ECG that use various ECG signal analyses and/or the inclusion of clinical and laboratory variables. Most improved in terms of sensitivity, but most also failed to outperform specificity compared to the classic ECG criteria. ML algorithms should be compared or tested on the same (standard) database.
Collapse
Affiliation(s)
- Simon W Rabkin
- Department of Medicine, Division of Cardiology, University of British Columbia, 9th Floor 2775 Laurel St., Vancouver, BC V5Z 1M9, Canada
| |
Collapse
|
4
|
Miller RJH, Killekar A, Shanbhag A, Bednarski B, Michalowska AM, Ruddy TD, Einstein AJ, Newby DE, Lemley M, Pieszko K, Van Kriekinge SD, Kavanagh PB, Liang JX, Huang C, Dey D, Berman DS, Slomka PJ. Predicting mortality from AI cardiac volumes mass and coronary calcium on chest computed tomography. Nat Commun 2024; 15:2747. [PMID: 38553462 PMCID: PMC10980695 DOI: 10.1038/s41467-024-46977-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
Chest computed tomography is one of the most common diagnostic tests, with 15 million scans performed annually in the United States. Coronary calcium can be visualized on these scans, but other measures of cardiac risk such as atrial and ventricular volumes have classically required administration of contrast. Here we show that a fully automated pipeline, incorporating two artificial intelligence models, automatically quantifies coronary calcium, left atrial volume, left ventricular mass, and other cardiac chamber volumes in 29,687 patients from three cohorts. The model processes chamber volumes and coronary artery calcium with an end-to-end time of ~18 s, while failing to segment only 0.1% of cases. Coronary calcium, left atrial volume, and left ventricular mass index are independently associated with all-cause and cardiovascular mortality and significantly improve risk classification compared to identification of abnormalities by a radiologist. This automated approach can be integrated into clinical workflows to improve identification of abnormalities and risk stratification, allowing physicians to improve clinical decision-making.
Collapse
Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Gora, Poland
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
5
|
Barbour W, Wolff E, Puar P, Hibino M, Bakbak E, Krishnaraj A, Verma R, Verma M, Quan A, Yan AT, Connelly KA, Teoh H, Mazer CD, Verma S. Effect of empagliflozin on cardiac remodelling in South Asian and non-South Asian individuals: insights from the EMPA-HEART CardioLink-6 randomised clinical trial. BMC Cardiovasc Disord 2023; 23:557. [PMID: 37964221 PMCID: PMC10648366 DOI: 10.1186/s12872-023-03549-5] [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: 05/03/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND This exploratory sub-analysis of the EMPA-HEART CardioLink-6 trial examined whether the previously reported benefit of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) mass (LVM) regression differs between individuals of South Asian and non-South Asian ethnicity. METHODS EMPA-HEART CardioLink-6 was a double-blind, placebo-controlled clinical trial that randomised 97 individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to either empagliflozin 10 mg daily or placebo for 6 months. LV parameters and function were assessed using cardiac magnetic resonance imaging. The 6-month changes in LVM and LV volumes, all indexed to baseline body surface area, for South Asian participants were compared to those for non-South Asian individuals. RESULTS Compared to the non-South Asian group, the South Asian sub-cohort comprised more males, was younger and had a lower median body mass index. The adjusted difference for LVMi change over 6 months was -4.3 g/m2 (95% confidence interval [CI], -7.5, -1.0; P = 0.042) for the South Asian group and -2.3 g/m2 (95% CI, -6.4, 1.9; P = 0.28) for the non-South Asian group (Pinteraction = 0.45). There was no between-group difference for the adjusted differences in baseline body surface area-indexed LV volumes and LV ejection fraction. CONCLUSIONS There was no meaningful difference in empagliflozin-associated LVM regression between South Asian and non-South Asian individuals living with T2DM and CAD in the EMPA-HEART CardioLink-6 trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02998970 (First posted on 21/12/ 2016).
Collapse
Affiliation(s)
- William Barbour
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5C1, Canada
| | - Erika Wolff
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- School of Medicine, University College Cork, Cork, T12 K8AF, Ireland
| | - Pankaj Puar
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ehab Bakbak
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Aishwarya Krishnaraj
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Raj Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
| | - Meena Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - C David Mazer
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada.
| |
Collapse
|
6
|
Monisha K, Mahema S, Chokkalingam M, Ahmad SF, Emran TB, Prabu P, Ahmed SSSJ. Elucidating the Histone Deacetylase Gene Expression Signatures in Peripheral Blood Mononuclear Cells That Correlate Essential Cardiac Function and Aid in Classifying Coronary Artery Disease through a Logistic Regression Model. Biomedicines 2023; 11:2952. [PMID: 38001953 PMCID: PMC10669643 DOI: 10.3390/biomedicines11112952] [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: 09/30/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
A proinflammatory role of HDACs has been implicated in the pathogenesis of atherosclerosis as an emerging novel epigenetic diagnostic biomarker. However, its association with the clinical and cardiovascular function in coronary artery disease is largely unknown. The study aimed to profile the gene expression of HDAC1-11 in human peripheral blood mononuclear cells and to evaluate their influence on hematological, biochemical, and two-dimensional echocardiographic indices in CAD. The HDAC gene expression profiles were assessed in 62 angioproven CAD patients and compared with 62 healthy controls. Among the HDACs, upregulated HDACs 1,2, 4, 6, 8, 9, and 11 were upregulated, and HDAC3 was downregulated, which was significantly (p ≤ 0.05) linked with the hematological (basophils, lymphocytes, monocytes, and neutrophils), biochemical (LDL, HDL, and TGL), and echocardiographic parameters (cardiac function: biplane LVEF, GLS, MV E/A, IVRT, and PV S/D) in CAD. Furthermore, our constructed diagnostic model with the crucial HDACs establishes the most crucial HDACs in the classification of CAD from control with an excellent accuracy of 88.6%. Conclusively, our study has provided a novel perspective on the HDAC gene expression underlying cardiac function that is useful in developing molecular methods for CAD diagnosis.
Collapse
Affiliation(s)
- K. Monisha
- Drug Discovery and Multi-omics Laboratory, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Kelambakkam 603103, India
| | - S. Mahema
- Drug Discovery and Multi-omics Laboratory, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Kelambakkam 603103, India
| | - M. Chokkalingam
- Department of Cardiology, Chettinad Hospital and Research Institute, Chettinad Health City, Kelambakkam 603103, India
| | - Sheikh F. Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Talha Bin Emran
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Legorreta Cancer Center, Brown University, Providence, RI 02912, USA
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
| | - Paramasivam Prabu
- Madras Diabetes Research Foundation, Chennai 600086, India
- Department of Neurology, University of New Mexico Albuquerque, Albuquerque, NM 87131, USA
| | - Shiek S. S. J. Ahmed
- Drug Discovery and Multi-omics Laboratory, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Kelambakkam 603103, India
| |
Collapse
|
7
|
Sveric KM, Cansız B, Winkler A, Ulbrich S, Ende G, Heidrich F, Kaliske M, Linke A, Jellinghaus S. Accuracy of Devereaux and Teichholz formulas for left ventricular mass calculation in different geometric patterns: comparison with cardiac magnetic resonance imaging. Sci Rep 2023; 13:14089. [PMID: 37640771 PMCID: PMC10462733 DOI: 10.1038/s41598-023-41020-9] [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: 04/25/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
Left ventricular (LV) myocardial mass is important in the evaluation of cardiac remodeling and requires accurate assessment when performed on linear measurements in two-dimensional echocardiography (Echo). We aimed to compare the accuracy of the Devereaux formula (DEV) and the Teichholz formula (TEICH) in calculating LV myocardial mass in Echo using cardiac magnetic resonance (CMR) as the reference method. Based on preceding mathematical calculations, we identified primarily LV size rather than wall thickness as the main source of bias between DEV and TEICH in a retrospective derivation cohort (n = 1276). Although LV mass from DEV and TEICH were correlated with CMR, TEICH did not show a proportional bias as did DEV (- 2 g/m2 vs. + 22 g/m2). This could be validated in an independent prospective cohort (n = 226) with symptomatic non-ischemic heart failure. DEV systematically overestimated LV mass in all tiers of LV remodeling as compared to TEICH. In conclusion, the TEICH method accounts for the changes in LV geometry with increasing LV mass and thus better reflects the different pattern of LV remodeling than the DEV method. This has important clinical implications, as TEICH may be more appropriate for use in clinical practice, rather than DEV, currently recommended.
Collapse
Affiliation(s)
- Krunoslav Michael Sveric
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
| | - Barış Cansız
- Institute for Structural Analysis, Technische Universität Dresden, 01062, Dresden, Germany
| | - Anna Winkler
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Stefan Ulbrich
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Georg Ende
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Felix Heidrich
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Michael Kaliske
- Institute for Structural Analysis, Technische Universität Dresden, 01062, Dresden, Germany
| | - Axel Linke
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Stefanie Jellinghaus
- Department for Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| |
Collapse
|
8
|
Puar P, Hibino M, Mazer CD, Yan AT, Pandey AK, Quan A, Teoh H, Hess DA, Verma R, Connelly KA, Verma S. Left ventricular mass predicts cardiac reverse remodelling in patients treated with empagliflozin. Cardiovasc Diabetol 2023; 22:152. [PMID: 37380983 DOI: 10.1186/s12933-023-01849-w] [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: 12/24/2022] [Accepted: 05/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The cardiovascular (CV) benefits of sodium-glucose transport protein 2 inhibitors have been attributed, in part, to cardiac reverse remodelling. The EMPA-HEART CardioLink-6 study reported that sodium-glucose cotransporter-2 inhibition for 6 months with empagliflozin was associated with a significant reduction in left ventricular mass indexed to body surface area (LVMi). In this sub-analysis, we evaluated whether baseline LVMi may influence how empagliflozin affects cardiac reverse remodelling. METHODS A total of 97 patients with type 2 diabetes and coronary artery disease were randomized to empagliflozin (10 mg/d) or matching placebo for 6 months. The study cohort was divided into those whose baseline LVMi was ≤ 60 g/m2 and those who had a baseline LVMi > 60 g/m2. Subgroup comparisons were conducted using a linear regression model adjusted for baseline values (ANCOVA) that included an interaction term between LVMi subgroup and treatment. RESULTS Baseline LVMi was 53.3 g/m2 (49.2-57.2) and 69.7 g/m2 (64.2-76.1) for those with baseline ≤ 60 g/m2 (n = 54) and LVMi > 60 g/m2 (n = 43) respectively. The adjusted difference of LVMi regression between those randomized to empagliflozin and placebo were - 0.46 g/m2 (95% CI: -3.44, 2.52, p = 0.76) in the baseline LVMi ≤ 60 g/m2 subgroup and - 7.26 g/m2 (95% CI: -11.40, -3.12, p = 0.0011) in the baseline LVMi > 60 g/m2 subgroup (p-for-interaction = 0.007). No significant associations were found between baseline LVMi and 6-month change in LV end systolic volume-indexed (p-for-interaction = 0.086), LV end diastolic volume-indexed (p-for-interaction = 0.34), or LV ejection fraction (p-for-interaction = 0.15). CONCLUSIONS Patients with higher LVMi at baseline experienced greater LVM regression with empagliflozin.
Collapse
Affiliation(s)
- Pankaj Puar
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Makoto Hibino
- Department of Cardiac Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - C David Mazer
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
- Departments of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arjun K Pandey
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
| | - David A Hess
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Molecular Medicine Research Laboratories, Krembil Centre for Stem Cells Biology, Robarts Research Institute, University of Western Ontario, London, ON, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Raj Verma
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kim A Connelly
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, Canada.
- Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
9
|
Renal Insufficiency Increases the Combined Risk of Left Ventricular Hypertrophy and Dysfunction in Patients at High Risk of Cardiovascular Diseases. J Clin Med 2023; 12:jcm12051818. [PMID: 36902605 PMCID: PMC10003474 DOI: 10.3390/jcm12051818] [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: 12/20/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in patients at high risk of cardiovascular diseases (CVD). METHODS Patients undergoing coronary angiography and/or percutaneous coronary interventions were enrolled from the Cardiorenal ImprovemeNt II (CIN-II) cohort study, and their echocardiography and renal function were assessed at admission. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR). Our outcomes were LV hypertrophy and LV systolic and diastolic dysfunction. Multivariable logistic regression analyses were conducted to investigate the associations of eGFR with LV hypertrophy and LV systolic and diastolic dysfunction. RESULTS A total of 5610 patients (mean age: 61.6 ± 10.6 years; 27.3% female) were included in the final analysis. The prevalence of LV hypertrophy assessed by echocardiography was 29.0%, 34.8%, 51.9%, 66.7%, and 74.3% for the eGFR categories >90, 61-90, 31-60, 16-30, and ≤15 mL/min per 1.73 m2 or for patients needing dialysis, respectively. Multivariate logistic regression analysis showed that subjects with eGFR levels of ≤15 mL/min per 1.73 m2 or needing dialysis (OR: 4.66, 95% CI: 2.96-7.54), as well as those with eGFR levels of 16-30 (OR: 3.87, 95% CI: 2.43-6.24), 31-60 (OR: 2.00, 95% CI: 1.64-2.45), and 61-90 (OR: 1.23, 95% CI: 1.07-1.42), were significantly associated with LV hypertrophy. This reduction in renal function was also significantly associated with LV systolic and diastolic dysfunction (all P for trend <0.001). In addition, a per one unit decrease in eGFR was associated with a 2% heightened combined risk of LV hypertrophy and systolic and diastolic dysfunction. CONCLUSIONS Among patients at high risk of CVD, poor renal function was strongly associated with cardiac structural and functional abnormalities. In addition, the presence or absence of CAD did not change the associations. The results may have implications for the pathophysiology behind cardiorenal syndrome.
Collapse
|
10
|
Tavoosi AN, Kadoya Y, Ruddy TD. Added value to stress myocardial perfusion imaging studies with measurement of left ventricular mass. J Nucl Cardiol 2022; 29:2374-2377. [PMID: 34668151 DOI: 10.1007/s12350-021-02802-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Anahita N Tavoosi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Yoshito Kadoya
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
- University of Ottawa Heart Institute, 40 Ruskin Street, Room H-S407, Ottawa, ON, K1Y 4W7, Canada.
| |
Collapse
|
11
|
Van Tosh A, Nichols KJ. 82Rb PET/CT left ventricular mass computations. J Nucl Cardiol 2022; 29:1643-1646. [PMID: 33748939 DOI: 10.1007/s12350-021-02593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Andrew Van Tosh
- Department of Cardiovascular Research, St. Francis Hospital, Roslyn, NY, USA.
- Noninvasive Imaging Laboratory, St. Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, 11576-1348, USA.
| | - Kenneth J Nichols
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
12
|
Cornhill AK, Dykstra S, Satriano A, Labib D, Mikami Y, Flewitt J, Prosio E, Rivest S, Sandonato R, Howarth AG, Lydell C, Eastwood CA, Quan H, Fine N, Lee J, White JA. Machine Learning Patient-Specific Prediction of Heart Failure Hospitalization Using Cardiac MRI-Based Phenotype and Electronic Health Information. Front Cardiovasc Med 2022; 9:890904. [PMID: 35783851 PMCID: PMC9245012 DOI: 10.3389/fcvm.2022.890904] [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: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure (HF) hospitalization is a dominant contributor of morbidity and healthcare expenditures in patients with systolic HF. Cardiovascular magnetic resonance (CMR) imaging is increasingly employed for the evaluation of HF given capacity to provide highly reproducible phenotypic markers of disease. The combined value of CMR phenotypic markers and patient health information to deliver predictions of future HF events has not been explored. We sought to develop and validate a novel risk model for the patient-specific prediction of time to HF hospitalization using routinely reported CMR variables, patient-reported health status, and electronic health information.MethodsStandardized data capture was performed for 1,775 consecutive patients with chronic systolic HF referred for CMR imaging. Patient demographics, symptoms, Health-related Quality of Life, pharmacy, and routinely reported CMR features were provided to both machine learning (ML) and competing risk Fine-Gray-based models (FGM) for the prediction of time to HF hospitalization.ResultsThe mean age was 59 years with a mean LVEF of 36 ± 11%. The population was evenly distributed between ischemic (52%) and idiopathic non-ischemic cardiomyopathy (48%). Over a median follow-up of 2.79 years (IQR: 1.59–4.04) 333 patients (19%) experienced HF related hospitalization. Both ML and competing risk FGM based models achieved robust performance for the prediction of time to HF hospitalization. Respective 90-day, 1 and 2-year AUC values were 0.87, 0.83, and 0.80 for the ML model, and 0.89, 0.84, and 0.80 for the competing risk FGM-based model in a holdout validation cohort. Patients classified as high-risk by the ML model experienced a 34-fold higher occurrence of HF hospitalization at 90 days vs. the low-risk group.ConclusionIn this study we demonstrated capacity for routinely reported CMR phenotypic markers and patient health information to be combined for the delivery of patient-specific predictions of time to HF hospitalization. This work supports an evolving migration toward multi-domain data collection for the delivery of personalized risk prediction at time of diagnostic imaging.
Collapse
Affiliation(s)
- Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Easter Prosio
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Cathy A. Eastwood
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- *Correspondence: James A. White,
| |
Collapse
|
13
|
Wang S, Patel H, Miller T, Ameyaw K, Narang A, Chauhan D, Anand S, Anyanwu E, Besser SA, Kawaji K, Liu XP, Lang RM, Mor-Avi V, Patel AR. AI Based CMR Assessment of Biventricular Function: Clinical Significance of Intervendor Variability and Measurement Errors. JACC Cardiovasc Imaging 2022; 15:413-427. [PMID: 34656471 PMCID: PMC8917993 DOI: 10.1016/j.jcmg.2021.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) and left ventricular mass (LVM) measurements made using 3 fully automated deep learning (DL) algorithms are accurate and interchangeable and can be used to classify ventricular function and risk-stratify patients as accurately as an expert. BACKGROUND Artificial intelligence is increasingly used to assess cardiac function and LVM from cardiac magnetic resonance images. METHODS Two hundred patients were identified from a registry of individuals who underwent vasodilator stress cardiac magnetic resonance. LVEF, LVM, and RVEF were determined using 3 fully automated commercial DL algorithms and by a clinical expert (CLIN) using conventional methodology. Additionally, LVEF values were classified according to clinically important ranges: <35%, 35% to 50%, and ≥50%. Both ejection fraction values and classifications made by the DL ejection fraction approaches were compared against CLIN ejection fraction reference. Receiver-operating characteristic curve analysis was performed to evaluate the ability of CLIN and each of the DL classifications to predict major adverse cardiovascular events. RESULTS Excellent correlations were seen for each DL-LVEF compared with CLIN-LVEF (r = 0.83-0.93). Good correlations were present between DL-LVM and CLIN-LVM (r = 0.75-0.85). Modest correlations were observed between DL-RVEF and CLIN-RVEF (r = 0.59-0.68). A >10% error between CLIN and DL ejection fraction was present in 5% to 18% of cases for the left ventricle and 23% to 43% for the right ventricle. LVEF classification agreed with CLIN-LVEF classification in 86%, 80%, and 85% cases for the 3 DL-LVEF approaches. There were no differences among the 4 approaches in associations with major adverse cardiovascular events for LVEF, LVM, and RVEF. CONCLUSIONS This study revealed good agreement between automated and expert-derived LVEF and similarly strong associations with outcomes, compared with an expert. However, the ability of these automated measurements to accurately classify left ventricular function for treatment decision remains limited. DL-LVM showed good agreement with CLIN-LVM. DL-RVEF approaches need further refinements.
Collapse
Affiliation(s)
- Shuo Wang
- University of Chicago, Chicago, Illinois,Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hena Patel
- University of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | - Keigo Kawaji
- University of Chicago, Chicago, Illinois,Illinois Institute of Technology, Chicago, Illinois
| | - Xing-Peng Liu
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | | | | | | |
Collapse
|
14
|
Müller LO, Fossan FE, Bråten AT, Jørgensen A, Wiseth R, Hellevik LR. Impact of baseline coronary flow and its distribution on fractional flow reserve prediction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3246. [PMID: 31397083 DOI: 10.1002/cnm.3246] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
Model-based prediction of fractional flow reserve (FFR) in the context of stable coronary artery disease (CAD) diagnosis requires a number of modelling assumptions. One of these assumptions is the definition of a baseline coronary flow, ie, total coronary flow at rest prior to the administration of drugs needed to perform invasive measurements. Here we explore the impact of several methods available in the literature to estimate and distribute baseline coronary flow on FFR predictions obtained with a reduced-order model. We consider 63 patients with suspected stable CAD, for a total of 105 invasive FFR measurements. First, we improve a reduced-order model with respect to previous results and validate its performance versus results obtained with a 3D model. Next, we assess the impact of a wide range of methods to impose and distribute baseline coronary flow on FFR prediction, which proved to have a significant impact on diagnostic performance. However, none of the proposed methods resulted in a significant improvement of prediction error standard deviation. Finally, we show that intrinsic uncertainties related to stenosis geometry and the effect of hyperemic inducing drugs have to be addressed in order to improve FFR prediction accuracy.
Collapse
Affiliation(s)
- Lucas O Müller
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fredrik E Fossan
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders T Bråten
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arve Jørgensen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leif R Hellevik
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
15
|
Stress Cardiac Magnetic Resonance Myocardial Perfusion Imaging: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1655-1668. [PMID: 34649703 DOI: 10.1016/j.jacc.2021.08.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022]
Abstract
Stress cardiovascular magnetic resonance imaging (CMR) is a cost-effective, noninvasive test that accurately assesses myocardial ischemia, myocardial viability, and cardiac function without the need for ionizing radiation. There is a large body of literature, including randomized controlled trials, validating its diagnostic performance, risk stratification capabilities, and ability to guide appropriate use of coronary intervention. Specifically, stress CMR has shown higher diagnostic sensitivity than single-photon emission computed tomography imaging in detecting angiographically significant coronary artery disease. Stress CMR is particularly valuable for the evaluation of patients with moderate to high pretest probability of having stable ischemic heart disease and for patients known to have challenging imaging characteristics, including women, individuals with prior revascularization, and those with left ventricular dysfunction. This paper reviews the basics principles of stress CMR, the data supporting its clinical use, the added-value of myocardial blood flow quantification, and the assessment of myocardial function and viability routinely obtained during a stress CMR study.
Collapse
|
16
|
Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, Hameed W, Cooper AC, Jean-Charles G. Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy. Cureus 2021; 13:e17550. [PMID: 34646607 PMCID: PMC8479854 DOI: 10.7759/cureus.17550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
Collapse
Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Dina Ismail
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Dhriti Gupta
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Roshini Pradeep
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Warda Hameed
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
| |
Collapse
|
17
|
Sone M, Saito C, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. Association between elevated left ventricular mass index and increased cardiovascular events in patients with acute coronary syndrome: A sub-analysis of the HIJ-PROPER study. Echocardiography 2021; 38:1567-1573. [PMID: 34346521 DOI: 10.1111/echo.15173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
AIM This study aimed to assess the association between left ventricular mass index (LVMI) and cardiovascular events in patients with acute coronary syndrome (ACS) under standard ACS management. METHODS AND RESULTS This study is the sub-analysis of the HIJ-PROPER study. A total of 299 patients who had echocardiographic LVMI data were included in the current analysis. The participants were divided into four groups according to the LVMI quartile [quartile 1 (Q1), 77 (25.8%); quartile 2 (Q2), 73 (24.4%); quartile 3 (Q3), 74 (24.7%); and quartile 4 (Q4), 75 (25.1%)]. The incidence of cardiovascular events was compared among the four groups. The primary endpoint was defined as the composite endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure. Mean LVMI in the four groups was 68.1±8.6, 86.2±3.8, 101.1±4.9, and 126.0±18.5 g/m2 , respectively. The primary endpoint was noted in 4, 4, 7, and 14 patients in Q1, Q2, Q3, and Q4, corresponding to an incidence of 5.2%, 5.5%, 9.5%, and 18.7%, respectively (p = 0.03 for difference among four groups). The cumulative incidence of the primary endpoint was significantly higher in patients in Q4 than in those in Q1 and Q2 [hazard ratio (HR) 3.75; 95% confidence interval (CI), 1.23-11.4; p = 0.02 for Q4 vs Q1; HR 3.43; 95% CI, 1.13-10.4; p = 0.03 for Q4 vs Q2]. This tendency was noted even after adjusting for patient characteristics and echocardiography parameters (p = 0.039 for Q4 vs Q1). CONCLUSION Elevated LVMI was associated with increased cardiovascular events in patients with ACS under standard management. Adequately powered studies are warranted to validate these findings.
Collapse
Affiliation(s)
- Maiko Sone
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Ogawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
18
|
Sarmiento-Cobos M, Rivera C, Okida LF, Cogollo VJ, Montorfano L, Gutierrez Blanco D, Lo Menzo E, Szomstein S, Rosenthal RJ. Left ventricular mass index and ventricular contractility improvement in patients with severe obesity following rapid weight loss after bariatric surgery. Surg Obes Relat Dis 2021; 17:1140-1145. [PMID: 33812788 DOI: 10.1016/j.soard.2021.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obesity is a well-known risk factor for heart disease, resulting in a broad spectrum of cardiovascular changes. Left ventricular mass (LVM) and contractility are recognized markers of cardiac function. OBJECTIVES To determine the changes of LVM and contractility after bariatric surgery (BaS). SETTING University hospital, United States METHODS: To determine the cardiac changes in ventricular mass, ventricular contractility, and left ventricular shortening fraction (LVSF), we retrospectively reviewed the 2-dimensional echocardiographic parameters of patients with obesity who underwent BaS at our institution. We compared these results before and after BaS. RESULTS A total of 40 patients met the inclusion criteria. The majority were females (57.5%; n = 23), with an average age of 63.5 ± 12.1. The excess body mass index (BMI) lost at 12 months was 48.9 ± 28.9%. The percent total weight loss after BaS was 16.46 ± 9.9%. The left ventricular mass was 234.9 ± 88.1 grams before and 181.5 ± 52.7 grams after BaS (P = .002). The LVM index was 101.3 ± 38.3 g/m2 before versus 86.7 ± 26.6 g/m2 after BaS (P = .005). The LVSF was 31% ± 8.8% before and 36.3% ± 8.2% after BaS (P = .007). We found a good correlation between the decrease in LVM index and the BMI after BaS (P = .03). CONCLUSION Rapid weight loss results in a decrease of the LVM index, as well as improvement in the left ventricular muscle contractility. Our results suggest that there is left ventricular remodeling and an improvement of heart dynamics following bariatric surgery. Further studies are needed to better assess these findings.
Collapse
Affiliation(s)
- Mauricio Sarmiento-Cobos
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Carlos Rivera
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Luis Felipe Okida
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Vicente J Cogollo
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Lisandro Montorfano
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida.
| |
Collapse
|
19
|
Yu Z, Song J, Cheng L, Li S, Lu Q, Zhang Y, Lin X, Liu D. Peguero-Lo Presti criteria for the diagnosis of left ventricular hypertrophy: A systematic review and meta-analysis. PLoS One 2021; 16:e0246305. [PMID: 33513186 PMCID: PMC7846009 DOI: 10.1371/journal.pone.0246305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Peguero-Lo Presti criteria are novel electrocardiographic (ECG) diagnostic criteria for the detection of left ventricular hypertrophy (LVH) and represent the sum of the amplitude of the deepest S wave in any lead with the S wave in lead V4 (SD+SV4). The diagnostic efficacy of the Peguero-Lo Presti criteria in LVH is still debatable. We aimed to test the sensitivity and specificity of the Peguero-Lo Presti criteria and compared them with those of the Cornell voltage index to assess their overall performance in LVH diagnosis. Methods Electronic databases (e.g., Medline, Web of Knowledge, Embase, and the Cochrane Library) were searched from their inception until May 18, 2020. Trials written in English that investigated the Peguero-Lo Presti criteria for detecting LVH were included. Data were independently extracted and analyzed by two investigators. Results A total of 51 records were screened, and 6 trials comprising 13,564 patients were finally included. A bivariate analysis showed that the sensitivity of the Peguero-Lo Presti criteria (0.52, 95% confidence interval (CI) 0.46–0.58) was higher than that of the Cornell voltage index (0.29, 95% CI 0.23–0.36) and Sokolow-Lyon criteria (0.24, 95% CI 0.21–0.27); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.69, 95% CI 0.65–0.73) was also higher than that of the Cornell voltage index (0.67, 95% CI 0.62–0.71) and Sokolow-Lyon criteria (0.28, 95% CI 0.25–0.32); and the specificity of the Peguero-Lo Presti criteria (0.85, 95% CI 0.79–0.90) was similar to that of the Cornell voltage index (0.92, 95% CI 0.89–0.95) and Sokolow-Lyon criteria (0.94, 95%CI 0.88–0.97). Two trials (including 12,748 patients) were discharged because they included partly healthy subjects and accounted for substantial heterogeneity. Pooled analysis of the remaining 4 trials (including 816 patients) showed that the sensitivity of the Peguero-Lo Presti criteria (0.56, 95% CI 0.51–0.61) was also higher than that of the Cornell voltage index (0.36, 95% CI 0.31–0.42) and Sokolow-Lyon criteria (0.24, 95% CI 0.18–0.31); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.84, 95% CI 0.80–0.87) was also higher than that of the Cornell voltage index (0.54, 95% CI 0.50–0.58) and Sokolow-Lyon criteria (0.38, 95% CI 0.34–0.42); and the specificity of the Peguero-Lo Presti criteria (0.90, 95% CI 0.87–0.92) was similar to that of the Cornell voltage index (0.93, 95% CI 0.88–0.96) and Sokolow-Lyon criteria (0.97, 95% CI 0.90–0.99). Both the likelihood ratio and posttest probability of the Peguero-Lo Presti criteria and Cornell voltage index were moderate. Conclusion Based on this systematic review and meta-analysis, the Peguero-Lo Presti criteria-based ECG diagnostic method for LVH has high sensitivity, specificity and diagnostic accuracy and should be applied in clinical practice settings.
Collapse
Affiliation(s)
- Zongying Yu
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jie Song
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Li Cheng
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Shasha Li
- Department of Cardiology, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qun Lu
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yafeng Zhang
- Department of Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaoci Lin
- Department of Internal Medicine, The First People's Hospital of Daishan, Zhejiang, China
| | - Dadong Liu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
- * E-mail:
| |
Collapse
|
20
|
Miller RJH, Mikami Y, Heydari B, Wilton SB, James MT, Howarth AG, White JA, Lydell CP. Sex-specific relationships between patterns of ventricular remodelling and clinical outcomes. Eur Heart J Cardiovasc Imaging 2020; 21:983-990. [DOI: 10.1093/ehjci/jeaa164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
Abstract
Aims
Left ventricular hypertrophy (LVH) is the most common form of myocardial remodelling and predicts adverse outcomes in patients with coronary artery disease (CAD). However, sex-specific prevalence and prognostic significance of LVH patterns are poorly understood. We investigated the sex-specific influence of LVH pattern on clinical outcomes in patients undergoing cardiovascular magnetic resonance (CMR) and coronary angiography following adjustment for co-morbidities including CAD burden.
Methods and results
Patients undergoing CMR and coronary angiography between 2005 and 2013 were included. Volumetric measurements of left ventricular (LV) mass with classification of concentric vs. eccentric remodelling patterns were determined from CMR cine images. Multivariable Cox analysis was performed to assess independent associations with the primary outcome of all-cause mortality. In total, 3754 patients were studied (mean age 59.3 ± 13.1 years), including 1039 (27.7%) women. Women were more likely to have concentric remodelling (8.1% vs. 2.1%, P < 0.001), less likely to have eccentric hypertrophy (15.1% vs. 26.8%, P < 0.001) and had a similar prevalence of concentric hypertrophy (6.1 vs. 5.2%, P = 0.296) compared to men. At a median follow-up of 3.7 years, 315 (8.4%) patients died. Following adjustment including CAD burden, concentric hypertrophy was associated with increased all-cause mortality in women [adjusted hazard ratio (HR) 3.48, P < 0.001] and men (adjusted HR 2.57, P < 0.001). Eccentric hypertrophy was associated with all-cause mortality only in women (adjusted HR 1.78, P = 0.047).
Conclusion
Patterns of LV remodelling differ by sex and LVH and provides prognostic information in both men and women. Our findings support the presence of sex-specific factors influencing LV remodelling.
Collapse
Affiliation(s)
- Robert J H Miller
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthew T James
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
21
|
Desai YB, Mishra RK, Fang Q, Whooley MA, Schiller NB. Association of Longitudinal Change in High-Sensitivity Troponin with All-Cause Mortality in Coronary Artery Disease: The Heart and Soul Study. Cardiology 2020; 145:63-70. [PMID: 31910405 DOI: 10.1159/000503954] [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: 03/16/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serial increases in high-sensitivity cardiac troponin (hs-cTnT) have been associated with death in community-dwelling adults, but the association remains uninvestigated in those with coronary artery disease (CAD). METHODS We measured hs-cTnT at baseline and after 5 years in 635 ambulatory Heart and Soul Study patients with CAD. We also performed echocardiography at rest and after treadmill exercise at baseline and after 5 years. Participants were subsequently followed for the outcome of death. We used a multivariable-adjusted Cox proportional hazards model to evaluate the association between 5-year change in hs-cTnT and subsequent all-cause mortality. RESULTS Of the 635 subjects, there were 386 participants (61%) who had an increase in hs-cTnT levels between baseline and year 5 measurements (median increase 5.6 pg/mL, IQR 3.2-9.9 pg/mL). There were 182 deaths after a mean 4.2-year follow-up after the year 5 visit. After adjusting for clinical variables, a >50% increase in hs-cTnT between baseline and year 5 was associated with a nearly 2-fold increased risk of death from any cause (hazard ratio 1.7, 95% confidence interval 1.1-2.7). When addition of year 5 hs-cTnT was compared to a model including clinical variables and baseline hs-cTnT, there was a modest but statistically significant increase in C-statistic from 0.82 to 0.83 (p = 0.04). CONCLUSION In ambulatory patients with CAD, serial increases in hs-cTnT over time are associated with an increased risk of death.
Collapse
Affiliation(s)
- Yaanik B Desai
- Department of Medicine, UCSF School of Medicine, San Francisco, California, USA,
| | - Rakesh K Mishra
- Division of Cardiology, UCSF School of Medicine, San Francisco, California, USA
| | - Qizhi Fang
- Division of Cardiology, UCSF School of Medicine, San Francisco, California, USA
| | - Mary A Whooley
- Department of Medicine, UCSF School of Medicine, San Francisco, California, USA.,Section of General Internal Medicine, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Nelson B Schiller
- Division of Cardiology, UCSF School of Medicine, San Francisco, California, USA
| |
Collapse
|
22
|
Verma S, Mazer CD, Yan AT, Mason T, Garg V, Teoh H, Zuo F, Quan A, Farkouh ME, Fitchett DH, Goodman SG, Goldenberg RM, Al-Omran M, Gilbert RE, Bhatt DL, Leiter LA, Jüni P, Zinman B, Connelly KA. Effect of Empagliflozin on Left Ventricular Mass in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The EMPA-HEART CardioLink-6 Randomized Clinical Trial. Circulation 2019; 140:1693-1702. [PMID: 31434508 DOI: 10.1161/circulationaha.119.042375] [Citation(s) in RCA: 359] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND SGLT2 (sodium-glucose cotransporter 2) inhibitors lower cardiovascular events in type 2 diabetes mellitus but whether they promote direct cardiac effects remains unknown. We sought to determine if empagliflozin causes a decrease in left ventricular (LV) mass in people with type 2 diabetes mellitus and coronary artery disease. METHODS Between November 2016 and April 2018, we recruited 97 individuals ≥40 and ≤80 years old with glycated hemoglobin 6.5% to 10.0%, known coronary artery disease, and estimated glomerular filtration rate ≥60mL/min/1.73m2. The participants were randomized to empagliflozin (10 mg/day, n=49) or placebo (n=48) for 6 months, in addition to standard of care. The primary outcome was the 6-month change in LV mass indexed to body surface area from baseline as measured by cardiac magnetic resonance imaging. Other measures included 6-month changes in LV end-diastolic and -systolic volumes indexed to body surface area, ejection fraction, 24-hour ambulatory blood pressure, hematocrit, and NT-proBNP (N-terminal pro b-type natriuretic peptide). RESULTS Among the 97 participants (90 men [93%], mean [standard deviation] age 62.8 [9.0] years, type 2 diabetes mellitus duration 11.0 [8.2] years, estimated glomerular filtration rate 88.4 [16.9] mL/min/1.73m2, LV mass indexed to body surface area 60.7 [11.9] g/m2), 90 had evaluable imaging at follow-up. Mean LV mass indexed to body surface area regression over 6 months was 2.6 g/m2 and 0.01 g/m2 for those assigned empagliflozin and placebo, respectively (adjusted difference -3.35 g/m2; 95% CI, -5.9 to -0.81g/m2, P=0.01). In the empagliflozin-allocated group, there was significant lowering of overall ambulatory systolic blood pressure (adjusted difference -6.8mmHg, 95% CI -11.2 to -2.3mmHg, P=0.003), diastolic blood pressure (adjusted difference -3.2mmHg; 95% CI, -5.8 to -0.6mmHg, P=0.02) and elevation of hematocrit (P=0.0003). CONCLUSIONS Among people with type 2 diabetes mellitus and coronary artery disease, SGLT2 inhibition with empagliflozin was associated with significant reduction in LV mass indexed to body surface area after 6 months, which may account in part for the beneficial cardiovascular outcomes observed in the EMPA-REG OUTCOME (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02998970.
Collapse
Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery (S.V., M.A.O.), University of Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesia (C.D.M.), University of Toronto, Ontario, Canada.,Department of Physiology (C.D.M., K.A.C.), University of Toronto, Ontario, Canada
| | - Andrew T Yan
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
| | - Tamique Mason
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada
| | - Vinay Garg
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital/Mount Sinai Hospital, Ontario, Canada (M.E.F.)
| | - David H Fitchett
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Shaun G Goodman
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Canadian Heart Research Centre, Toronto, Ontario (S.G.G.).,Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research Centre, University of Alberta, Edmonton (S.G.G.)
| | | | - Mohammed Al-Omran
- Division of Vascular Surgery (M.A.O.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery (S.V., M.A.O.), University of Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada
| | - Richard E Gilbert
- Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Department of Nutritional Sciences (L.A.L.), University of Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation (P.J.), University of Toronto, Ontario, Canada
| | - Bernard Zinman
- Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (B.Z.)
| | - Kim A Connelly
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physiology (C.D.M., K.A.C.), University of Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
| |
Collapse
|
23
|
Kim SH, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Supra-annular versus intra-annular prostheses in aortic valve replacement: impact on haemodynamics and clinical outcomes. Interact Cardiovasc Thorac Surg 2019; 28:58-64. [PMID: 30010890 DOI: 10.1093/icvts/ivy190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/13/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The superiority of supra-annular aortic prostheses over intra-annular equivalents in long-term haemodynamics and clinical outcomes remains controversial. This study compared outcomes among patients receiving supra-annular or intra-annular prostheses during aortic valve replacement. METHODS We enrolled 587 consecutive patients (mean age 55.1 ± 11.3 years; 188 women) undergoing aortic valve replacement with either supra-annular (n = 316) or intra-annular (n = 271) mechanical prostheses between 2000 and 2016 in our institute. Clinical outcomes and haemodynamic profiles in the 2 groups were compared after propensity score adjustment. RESULTS Early death (1.1% vs 0.6%; P = 0.863) was equivalent for both groups. Patients receiving supra-annular prostheses showed a lower rate of patient-prosthesis mismatch (1.2% vs 25.8%; P < 0.001). During a median follow-up of 65 months (quartile 1-3, 30-108 months), overall deaths occurred in 84 (14.3%) patients. The latest echocardiographic assessment in the 136 propensity score-matched pairs demonstrated superior haemodynamics with implantation of supra-annular prostheses: peak velocity (2.7 ± 0.6 vs 2.3 ± 0.5 m/s; P < 0.001), mean pressure gradient (16.5 ± 9.0 vs 12.0 ± 6.2 mmHg; P < 0.001) and left ventricular mass index (113.6 ± 30.3 vs 105.3 ± 26.3 g/m2; P = 0.016). After adjusting with inverse-probability-of-treatment weighting, however, the choice of supra-annular over intra-annular prosthesis did not significantly affect the risk of overall mortality (P = 0.693) or major adverse events: stroke (P = 0.944), infective endocarditis (P = 0.958) and reoperation (P = 0.944). CONCLUSIONS The implantation of supra-annular prostheses resulted in superior haemodynamics and left ventricular mass regression, while conferring no apparent clinical benefits. Follow-up studies are required to further evaluate the impact of superior haemodynamics associated with supra-annular prostheses on long-term clinical outcomes.
Collapse
Affiliation(s)
- Sang Hyun Kim
- College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Packard RRS, Maddahi J. Assessment of left ventricular mass by SPECT MPI. J Nucl Cardiol 2019; 26:906-908. [PMID: 29243071 DOI: 10.1007/s12350-017-1146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jamshid Maddahi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| |
Collapse
|
25
|
Seng MC, Shen X, Wang K, Chong DT, Fam JM, Hamid N, Amanullah MR, Yeo KK, Ewe SH, Chua TS, Ding ZP, Sahlén A. Allometric Relationships for Cardiac Size and Longitudinal Function in Healthy Chinese Adults - Normal Ranges and Clinical Correlates. Circ J 2018; 82:1836-1843. [PMID: 29695648 DOI: 10.1253/circj.cj-18-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac size measurements require indexing to body size. Allometric indexing has been investigated in Caucasian populations but a range of different values for the so-called allometric power exponent (b) have been proposed, with uncertainty as to whether allometry offers clinical utility above body surface area (BSA)-based indexing. We derived optimal values for b in normal echocardiograms and validated them externally in cardiac patients. METHODS AND RESULTS Values for b were derived in healthy adult Chinese males (n=1,541), with optimal b for left ventricular mass (LVM) of 1.66 (95% confidence interval 1.41-1.92). LV hypertrophy (LVH) defined as indexed LVM >75 g/m1.66 was associated with adverse outcomes in an external validation cohort (n=738) of patients with acute coronary syndrome (odds ratio for reinfarction: 2.4 (1.1-5.4)). In contrast, LVH defined by BSA-based indexing or allometry using exponent 2.7 exhibited no significant association with outcomes (P=NS for both). Cardiac longitudinal function also varied with body size: septal and RV free wall s', TAPSE and lateral e' all scaled allometrically (b=0.3-0.9). CONCLUSIONS An optimal b of 1.66 for LVM in healthy Chinese was found to validate well, with superior clinical utility both to that of BSA-based indexing and to b=2.7. The effect of allometric indexing of cardiac function requires further study.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anders Sahlén
- National Heart Centre Singapore.,Karolinska Institutet
| |
Collapse
|
26
|
Reichek N. LVH and CAD: New Steps Down an Old Path. JACC Cardiovasc Imaging 2017; 11:434-436. [PMID: 28734917 DOI: 10.1016/j.jcmg.2017.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nathaniel Reichek
- Research Department and the Cardiac Imaging Program, St. Francis Hospital, The Heart Center, Roslyn, New York; Cardiology Division and Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York.
| |
Collapse
|