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Kim M, Choi JH, Kim HK, Kim HL, Shin SH, Jang JY, Park JH, Kim KH, Hong GR, Park SM, Lee SA, Kang DH. Effects of intensive blood pressure control on left ventricular hypertrophy in aortic valve disease. Am Heart J 2024; 268:45-52. [PMID: 38006908 DOI: 10.1016/j.ahj.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Hypertension adds to the pressure overload on the left ventricle (LV) in combination with aortic valve (AV) disease, but the optimal blood pressure (BP) targets for patients with AV disease remain unclear. We tried to investigate whether intensive BP control reduces LV hypertrophy in asymptomatic patients with aortic stenosis (AS) or aortic regurgitation (AR). METHODS A total of 128 hypertensive patients with mild to moderate AS (n = 93) or AR (n = 35) were randomly assigned to intensive therapy, targeting a systolic BP <130 mm Hg, or standard therapy, targeting a systolic BP <140 mm Hg. The primary end point was the change in LV mass from baseline to the 24-month follow-up. Secondary end points included changes in severity of AV disease, LV volumes, ejection fraction and global longitudinal strain (GLS). RESULTS The treatment groups were generally well balanced regarding the baseline characteristics. The mean (±SD) age of the patients was 68 ± 8 years and 48% were men. The mean BP was 145 ± 12/81 ± 10 mm Hg at baseline. Medication at baseline was similar between the 2 groups. The 2 treatment strategies resulted in a rapid and sustained difference in systolic BP (P < .05). At 24-month, the mean systolic BP was 129 ± 12 mm Hg in the intensive therapy group and 135 ± 14 mm Hg in the standard therapy group. No patient died or underwent AV surgery during follow-up in either of the groups. LV mass was changed from 189.5 ± 41.3 to 185.6 ± 41.5 g in the intensive therapy group (P = .19) and from 183.8 ± 38.3 to 194.0 ± 46.4 g in the standard therapy group (P < .01). The primary end point of change in LV mass was significantly different between the intensive therapy and the standard therapy group (-3.9 ± 20.2 g vs 10.3 ± 20.4 g; P = .0007). The increase in LV mass index was also significantly greater in the standard therapy group (P = .01). No significant differences in secondary end points (changes in severity of AV disease, LV volumes, ejection fraction and GLS) were observed between the treatment groups. CONCLUSIONS Among hypertensive patients with AV disease, intensive hypertensive therapy resulted in a significant reduction in LV hypertrophy, although progression of AV disease was similar between the treatment groups. CLINICAL TRIAL REGISTRATION http://ClinicalTrials.gov (Number NCT03666351).
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Affiliation(s)
- Mijin Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jung-Hyun Choi
- Division of Cardiology, Pusan National University, Pusan, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Boramae Medical Center, Seoul, Republic of Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Jeong-Yoon Jang
- Division of Cardiology, Gyoungsang University Hospital, Changwon, Republic of Korea
| | - Jae-Hyung Park
- Division of Cardiology, Chungnam National University Hospital, Daecheon, Republic of Korea
| | - Kye-Hun Kim
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Hospital, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Hospital, Seoul, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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de Simone G, Mancusi C. Diastolic function in chronic kidney disease. Clin Kidney J 2023; 16:1925-1935. [PMID: 37915916 PMCID: PMC10616497 DOI: 10.1093/ckj/sfad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by clustered age-independent concentric left ventricular (LV) geometry, geometry-independent systolic dysfunction and age and heart rate-independent diastolic dysfunction. Concentric LV geometry is always associated with echocardiographic markers of abnormal LV relaxation and increased myocardial stiffness, two hallmarks of diastolic dysfunction. Non-haemodynamic mechanisms such as metabolic and electrolyte abnormalities, activation of biological pathways and chronic exposure to cytokine cascade and the myocardial macrophage system also impact myocardial structure and impair the architecture of the myocardial scaffold, producing and increasing reactive fibrosis and altering myocardial distensibility. This review addresses the pathophysiology of diastole in CKD and its relations with cardiac mechanics, haemodynamic loading, structural conditions, non-haemodynamic factors and metabolic characteristics. The three mechanisms of diastole will be examined: elastic recoil, active relaxation and passive distensibility and filling. Based on current evidence, we briefly provide methods for quantification of diastolic function and discuss whether diastolic dysfunction represents a distinct characteristic in CKD or a proxy of the severity of the cardiovascular condition, with the potential to be predicted by the general cardiovascular phenotype. Finally, the review discusses assessment of diastolic function in the context of CKD, with special emphasis on end-stage kidney disease, to indicate whether and when in-depth measurements might be helpful for clinical decision making in this context.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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3
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Chen J, Pei Y, Wang Q, Li C, Liang W, Yu J. Effect of sacubitril/valsartan or valsartan on ventricular remodeling and myocardial fibrosis in perimenopausal women with hypertension. J Hypertens 2023; 41:1077-1083. [PMID: 37071432 PMCID: PMC10241445 DOI: 10.1097/hjh.0000000000003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the impact of sacubitril/valsartan on blood pressure (BP), ventricular structure, and myocardial fibrosis compared with valsartan in perimenopausal hypertensive women. METHODS This prospective, randomized, actively controlled, open-label study included 292 women with perimenopausal hypertension. They were randomly divided into two groups: sacubitril/valsartan 200 mg once daily and valsartan 160 mg once daily for 24 weeks. The relevant indicators of ambulatory BP, echocardiography, and myocardial fibrosis regulation were assessed at baseline and at 24 weeks. RESULTS The 24-h mean SBP after 24 weeks of treatment was 120.08 ± 10.47 mmHg in the sacubitril/valsartan group versus 121.00 ± 9.76 mmHg in the valsartan group ( P = 0.457). After 24 weeks of treatment, there was no difference in central SBP between the sacubitril/valsartan and valsartan groups (117.17 ± 11.63 versus 116.38 ± 11.58, P = 0.568). LVMI in the sacubitril/valsartan group was lower than that in the valsartan group at week 24 ( P = 0.009). LVMI decreased by 7.23 g/m 2 from the baseline in the sacubitril/valsartan group and 3.70 g/m 2 in the valsartan group at 24 weeks ( P = 0.000 versus 0.017). A statistically significant difference in LVMI between the two groups was observed at 24 weeks after adjusting for the baseline LVMI ( P = 0.001). The levels of α-smooth muscle actin (α-SMA), connective tissue growth factor (CT-GF) and transforming growth factor-β (TGF-β) were reduced in the sacubitril/valsartan group compared with the baseline ( P = 0.000, 0.005, and 0.000). LVMI between the two groups was statistically significant at 24 weeks after correcting for confounding factors 24-h mean SBP and 24-h mean DBP ( P = 0.005). The LVMI, serum TGF-β, α-SMA, and CT-GF remained statistically significant between the two groups after further correcting the factors of age, BMI, and sex hormone levels ( P < 0.05). CONCLUSION Sacubitril/valsartan could reverse ventricular remodeling more effectively than valsartan. The different effects of these two therapies on ventricular remodeling in perimenopausal hypertensive women might be because of their different effects on the down-regulation of fibrosis-related factors.
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Affiliation(s)
- Jianshu Chen
- Hypertension Center, Lanzhou University Second Hospital
| | - Ying Pei
- Lanzhou University Second College of Clinical Medicine, Lanzhou, China
| | - Qiongying Wang
- Hypertension Center, Lanzhou University Second Hospital
- Lanzhou University Second College of Clinical Medicine, Lanzhou, China
| | - Caie Li
- Hypertension Center, Lanzhou University Second Hospital
| | - Wei Liang
- Hypertension Center, Lanzhou University Second Hospital
| | - Jing Yu
- Hypertension Center, Lanzhou University Second Hospital
- Lanzhou University Second College of Clinical Medicine, Lanzhou, China
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4
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Auer J, Weber T. Blood pressure measurement for prediction of chronic pressure overload and cardiovascular events. Eur J Clin Invest 2023; 53:e13902. [PMID: 36349443 DOI: 10.1111/eci.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria.,Department of Cardiology and Intensive Care, Kepler University Hospital Linz, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Weber
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
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Zhang M, Chen X, Yang F, Song Y, Zhang D, Chen Q, Ma Y, Wang S, Ji D, Duan Z, Zhang L, Wang Q. Evaluation of Left Ventricular Mass in Different Cardiac Geometry Using Three-Dimensional Contrast-Enhanced Echocardiography. Int Heart J 2023; 64:885-893. [PMID: 37778991 DOI: 10.1536/ihj.22-663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A total of 69 patients were enrolled in the study, including 23 patients with hypertrophic cardiomyopathy (HCM), 26 patients with Left Ventricle (LV) enlargement comprising 16 dilated cardiomyopathy (DCM) patients and 10 ischemic cardiomyopathy (ICM) patients, and 20 control subjects. All patients underwent 2DE, contrast-enhanced 2DE (Contrast-2DE), 3DE, Contrast-3DE, and single photon emission computed tomography (SPECT) examinations. The 2DE-AL and 3DE methods measured the left ventricular mass (LVM). The results were compared with those measured by SPECT. The measured LVM of the 69 patients was systematically overestimated by 2DE-AL (177.4 ± 56.2 g), Contrast-2DE-AL (174.5 ± 55.5 g), 3DE (167.3 ± 59.2 g), and Contrast-3DE (154.2 ± 46.7 g) when compared with SPECT (148.5 ± 52.4 g) (P < 0.05), while Contrast-3DE provided the best agreement with SPECT in LVM measurement (r = 0.898, P < 0.001) and had the smallest deviation (5.7 ± 23.1 g). 3DE overestimated LVM more compared to Contrast-3DE in LV hypertrophy group (165.5 ± 37.9 g versus 153.5 ± 27.6 g, P = 0.003) and LV enlargement group (204.5 ± 69.3 g versus 183.5 ± 53.5 g, P = 0.006). For 2DE methods, there was no significant difference between the LVM obtained with or without contrast enhancement in control group (132.3 ± 23.6 g versus 128.4 ± 23.3 g), LV hypertrophy group (177.7 ± 38.6 versus 178.3 ± 30.9 g, P = 0.889), and LV enlargement group (211.9 ± 63.2 g versus 206.5 ± 66.0 g, P = 0.386). The difference between LVM measured by 2DE-AL and SPECT was the greatest (27.9 ± 34.0 g), especially in LV hypertrophy group and LV enlargement group (LV hypertrophy group 39.7 ± 26.0 g; LV enlargement group 24.2 ± 42.8 g). To conclude, Contrast-3DE and SPECT show greater consistency in LVM measurement, especially in cardiomyopathy, when compared with 2DE. Administering contrast can effectively reduce the overestimation of LVM by non-contrast DE.
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Affiliation(s)
- Meiqing Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Xu Chen
- Medical School of Chinese PLA
| | - Feifei Yang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Yanjie Song
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dai Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Qiang Chen
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Yongjiang Ma
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Shuhua Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dongdong Ji
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Zhongxiang Duan
- Department of Nuclear Medicine, Fourth Medical Center of Chinese PLA General Hospital
| | - Liwei Zhang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Qiushuang Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Hypertension mediated kidney and cardiovascular damage and risk stratification: Redefining concepts. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Márquez DF, Rodríguez-Sánchez E, de la Morena JS, Ruilope LM, Ruiz-Hurtado G. Hypertension mediated kidney and cardiovascular damage and risk stratification: Redefining concepts. Nefrologia 2022; 42:519-530. [PMID: 36792306 DOI: 10.1016/j.nefroe.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/18/2021] [Indexed: 06/18/2023] Open
Abstract
Hypertension mediated organ damage (HMOD) refers to structural or functional changes in arteries or target organs that can be present in long-standing hypertension, but it can be also found in naïve never treated patients. Traditionally, cardiovascular risk is stratified with charts or calculators that tend to underestimate the real cardiovascular risk. The diagnosis of HMOD automatically reclassifies patients to the highest level of cardiovascular risk. Subclinical HMOD can be present already at the diagnosis of hypertension and more than 25% of hypertensives are misclassified with the routine tests recommended by hypertension guidelines. Whether HMOD regression improves cardiovascular outcomes has never been investigated in randomized clinical trials and remains controversial. However, different drugs have been probed with promising results in high cardiovascular risk patients, such as the new antidiabetic or the novel non-steroid mineralocorticoid antagonists. Accordingly, trials have shown that lowering blood pressure reduces cardiovascular events. In this narrative review, we will discuss the role of HMOD in cardiovascular risk stratification, the different types of organ damage, and the evidence available to define whether HMOD can be used as a therapeutic target.
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Affiliation(s)
- Diego Francisco Márquez
- Unidad de Hipertensión Arterial-Servicio de Clínica Médica, Hospital San Bernardo, Salta, Argentina; Instituto de NefroUrología y Nutrición de Salta, Salta, Argentina
| | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12 and Hospital 12 de Octubre, Madrid, Spain
| | - Julián Segura de la Morena
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12 and Hospital 12 de Octubre, Madrid, Spain; Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Miguel Ruilope
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12 and Hospital 12 de Octubre, Madrid, Spain; Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; Escuela de Estudios Postdoctorales and Investigación, Universidad Europea de Madrid, Madrid, Spain; CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12 and Hospital 12 de Octubre, Madrid, Spain; Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Canciello G, Mancusi C, Izzo R, Morisco C, Strisciuglio T, Barbato E, Trimarco B, Luca ND, de Simone G, Losi MA. Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network. Eur J Prev Cardiol 2021; 28:1508-1514. [PMID: 32529944 DOI: 10.1177/2047487320931630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Determinants of changes of aortic root dimension over time are not well defined. DESIGN We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network. METHODS N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution. RESULTS At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0-8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up (p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time (p < 0.05). Anti-renin-angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension. CONCLUSIONS Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
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Affiliation(s)
- Grazia Canciello
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Carmine Morisco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Teresa Strisciuglio
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Emanuele Barbato
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
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Cardiac computed tomography for left ventricular remodeling assessment: does it mean echocardiography moves for the past? J Hypertens 2021; 39:602-603. [PMID: 33649280 DOI: 10.1097/hjh.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Le TT, Lim V, Ibrahim R, Teo MT, Bryant J, Ang B, Su B, Aw TC, Lee CH, Bax J, Cook S, Chin CWL. The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2021; 22:670-679. [PMID: 32255186 PMCID: PMC8110315 DOI: 10.1093/ehjci/jeaa040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/26/2019] [Accepted: 03/03/2020] [Indexed: 01/19/2023] Open
Abstract
Aims Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications. Methods and results Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (EDV3t, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P < 0.001). The RI provided incremental prognostic value over and above a model consisting of clinical variables, LVH and concentricity; and predicted adverse events independent of clinical variables, LVH, and other prognostic markers. Concentric and eccentric LVH were associated with adverse prognosis (log-rank P = 0.62) that was similar to the natural history of hypertensive LVH (5.1 events/100 patient-years). Conclusion The RI provides prognostic value that improves risk stratification of hypertensive LVH.
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Affiliation(s)
- Thu-Thao Le
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Vanessa Lim
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Rositaa Ibrahim
- Department of Cardiology, National Heart Center Singapore, Singapore.,Department of Radiology, Penang General Hospital, Penang, Malaysia
| | - Muh-Tyng Teo
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Jennifer Bryant
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Briana Ang
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Boyang Su
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Jeroen Bax
- Faculty in Medicine, Leiden University, the Netherlands
| | - Stuart Cook
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Calvin W L Chin
- Department of Cardiology, National Heart Center Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School, Singapore
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Guide de Pratique Clinique. Prise en charge de l’hypertension artérielle chez l’adulte en Tunisie. LA TUNISIE MÉDICALE 2021. [PMCID: PMC9003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ce document a été réalisé dans le cadre d'une collaboration entre l'Instance Nationale de l’Évaluation et de l'Accréditation en Santé (INEAS), la Société Tunisienne de Cardiologie et de Chirurgie Cardiovasculaire (STCCCV) et la Caisse Nationale d’Assurance Maladie (CNAM).
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Li T, Li G, Guo X, Li Z, Sun Y. Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study. BMC Cardiovasc Disord 2021; 21:238. [PMID: 33980151 PMCID: PMC8114526 DOI: 10.1186/s12872-021-02055-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02055-w.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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Barbieri A, Albini A, Maisano A, De Mitri G, Camaioni G, Bonini N, Mantovani F, Boriani G. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8:667984. [PMID: 33987213 PMCID: PMC8110723 DOI: 10.3389/fcvm.2021.667984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maisano
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gerardo De Mitri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Camaioni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Interrelation between midwall mechanics and longitudinal strain in newly diagnosed and never-treated hypertensive patients without clinically defined hypertrophy. J Hypertens 2021; 38:295-302. [PMID: 31584519 DOI: 10.1097/hjh.0000000000002257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In hypertensive patients, an impairment of midwall myocardial mechanics was described in presence of left ventricular (LV) concentric geometry. Under these circumstances, also LV longitudinal dysfunction was found. PURPOSE Our aim was to evaluate longitudinal and circumferential systolic function and correlations between these two functional components in newly diagnosed hypertensive patients without clinically defined LV hypertrophy (LVH). One hundred and thirty-eight newly diagnosed, never-treated hypertensive patients without LVH and a control group of 105 healthy normotensive individuals underwent two-dimensional and speckle tracking echocardiography. Global longitudinal strain (GLS) was derived (in absolute value) and midwall fractional shortening (MFS) computed. In addition, the hypertensive population was divided into two groups according to GLS: normal GLS (≥20%, n = 94) and reduced GLS (<20%, n = 44). RESULTS Hypertensive patients had lower MFS (P < 0.001) and GLS (P < 0.0001) than healthy controls. By dividing hypertensive patients according to GLS thresholds of normalcy, MFS was lower in patients with GLS less than 20% (P < 0.0001) while no significant difference was found in LV geometry, ejection fraction and diastolic parameters in comparison with patients with GLS at least 20%. In the pooled hypertensive population, GLS resulted positively related to MFS (r = 0.33, P < 0.0001). By a multiple linear regression analysis, after adjusting for female sex, age, BMI, circumferential end-systolic stress, average e', ejection fraction and relative wall thickness, MFS remained independently associated with GLS (β = 0.222, P < 0.005). CONCLUSION In newly diagnosed and never-treated hypertensive patients without LVH, an early LV systolic dysfunction is testified by the reduction of both MFS and GLS. These two parameters resulted independently associated after adjusting for several confounders.
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Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6631500. [PMID: 33564678 PMCID: PMC7850832 DOI: 10.1155/2021/6631500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/19/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Objective The objective of the study was to compare polygraphic parameters and selected laboratory parameters in patients with obstructive sleep apnoea (OSA) who develop various types of left ventricular (LV) geometry. Material and Methods. The research covered 122 patients with obstructive sleep apnoea and coexisting effectively treated systemic hypertension (95 men, 27 women, average age: 54 ± 10.63). Overnight polygraphy, echocardiography, carotid artery ultrasonography, and laboratory measurements were performed. The patients were classified into four groups, depending on LV geometry. Group 1 comprised patients with normal LV geometry, group 2 included those with LV concentric remodelling. Group 3 and group 4 were patients with LV hypertrophy, concentric or eccentric, respectively. Results The most frequent type of LV geometry in the examined population was eccentric hypertrophy (36%). The highest average values of BMI and T-Ch were observed in the group of patients with concentric remodelling (group 2). The most severe respiratory disorders were found in the group of patients developing LV concentric hypertrophy (group 3); however, these differences were not statistically significant in comparison to other groups. Patients with LV eccentric hypertrophy had significantly decreased LV ejection fraction (p = 0.0008). Conclusions LV eccentric hypertrophy is the most frequent type of LV geometry in OSA patients. Patients with severe sleep-disordered breathing are more likely to develop concentric hypertrophy, while concentric remodelling occurs more frequently among OSA patients with other coexisting conditions, such as obesity or lipid-related disorders.
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Wyss F, Coca A, Lopez-Jaramillo P, Ponte-Negretti C. Position statement of the Interamerican Society of Cardiology (IASC) on the current guidelines for the prevention, diagnosis and treatment of arterial hypertension 2017-2020. Int J Cardiol Hypertens 2020; 6:100041. [PMID: 33447767 PMCID: PMC7803017 DOI: 10.1016/j.ijchy.2020.100041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES As an Inter-American Society we are convinced of the need to standardize the steps in which we diagnose, evaluate, treat and control hypertension, establishing guidelines and rules that should be adopted in all countries of Latin America, aimed at standardizing management and control of CV risk in order to achieve a substantial decrease in CV events. METHODS In the last four years important international guidelines for the diagnosis, management, treatment and control of arterial hypertension have been published. In America, mostly in mid- and low-income countries, hypertension is a major problem of public health, being the most important cardiovascular risk factor due to its great population impact. Therefore, it is crucial to dedicate all the possible efforts to increase substantially the number of hypertensive patients diagnosed in a given area, and to improve the percentage of controlled patients. This is a major necessity in order to reduce the morbidity and mortality for CVD in the Latin American region, although no guidelines takes the Latin American populations into account, and much less standardizes their diagnosis and management. CONCLUSIONS The Inter-American Society of Cardiology suggest the use of the blood pressure classification of the Latin American Society of Hypertension (LASH) and recommends the use of the SCORE System to stratify the global CV risk because this system has the capability to adapt the global risk by means of a correcting factor based on the ethnicity of the different native populations in America.
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Affiliation(s)
| | - Antonio Coca
- Internal Medicine, Universidad de Barcelona, Espana
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Impact of left ventricular mass/end-diastolic volume ratio by three-dimensional echocardiography on two-dimensional global longitudinal strain and diastolic function in native hypertensive patients. J Hypertens 2020; 37:2041-2047. [PMID: 31157744 DOI: 10.1097/hjh.0000000000002147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In hypertensive patients, high left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) is related to LV dysfunction and myocardial fibrosis. PURPOSE We examined the ability of 3D-echo-derived LVM/EDV ratio in identifying early systolic and diastolic dysfunction in relation with LV concentric geometry in native hypertensive patients. METHODS One-hundred and forty-four newly diagnosed, never treated hypertensive patients underwent 2D-echo, including computation of 2D-derived global longitudinal strain (GLS), and 3D-echo. The study population was divided into two groups: elevated 3D-LVM/EDV (≥1.23 in women and ≥1.22 in men), corresponding to LV concentric geometry (n = 50), and normal ratio (<1.23 in women and <1.22 in men) corresponding to LV normal or eccentric geometry (n = 94). RESULTS The two groups were comparable for sex, heart rate, BMI, and blood pressure (BP). Patients with elevated 3D-LVM/EDV ratio were older and had lower GLS (P < 0.001) than patients with normal LVM/EDV ratio. Transmitral E/A ratio (P < 0.0001) and e' velocity (P < 0.0001) were lower, and E/e' ratio (P < 0.0001) higher in patients with elevated LVM/EDV ratio. In the pooled population, LVM/EDV ratio was positively correlated to E/e' (r = 0.39, P < 0.0001) and negatively to GLS (r = -0.29, P < 0.001). By separate multilinear regression analyses, after adjusting for sex, age, heart rate, mean BP and BMI, LVM/EDV ratio - but not 2D-relative wall thickness - was independently associated with E/e' (β = 0.304, P = 0.003) and GLS (β = -0.501, P < 0.0001). CONCLUSION Three-dimensional echocardiographic assessment of LV concentric geometry allows identifying an early diastolic and longitudinal systolic dysfunction in native hypertensive patients. In particular, 3D-LVM/EDV ratio is independently associated with both E/e' ratio and GLS.
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Mancusi C, de Simone G, Brguljan Hitij J, Sudano I, Mahfoud F, Parati G, Kahan T, Barbato E, Pierard LA, Garbi M, Flachskampf FA, Gerdts E. Management of patients with combined arterial hypertension and aortic valve stenosis: a consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:242-250. [PMID: 32353143 DOI: 10.1093/ehjcvp/pvaa040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/13/2022]
Abstract
Aortic valve stenosis (AS) is the third most common cardiovascular disease. The prevalence of both AS and arterial hypertension increases with age, and the conditions therefore often co-exist. Co-existence of AS and arterial hypertension is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Arterial hypertension may also influence grading of AS, leading to underestimation of the true AS severity. Current guidelines suggest re-assessing patients once arterial hypertension is controlled. Management of arterial hypertension in AS has historically been associated with prudence and concerns, mainly related to potential adverse consequences of drug-induced peripheral vasodilatation combined with reduced stroke volume due to the fixed LV outflow obstruction. Current evidence suggests that patients should be treated with antihypertensive drugs blocking the renin-angiotensin-aldosterone system, adding further drug classes when required, to achieve similar target blood pressure (BP) values as in hypertensive patients without AS. The introduction of transcatheter aortic valve implantation has revolutionized the management of patients with AS, but requires proper BP management during and following valve replacement. The purpose of this document is to review the recent evidence and provide practical expert advice on management of hypertension in patients with AS.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University of Naples, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University of Naples, Naples, Italy
| | - Jana Brguljan Hitij
- Hypertension Division, Department of Internal Medicine, University Medical Centre Ljubljana, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Isabella Sudano
- Department of Cardiology, University Heart Center Zurich, University Hospital of Zürich, Zürich, Switzerland
| | - Felix Mahfoud
- Department for Cardiology, Angiology, Intensive Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca & Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Emanuele Barbato
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University of Naples, Naples, Italy
| | - Luc A Pierard
- Department of Cardiology, Heart Valve Clinic, University Hospital Sart-Tilman, Liège, Belgium
| | - Madalina Garbi
- Royal Papworth Hospital NHS Foundation Trust Papworth Road, Cambridge Biomedical Campus, Cambridge, UK
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, and Clinical Physiology and Cardiology, Akademiska, Uppsala, Sweden
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Targeting Concentric Left Ventricular Hypertrophy in Obstructive Sleep Apnea Syndrome. A Meta-analysis of Echocardiographic Studies. Am J Hypertens 2020; 33:310-315. [PMID: 31863113 DOI: 10.1093/ajh/hpz198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022] Open
Abstract
AIM We assessed the association between obstructive sleep apnea (OSA) and left ventricular hypertrophy (LVH) subtypes (i.e., concentric and eccentric LVH) trough a meta-analysis of echocardiographic studies. DESIGN The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search full papers published from 1st January 2000 to 31st August 2019. Studies were detected by using the following terms: "obstructive sleep apnea", "sleep disordered breathing", "left ventricular mass", "left ventricular geometry", "left ventricular hypertrophy", "echocardiography". RESULTS Meta-analysis included 1,760 patients with OSA and 1,284 non-OSA controls from 9 studies. The prevalence rates of concentric and eccentric LVH in the pooled OSA population were 24.0% (confidence interval [CI] 16.0-33.0%) and 16.0% (CI 12.0-23.0%), respectively. Meta-analysis of six studies comparing the prevalence of LVH subtypes in participants with OSA and controls showed that OSA was associated with an increased risk of both concentric (odds ratio [OR] = 1.62, CI: 1.27-2.07, P < 0.0001) and eccentric (OR = 1.34, CI: 1.07-1.67, P < 0.009) LVH, respectively. CONCLUSIONS Our findings suggest that in the OSA setting concentric LVH is more frequent than eccentric LVH. From a practical perspective, in consideration of the particularly adverse prognostic significance of concentric LVH, a comprehensive echocardiographic evaluation targeting LVH subtypes could improve cardiovascular risk stratification in patients with OSA.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- Istituto Auxologico Italiano, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment. J Hypertens 2020; 38:588-598. [PMID: 31809464 DOI: 10.1097/hjh.0000000000002323] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Change in left ventricular geometry over 10 years in the elderly and risk of incident cardiovascular disease. J Hypertens 2020; 37:325-330. [PMID: 30113528 DOI: 10.1097/hjh.0000000000001897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Left ventricular hypertrophy (LVH) is related to a poor prognosis. We aimed to determine how left ventricular (LV) geometry changes over time, and how this relates to future cardiovascular disease. METHODS In the Prospective Study of the Vasculature in Uppsala Seniors study, 1016 individuals were investigated with echocardiography at age 70. This was repeated after 5 and 10 years. Incident cardiovascular disease (myocardial infarction, stroke, and heart failure, n = 163) was recorded over 10 years. RESULTS LV mass index (LVMI) and LV end-diastolic diameter (LVEDD) progressively increased over 10 years, while LV thickness declined (P < 0.0001 for all). Adjusting for traditional cardiovascular risk factors, LVMI at baseline, but not LVEDD, was significantly associated with incident cardiovascular disease [hazard ratio (HR) 1.02, 95% confidence interval 1.003-1.03, P = 0.019]. When adding the change in LVMI, or change in LVEDD, between ages 70 and 75 years to the models and using the time between 75 and 80 as follow-up (in total 82 incident cases), neither the change in LVMI nor the change in LVEDD were significant. Using updated information on LV geometric groups, an increased risk was seen for concentric LVH as compared with the normal group following adjustment for traditional risk factors (HR 2.29, P = 0.0014, 95% confidence interval 1.38-3.82). Eccentric LVH and concentric remodeling were not associated with a statistically significant increased risk of cardiovascular disease. CONCLUSION In elderly individuals without myocardial infarction, a progressive dilatation of the LV was seen over 10 years. However, the LV dilation seen over time in this age group was not associated with a major increase in risk of future cardiovascular disease.
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Varshney AS, Manandhar P, Vemulapalli S, Kirtane AJ, Mathew V, Shah B, Lowenstern A, Kosinski AS, Kaneko T, Thourani VH, Bhatt DL. Left Ventricular Hypertrophy Does Not Affect 1-Year Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 12:373-382. [PMID: 30784643 DOI: 10.1016/j.jcin.2018.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/21/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between pre-procedural left ventricular hypertrophy (LVH) patterns and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND The association between pre-procedural LVH pattern and severity and clinical outcomes after TAVR is uncertain. METHODS Patients (n = 31,199) across 422 sites who underwent TAVR from November 2011 through June 2016 as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapies) Registry linked with the Centers for Medicare and Medicaid Services database were evaluated by varying LVH patterns, according to sex-specific cutoffs for left ventricular mass index and relative wall thickness. The association between LVH pattern (concentric remodeling, concentric LVH, and eccentric LVH) and outcomes (rates of mortality, myocardial infarction [MI], stroke, new dialysis requirement) at 1-year follow-up were evaluated using multivariate hazard models. RESULTS There were no significant associations between concentric remodeling (death: adjusted hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 0.93 to 1.15; MI: HR: 1.05; 95% CI: 0.76 to 1.46; stroke: HR: 1.11; 95% CI: 0.89 to 1.39; new dialysis: HR: 0.86; 95% CI: 0.64 to 1.15), concentric LVH (death: HR: 1.04; 95% CI: 0.95 to 1.15; MI: HR: 1.12; 95% CI: 0.82 to 1.52; stroke: HR: 1.14; 95% CI: 0.92 to 1.40; new dialysis: HR: 1.17; 95% CI: 0.90 to 1.52), or eccentric LVH (death: HR: 0.98; 95% CI: 0.87 to 1.10; MI: HR: 1.07; 95% CI: 0.71 to 1.63; stroke: HR: 1.01; 95% CI: 0.78 to 1.32; new dialysis: HR: 1.25; 95% CI: 0.92 to 1.70) and outcomes at 1 year compared with patients without LVH. CONCLUSIONS In a contemporary cohort of patients who underwent TAVR, pre-procedural LVH according to left ventricular mass index and relative wall thickness was not associated with adverse outcomes at 1-year follow-up. TAVR is likely to benefit patients with severe aortic stenosis regardless of the presence of LVH.
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Affiliation(s)
- Anubodh S Varshney
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | | | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University, Durham, North Carolina
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Verghese Mathew
- Division of Cardiology, Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Binita Shah
- Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Angela Lowenstern
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute/Georgetown University, Washington, DC
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
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Tadic M, Cuspidi C, Plein S, Milivojevic IG, Wang DW, Grassi G, Mancia G. Comprehensive assessment of hypertensive heart disease: cardiac magnetic resonance in focus. Heart Fail Rev 2020; 26:1383-1390. [DOI: 10.1007/s10741-020-09943-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Palomba C, Donadio S, Canciello G, Losi MA, Izzo R, Manzi MV, De Pisapia F, Mancusi C, De Luca N. Unattended Automated Office Blood Pressure Measurement and Cardiac Target Organ Damage, A Pilot Study. High Blood Press Cardiovasc Prev 2019; 26:383-389. [PMID: 31444783 DOI: 10.1007/s40292-019-00337-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The ESC-2018 guidelines suggest the use of Unattended automated office blood pressure (UAOBP) to avoid or at least reduce the white coat effect, even if do not support its use as preferred method. AIM To assess the pressure difference between UAOBP and Attended office blood pressure (AOBP) and to evaluate their correlations with target organ damage in hypertensive patients. METHODS UAOBP and AOBP were taken in a cohort of 48 outpatients. The pressure difference between the 2 methods and their correlation with anthropometric and cardiac parameters were analyzed. RESULTS Unattended systolic and diastolic BP were lower than Attended systolic and diastolic BP (135 ± 17 mmHg vs 139 ± 21 mmHg and 79 ± 10 mmHg vs 82 ± 10 mmg). ΔDBP was significantly directly correlated with female sex (r = 0.347, p = 0.016) and it was lower in men compared to women (0.11 ± 8.9 mmHg vs 6.07 ± 7.42 mmHg, p = 0.016). Correlation coefficients for LVMi and RWT for attended and unattended BP were not statistically different (for LVMi r = 0.286 vs r = 0.381, p = 0.61, for RWT r = 0.413 vs r = 0.363, p = 0.78). The relationship between attended and unattended BP was described by the following equation: y = - 4.68 + 1.06*x; where Y is the attended systolic BP and X is the unattended systolic BP; in accordance with this equation, an unattended systolic BP of 140 mmHg corresponds to an attended systolic BP of 143.7 mmHg. CONCLUSIONS UAOBP provides significantly lower values than AOBP. The difference in BP values between the two methods is much lower than the one obtained in most clinical studies.
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Affiliation(s)
- Claudia Palomba
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
| | - Simone Donadio
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Federica De Pisapia
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy. .,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy.
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy.,Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
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Losi MA, Izzo R, Mancusi C, Wang W, Roman MJ, Lee ET, Howard BV, Devereux RB, de Simone G. Depressed Myocardial Energetic Efficiency Increases Risk of Incident Heart Failure: The Strong Heart Study. J Clin Med 2019; 8:jcm8071044. [PMID: 31319598 PMCID: PMC6678469 DOI: 10.3390/jcm8071044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
An estimation of myocardial mechano-energetic efficiency (MEE) per unit of left ventricular (LV) mass (MEEi) can significantly predict composite cardiovascular (CV) events in treated hypertensive patients with normal ejection fraction (EF), after adjustment for LV hypertrophy (LVH). We have tested whether MEEi predicts incident heart failure (HF), after adjustment for LVH, in the population-based cohort of a “Strong Heart Study” (SHS) with normal EF. We included 1912 SHS participants (age 59 ± 8 years; 64% women) with preserved EF (≥50%) and without prevalent CV disease. MEE was estimated as the ratio of stroke work to the “double product” of heart rate times systolic blood pressure. MEEi was calculated as MEE/LV mass, and analyzed in quartiles. During a follow-up study of 9.2 ± 2.3 years, 126 participants developed HF (7%). HF was preceded by acute myocardial infarction (AMI) in 94 participants. A Kaplan-Meier plot, in quartiles of MEEi, demonstrated significant differences, substantially due to the deviation of the lowest quartile (p < 0.0001). Using AMI as a competing risk event, sequential models of Cox regression for incident HF (including significant confounders), demonstrated that low MEEi predicted incident HF not due to AMI (p = 0.026), after adjustment for significant effect of age, LVH, prolonged LV relaxation, diabetes, and smoking habits with negligible effects for sex, hypertension, antihypertensive therapy, obesity, and hyperlipemia. Low LV mechano-energetic efficiency per unit of LVM, is a predictor of incident, non-AMI related, HF in subjects with initially normal EF.
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Affiliation(s)
- Maria-Angela Losi
- Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy
| | - Wenyu Wang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Mary J Roman
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA
| | - Barbara V Howard
- Medstar Health Research Institute, and Georgetown-Howard Universities Center for Translational Sciences, Washington, DC 20057, USA
| | - Richard B Devereux
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Giovanni de Simone
- Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy.
- Department of Advanced Biomedical Sciences, University Federico II of Naples, I-80131 Naples, Italy.
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
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Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry. J Hypertens 2019; 36:1697-1704. [PMID: 29570513 DOI: 10.1097/hjh.0000000000001717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability. OBJECTIVES We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients. METHODS One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women. RESULTS An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P < 0.0001) was lower in patients with elevated LVM/EDV ratio. By a multilinear regression analysis, after adjusting for sex, age, heart rate, mean blood pressure and BMI, stroke volume was independently and negatively associated to LVM/EDV ratio (β = -0.55, P < 0.0001). CONCLUSION In native hypertensive patients, 3D-echo-derived LVM/EDV ratio identifies a higher prevalence of LV concentric geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.
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Achievement of target SBP without attention to decrease in DBP can increase cardiovascular morbidity in treated arterial hypertension: the Campania Salute Network. J Hypertens 2019; 37:1889-1897. [PMID: 31205199 DOI: 10.1097/hjh.0000000000002128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Results of the SPRINT study have influenced recent guidelines on arterial hypertension, in the identification of target SBP, but scarce attention has been paid to the consequences on DBP. However, there is evidence that reducing DBP too much can be harmful. METHODS We analyzed outcome in 4005 treated hypertensive patients (22% obesity, 8% diabetes and 21% current smoking habit) with target attended office SBP less than 140 mmHg, in relation to quintiles of DBP, cardiovascular risk profile and target organ damage (LV hypertrophy, carotid plaque and left atrial dilatation). Composite fatal and nonfatal cardiovascular event was the outcome variable in this analysis (stroke and myocardial infarction, sudden cardiac death, heart failure requiring hospitalization, transient ischemic attack, myocardial revascularization, de novo angina, carotid stenting and atrial fibrillation). RESULTS Lower DBP was associated with greater proportion of women and diabetes, older age, decline in kidney function and greater values of LV mass index and left atrial volume and greater prevalence of carotid plaque (all 0.04 < P < 0.0001). The lowest quintile of DBP (74.1 ± 3.7 mmHg) was associated with 1.49 higher hazard of composite cardiovascular events, independently of significant effect of older age, female sex, LV hypertrophy and borderline effect of left atrial dilatation (0.04 < P < 0.001). CONCLUSION Increased risk associated with aggressive reduction of DBP should be balanced with the advantage of reducing aggressively SBP to predict the net benefit of antihypertensive treatment, especially in the oldest old individuals.
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Mancusi C, Losi MA, Izzo R, Gerdts E, Canciello G, Arnone MI, Trimarco B, de Simone G, De Luca N. Prognostic impact of increased pulse pressure/stroke index in a registry of hypertensive patients: the Campania Salute Network. Blood Press 2019; 28:268-275. [DOI: 10.1080/08037051.2019.1612705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Eva Gerdts
- Hypertension Research Center, Federico II University, Naples, Italy
- Department for Clinical Science, University of Bergen, Bergen, Norway
| | - Grazia Canciello
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Maria Immacolata Arnone
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University, Naples, Italy
- Department for Clinical Science, University of Bergen, Bergen, Norway
| | - Nicola De Luca
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
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Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort. Cardiovasc Diabetol 2019; 18:56. [PMID: 31039789 PMCID: PMC6492323 DOI: 10.1186/s12933-019-0862-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS). METHODS We selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18-93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/"double product" of SBP × heart rate (HR), as an estimate of O2 consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi). RESULTS Linear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001). CONCLUSIONS Severity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians. Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134 , Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.
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Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Licenziati MR, Manco M, Giudice EMD, Baroni MG, Loche S, Tornese G, Franco F, Maffeis C, de Simone G. Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth. J Hypertens 2019; 37:732-738. [PMID: 30817454 DOI: 10.1097/hjh.0000000000001954] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth. METHODS This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017. RESULTS Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines. CONCLUSION The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome
| | - Cecilia Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona
| | | | | | | | | | - Sandro Loche
- Pediatric Endocrine Unit, Pediatric hospital for microcitemia, AO Brotzu, Cagliari
| | - Gianluca Tornese
- Institute for maternal and child health IRCCS 'Burlo Garofolo', Trieste
| | | | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona
| | - Giovanni de Simone
- Hypertension Research Center & Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
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Asami M, Pilgrim T. Patterns of Left Ventricular Geometry and Clinical Outcome After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:383-384. [PMID: 30784644 DOI: 10.1016/j.jcin.2018.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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Dini FL, Galeotti GG, Terlizzese G, Fabiani I, Pugliese NR, Rovai I. Left Ventricular Mass and Thickness: Why Does It Matter? Heart Fail Clin 2019; 15:159-166. [PMID: 30832808 DOI: 10.1016/j.hfc.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Several left ventricular geometric patterns have been described both in healthy and pathologic hearts. Left ventricular mass, wall thickness, and the ratio of wall thickness to radius are important measures to characterize the spectrum of left ventricular geometry. For clinicians, an increase in left ventricular mass is the hallmark of left ventricular hypertrophy. Although pathologic hypertrophy initially can be compensatory, eventually it may become maladaptive and evolve toward progressive left ventricular dysfunction and heart failure. In particular, patients who show left ventricular dilation and hypertrophy in association with a low relative wall thickness are likely to carry the highest risk.
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Affiliation(s)
- Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
| | | | | | - Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Rovai
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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Gerdts E, Izzo R, Mancusi C, Losi MA, Manzi MV, Canciello G, De Luca N, Trimarco B, de Simone G. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network). Int J Cardiol 2018; 258:257-261. [PMID: 29544940 DOI: 10.1016/j.ijcard.2017.12.086] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). METHODS 12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/m2.7 in women and >50g/m2.7 in men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). RESULTS The cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients without LVH (n=7764), women had a 35% lower hazard rate (HR) for MACE (n=179) than men (95% confidence interval [CI] 0.44-0.96, p=0.031) in Cox regression analysis adjusting for cardiovascular risk factors and antihypertensive treatment during follow up. In contrast, among patients with LVH (n=4565), women had a similar HR for MACE as men (HR 0.94 [95% CI 0.69-1.30], p=0.720). CONCLUSION This study demonstrates that presence of LVH in hypertension offsets the female sex-protection in cardiovascular risk. Thus among hypertensive subjects with LVH, women and men have comparable cardiovascular risk.
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Affiliation(s)
- Eva Gerdts
- Department of Clinical Science, University of Bergen, Norway; Hypertension Research Center, Federico II University Hospital, Naples, Italy.
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1785] [Impact Index Per Article: 297.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Jekell A, Kalani M, Kahan T. The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: results from the Doxazosin-ramipril study. Heart Vessels 2018; 34:484-495. [PMID: 30244381 PMCID: PMC6373355 DOI: 10.1007/s00380-018-1265-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022]
Abstract
There are several non-invasive methods to study endothelial function, but their interrelation and association to cardiovascular risk have not been well evaluated. We studied macrovascular and microvascular endothelial function simultaneously in different vascular beds in relation to cardiovascular mortality risk (Systematic Coronary Risk Evaluation, SCORE) and hypertension induced cardiac organ damage, and their interrelationship. The study investigated 71 hypertensive patients by forearm post-ischemic flow-mediated vasodilation, pulse wave analysis (applanation tonometry) and beta 2-adrenoceptor agonist stimulation for changes in reflection index, skin microvascular reactivity by laser Doppler fluxmetry with iontophoresis and heat-induced hyperaemia, and coronary microvascular function by subendocardial viability ratio (derived from pulse wave analysis). Flow mediated vasodilation related inversely to SCORE (r = 0.34, P = 0.011). Adding microalbuminuria and pulse wave velocity strengthened the associations. Pulse wave reflection changes did not relate to SCORE. Skin microvascular reactivity related inversely to SCORE (peak flux change to sodium nitroprusside r = 0.29, P = 0.033, and to heating r = 0.31, P = 0.018). Subendocardial viability ratio did not relate to SCORE. Endothelial function indices showed no consistent relation to cardiac target organ damage. The agreement between the different methods for evaluating indices of macrovascular and microvascular endothelial function was weak. In conclusion, indices of macrovascular and microvascular endothelial function relate to cardiovascular mortality risk. Their use may improve cardiovascular risk prediction in hypertension. However, methods representing different vascular beds show little interrelationship and are not interchangeable, which may depend on different pathogenetic mechanisms representing different aspects of future cardiovascular risk. Trial registry: NCT02901977
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Affiliation(s)
- Andreas Jekell
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden.
| | - Majid Kalani
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
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Wang H, Wang S, Yi X, Tao Y, Qian H, Jia P, Chen Y, Sun Y. Estimate of ischemic stroke prevalence according to a novel 4-tiered classification of left ventricular hypertrophy: insights from the general Chinese population. Ann Med 2018; 50:519-528. [PMID: 30001637 DOI: 10.1080/07853890.2018.1500702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population. METHODS We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data were available to subdivide patients with LVH into four geometric patterns: indeterminate, dilated, thick and both thick and dilated hypertrophy. RESULTS Compared with normal LV geometry, indeterminate and thick hypertrophy showed a higher prevalence of ischemic stroke (p < .05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115-2.398) and thick (2.143 [1.329-3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803-1.950]) and both thick and dilated hypertrophy (0.926 [0.435-1.971]) compared with normal geometry in multivariable analysis. CONCLUSIONS Indeterminate and thick hypertrophy were significantly associated with the presence of ischemic stroke in the general Chinese population. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy. Key messages This was the first study to investigate whether a 4-tiered classification of LVH defines subgroups in the general population that are at variable risks of ischemic stroke. We identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH emerged as a valuable operational approach, a potential alternative to LVM, to refine ischemic stroke stratification in general population.
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Affiliation(s)
- Haoyu Wang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Shuze Wang
- b Department of Computational Medicine and Bioinformatics , University of Michigan , Ann Arbor , MI , USA
| | - Xin Yi
- c Department of Cardiovascular Medicine , Beijing Moslem Hospital , Beijing , China
| | - Yining Tao
- d Department of Radiology , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Hao Qian
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Pengyu Jia
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Yintao Chen
- e Department of Cardiovascular Medicine , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yingxian Sun
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5560] [Impact Index Per Article: 926.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Refining the classification of left ventricular hypertrophy to provide new insights into the progression from hypertension to heart failure. Curr Opin Cardiol 2018; 31:387-93. [PMID: 27168169 DOI: 10.1097/hco.0000000000000299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH), an important consequence of hypertension, is traditionally classified as either concentric or eccentric based on the presence or absence of increased relative wall thickness. In 2010, we proposed a novel four-tiered classification that accounted for LV dilatation in addition to LV wall thickness. The purpose of this review is to discuss the rationale for this revised classification and highlight subsequent studies that have assessed its utility. RECENT FINDINGS A series of recent observational studies have tested whether the four-tiered classification identifies subphenotypes of LVH with differential risk of adverse outcomes, including incident heart failure. The majority have confirmed that eccentric hypertrophy can be subdivided into a high-risk and a low-risk group based on whether LV dilatation is present. Additional studies have shown that LV dilatation is an independent risk factor for the development of heart failure. SUMMARY Incorporation of LV dilatation into the assessment of LVH identifies important subphenotypes within the standard two-tiered classification that have differential risk. Such refinements in the classification of LVH may yield new insights into how LVH progresses to heart failure, help identify risk factors for this transition, and improve therapeutic efforts to prevent its occurrence.
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de Simone G, Mancusi C, Esposito R, De Luca N, Galderisi M. Echocardiography in Arterial Hypertension. High Blood Press Cardiovasc Prev 2018; 25:159-166. [DOI: 10.1007/s40292-018-0259-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/21/2018] [Indexed: 01/08/2023] Open
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Mancusi C, Izzo R, de Simone G, Carlino MV, Canciello G, Stabile E, de Luca N, Trimarco B, Losi MA. Determinants of decline of renal function in treated hypertensive patients: the Campania Salute Network. Nephrol Dial Transplant 2018; 33:435-440. [DOI: 10.1093/ndt/gfx062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Maria Viviana Carlino
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Eugenio Stabile
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Nicola de Luca
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, University of Naples, Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
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Mancusi C, Losi MA, Izzo R, Canciello G, Carlino MV, Albano G, De Luca N, Trimarco B, de Simone G. Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network. Eur J Prev Cardiol 2018; 25:235-243. [DOI: 10.1177/2047487317747498] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980). Results High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy. Conclusions High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Maria A Losi
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Translational Medical Science, Federico II University Hospital, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Maria V Carlino
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Giovanni Albano
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Translational Medical Science, Federico II University Hospital, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
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Ojji DB, Libhaber E, Alfa J, Murtala N, Abdullahi B, Nwankwo A, Nnamonu A, Karen S. Left ventricular mass estimation by different partition values in a large population of black hypertensive subjects. Health Sci Rep 2018; 1:e25. [PMID: 30623057 PMCID: PMC6266419 DOI: 10.1002/hsr2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/19/2023] Open
Abstract
AIMS Our aim is to compare the impact of the 2 most widely used methods of indexing left ventricular mass (LVM) on the distribution of abnormal left ventricular (LV) geometric patterns, in a large sample of untreated asymptomatic black hypertensive subjects. METHODS AND RESULTS All patients with hypertension referred to the Cardiology unit of University of Abuja Teaching Hospital, Abuja, Nigeria from 2006 to 2013, who gave informed consent, and underwent physical examination and echocardiography. LVM indexation was classified into 4 geometric patterns after echocardiography: normal geometry, concentric hypertrophy, concentric remodeling, and eccentric hypertrophy. Concentric hypertrophy was the commonest geometric pattern and was detected in 33.6% to 39.5% of the patients. LVM/height2.7 was a better method to detect abnormal geometric pattern than LVM/BSA (P < 0.0001). CONCLUSION In a large cohort of hypertensive subjects with no clinical evidence of cardiovascular disease, abnormal LV geometry was found in greater than four-fifths of the population. In addition, LVM indexed for height 2.7 was found to be a better method for detecting LVH than LVM indexed for BSA, as the highest prevalence of abnormal geometry was diagnosed when LVM was indexed for height2.7.
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Affiliation(s)
- Dike B. Ojji
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Elena Libhaber
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Jacob Alfa
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ngabea Murtala
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Bolaji Abdullahi
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ada Nwankwo
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Anita Nnamonu
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Sliwa Karen
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownSouth Africa
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Zoppini G, Bergamini C, Bonapace S, Trombetta M, Mantovani A, Toffalini A, Lanzoni L, Bertolini L, Zenari L, Bonora E, Targher G, Rossi A. Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes. BMJ Open Diabetes Res Care 2018; 6:e000529. [PMID: 29942525 PMCID: PMC6014226 DOI: 10.1136/bmjdrc-2018-000529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Type 2 diabetes may alter cardiac structure and function. Many patients with type 2 diabetes have diastolic dysfunction with preserved ejection fraction (EF). Recently, this latter measure was criticised. Thus, this research looked at the impact of left ventricular end-diastolic volume and E/e' ratio variations in patients with type 2 diabetes and preserved EF with the aim to recognise different clinical phenotypes. METHODS In this cross-sectional study, we evaluated 176 men affected by type 2 diabetes with transthoracic echocardiography. All subjects have preserved EF (>50%). Patients were stratified into four groups based on the median value of both left ventricular end-diastolic volume and E/e' ratio, and the clinical variables were registered. The independent predictors associated with the groups were analysed by a multinomial logistic regression model. RESULTS Diabetes duration, age, estimated glomerular filtration rate and antihypertensive treatments were significantly different among the groups as were EF, left atrial volume index (LAVI), E/A, septum thickness and s' mean wave. Multinomial regression analysis showed that the groups significantly differed for age, diabetes duration, EF, LAVI, septum thickness and s' mean wave. The main result of this study was that patients with higher left ventricular volume and higher E/e' ratio (group 2) showed the worse clinical profile. CONCLUSIONS Our study might suggest that variations of left ventricular end-diastolic volume along with E/e' ratio variations, even in the normal range, may allow to recognise phenotypes of patients with type 2 diabetes with worse clinical characteristics. This finding should be tested in prospective studies to assess the predictive roles of these phenotypes.
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Affiliation(s)
- Giacomo Zoppini
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Department of Medicine, Section of Cardiology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | | | - Maddalena Trombetta
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Anna Toffalini
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Laura Lanzoni
- Division of Cardiology, ‘Sacro Cuore’ Hospital, Negrar, Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit, ‘Sacro Cuore’ Hospital, Negrar, Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit, ‘Sacro Cuore’ Hospital, Negrar, Italy
| | - Enzo Bonora
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Andrea Rossi
- Department of Medicine, Section of Cardiology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy. J Hypertens 2017; 34:1846-53. [PMID: 27367264 DOI: 10.1097/hjh.0000000000001007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Myocardial mechano-energetic efficiency (MEE) can be easily approximated by the ratio of stroke work [i.e. SBP times stroke volume (SV)] to a rough estimate of energy consumption, the 'double product' [SBP times heart rate (HR)], which can be simplified as SV/HR. We evaluated whether MEE is associated with adverse prognosis in relation to the presence of left ventricular hypertrophy (LVH). METHODS Hypertensive participants of the Campania Salute Network (n = 12 353) without prevalent coronary or cerebrovascular disease and with ejection fraction more than 50% were cross-sectionally and longitudinally analyzed, over a median follow-up of 31 months. MEE was estimated by echocardiographic SV (z-derived)/(HR × 0.6). RESULTS Due to the close relation with left ventricular mass (LVM) (P < 0.0001), MEE was normalized for LVM (MEEi) and divided into quartiles. The lowest quartile of MEEi (<0.29 ml/s per g) was considered 'low MEEi'. MEEi was greater in women than in men (P < 0.0001). Progressively lower MEEi was associated with older age, male sex, obesity, diabetes, LVH, concentric geometry, inappropriate LVM and diastolic dysfunction, more use of antihypertensive therapy, and higher BP (all P < 0.002). In Cox regression, after controlling for LVH, age, sex, and average follow-up SBP, low MEEi exhibited increased hazard of composite fatal and nonfatal cardiovascular end-points (P < 0.01), independently of antihypertensive therapy and associated cardiovascular risk factors. CONCLUSION A simple estimate of low myocardial mechano-energetic efficiency is associated with altered metabolic profile, LVH, concentric left ventricular geometry, and diastolic dysfunction and predicts cardiovascular end-points, independently of age, sex, LVH antihypertensive therapy, and cardiovascular risk factors.
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Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. J Hypertens 2017; 35:1727-1741. [DOI: 10.1097/hjh.0000000000001396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Prevalence and correlates of new-onset left ventricular geometric abnormalities in a general population: the PAMELA study. J Hypertens 2017; 34:1423-31. [PMID: 27136313 DOI: 10.1097/hjh.0000000000000956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM We sought to evaluate new-onset abnormal LV (left ventricle) patterns and their correlates over a 10-year period in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 817 patients with normal LV geometry at baseline evaluation having a readable echocardiogram at the end of follow-up. Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the Pressioni Arteriose Monitorate e Loro Associazioni population. RESULTS Over a 10-year period 39% of participants progressed to abnormal LV geometric patterns as follows: LV concentric remodelling (15.2%), eccentric dilated left ventricular hypertrophy (LVH) (8.4%), concentric LVH (7.9%), eccentric nondilated LVH (6.8%), and concentric dilated LVH (0.7%). Age [odds ratio (OR): 1.039; 95% confidence interval (CI) 1.023-1.056, P < 0.0001], LV mass index (OR: 1.039; 95% CI 1.026-1.052, P < 0.0001), night-time SBP (OR: 1.024; 95% CI 1.005-1.043, P = 0.01), office SBP changes during follow-up (OR: 1.017 95% CI 1.007-1028, P = 0.001), and BMI (OR: 1.067; 95% CI 1.017-1.120, P = 0.009) emerged as key correlates of new-onset abnormal LV geometry. Age and LV mass index turned out to be strong determinants of all sub-types of LVH; whereas blood pressure, BMI, and sex exhibited a different predictive value across the various LV geometric patterns. CONCLUSIONS Our study provides the first evidence that long-term changes from normal cardiac morphology toward abnormal LV geometry represent a clinically relevant phenomenon at the community level. From a practical perspective this finding reinforces the concept that life-style changes and pharmacologic treatment aimed to reduce over-weight/obesity and optimize blood pressure are of paramount importance for prevention of subclinical cardiac damage.
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Perrone-Filardi P, Coca A, Galderisi M, Paolillo S, Alpendurada F, de Simone G, Donal E, Kahan T, Mancia G, Redon J, Schmieder R, Williams B, Agabiti-Rosei E, Delgado V, Cosyns B, Lombardi M, Lancellotti P, Muraru D, Kauffmann P, Cardim N, Haugaa K, Hagendorff A. Non-invasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. Eur Heart J Cardiovasc Imaging 2017; 18:945-960. [DOI: 10.1093/ehjci/jex094] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Pasquale Perrone-Filardi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maurizio Galderisi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | | | - Francisco Alpendurada
- NIHR Cardiovascular BRU, Royal Brompton & Harefield NHS Trust, Imperial College London, London, UK
| | - Giovanni de Simone
- Hypertension Research Center (CIRIAPA), Federico II University of Naples, Naples, Italy
| | - Erwan Donal
- Cardiology & Cic-it 1414, CHU Rennes LTSI, Insert 1099, Université Rennes-1, Rennes, France
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Giuseppe Mancia
- IRCCS Istituto Auxologico Italiano e Istituto Clinico Universitario di Verano Brianza, Policlinico di Monza, Italy
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia and CIBERObn Carlos III Institute, Madrid, Spain
| | - Roland Schmieder
- University Hospital, Nephrology and Hypertension, Erlangen, Germany
| | - Bryan Williams
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, University College London, London, UK
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, Hypertension and Cardiovascular Risk Research Centre, University of Brescia, Spedali Civili, Brescia
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Le Jemtel TH, Samson R, Jaiswal A, Lewine EB, Oparil S. Regression of Left Ventricular Mass After Bariatric Surgery. Curr Hypertens Rep 2017; 19:68. [DOI: 10.1007/s11906-017-0767-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Assessment of left ventricular function and geometry in hypertensive patients: Novel approaches in every day clinical practice. Hellenic J Cardiol 2017; 58:171-173. [PMID: 28698060 DOI: 10.1016/j.hjc.2017.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023] Open
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