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Cuspidi C, Faggiano A, Mancia G, Grassi G. Echocardiographic Phenotypes of Subclinical Organ Damage: Clinical and Prognostic Value in the General Population. Findings from the Pamela Study. High Blood Press Cardiovasc Prev 2023; 30:497-511. [PMID: 38032423 DOI: 10.1007/s40292-023-00610-4] [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: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of established adverse prognostic significance such as left ventricular hypertrophy (LVH), alterations of LV geometry, left atrial (LA) enlargement, and aortic root (AR) dilatation. The excess cardiovascular (CV) risk associated with these phenotypes has been consistently demonstrated in different clinical settings such in patients with systemic hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, heart failure and in geneal population samples. The Pressioni Monitorate e Loro Associazioni (PAMELA), a longitudinal population-based study originally designed to assess the normality values, prognostic significance of office, home and 24-hour blood pressure, including among the many clinical and laboratory variables the collection of echocardiographic data, allowed to gather important information on the clinical prognostic significance of subclinical cardiac damage during a long follow-up period. This article summarizes the original findings provided by the PAMELA study on the clinical correlates and prognostic significance of echocardiographic markers of subclinical organa damage namely LVH, left atrial enlargement (LA) and AR dilatation at the community level.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Urbina EM, Isom S, Dabelea D, D’Agostino R, Daniels SR, Dolan LM, Imperatore G, Lustigova E, Marcovina S, Mottl A, Pihoker C, Shah AS. Association of Elevated Arterial Stiffness With Cardiac Target Organ Damage and Cardiac Autonomic Neuropathy in Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:786-793. [PMID: 36730642 PMCID: PMC10090911 DOI: 10.2337/dc22-1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Adults with diabetes are at risk for cardiovascular (CV) events, possibly due to increased arterial stiffness (AS) and cardiac autonomic neuropathy (CAN). We sought to determine whether 1) AS is associated with cardiac target organ damage in young adults with youth-onset diabetes, 2) whether CAN is associated with AS, as one possible etiology for increased AS in this cohort, and 3) whether these relationships differ by type of diabetes. RESEARCH DESIGN AND METHODS Participants from the SEARCH for Diabetes in Youth Study (type 1 diabetes [T1D], n = 222; type 2 diabetes [T2D], n = 177; mean age 23 years) had clinical, echocardiographic, AS, and CAN assessed. Linear regression was performed to determine whether AS was associated with cardiac changes and CAN and whether relationships differed by diabetes type. RESULTS AS was significantly associated with cardiac structure (left ventricular mass index, P < 0.0001), systolic function (ejection fraction, P = 0.03) and diastolic function (transmitral peak early [E]/atrial [A] wave velocities ratio, P = 0.008; early [e']/atrial [a'] waves, P = 0.02) after adjustments for CV risk factors. The association between AS and CAN was not significant when other important covariates were added. These relationships were mostly similar in both T1D and T2D. CONCLUSIONS AS is associated with cardiac changes in young adults with diabetes. CAN-induced AS does not appear to be an etiology for cardiac abnormalities in this cohort.
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Affiliation(s)
- Elaine M. Urbina
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO
| | - Ralph D’Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen R. Daniels
- Department of Pediatrics, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO
| | - Lawrence M. Dolan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eva Lustigova
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Amy Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Amy S. Shah
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, OH
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Bello H, Norton GR, Peterson VR, Libhaber CD, Mmopi KN, Mthembu N, Masiu M, Da Silva Fernandes D, Bamaiyi AJ, Peters F, Sareli P, Woodiwiss AJ. Hemodynamic and Functional Correlates of Concentric vs. Eccentric LVH in a Community-Based Sample With Prevalent Volume-Dependent Hypertension. Am J Hypertens 2021; 34:1300-1310. [PMID: 34379750 DOI: 10.1093/ajh/hpab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (P < 0.0001) and eccentric (P < 0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial, or 24-hour blood pressures (BP), but neither increases in SVR or Zc nor decreases in TAC. LV RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall shortening and s') (P < 0.05 to <0.005) and decreases in LV systolic function were noted in concentric (P < 0.05), but not eccentric LVH. CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH.
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Affiliation(s)
- Hamza Bello
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vernice R Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe N Mmopi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Mthembu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohlabani Masiu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Da Silva Fernandes
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adamu J Bamaiyi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Tadic M, Sala C, Carugo S, Mancia G, Grassi G, Cuspidi C. Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension. J Hypertens 2021; 39:2297-2306. [PMID: 34128494 DOI: 10.1097/hjh.0000000000002911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'left ventricular hypertrophy', left ventricular remodeling", 'concentric hypertrophy', 'eccentric hypertrophy'. RESULTS Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e' gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (-19.5 ± 0.6 versus -18.8 ± 0.73 versus -17.6 ± 0.66 versus -16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one. CONCLUSION The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.
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Affiliation(s)
- Marijana Tadic
- University Hospital 'Dr Dragisa Misovic - Dedinje' Department of Cardiology, Belgrade, Serbia
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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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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Grassi G, Quarti-Trevano F, Dell'oro R, Cuspidi C, Mancia G. The pressioni arteriose monitorate e loro associazioni (PAMELA) research project: a 25-year long journey. Panminerva Med 2021; 63:430-435. [PMID: 33878850 DOI: 10.23736/s0031-0808.21.04396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Among the observational studies performed in the area of blood pressure measurements in the population the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) investigation represents an unique research for a number of reasons. EVIDENCE ACQUISITION AND SYNTHESIS The PAMELA study combines clinic, home and 24-hour blood pressure measurements in all partiicipants, which were representative of the general population. Examination included metabolic variables, allowing us to determine the interrelationships between bood pressure and metabolic profile. The protocol also included evaluation of organ damage, such as left ventricular hypertrophy, left ventricular diastolic dysfunction, left atrial dimensions and aortic root diameters. Finally, PAMELA represents one of the few studies with a prolonged follow-up, the last survey being completed three years ago and data collected are actually under analysis. This will allow to update the information related to cardiovascular morbidity and mortality in the study cohort. CONCLUSIONS The present paper will provide an overview of the various scientific contributions of the PAMELA study to the epidemiology, pathophysiology and clinical aspects of hypertension and hypertension related cardiovascular risk.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy -
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Dell'oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Mancia
- Policlinico di Monza, Monza, Italy.,University Milano-Bicocca, Milan, Italy
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Yu F, Huang H, Yu Q, Ma Y, Zhang Q, Zhang B. Artificial intelligence-based myocardial texture analysis in etiological differentiation of left ventricular hypertrophy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:108. [PMID: 33569410 PMCID: PMC7867873 DOI: 10.21037/atm-20-4891] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Transthoracic echocardiography (TTE) is widely used in clinics to evaluate left ventricular hypertrophy (LVH). However, TTE is usually insufficient for the etiological diagnoses when morphological and functional features are nonspecific. With the booming of computer science and artificial intelligence (AI), previous literature has reported the application of radiomics based on cardiac magnetic resonance imaging, cardiac computed tomography and TTE in diagnosing several myocardial abnormalities, such as myocardial infarction, myocarditis, cardiac amyloidosis, and hypertrophic cardiomyopathy (HCM). In this study, we explored the possibility of using myocardial texture features in differentiating HCM, hypertensive heart disease (HHD) and uremic cardiomyopathy (UCM) based on echocardiography. To our knowledge, this was the first study to explore TTE myocardial texture analysis for multiple LVH etiology differentiation. Methods TTE images were reviewed retrospectively from January 2018 to collect 50 cases for each group of HHD, HCM and UCM. The apical four chamber view was retrieved. Seventeen first-order statistics and 60 gray level co-occurrence matrix (GLCM) features were extracted for statistics and classification test by support vector machine (SVM). Results Of all the parameters, entropy of brightness (EtBrt), standard deviation (Std), coefficient of variation (CoV), skewness (Skew), contrast7 (Cont7) and homogeneity5 (Hm5) were found statistically significant among the three groups (all P<0.05) and with acceptable reproducibility (intraobserver and interobserver ICC >0.50). As a result, HCM showed the most homogeneous myocardial texture, and was significantly different from HHD and UCM (all six features: P≤0.005). HHD appeared slightly more homogeneous than UCM, as only EtBrt and CoV were significant (P=0.011 and P=0.008). According to higher areas under the receiver operating characteristic curve (AUC) (>0.50), EtBrt, Std, and CoV were selected for test of classification as a combination of features. The AUC derived from SVM model was slightly improved compared with those of EtBrt, Std and CoV individually. Conclusions AI-based myocardial texture analysis using ultrasonic images may be a potential approach to aiding LVH etiology differentiation.
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Affiliation(s)
- Fei Yu
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haibo Huang
- Shanghai Institute of Advanced Communication and Data Science, The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai University, Shanghai, China.,Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Qihui Yu
- Shanghai Institute of Advanced Communication and Data Science, The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai University, Shanghai, China.,Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Yuqing Ma
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Zhang
- Shanghai Institute of Advanced Communication and Data Science, The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai University, Shanghai, China.,Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai, China.,Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Bo Zhang
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study. J Hypertens 2020; 39:952-960. [PMID: 33323911 DOI: 10.1097/hjh.0000000000002746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography. RESULTS During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (-8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91-0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83-0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95-0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93-0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry. CONCLUSION The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.
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Left ventricular mass reduction and hypertrophy regression following renal artery revascularization: a meta-analysis. J Hypertens 2020; 39:4-11. [PMID: 32833917 DOI: 10.1097/hjh.0000000000002586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Few echocardiographic studies have focused on regression of left ventricular hypertrophy (LVH) in patients with renal artery stenosis after revascularization, with inconsistent results. We performed a systematic meta-analysis of these studies in order to offer a comprehensive information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English-language articles published from 1 January 1990 up to 31 March 2020. Studies were identified by crossing the following terms: 'renal artery stenosis', 'renovascular hypertension', 'fibromuscular dysplasia', 'renal artery stenting', 'renal artery surgery' with 'cardiac damage', 'hypertensive heart disease' 'left ventricular mass', 'left ventricular hypertrophy', 'echocardiography'. RESULTS A total of 726 hypertensive patients with renal artery stenosis (mean age 61 years, 64% men, 98% treated, 10% with fibromuscular dysplasia) were included in 13 studies. Baseline and postintervention pooled mean LVM values were 220 ± 15 and 203 ± 19 g, respectively (SMD -0.24 ± 0.06, CI -0.37 to -0.21, P<0.0001); corresponding values for LV mass index were 129.0 ± 6 and 115 ± 7 g/m, respectively (SMD -0.28 ± 0.04, CI -0.36 to 0.21, P < 0.0001). Renal revascularization was associated with a 40% lower risk of LVH. This trend was accompanied by a reduction in the number of antihypertensive drugs (SMD -0.27 ± 0.04, CI -0.37 to 0.17, P < 0.0001). CONCLUSION The present meta-analysis suggests that renal artery revascularization added to antihypertensive therapy promotes a favourable effect on LV structure, as reflected by a significant decrease in absolute and indexed LV mass index as well by a lower risk of LVH. Limitations include: high prevalence of modest renal artery stenosis (≥50%); small sample of fibromuscular dysplasia; lack of randomized design of most studies.
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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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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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12
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Kawel-Boehm N, Kronmal R, Eng J, Folsom A, Burke G, Carr JJ, Shea S, Lima JAC, Bluemke DA. Left Ventricular Mass at MRI and Long-term Risk of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2019; 293:107-114. [PMID: 31453766 PMCID: PMC6776886 DOI: 10.1148/radiol.2019182871] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/02/2019] [Accepted: 07/12/2019] [Indexed: 01/19/2023]
Abstract
Background Few data exist on the long-term risk prediction of elevated left ventricular (LV) mass quantified by MRI for cardiovascular (CV) events in a contemporary, ethnically diverse cohort. Purpose To assess the long-term impact of elevated LV mass on CV events in a prospective cohort study of a multiethnic population in relationship to risk factors and coronary artery calcium (CAC) score. Materials and Methods The Multi-Ethnic Study of Atherosclerosis, or MESA (ClinicalTrials.gov: NCT00005487), is an ongoing prospective multicenter population-based study in the United States. A total of 6814 participants (age range, 45-84 years) free of clinical CV disease at baseline were enrolled between 2000 and 2002. In 4988 participants (2613 [52.4%] women; mean age, 62 years ± 10.1 [standard deviation]) followed over 15 years for CV events, LV mass was derived from cardiac MRI at baseline enrollment by using semiautomated software at a central core laboratory. Cox proportional hazard models, Kaplan-Meier curves, and z scores were applied to assess the impact of LV hypertrophy. Results A total of 290 participants had hard coronary heart disease (CHD) events (207 myocardial infarctions [MIs], 95 CHD deaths), 57 had other CV disease-related deaths, and 215 had heart failure (HF). LV hypertrophy was an independent predictor of hard CHD events (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.9, 3.8), MI (HR: 2.8; 95% CI: 1.8, 4.0), CHD death (HR: 4.3; 95% CI: 2.5, 7.3), other CV death (HR: 7.5; 95% CI: 4.2, 13.5), and HF (HR: 5.4; 95% CI: 3.8, 7.5) (P < .001 for all end points). LV hypertrophy was a stronger predictor than CAC for CHD death, other CV death, and HF (z scores: 5.4 vs 3.4, 6.8 vs 2.4, and 9.7 vs 3.2 for LV hypertrophy vs CAC, respectively). Kaplan-Meier analysis demonstrated an increased risk of CV events in participants with LV hypertrophy, particularly after 5 years. Conclusion Elevated left ventricular mass was strongly associated with hard coronary heart disease events, other cardiovascular death, and heart failure over 15 years of follow-up, independent of traditional risk factors and coronary artery calcium score. © RSNA, 2019 See also the editorial by Hanneman in this issue.
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Affiliation(s)
- Nadine Kawel-Boehm
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Richard Kronmal
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - John Eng
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Aaron Folsom
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Gregory Burke
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - J. Jeffrey Carr
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Steven Shea
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - João A. C. Lima
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
| | - David A. Bluemke
- From the Department of Radiology, Kantonsspital Graubuenden,
Loestrasse 170, 7000 Chur, Switzerland (N.K.); Collaborative Health Studies
Coordinating Center, University of Washington, Seattle, Wash (R.K.); Department
of Radiology and Radiological Science (J.E.) and Division of Cardiology
(J.A.C.L.), Johns Hopkins University, Baltimore, Md; Division of Epidemiology
and Community Health, University of Minnesota, Minneapolis, Minn (A.F.);
Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
(G.B.); Department of Radiology, Vanderbilt University Medical Center,
Nashville, Tenn (J.J.C.); Department of Medicine, Columbia University, New York,
NY (S.S.); and Department of Radiology, University of Wisconsin School of
Medicine and Public Health, Madison, Wis (D.A.B.)
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Bangalore S, Maron DJ, Reynolds HR, Stone GW, O'Brien SM, Alexander KP, Hochman JS. ISCHEMIA: Establishing the Primary End Point. Circ Cardiovasc Qual Outcomes 2019; 11:e004791. [PMID: 29752391 DOI: 10.1161/circoutcomes.118.004791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation (G.W.S.)
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, NC (S.M.O., K.P.A.)
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14
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Gorgis NM, Kennedy C, Lam F, Thompson K, Coss-Bu J, Akcan Arikan A, Nguyen T, Hosek K, Miloh T, Karpen SJ, Penny DJ, Goss J, Desai MS. Clinical Consequences of Cardiomyopathy in Children With Biliary Atresia Requiring Liver Transplantation. Hepatology 2019; 69:1206-1218. [PMID: 30076624 DOI: 10.1002/hep.30204] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/28/2018] [Indexed: 12/13/2022]
Abstract
Cirrhotic cardiomyopathy (CCM), a comorbidity of end-stage cirrhotic liver disease, remains uncharacterized in children, largely because of a lack of an established pediatric definition. The aim of this retrospective cohort analysis is to derive objective two-dimensional echocardiographic (2DE) criteria to define CCM associated with biliary atresia (BA), or BA-CCM, and correlate presence of BA-CCM with liver transplant (LT) outcomes in this population. Using receiver operating characteristic (ROC) curve analysis, optimal cut-off values for left ventricular (LV) geometrical parameters that were highly sensitive and specific for the primary outcomes: A composite of serious adverse events (CSAE) and peritransplant death were determined. These results were used to propose a working definition for BA-CCM: (1) LV mass index (LVMI) ≥95 g/m2.7 or (2) relative wall thickness of LV ≥0.42. Applying these criteria, BA-CCM was found in 34 of 69 (49%) patients with BA listed for LT and was associated with increased multiorgan dysfunction, mechanical and vasopressor support, and longer intensive care unit (ICU) and hospital stays. BA-CCM was present in all 4 waitlist deaths, 7 posttransplant deaths, and 20 patients with a CSAE (P < 0.01). On multivariable regression analysis, BA-CCM remained independently associated with both death and a CSAE (P < 0.01). Utilizing ROC analysis, LVMI was found to be a stronger predictor for adverse outcomes compared with current well-established markers, including Pediatric End-Stage Liver Disease (PELD) score. Conclusion: BA-CCM is highly sensitive and specific for morbidity and mortality in children with BA listed for LT. 2DE screening for BA-CCM may provide pertinent clinical information for prioritization and optimal peritransplant management of these children.
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Affiliation(s)
- Noelle M Gorgis
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Curtis Kennedy
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Fong Lam
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Kathleen Thompson
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Jorge Coss-Bu
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Ayse Akcan Arikan
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX.,Section of Pediatric Nephrology, Baylor College of Medicine, Houston, TX
| | - Trung Nguyen
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Kathleen Hosek
- Section of Pediatric Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX
| | - Tamir Miloh
- Section of Pediatric Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX
| | - Saul J Karpen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Daniel J Penny
- Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - John Goss
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX
| | - Moreshwar S Desai
- Section of Pediatric Critical Care, Baylor College of Medicine, Houston, TX
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15
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Norton GR, Peterson VR, Robinson C, Norman G, Libhaber CD, Libhaber E, Gomes M, Sareli P, Woodiwiss AJ. Independent of left ventricular mass, circulating inflammatory markers rather than pressure load are associated with concentric left ventricular remodelling. Int J Cardiol 2019; 274:342-347. [DOI: 10.1016/j.ijcard.2018.09.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/09/2023]
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16
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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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Three-dimensional echocardiography: a further step in the evaluation of hypertensive heart disease. J Hypertens 2018; 36:1648-1650. [PMID: 29952849 DOI: 10.1097/hjh.0000000000001734] [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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18
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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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Tadic M, Cuspidi C, Bombelli M, Grassi G. Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful? J Clin Hypertens (Greenwich) 2018; 20:400-407. [PMID: 29370476 DOI: 10.1111/jch.13186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
Left ventricular structural and functional changes in patients with arterial hypertension are well established. However, the influence of arterial hypertension on right ventricular (RV) remodeling is still being investigated. The introduction of strain analysis provided an insight into RV function and mechanics. Previous research has demonstrated the predictive value of RV longitudinal strain in patients with various cardiovascular conditions, such as pulmonary hypertension, heart failure, congenital heart diseases, and valvular disease. Nowadays, we are aware of the fact that conventional echocardiographic methods usually do not provide necessary information about RV dysfunction in patients with arterial hypertension, which is why the evaluation of new parameters that could detect RV subtle changes in hypertension is essential. The present review article is an overview of the main principles of RV deformation and a summary of the current knowledge and clinical significance of RV strain in patients with arterial hypertension.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Meda, Italy
| | - Michele Bombelli
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore Policlinico di Milano, University of Milano, Milano, Italy
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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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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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22
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Krishnan A, Teixeira-Pinto A, Chan D, Chakera A, Dogra G, Boudville N, Irish A, Morgan K, Phillips J, Wong G, Lim WH. Impact of early conversion from cyclosporin to everolimus on left ventricular mass index: A randomized controlled trial. Clin Transplant 2017; 31. [PMID: 28662279 DOI: 10.1111/ctr.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/29/2022]
Abstract
This is an 18-month prospective, randomized controlled trial (RCT) designed to compare the effect of early conversion from cyclosporin to everolimus/mycophenolic acid (E-MPA) between 3 and 4 months post-transplant to cyclosporin/mycophenolic acid (CsA-MPA) on left ventricular mass index (LVMI) at 3 and 18 months post-transplant (primary outcome). Secondary outcomes included estimated glomerular filtration rate (eGFR), viral infection, and adverse events. Twenty-four patients were randomized in a 1:1 ratio to E-MPA or CsA-MPA groups. There were no significant differences in mean (SD) LVMI at 3 (51.6±18.5 vs 53.7±15.7 g/m2.7 ) and 18 months (52.7±16.3 vs 51.7±16.8 g/m2.7 ) between CsA-MPA and E-MPA groups. The incidence of viral infections was reduced in E-MPA compared to CsA-MPA treatment groups (8% vs 50%, P=.02), but the incidences of acute rejection, adverse events, and drug discontinuation were similar between groups. There was an overall increase in eGFR with time (0.04 log- mL/min/1.73 m2 per 6 months, P=.012) but no significant difference between the two groups across time (0.11 log- mL/min/1.73 m2 , P=.311). Immunosuppressive regimen comprising early conversion from cyclosporine to everolimus was not associated with a regression of LVMI, but a lower risk of viral infections was observed.
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Affiliation(s)
- Anoushka Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Doris Chan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Aron Chakera
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Gursharan Dogra
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Ashley Irish
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Kelly Morgan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jessica Phillips
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Camden, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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23
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Verdecchia P, Angeli F, Mazzotta G, Bartolini C, Garofoli M, Aita A, Poltronieri C, Pinzagli MG, Valecchi F, Martone S, Ramundo E, Turturiello D, Reboldi G. Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.005948. [PMID: 28539381 PMCID: PMC5669190 DOI: 10.1161/jaha.117.005948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear. METHODS AND RESULTS We studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24-hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow-up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient-years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log-rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24-hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model. CONCLUSIONS In initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.
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Affiliation(s)
| | - Fabio Angeli
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
| | | | | | | | - Adolfo Aita
- Department of Medicine, Hospital of Assisi, Italy
| | | | | | | | | | | | - Dario Turturiello
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
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24
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Prevalence and determinants of left ventricular geometric abnormalities in hypertensive patients: A study based on the updated classification system of left ventricular geometry. Hellenic J Cardiol 2017; 58:124-132. [PMID: 28179146 DOI: 10.1016/j.hjc.2016.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study was to determine whether different risk factors were associated with different type of left ventricular (LV) geometric abnormalities. METHODS This retrospective analysis included 2290 hypertensive participants without other cardiovascular disease, valve disease and with ejection fraction ≥50%. The type of LV geometric abnormality was defined on the basis of the new classification system. RESULTS LV geometric abnormalities were detected in 1479 subjects (64.6%), wherein concentric LV remodeling is the most common LV geometric abnormality (40.3%). Large waist circumference (WC) and neck circumference (NC) were positively associated with concentric LV remodeling, whereas body mass index (BMI) [odds ratio (OR) 0.89, 95% CI 0.85∼0.92, P < 0.001] and systolic blood pressure (SBP) (OR 0.99, 95% CI 0.98∼0.99, P = 0.018) were inversely associated with concentric abnormalities. SBP and age were positively associated with eccentric dilated LVH, while male was inversely associated with eccentric dilated left ventricular hypertrophy (LVH). Age was the strongest risk factor for eccentric dilated LVH (OR 1.05, 95% CI 1.03∼1.07, P < 0.001). Age, NC, SBP, hyperuricemia, and alcohol use were positively associated with concentric LVH, whereas BMI (OR 0.95, 95% CI 0.90∼0.99, P = 0.033) and male (OR 0.12, 95% CI 0.07∼0.18, P < 0.001) were negatively associated with concentric LVH. CONCLUSION The prevalence of hypertensive LV geometric abnormality in rural area of Southern China was obvious higher. Compared with eccentric LV geometric abnormalities, there were more risk factors, including large WC and NC, age, NC, SBP, hyperuricemia, alcohol use, BMI and gender, which were associated with concentric LV geometric abnormalities.
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25
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Clinical and prognostic value of hypertensive cardiac damage in the PAMELA Study. Hypertens Res 2016; 40:329-335. [DOI: 10.1038/hr.2016.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 11/08/2022]
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26
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Cuspidi C, Tadic M, Sala C. Beyond left ventricular mass: the prognostic power of left ventricular shape. Heart 2016; 103:481-482. [PMID: 27794016 DOI: 10.1136/heartjnl-2016-310471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy
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27
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Agra RM, Al-Daghri NM, Badimon L, Bodi V, Carbone F, Chen M, Cubedo J, Dullaart RPF, Eiras S, García-Monzón C, Gary T, Gnoni A, González-Rodríguez Á, Gremmel T, Hafner F, Hakala T, Huang B, Ickmans K, Irace C, Kholová I, Kimer N, Kytö V, März W, Miazgowski T, Møller S, Montecucco F, Niccoli G, Nijs J, Ozben S, Ozben T, Papassotiriou I, Papastamataki M, Reina-Couto M, Rios-Navarro C, Ritsch A, Sabico S, Seetho IW, Severino A, Sipilä J, Sousa T, Taszarek A, Taurino F, Tietge UJF, Tripolino C, Verloop W, Voskuil M, Wilding JPH. Research update for articles published in EJCI in 2014. Eur J Clin Invest 2016; 46:880-94. [PMID: 27571922 DOI: 10.1111/eci.12671] [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: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Rosa María Agra
- Department of Cardiology and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Lina Badimon
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Cardiovascular Research Chair, UAB, Barcelona, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Federico Carbone
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sonia Eiras
- Health Research Institute, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmelo García-Monzón
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Águeda González-Rodríguez
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Baotao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kelly Ickmans
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Nina Kimer
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Augsburg, Germany
| | - Tomasz Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fabrizio Montecucco
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino-IST, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Serkan Ozben
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tomris Ozben
- Department of Medical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Maria Papastamataki
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Marta Reina-Couto
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal.,Departamento de Medicina Intensiva, Centro Hospitalar São João, Porto, Portugal
| | - Cesar Rios-Navarro
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Andreas Ritsch
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ian W Seetho
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
| | | | - Jussi Sipilä
- North Karelia Central Hospital, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Teresa Sousa
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal
| | - Aleksandra Taszarek
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Federica Taurino
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Uwe J F Tietge
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cesare Tripolino
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Willemien Verloop
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - John P H Wilding
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
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28
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Cuspidi C, Facchetti R, Sala C, Bombelli M, Tadic M, Grassi G, Mancia G. Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation? J Clin Hypertens (Greenwich) 2016; 18:846-54. [PMID: 27160298 PMCID: PMC8032070 DOI: 10.1111/jch.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/31/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
The authors estimated the risk of cardiovascular mortality associated with echocardiographic (ECHO) left ventricular hypertrophy (LVH) and subtypes of this phenotype in patients with and without electrocardiographic (ECG) LVH. A total of 1691 representatives of the general population were included in the analysis. During a follow-up of 211 months, 89 cardiovascular deaths were recorded. Compared with individuals with neither ECHO LVH nor ECG LVH, fully adjusted risk of cardiovascular mortality increased (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.51-7.47; P=.003) in patients with both ECHO-LVH and ECG-LVH, whereas the risk entailed by ECHO-LVH alone was of borderline statistical significance (P=.04). Combined concentric nondilated LVH and ECG-LVH, but not concentric nondilated LVH alone, predicted cardiovascular death (HR, 3.79; 95% CI, 1.25-11.38; P=.01). Similar findings were observed for eccentric nondilated LVH (HR, 3.37; 95% CI, 1.05-10.78; P=.04.). The present analysis underlines the value of combining ECG and ECHO in the assessment of cardiovascular prognosis related to abnormal left ventricular geometric patterns.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.
- Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Rita Facchetti
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Bombelli
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
- IRCCS Multimedica, Milano, Italy
| | - Giuseppe Mancia
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
- Istituto Auxologico Italiano IRCCS, Milano, Italy
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29
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Abdalla M, Booth JN, Diaz KM, Sims M, Muntner P, Shimbo D. Hypertension and alterations in left ventricular structure and geometry in African Americans: the Jackson Heart Study. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2016; 10:550-558.e10. [PMID: 27339075 PMCID: PMC4958512 DOI: 10.1016/j.jash.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 01/13/2023]
Abstract
African Americans (AAs) have an increased risk for hypertension-related cardiovascular outcomes compared with whites, which may be related to abnormal left ventricular (LV) structure. We examined the association of prevalent hypertension with concentric remodeling (CR; normal LV mass index [LVMI] and increased relative wall thickness [RWT]), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (CH; increased LVMI and increased RWT) within the Jackson Heart Study. Among 4721 participants (mean ± SD, age 55.7 ± 12.7 years), 2841 (60.2%) had prevalent hypertension, defined as mean clinic blood pressure ≥140/90 mm Hg or antihypertensive medication use. Prevalent hypertension was associated with a statistically significantly increased odds for having CR (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.42-2.24), eccentric hypertrophy (OR = 1.68; 95% CI = 1.15-2.44), and CH (OR = 3.86, 95% CI = 2.28-6.54) after multivariable adjustment. In conclusion, in a population-based sample of AAs, hypertension was associated with increased odds for having abnormal LV structure, particularly CH.
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Affiliation(s)
- Marwah Abdalla
- Department of Medicine, Columbia University Medical Center, New York, NY, US
| | - John N. Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, US
| | - Keith M. Diaz
- Department of Medicine, Columbia University Medical Center, New York, NY, US
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, US
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, US
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY, US
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30
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Mulè' G, Nardi E, Guarneri M, Cottone S. Electrocardiography for Assessment of Hypertensive Heart Disease: A New Role for an Old Tool. J Clin Hypertens (Greenwich) 2016; 18:843-5. [PMID: 27160048 DOI: 10.1111/jch.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Mulè'
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Marco Guarneri
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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31
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Szewieczek J, Gąsior Z, Duława J, Francuz T, Legierska K, Batko-Szwaczka A, Hornik B, Janusz-Jenczeń M, Włodarczyk I, Wilczyński K. ECG low QRS voltage and wide QRS complex predictive of centenarian 360-day mortality. AGE (DORDRECHT, NETHERLANDS) 2016; 38:44. [PMID: 27039197 PMCID: PMC5005906 DOI: 10.1007/s11357-016-9907-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
We examined the electrocardiographic (ECG) findings of centenarians and associated them with >360-day survival. Physical and functional assessment, resting electrocardiogram and laboratory tests were performed on 86 study participants 101.9 ± 1.2 years old (mean ± SD) (70 women, 16 men) and followed for at least 360 days. Centenarian ECGs were assessed for left ventricular hypertrophy (LVH) according to the Romhilt-Estes score, Sokolow-Lyon criteria and Cornell voltage criteria which were positive for 12.8, 6.98, and 10.5 % of participants, respectively. Fifty-two study participants (60 %) survived ≥360 days. Multivariate logistic regression analysis revealed a negative relationship between 360-day survival and the following: R II <0.45 mV adjusted for CRP (odds ratio (OR) = 0.108, 95 % confidence interval (CI) = 0.034-0.341, P < .001), R aVF < 0.35 mV adjusted for CRP (OR = 0.151, 95 % CI = 0.039-0.584, P < .006), Sokolow-Lyon voltage <1.45 mV adjusted for CRP (OR = 0.178, 95 % CI = 0.064-0.492, P = .001), QRS ≥90 ms adjusted for CRP (OR = 0.375, 95 % CI = 0.144-0.975, P = .044), and Romhilt-Estes score ≥5 points adjusted for sex and Barthel Index (OR = 0.459, 95 % CI = 0.212-0.993, P = .048) in single variable ECG models. QRS voltage correlated positively with systolic and pulse pressure, serum vitamin B12 level, sodium, calcium, phosphorous, TIMP-1, and eGFR. QRS voltage correlated negatively with BMI, WHR, serum leptin, IL-6, TNF-α, and PAI-1 levels. QRS complex duration correlated positively with CRP; QTc correlated positively with TNF-α. Results suggest that Romhilt-Estes LVH criteria scores ≥5 points, low ECG QRS voltages (Sokolow-Lyon voltage <1.45 mV), and QRS complexes ≥90 ms are predictive of centenarian 360-day mortality.
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Affiliation(s)
- Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Francuz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Legierska
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Batko-Szwaczka
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Hornik
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Janusz-Jenczeń
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Iwona Włodarczyk
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Wilczyński
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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