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Kazzi B, Jani V, Akl EW, Rana R, Gilotra NA, Bavaro N, Metkus TS, Hays AG, Mukherjee M. Sex Differences in Echocardiographic Characteristics of COVID-19 Patients. JACC. ADVANCES 2023; 2:100440. [PMID: 38939435 PMCID: PMC11198622 DOI: 10.1016/j.jacadv.2023.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | | | | | | | | | | | | | | | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, 301 Mason Lord Drive, Suite 2400, Baltimore, Maryland 21224, USA.
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Alhakak AS, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Espersen C, Abildgaard U, Jensen GB, Schnohr P, Marott JL, Søgaard P, Møgelvang R, Biering-Sørensen T. Changes in cardiac time intervals over a decade and the risk of incident heart failure: The Copenhagen City heart study. Int J Cardiol 2023:S0167-5273(23)00709-X. [PMID: 37178800 DOI: 10.1016/j.ijcard.2023.05.018] [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: 01/01/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The cardiac time intervals include the isovolumic contraction time (IVCT), the left ventricular ejection time (LVET), the isovolumic relaxation time (IVRT) and the combination of all the cardiac time intervals in the myocardial performance index (MPI) (defined as [(IVCT+IVRT)/LVET)]. Whether the cardiac time intervals change over time and which clinical factors that accelerate these changes is not well-established. Additionally, whether these changes are associated with subsequent heart failure (HF), remains unknown. METHODS We investigated participants from the general population (n = 1064) who had an echocardiographic examination including color tissue Doppler imaging performed in both the 4th and 5th Copenhagen City Heart Study. The examinations were performed 10.5 years apart. RESULTS The IVCT, LVET, IVRT and MPI increased significantly over time. None of the investigated clinical factors were associated with increase in IVCT. Systolic blood pressure (standardized β= - 0.09) and male sex (standardized β= - 0.08) were associated with an accelerated decrease in LVET. Age (standardized β=0.26), male sex (standardized β=0.06), diastolic blood pressure (standardized β=0.08), and smoking (standardized β=0.08) were associated with an increase in IVRT, while HbA1c (standardized β= - 0.06) was associated with a decrease in IVRT. Increasing IVRT over a decade was associated with an increased risk of subsequent HF in participants aged <65 years (per 10 ms increase: HR 1.33; 95%CI (1.02-1.72), p = 0.034). CONCLUSION The cardiac time increased significantly over time. Several clinical factors accelerated these changes. An increase in IVRT was associated with an increased risk of subsequent HF in participants aged <65 years.
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Affiliation(s)
- Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Espersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Meloni A, Righi R, Missere M, Renne S, Schicchi N, Gamberini MR, Cuccia L, Lisi R, Spasiano A, Roberti MG, Zuccarelli A, Ait-Ali L, Festa P, Aquaro GD, Mangione M, Barra V, Positano V, Pepe A. Biventricular Reference Values by Body Surface Area, Age, and Gender in a Large Cohort of Well-Treated Thalassemia Major Patients Without Heart Damage Using a Multiparametric CMR Approach. J Magn Reson Imaging 2020; 53:61-70. [PMID: 32311193 DOI: 10.1002/jmri.27169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cardiac MRI plays a critical role in the management of thalassemic patients. No accurate biventricular reference values are available. PURPOSE To establish the ranges for normal left ventricular (LV) and right ventricular (RV) volumes and ejection fraction (EF) and LV mass normalized to body surface area (BSA), age, and gender in a large cohort of well-treated beta-thalassemia major (β-TM) patients without heart damage using a multiparametric MRI. STUDY TYPE Retrospective/cohort study. POPULATION In all, 251 β-TM patients with no known risk factors or cardiac disease, normal electrocardiogram, no macroscopic myocardial fibrosis, and all cardiac segments with T2 * ≥20 msec, and 246 healthy subjects. FIELD STRENGTH/SEQUENCE 1.5T/cine steady-state free precession (SSFP), gradient-echo T2 *, late gadolinium enhancement (LGE) images. ASSESSMENT Biventricular end-diastolic volume, end-systolic volume, stroke volume, and LV mass were normalized to BSA (EDVI, ESVI, SVI). STATISTICAL TESTS Comparisons between the two groups was performed with two-samples t-test or Wilcoxon's signed rank test. For more than two groups, one-way analysis of variance (ANOVA) or a Kruskal-Wallis test were applied. RESULTS Compared to controls, males with β-TM showed significantlt higher LVEDVI in all the age groups, while for the other volumes the difference was significant only within one or more age groups. In females the volumes were comparable between β-TM patients and healthy subjects in all the age groups. In the male β-TM population we found a significant effect of age on LVEDVI (P = 0.017), LVESVI (P = 0.001), RVESVI (P = 0.029), and RVEF (P = 0.031), while for females none of the biventricular parameters were significantly different among the age groups (LVEDVI: P = 0.614; LVESVI: P = 0.449; LVSVI: P = 0.186; LV mass index: P = 0.071; LVEF: P = 0.059; RVEDVI: P = 0.374; RVESVI: P = 0.180; RVSVI: P = 0.206; RVEF: P = 0.057). In β-TM patients all biventricular volume indexes as well as the LV mass index were significantly larger in males than in females (P < 0.0001 in all cases). The LV and the RV EF were comparable between the sexes (P = 0.568 and P = 0.268, respectively). DATA CONCLUSION Appropriate "normal" reference ranges normalized to BSA, sex, and age are recommended to avoid misdiagnosis of cardiomyopathy in β-TM patients. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Italy
| | - Massimiliano Missere
- Dipartimento di Immagini, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | - Nicolò Schicchi
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-Lancisi-Salesi", Ancona, Italy
| | - Maria Rita Gamberini
- Dipartimento della Riproduzione e dell'Accrescimento Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria Arcispedale "S. Anna", Ferrara, Italy
| | - Liana Cuccia
- Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico "Benfratelli-Di Cristina", Palermo, Italy
| | - Roberto Lisi
- Unità Operativa Dipartimentale Talassemia, Presidio Ospedaliero Garibaldi-Centro-ARNAS Garibaldi, Catania, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Maria Grazia Roberti
- Servizio Trasfusionale, Azienda Ospedaliero-Universitaria OO.RR. Foggia, Foggia, Italy
| | - Angelo Zuccarelli
- U.O. Medicina trasfusionale, Presidio Ospedaliero Sirai, Carbonia, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Massa, Italy
| | - Pierluigi Festa
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.,Pediatric Cardiology and GUCH Unit, Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy
| | - Giovanni Donato Aquaro
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maurizio Mangione
- U.O.S. Sistemi informativi (UOSI), Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Valerio Barra
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vincenzo Positano
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
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Kobayashi T, Shiba T, Nishiwaki Y, Kinoshita A, Matsumoto T, Hori Y. Influence of age and gender on the pulse waveform in optic nerve head circulation in healthy men and women. Sci Rep 2019; 9:17895. [PMID: 31784662 PMCID: PMC6884619 DOI: 10.1038/s41598-019-54470-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023] Open
Abstract
The influences of age and gender differences on the pulse waveform in the optic nerve head (ONH) in healthy adults, using laser speckle flowgraphy (LSFG) were evaluated. We studied 908 healthy subjects (men = 701, age: 50.0 ± 9.1, women = 208, age: 49.8 ± 9.5, p = 0.76), evaluating these pulse waveform parameters: the blowout score (BOS), blowout time (BOT), acceleration time index (ATI), and the rising and falling rates. The parameters were analyzed separately for the tissue, vessels, and throughout the optic nerve head (All). All parameters were compared between genders. We investigated which independent factors for the pulse waveform in the ONH is most strongly correlated with age. All sections of the BOS, BOT, ATI, and falling rate showed a significant gender difference. A univariate regression analysis revealed that BOT-Tissue showed the strongest correlation with age (r = −0.51). The factors contributing independently to the BOT-Tissue were gender, age, heart rate, mean arterial blood pressure, pulse pressure, spherical refraction, and estimated glomerular filtration rate. Among the subjects aged >41 years, the chronological changes of BOT-Tissue in the women were significantly lower than those in the men. We concluded that the pulse waveform in the ONH has clear differences between the genders and shows chronological changes.
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Affiliation(s)
- Tatsuhiko Kobayashi
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Tomoaki Shiba
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan.
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Ayako Kinoshita
- Department of Ophthalmology, Japan Community Health Care Organization, Tokyo Kamata Medical Center, Tokyo, Japan
| | - Tadashi Matsumoto
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
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Petitto M, Esposito R, Sorrentino R, Lembo M, Luciano F, De Roberto AM, La Mura L, Pezzullo E, Maffei S, Galderisi M, Lancellotti P. Sex-specific echocardiographic reference values: the women's point of view. J Cardiovasc Med (Hagerstown) 2019; 19:527-535. [PMID: 30015781 DOI: 10.2459/jcm.0000000000000696] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: Clinical presentation, diagnosis and outcomes of cardiac diseases are influenced by the activity of sex steroid hormones. These hormonal differences explain the later development of heart diseases in women in comparison with men and the different clinical picture, management and prognosis. Echocardiography is a noninvasive and easily available technique for the analysis of cardiac structure and function. The aim of the present review is to underline the most important echocardiographic differences between sexes. Several echocardiographic studies have found differences in healthy populations between women and men. Sex-specific difference of some of these parameters, such as left ventricular (LV) linear dimensions and left atrial volume, can be explained on the grounds of smaller body size of women, but other parameters (LV volumes, stroke volume and ejection fraction, right ventricular size and systolic function) are specifically lower in women, even after adjusting for body size and age. Sex-specific differences of standard Doppler and Tissue Doppler diastolic indices remain controversial, but it is likely for aging to affect LV diastolic function more in women than in men. Global longitudinal strain appears to be higher in women during the childbearing age - a finding that also highlights a possible hormonal influence in women. All these findings have practical implications, and sex-specific reference values are necessary for the majority of echocardiographic parameters in order to distinguish normalcy from disease. Careful attention on specific cut-off points in women could avoid misinterpretation, inappropriate management and delayed treatment of cardiac diseases such as valvular disease and heart failure.
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Affiliation(s)
- Marta Petitto
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Roberta Esposito
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Regina Sorrentino
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Maria Lembo
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Federica Luciano
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Anna Maria De Roberto
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Lucia La Mura
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Enrica Pezzullo
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Silvia Maffei
- Cardiovascular and Gynecological Endocrinology, Fondazione Toscana 'G. Monasterio' for Clinical Research and Public Health, CNR-Regione Toscana, Pisa, Italy
| | - Maurizio Galderisi
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Patrizio Lancellotti
- Department of Cardiology and Cardiovascular Surgery, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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6
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Michalson KT, Groban L, Howard TD, Shively CA, Sophonsritsuk A, Appt SE, Cline JM, Clarkson TB, Carr JJ, Kitzman DW, Register TC. Estradiol Treatment Initiated Early After Ovariectomy Regulates Myocardial Gene Expression and Inhibits Diastolic Dysfunction in Female Cynomolgus Monkeys: Potential Roles for Calcium Homeostasis and Extracellular Matrix Remodeling. J Am Heart Assoc 2018; 7:e009769. [PMID: 30571375 PMCID: PMC6404177 DOI: 10.1161/jaha.118.009769] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023]
Abstract
Background Left ventricular ( LV ) diastolic dysfunction often precedes heart failure with preserved ejection fraction, the dominant form of heart failure in postmenopausal women. The objective of this study was to determine the effect of oral estradiol treatment initiated early after ovariectomy on LV function and myocardial gene expression in female cynomolgus macaques. Methods and Results Monkeys were ovariectomized and randomized to receive placebo (control) or oral estradiol at a human-equivalent dose of 1 mg/day for 8 months. Monkeys then underwent conventional and tissue Doppler imaging to assess cardiac function, followed by transcriptomic and histomorphometric analyses of LV myocardium. Age, body weight, blood pressure, and heart rate were similar between groups. Echocardiographic mitral early and late inflow velocities, mitral annular velocities, and mitral E deceleration slope were higher in estradiol monkeys (all P<0.05), despite similar estimated LV filling pressure. MCP1 (monocyte chemoattractant protein 1) and LV collagen staining were lower in estradiol animals ( P<0.05). Microarray analysis revealed differential myocardial expression of 40 genes (>1.2-fold change; false discovery rate, P<0.05) in estradiol animals relative to controls, which implicated pathways associated with better calcium ion homeostasis and muscle contraction and lower extracellular matrix deposition ( P<0.05). Conclusions Estradiol treatment initiated soon after ovariectomy resulted in enhanced LV diastolic function, and altered myocardial gene expression towards decreased extracellular matrix deposition, improved myocardial contraction, and calcium homeostasis, suggesting that estradiol directly or indirectly modulates the myocardial transcriptome to preserve cardiovascular function.
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Affiliation(s)
- Kristofer T. Michalson
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - Leanne Groban
- Department of AnesthesiologyWake Forest University School of MedicineWinston‐SalemNC
| | - Timothy D. Howard
- Department of BiochemistryWake Forest University School of MedicineWinston‐SalemNC
| | - Carol A. Shively
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - Areepan Sophonsritsuk
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - Susan E. Appt
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - J. Mark Cline
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - Thomas B. Clarkson
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
| | - J. Jeffrey Carr
- Department of RadiologyVanderbilt University School of MedicineNashvilleTN
| | - Dalane W. Kitzman
- Section on CardiologyDepartment of Internal MedicineWake Forest University School of MedicineWinston‐SalemNC
| | - Thomas C. Register
- Section on Comparative MedicineDepartment of PathologyWake Forest University School of MedicineWinston‐SalemNC
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Shiba T, Takahashi M, Shiba C, Matsumoto T, Hori Y. The relationships between the pulsatile flow form of ocular microcirculation by laser speckle flowgraphy and the left ventricular end-diastolic pressure and mass. Int J Cardiovasc Imaging 2018; 34:1715-1723. [PMID: 29858961 DOI: 10.1007/s10554-018-1388-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
Abstract
To evaluate the relationships between parameters of the pulsatile flow form in the optic nerve head shown by laser speckle flowgraphy (LSFG) and the left ventricular (LV) end-diastolic pressure and mass obtained by echocardiography. We cross sectional analyzed the cases of 175 subjects who had undergone polysomnography. Standard M-mode two-dimensional color Doppler imaging was performed to evaluate the E/e' ratio (which represents the LV end-diastolic pressure) and LV mass. The pulsatile flow form analysis parameters of the blowout score and acceleration time index were evaluated. The parameters were analyzed separately for the tissue, vessels and throughout the optic nerve head (All). We performed a single regression analysis and a multiple regression analysis to determine whether pulsatile flow form are independent factors for the E/e' ratio and LV mass. The factors contributing independently to the E/e' ratio were blowout time-Tissue (standard regression = - 0.27, t-value = - 2.90, p < 0.0001) and body mass index (BMI) (0.16, 2.05, p = 0.04). The factors that were shown to independently contribute to the LV mass were urinary albumin concentration (0.30, - 2.90, p < 0.0001), BMI (0.28, 4.09, p < 0.0001), differences of gender (men = 1, women = 0: 0.23, 3.28, p = 0.001), acceleration time index-Vessel (- 0.23, - 2.99, p = 0.003) and mean arterial blood pressure (0.17, 2.61, p = 0.01). Our results confirmed that parameters of the pulsatile flow form of ocular microcirculation obtained by LSFG are significantly correlated with the LV end-diastolic pressure ratio and LV mass.
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Affiliation(s)
- Tomoaki Shiba
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Mao Takahashi
- Cardiovascular Center, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Chieko Shiba
- Shiba Eye Clinic, Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan
| | - Tadashi Matsumoto
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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8
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Chandramouli C, Reichelt ME, Curl CL, Varma U, Bienvenu LA, Koutsifeli P, Raaijmakers AJA, De Blasio MJ, Qin CX, Jenkins AJ, Ritchie RH, Mellor KM, Delbridge LMD. Diastolic dysfunction is more apparent in STZ-induced diabetic female mice, despite less pronounced hyperglycemia. Sci Rep 2018; 8:2346. [PMID: 29402990 PMCID: PMC5799292 DOI: 10.1038/s41598-018-20703-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/23/2018] [Indexed: 12/17/2022] Open
Abstract
Diabetic cardiomyopathy is a distinct pathology characterized by early emergence of diastolic dysfunction. Increased cardiovascular risk associated with diabetes is more marked for women, but an understanding of the role of diastolic dysfunction in female susceptibility to diabetic cardiomyopathy is lacking. To investigate the sex-specific relationship between systemic diabetic status and in vivo occurrence of diastolic dysfunction, diabetes was induced in male and female mice by streptozotocin (5x daily i.p. 55 mg/kg). Echocardiography was performed at 7 weeks post-diabetes induction, cardiac collagen content assessed by picrosirius red staining, and gene expression measured using qPCR. The extent of diabetes-associated hyperglycemia was more marked in males than females (males: 25.8 ± 1.2 vs 9.1 ± 0.4 mM; females: 13.5 ± 1.5 vs 8.4 ± 0.4 mM, p < 0.05) yet in vivo diastolic dysfunction was evident in female (E/E' 54% increase, p < 0.05) but not male diabetic mice. Cardiac structural abnormalities (left ventricular wall thinning, collagen deposition) were similar in male and female diabetic mice. Female-specific gene expression changes in glucose metabolic and autophagy-related genes were evident. This study demonstrates that STZ-induced diabetic female mice exhibit a heightened susceptibility to diastolic dysfunction, despite exhibiting a lower extent of hyperglycemia than male mice. These findings highlight the importance of early echocardiographic screening of asymptomatic prediabetic at-risk patients.
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Affiliation(s)
- Chanchal Chandramouli
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- National Heart Centre, Singapore, Singapore
| | - Melissa E Reichelt
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Claire L Curl
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Upasna Varma
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura A Bienvenu
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Parisa Koutsifeli
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | | | - Miles J De Blasio
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- School of Biosciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Cheng Xue Qin
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca H Ritchie
- Heart Failure Pharmacology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kimberley M Mellor
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Lea M D Delbridge
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia.
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Pavlovic M, Schaller A, Steiner B, Berdat P, Carrel T, Pfammatter JP, Ammann RA, Gallati S. Gender Modulates the Expression of Calcium-Regulating Proteins in Pediatric Atrial Myocardium. Exp Biol Med (Maywood) 2016; 230:853-9. [PMID: 16339750 DOI: 10.1177/153537020523001110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A differential expression of sarcoplasmic reticulum calcium-ATPase (SERCA2a) and phospholamban (PLB) characterizes the remodeling process in heart failure and atrial arrhythmias in adult patients. Gender is known to modulate the course and Prognosis of different forms of heart disease. We hypothesized that gender plays a role in molecular changes of myocardial calcium regulating components already in childhood. Moreover, we studied the influence of volume overloaded (VO) on SERCA2a and PLB in pediatric patients. Quantitative reverse transcription-polymerase chain reaction was used to measure mRNA expression of SERCA2a and PLB in atrial myocardium from 30 pediatric patients (12 girls, 18 boys). Eighteen patients had VO right atria, and 12 patients had not-overloaded atria (NO). Protein expression was studied by Western blot. In the entire population, SERCA2a and PLB expression was not different between girls and boys. If hemodynamic overload was taken into account, SERCA2a mRNA expression was significantly reduced in the VO group compared with the NO group (P = 0.021). The VO versus NO difference was restricted to toys, which corresponds to a highly significant interaction of gender versus VO status (P = 0.002). The PLB to SERCA2a Protein ratio was significantly lower in girls (P = 0.028). The decrease in SERCA2a mRNA expression in VO atrial myocardium and the PLB to SERCA2a ratio of protein expression was modulated by gender in this pediatric population. To our knowledge, this study is the first to show the impact of gender on the differential expression of calcium-regulating components in Pediatric cardiac patients.
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Affiliation(s)
- Mladen Pavlovic
- Division of Pediatric Cardiology, University Children's Hospital, Berne, Switzerland.
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Waggoner AD. Echocardiographic Assessment of Left Ventricular Structure in Hypertension and the Impact on Clinical Outcomes. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479304268200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertension (HTN) is present in nearly 50 million individuals, or approximately 29% of the adult US population. The prevalence of HTN is higher in men, increases with age, and varies among ethnic groups. Alterations of left ventricular structure and function can be present in patients with HTN and accurately characterized by echocardiography. The presence of left ventricular hypertrophy with increased left ventricular mass has prognostic implications in patients with HTN.
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Affiliation(s)
- Alan D. Waggoner
- Cardiovascular Division, Washington University School of Medicine, Saint Louis, MO.,
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Effects of sex and hypertension subtype on haemodynamics and left ventricular diastolic function in older patients with stage 1 hypertension. J Hypertens 2015; 31:2282-9; discussion 2289. [PMID: 24077248 DOI: 10.1097/hjh.0b013e3283649730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertension is associated with cardiovascular stiffening and left ventricular diastolic dysfunction, leading to comorbidities such as heart failure with preserved ejection fraction (HFpEF). It is unknown whether sex and hypertension subtype affect haemodynamics and left ventricular function in older individuals. METHODS Ninety-five older patients with Stage 1 hypertension (ambulatory awake SBP135-159 mmHg) and 56 normotensive controls were enrolled. Patients were stratified prospectively into isolated systolic hypertension (ISH, DBP <85 mmHg) or systolic-diastolic hypertension (SDH, DBP ≥85 mmHg). Haemodynamics and Doppler variables including early filling (E) and averaged mitral annular (E'mean) velocities were measured during supine rest. RESULTS Ambulatory awake blood pressures (BPs) were the highest in SDH, whereas supine SBP was similar in both hypertensive groups. No sex difference was observed in supine or ambulatory awake BPs in all groups. Stroke volume was similar among groups within the same sex, but smaller in women. Women exhibited faster E, slower E'mean and greater E/E'mean, whereas no group difference was observed in E within the same sex. In women, E'mean was significantly slower in SDH (5.9 ± 1.6 vs. 7.4 ± 1.1 cm/s, P < 0.01) and ISH (6.6 ± 1.6 cm/s, P = 0.07) than controls, resulting in the highest E/E'mean in SDH. In men, E'mean and E/E'mean were similar among the three groups. CONCLUSION These results suggest that elderly hypertensive women may have left ventricular early diastolic dysfunction and higher estimated filling pressure, consistent with their susceptibility to HFpEF. Women with SDH seemed to have more left ventricular diastolic dysfunction, which might be explained by the greater cumulative afterload when ambulatory.
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Scantlebury DC, Kane GC, Wiste HJ, Bailey KR, Turner ST, Arnett DK, Devereux RB, Mosley TH, Hunt SC, Weder AB, Rodriguez B, Boerwinkle E, Weissgerber TL, Garovic VD. Left ventricular hypertrophy after hypertensive pregnancy disorders. Heart 2015; 101:1584-90. [PMID: 26243788 DOI: 10.1136/heartjnl-2015-308098] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/09/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Cardiac changes of hypertensive pregnancy include left ventricular hypertrophy (LVH) and diastolic dysfunction. These are thought to regress postpartum. We hypothesised that women with a history of hypertensive pregnancy would have altered LV geometry and function when compared with women with only normotensive pregnancies. METHODS In this cohort study, we analysed echocardiograms of 2637 women who participated in the Family Blood Pressure Program. We compared LV mass and function in women with hypertensive pregnancies with those with normotensive pregnancies. RESULTS Women were evaluated at a mean age of 56 years: 427 (16%) had at least one hypertensive pregnancy; 2210 (84%) had normotensive pregnancies. Compared with women with normotensive pregnancies, women with hypertensive pregnancy had a greater risk of LVH (OR: 1.42; 95% CI 1.01 to 1.99, p=0.05), after adjusting for age, race, research network of the Family Blood Pressure Program, education, parity, BMI, hypertension and diabetes. When duration of hypertension was taken into account, this relationship was no longer significant (OR: 1.19; CI 0.08 to 1.78, p=0.38). Women with hypertensive pregnancies also had greater left atrial size and lower mitral E/A ratio after adjusting for demographic variables. The prevalence of systolic dysfunction was similar between the groups. CONCLUSIONS A history of hypertensive pregnancy is associated with LVH after adjusting for risk factors; this might be explained by longer duration of hypertension. This finding supports current guidelines recommending surveillance of women following a hypertensive pregnancy, and sets the stage for longitudinal echocardiographic studies to further elucidate progression of LV geometry and function after pregnancy. CLINICAL TRIAL REGISTRATIONS GENOA- NCT00005269; HyperGEN- NCT00005267; Sapphire- NCT00005270; GenNet- NCT00005268.
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Affiliation(s)
- Dawn C Scantlebury
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather J Wiste
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Donna K Arnett
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Thomas H Mosley
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Alan B Weder
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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13
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Influence of age and gender on Doppler index of diastolic function in Chinese hypertensive patients. Ir J Med Sci 2014; 184:791-7. [DOI: 10.1007/s11845-014-1173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
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14
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Glasser SP, Lynch AI, Devereux RB, Hopkins P, Arnett DK. Hemodynamic and echocardiographic profiles in African American compared with White offspring of hypertensive parents: the HyperGEN study. Am J Hypertens 2014; 27:21-6. [PMID: 24242823 DOI: 10.1093/ajh/hpt178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Alterations in cardiovascular structure and function have been shown to precede the finding of elevated blood pressure. METHODS This study is part of the Hypertension Genetic Epidemiologic Network (HyperGEN) in which genetic and environmental determinants of hypertension were investigated in 5 geographical field centers. All nonhypertensive offspring (n = 1,035) were included from the entire HyperGEN study population that consists of 2,225 hypertensive patients and 1,380 nonhypertensive patients who had adequate echocardiographic left ventricular (LV) mass measurements. Participants were compared by self-declared race (African American and white). RESULTS Nonhypertensive African American offspring were younger (aged 31 years vs. 38 years), more likely to be female, and had a higher body mass index (BMI) and higher systolic blood pressure (SBP) than their white counterparts. After adjusting for age, sex, SBP, pulse pressure (PP), BMI, diabetes status, and family effects, we observed statistically significant and potentially pathophysiological differences (all with P ≤ 0.001) with greater LV mass/height, relative wall thickness, and posterior wall thickness and with lesser midwall shortening, PP/stroke volume, and (PP/stroke volume)/fat-free body mass. CONCLUSION This study shows that ethnic differences in hemodynamic and echocardiographic profiles exist in a large, population-based cohort of nonhypertensive offspring of hypertensive parents.
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Affiliation(s)
- Stephen P Glasser
- Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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15
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Ghosh E, Kovács SJ. The vortex formation time to diastolic function relation: assessment of pseudonormalized versus normal filling. Physiol Rep 2013; 1:e00170. [PMID: 24400169 PMCID: PMC3871482 DOI: 10.1002/phy2.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 01/18/2023] Open
Abstract
In early diastole, the suction pump feature of the left ventricle opens the mitral valve and aspirates atrial blood. The ventricle fills via a blunt profiled cylindrical jet of blood that forms an asymmetric toroidal vortex ring inside the ventricle whose growth has been quantified by the standard (dimensionless) expression for vortex formation time, VFTstandard = {transmitral velocity time integral}/{mitral orifice diameter}. It can differentiate between hearts having distinguishable early transmitral (Doppler E-wave) filling patterns. An alternative validated expression, VFTkinematic reexpresses VFTstandard by incorporating left heart, near “constant-volume pump” physiology thereby revealing VFTkinematic's explicit dependence on maximum rate of longitudinal chamber expansion (E′). In this work, we show that VFTkinematic can differentiate between hearts having indistinguishable E-wave patterns, such as pseudonormal (PN; 0.75 < E/A < 1.5 and E/E′ > 8) versus normal. Thirteen age-matched normal and 12 PN data sets (738 total cardiac cycles), all having normal LVEF, were selected from our Cardiovascular Biophysics Laboratory database. Doppler E-, lateral annular E′-waves, and M-mode data (mitral leaflet separation, chamber dimension) was used to compute VFTstandard and VFTkinematic. VFTstandard did not differentiate between groups (normal [3.58 ± 1.06] vs. PN [4.18 ± 0.79], P = 0.13). In comparison, VFTkinematic for normal (3.15 ± 1.28) versus PN (4.75 ± 1.35) yielded P = 0.006. Hence, the applicability of VFTkinematic for diastolic function quantitation has been broadened to include analysis of PN filling patterns in age-matched groups.
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Affiliation(s)
- Erina Ghosh
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University in St Louis St. Louis, Missouri
| | - Sándor J Kovács
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University in St Louis St. Louis, Missouri ; Cardiovascular Biophysics Laboratory, Cardiovascular Division, Department of Internal Medicine, School of Medicine, Washington University in St Louis St. Louis, Missouri
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16
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Başçiftçi F, Eldem A. Using reduced rule base with Expert System for the diagnosis of disease in hypertension. Med Biol Eng Comput 2013; 51:1287-93. [DOI: 10.1007/s11517-013-1096-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/23/2013] [Indexed: 11/28/2022]
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17
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Meloni A, Detterich J, Berdoukas V, Pepe A, Lombardi M, Coates TD, Wood JC. Comparison of biventricular dimensions and function between pediatric sickle-cell disease and thalassemia major patients without cardiac iron. Am J Hematol 2013; 88:213-8. [PMID: 23386313 DOI: 10.1002/ajh.23376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/02/2012] [Accepted: 12/06/2012] [Indexed: 11/06/2022]
Abstract
Patients with chronic anemia develop compensatory ventricular dilation, even when maintained on chronic transfusion regimens. It is important to characterize these effects to interpret pathological changes in cardiac dimensions and function introduced by iron overload and sickle cell vasculopathy. Our primary goal was to compare biventricular dimensions and function assessed by cardiovascular magnetic resonance (CMR) in pediatric, chronically-transfused sickle-cell disease (SCD) and thalassemia major (TM) patients who had normal cardiac iron levels. Moreover, we explored systematic sex differences in ventricular dimensions in both populations. We identified 261 studies suitable for analysis from 64 patients with SCD (34 females) and 49 patients with TM (20 females). All demographic and CMR parameters were inversely weighted by the number of exams. In both populations, males had larger left and right ventricular dimensions than females, with a more marked effect observed in patients with SCD. Compared to patients with TM, patients with SCD showed significantly greater biventricular dilation and left ventricular hypertrophy. This difference could not be explained by different hemoglobin levels, cardiac iron overload, and systolic blood pressure. The left ventricular (LV) ejection fraction (EF) for the males and the right ventricular (RV) EF for both the sexes were comparable between SCD and TM groups, while females with SCD had significantly lower LV EF than females with TM. Our results represent important baseline findings that place changes introduced by iron overload as well as systemic and pulmonary vasculopathy in proper context.
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Affiliation(s)
| | - Jon Detterich
- Division of Cardiology; Children's Hospital Los Angeles; Los Angeles; California
| | - Vasili Berdoukas
- Division of Hematology; Children's Hospital Los Angeles; Los Angeles; California
| | - Alessia Pepe
- CMR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa; Italy
| | - Massimo Lombardi
- CMR Unit; Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology; Pisa; Italy
| | - Thomas D. Coates
- Division of Hematology; Children's Hospital Los Angeles; Los Angeles; California
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Gudmundsdottir H, Høieggen A, Stenehjem A, Waldum B, Os I. Hypertension in women: latest findings and clinical implications. Ther Adv Chronic Dis 2012; 3:137-46. [PMID: 23251774 DOI: 10.1177/2040622312438935] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease claims more women's lives than any other disease. Hypertension is an important risk factor for cardiovascular disease in women but is often underestimated and undiagnosed and there is an ongoing misperception that women are at a lower risk of cardiovascular disease than men. The attainment of clinical blood pressure goals can markedly reduce cardiovascular morbidity and mortality, yet approximately two-thirds of treated hypertensive women have uncontrolled blood pressure. Furthermore, there are special risk factors that are unique for women that needs acknowledgement in order to help prevent the great number of hypertension-related events in women. Guidelines for treatment of hypertension are similar for men and women. More studies on the interaction between gender and response to antihypertensive drugs would be of interest.
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Lindqvist P, Mörner S, Henein MY. Cardiac mechanisms underlying normal exercise tolerance: gender impact. Eur J Appl Physiol 2011; 112:451-9. [PMID: 21584684 DOI: 10.1007/s00421-011-1992-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 04/30/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study is to test our hypothesis that normal exercise tolerance differs according to gender and to identify potential functional cardiac relationships, which could explain those differences. A total of 44 healthy individuals with mean age of 49 ± 12 years (28-74 years, 22 males) constituted the study cohort. All individuals underwent resting and exercise Doppler echocardiogram simultaneously with peak oxygen uptake analysis (pVO(2)). At equal pVO(2), males achieved higher peak exercise workload (p < 0.001) and females higher heart rate (p < 0.001) but the two groups maintained similar indexed left ventricular (LV) stroke volume (SV) and cardiac output. Indexed LV end-diastolic (LVDVI) and end-systolic volumes (LVSVI) were smaller in females (p < 0.001 and p < 0.01, respectively), but filling time (FT) was shorter (p < 0.001) and they had higher early diastolic (E) velocity (p = 0.004), E/E (m) (myocardial E velocity) (p < 0.001) and global longitudinal strain rate atrial velocity (GLSRa') (p = 0.02), compared to males. In males, workload (p < 0.01), LVDVI (p < 0.01), LVSVI (p < 0.05), SVI (p < 0.001) directly but LV myocardial isovolumic relaxation time (IVRTm) (p < 0.01) inversely correlated with pVO(2). In females, mitral E velocity (p < 0.01), GLSRs' (p < 0.05) positively and LVFT negatively (p < 0.05) correlated with pVO(2). In a multivariable analysis SVI in males (p < 0.01) and GLSRs' in females (p < 0.01) were the strongest predictors for pVO(2). Thus, normal exercise capacity as determined by pVO(2) is related to the indexed stroke volume in males and left atrial pressure in females. These native normal differences between genders may explain the known vulnerability of women to endurance exercise compared to men.
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Affiliation(s)
- Per Lindqvist
- Department of Clinical Physiology, Heart Centre, Umeå University Hospital, 90185 Umeå, Sweden.
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21
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Kang S, Fan HM, Li J, Fan LY, Miao AY, Bao Y, Wu LZ, Zhu Y, Zhang DF, Liu ZM. Relationship of arterial stiffness and early mild diastolic heart failure in general middle and aged population. Eur Heart J 2010; 31:2799-807. [DOI: 10.1093/eurheartj/ehq296] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Otsuka T, Suzuki M, Yoshikawa H, Sugi K. Gender differences of pulsed and tissue Doppler indexes of left ventricular diastolic function in healthy subjects. J Echocardiogr 2010; 8:40-4. [PMID: 27278659 DOI: 10.1007/s12574-009-0030-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/21/2009] [Accepted: 10/23/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study is to determine the normative Doppler values and gender differences in left ventricular (LV) diastolic function in healthy subjects at each decade of life. METHODS Four hundred sixty-seven male and 455 female healthy subjects, aged 20-90 years, underwent standard echocardiography and tissue Doppler imaging. We divided the subjects into seven groups, based on the decade of their age (i.e., 20s, 30s, 40s, 50s, 60s, 70s, and 80s), and measured standard echocardiographic parameters and Doppler indices. RESULTS Females younger than 50 years had significantly higher mitral E velocity, and females older than 40 years had significantly higher mitral A velocity, compared with their male counterparts. There was no difference in mitral E to A velocity ratio (E/A) at any age. The tissue Doppler method showed significantly lower early diastole velocity of the mitral annulus (E a) in females-especially females older than 50 years-than in males (10.7 ± 3.7 versus 11.2 ± 3.7 cm/s, p < 0.025). Mean E/E a ratio was higher in females than in males (6.9 ± 2.4 versus 6.0 ± 2.0, p < 0.0001). CONCLUSION Our results indicate gender differences in Doppler indexes of LV diastolic function in healthy subjects. In clinical settings, assessment of LV diastolic function using the Doppler method should take into account patient gender.
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Affiliation(s)
- Takenori Otsuka
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-1-17 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
- Division of Clinical Physiology, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Makoto Suzuki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-1-17 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Hisao Yoshikawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-1-17 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-1-17 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
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Impact of gender on left ventricle function in postmenopausal women and age-matched men: analysis of echocardiographic parameters in healthy participants and patients with coronary artery disease. Menopause 2010; 17:560-5. [PMID: 20042894 DOI: 10.1097/gme.0b013e3181c4ef85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Our aim was to evaluate the impact of gender on the diastolic function of the left ventricle in healthy men and women and in patients with coronary artery disease (CAD) without systolic impairment. METHODS We examined 67 healthy participants (34 men with a mean age of 51 +/- 13 y and ejection fraction [EF] of 62% +/- 3% and 33 women with a mean age of 53 +/- 11 y and EF of 63% +/- 3%; P = NS) and 60 patients with CAD (36 men with a mean age of 57 +/- 10 y and EF of 59% +/- 3% and 24 women with a mean age of 59 +/- 10 y and EF of 60% +/- 3%), paired with regard to age, heart rate, and medical treatment by transthoracic echocardiography with the assessment of mitral and pulmonary vein flow parameters, propagation of mitral filling waves, and tissue Doppler variables of mitral annulus motion (MAM). The impact of gender was assessed separately for the healthy participants and the CAD group. RESULTS In healthy participants, the velocity of mitral inflow early wave and the systolic velocity of the pulmonary vein flow were significantly higher in women than in men: 77 +/- 18 versus 65 +/- 19 cm/second (P < 0.05) and 64 +/- 14 versus 57 +/- 11 cm/second (P < 0.05), respectively. On the other hand, velocities of MAM in the atrial and systolic phases were higher in men than in women: 13 +/- 2 versus 12 +/- 2 cm/second and 11 +/- 2 versus 10 +/- 2 cm/second, respectively (P < 0.05). The opposite tendency was observed in the CAD group: the ratio of early mitral inflow velocity to atrial mitral inflow velocity was significantly higher in male patients (1.1 +/- 0.5 vs 0.8 +/- 0.2; P = 0.007) and there was a trend toward faster early wave propagation in men (40 +/- 9 vs 36 +/- 8 cm/s; P = 0.08). CONCLUSIONS Our data suggest more efficient early diastolic filling in postmenopausal women than in age-matched men in healthy participants but an opposite relationship in patients with CAD.
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Chiu YW, Huang CT, Chuang HY, Chang YT, Wu MT, Liu HW. Sex Differences in Metabolic Morbidities: Influenced by Diet or Exercise Habits? Kaohsiung J Med Sci 2009; 25:647-55. [DOI: 10.1016/s1607-551x(09)70570-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Okura H, Takada Y, Yamabe A, Kubo T, Asawa K, Ozaki T, Yamagishi H, Toda I, Yoshiyama M, Yoshikawa J, Yoshida K. Age- and gender-specific changes in the left ventricular relaxation: a Doppler echocardiographic study in healthy individuals. Circ Cardiovasc Imaging 2009; 2:41-6. [PMID: 19808563 DOI: 10.1161/circimaging.108.809087] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although left ventricular diastolic function has been shown to deteriorate with advancing age, its gender-specific change is unknown. The aim of this study was to investigate age- and gender-specific changes in tissue Doppler-derived left ventricular diastolic index, E'. METHODS AND RESULTS A total of 1333 healthy individual without known heart disease or hypertension (mean age, 55 years; range, 10 to 89) were enrolled and studied. Peak early mitral annular velocity (E') and peak late mitral annular velocity (A') were recorded and measured. As an index of the left ventricular relaxation, E' was used. As an index of the left ventricular filling pressure, E/E' was calculated. Although systolic indices poorly correlated with age, diastolic indices correlated well with age. Among those aged 30 to 39 and 40 to 49 years, E' was significantly lower in males than in females. In subjects aged 50 to 59 and 60 to 69 years, E' was similar in both genders. Among those aged 70 to 79 and 80 to 89 years, E' was significantly lower in females than in males. Predictors of the lowest quartile of E' among subjects aged >50 years were age (P<0.0001; chi(2)=66.11; odds ratio, 1.08; 95% CI, 1.058 to 1.097) and female gender (P=0.002; chi(2)=9.23; odds ratio, 1.68; 95% CI, 1.202 to 2.343). CONCLUSIONS Age-related changes in diastolic indices were gender specific. In the elderly population, diastolic function deteriorated more significantly in the female gender than in the male gender. These results may explain the relatively higher incidence in elderly females among patients with diastolic heart failure and higher cardiovascular mortality in the female gender.
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Affiliation(s)
- Hiroyuki Okura
- Division of Cardiology, Bell Land General Hospital, Sakai, Japan.
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Affiliation(s)
- Ingrid Os
- Department of Pharmacotherapeutics, University of Oslo, Oslo, Norway.
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Tsioufis CP, Tsiachris DL, Selima MN, Dimitriadis KS, Thomopoulos CG, Tsiliggiris DC, Gennadi AS, Syrseloudis DC, Stefanadi ES, Toutouzas KP, Kallikazaros IE, Stefanadis CI. Impact of waist circumference on cardiac phenotype in hypertensives according to gender. Obesity (Silver Spring) 2009; 17:177-82. [PMID: 18948974 DOI: 10.1038/oby.2008.462] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our aim was to assess the differential effect of waist circumference on left-ventricular (LV) structural and functional alterations, in hypertensive males and females. One thousand seven hundred and eighty nine consecutive, nondiabetic, essential hypertensives (aged 55.8 +/- 13.5 years, 966 females), included in the 3H Study, an ongoing registry of hypertension-related-target-organ damage, were classified to obese and nonobese groups according to Adult Treatment Panel III criteria. All participants underwent complete echocardiographic study including LV diastolic function evaluation by means of conventional and tissue Doppler imaging (TDI) methods, averaging early and late diastolic mitral annular peak velocities (Em, Am, Em/Am) from four separate sites of measurement. Hypertensive obese women compared with nonobese exhibited significantly greater LV mass index and prevalence of LV hypertrophy (by 5.5 g/m(2), P = 0.003, and 8.8%, P = 0.005, respectively), while such differences were not present among men. Obese women compared to nonobese ones were accompanied by lower transmitral E/A (by 0.08, P < 0.001), TDI-derived Em/Am (by 0.12, P < 0.001), and higher E/Em ratio (by 0.8, P = 0.016). In contrast, hypertensive obese men compared to nonobese ones exhibited lower E and Em (by 0.04 m/s and 0.6 cm/s, both P < 0.05). A significant interaction between sex and abdominal obesity was observed only regarding TDI-derived Am and Em/Am. Furthermore, waist circumference was a predictor of E/A (beta = -0.097, P = 0.002) and Em/Am (beta = -0.116, P = 0.001), independently of body size, in females but not in males. The adverse effect of abdominal obesity on LV alterations is more pronounced among female hypertensives, suggesting that routine measurement of waist circumference provides additional information on cardiac phenotype especially in women.
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Affiliation(s)
- Costas P Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
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Adebayo AK, Oladapo OO, Adebiyi AA, Ogunleye OO, Ogah OS, Ojji DB, Aje A, Adeoye MA, Ochulor KC, Enakpene EO, Falase AO. Changes in left atrial dimension and function and left ventricular geometry in newly diagnosed untreated hypertensive subjects. J Cardiovasc Med (Hagerstown) 2008; 9:561-9. [DOI: 10.2459/jcm.0b013e3282f2197f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Groban L, Yamaleyeva LM, Westwood BM, Houle TT, Lin M, Kitzman DW, Chappell MC. Progressive diastolic dysfunction in the female mRen(2). Lewis rat: influence of salt and ovarian hormones. J Gerontol A Biol Sci Med Sci 2008; 63:3-11. [PMID: 18245755 DOI: 10.1093/gerona/63.1.3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study determined the contribution of chronic salt loading and early loss of ovarian hormones on diastolic function in the hypertensive female mRen(2). Lewis rat, a monogenetic strain that expresses the mouse renin-2 gene in various tissues. Estrogen-intact mRen2 rats fed a high salt (HS) (8% sodium chloride) diet exhibited early diastolic dysfunction when compared to normal salt-fed (NS) (1% sodium chloride) rats. In contrast, ovariectomized (OVX) rats on either NS or HS diets showed impaired relaxation with evidence of elevated left ventricular filling pressures (E/e') or pseudonormalization. This more advanced stage of diastolic dysfunction was associated with increases in interstitial cardiac fibrosis and high circulating levels of aldosterone, two factors leading to reduced ventricular compliance. These findings may explain the preponderance of diastolic dysfunction and diastolic heart failure in postmenopausal women and provide a potential animal model for evaluating prevention and treatment interventions for this disorder.
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Affiliation(s)
- Leanne Groban
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27127-1009, USA.
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Kapuku GK, Davis HC, Shah N, McMillan AM, Harshfield GA. Gender differences in diastolic function among youth. Pediatr Cardiol 2008; 29:102-7. [PMID: 17899243 DOI: 10.1007/s00246-007-9093-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 06/27/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Youth were studied to determine the influence of gender on diastolic function, which has been shown to express abnormalities early in the course of congestive heart failure. METHODS The study participants were 121 normotensive individuals (53 girls, 68 boys) ages 14 to 18 years. Demographics, hemodynamics, and Doppler-derived indices of diastolic function were collected. Dependent measures of diastolic function were the ratio of early (E) to late (A) peak filling velocities and the isovolumetric relaxation time (IVRT). RESULTS The girls had a higher relative wall thickness (RWT) (36.58% +/- 4.59% vs 34.60% +/- 4.01%; p < 0.02), higher A (48.40 +/- 8.47 cm/s vs 42.36 +/- 10.43 cm/s; p < 0.001), a lower E/A ratio (1.96 +/- 0.40 vs 2.38 +/- 0.68; p < 0.01), and a shorter IVRT (51.80 +/- 11.14 ms vs 59.00 +/- 14.36 ms; p < 0.01) than the boys. The differences in deceleration time were not significant (181.30 +/- 81.33 ms vs 170.30 +/- 31.06 ms). Hierarchical stepwise regression analysis predicting E/A ratio found gender (male > female) to be the best predictor (R (2 )= 0.09) followed by heart rate (R (2) increase = 0.07; total R (2 )= 0.15; p < 0.01) and by RWT (R (2) increase = 0.05; total R (2 )= 0.21; p < 0.015). For IVRT prediction, gender (male > female) was the best predictor (R (2 )= 0.11), followed by total peripheral resistance (R (2) increase = 0.06; total R (2 )= 0.17; p < 0.017). CONCLUSION The study data indicate that gender differences in diastolic function exist already in youth. Girls show a higher RWT, a lower E/A ratio, and a shorter IVRT. The implications of these differences for cardiovascular morbidity and mortality of the two genders require attention.
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Affiliation(s)
- G K Kapuku
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, MCG Annex H.S. 1640, Augusta, GA 30912-4534, USA.
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Braunstein JB, Sherber NS, Schulman SP, Ding EL, Powe NR. Race, medical researcher distrust, perceived harm, and willingness to participate in cardiovascular prevention trials. Medicine (Baltimore) 2008; 87:1-9. [PMID: 18204365 DOI: 10.1097/md.0b013e3181625d78] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Minority underrepresentation exists in medical research including cardiovascular clinical trials, but the hypothesis that this relates to distrust in medical researchers is unproven. Therefore, we examined whether African American persons differ from white persons in perceptions of the risks/benefits of trial participation and distrust toward medical researchers, and whether these factors influence willingness to participate (WTP) in a clinical drug trial. Participants were self-administered a survey regarding WTP in a cardiovascular drug trial given to 1440 randomly selected patients from 13 Maryland outpatient cardiology and general medicine clinics. Patients reported their WTP, rated their perceived chances of experiencing health benefit and harm, and rated their distrust toward researchers. Of eligible participants, 70% responded, and 717 individuals were included: 36% African American and 64% white. African American participants possessed lower WTP than white participants (27% vs. 39%, p = 0.001) and had higher mean distrust scores than whites (p < 0.0001). African American participants more frequently reported that doctors would less fully explain research participation to them (24% vs. 13%, p < 0.001), use them as guinea pigs without their consent (72% vs. 49%, p < 0.001), prescribe medication as a way of experimenting on people without their knowledge (35% vs. 16%, p < 0.001), and ask them to participate in research even if it could harm them (24% vs. 15%, p = 0.002). African American participants also more often believed they could less freely ask their doctor questions (8% vs. 2%, p < 0.001) and that doctors had previously experimented on them without their consent (58% vs. 25%, p < 0.001). African American participants expressed lesser WTP than white participants after controlling for racial differences in age, sex, socioeconomic status and cardiovascular disease risk profiles (multivariable odds ratio [OR], 0.57; 95% confidence interval [CI], 0.39-0.85). The impact of race was attenuated and nonsignificant after adjustment for potential mediating factors of racial differences in medical researcher distrust and perceived risk of harm (explanatory model OR, 0.84; 95% CI 0.54-1.30). In summary, African American participants expressed markedly greater concerns about experiencing harm from participation in clinical trials and distrust toward medical researchers than white participants. These factors, in turn, appear to explain much of the resistance among African American persons to participate in clinical trials compared to white persons.
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Affiliation(s)
- Joel B Braunstein
- From Center for Outcomes Research and Evaluation (JBB), Yale School of Medicine, New Haven, Connecticut; Department of Dermatology (NSS), Johns Hopkins School of Medicine; Division of Cardiology (SPS) and Division of General Internal Medicine (NRP), Department of Medicine, Johns Hopkins Hospital; Department of Health Policy and Management (NRP), Johns Hopkins Bloomberg School of Public Health; and Welch Center for Prevention, Epidemiology and Clinical Research (NRP), Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of Preventive Medicine (ELD), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; and Departments of Epidemiology and Nutrition (ELD), Harvard School of Public Health, Boston, Massachusetts
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Abstract
Most elderly patients, particularly women, who have heart failure have a normal ejection fraction. Patients who have this syndrome have severe symptoms of exercise intolerance, frequent hospitalizations, and increased mortality. The pathophysiology and treatment are not well defined. Control of systemic hypertension may be a key to prevention and treatment. Several large trials of specific agents are currently underway.
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Affiliation(s)
- Dalane W Kitzman
- Wake Forest University Health Sciences Center, Winston-Salem, NC, USA.
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Horváth P, Kneffel Z, Lénárd Z, Kispéter Z, Petrekanits M, Pavlik G. Echocardiographic Parameters in Athlete and Nonathlete Offspring of Hypertensive Parents. Echocardiography 2007; 25:1-7. [DOI: 10.1111/j.1540-8175.2007.00551.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Persic V, Ruzic A, Miletic B, Balen S, Jovanovic Z, Vcev A, Racki S, Vujicic B. Left ventricle diastolic dysfunction in obese patients with newly diagnosed arterial hypertension. Wien Klin Wochenschr 2007; 119:423-7. [PMID: 17671824 DOI: 10.1007/s00508-007-0818-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The frequent coexistence of obesity and arterial hypertension is well known. Although both conditions have been identified as independent risk factors for impaired left ventricular diastolic function, there is a paucity of data on the dysfunction among obese patients with newly diagnosed arterial hypertension. The study was performed to determine the prevalence of diastolic dysfunction in obese individuals with newly diagnosed arterial hypertension and to compare it with the prevalence in normotensive obese persons. METHODS We enrolled 125 obese patients: 65 with newly diagnosed hypertension and 60 normotensive patients matched for age, sex and body mass index. Left ventricular diastolic function was assessed from the following Doppler-echocardiographic measurements: mitral inflow velocities (E and A wave), E wave deceleration time, isovolumetric relaxation time, left atrial and left ventricular diameters, left ventricular wall thickness and left ventricular heart mass index. Diastolic dysfunction was considered when the E/A ratio was <1. RESULTS We found significantly higher A wave, lower E/A ratio, longer E deceleration time and a bigger left atrium in obese patients with newly diagnosed arterial hypertension. We did not find significant differences in E wave peak velocities between the two groups. Although there was no difference in left ventricle heart mass or the prevalence of left ventricle hypertrophy, the prevalence of diastolic dysfunction was higher in the group with newly diagnosed arterial hypertension. CONCLUSION This study suggests that newly diagnosed arterial hypertension significantly contributes to impairment of left ventricular diastolic function in obese patients before development of structural aberrations detectable on echocardiography.
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Affiliation(s)
- Viktor Persic
- Department of Cardiology, Thalassotherapia Opatija, M. Tita 188, 51410 Opatija, Croatia
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Granger BB, Moser D, Harrell J, Sandelowski M, Ekman I. A Practical Use of Theory to Study Adherence. ACTA ACUST UNITED AC 2007; 22:152-8. [PMID: 17786091 DOI: 10.1111/j.0889-7204.2007.888144.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic heart failure (CHF) is a costly Medicare expenditure, with approximately 70% of the costs of heart failure care attributable to acute, symptom-related hospitalizations. The most common preventable cause of rehospitalization is nonadherence to the CHF regimen. Theoretic models have been used to study adherence; however, these models are predominantly designed for health behavior interventions (ie, smoking cessation, diet modification, or exercise) and focus less on conceptualizing the work involved in carrying out complex self-care regimens. The purpose of this paper was to present one approach for operationalizing the Trajectory Theory of Chronic Illness to study adherence in patients with heart failure. The trajectory model offers unique opportunities to study adherence, specifically because measurable patient attributes are clearer when evaluated in the context of the work required to adhere over time. Using trajectory theory may allow providers to better understand and facilitate patient adherence to the CHF regimen.
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Affiliation(s)
- Bradi B Granger
- Duke University Health Systems, Duke University School of Nursing, Durham, NC, USA.
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36
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Abstract
Most elderly patients, particularly women, who have heart failure have a normal ejection fraction. Patients who have this syndrome have severe symptoms of exercise intolerance, frequent hospitalizations, and increased mortality. The pathophysiology and treatment are not well defined. Control of systemic hypertension may be a key to prevention and treatment. Several large trials of specific agents are currently underway.
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Affiliation(s)
- Dalane W Kitzman
- Department of Internal Medicine, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Regitz-Zagrosek V, Brokat S, Tschope C. Role of Gender in Heart Failure with Normal Left Ventricular Ejection Fraction. Prog Cardiovasc Dis 2007; 49:241-51. [PMID: 17185112 DOI: 10.1016/j.pcad.2006.08.011] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Heart failure with normal ejection fraction (HF-NEF) is frequently believed to be more common in women than in men. However, the interaction of gender and age has rarely been analyzed in detail, and knowledge of the distinction between pre- and postmenopausal women is lacking. Some of the studies that have described a higher prevalence of HF-NEF in women relied on clinical diagnoses of HF together with normal systolic function and did not measure diastolic function. This applies to the analysis of patients hospitalized for HF and some epidemiological investigations that agree on the greater prevalence of HF-NEF in women. Population-based studies with echocardiographic determination of diastolic function have suggested equal or greater prevalence of diastolic dysfunction in men. Major risk factors for HF-NEF include hypertension, aging, obesity, diabetes, and ischemia. Hypertension is more frequent in women and can contribute to left ventricular and arterial stiffening in a gender-specific way. Aging, obesity, and diabetes affect myocardial and vascular stiffness differently and lead to different forms of myocardial hypertrophy in women and men. In contrast, ischemia may play a greater role in men. Gender differences in ventricular diastolic distensibility, in vascular stiffness and ventricular/vascular coupling, in skeletal muscle adaptation to HF, and in the perception of symptoms may contribute to a greater rate of HF-NEF in women. The underlying molecular mechanisms include gender differences in calcium handling, in the NO system, and in natriuretic peptides. Estrogen affects collagen synthesis and degradation and inhibits the renin-angiotensin system. Effects of estrogen may provide benefit to premenopausal women, and the loss of its protective mechanisms may render the heart of postmenopausal women more vulnerable. Thus, a number of molecular mechanisms can contribute to the gender differences in HF-NEF.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Center for Cardiovascular Research, (CCR), Department of Cardiology and Pneumology, University Hospital Benjamin Franklin, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
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Nunes JPL, Oliveira NP. Cardiac structure and apnea/hypopnea index in patients with arterial hypertension and excessive weight. Kidney Blood Press Res 2006; 29:159-64. [PMID: 16931894 DOI: 10.1159/000095349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 07/07/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Arterial hypertension is frequently associated with sleep apnea, excessive weight, and with changes in the echocardiographic characteristics of the left cardiac chambers. The present investigation was conducted in order to search for a possible relation between left cardiac structure and sleep apnea magnitude in patients with arterial hypertension and excessive weight. METHODS A group of 56 patients with arterial hypertension and mean body mass index of 30.6 +/- 3.8 (weight in kilograms/height in meters squared) was studied by echocardiography, sleep study and electrocardiography. RESULTS A relatively high mean apnea-hypopnea index (AHI) was found (17.9 +/- 17.2 episodes/h sleep), but this parameter was not found to be correlated with cardiac echocardiographic diameters. Patients with an AHI <5 episodes/h had smaller mean values for left atrial diameter, left ventricular mass index and left ventricular relative wall thickness, when compared to patients with an AHI value of > or =5. The mean corrected QT interval was found to be longer in female patients, whereas left ventricular end-diastolic diameter was smaller than in male patients. CONCLUSION In patients with arterial hypertension and excessive weight, significant apnea seems to be very common. In such patients, left ventricle wall thickness, left ventricle mass index and the left atrium diameter may act as surrogate markers for significant sleep apnea. Thus, the hypothesis is raised that hypoxia may lead to changes in heart structure.
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Lim JG, Shapiro EP, Vaidya D, Najjar SS, Turner KL, Bacher AC, Ouyang P, Stewart KJ. Sex differences in left ventricular function in older persons with mild hypertension. Am Heart J 2005; 150:934-40. [PMID: 16290968 DOI: 10.1016/j.ahj.2005.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 01/07/2005] [Indexed: 01/11/2023]
Abstract
BACKGROUND Epidemiologic studies suggest that women are at increased risk of developing heart failure secondary to hypertension. Other studies have documented sex differences in left ventricular systolic and diastolic function in the presence of pressure overload states such as seen in aortic stenosis and hypertension. It is less clear if sex differences are present among older persons with mild hypertension. METHODS One hundred seven healthy subjects, aged 55 to 75 years, with blood pressures ranging from 130 to 159 mm Hg systolic and/or 85 to 99 mm Hg diastolic, were examined by standard echocardiography and the newer modalities of tissue Doppler and color M-mode imaging. RESULTS Women had a lower peak mitral annular systolic velocity (Sm), 8.9 (95% CI 8.4-9.5) cm/s versus 10.2 (95% CI 9.6-11.0) cm/s, (P < .01) than men. Among women, increasing age was associated with a reduction in diastolic function. For every decade of age, peak early mitral annular diastolic velocity (Em) declined by 1.6 cm/s (P < .01), mitral inflow velocity of propagation (Vp) declined by 26% (P < .01), E/Vp ratio increased by 20% (P = .03), and E/Em ratio increased by 11% (P = .04) in women. No age-associated changes were seen in men. CONCLUSIONS As revealed by newer echocardiographic imaging modalities, women with mild hypertension showed greater reductions in systolic and diastolic function as they aged compared with men. Our findings are consistent with the increased risk older women have of developing heart failure because of hypertension.
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Affiliation(s)
- Jimmy G Lim
- Division of Cardiology, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA
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Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation 2005; 112:2254-62. [PMID: 16203909 DOI: 10.1161/circulationaha.105.541078] [Citation(s) in RCA: 570] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Increases in vascular (Ea), ventricular systolic (Ees), and ventricular diastolic (Ed) elastance (stiffness) may contribute to the pathogenesis of heart failure (HF) with preserved ejection fraction (HFnlEF). The prevalence of HFnlEF increases strikingly with age, particularly in women. We hypothesized that ventricular-vascular stiffening may occur with age and be more pronounced in women in the general community. METHODS AND RESULTS In a cross-sectional sample of Olmsted County, Minn, residents > or =45 years old (n=2042), clinical data, Doppler echocardiography, and blood pressure (BP) measurements were obtained. Ea was calculated from stroke volume and systolic BP and indexed to body size (EaI). Ees was calculated by a modified single-beat method using systolic and diastolic BP, stroke volume, ejection fraction, timing intervals, and an estimated normalized ventricular elastance at arterial end diastole. Operant Ed was calculated from Doppler indices reflective of atrial pressures and the diastolic filling volume. EaI, Ees, and Ed all increased with age in men and in women (P<0.0001 for all). Ees increased more steeply with age in women (P=0.002). Adjusted for age, EaI, Ees, and Ed were higher in women than in men (P<0.0001 for all). Findings were similar in those without known or suspected cardiovascular disease (n=623). CONCLUSIONS In the community, advancing age and female gender are associated with increases in vascular and ventricular systolic and diastolic stiffness even in the absence of cardiovascular disease. We speculate that this combined ventricular-vascular stiffening may contribute to the increased prevalence of HFnlEF in elderly persons and particularly in elderly women.
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Affiliation(s)
- Margaret M Redfield
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Martín Raymondi D, Díaz Dorronsoro I, Barba J, Díez J. [Characteristics of hypertensive cardiomyopathy in a population of hypertensive patients never treated]. Med Clin (Barc) 2005; 125:321-4. [PMID: 16185630 DOI: 10.1157/13078771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension. PATIENTS AND METHOD One hundred and sixteen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness. RESULTS Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p < 0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction. CONCLUSIONS These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling.
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Affiliation(s)
- Diego Martín Raymondi
- Departamento de Cardiología y Cirugía Cardiovascular, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain.
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Bella JN, Palmieri V, Wachtell K, Liu JE, Gerdts E, Nieminen MS, Koren MJ, Zabalgoitia M, Wright JT, Dahlöf B, Devereux RB. Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study. J Hum Hypertens 2004; 18:411-6. [PMID: 15042116 DOI: 10.1038/sj.jhh.1001708] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While left ventricular (LV) structure and function differ between hypertensive women and men, it remains unclear whether sex affects regression of LV hypertrophy with antihypertensive treatment. We analysed paired echocardiograms in 500 men and 347 women enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study at baseline and after 12 months of antihypertensive treatment with either losartan or atenolol. At enrollment, 177 women and 242 men were randomized to losartan-based treatment and 161 women and 247 men were randomized to atenolol-based treatment (sex difference=NS). After 12 months of antihypertensive treatment, blood pressure was lowered similarly in women (152/83 from 174/97 mmHg) and men (149/85 from 173/99 mmHg; both P<0.001, sex difference=NS), without significant change in body weight in either sex. Cardiac output and pulse pressure/stroke volume were equivalently reduced in both sexes (-0.2 vs -0.1 l/min and both -0.20 mmHg/ml/m(2), respectively; both P=NS). Absolute LV mass change after 12 months of antihypertensive treatment was greater in men than in women (-30 vs -24 g, P=0.01). However, after adjusting for baseline LV mass and randomized study treatment, LV mass reduction was greater in women than in men (-33 vs -23 g, P=0.001). LV mass regression was greater in women, by 8.0+/-2.8 g, after adjusting for baseline LV mass and randomized study treatment. After consideration of baseline LV mass and randomized study treatment, antihypertensive treatment regressed LV hypertrophy more in women. Further studies are needed to identify the mechanisms and prognostic implications of this sex-related difference.
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Affiliation(s)
- J N Bella
- Weill Medical College of Cornell University, New York, NY, USA.
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Kontos J, Papademetriou V, Wachtell K, Palmieri V, Liu JE, Gerdts E, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:431-6. [PMID: 15042117 DOI: 10.1038/sj.jhh.1001715] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1+) valvular regurgitation, and 51 patients had moderate (2+ or 3+) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, P<0.05), higher LV mass indexed for body surface area (122 vs 125 g/m(2), P<0.05) or height(2.7) (55.4 vs 57.3, P<0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, P<0.001), greater mean LV mass (232 vs 248 g, P<0.001) and LV mass indexed for body surface area or height(2.7), and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.
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Affiliation(s)
- J Kontos
- VA Medical Center, Washington, DC 20422, USA.
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Ito T, Suwa M, Imai M, Nakamura T, Kitaura Y. Assessment of regional left ventricular filling dynamics using color kinesis in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2004; 17:146-51. [PMID: 14752489 DOI: 10.1016/j.echo.2003.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Using color kinesis, we evaluated regional left ventricular filling dynamics in patients with hypertrophic cardiomyopathy (HCM). METHODS In all, 20 patients (14 men and 6 women) and 20 age-matched healthy control subjects (10 men and 10 women) were studied. From color kinesis diastolic images in a left ventricular short-axis view, we generated regional time curves (6 segments) of left ventricular filling. The percent filling fraction at 25%, 50%, and 75% of filling time was averaged for all segments in each patient, and the SD of its mean was used as an asynchrony index at each particular filling time. The mean filling time for each segment was also measured. RESULTS The asynchrony index was increased significantly in mid (50%) to late (75%) diastole in patients with HCM as compared with control subjects. Patients with HCM had regional mean filling times prolonged even in the nonhypertrophic segments. Moreover, there was significant correlation between the asynchrony index at mid and late diastole, and the global mean filling time. CONCLUSIONS Color kinesis is useful in evaluating regional filling dynamics in patients with HCM. Our data reinforce the notion that HCM is a functionally heterogeneous disorder.
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Affiliation(s)
- Takahide Ito
- Third Division, Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki City, Osaka 569-8686, Japan.
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