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Shinohara K. Renal denervation for hypertensive heart disease and atrial fibrillation. Hypertens Res 2024:10.1038/s41440-024-01755-y. [PMID: 38877310 DOI: 10.1038/s41440-024-01755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
Accumulating evidence supports the efficacy of renal denervation (RDN) as an antihypertensive treatment. Additionally, several RDN clinical studies, including meta-analyses, have suggested that RDN may potentially have beneficial effects on left ventricular hypertrophy, diastolic function, and new-onset/recurrence of atrial fibrillation (AF), although most studies were not randomized sham-controlled. In particular, the effects of RDN on left ventricular hypertrophy and AF recurrence appear to be relatively evident. Sympathetic activation plays a critical role in the development of hypertension, hypertensive heart disease, and AF. Notably, several studies suggest the cardioprotective effects of RDN even in the absence of significant blood pressure reduction, probably due to its sympathoinhibitory effects. It is imperative to establish the efficacy of RDN in patients with hypertensive heart disease and/or AF, focusing on parameters of sympathetic activity in the clinical setting, including randomized sham-controlled trials. Moreover, further basic research is essential to elucidate the therapeutic mechanisms of RDN beyond blood pressure lowering and the renal nerves-linked pathophysiologies of hypertensive heart disease and AF. This review outlines the effects of renal denervation on hypertensive heart disease, particularly on left ventricular hypertrophy and diastolic function, and on atrial fibrillation. The sympathoinhibitory effect of renal denervation, an important potential mechanism of its beneficial effects on heart disease, is also discussed.
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Affiliation(s)
- Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
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2
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Liu Z, Thergarajan P, Antonic-Baker A, Chen Z, Sparks PB, Lannin NA, Kwan P, Jones NC, Casillas-Espinosa PM, Perucca P, O'Brien TJ, Sivathamboo S. Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis. Epilepsia Open 2023; 8:46-59. [PMID: 36648338 PMCID: PMC9977759 DOI: 10.1002/epi4.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and meta-analysis of studies evaluating cardiac structure and function in patients with epilepsy. METHODS We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools. RESULTS Among the 10 case-control studies with epilepsy patients (n = 515) and healthy controls (n = 445), LVEF was significantly decreased in epilepsy group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P = 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P = 0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P = 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P = 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n = 714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls. SIGNIFICANCE Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance of such changes. Echocardiography may be a useful noninvasive diagnostic test in epilepsy population.
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Affiliation(s)
- Zining Liu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peravina Thergarajan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul B Sparks
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine (Austin Health), Epilepsy Research Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Hung WC, Yu TH, Wu CC, Lee TL, Tang WH, Chen CC, Lu IC, Chung FM, Lee YJ, Hsu CC. Nonalcoholic Fatty Liver Disease Is Related to Abnormal Corrected QT Interval and Left Ventricular Hypertrophy in Chinese Male Steelworkers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14555. [PMID: 36361436 PMCID: PMC9657484 DOI: 10.3390/ijerph192114555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) has been associated with an increased risks of corrected QT (QTc) prolongation and left ventricular hypertrophy (LVH), both of which are associated with the development of cardiovascular disease. Rotating night shift work and a higher risk of incident NAFLD have been reported in male steelworkers. This study aimed to investigate the association of the severity of NAFLD with a prolonged QTc interval and LVH in a large cohort of Chinese male steelworkers. METHODS We examined baseline data of 2998 male steel workers aged 26 to 71 years at two plants. All workers at both plants received regular health assessments, including 12-lead ECG and echocardiography. Abdominal ultrasonography was performed to evaluate the severity of NAFLD. QTc prolongation was defined as follows: normal ≤ 430 ms, borderline 431-450 ms, and abnormal ≥ 451 ms. LVH was defined as a left ventricular mass index (LVMI) >131 g/m2. Associations of NAFLD with an abnormal QTc interval and LVH were examined using univariate and multivariate analyses. RESULTS The QTc interval and the LVMI were significantly correlated with the NAFLD fibrosis score, and the severity of NAFLD was correlated with an abnormal QTc interval and LVH (p for trend < 0.05). Multivariate analysis showed that in comparison to the workers without NAFLD, the odds ratios of having an abnormal QTc interval and LVH were 2.54 (95% CI: 1.22-5.39, p = 0.013) times and 2.23 (95% CI: 1.02-5.01, p = 0.044) times higher in the workers with moderate/severe NAFLD. CONCLUSIONS NAFLD may be closely associated with the risks of an abnormal QTc interval and LVH, suggesting that regular electrocardiogram and echocardiogram monitoring could be used to evaluate the risk of arrhythmia and LVH in male steelworkers with NAFLD.
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Affiliation(s)
- Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien 98142, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chia-Chi Chen
- Department of Pathology, E-Da Hospital, Kaohsiung 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - I-Cheng Lu
- Department of Occupational Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
| | | | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- Health Examination Center, E-Da Dachang Hospital, Kaohsiung 80794, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
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Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
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Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
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Chinali M, Aurigemma GP, Gerdts E, Wachtell K, Okin PM, Muthiah A, Kjeldsen SE, Julius S, de Simone G, Devereux RB. Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion.
Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF < 50%.
Results: During a mean follow-up of 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all P < 0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001).
Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Marcello Chinali
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; Division of Cardiology, Bambino Gesù Children’s Hospital–IRCSS, 001655 Rome, Italy; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Anujan Muthiah
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Giovanni de Simone
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Blood pressure categorization and subclinical left ventricular dysfunction in antihypertensive medication-naive subjects. ESC Heart Fail 2022; 9:1766-1774. [PMID: 35199967 PMCID: PMC9065812 DOI: 10.1002/ehf2.13860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 01/14/2023] Open
Abstract
Aims The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex‐specific difference remains unclarified. This study investigated the relationship between BP categories given in the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and subclinical LV dysfunction in subjects free of cardiac disease. Methods and results We examined antihypertensive medication‐naive 858 individuals who underwent extensive cardiovascular health check‐up. LV global longitudinal (LVGLS) and circumferential strain (LVGCS) were assessed by two‐dimensional speckle‐tracking echocardiography. Participants were categorized into four groups: normal BP, elevated BP, isolated diastolic hypertension (IDH), and systolic hypertension (SH). Among the 858 participants, 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (>−18.6%) was greatest in SH (19.0%), followed by IDH (17.5%), elevated BP (14.2%), and normal BP (7.1%, P < 0.001); no significant differences were observed for LVGCS (P = 0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS [adjusted odds ratio (OR) 2.69 and 2.66, P < 0.001], and borderline significance was observed for elevated BP (adjusted OR 1.90, P = 0.060); there was no significant association between any of the BP groups and LVGCS. In sex‐stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women. Conclusions Isolated diastolic hypertension and SH redefined by ACC/AHA guideline carried significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.
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Affiliation(s)
- Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Medicine, Columbia University, New York, NY, USA
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Huang TH, Chiu H, Wu PY, Huang JC, Lin MY, Chen SC, Chang JM. The association of echocardiographic parameters on renal outcomes in chronic kidney disease. Ren Fail 2021; 43:433-444. [PMID: 33682579 PMCID: PMC7946016 DOI: 10.1080/0886022x.2021.1885444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) often have structural abnormalities of the heart due to pressure and volume overload. The aim of this study was to evaluate associations between echocardiographic parameters and renal outcomes (estimated glomerular filtration rate [eGFR] slope and progression to dialysis) in patients with stage 3-5 CKD. METHODS This longitudinal study enrolled 419 patients. Changes in renal function were assessed using the eGFR slope. Rapid renal progression was defined as an eGFR slope < -3 mL/min/1.73 m2/year, and the renal endpoint was defined as commencing dialysis. RESULTS Increased left atrial diameter (LAD), ratio of left ventricular mass to body surface area (LVM/BSA), ratio of LVM to height2.7 (LVM/ht2.7), and ratio of observed to predicted LVM (o/p LVM) were associated with eGFR slope in an adjusted model, but left ventricular ejection fraction (LVEF) was not. Furthermore, LAD ≥ 4.7 cm, LVM/BSA > 115 g/m2 in males and > 95 g/m2 in females, and LVM/ht2.7 > 48 g/ht2.7 in males and > 44 g/ht2.7 in females were correlated with progression to dialysis, but o/p LVM and LVEF were not. The maximum change in χ2 change to predict renal outcomes was observed for LAD, followed by LVM/BSA and LVM/ht2.7. CONCLUSIONS A large LAD and increased LVM, regardless of how it was measured (LVM/BSA, LVM/ht2.7 and o/p LVM), were correlated with adverse renal outcomes in patients with CKD stage 3-5. LAD had superior prognostic value to LVM and LVEF.
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Affiliation(s)
- Tzu-Heng Huang
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsuan Chiu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kianu Phanzu B, Nkodila Natuhoyila A, Kintoki Vita E, M'Buyamba Kabangu JR, Longo-Mbenza B. Association between insulin resistance and left ventricular hypertrophy in asymptomatic, Black, sub-Saharan African, hypertensive patients: a case-control study. BMC Cardiovasc Disord 2021; 21:1. [PMID: 33388039 PMCID: PMC7777396 DOI: 10.1186/s12872-020-01829-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH). We described the associations between obesity, fasting insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), and LVH in Black patients with essential hypertension. Methods A case–control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationships between obesity indices, physical inactivity, glucose metabolism and lipid disorder parameters, and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analyses, respectively. When differences were observed between LVH and independent variables, the effects of potential confounders were studied through the use of multiple linear regression and in conditional logistic regression in multivariate analyses. The coefficients of determination (R2), adjusted odds ratios (aORs), and their 95% confidence intervals (95% CIs) were calculated to determine associations between LVH and the independent variables.
Results Eighty-eight LVH cases (52 men) were compared against 132 controls (81 men). Variation in left ventricular mass (LVM) could be predicted by the following variables: age (19%), duration of hypertension (31.3%), body mass index (BMI, 44.4%), waist circumference (WC, 42.5%), glycemia (20%), insulinemia (44.8%), and HOMA-IR (43.7%). Hypertension duration, BMI, insulinemia, and HOMA-IR explained 68.3% of LVM variability in the multiple linear regression analysis. In the logistic regression model, obesity increased the risk of LVH by threefold [aOR 2.8; 95% CI (1.06–7.4); p = 0.038], and IR increased the risk of LVH by eightfold [aOR 8.4; 95 (3.7–15.7); p < 0.001]. Conclusion Obesity and IR appear to be the primary predictors of LVH in Black sub-Saharan African hypertensive patients. The comprehensive management of cardiovascular risk factors should be emphasized, with particular attention paid to obesity and IR. A prospective population-based study of Black sub-Saharan individuals that includes the use of serial imaging remains essential to better understand subclinical LV deterioration over time and to confirm the role played by IR in Black sub-Saharan individuals with hypertension.
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Affiliation(s)
- Bernard Kianu Phanzu
- Cardiology Unit, University Hospital of Kinshasa, PO Box 1038, Kinshasa, Democratic Republic of Congo. .,Centre Médical de Kinshasa (CMK), Kinshasa, Democratic Republic of Congo.
| | | | - Eleuthère Kintoki Vita
- Cardiology Unit, University Hospital of Kinshasa, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | | | - Benjamin Longo-Mbenza
- Cardiology Unit, University Hospital of Kinshasa, PO Box 1038, Kinshasa, Democratic Republic of Congo
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Krueger W, Bender N, Haeusler M, Henneberg M. The role of mechanotransduction in heart failure pathobiology-a concise review. Heart Fail Rev 2020; 26:981-995. [PMID: 31965473 DOI: 10.1007/s10741-020-09915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This review evaluates the role of mechanotransduction (MT) in heart failure (HF) pathobiology. Cardiac functional and structural modifications are regulated by biomechanical forces. Exposing cardiomyocytes and the myocardial tissue to altered biomechanical stress precipitates changes in the end-diastolic wall stress (EDWS). Thereby various interconnected biomolecular pathways, essentially mediated and orchestrated by MT, are launched and jointly contribute to adapt and remodel the myocardium. This cardiac MT-mediated feedback decisively determines the primary cardiac cellular and tissue response, the sort (concentric or eccentric) of hypertrophy/remodeling, to mechanical and/or hemodynamic alterations. Moreover, the altered EDWS affects the diastolic myocardial properties independent of the systolic function, and elevated EDWS causes diastolic dysfunction. The close interconnection between MT pathways and the cell nucleus, the genetic endowment, principally allows for the wide variety of phenotypic appearances. However, demographic, environmental features, comorbidities, and also the genetic make-up may modulate the phenotypic result. Cardiac MT takes a fundamental and superordinate position in the myocardial adaptation and remodeling processes in all HF categories and phenotypes. Therefore, the effects of MT should be integrated in all our scientific, clinical, and therapeutic considerations.
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Affiliation(s)
- Wolfgang Krueger
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland. .,Medical University Department, Kantonsspital Aarau, Aarau, Switzerland.
| | - Nicole Bender
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Maciej Henneberg
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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10
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Limited contribution of left ventricular mass and remodelling to the impact of blood pressure on diastolic function in a community sample. J Hypertens 2019; 37:1191-1199. [DOI: 10.1097/hjh.0000000000002051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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11
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Méndez C, Soler R, Rodríguez E, Barriales R, Ochoa JP, Monserrat L. Differential diagnosis of thickened myocardium: an illustrative MRI review. Insights Imaging 2018; 9:695-707. [PMID: 30302634 PMCID: PMC6206373 DOI: 10.1007/s13244-018-0655-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023] Open
Abstract
Objectives The purpose of this article is to describe the key cardiac magnetic resonance imaging (MRI) features to differentiate hypertrophic cardiomyopathy (HCM) phenotypes from other causes of myocardial thickening that may mimic them. Conclusions Many causes of myocardial thickening may mimic different HCM phenotypes. The unique ability of cardiac MRI to facilitate tissue characterisation may help to establish the aetiology of myocardial thickening, which is essential to differentiate it from HCM phenotypes and for appropriate management. Teaching points • Many causes of myocardial thickening may mimic different HCM phenotypes. • Differential diagnosis between myocardial thickening aetiology and HCM phenotypes may be challenging. • Cardiac MRI is essential to differentiate the aetiology of myocardial thickening from HCM phenotypes.
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Affiliation(s)
- Cristina Méndez
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain
| | - Rafaela Soler
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain
| | - Esther Rodríguez
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain.
| | - Roberto Barriales
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
| | - Juan Pablo Ochoa
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
| | - Lorenzo Monserrat
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
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12
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Nazário Leão R, Marques da Silva P, Marques Pocinho R, Alves M, Virella D, Palma dos Reis R. Determinants of left ventricular diastolic dysfunction in hypertensive patients. HIPERTENSION Y RIESGO VASCULAR 2018; 35:160-168. [DOI: 10.1016/j.hipert.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/16/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
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13
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Mavrogeni S, Katsi V, Vartela V, Noutsias M, Markousis-Mavrogenis G, Kolovou G, Manolis A. The emerging role of Cardiovascular Magnetic Resonance in the evaluation of hypertensive heart disease. BMC Cardiovasc Disord 2017; 17:132. [PMID: 28535761 PMCID: PMC5442666 DOI: 10.1186/s12872-017-0556-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Arterial hypertension is the commonest cause of cardiovascular death. It may lead to hypertensive heart disease (HHD), including heart failure (HF), ischemic heart disease (IHD) and left ventricular hypertrophy (LVH). MAIN BODY According to the 2007 ESH/ESC guidelines, the recommended imaging technique is echocardiography (echo), when a more sensitive detection of LVH than that provided by ECG, is needed. Cardiovascular Magnetic Resonance (CMR), a non-invasive, non-radiating technique, offers the following advantages, beyond echo: a) more reliable and reproducible measurements of cardiac parameters such as volumes, ejection fraction and cardiac mass b) more accurate differentiation of LVH etiology by providing information about tissue characterisation c) more accurate evaluation of myocardial ischemia, specifically if small vessels disease is present d) technique of choice for diagnosis of renovascular, aortic tree/branches lesions and quantification of aortic valve regurgitation e) technique of choice for treatment evaluation in clinical trials. The superiority of CMR against echocardiography in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterization makes the technique ideal for evaluation of heart, quantification of aortic valve regurgitation, aorta and aortic branches. CONCLUSIONS CMR has a great potential in early diagnosis, risk stratification and treatment follow up of HHD. However, an international consensus about CMR in HHD, taking under consideration the cost-benefit ratio, expertise and availability, is still warranted.
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Affiliation(s)
- Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
| | | | - Vasiliki Vartela
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
| | - Michel Noutsias
- Department of Cardiology, Pneumonology and Intensive Care Medicine, Clinic for Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
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15
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Abstract
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals. Blood pressure lowering using antihypertensive medications can improve LVDD; however, it remains unclear whether this improvement in LV diastolic function can improve cardiovascular outcomes.
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Affiliation(s)
- Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Zakynthinos E, Pierutsakos C, Konstantinidis K, Zakynthinos S, Papadogiannis D. Losartan Reduces Left Ventricular Hypertrophy Proportionally to Blood Pressure Reduction in Hypertensives, but Does Not Affect Diastolic Cardiac Function. Angiology 2016; 55:669-78. [PMID: 15547653 DOI: 10.1177/00033197040550i608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In contrast to the well-recognized salutary effects of angiotensin-converting enzyme inhibition, the value of angiotensin II type I (ATl)-receptor blockade on left ventricular hypertrophy (LVH) is controversial. In addition, the data on the influence of this therapy on cardiac diastolic function are scarce. Thirty-nine patients with moderate primary hypertension, LVH, and normal systolic function received losartan, 50 to 100 mg daily. Transthoracic echocardiography was performed at baseline and after 6 months of treatment. Thirty-one patients completed and were included in the study (16 males, 61.1 ±1.0 years). The patients were divided into responders if mean blood pressure (BP) decreased >5 mm Hg at the end of the study (20 patients) and non-responders (mean BP decrease ≤5 mm Hg, 11 patients). The BP and the LVH were significantly reduced (systolic BP by 10.0%, diastolic BP 6.5%, mean BP 8.2%, left ventricular mass index [LVMI] 6.2%, interventricular septum 5.8%, posterior wall 3.0%) (p≤0.02), attributed to the reduction of BP and LVH in responders; the LVH in non-responders did not alter with treatment. A significant correlation was noted between changes in BP and LVMI ( r =0.60, p<0.001). The systolic cardiac function remained normal. The Doppler parameters usually used to assess the diastolic function of the LV (early diastolic filling velocity [E wave], late diastolic filling velocity [A wave], ratio of E/A waves, isovolumic relaxation time), which were abnormal at baseline, did not change with treatment. The size of the left atrium increased (p<0.05) at the end of the study. In conclusion, a 6-month course with losartan decreased BP and LVH. However, the LVH regression was rather associated with the reduction of the hemodynamic stimulus per se, than any trophic effect of the drug in the myocardium. The diastolic cardiac function remained abnormal with treatment.
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Affiliation(s)
- E Zakynthinos
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
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Tanoue MT, Kjeldsen SE, Devereux RB, Okin PM. Relationship between abnormal P-wave terminal force in lead V1 and left ventricular diastolic dysfunction in hypertensive patients: the LIFE study. Blood Press 2016; 26:94-101. [DOI: 10.1080/08037051.2016.1215765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michael T. Tanoue
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Sverre E. Kjeldsen
- Ullevål Hospital, University of Oslo, Oslo, Norway
- Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
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Li T, Yang J, Guo X, Chen S, Sun Y. Geometrical and functional changes of left heart in adults with prehypertension and hypertension: a cross-sectional study from China. BMC Cardiovasc Disord 2016; 16:114. [PMID: 27234840 PMCID: PMC4884422 DOI: 10.1186/s12872-016-0286-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/14/2016] [Indexed: 01/19/2023] Open
Abstract
Background Studies regarding the association between prehypertension and the structual changes of left heart are scanty. However, which type of the geometrical change of left heart is predominated one in prehypertension and hypertension is controversial. It is therefore important to investigate geometrical and functional changes of left heart in adults with prehypertension and hypertension because of their prognostic significance. Methods The study was based on a cross-sectional design, a total of 10547 participants were classified into normotension group, prehypertension group and hypertension group. We analyzed clinical characteristics, echocardiographic parameters and distribution of left ventricular (LV) geometrical patterns in different groups. Results Participants with prehypertension had higher values of most of echocardiographic parameters than those with normotension. The prevalence of left ventricular hypertrophy(LVH) was statistically different among three groups (P <0.001), and the rates of LVH in the three groups were 5.9, 8.6, 28.4 % by indexation to height2.7 and 4.9, 5.3, 19.3 % by indexation to BSA, respectively. The prevalence rates of eccentric hypertrophy, concentric remodeling and concentric hypertrophy were 7.3 %, 5.3 % and 1.4 % in prehypertension group, and 17.8 %, 8.8 % and 10.6 % in hypertension group. Logistic regression analysis showed that systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean artery pressure (MAP) were all independent risk factors for left cardiac structural changes, and pulse pressure (PP) was independent risk factor for concentric and eccentric hypertrophy. Among four indices, DBP levels with OR values of 1.192, 1.759 and 1.278 were the strongest indicator for concentric remodeling, concentric hypertrophy and eccentric hypertrophy, respectively (P <0.001). Conclusions There exists LV geometrical change in adults with prehypertension and hypertension in rural Chinese population, and the eccentric hypertrophy was the highest proportion of geometric alterations. SBP, DBP, MAP and PP were all positively associated with left cardiac structural changes, and the association of DBP was the strongest.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Shuang Chen
- Department of Cardiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
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19
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Risk of mortality in relation to an updated classification of left ventricular geometric abnormalities in a general population: the Pamela study. J Hypertens 2016. [PMID: 26196652 DOI: 10.1097/hjh.0000000000000658] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular geometric patterns, as defined by a new classification system proposed by the Dallas Heart Study, in 1716 representatives of the general population of Monza enrolled in the Pressioni Monitorate e Loro Associazioni (PAMELA) study. METHODS Cut-points for abnormal left ventricular geometric patterns were derived from reference values of the healthy fraction of the PAMELA population by combining left ventricular mass (LVM) index, left ventricular diameter and relative wall thickness. Death certificates were collected over an average 211 months follow-up period. RESULTS During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were recorded. Concentric remodelling was the most common left ventricular geometric abnormality (9.4%) followed by eccentric nondilated left ventricular hypertrophy (LVH) (6.3%), concentric LVH (4.6%) and eccentric dilated LVH (3.5%). Compared with normal left ventricular geometry, concentric LVH [hazard ratio 2.20, 95% confidence interval (95% CI) 1.44-3.37, P < 0.0003], eccentric dilated LVH (hazard ratio 1.90, 95% CI 1.17-3.08, P = 0.009) and eccentric nondilated LVH (hazard ratio 1.57, 95% CI 1.07-2.31, P = 0.02) predicted the risk of cardiovascular mortality, after adjustment for baseline covariates, including ambulatory blood pressure. Similar findings were observed for all-cause mortality. Only concentric LVH maintained a significant prognostic value for both outcomes after adjustment for baseline differences in LVM index. CONCLUSION The new classification system of left ventricular geometric patterns may improve mortality risk stratification in a general population. The risk is markedly dependent on LVM values; only concentric LVH provides a prognostic information beyond that conveyed by cardiac mass.
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20
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Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14:915-26. [DOI: 10.1080/14779072.2016.1186542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Tanoue MT, Kjeldsen SE, Devereux RB, Okin PM. Relationship of diastolic function to new or persistent electrocardiographic left ventricular hypertrophy. Blood Press 2016; 25:364-372. [DOI: 10.1080/08037051.2016.1179514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Michael T. Tanoue
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Sverre E. Kjeldsen
- Ullevål Hospital, Oslo, Norway and University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
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Melka J, Rienzo M, Bizé A, Jozwiak M, Sambin L, Hittinger L, Su JB, Berdeaux A, Ghaleh B. Improvement of left ventricular filling by ivabradine during chronic hypertension: involvement of contraction-relaxation coupling. Basic Res Cardiol 2016; 111:30. [PMID: 27040115 DOI: 10.1007/s00395-016-0550-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
Chronic hypertension is associated with left ventricular (LV) hypertrophy and LV diastolic dysfunction with impaired isovolumic relaxation and abnormal LV filling. Increased heart rate (HR) worsens these alterations. We investigated whether the I f channel blocker ivabradine exerts beneficial effects on LV filling dynamic. In this setting, we also evaluated the relationship between LV filling and isovolumic contraction as a consequence of contraction-relaxation coupling. Therefore, hypertension was induced by a continuous infusion of angiotensin II during 28 days in 10 chronically instrumented pigs. LV function was investigated after stopping angiotensin II infusion to offset the changes in loading conditions. In the normal heart, LV relaxation filling, LV early filling, LV peak early filling rate were positively correlated to HR. In contrast, these parameters were significantly reduced at day 28 vs. day 0 (18, 42, and 26 %, respectively) despite the increase in HR (108 ± 6 beats/min vs. 73 ± 2 beats/min, respectively). These abnormalities were corrected by acute administration of ivabradine (1 mg/kg, iv). Ivabradine still exerted these effects when HR was controlled at 150 beats/min by atrial pacing. Interestingly, LV relaxation filling, LV early filling and LV peak early filling were strongly correlated with both isovolumic contraction and relaxation. In conclusion, ivabradine improves LV filling during chronic hypertension. The mechanism involves LV contraction-relaxation coupling through normalization of isovolumic contraction and relaxation as well as HR-independent mechanisms.
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Affiliation(s)
- Jonathan Melka
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Mario Rienzo
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Hôpital Européen Georges Pompidou, Service d'Anesthésie-Réanimation Chirurgicale, 75015, Paris, France
| | - Alain Bizé
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Mathieu Jozwiak
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Lucien Sambin
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Luc Hittinger
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, 94000, Créteil, France
| | - Jin Bo Su
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Alain Berdeaux
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
- AP-HP, Groupe Hospitalier Henri Mondor, Fédération de Cardiologie, 94000, Créteil, France
| | - Bijan Ghaleh
- Faculté de Médecine, Inserm, U955, Equipe 03, 8 rue du Général Sarrail, 94000, Créteil, France.
- Université Paris-Est, UMR_S955, DHU A-TVB, UPEC, 94000, Créteil, France.
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France.
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Abstract
The global burden of hypertension is rising and accounts for substantial morbidity and mortality. Lifestyle factors such as diet and physical inactivity contribute to this burden, further highlighting the need for prevention efforts to curb this public health epidemic. Regular physical activity is associated with lower blood pressure, reduced cardiovascular risk, and cardiac remodeling. While exercise and hypertension can both be associated with the development of left ventricular hypertrophy (LVH), the cardiac remodeling from hypertension is pathologic with an associated increase in myocyte hypertrophy, fibrosis, and risk of heart failure and mortality, whereas LVH in athletes is generally non-pathologic and lacks the fibrosis seen in hypertension. In hypertensive patients, physical activity has been associated with paradoxical regression or prevention of LVH, suggesting a mechanism by which exercise can benefit hypertensive patients. Further studies are needed to better understand the mechanisms underlying the benefits of physical activity in the hypertensive heart.
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Affiliation(s)
- Sheila M Hegde
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
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Chen SC, Tsai YC, Huang JC, Lee SC, Chang JM, Hwang SJ, Chen HC. Interankle systolic blood pressure difference and renal outcomes in patients with chronic kidney disease. Nephrology (Carlton) 2015; 21:379-86. [PMID: 26370877 DOI: 10.1111/nep.12619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 11/30/2022]
Abstract
AIM Interankle blood pressure (BP) difference has been associated with peripheral artery disease and adverse cardiovascular outcomes. However, the relationship between interankle BP difference and renal outcomes in chronic kidney disease (CKD) has never been evaluated. The purpose of this study was to determine whether interankle BP difference is associated with the rate of renal function decline and progression to renal end points in patients with stage 3-5 CKD. METHODS We enrolled 144 patients with CKD from one regional hospital. The BP in four limbs was simultaneously measured using an ABI-form device. The decline in renal function was evaluated using an estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as an eGFR slope < -3 mL/min per 1.73 m(2) per year. The renal end points were defined as ≥ 25% decline in eGFR or commencement of dialysis during the follow-up period. RESULTS During a mean follow-up period of 3.1 years, 90 patients (62.5%) reached renal end points. Multivariate analysis showed that an increased interankle systolic BP difference (per 5 mmHg) was associated with a worse eGFR slope (regression β, -0.292; 95% confidence interval [CI], -0.482 to -0.102; P = 0.003), rapid renal progression (odds ratio, 1.189; 95% CI, 1.015-1.394; P = 0.032), and an increased risk of progression to renal end points (hazard ratio, 1.126; 95% CI, 1.052-1.204, P = 0.001). CONCLUSION Interankle systolic BP difference was associated with rapid renal progression and progression to renal end points in patients with stage 3-5 CKD in our study.
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Affiliation(s)
- Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University.,Faculty of Medicine
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University.,Faculty of Medicine
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University
| | - Su-Chu Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University.,Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Dahl JS, Eleid MF, Pislaru SV, Scott CG, Connolly HM, Pellikka PA. Development of paradoxical low-flow, low-gradient severe aortic stenosis. Heart 2015; 101:1015-23. [DOI: 10.1136/heartjnl-2014-306838] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/11/2015] [Indexed: 11/03/2022] Open
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Cuspidi C, Tadic M, Sala C, Grassi G. How to identify hypertensive patients at high cardiovascular risk? The role of echocardiography. High Blood Press Cardiovasc Prev 2015; 22:113-7. [PMID: 25749858 DOI: 10.1007/s40292-015-0079-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/10/2015] [Indexed: 11/24/2022] Open
Abstract
Scientific authorities recommend that patients with arterial hypertension should be managed not only on the basis of blood pressure (BP) levels, but also on the assemement of total cardiovascular risk. In particular, evaluation of target organ damage (TOD) is of major relevance for identifying hypertensive individuals at high cardiovascular risk independently of clinic BP levels. Evidence of cardiac and extra-cardiac TOD has been consistently associated with worse cardiovascular prognosis. Unfortunately, detection of TOD markedly depends on sensitivity of diagnostic tools, at difference from evaluation of risk factors and associated diseases, usually reliably provided by accurate clinical examination and routine investigation. The purpose of this paper was to provide an updated, comprehensive review on the role of echocardiography in identifying hypertensive patients apparently uncomplicated, but exposed to a high cardiovascular risk due to the presence of subclinical structural and functional cardiac alterations of adverse prognostic significance.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milan, Italy,
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Relationship of left ventricular systolic function to persistence or development of electrocardiographic left ventricular hypertrophy in hypertensive patients. J Hypertens 2014; 32:2472-8; discussion 2478. [DOI: 10.1097/hjh.0000000000000432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hypertension is a powerful risk factor for cardiovascular mortality and morbidity, including heart failure with both preserved and reduced ejection fraction. Hypertensive heart disease (HHD) defines the complex and diverse perturbations of cardiac structure and function occurring secondary to hypertension. Left ventricular hypertrophy (LVH) is one of the most recognized features of HHD and is an established risk factor for adverse cardiovascular (CV) outcomes in hypertension. Beyond LVH, LV geometry provides additional information regarding the cardiac response to hypertension. Imaging studies from larger cohorts of hypertensive patients reveal wide variability in the prevalence of LVH and LV geometric patterns, with the prevalence of concentric LVH similar to that of eccentric LVH. Hypertension is also associated with concomitant impairments in LV diastolic and systolic function. It remains uncertain why patients develop different patterns of LVH, although demographics and clinical comorbidities appear to influence that response.
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Affiliation(s)
- Mário Santos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
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29
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Left ventricular geometry and all-cause mortality in advanced age. Heart Lung Circ 2014; 24:32-9. [PMID: 25130383 DOI: 10.1016/j.hlc.2014.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Abnormalities of cardiac structure and function are common in a wide range of populations including those with and without established clinical cardiovascular disease (CVD). This study reports the prevalence of left ventricular hypertrophy (LVH), the four patterns of LV geometry and establishes clinical characteristics and five-year outcomes of each group in people of advanced age. METHOD A study conducted in general practices and Māori Health Services in three New Zealand North Island locations. One hundred participants had a full clinical echocardiogram performed and analysed in 2008 by one experienced cardiologist blinded to the participant's clinical history. RESULTS Two-thirds of the participants had CVD. Thirty-two participants had echocardiographic LVH. Those with LVH had higher left atrial area [median (IQR) 26.4cm(2) (10.9) vs. 22.0cm(2) (7.0), p<0.01] and E/e' [median (IQR) 13 (6.8) vs.10.8 (4.1), p=0.01] than those without LVH. Of those with LVH, 10 demonstrated concentric hypertrophy (CH) and 22 eccentric hypertrophy (EH); 12 concentric remodelling (CR) and 40 normal geometry (NG). Both CR and EH were independently associated with higher risk of all-cause mortality (p<0.01) and hospital admissions (p<0.05) than those with NG. Those with EH also had a higher risk of CVD events (p=0.029). CONCLUSIONS Despite a high prevalence of CVD and hypertension in this sample, half had normal LV geometry. Concentric remodelling and eccentric hypertrophy were associated with higher mortality and adverse CVD outcomes in people of advanced age.
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Huynh K, Bernardo BC, McMullen JR, Ritchie RH. Diabetic cardiomyopathy: mechanisms and new treatment strategies targeting antioxidant signaling pathways. Pharmacol Ther 2014; 142:375-415. [PMID: 24462787 DOI: 10.1016/j.pharmthera.2014.01.003] [Citation(s) in RCA: 400] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is the primary cause of morbidity and mortality among the diabetic population. Both experimental and clinical evidence suggest that diabetic subjects are predisposed to a distinct cardiomyopathy, independent of concomitant macro- and microvascular disorders. 'Diabetic cardiomyopathy' is characterized by early impairments in diastolic function, accompanied by the development of cardiomyocyte hypertrophy, myocardial fibrosis and cardiomyocyte apoptosis. The pathophysiology underlying diabetes-induced cardiac damage is complex and multifactorial, with elevated oxidative stress as a key contributor. We now review the current evidence of molecular disturbances present in the diabetic heart, and their role in the development of diabetes-induced impairments in myocardial function and structure. Our focus incorporates both the contribution of increased reactive oxygen species production and reduced antioxidant defenses to diabetic cardiomyopathy, together with modulation of protein signaling pathways and the emerging role of protein O-GlcNAcylation and miRNA dysregulation in the progression of diabetic heart disease. Lastly, we discuss both conventional and novel therapeutic approaches for the treatment of left ventricular dysfunction in diabetic patients, from inhibition of the renin-angiotensin-aldosterone-system, through recent evidence favoring supplementation of endogenous antioxidants for the treatment of diabetic cardiomyopathy. Novel therapeutic strategies, such as gene therapy targeting the phosphoinositide 3-kinase PI3K(p110α) signaling pathway, and miRNA dysregulation, are also reviewed. Targeting redox stress and protective protein signaling pathways may represent a future strategy for combating the ever-increasing incidence of heart failure in the diabetic population.
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Affiliation(s)
- Karina Huynh
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Julie R McMullen
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Department of Physiology, Monash University, Clayton, Victoria, Australia.
| | - Rebecca H Ritchie
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia.
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Dzudie A, Kengne AP, Mbahe S, Menanga A, Kenfack M, Kingue S. Chronic heart failure, selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon. Eur J Heart Fail 2014; 10:367-72. [DOI: 10.1016/j.ejheart.2008.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 11/25/2007] [Accepted: 02/04/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anastase Dzudie
- Heart failure and transplantation Unit; Louis Pradel's Cardiovascular Hospital; Lyon France
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Andre Pascal Kengne
- The George Institute For International Health; University of Sydney; Australia
| | - Salomon Mbahe
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Alain Menanga
- Cardiology Unit, Service of Internal Medicine B; Yaoundé General Hospital; Cameroon
| | - Monique Kenfack
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Samuel Kingue
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
- Cardiology Unit, Service of Internal Medicine B; Yaoundé General Hospital; Cameroon
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Somaratne JB, Whalley GA, Bagg W, Doughty RN. Early detection and significance of structural cardiovascular abnormalities in patients with Type 2 diabetes mellitus. Expert Rev Cardiovasc Ther 2014; 6:109-25. [DOI: 10.1586/14779072.6.1.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Gerdts E, de Simone G, Lund BP, Okin PM, Wachtell K, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Impact of overweight and obesity on cardiac benefit of antihypertensive treatment. Nutr Metab Cardiovasc Dis 2013; 23:122-129. [PMID: 21775111 DOI: 10.1016/j.numecd.2011.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 02/06/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Increased body mass index (BMI) has been associated with increased cardiovascular morbidity and mortality in hypertension. Less is known about the impact of BMI on improvement in left ventricular (LV) structure and function during antihypertensive treatment. METHODS AND RESULTS Annual BMI, echocardiograms and cardiovascular events were recorded in 875 hypertensive patients with LV hypertrophy during 4.8 years randomized treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. Patients were grouped by baseline BMI into normal (n = 282), overweight (n = 405), obese (n = 150) and severely obese groups (n = 38) (BMI ≤24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2), respectively). At study end, residual LV hypertrophy was present in 54% of obese and 79% of severely obese patients compared to 31% of normal weight patients (both p < 0.01). In regression analyses, adjusting for initial LV mass/height(2.7), higher BMI predicted less LV hypertrophy reduction and more reduction in LV ejection fraction (both p < 0.05), independent of blood pressure reduction, diabetes and in-study weight change. During follow-up, 91 patients suffered cardiovascular death, myocardial infarction or stroke. In Cox regression analysis 1 kg/m(2) higher baseline BMI predicted a 5% higher rate of cardiovascular events and 10% higher cardiovascular mortality over 4.8 years (both p < 0.05). CONCLUSIONS In hypertensive patients in the LIFE study, increased BMI was associated with less reduction of LV hypertrophy and less improvement in LV systolic function which may contribute to the observed higher cardiovascular event rate of treated hypertensive patients.
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Affiliation(s)
- E Gerdts
- Institute of Medicine, University of Bergen, N-5021, Bergen, Norway.
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Kolo PM, Sanya EO, Omotoso AB, Soladoye A, Ogunmodede JA. Left ventricular hypertrophy is associated with diastolic filling alterations in normotensive offspring of hypertensive nigerians. ISRN CARDIOLOGY 2012. [PMID: 23193485 PMCID: PMC3501814 DOI: 10.5402/2012/256738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contribution of left ventricular diastolic dysfunction to adverse events in patients with cardiovascular diseases is increasingly being recognized and individuals with pedigree for hypertension are thought to exhibit anatomic and or functional changes in their left ventricle before they become hypertensive. This study aimed at characterizing left ventricular diastolic function in normotensive offspring of hypertensive Nigerians. Sixty-five offspring of hypertensive parents aged 15–25 years (subjects) with 65-age and sex-matched offspring of normotensive parents (controls) were studied for early makers of hypertensive cardiovascular disease using Doppler echocardiogram. Mean mitral E velocity was reduced (P = 0.01) in the subjects (73.3 ± 12.6 cm/s) compared with the controls (80.2 ± 22.5 cm/s). Similarly, mean S velocity of pulmonary venous flow was lower (P = 0.01) in the subjects than in the controls. Left atrial dimension and mitral E/A ratio in the subjects with left ventricular hypertrophy were higher (P = 0.002, 0.004 respectively) than in the subjects without this abnormality. We concluded that normotensive offspring of hypertensive Nigerians showed early alterations in indexes of left ventricular diastolic filling and these abnormalities were exaggerated in the presence of left ventricular hypertrophy.
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Affiliation(s)
- P M Kolo
- Department of Medicine, University of Ilorin, PMB 1515, Ilorin, Nigeria
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35
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Strand A, Gudmundsdottir H, Høieggen A, Fossum E, Bjørnerheim R, Os I, Kjeldsen SE. Increased hematocrit before blood pressure in men who develop hypertension over 20 years. ACTA ACUST UNITED AC 2012; 1:400-6. [PMID: 20409872 DOI: 10.1016/j.jash.2007.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/02/2007] [Accepted: 07/09/2007] [Indexed: 12/01/2022]
Abstract
We have previously demonstrated that neurohormonal activity can predict left ventricular (LV) mass in men who developed hypertension over 20 years. The aim of the study was to investigate early markers of cardiac and hemorheological changes at baseline in these men, i.e., before a rise in blood pressure. Fifty-six middle-aged men were followed for 20 years; 22 were sustained hypertensives, 17 developed hypertension, and 17 were sustained normotensives. They were compared at baseline (42 years) and follow-up (62 years). We investigated Cornell voltage product and Sokolow-Lyon voltage, hematocrit (Hct), and echocardiographic LV parameters. There was no sign of LV hypertrophy by electrocardiography (ECG) at baseline. Baseline Hct discriminated between the groups (P= .015) and correlated to diastolic blood pressure (DBP) at baseline (r = 0.37, P= .006) and follow-up (r = 0.31, P= .020). Regression analysis identified baseline Hct as an independent correlate of DBP in the cohort at baseline when they were untreated (beta = .33, P= .013, R(2) = 0.25), and of borderline significance at follow-up (beta = .26, P= .060, R(2) = 0.12) despite possible interference by antihypertensive drugs. Hct was elevated at baseline compatible with the hypothesis that pathogenic hemorheological processes could be activated at the outset and prior to cardiac changes in men who later develop hypertension.
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Affiliation(s)
- Arne Strand
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
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Mortensen KH, Gravholt CH, Hjerrild BE, Stochholm K, Andersen NH. Left Ventricular Hypertrophy in Turner Syndrome: A Prospective Echocardiographic Study. Echocardiography 2012; 29:1022-30. [DOI: 10.1111/j.1540-8175.2012.01754.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Fici F, Ural D, Tayfun S, Kozdag G, Facchetti R, Brambilla G, Dell'Oro R, Grassi G, Mancia G. Left ventricular diastolic dysfunction in newly diagnosed untreated hypertensive patients. Blood Press 2012; 21:331-7. [DOI: 10.3109/08037051.2012.686179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Inappropriately high left-ventricular mass in asymptomatic mild-moderate aortic stenosis. J Hypertens 2012; 30:421-8. [DOI: 10.1097/hjh.0b013e32834f0b00] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE To evaluate whether lower stroke volume during antihypertensive treatment is a predictor of cardiovascular events independent of left ventricular geometric pattern. METHODS The association between left ventricular stroke volume and combined cardiovascular death, stroke and myocardial infarction, the prespecified primary study endpoint, was assessed in Cox regression analysis using data from baseline and annual follow-up visits in 855 patients during 4.8 years of randomized losartan-based or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. RESULTS During follow-up, a total of 91 primary endpoints occurred. At baseline, lower left ventricular stroke volume was associated with smaller body size, female sex, lower left ventricular mass and stress-corrected midwall shortening, higher relative wall thickness and total peripheral resistance, more concentric left ventricular geometry and impaired diastolic relaxation (all P < 0.01). Baseline stroke volume did not predict outcome. However, in time-varying multivariable Cox regression analysis, lower in-treatment left ventricular stroke volume indexed for height was associated with higher risk of cardiovascular events {hazard ratio 1.69 per 1 SD (6 ml/m) lower stroke volume [95% confidence interval (CI) 1.35-2.11], P < 0.001} independent of in-treatment left ventricular mass and concentric geometry and in a secondary model also independent of stress-corrected midwall shortening, impaired diastolic relaxation, heart rate, new-onset atrial fibrillation and study treatment [hazard ratio 1.46 per 1 SD (6 ml/m) lower stroke volume (95% CI 1.13-1.88)]. CONCLUSION Assessment of in-treatment left ventricular stroke volume may reflect cardiac and vascular remodeling and impairment and, hence, adds information on cardiovascular risk in treated hypertensive patients beyond assessment of left ventricular structure alone. CLINICAL TRIAL REGISTRATION INFORMATION NCT 00338260.
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Chen SC, Su HM, Hung CC, Chang JM, Liu WC, Tsai JC, Lin MY, Hwang SJ, Chen HC. Echocardiographic parameters are independently associated with rate of renal function decline and progression to dialysis in patients with chronic kidney disease. Clin J Am Soc Nephrol 2011; 6:2750-8. [PMID: 21980185 PMCID: PMC3255363 DOI: 10.2215/cjn.04660511] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 09/06/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Cardiac abnormalities were frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether echocardiographic parameters are associated with rate of renal function decline and progression to dialysis in CKD stage 3 to 5 patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This longitudinal study enrolled 415 patients. The renal end point was defined as commencement of dialysis. The change in renal function was measured by estimated GFR (eGFR) slope. RESULTS Progression to dialysis was predicted by wide pulse pressure, low albumin, low hemoglobin, high calcium-phosphorous product, proteinuria, diuretics use, and concentric left ventricular hypertrophy (LVH) (hazard ratio, 2.03; 95% confidence interval [CI], 1.00 to 4.10; P = 0.05). The eGFR slope was negatively associated with total cholesterol, uric acid, proteinuria, diuretics use, and left atrial (LA) diameter (change in slope, -0.50; 95% CI, -0.89 to -0.11; P = 0.01) and positively associated with albumin and left ventricular ejection fraction (LVEF) (change in slope, 0.06; 95% CI, 0.03 to 0.08; P < 0.001). CONCLUSIONS Our study in patients of CKD stage 3 to 5 demonstrated that concentric LVH was associated with progression to dialysis, and that increased LA diameter and decreased LVEF were associated with faster renal function decline. Echocardiography may help identify high-risk groups with progressive decline in renal function to dialysis and rapid progression of renal dysfunction in CKD stage 3 to 5 patients.
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Affiliation(s)
- Szu-Chia Chen
- Division of Nephrology
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Jer-Ming Chang
- Division of Nephrology
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
- Faculty of Renal Care
| | - Wan-Chun Liu
- Division of Nephrology
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
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Impaired left ventricular systolic function in patients with left ventricular hypertrophy. J Hypertens 2011; 29:2068-9. [DOI: 10.1097/hjh.0b013e32834d58d2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akintunde AA, Akinwusi PO, Opadijo GO. Relationship between Tei index of myocardial performance and left ventricular geometry in Nigerians with systemic hypertension. Cardiovasc J Afr 2011; 22:124-7. [PMID: 21713301 PMCID: PMC3721924 DOI: 10.5830/cvja-2010-050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 06/30/2010] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Left ventricular geometry is associated with cardiovascular events and prognosis. The Tei index of myocardial performance is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases. The relationship between the Tei index and left ventricular geometry has not been well studied. This study examined the association between the Tei index and left ventricular geometry among hypertensive Nigerian subjects. METHODS We performed echocardiography on 164 hypertensives and 64 control subjects. They were grouped into four geometric patterns based on left ventricular mass and relative wall thickness. The Tei index was obtained from the summation of the isovolumic relaxation time and the isovolumic contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0. RESULTS Among the hypertensive subjects, 68 (41.4%) had concentric hypertrophy, 43 (26.2%) had concentric remodelling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%) had normal geometry. The Tei index was significantly higher among the hypertensives with concentric hypertrophy (CH), concentric remodelling (CR) and eccentric hypertrophy (EH) compared to the hypertensives with normal geometry (0.83 ± 1.0, 0.71 ± 0.2, 0.80 ± 0.2 vs 0.61 ± 0.2, respectively). The Tei index was higher among hypertensives with CH and EH than those with CR. Stepwise regression analysis showed that the Tei index was related to ejection fraction, fractional shortening and mitral E/A ratio. CONCLUSION Among Nigerian hypertensives, LV systolic and diastolic functions (using the Tei index) were impaired in all subgroups of hypertensive patients according to their left ventricle geometry compared to the control group. This impairment was more advanced in patients with concentric and eccentric hypertrophy.
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Affiliation(s)
- Adeseye A Akintunde
- Division of Cardiology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
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Cioffi G, Cramariuc D, Dalsgaard M, Davidsen ES, Egstrup K, de Simone G, Gerdts E. Left Atrial Systolic Force in Asymptomatic Aortic Stenosis. Echocardiography 2011; 28:968-77. [DOI: 10.1111/j.1540-8175.2011.01488.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Abstract
Hypertensive heart disease is the target organ response to arterial hypertension. Left ventricular hypertrophy represents an important predictor for cardiovascular events. Myocardial fibrosis, a common end point in hypertensive heart disease, has been linked to the development of left ventricular hypertrophy and diastolic dysfunction. Echocardiography is clinically useful in the detection of left ventricular hypertrophy and the assessment of diastolic function. Although echocardiography is more widely available, cardiac magnetic resonance has been demonstrated to be more reproducible for the estimation of left ventricular mass. Future developments in cardiac magnetic resonance techniques may facilitate the quantification of diffuse fibrosis that occurs in hypertensive heart disease. Thus, advances in cardiac imaging provide comprehensive, noninvasive tools for imaging left ventricular hypertrophy, diastolic dysfunction, myocardial fibrosis and ischemia observed in hypertensive heart disease. The objective of this article is to summarize the state-of-the-art and the future of multimodality imaging of hypertensive heart disease.
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Affiliation(s)
- Rajesh Janardhanan
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee St., Box 800170, Charlottesville, VA 22908, USA
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Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusmà-Piccione M, Di Bella G, Saitta C, Saitta A. Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography. Echocardiography 2011; 28:649-57. [DOI: 10.1111/j.1540-8175.2011.01410.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Age-related Ventricular Remodeling is an Independent Risk for Heart Failure Symptoms in Subjects With Preserved Systolic Function. INT J GERONTOL 2011. [DOI: 10.1016/j.ijge.2011.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Impact of concomitant diabetes and chronic kidney disease on preload-induced changes in left ventricular diastolic filling in hypertensive patients. J Hypertens 2011; 29:144-53. [DOI: 10.1097/hjh.0b013e32833f387c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation. J Hypertens 2010; 28:1534-40. [PMID: 20589977 DOI: 10.1097/hjh.0b013e328338c20e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persistence and development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of atrial fibrillation compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via greater left atrial enlargement (LAE) in patients with new and persistent ECG LVH. METHODS AND RESULTS Baseline and third year ECG LVH and left atrial systolic diameter were examined in 663 patients in the Losartan Intervention For Endpoint reduction in hypertension echocardiographic substudy who were in sinus rhythm at baseline and had no history of atrial fibrillation. Left atrial systolic diameter was measured and considered enlarged if more than 3.8 cm in women or more than 4.2 cm in men. Cornell product LVH above 2440 mm-ms was considered consistent with LVH. After 3 years follow-up, 238 patients (35.9%) had continued absence of Cornell product LVH, 156 (23.5%) had regression of LVH, 236 (35.6%) had persistent LVH and 33 patients (5.0%) developed new ECG LVH. Compared with third year mean left atrial systolic dimension and prevalence of LAE in patients with continued absence of LVH (3.62+/-0.52 cm, 12.6%), there were step-wise increases in patients with regression of LVH (3.71+/-0.49 cm, 20.5%), persistence of LVH (3.82+/-0.57 cm, 32.2%) and development of new ECG LVH (3.91+/-0.42 cm, 36.4%, both P<0.001). After controlling for differences in age, sex, baseline SBP, BMI and Sokolow-Lyon voltage, randomized treatment allocation, change in DBP and SBP between baseline and third year and for isovolumic relaxation time and presence of an abnormal mitral E/A ratio at baseline and third year, the odds of having LAE were significantly increased in patients with persistent LVH (odds ratio 1.8, 95% confidence interval 1.1-3.2, P=0.043) or new LVH (odds ratio 3.1, 95% confidence interval 1.3-7.7, P=0.016), but not in patients with regression of Cornell product LVH (odds ratio 1.1, 95% confidence interval 0.6-2.0, P=0.860). CONCLUSION Persistence or development of new ECG LVH during antihypertensive therapy are associated with an increased risk of LAE after 3-year follow-up, whereas regression of ECG LVH is not associated with an increased risk of LAE. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing atrial fibrillation.
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Wachtell K, Palmieri V, Gerdts E, Bella JN, Aurigemma GP, Papademetriou V, Dahlöf B, Aalto T, Ibsen H, Rokkedal JE, Devereux RB. Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension (the LIFE Study). Am J Cardiol 2010; 106:999-1005. [PMID: 20854964 DOI: 10.1016/j.amjcard.2010.05.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 12/29/2022]
Abstract
Patients with hypertension and left ventricular (LV) hypertrophy commonly have impaired diastolic filling. However, it remains unknown whether changes in LV diastolic filling variables are associated with cardiovascular morbidity and mortality. In this study, 778 patients with hypertension with electrocardiographic LV hypertrophy who underwent echocardiography at baseline and annually thereafter during randomized losartan- or atenolol-based antihypertensive treatment were followed for a mean of 4.6 years. The composite cardiovascular end point was the first occurrence of fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, and cardiovascular mortality. Antihypertensive therapy resulted in an increase in the prevalence of normal transmitral flow pattern from 28% to 46% of patients. Although antihypertensive treatment often resulted in a marked increase in the prevalence of normal mitral valve flow pattern, this was not associated with reduced cardiovascular morbidity and mortality when adjusting for blood pressure, left atrial diameter, LV mass index, and treatment in time-varying Cox analyses. In contrast, lower in-treatment E/A ratios and shorter mitral valve deceleration times were associated with less risk for heart failure. Similarly, normal in-treatment transmitral flow pattern was strongly associated with less risk for heart failure (hazard ratio 0.22, 95% confidence interval 0.05 to 0.98, p = 0.048), even when taking in-treatment left atrial diameter and blood pressure into account. In conclusion, antihypertensive treatment in patients with hypertension with electrocardiographic LV hypertrophy resulted in significant improvement in transmitral flow patterns; this was not associated with reduced cardiovascular morbidity and mortality. However, normal in-treatment LV filling was strongly associated with a reduced risk for hospitalization for heart failure.
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Abstract
Progressive abnormalities of passive stiffness or active relaxation of the myocardium that impair ventricular filling during diastole may be an important contributor to the development of heart failure in patients with preserved ejection fraction. In this review, we discuss the epidemiology and pathophysiology of diastolic dysfunction and heart failure with preserved ejection fraction, highlighting potential therapeutic approaches and exploring the limited available evidence base for improving clinical outcomes in patients with these challenging entities.
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