1
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Complementary value of ECG and echocardiographic left ventricular hypertrophy for prediction of adverse outcomes in the general population. J Hypertens 2021; 39:548-555. [PMID: 33543885 DOI: 10.1097/hjh.0000000000002652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether ECG left ventricular hypertrophy (ECG-LVH) has prognostic value independent of echocardiography LVH (Echo-LVH). METHODS Participants (N = 9744, mean age, 53.81 ± 10.49 years and 45.5% male) from the Northeast China Rural Cardiovascular Health Study were included. Associations between Echo-LVH (sex-specific left ventricular mass normalized to BSA) and ECG-LVH (diagnosed using the Cornell-voltage duration product) and adverse outcomes were evaluated using Cox regression. The value of ECG-LVH for predicting adverse events was evaluated by reclassification and discrimination analyses. RESULTS Median follow-up was 4.65 years; 563 participants developed incident stroke or coronary heart disease (CHD) and 402 died. Compared with participants without either condition, those with both Echo-LVH and ECG-LVH had a significantly increased risk of incident stroke or CHD (hazard ratio, 2.42; 95% confidence interval, 1.82-3.22) and mortality (2.58; 1.85-3.60). ECG-LVH remained an independent risk factors for both outcomes when ECG-LVH and Echo-LVH were included in the model as separate variables [incident stroke or CHD (1.43; 1.14-1.79); mortality (1.41; 1.08-1.84)]. Reclassification and discrimination analyses indicated ECG-LVH addition could improve the conventional model for predicting adverse outcomes within 4 years. These relationships persisted after excluding participants with cardiovascular disease history or taking antihypertension drugs or upon applying other ECG-LVH and Echo-LVH diagnostic criteria. CONCLUSION Our study provides strong evidence that ECG-LVH is associated with adverse outcomes, independent of Echo-LVH. Clinically, ECG-LVH could be considered as a consequential factor, especially in those with Echo-LVH. These findings have potential clinical relevance for risk stratification.
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2
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Sun K, Wang Y, Yan M, Xia VW. Pretransplant left ventricular hypertrophy in association with postoperative myocardial injury in liver transplantation. Clin Transplant 2020; 34:e13847. [PMID: 32097498 DOI: 10.1111/ctr.13847] [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: 10/03/2019] [Revised: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 12/01/2022]
Abstract
Pretransplant left ventricular hypertrophy (LVH) is a common finding during preoperative cardiac evaluation. We hypothesized that patients with pretransplant LVH were associated with a higher risk of postoperative myocardial injury (PMI) in adult patients undergoing liver transplantation (LT). A retrospective cohort analysis was performed by reviewing the medical records of adult patients who underwent LT between January 2006 and October 2013. Of 893 patients, the incidences of mild, moderate, and severe LVH were 7.8%, 5.6%, and 2.5%, respectively. Propensity match was used to eliminate the pretransplant imbalance between the LVH and non-LVH groups. In after-match patients, 23.5% of LVH patients developed PMI compared to 11.8% in the control group (P = .011). The incidence of PMI in patients with moderate-severe degrees of LVH was significantly higher compared with that in patients with mild LVH (27.9% vs 19.1%, P = .016). When controlling intraoperative variables, patients with LVH had 4.5 higher odds of developing PMI (95% CI1.18-17.19, P = .028). Patients experiencing PMI had significantly higher 1-year mortality (37.5% vs 15.7%, log-rank test P < .001). Our results suggest that patients with pretransplant LVH were at a high risk of developing PMI and should be monitored closely in the perioperative period. More studies are warranted.
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Affiliation(s)
- Kai Sun
- Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Wang
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Min Yan
- Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Victor W Xia
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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3
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Tan ES, Chan SP, Xu CF, Yap J, Richards AM, Ling LH, Sim D, Jaufeerally F, Yeo D, Loh SY, Ong HY, Leong KTG, Ng TP, Nyunt SZ, Feng L, Okin P, Lam CS, Lim TW. Cornell product is an ECG marker of heart failure with preserved ejection fraction. HEART ASIA 2019; 11:e011108. [PMID: 31244913 DOI: 10.1136/heartasia-2018-011108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Abstract
Objective ECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF. Methods CP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations. Results CP increased across groups from healthy controls to hypertensive controls to HFpEF, and distinguished between HFpEF and hypertension with an optimal cut-off of ≥1800 mm*ms (sensitivity 40%, specificity 85%). Age, male sex, systolic blood pressure (SBP) and heart rate were independent predictors of CP ≥1800 mm*ms, and CP was associated with echocardiographic E/e' (r=0.27, p<0.01) and left ventricular mass index (r=0.46, p<0.01). Adjusting for clinical and echocardiographic variables and log N-terminal pro B-type natriuretic peptide (NT-proBNP), CP ≥1800 mm*ms was significantly associated with HFpEF (adjusted OR 2.7, 95% CI 1.0 to 7.0). At 2-year follow-up, there were 29 deaths and 61 HF hospitalisations, all within the HFpEF group. Even after adjusting for log NT-proBNP, clinical and echocardiographic variables, CP ≥1800 mm*ms remained strongly associated with a higher composite endpoint of all-cause mortality and HF hospitalisations (adjusted HR 2.1, 95% CI 1.2 to 3.5). Conclusion The Cornell product is an easily applicable ECG marker of HFpEF and predicts poor prognosis by reflecting the severity of diastolic dysfunction and LV hypertrophy.
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Affiliation(s)
- Eugene Sj Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Healthy System, Singapore, Singapore
| | - Chang Fen Xu
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Healthy System, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Otago, New Zealand
| | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Fazlur Jaufeerally
- Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Internal Medicine, Singapre General Hospital, Singapore, Singapore
| | - Daniel Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hean Yee Ong
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Shwe Zin Nyunt
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Liang Feng
- Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Peter Okin
- Department of Cardiology, Weill Cornell Medical College, New York City, New York, USA
| | - Carolyn Sp Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
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4
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Januszko-Giergielewicz B, Gromadziński L, Dudziak M, Dębska-Ślizień A. Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease. ACTA ACUST UNITED AC 2019; 55:medicina55040113. [PMID: 31009994 PMCID: PMC6524063 DOI: 10.3390/medicina55040113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022]
Abstract
Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR > 60 mL/min/1.73 m2 (CKD-). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 ± 13.2) and in 8 out of 22 CKD- patients (average age 60.50 ± 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH- patients, lower when standing. In the eGFR range of 30-60 mL/min/1.73 m2 correlation was revealed between OH and β-blockers (p = 0.04), in the entire CKD+ group between β-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with β-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with β-blockers, combined with ACE-I and diuretics.
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Affiliation(s)
- Beata Januszko-Giergielewicz
- Family Medicine Unit, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland.
| | - Leszek Gromadziński
- II Clinical Department of Cardiology and Internal Medicine, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland.
| | - Maria Dudziak
- Cardiac Diagnostic Unit, II Department of Cardiology, Medical University of Gdańsk, ul. Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland.
| | - Alicja Dębska-Ślizień
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
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5
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Gao Y, Wang Z, Zhang Y, Liu Y, Wang S, Sun W, Guo J, Yu C, Wang Y, Kong W, Zheng J. Naringenin inhibits N G-nitro-L-arginine methyl ester-induced hypertensive left ventricular hypertrophy by decreasing angiotensin-converting enzyme 1 expression. Exp Ther Med 2018; 16:867-873. [PMID: 30112041 PMCID: PMC6090443 DOI: 10.3892/etm.2018.6258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022] Open
Abstract
Naringenin (NGN) is a natural flavonoid that exerts antiinflammatory, antioxidant and cardioprotective effects. The present study investigated the effects of NGN on left ventricular hypertrophy in rats with NG-nitro-L-arginine methyl ester (L-NAME)-induced hypertension, and sought to determine the underlying mechanism of action. The rats received the following by gavage daily for 56 days: L-NAME (50 mg/kg/day) + NGN (100 mg/kg/day), L-NAME (50 mg/kg/day) + saline, or saline + saline. Blood pressure, heart rate and body weight were recorded. Left ventricular hypertrophy was assessed by echocardiography and hematoxylin-eosin staining. Angiotensin II (Ang II) and angiotensin-converting enzyme 1 (ACE1), which serve a pivotal role in cardiac remodeling, were evaluated by ELISA, reverse transcription-quantitative polymerase chain reaction and western blot analysis. NGN had no significant effect on body weight, heart rate or blood pressure. The extent of left ventricular hypertrophy in the L-NAME + NGN group was lower than in the L-NAME + saline group on day 56. NGN decreased Ang II and ACE1 protein levels in myocardial tissues. In conclusion, Ang II and ACE1 expression in cardiac tissue was inhibited by NGN in L-NAME-treated rats, which may contribute to the inhibitory effects of NGN on left ventricular hypertrophy that is induced by pressure overload.
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Affiliation(s)
- Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Zhizhi Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yayun Zhang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yuting Liu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Shanshan Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Weiliang Sun
- Biomedical Experimental Research, Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Jing Guo
- Biomedical Experimental Research, Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Changan Yu
- Central Laboratory of Cardiovascular Disease, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yong Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing 100191, P.R. China.,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, P.R. China
| | - Jingang Zheng
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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6
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Okin PM, Hille DA, Kjeldsen SE, Devereux RB. Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.007564. [PMID: 29151037 PMCID: PMC5721804 DOI: 10.1161/jaha.117.007564] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with hypertension with ECG left ventricular hypertrophy (LVH) have higher cardiovascular morbidity and mortality, but single ECG criteria may underestimate risk. Whether continued presence or new development of ECG LVH by 2 criteria can further concentrate risk during blood pressure lowering is unclear. METHODS AND RESULTS Incident stroke, myocardial infarction, cardiovascular death, the composite of these outcomes, and all-cause mortality were examined in relation to the presence of on-treatment ECG LVH by Cornell product and/or Sokolow-Lyon voltage during a mean of 4.8±0.9 years follow-up in 9193 patients with hypertension randomized to losartan- or atenolol-based regimens. Patients were categorized into 4 groups according to the presence or absence of ECG LVH by each criterion at baseline and yearly during the study. At baseline, LVH by both criteria was present in 960 patients (10.4%). Compared with the absence of ECG LVH by both criteria, persistence or development of ECG LVH by both criteria entered as a time-varying covariate was associated with >3-fold increased risks of events in multivariable Cox analyses adjusting for randomized treatment, baseline risk factors, and on-treatment heart rate and systolic and diastolic blood pressures. Patients with ECG LVH by either Cornell product or Sokolow-Lyon voltage had 45% to 140% higher risks of all end points. CONCLUSIONS Persistence or development of ECG LVH by both Cornell product and Sokolow-Lyon voltage criteria during antihypertensive therapy is associated with markedly increased risks of cardiovascular end points and all-cause mortality. Further study is indicated to determine whether additional therapy in these patients can reduce their risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
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Affiliation(s)
- Peter M Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY
| | | | - Sverre E Kjeldsen
- Department of Cardiology, Ullevål Hospital, University of Oslo, Norway.,Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY
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7
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Aronow WS. Hypertension and left ventricular hypertrophy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:310. [PMID: 28856150 DOI: 10.21037/atm.2017.06.14] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College Valhalla, NY, USA
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8
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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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9
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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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10
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Mulè' G, Nardi E, Guarneri M, Cottone S. Electrocardiography for Assessment of Hypertensive Heart Disease: A New Role for an Old Tool. J Clin Hypertens (Greenwich) 2016; 18:843-5. [PMID: 27160048 DOI: 10.1111/jch.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Mulè'
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Marco Guarneri
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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11
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Cuspidi C, Facchetti R, Sala C, Bombelli M, Tadic M, Grassi G, Mancia G. Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation? J Clin Hypertens (Greenwich) 2016; 18:846-54. [PMID: 27160298 DOI: 10.1111/jch.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/31/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
The authors estimated the risk of cardiovascular mortality associated with echocardiographic (ECHO) left ventricular hypertrophy (LVH) and subtypes of this phenotype in patients with and without electrocardiographic (ECG) LVH. A total of 1691 representatives of the general population were included in the analysis. During a follow-up of 211 months, 89 cardiovascular deaths were recorded. Compared with individuals with neither ECHO LVH nor ECG LVH, fully adjusted risk of cardiovascular mortality increased (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.51-7.47; P=.003) in patients with both ECHO-LVH and ECG-LVH, whereas the risk entailed by ECHO-LVH alone was of borderline statistical significance (P=.04). Combined concentric nondilated LVH and ECG-LVH, but not concentric nondilated LVH alone, predicted cardiovascular death (HR, 3.79; 95% CI, 1.25-11.38; P=.01). Similar findings were observed for eccentric nondilated LVH (HR, 3.37; 95% CI, 1.05-10.78; P=.04.). The present analysis underlines the value of combining ECG and ECHO in the assessment of cardiovascular prognosis related to abnormal left ventricular geometric patterns.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy. .,Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Rita Facchetti
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Bombelli
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,IRCCS Multimedica, Milano, Italy
| | - Giuseppe Mancia
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Milano, Italy
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12
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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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13
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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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14
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Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733-79. [PMID: 25173338 DOI: 10.1093/eurheartj/ehu284] [Citation(s) in RCA: 2845] [Impact Index Per Article: 284.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Ablation Techniques/methods
- Adult
- Angina Pectoris/etiology
- Arrhythmias, Cardiac/etiology
- Cardiac Imaging Techniques/methods
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Clinical Laboratory Techniques/methods
- Death, Sudden, Cardiac/prevention & control
- Delivery of Health Care
- Diagnosis, Differential
- Electrocardiography/methods
- Female
- Genetic Counseling/methods
- Genetic Testing/methods
- Heart Failure/etiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Medical History Taking/methods
- Pedigree
- Physical Examination/methods
- Preconception Care/methods
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prenatal Care/methods
- Risk Factors
- Sports Medicine
- Syncope/etiology
- Thoracic Surgical Procedures/methods
- Ventricular Outflow Obstruction/etiology
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15
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Batra S, Machicao VI, Bynon JS, Mehta S, Tanikella R, Krowka MJ, Zacks S, Trotter J, Roberts KE, Brown RS, Kawut SM, Fallon MB. The impact of left ventricular hypertrophy on survival in candidates for liver transplantation. Liver Transpl 2014; 20:705-12. [PMID: 24659368 PMCID: PMC4342997 DOI: 10.1002/lt.23875] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/26/2014] [Indexed: 12/21/2022]
Abstract
Left ventricular hypertrophy (LVH) occurs in 12% to 30% of patients with cirrhosis; however, its prognostic significance is not well studied. We assessed the association of LVH with survival in patients undergoing a liver transplantation (LT) evaluation. We performed a multicenter cohort study of patients undergoing an evaluation for LT. LVH was defined with transthoracic echocardiography. The outcome of interest was all-cause mortality. LVH was present in 138 of 485 patients (28%). Patients with LVH were older, more likely to be male and African American, and were more likely to have hypertension. Three hundred forty-five patients did not undergo transplantation (212 declined, and 133 were waiting): 36 of 110 patients with LVH (33%) died, whereas 57 of 235 patients without LVH (24%) died (P = 0.23). After LT, 8 of 28 patients with LVH (29%) died over the course of 3 years, whereas 9 of 112 patients without LVH (8%) died (P = 0.007). This finding was independent of conventional risk factors for LVH, and all deaths for patients with LVH occurred within 9 months of LT. No clinical or demographic characteristics were associated with mortality among LVH patients. In conclusion, the presence of LVH is associated with an early increase in mortality after LT, and this is independent of conventional risk factors for LVH. Further studies are needed to confirm these findings and identify factors associated with mortality after transplantation to improve outcomes.
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Affiliation(s)
- Sachin Batra
- Departments of Medicine University of Texas Health Science Center, Houston, TX
| | - Victor I. Machicao
- Departments of Medicine University of Texas Health Science Center, Houston, TX
| | - John S. Bynon
- Departments of Surgery, University of Texas Health Science Center, Houston, TX
| | - Shivang Mehta
- Departments of Medicine University of Texas Health Science Center, Houston, TX
| | | | | | - Steven Zacks
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - James Trotter
- Department of Medicine, Baylor University, Dallas, TX
| | - Kari E. Roberts
- Department of Medicine, Tufts–New England Medical Center, Boston, MA
| | - Robert S. Brown
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven M. Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael B. Fallon
- Departments of Medicine University of Texas Health Science Center, Houston, TX
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Accuracy and prognostic significance of electrocardiographic markers of left ventricular hypertrophy in a general population. J Hypertens 2014; 32:921-8. [DOI: 10.1097/hjh.0000000000000085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Electrocardiographic versus echocardiographic left ventricular hypertrophy and sudden cardiac arrest in the community. Heart Rhythm 2014; 11:1040-6. [PMID: 24657425 DOI: 10.1016/j.hrthm.2014.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is associated with increased risk of sudden cardiac arrest (SCA). Whether LVH diagnosed by 12-lead ECG vs echocardiogram conveys identical or distinct risk information has not been previously evaluated. OBJECTIVE The purpose of this study was to compare the association between ECG vs echocardiographic LVH and SCA in the community. METHODS In a large, prospective population-based study (The Oregon Sudden Unexpected Death Study; population approximately 1 million), cases of SCA were compared to controls recruited from the same geographical area. The association between LVH and SCA was evaluated, specifically comparing LVH diagnosed by ECG vs echocardiogram. RESULTS Cases (n = 132, age 66.9 ± 13.5 years, 58.3% male) compared to controls (n = 211; age 66.2 ± 12 years, 59.2% male) were more likely to have both ECG LVH (12.1% vs 5.7%, P = .03) and echocardiographic LVH (35.0% vs 15.5%, P <.001). However, there was poor agreement between the tests (kappa statistic = 0.128). A large subgroup of patients with ECG LVH (57.1%) did not have echocardiographic LVH; conversely, 83.6% of patients with echocardiographic LVH did not have ECG LVH. In multivariate analysis, ECG LVH was significantly associated with SCA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-6.0, P = .04). When echocardiographic LVH was added to the model, this association was only mildly attenuated (OR 2.4, 95% CI 1.0-6.0, P= .05), and echocardiographic LVH was also independently associated with SCA (OR 2.7, 95% CI 1.5-4.9, P = .001). CONCLUSION ECG and echocardiographic LVH may convey distinct risk information in patients with SCA, reflecting electrical vs anatomic remodeling. These findings have potential implications for SCA mechanisms and risk stratification.
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Cuspidi C, Re A, Dell'oro R, Grassi G, Sala C. The neglected role of the electrocardiogram in the diagnostic work-up of hypertensive patients: a study in clinical practice. High Blood Press Cardiovasc Prev 2013; 20:39-43. [PMID: 23620273 DOI: 10.1007/s40292-013-0003-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/15/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The electrocardiogram (ECG) is listed among the routine diagnostic examinations for hypertensive patients according to international guidelines. OBJECTIVE The aim of this survey was to investigate whether an ECG is routinely prescribed before an echocardiographic examination by general practitioners for the evaluation of subclinical cardiac damage in uncomplicated hypertensive patients in a suburban area of Italy. METHODS A total of 60 consecutive hypertensive patients (45% men, mean age 60 ± 14 years) referred to a single out-patient cardiology service by their general practitioners for the assessment of cardiac organ damage by echocardiography were enrolled in the study. Patients' demographic data and medical history were collected at the echocardiographic laboratory on a questionnaire administered by the attending physician. RESULTS Less than 40% of the study sample had undergone an ECG during the 12-month period preceding the echocardiographic examination. Notably, only 60% of newly diagnosed hypertensive patents had an ECG done after the discovery of their hypertensive status. CONCLUSIONS These findings show that an ECG is not routinely prescribed as a first-line examination in the assessment of cardiac organ damage related to hypertension by a large fraction of general practitioners in current clinical practice in a northern area of Italy. This contrasts with available evidence that the combined assessment of left ventricular hypertrophy by ECG and echocardiogram provides the best evaluation of cardiac damage and stratification of cardiovascular risk in hypertension.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milan, Bicocca, Milan, Italy.
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Cox AJ, Hugenschmidt CE, Wang PT, Hsu FC, Kenchaiah S, Daniel K, Langefeld CD, Freedman BI, Herrington DM, Carr JJ, Stacey B, Bowden DW. Usefulness of biventricular volume as a predictor of mortality in patients with diabetes mellitus (from the Diabetes Heart Study). Am J Cardiol 2013; 111:1152-8. [PMID: 23351459 DOI: 10.1016/j.amjcard.2012.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/23/2012] [Accepted: 12/23/2012] [Indexed: 01/12/2023]
Abstract
Patients with type 2 diabetes mellitus are at increased risk for cardiovascular disease (CVD) and mortality. Beyond traditional CVD risk factors, novel measures reflecting additional aspects of disease pathophysiology, such as biventricular volume (BiVV), may be useful for risk stratification. The aim of this study was to examine the relationship between BiVV and risk for mortality in European Americans with type 2 diabetes mellitus from the Diabetes Heart Study (DHS). BiVV was calculated from 771 noncontrast computed tomographic scans performed to image coronary artery calcified plaque. Relationships between BiVV and traditional CVD risk factors were examined. Cox proportional-hazards regression was performed to determine risk for mortality (all-cause and CVD mortality) associated with increasing BiVV. Area under the curve analysis was used to assess BiVV utility in risk prediction models. During 8.4 ± 2.4 years of follow-up, 23% of the patients died. In unadjusted analyses, BiVV was significantly associated with increasing body mass index, height, coronary artery calcified plaque, history of hypertension, and previous myocardial infarction (p <0.0001 to 0.012). BiVV was significantly associated with all-cause (hazard ratio 2.45, 95% confidence interval 1.06 to 5.67, p = 0.036) and CVD (hazard ratio 4.36, 95% confidence interval 1.36 to 14.03, p = 0.014) mortality in models adjusted for other known CVD risk factors. Area under the curve increased from 0.76 to 0.78 (p = 0.04) and from 0.74 to 0.77 (p = 0.02) for all-cause and CVD mortality with the inclusion of BiVV. In conclusion, in the absence of echocardiography or other noninvasive imaging modalities to assess ventricular volumes, or when such methods are contraindicated, BiVV from computed tomography may be considered a tool for the stratification of high-risk patients, such as those with type 2 diabetes mellitus.
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Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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