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Deal O, Rayner J, Stracquadanio A, Wijesurendra RS, Neubauer S, Rider O, Spartera M. Effect of Weight Loss on Early Left Atrial Myopathy in People With Obesity But No Established Cardiovascular Disease. J Am Heart Assoc 2022; 11:e026023. [PMID: 36346054 PMCID: PMC9750071 DOI: 10.1161/jaha.122.026023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Obesity is associated with left atrial (LA) remodeling (ie, dilatation and dysfunction) which is an independent determinant of future cardiovascular events. We aimed to assess whether LA remodeling is present in obesity even in individuals without established cardiovascular disease and whether it can be improved by intentional weight loss. Methods and Results Forty-five individuals with severe obesity without established cardiovascular disease (age, 45±11 years; body mass index; 39.1±6.7 kg/m2; excess body weight, 51±18 kg) underwent cardiac magnetic resonance for quantification of LA and left ventricular size and function before and at a median of 373 days following either a low glycemic index diet (n=28) or bariatric surgery (n=17). Results were compared with those obtained in 27 normal-weight controls with similar age and sex. At baseline, individuals with obesity displayed reduced LA reservoir function (a marker of atrial distensibility), and a higher mass and LA maximum volume (all P<0.05 controls) but normal LA emptying fraction. On average, weight loss led to a significant reduction of LA maximum volume and left ventricular mass (both P<0.01); however, significant improvement of the LA reservoir function was only observed in those at the upper tertile of weight loss (≥47% excess body weight loss). Following weight loss, we found an average residual increase in left ventricular mass compared with controls but no residual significant differences in LA maximum volume and strain function (all P>0.05). Conclusions Obesity is linked to subtle LA myopathy in the absence of overt cardiovascular disease. Only larger volumes of weight loss can completely reverse the LA myopathic phenotype.
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Affiliation(s)
- Oscar Deal
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Jennifer Rayner
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Antonio Stracquadanio
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Rohan S. Wijesurendra
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Oliver Rider
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Marco Spartera
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
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Freedland KE, Carney RM, Steinmeyer BC, Skala JA, Rich MW. Left Ventricular Dysfunction and Depression in Hospitalized Patients with Heart Failure. Psychosom Med 2021; 83:274-282. [PMID: 33793455 PMCID: PMC8903038 DOI: 10.1097/psy.0000000000000915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined whether the severity of left ventricular systolic dysfunction is associated with depression in patients with heart failure (HF). Other factors were also studied to identify independent correlates of depression in HF. METHODS The sample consisted of 400 hospitalized patients with HF. Left ventricular ejection fraction and other medical data were obtained from medical records. Depression and other psychosocial characteristics were assessed by an interview and questionnaires. Proportional odds models were used to test the relationships of these characteristics to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) depressive disorders, and analysis of covariance was used to test relationships with continuous measures of depression in secondary models. RESULTS The models produced no evidence of an association between left ventricular ejection fraction and depression. The adjusted odds ratio (95% confidence interval) was 1.00 (0.98-1.01; p = .87) for depression diagnosis. Analysis of covariance estimates (standard errors) were -0.01 (0.02; p = .54) for the Hamilton Rating Scale for Depression and -0.01 (0.01; p = .59) for the Patient Health Questionnaire. The odds of depression were higher in African American patients and in those with high levels of anxiety or stress. Other characteristics that have been associated with depression in previous studies, including sex and age, were not consistently associated with depression in this study. CONCLUSIONS There is no relationship between the severity of left ventricular systolic dysfunction and depression in hospitalized patients with HF. In contrast, African American patients and those with a high level of anxiety or perceived stress are more likely than other patients to have a comorbid depressive disorder.
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Plompen MV, van der Schouw YT, Rutten FH, Verschuren WM, Boer JM, Asselbergs FW, Onland-Moret NC. Age at menarche and heart failure risk: The EPIC-NL study. Maturitas 2020; 131:34-39. [DOI: 10.1016/j.maturitas.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/28/2022]
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Triposkiadis F, Giamouzis G, Parissis J, Starling RC, Boudoulas H, Skoularigis J, Butler J, Filippatos G. Reframing the association and significance of co-morbidities in heart failure. Eur J Heart Fail 2016; 18:744-58. [DOI: 10.1002/ejhf.600] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 01/09/2023] Open
Affiliation(s)
| | - Gregory Giamouzis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - John Parissis
- Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Randall C. Starling
- Kaufman Center for Heart Failure; Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - Harisios Boudoulas
- The Ohio State University, Columbus, OH, USA; Biomedical Research Foundation Academy of Athens, Athens, and; Aristotelian University of Thessaloniki; Thessaloniki Greece
| | - John Skoularigis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - Javed Butler
- Cardiology Division, School of Medicine; Stony Brook University; Stony Brook NY USA
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Abstract
Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause and prognosis. The overall reported prognosis of patients with HFPEF remains poor.
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Affiliation(s)
- Charlotte Andersson
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Department of Cardiology, Gentofte Hospital, Niels Andersens vej 65, Hellerup 2900, Denmark.
| | - Ramachandran S Vasan
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Section of Cardiology, Boston University School of Medicine, 801 Massachussetts Avenue, Suite 470, Boston, MA 02118, USA
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Campbell RT, McMurray JJV. Comorbidities and differential diagnosis in heart failure with preserved ejection fraction. Heart Fail Clin 2015; 10:481-501. [PMID: 24975911 DOI: 10.1016/j.hfc.2014.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Careful consideration must be given when diagnosing heart failure with preserved ejection fraction (HF-PEF). HF-PEF diagnosis is challenging and essentially a diagnosis of exclusion, with comorbidities potentially making the diagnosis more difficult. This article describes the comorbidities commonly associated with HF-PEF, the potential influence of these comorbidities on morbidity and mortality, and the differential diagnosis.
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Affiliation(s)
- Ross T Campbell
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
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Helfand BKI, Maselli NJ, Lessard DM, Yarzebski J, Gore JM, McManus DD, Saczynski JS, Goldberg RJ. Elevated serum glucose levels and survival after acute heart failure: a population-based perspective. Diab Vasc Dis Res 2015; 12:119-25. [PMID: 25525077 DOI: 10.1177/1479164114559024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Limited data are available about the characteristics, treatment and survival in patients without diabetes mellitus (DM), previously diagnosed DM and patients with hyperglycaemia who present with acute decompensated heart failure (ADHF). Our objectives were to examine differences in these endpoints in patients hospitalized with ADHF. METHODS Patients hospitalized with ADHF during 1995, 2000, 2002 and 2004 comprised the study population. RESULTS A total of 5428 non-diabetic patients were hospitalized with ADHF, 3807 with diagnosed DM and 513 with admission hyperglycaemia. Patients with admission hyperglycaemia experienced the highest in-hospital death rates (9.9%) compared to those with diagnosed DM (6.5%) and non-diabetics (7.5%). Patients with diagnosed DM had the greatest risk of dying after hospital discharge. CONCLUSIONS Patients with elevated blood glucose levels at hospital admission are more likely to die acutely. After resolution of the acute illness, patients with previously diagnosed DM need careful monitoring and enhanced treatment.
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Affiliation(s)
- Benjamin K I Helfand
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nicholas J Maselli
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen M Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Bishu K, Redfield MM. Acute heart failure with preserved ejection fraction: unique patient characteristics and targets for therapy. Curr Heart Fail Rep 2013; 10:190-7. [PMID: 23868335 PMCID: PMC3870333 DOI: 10.1007/s11897-013-0149-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Currently, there are 1.0 million annual hospital discharges for acute heart failure (AHF). The total cost of heart failure (HF) care in the United States is projected to increase to $53 billion in 2030, with the majority of costs (80 %) related to AHF hospitalizations. Approximately 50 % of AHF episodes occur in patients with preserved ejection fraction (HFpEF). There is a dearth of evidence-based guidelines for the management of AHF in HFpEF patients. Here, we briefly review the epidemiology, pathophysiology, and treatment of AHF patients with HFpEF.
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Affiliation(s)
- Kalkidan Bishu
- Mayo Clinic Cardiovascular Research, Guggenheim 9, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Margaret M. Redfield
- Mayo Clinic Cardiovascular Research, Guggenheim 9, 200 First Street Southwest, Rochester, MN 55905, USA
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Brouwers FP, Hillege HL, van Gilst WH, van Veldhuisen DJ. Comparing new onset heart failure with reduced ejection fraction and new onset heart failure with preserved ejection fraction: an epidemiologic perspective. Curr Heart Fail Rep 2013; 9:363-8. [PMID: 22968403 DOI: 10.1007/s11897-012-0115-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence and prevalence of heart failure is increasing, especially heart failure with preserved ejection fraction (HFpEF) relative to heart failure with reduced ejection fraction (HFrEF). For both HFrEF and HFpEF, there is need to shift our focus from secondary to primary prevention. Detailed epidemiologic data on both HFpEF and HFrEF are needed to allow early identification of at-risk subjects. Current cohorts with new onset heart failure lack uniformity with respect to diagnosis, follow-up, and population characteristics, but most important, fail to distinguish between HFpEF and HFrEF. Studies on prevalent heart failure show ischemic heart disease as the predominant risk factor for HFrEF, while hypertension, atrial fibrillation, and diabetes are risk factors for HFpEF. As it becomes increasingly clear that both subtypes of heart failure are different syndromes, new cohorts and trials are necessary to obtain separate data on both subtypes of heart failure.
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Affiliation(s)
- Frank P Brouwers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, The Netherlands.
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Bierig SM, Hill J. Echocardiographic Evaluation of Diastolic Function. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311401914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Left ventricular diastolic dysfunction is common in patients with heart failure. Echocardiographic evaluation of diastolic function provides the clinician with important information about ventricular relaxation and estimation of filling pressures. Optimal evaluation includes the integration of multiple echocardiographic parameters such as Doppler, M-mode, and volumes. This article aims to review the components of diastolic filling and ventricular performance, as well as discuss the techniques used for the assessment of left ventricular diastolic function.
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