1
|
Masrouri S, Tamehri Zadeh SS, Afaghi S, Hadaegh F, Khalili D, Shapiro MD. Association of Anthropometric Indices With Midlife Cardiovascular Risk in Young Individuals Without Obesity and Traditional Risk Factors. J Am Heart Assoc 2024; 13:e033355. [PMID: 38842274 PMCID: PMC11255689 DOI: 10.1161/jaha.123.033355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The aim of this study was to assess how early-adulthood body mass index (BMI) and waist circumference (WC) relate to long-term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden. METHODS AND RESULTS A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF-optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low-density lipoprotein cholesterol <130, and women with high-density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima-media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all-cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow-up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1-SD BMI increase was associated with 27% (95% CI, 1.10-1.47), 24% (1.08-1.43), 42% (1.20-1.68), 28% (1.05-1.57), 51% (1.20-1.90), and 49% (1.10-2.02) higher odds of coronary artery calcification presence, increased carotid intima-media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF-low group. Generally, similar associations were found for WC and in the CVRF-optimal subgroup. No significant associations between BMI and WC with CVD and death were found. CONCLUSIONS Elevations in BMI and WC among young low-risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.
Collapse
Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular MedicineWake Forest University School of MedicineWinston SalemNCUSA
| |
Collapse
|
2
|
Beussink-Nelson L, Freed BH, Chirinos JA, Brubaker PH, Kitzman DW, Yeboah J, Rosas SE, Hu M, Lima JAC, Pandit J, Bertoni AG, Shah SJ. Multi-Ethnic Study of Atherosclerosis Early Heart Failure Study: Rationale, Design, and Baseline Characteristics. Circ Heart Fail 2024; 17:e010289. [PMID: 38456289 PMCID: PMC11073782 DOI: 10.1161/circheartfailure.122.010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Current prevalence estimates of heart failure (HF) are primarily based on self-report or HF hospitalizations. There is an unmet need to define the prevalence and pathogenesis of early symptomatic HF, which may be undiagnosed and precedes HF hospitalization. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) Early HF study was conducted during MESA exam 6 to determine the prevalence of early HF and investigate the transition from risk factors to early HF in a diverse population-based cohort of older adults. Between 2016 and 2018, 3285 MESA participants from 6 field centers underwent comprehensive speckle-tracking echocardiography with passive leg raise maneuver, Kansas City Cardiomyopathy Questionnaire, 6-minute walk test, arterial stiffness assessment, and proteomics (including NT-proBNP [N-terminal pro-B-type natriuretic peptide]). RESULTS Median age was 73 (25th-75th percentile 67-81) years, 53.2% were female, 25.6% were Black, 12.8% were Chinese, and 40.0% were White. The prevalence of HF risk factors was high: hypertension, 61.9%; former or current smoking, 53.7%; obesity 34.8%; diabetes; 24.7%; and chronic kidney disease; 22%. Overt cardiovascular disease, which ranged from 2.1% (HF) to 13.6% (atrial fibrillation), was less common. Of the 3285 participants, 96% underwent proteomics, 94% Kansas City Cardiomyopathy Questionnaire, 93% speckle-tracking echocardiography with passive leg raise, 82% arterial stiffness exam, and 77% 6-minute walk test. Feasibility of resting speckle-tracking echocardiography (87%-99% across cardiac chambers) and passive leg raise Doppler/speckle-tracking echocardiography (>84%) measurements was high. A total of 120 unique echocardiographic indices were measured. CONCLUSIONS The MESA Early HF study is a key resource for cardiovascular researchers who are interested in improving the epidemiological and phenotypic characterization of early HF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
Collapse
Affiliation(s)
- Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Benjamin H Freed
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia (J.A.C.)
| | - Peter H Brubaker
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Dalane W Kitzman
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Joseph Yeboah
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center (S.E.R.), Harvard Medical School, Boston, MA
| | - Mo Hu
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.A.C.L.)
| | - Jay Pandit
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Alain G Bertoni
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| |
Collapse
|
3
|
Colangelo LA, Carroll AJ, Perak AM, Gidding SS, Lima JAC, Lloyd-Jones DM. Association of 20-Year Longitudinal Depressive Symptoms With Left Ventricular Geometry Outcomes in the Coronary Artery Risk Development in Young Adults Study: A Role for Androgens? Psychosom Med 2024; 86:60-71. [PMID: 38193784 PMCID: PMC10922617 DOI: 10.1097/psy.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Depression is a risk factor for coronary heart disease and left ventricular hypertrophy (LVH) is a potent predictor of coronary heart disease events. Whether depression is associated with LVH has received limited investigation. This study assessed cross-sectional and 20-year longitudinal associations of depressive symptoms with LVH outcomes after accounting for important known confounders. METHODS From 5115 participants enrolled in 1985-1986 in the Coronary Artery Risk Development in Young Adults Study, 2533 had serial measures of depressive symptoms and subsequent echocardiography to measure normal LV geometry, concentric remodeling, and LVH. The primary exposure variable was trajectories of the Center for Epidemiologic Studies Depression (CES-D) scale score from 1990-1991 to 2010-2011. Multivariable polytomous logistic regression was used to assess associations of trajectories with a composite LV geometry outcome created using echocardiogram data measured in 2010-2011 and 2015-2016. Sex-specific conflicting results led to exploratory models that examined potential importance of testosterone and sex hormone-binding globulin. RESULTS Overall CES-D and Somatic subscale trajectories had significant associations with LVH for female participants only. Odds ratios for the subthreshold (mean CES-D ≈ 14) and stable (mean CES-D ≈ 19) groups were 1.49 (95% confidence interval = 1.05-2.13) and 1.88 (95% confidence interval = 1.16-3.04), respectively. For female participants, sex hormone-binding globulin was inversely associated with LVH, and for male participants, bioavailable testosterone was positively associated with concentric geometry. CONCLUSIONS Findings from cross-sectional and longitudinal regression models for female participants, but not male ones, and particularly for Somatic subscale trajectories suggested a plausible link among depression, androgens, and LVH. The role of androgens to the depression-LVH relation requires additional investigation in future studies.
Collapse
Affiliation(s)
- Laura A Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 10-132, Chicago, IL 60611
| | - Amanda M Perak
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
- Division of Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Samuel S Gidding
- Geisinger Genomic Medicine Institute, Geisinger, Danville, PA; 1631 Hale hollow Road, Bridgewater Corners, VT
| | - Joao AC Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611
| |
Collapse
|
4
|
Xu X, Wang Z, Huang R, Guo Y, Xiong Z, Zhuang X, Liao X. Remnant Cholesterol in Young Adulthood Is Associated With Left Ventricular Remodeling and Dysfunction in Middle Age: The CARDIA Study. Circ Cardiovasc Imaging 2023; 16:e015589. [PMID: 37988449 PMCID: PMC10659242 DOI: 10.1161/circimaging.123.015589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Recent studies have shown that remnant cholesterol (RC) is associated with incident heart failure; however, its association with left ventricular (LV) structure and function is unclear. We aimed to evaluate the association between RC levels in young adulthood and LV structure and function in middle age. METHODS We included 3321 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) at baseline. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus calculated low-density lipoprotein cholesterol, and the RC trajectories that followed a similar pattern of change over time were identified using the latent class growth mixture model. LV structure and function were assessed using echocardiography at CARDIA study year 25. Multivariable linear regression models were performed to assess the associations of both baseline and trajectories of RC levels with LV structure and function. RESULTS Among 3321 participants, the mean age was 24.99±3.62 years: 1450 (43.90%) were male, and 1561 (47.00%) were Black. After multivariate adjustment, higher baseline RC (per SD in log-transformed) was associated with higher LV mass index (β=1.29; P=0.004), worse global longitudinal strain (β=0.19; P<0.001), worse global circumferential strain (β=0.16; P=0.014), lower septal e' (β=-0.26; P<0.001), lower lateral e' (β=-0.18; P=0.003), and higher E/e' (β=0.15; P=0.003). Three RC trajectories were identified during follow-up: low increasing (42.4%), moderate increasing (45.5%), and high increasing (12.1%). Similarly, compared with the low-increasing group, the high-increasing RC trajectory group was related to higher LV mass index, worse global longitudinal strain, lower septal e', lower lateral e', and higher E/e'. CONCLUSIONS Elevated RC levels in young adulthood were related to adverse LV structural and functional alterations in midlife. Long-term trajectories of RC levels during young adulthood help identify individuals at a higher risk for adverse LV remodeling and dysfunction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.
Collapse
Affiliation(s)
- Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Zhaoyan Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (Z.W.)
| | - Rihua Huang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| |
Collapse
|
5
|
Association of metabolically healthy obesity in young adulthood with myocardial structure and function. Int J Obes (Lond) 2023; 47:399-405. [PMID: 36899038 DOI: 10.1038/s41366-023-01288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Obesity is major cause of cardiovascular diseases. Metabolically healthy obesity (MHO) may increase heart failure risk early in life, and may be reflected in impaired cardiac structure and function. Therefore, we aimed to examine the relationship between MHO in young adulthood and cardiac structure and function. METHODS A total of 3066 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study were included, who completed echocardiography in young adulthood and middle age. The participants were grouped by obesity status (body mass index ≥30 kg/m2) and poor metabolic health (≥2 criteria for metabolic syndrome) into four metabolic phenotypes as follows: metabolically healthy non-obesity (MHN), MHO, metabolically unhealthy non-obesity (MUN), metabolically unhealthy obesity (MUO). The associations of the metabolic phenotypes (MHN serving as the reference) with left ventricular (LV) structure and function were evaluated using multiple linear regression models. RESULTS At baseline, mean age was 25 years, 56.4% were women, and 44.7% were black. After a follow-up 25 years, MUN in young adulthood was associated with worse LV diastolic function (E/é ratio, β [95% CI], 0.73 [0.18, 1.28]), worse systolic function (global longitudinal strain [GLS], 0.60 [0.08, 1.12]) in comparison with MHN. MHO and MUO were associated with LV hypertrophy (LV mass index, 7.49 g/m2 [4.63, 10.35]; 18.23 g/m2 [12.47, 23.99], respectively), worse diastolic function (E/é ratio, 0.67 [0.31, 1.02]; 1.47 [0.79, 2.14], respectively), and worse systolic function (GLS, 0.72 [0.38, 1.06]; 1.35 [0.64, 2.05], respectively) in comparison with MHN. These results were consistent in several sensitivity analyses. CONCLUSIONS In this community-based cohort using data from the CARDIA study, obesity in young adulthood was significantly associated with LV hypertrophy, worse systolic and diastolic function regardless of metabolic status. Relationship of Baseline Metabolic Phenotypes with Young Adulthood and Midlife Cardiac Structure and Function. Adjusted for year 0 covariates: age, sex, race, educational level, smoking status, drinking status, and physical activity; metabolically healthy non-obesity was used as a reference category for comparison. † Criteria for metabolic syndrome are listed in Supplementary Table S6. MUN metabolically unhealthy non-obesity, MHO metabolically healthy obesity, LVMi left ventricular mass index, LVEF left ventricular ejection fraction, E/A early to late peak diastolic mitral flow velocity ratio, E/é mitral inflow velocity to early diastolic mitral annular velocity, CI confidence interval.
Collapse
|
6
|
Gong Y, Zhu H, Li J, Yang J, Cheng J, Chang Y, Bai X, Ji X. SCCNet: Self-correction boundary preservation with a dynamic class prior filter for high-variability ultrasound image segmentation. Comput Med Imaging Graph 2023; 104:102183. [PMID: 36623451 DOI: 10.1016/j.compmedimag.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The highly ambiguous nature of boundaries and similar objects is difficult to address in some ultrasound image segmentation tasks, such as neck muscle segmentation, leading to unsatisfactory performance. Thus, this paper proposes a two-stage network called SCCNet (self-correction context network) using a self-correction boundary preservation module and class-context filter to alleviate these problems. The proposed self-correction boundary preservation module uses a dynamic key boundary point (KBP) map to increase the capability of iteratively discriminating ambiguous boundary points segments, and the predicted segmentation map from one stage is used to obtain a dynamic class prior filter to improve the segmentation performance at Stage 2. Finally, three datasets, Neck Muscle, CAMUS and Thyroid, are used to demonstrate that our proposed SCCNet outperforms other state-of-the art methods, such as BPBnet, DSNnet, and RAGCnet. Our proposed network shows at least a 1.2-3.7% improvement on the three datasets, Neck Muscle, Thyroid, and CAMUS. The source code is available at https://github.com/lijixing0425/SCCNet.
Collapse
Affiliation(s)
- Yuxin Gong
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Department of Ultrasound Diagnosis, Xuanwu Hospital, Capital Medical University, China
| | - Haogang Zhu
- State Key Laboratory of Software Development Environment, School of Computer Science and Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China.
| | - Jixing Li
- Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, China; University of Chinese Academy of Sciences, Beijing 100089, China
| | - Jingchun Yang
- Department of Ultrasound Diagnosis, Xuanwu Hospital, Capital Medical University, China.
| | - Jian Cheng
- State Key Laboratory of Software Development Environment, School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Ying Chang
- Department of Ultrasound Diagnosis, Xuanwu Hospital, Capital Medical University, China
| | - Xiao Bai
- State Key Laboratory of Software Development Environment, School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Monkam P, Jin S, Lu W. An efficient annotated data generation method for echocardiographic image segmentation. Comput Biol Med 2022; 149:106090. [PMID: 36115304 DOI: 10.1016/j.compbiomed.2022.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In recent years, deep learning techniques have demonstrated promising performances in echocardiography (echo) data segmentation, which constitutes a critical step in the diagnosis and prognosis of cardiovascular diseases (CVDs). However, their successful implementation requires large number and high-quality annotated samples, whose acquisition is arduous and expertise-demanding. To this end, this study aims at circumventing the tedious, time-consuming and expertise-demanding data annotation involved in deep learning-based echo data segmentation. METHODS We propose a two-phase framework for fast generation of annotated echo data needed for implementing intelligent cardiac structure segmentation systems. First, multi-size and multi-orientation cardiac structures are simulated leveraging polynomial fitting method. Second, the obtained cardiac structures are embedded onto curated endoscopic ultrasound images using Fourier Transform algorithm, resulting in pairs of annotated samples. The practical significance of the proposed framework is validated through using the generated realistic annotated images as auxiliary dataset to pretrain deep learning models for automatic segmentation of left ventricle and left ventricle wall in real echo data, respectively. RESULTS Extensive experimental analyses indicate that compared with training from scratch, fine-tuning after pretraining with the generated dataset always results in significant performance improvement whereby the improvement margins in terms of Dice and IoU can reach 12.9% and 7.74%, respectively. CONCLUSION The proposed framework has great potential to overcome the shortage of labeled data hampering the deployment of deep learning approaches in echo data analysis.
Collapse
Affiliation(s)
- Patrice Monkam
- Easysignal Group, State Key Laboratory of Intelligent Technology and Systems, Tsinghua National Laboratory for Information Science and Technology, Department of Automation, Tsinghua University, Beijing 100084, China.
| | - Songbai Jin
- Easysignal Group, State Key Laboratory of Intelligent Technology and Systems, Tsinghua National Laboratory for Information Science and Technology, Department of Automation, Tsinghua University, Beijing 100084, China.
| | - Wenkai Lu
- Easysignal Group, State Key Laboratory of Intelligent Technology and Systems, Tsinghua National Laboratory for Information Science and Technology, Department of Automation, Tsinghua University, Beijing 100084, China.
| |
Collapse
|
8
|
Moal O, Roger E, Lamouroux A, Younes C, Bonnet G, Moal B, Lafitte S. Explicit and automatic ejection fraction assessment on 2D cardiac ultrasound with a deep learning-based approach. Comput Biol Med 2022; 146:105637. [PMID: 35617727 DOI: 10.1016/j.compbiomed.2022.105637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ejection fraction (EF) is a key parameter for assessing cardiovascular functions in cardiac ultrasound, but its manual assessment is time-consuming and subject to high inter and intra-observer variability. Deep learning-based methods have the potential to perform accurate fully automatic EF predictions but suffer from a lack of explainability and interpretability. This study proposes a fully automatic method to reliably and explicitly evaluate the biplane left ventricular EF on 2D echocardiography following the recommended modified Simpson's rule. METHODS A deep learning model was trained on apical 4 and 2-chamber echocardiography to segment the left ventricle and locate the mitral valve. Predicted segmentations are then validated with a statistical shape model, which detects potential failures that could impact the EF evaluation. Finally, the end-diastolic and end-systolic frames are identified based on the remaining LV segmentations' areas and EF is estimated on all available cardiac cycles. RESULTS Our approach was trained on a dataset of 783 patients. Its performances were evaluated on an internal and external dataset of respectively 200 and 450 patients. On the internal dataset, EF assessment achieved a mean absolute error of 6.10% and a bias of 1.56 ± 7.58% using multiple cardiac cycles. The approach evaluated EF with a mean absolute error of 5.39% and a bias of -0.74 ± 7.12% on the external dataset. CONCLUSION Following the recommended guidelines, we proposed an end-to-end fully automatic approach that achieves state-of-the-art performance in biplane EF evaluation while giving explicit details to clinicians.
Collapse
Affiliation(s)
| | | | | | | | - Guillaume Bonnet
- Hôpital Cardiologique Haut Lévêque, CHU de Bordeaux, CIC 0005, Pessac, France.
| | | | - Stephane Lafitte
- Hôpital Cardiologique Haut Lévêque, CHU de Bordeaux, CIC 0005, Pessac, France.
| |
Collapse
|
9
|
Dehghan B, Ahmadi A, Sarfarazi Moghadam S, Sabri MR, Ghaderian M, Mahdavi C, Sedighi M, Bigdelian H. Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case-control study. Health Sci Rep 2022; 5:e613. [PMID: 35517373 PMCID: PMC9063058 DOI: 10.1002/hsr2.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/23/2022] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls. Methods Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls. Results Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = −0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = −0.46, p = 0.04). Conclusion Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE‐driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications.
Collapse
Affiliation(s)
- Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Shima Sarfarazi Moghadam
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Chehreh Mahdavi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mohsen Sedighi
- Trauma and Injury Research Center Iran University of Medical Sciences Tehran Iran
| | - Hamid Bigdelian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| |
Collapse
|
10
|
Automated Endocardial Border Detection and Left Ventricular Functional Assessment in Echocardiography Using Deep Learning. Biomedicines 2022; 10:biomedicines10051082. [PMID: 35625819 PMCID: PMC9138644 DOI: 10.3390/biomedicines10051082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
Endocardial border detection is a key step in assessing left ventricular systolic function in echocardiography. However, this process is still not sufficiently accurate, and manual retracing is often required, causing time-consuming and intra-/inter-observer variability in clinical practice. To address these clinical issues, more accurate and normalized automatic endocardial border detection would be valuable. Here, we develop a deep learning-based method for automated endocardial border detection and left ventricular functional assessment in two-dimensional echocardiographic videos. First, segmentation of the left ventricular cavity was performed in the six representative projections for a cardiac cycle. We employed four segmentation methods: U-Net, UNet++, UNet3+, and Deep Residual U-Net. UNet++ and UNet3+ showed a sufficiently high performance in the mean value of intersection over union and Dice coefficient. The accuracy of the four segmentation methods was then evaluated by calculating the mean value for the estimation error of the echocardiographic indexes. UNet++ was superior to the other segmentation methods, with the acceptable mean estimation error of the left ventricular ejection fraction of 10.8%, global longitudinal strain of 8.5%, and global circumferential strain of 5.8%, respectively. Our method using UNet++ demonstrated the best performance. This method may potentially support examiners and improve the workflow in echocardiography.
Collapse
|
11
|
Appiah D, Nwabuo CC, Ebong IA, Vasconcellos HD, Wellons MF, Lewis CE, Lima JA, Schreiner PJ. The association of age at natural menopause with pre- to postmenopausal changes in left ventricular structure and function: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Menopause 2022; 29:564-572. [PMID: 35324538 PMCID: PMC9058182 DOI: 10.1097/gme.0000000000001950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between menopause and incident cardiovascular disease (CVD) is controversial. We evaluated the relationships of estrogen deficiency (ovarian reproductive aging) assessed by age at natural menopause (ANM), chronological aging, and antecedent CVD risk factors (biological aging) with left ventricular (LV) structure and function among women transitioning from pre- to postmenopause. METHODS We studied 771 premenopausal women (37% Black) from the Coronary Artery Risk Development in Young Adults Study with echocardiographic data in 1990 to 1991 (mean age: 32 y) who later reached natural menopause by 2015 to 2016 and had repeated echocardiographic measurements. Linear regression models were used to evaluate the association of ANM with parameters of LV structure and function. RESULTS Mean ANM was 50 (± 3.8) years and the average time from ANM to the last echocardiograph was 7 years. In cross-sectional analyses, a 1-year increase in ANM was significantly associated with lower postmenopausal LV mass (LVM), LVM indexed to body surface area, LV mass-to-volume ratio, and relative wall thickness. In age-adjusted longitudinal analyses, higher ANM was inversely associated with pre- to postmenopausal changes in LVM (β = -0.97; 95% CI: -1.81 to -0.13, P = 0.024) and LVM indexed (β = -0.48; 95% CI: -0.89 to -0.07, P = 0.021). Controlling for baseline LV structure parameters and traditional CVD risk factors attenuated these associations. Further adjustment for hormone therapy uses did not alter these results. CONCLUSION In this study, premenopausal CVD risk factors attenuated the association of ANM with changes in LV structure parameters. These data suggest that premenopausal CVD risk factors may predispose women to elevated future CVD risk more than ovarian aging.
Collapse
Affiliation(s)
- Duke Appiah
- Department of Public Health. Texas Tech University Health Sciences Center, Lubbock, TX
| | | | - Imo A. Ebong
- Division of Cardiovascular Sciences, University of California, Davis, Sacramento, CA
| | | | - Melissa F. Wellons
- Division of Diabetes, Endocrinology, & Metabolism, Vanderbilt University, Nashville, TN
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Joao A. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| |
Collapse
|
12
|
Rouch L, Hoang T, Xia F, Sidney S, Lima JAC, Yaffe K. Twenty-Five-Year Change in Cardiac Structure and Function and Midlife Cognition: The CARDIA Study. Neurology 2022; 98:e1040-e1049. [PMID: 35082172 PMCID: PMC8967387 DOI: 10.1212/wnl.0000000000013249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The goal of this work was to determine whether midlife cardiac structure and function and their 25-year change from early to middle adulthood are associated with lower midlife cognition. METHODS We studied 2,653 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study (57% women, 46% Black). Echocardiograms were obtained at year 5, 25, and 30 visits (participant mean age 30, 50, and 55 years) to assess left ventricular (LV) mass (LVM), LV systolic function with LV ejection fraction (LVEF), and LV diastolic function with left atrial volume (LAV) and early peak mitral velocity (E)/early peak mitral annular velocity (e') ratio. LVM and LAV were indexed to body surface area (LVMi and LAVi). At year 30, 5 cognitive domains were measured: global cognition, processing speed, executive function, delayed verbal memory, and verbal fluency. We investigated the association between midlife (year 30) and 25-year change in cardiac structure and function on midlife cognition using linear regressions. RESULTS Over 25 years, LVMi and LAVi increased with mean change (SD) per year of 0.27 (0.28) g/m2 and 0.42 (0.15) mL/m2, while LVEF decreased by 0.11% (0.02%). After adjustment for demographics and education, 25-year increase (≥1 SD) in LVMi was associated with lower cognition on most tests (p ≤ 0.02); 25-year increase in LAVi was associated with lower global cognition (p = 0.04), but 25-year decrease in LVEF was not associated with cognition. Further adjustment for cardiovascular risk factors led to similar results. In addition, unlike year 30 E/e' ratio and LVEF, higher year 30 LVMi and LAVi were significantly associated with worse cognition on most cognitive tests. DISCUSSION Midlife cardiac structure and its change from early to middle adulthood are associated with lower midlife cognition even after accounting for confounders. Unlike systolic function, midlife LV diastolic function and its 25-year change were also linked to cognition. Our results provide information linking early to midlife cardiac structure and function to cognition.
Collapse
Affiliation(s)
- Laure Rouch
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA.
| | - Tina Hoang
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Feng Xia
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Stephen Sidney
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Joao A C Lima
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| |
Collapse
|
13
|
Fibroblast growth factor-23 and subclinical markers of cardiac dysfunction: The coronary artery risk development in young adults (CARDIA) study. Am Heart J 2022; 245:10-18. [PMID: 34861237 PMCID: PMC9310562 DOI: 10.1016/j.ahj.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Elevated Fibroblast Growth Factor-23 (FGF23) levels have been associated with greater left ventricular mass (LVM) and heart failure. Whether higher FGF23 is associated with higher LVH prevalence and longitudinal changes in LVM and myocardial strain in middle-aged adults without cardiovascular disease (CVD) or chronic kidney disease (CKD) is unknown. METHODS We studied 3,113 adults without CVD at baseline participating in the Year 25 (2010-2011) follow-up exam of the Coronary Artery Risk Development in Young Adults (CARDIA) study. We studied the association of Year 25 c-terminal FGF23 concentrations with indexed LVM (LVMI=LVM/height2.7), LVH and myocardial strain as assessed by speckle tracking strain echocardiography. Among the 2,758 (88.6%) participants who returned for the Year 30 examination, we also investigated the association of Year 25 FGF23 with 5 Year change in LVMI, strain parameters and incident LVH. RESULTS The mean age was 50.0 (±3.6) years, 56.8% were female, 45.7% were Black and 6.4% had CKD. There was 6.0% LVH prevalence at Year 25. Mean 5 Year change in LVMI was 5.3 (±7.7) grams/meter. In multivariable models, FGF23 in the highest quartile was associated with greater odds of LVH at Year 25 compared to lower quartiles. [Odds Ratio 95% CI: 1.81 (1.28, 2.58)] with similar findings after exclusion of participants with CKD. There was no interaction between FGF23 and race (P = .18) or sex (P = .80). There was no association between FGF23 and global longitudinal strain. There was no association between FGF23 and 5 Year change in LVMI. There was no association between higher FGF23 and 5 year incident LVH. CONCLUSIONS In a middle-aged adult population without known CVD or CKD, higher FGF23 was associated with greater odds of LVH, but not with greater increases in LVM over time. Further study is needed to elucidate whether FGF23 is a risk marker for underlying LVH or a mechanism for increased LVM over time in younger and middle-aged adult populations without CKD.
Collapse
|
14
|
Romand X, Adeline F, Dalecky M, Pflimlin A, Bellier A, Barone-Rochette G, Wendling D, Gaudin P, Claudepierre P, Dougados M, Baillet A. Systematic assessment of heart valves and cardiac function by echocardiography in axial spondyloarthritis: a systematic review and meta-analysis. Joint Bone Spine 2022; 89:105375. [DOI: 10.1016/j.jbspin.2022.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
|
15
|
Zhou H, Zhang H, Zhan Q, Bai Y, Liu S, Yang X, Li J, Ma Z, Huang X, Zeng Q, Ren H, Xu D. Blood pressure trajectories in early adulthood and myocardial structure and function in later life. ESC Heart Fail 2022; 9:1258-1268. [PMID: 35049140 PMCID: PMC8934963 DOI: 10.1002/ehf2.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/24/2021] [Accepted: 12/28/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Haobin Zhou
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Hao Zhang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Yujia Bai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Shenrong Liu
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute Guangdong Academy of Medical Sciences/Guangdong General Hospital Guangzhou China
| | - Xi Yang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Jiaying Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Zhuang Ma
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Xingfu Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Hao Ren
- Department of Rheumatology, Nanfang Hospital Southern Medical University 1838 Northern Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| |
Collapse
|
16
|
Gilbert A, Marciniak M, Rodero C, Lamata P, Samset E, Mcleod K. Generating Synthetic Labeled Data From Existing Anatomical Models: An Example With Echocardiography Segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2783-2794. [PMID: 33444134 PMCID: PMC8493532 DOI: 10.1109/tmi.2021.3051806] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Deep learning can bring time savings and increased reproducibility to medical image analysis. However, acquiring training data is challenging due to the time-intensive nature of labeling and high inter-observer variability in annotations. Rather than labeling images, in this work we propose an alternative pipeline where images are generated from existing high-quality annotations using generative adversarial networks (GANs). Annotations are derived automatically from previously built anatomical models and are transformed into realistic synthetic ultrasound images with paired labels using a CycleGAN. We demonstrate the pipeline by generating synthetic 2D echocardiography images to compare with existing deep learning ultrasound segmentation datasets. A convolutional neural network is trained to segment the left ventricle and left atrium using only synthetic images. Networks trained with synthetic images were extensively tested on four different unseen datasets of real images with median Dice scores of 91, 90, 88, and 87 for left ventricle segmentation. These results match or are better than inter-observer results measured on real ultrasound datasets and are comparable to a network trained on a separate set of real images. Results demonstrate the images produced can effectively be used in place of real data for training. The proposed pipeline opens the door for automatic generation of training data for many tasks in medical imaging as the same process can be applied to other segmentation or landmark detection tasks in any modality. The source code and anatomical models are available to other researchers.1 1https://adgilbert.github.io/data-generation/.
Collapse
Affiliation(s)
- Andrew Gilbert
- GE Vingmed Ultrasound, GE Healthcare3183HortenNorway
- Department of InformaticsUniversity of Oslo0315OsloNorway
| | - Maciej Marciniak
- Biomedical Engineering DepartmentKing’s College LondonLondonWC2R 2LSU.K.
| | - Cristobal Rodero
- Biomedical Engineering DepartmentKing’s College LondonLondonWC2R 2LSU.K.
| | - Pablo Lamata
- Biomedical Engineering DepartmentKing’s College LondonLondonWC2R 2LSU.K.
| | - Eigil Samset
- GE Vingmed Ultrasound, GE Healthcare3183HortenNorway
- Department of InformaticsUniversity of Oslo0315OsloNorway
| | | |
Collapse
|
17
|
Jin C, Weber J, Singh H, Gliganic K, Cao JJ. The association of reduced left ventricular strains with increased extracellular volume and their collective impact on clinical outcomes. J Cardiovasc Magn Reson 2021; 23:93. [PMID: 34218790 PMCID: PMC8256505 DOI: 10.1186/s12968-021-00776-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial fibrosis and left ventricular (LV) longitudinal strain are independently associated with adverse clinical outcomes. However, the relationship between tissue properties and strain indices as well as their collective impact on outcomes are yet to be fully elucidated. We aim to investigate the relationship between LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) with extracellular volume (ECV) and their collective impact. METHODS Consecutive patients referred for clinical cardiovascular magnetic resonance (CMR) due to cardiomyopathy were prospectively enrolled. All patients underwent CMR with T1 mapping. ECV was calculated incorporating native and post-contrast T1 as well as hematocrit. LV GLS, GCS, and GRS were assessed by feature tracking. Hazard ratios and Kaplan-Meier curves were produced to assess the association between strains and T1 mapping indices with a composite outcome of all-cause mortality and hospitalized heart failure. RESULTS The study consisted of 259 patients with mixed referring diagnoses of non-ischemic/ischemic cardiomyopathy and 21 normal controls. Decreased GLS, GCS and GRS were associated with increased ECV, increased native T1, and reduced post-contrast T1 in a dose dependent manner when T1 or ECV was in the abnormal range. After a mean follow-up of 31 ± 23 months, 41 events occurred including 37 heart failure admissions and 4 deaths. Kaplan-Meier plots demonstrated that reduced strains were associated with reduced event-free survival predominantly in patients with increased ECV (≥ 28.3%). The worst outcome was among those with both reduced strains and increased ECV. In the multivariable models, increased ECV, reduced post-contrast T1 and reduced strains in all 3 directions remained predictors of outcome risk, respectively. CONCLUSION Our findings highlight the intrinsic link between altered CMR tissue properties and impaired myocardial mechanical performance and additionally demonstrate improved risk stratification by characterizing tissue property among patients with reduced strain.
Collapse
Affiliation(s)
- Chunna Jin
- St Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Jonathan Weber
- St Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
| | - Harsimar Singh
- St Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
| | - Kathleen Gliganic
- St Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
| | - J Jane Cao
- St Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA.
- State University of New York At Stony Brook, 100 Nicholls Road, Stony Brook, NY, 11794, USA.
| |
Collapse
|
18
|
Lin Y, Zhong X, Xiong Z, Zhang S, Liu M, Fan Y, Huang Y, Sun X, Zhou H, Xu X, Guo Y, Li Y, Yang D, Ye X, Zhuang X, Liao X. Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study. Front Physiol 2021; 12:614532. [PMID: 34248653 PMCID: PMC8260980 DOI: 10.3389/fphys.2021.614532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement. METHODS We included 2,859 participants, aged 18-30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models. RESULTS A 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e' ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], P < 0.001) and subgroups stratified by diabetes at Y25. CONCLUSION Higher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.
Collapse
Affiliation(s)
- Yifen Lin
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Zhong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Xiong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Fan
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiuting Sun
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Huimin Zhou
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xingfeng Xu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuqi Li
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Daya Yang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Ye
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
19
|
Ying W, Post WS, Michos ED, Subramanya V, Ndumele CE, Ouyang P, Ambale-Venkatesh B, Doria De Vasconcellos H, Nwabuo CC, Schreiner PJ, Lewis CE, Reis J, Lloyd-Jones D, Sidney S, Lima JAC, Vaidya D. Associations between menopause, cardiac remodeling, and diastolic function: the CARDIA study. Menopause 2021; 28:1166-1175. [PMID: 34127631 DOI: 10.1097/gme.0000000000001815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Heart failure with preserved ejection fraction (HFpEF) affects more women than men. Menopause may influence HFpEF development in women. We assessed cross-sectional and longitudinal associations between menopause and echocardiographic measures of left ventricular (LV) function and cardiac remodeling. METHODS We studied 1,723 women with available echo data from at least two of: year 5 (Y5) (1990-1991), Y25 (2010-2011), or Y30 (2015-2016) in the Coronary Artery Risk Development in Young Adults study. Cardiac structure and function were measured using 2D and Doppler echocardiography. Cross-sectional associations between menopausal status and repeated echo measures at Y25 and Y30 were analyzed using linear mixed models. Two-segmented models were used to compare longitudinal changes in echocardiographic measures in the premenopausal period to changes in the postmenopausal period. RESULTS Mean ± SD age (years) at enrollment was 27 ± 3 in those with menopause by Y25, 25 ± 3 in those with menopause between Y25 and Y30, and 21 ± 3 in those premenopausal at Y30. There were no significant differences in race, body mass index, systolic blood pressure, or diabetes between the groups. Postmenopausal women had higher early diastolic mitral inflow (E) to annular (e') velocity ratio than premenopausal after adjusting for demographics and risk factors (P < 0.05). Menopause was associated with relative increases in the rates of change in LV mass and left atrial volume, even after adjustment. Change in E/e' ratio was similar before and after menopause. CONCLUSIONS Menopause is associated cross-sectionally with worse diastolic function and longitudinally with adverse LV and left atrial remodeling. This may contribute to the increased HFpEF risk in postmenopausal women.
Collapse
Affiliation(s)
- Wendy Ying
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Chiadi E Ndumele
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Chike C Nwabuo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Jared Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Donald Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Joao A C Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
20
|
Sinha A, Zheng Y, Nannini D, Qu Y, Hou L, Shah SJ, Yancy CW, McNally EM, Fornage M, Lima J, Lloyd-Jones DM, Rasmussen-Torvik LJ, Khan SS. Association of the V122I Transthyretin Amyloidosis Genetic Variant With Cardiac Structure and Function in Middle-aged Black Adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Cardiol 2021; 6:718-722. [PMID: 33355618 PMCID: PMC7758832 DOI: 10.1001/jamacardio.2020.6623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
Importance The variant V122I is commonly enriched in the transthyretin (TTR) gene in individuals of African ancestry and associated with greater risk of heart failure (HF) in older adulthood, after age 65 years. Prevention of HF may be most effective earlier in life, but whether screening with echocardiography can identify subclinical cardiac abnormalities during middle age to risk-stratify individuals appears to be unknown. Objective To examine the association between the V122I TTR variant and cardiac structure and function during middle age in those without prevalent HF. Design, Setting, and Participants This serial cross-sectional study of 875 Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort was conducted at 4 urban sites across the US. Recruiting was completed in 1985-1986, and follow-up examinations occurred 25 and 30 years later. A subset of Black adults from the CARDIA cohort who underwent TTR genotyping was included. Data analysis was completed from January 2020 to October 2020. Exposures The V122I TTR genotype. Main Outcomes and Measures Echocardiographic left ventricular (LV) circumferential and longitudinal systolic strain and LV structure, measured at years 25 and 30 of follow-up. The analyses were adjusted for age, sex, echocardiography quality, genetic ancestry, and field center. Results Among the 875 Black adults (mean [SD] age, 49.4 [3.8] years at year 25; 543 women [62.1%]), there were 31 individuals who were heterozygous and 1 who was homozygous for the V122I TTR variant. Of the adults who had an echocardiogram at year 25, rates of hypertension (312 [46%]), diabetes (102 [15%]), and current smoking (128 [19%]) were not significantly different between those who did and did not carry V122I TTR. At year 25, there was no difference in LV circumferential strain, longitudinal strain, or LV structure between those who did vs did not carry V122I TTR. At year 30, those who carried V122I TTR had significantly lower absolute LV circumferential strain (mean [SD], 12.4 [4.2] percentage units) compared with those who did not carry the variant (mean [SD], 14.5 [3.7] percentage units). Those who carried V122I TTR also had significantly higher LV mass index values (mean [SD], 97.5 [34.1] g/m2) compared with those who did not (mean [SD], 83.7 [22.6] g/m2) at year 30. Conclusions and Relevance Carrier status for the V122I TTR variant is associated with subclinical cardiac abnormalities in middle age (worse LV systolic function and higher LV mass) that have been associated with increased risk of incident HF. Midlife screening of individuals who carry V122I TTR with echocardiography may prognosticate risk of symptomatic HF and inform prevention strategies.
Collapse
Affiliation(s)
- Arjun Sinha
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Drew Nannini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yishu Qu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J. Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Cardiology
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor for Translational Science, JAMA Cardiology
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston
| | - Joao Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura J. Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S. Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
21
|
Lei Y, Fu Y, Roper J, Higgins K, Bradley JD, Curran WJ, Liu T, Yang X. Echocardiographic image multi-structure segmentation using Cardiac-SegNet. Med Phys 2021; 48:2426-2437. [PMID: 33655564 DOI: 10.1002/mp.14818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Cardiac boundary segmentation of echocardiographic images is important for cardiac function assessment and disease diagnosis. However, it is challenging to segment cardiac ventricles due to the low contrast-to-noise ratio and speckle noise of the echocardiographic images. Manual segmentation is subject to interobserver variability and is too slow for real-time image-guided interventions. We aim to develop a deep learning-based method for automated multi-structure segmentation of echocardiographic images. METHODS We developed an anchor-free mask convolutional neural network (CNN), termed Cardiac-SegNet, which consists of three subnetworks, that is, a backbone, a fully convolutional one-state object detector (FCOS) head, and a mask head. The backbone extracts multi-level and multi-scale features from endocardium image. The FOCS head utilizes these features to detect and label the region-of-interests (ROIs) of the segmentation targets. Unlike the traditional mask regional CNN (Mask R-CNN) method, the FCOS head is anchor-free and can model the spatial relationship of the targets. The mask head utilizes a spatial attention strategy, which allows the network to highlight salient features to perform segmentation on each detected ROI. For evaluation, we investigated 450 patient datasets by a five-fold cross-validation and a hold-out test. The endocardium (LVEndo ) and epicardium (LVEpi ) of the left ventricle and left atrium (LA) were segmented and compared with manual contours using the Dice similarity coefficient (DSC), Hausdorff distance (HD), mean absolute distance (MAD), and center-of-mass distance (CMD). RESULTS Compared to U-Net and Mask R-CNN, our method achieved higher segmentation accuracy and fewer erroneous speckles. When our method was evaluated on a separate hold-out dataset at the end diastole (ED) and the end systole (ES) phases, the average DSC were 0.952 and 0.939 at ED and ES for the LVEndo , 0.965 and 0.959 at ED and ES for the LVEpi , and 0.924 and 0.926 at ED and ES for the LA. For patients with a typical image size of 549 × 788 pixels, the proposed method can perform the segmentation within 0.5 s. CONCLUSION We proposed a fast and accurate method to segment echocardiographic images using an anchor-free mask CNN.
Collapse
Affiliation(s)
- Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Yabo Fu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Kristin Higgins
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jeffrey D Bradley
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
22
|
Patel KV, Metzinger M, Park B, Allen N, Ayers C, Kawut SM, Sidney S, Goff DC, Jacobs DR, Zaky AF, Carnethon M, Berry JD, Pandey A. Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study. J Am Heart Assoc 2021; 10:e016968. [PMID: 33775106 PMCID: PMC8174339 DOI: 10.1161/jaha.120.016968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow-up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow-up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable-adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow-up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age. Conclusions Higher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age-related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.
Collapse
Affiliation(s)
- Kershaw V Patel
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center TX
| | - Mark Metzinger
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Bryan Park
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Norrina Allen
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Colby Ayers
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Steven M Kawut
- Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research Oakland CA
| | - David C Goff
- Kaiser Permanente Northern California Division of Research Oakland CA.,Colorado School of Public Health Aurora CO.,Division of Cardiovascular Sciences NHLBI Bethesda MD
| | - David R Jacobs
- School of Public Health University of Minnesota Minneapolis MN
| | - Ahmed F Zaky
- Department of Anesthesiology and Perioperative Medicine University of Alabama at Birmingham AL
| | - Mercedes Carnethon
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Jarett D Berry
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| |
Collapse
|
23
|
Nwabuo CC, Yano Y, Moreira HT, Appiah D, Vasconcellos HD, Aghaji QN, Viera A, Rana JS, Shah RV, Murthy VL, Allen NB, Schreiner PJ, Lloyd-Jones DM, Lima JAC. Association Between Visit-to-Visit Blood Pressure Variability in Early Adulthood and Myocardial Structure and Function in Later Life. JAMA Cardiol 2021; 5:795-801. [PMID: 32293640 DOI: 10.1001/jamacardio.2020.0799] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Long-term blood pressure (BP) variability has emerged as a reproducible measure that is associated with heart failure independent of systemic BP. Visit-to-visit BP variability may be associated with the risk of heart failure early in the life course and thus may be reflected in subclinical alterations in cardiac structure and function. Objective To evaluate the association between visit-to-visit BP variability in early adulthood and myocardial structure and function in middle age. Design, Setting, and Participants This cohort study used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a community-based cohort study of 5115 participants aged 18 to 30 years at baseline (year 0; March 25, 1985, to June 7, 1986) and followed up over a 30-year interval. A total of 2400 CARDIA study participants underwent evaluation at 4 field sites (Birmingham, Alabama; Oakland, California; Chicago, Illinois; and Minneapolis, Minnesota). Blood pressure was measured at 8 visits over a 25-year interval and participants received echocardiograms at year 25 (June 1, 2010, to August 31, 2011). Data analysis was conducted from June 7, 1986, to August 31, 2011. Exposures Visit-to-visit systolic and diastolic BP variability measures included SD, average real variability, and variability independent of the mean. Main Outcomes and Measures Echocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 25 examination. Results Of the 2400 participants, 1024 were men (42.7%) and 976 were African American (40.7%); mean (SD) age at the year 25 examination was 50.4 (3.6) years. Per 1-SD increment, greater visit-to-visit systolic BP variability independent of the mean was associated with higher left-ventricular (LV) mass index (β [SE], 2.66 [0.4] g/m2, P < .001), worse diastolic function (early peak diastolic mitral annular velocity [é]) (β [SE], -0.40 [0.1] cm/s, P < .001), higher LV filling pressures (mitral inflow velocity to early diastolic mitral annular velocity [E/é]) β [SE], 0.37 [0.1] cm/s, P < .001), and worse global longitudinal strain (β [SE], 0.17 [0.1], P = .002). Similarly, greater visit-to-visit diastolic BP variability was associated with higher LV mass index (β [SE], 3.21 [0.5] g/m2, P < .001), worse diastolic function (é: β [SE], -0.24 [0.1] cm/s [P < .001]; E/é: β [SE], 0.23 [0.1] cm/s [P < .001]), and worse global longitudinal strain (β [SE], 0.13 [0.1], P = .02). The findings remained consistent when other BP variability measures were used (SD and average real variability). Conclusions and Relevance In this cohort study using data from the CARDIA study, greater visit-to-visit systolic and diastolic BP variability have been associated with adverse alterations in cardiac structure as well as systolic and diastolic function independent of mean BP levels.
Collapse
Affiliation(s)
- Chike C Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Henrique T Moreira
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock
| | - Henrique D Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Queen N Aghaji
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anthony Viera
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jamal S Rana
- Kaiser Permanente Northern California, Division of Research, Oakland
| | - Ravi V Shah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Norrina B Allen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
24
|
Ferrara F, Gargani L, Contaldi C, Agoston G, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Citro R, Cittadini A, Cocchia R, D'Alto M, D'Andrea A, Douschan P, Ghio S, Grünig E, Guazzi M, Guida S, Kasprzak JD, Kolias TJ, Limongelli G, Marra AM, Mazzola M, Mauro C, Moreo A, Pieri F, Pratali L, Pugliese NR, Raciti M, Ranieri B, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan M, Voilliot D, Vriz O, Wierzbowska-Drabik K, Naeije R, Bossone E. A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET). Cardiovasc Ultrasound 2021; 19:9. [PMID: 33472662 PMCID: PMC7819251 DOI: 10.1186/s12947-021-00238-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) were measured. Results The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’ = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
Collapse
Affiliation(s)
- Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | - Carla Contaldi
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gergely Agoston
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Paola Argiento
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Francesco Bandera
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | - Philipp Douschan
- Medical University of Graz, Graz, Austria and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jaroslaw D Kasprzak
- I Dept. and Chair of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Pieri
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | | | | | - Mauro Raciti
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Mani Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, USA
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
25
|
Patel RB, Colangelo LA, Reis JP, Lima JAC, Shah SJ, Lloyd-Jones DM. Association of Longitudinal Trajectory of Albuminuria in Young Adulthood With Myocardial Structure and Function in Later Life: Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Cardiol 2021; 5:184-192. [PMID: 31734692 DOI: 10.1001/jamacardio.2019.4867] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Albuminuria, as measured by single urine albumin-to-creatinine ratio (UACR) levels, is associated with cardiac remodeling and adverse clinical outcomes. The longitudinal patterns of change in UACR through young adulthood and their associations with myocardial structure and function later in life remain unclear. Objective To describe the trajectory of albuminuria as measured by UACR across a 20-year span and evaluate the association of albuminuria trajectory with echocardiographic indices of structure and function in middle age. Design, Setting, and Participants In the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort of black and white participants aged 18 to 30 years at baseline (March 1985 to June 1986) were evaluated over 30 years. Participants underwent evaluations at 4 urban US sites. Data were collected from March 1985 to May 2016, and data were analyzed from September 2018 to April 2019. Exposures Trajectories of UACR from the year 10 examination to the year 30 examination as determined by latent class modeling. Main Outcomes and Measures Echocardiographic indices of myocardial structure, systolic function, and diastolic function at the year 30 examination. Results Of the 2647 included participants, 1441 (54.4%) were white, 1206 (45.6%) were black, and the mean (SD) age was 35.2 (3.6) years. A total of 5 trajectory groups of UACR were identified, including 1718 participants (64.9%) in the low-stable group, 682 (25.8%) in the moderate-stable group, 116 (4.4%) in the high-stable group, 88 (3.3%) in the moderate-increasing group, and 43 (1.6%) in the high-increasing group. Apart from the high-increasing cohort, the remaining 4 groups had median baseline UACR levels less than 30 mg/g. Male sex, current smoking, diabetes, and elevated blood pressure were more common in the moderate-increasing and high-increasing UACR groups. After adjustment for clinical variables and baseline UACR levels, there were significant differences in left ventricular (LV) mass by trajectory group (mean [SE] LV mass: high-increasing, 98.4 [3.4] g/m2; moderate-increasing, 91.7 [2.2] g/m2; high-stable, 86.0 [2.1] g/m2; moderate-stable, 82.3 [0.8] g/m2; low-stable, 78.6 [0.5] g/m2; P < .001). Significant differences by trajectory group were also noted in LV longitudinal strain, e' tissue velocities, and estimated LV filling pressures, even after adjustment for clinical variables and baseline UACR level. The association of trajectory group with indices of myocardial structure and function remained significant after adjustment for clinical variables and cumulative UACR from the year 10 to year 25 examinations. Conclusions and Relevance There are distinct patterns of change in albuminuria among young adults over a 20-year span, and these trajectory groups cannot be identified by baseline UACR level alone. Dynamic changes in albuminuria are independently associated with adverse alterations to cardiac structure, LV systolic function, and LV diastolic function.
Collapse
Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Associate Editor
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
26
|
Chang LW, Mbabali I, Hutton H, Amico KR, Kong X, Mulamba J, Anok A, Ssekasanvu J, Long A, Thomas AG, Thomas K, Bugos E, Pollard R, van Wickle K, Kennedy CE, Nalugoda F, Serwadda D, Bollinger RC, Quinn TC, Reynolds SJ, Gray RH, Wawer MJ, Nakigozi G. Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial. PLoS Med 2021; 18:e1003475. [PMID: 33406130 PMCID: PMC7787382 DOI: 10.1371/journal.pmed.1003475] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called "Health Scouts" to promote engagement in HIV treatment and prevention services. METHODS AND FINDINGS The study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters, n = 1,054 participants at baseline; 20 control clusters, n = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic outcomes of self-reported linkage to HIV care, antiretroviral therapy (ART) use, and male circumcision, and the primary biologic outcome of HIV viral suppression (<400 copies/mL). Secondary outcomes included HIV testing coverage, HIV incidence, and consistent condom use. The primary intent-to-treat analysis used log-linear binomial regression with generalized estimating equation to estimate prevalence risk ratios (PRR) in the intervention versus control arm. A total of 2,533 (45% female, mean age: 31 years) and 1,903 (46% female; mean age 32 years) residents completed the mid-study and end-study surveys, respectively. At mid-study, there were no differences in outcomes between arms. At end-study, self-reported receipt of the Health Scouts intervention was 38% in the intervention arm and 23% in the control arm, suggesting moderate intervention uptake in the intervention arm and substantial contamination in the control arm. At end-study, intention-to-treat analysis found higher HIV care coverage (PRR: 1.06, 95% CI: 1.01 to 1.10, p = 0.011) and ART coverage (PRR: 1.05, 95% CI: 1.01 to 1.10, p = 0.028) among HIV-positive participants in the intervention compared with the control arm. Male circumcision coverage among all men (PRR: 1.05, 95% CI: 0.96 to 1.14, p = 0.31) and HIV viral suppression among HIV-positive participants (PRR: 1.04, 95% CI: 0.98 to 1.12, p = 0.20) were higher in the intervention arm, but differences were not statistically significant. No differences were seen in secondary outcomes. Study limitations include reliance on self-report for programmatic outcomes and substantial contamination which may have diluted estimates of effect. CONCLUSIONS A novel community health worker intervention improved HIV care and ART coverage in an HIV hyperendemic setting but did not clearly improve male circumcision coverage or HIV viral suppression. This community-based, implementation strategy may be a useful component in some settings for HIV epidemic control. TRIAL REGISTRATION ClinicalTrials.gov NCT02556957.
Collapse
Affiliation(s)
- Larry W. Chang
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Rakai, Uganda
- * E-mail:
| | | | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - K. Rivet Amico
- Department of Health Behavior Health Education, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Xiangrong Kong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Rakai, Uganda
| | | | - Amanda Long
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alvin G. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kristin Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Eva Bugos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rose Pollard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kimiko van Wickle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Rakai, Uganda
| | | | | | - Robert C. Bollinger
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Thomas C. Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Steven J. Reynolds
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Rakai, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Rakai, Uganda
| | - Maria J. Wawer
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Rakai, Uganda
| | | |
Collapse
|
27
|
Nwabuo CC, Moreira HT, Vasconcellos HD, Mewton N, Opdahl A, Ogunyankin KO, Ambale-Venkatesh B, Schreiner PJ, Armstrong AAC, Lewis CE, Jacobs DR, Lloyd-Jones D, Gidding SS, Lima JAC. Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study. Eur Heart J Cardiovasc Imaging 2020; 20:533-540. [PMID: 30247530 DOI: 10.1093/ehjci/jey123] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 12/26/2022] Open
Abstract
AIMS Left ventricular (LV) ejection fraction (LVEF) is an extensively utilized marker of LV function that is often interpreted without recourse to alterations in LV geometry and hypertrophy. LV global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance. We evaluated the prognostic utility of LVGFI from young adulthood into middle age for incident heart failure (HF) and cardiovascular disease (CVD) in comparison to LVEF. METHODS AND RESULTS Included were 4107 CARDIA participants with echocardiograms in Year-5 (1990-1991). LVGFI was defined as LV stroke volume/LV global volume*100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). Adjusted Cox proportional hazard models were utilized to predict incident HF and CVD outcomes. Mean age of participants was 29.8 ± 3.7 years, 55% female, and 48.7% black. Higher body mass index [beta coefficient (B) = -0.11 standard error (SE) = 0.02, P < 0.001], higher blood pressure (B = -0.04, SE = 0.01, P < 0.01), smoking (B = -0.82, SE = 0.22, P < 0.001), male sex (P < 0.001), and black race (P < 0.001) were associated with worse LVGFI. A total of 207 incident CVD events were observed over the course of 98 035 person-years at risk. Higher LVGFI was associated with HF, hazard ratio (HR) = 0.70, 95% confidence interval (CI) (0.54-0.91), hard CVD HR = 0.83, 95% CI (0.71-0.96), and all CVD HR = 0.83, 95% CI (0.72-0.96). For HF outcomes, Harrell's C-statistic for LVGFI (0.80) was greater than LVEF (0.66). CONCLUSION LVGFI is a strong, independent predictor of incident HF and CVD that provides incremental prognostic value compared with LVEF. Male sex, black race, obesity, hypertension, and smoking are associated with worse LVGFI in the early adult lifespan.
Collapse
Affiliation(s)
- Chike C Nwabuo
- Department of Medicine, Harvard Medical School, 330 Mount Auburn St, Cambridge, MA, USA.,Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Henrique T Moreira
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA.,Division of Cardiology, Universidade of Sao Paulo, Av. Bandeirantes, 3.900 Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Henrique D Vasconcellos
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Nathan Mewton
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Anders Opdahl
- Department of cardiology, Oslo University hospital, Sognsvannsveien 20, Oslo, Norway
| | - Kofo O Ogunyankin
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Anderson A C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| | - Cora E Lewis
- Division of preventive medicine, University of Alabama, 619 19th St, Birmingham, AL, UK
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, 675 N St Clair St STE 19-100, Chicago, IL, USA
| | - Samuel S Gidding
- Division of Pediatrics Cardiology, Nemours Cardiac Center, 1600 Rockland Road Wilmington, DE, USA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD, USA
| |
Collapse
|
28
|
Nwabuo CC, Appiah D, Moreira HT, Vasconcellos HD, Aghaji QN, Ambale-Venkatesh B, Rana JS, Allen NB, Lloyd-Jones DM, Schreiner PJ, Gidding SS, Lima JAC. Temporal Changes in Resting Heart Rate, Left Ventricular Dysfunction, Heart Failure and Cardiovascular Disease: CARDIA Study. Am J Med 2020; 133:946-953. [PMID: 32001229 PMCID: PMC7477638 DOI: 10.1016/j.amjmed.2019.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prognostic significance of temporal changes in resting heart rate in young adults for premature heart failure and cardiovascular disease is unclear. We investigated the association between temporal changes in resting heart rate in young adults and early adult risk factors, subsequent cardiac function, and the risk of heart failure and cardiovascular by middle age. METHODS We examined 4343 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (mean [SD] age was 29.9 [3.6] years at the CARDIA Year-5 examination [1990-1991], 49% of participants were men, and 45% were African-American). Adjusted linear regression models were used to assess the association between temporal changes in resting heart rate, early life cardiovascular disease risk factors, and midlife cardiac function. Cox proportional hazard regression models were used to relate temporal changes in resting heart rate to heart failure and cardiovascular disease. Outcomes were followed up until August 31, 2017. RESULTS Higher alcohol consumption (β = 0.03, P <0.001), lower physical activity (β = 0.002, P = 001), smoking (β = 1.58, P <0.001), men (P <0.001), African Americans (P <0.001), impaired left ventricular relaxation (e´,β = -0.13, P = 0.002), and worse diastolic function (E/e´, β = 0.1, P = 0.01) were associated with longitudinal increases in resting heart rate. We observed 268 cardiovascular disease and 74 heart failure events over a median of 26 years. In Cox models, baseline and temporal changes in resting heart rate were associated with higher risk of heart failure (hazard ratio [HR] =1.37 95% confidence interval [CI] [1.05-1.79] and HR = 1.38 95% CI [1.02-1.86]) and a higher risk cardiovascular disease (HR = 1.23 95% CI [1.07-1.42] and HR = 1.23 95% CI [1.05-1.44]). CONCLUSIONS Baseline and temporal changes in resting heart rate in young adults were associated with incident heart failure and cardiovascular disease by midlife. Contributory factors were associations between temporal increases in resting heart rate and early adult risk factors and subsequent cardiac dysfunction.
Collapse
Affiliation(s)
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Tex
| | | | | | | | | | - Jamal S Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, Calif
| | - Norrina B Allen
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | | | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Del
| | | |
Collapse
|
29
|
Suvila K, McCabe EL, Lima JAC, Aittokallio J, Yano Y, Cheng S, Niiranen TJ. Self-reported Age of Hypertension Onset and Hypertension-Mediated Organ Damage in Middle-Aged Individuals. Am J Hypertens 2020; 33:644-651. [PMID: 32227078 PMCID: PMC7368170 DOI: 10.1093/ajh/hpaa055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 03/26/2020] [Indexed: 01/19/2023] Open
Abstract
Background Objectively defined early onset hypertension, based on repeated blood pressure measurements, is a strong risk factor for cardiovascular disease (CVD). We aimed to assess if also self-reported hypertension onset age is associated with hypertension-mediated organ damage (HMOD). Additionally, we evaluated the agreement between self-reported and objectively defined hypertension onset age. Methods We studied 2,649 participants (50 ± 4 years at the time of outcome assessment, 57% women) of the Coronary Artery Risk Development in Young Adults (CARDIA) study who underwent measurements for echocardiographic left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), coronary calcification, and albuminuria. We divided the participants into groups according to self-reported hypertension onset age (<35 years, 35–44 years, ≥45 years, and no hypertension). We used multivariable-adjusted logistic regression models to assess the relation between self-reported hypertension onset age with the presence of HMOD, with those who did not report hypertension as the referent group. Results Compared with individuals without self-reported hypertension, self-reported hypertension onset at <35 years was associated with LVH (odds ratio (OR), 2.38; 95% confidence interval (CI), 1.51–3.76), LVDD (OR, 2.32; 95% CI, 1.28–4.18, coronary calcification (OR, 2.87; 95% CI, 1.50–5.47), and albuminuria (OR, 1.62; 95% CI, 0.81–3.26). Self-reported hypertension onset at ≥45 years was only associated with LVDD (OR, 1.81; 95% CI, 1.06–3.08). The agreement between self-reported and objectively defined hypertension onset age groups was 78–79%. Conclusions Our findings suggest that self-reported hypertension onset age, a pragmatically feasible assessment in clinical practice, is a reasonable method for assessing risk of HMOD and CVD.
Collapse
Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Elizabeth L McCabe
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jenni Aittokallio
- Division of Perioperative Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Teemu J Niiranen
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
| |
Collapse
|
30
|
Saito M, Imai M, Wake D, Higaki R, Nakao Y, Morioka H, Sumimoto T, Inoue K. Prognostic assessment of relative apical sparing pattern of longitudinal strain for severe aortic valve stenosis. IJC HEART & VASCULATURE 2020; 29:100551. [PMID: 32529023 PMCID: PMC7280361 DOI: 10.1016/j.ijcha.2020.100551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023]
Abstract
Backgrounds The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis. Elderly patients with aortic valve stenosis (AS) complicated by transthyretin amyloid cardiomyopathy have poor prognosis. Furthermore, deteriorated basal LS in AS patients has been reported to be associated with adverse outcome. We investigated the association between RASP and outcomes in patients with severe AS. Methods We retrospectively studied 156 consecutive patients with severe AS and preserved LV ejection fraction. RASP was assessed by both of semi-quantitative (sRASP) and quantitative (qRASP) methods. sRASP was defined as a deterioration of LS (≥-10%) in ≥ 5 (of 6) basal segments, relative to preserved LS (<-15%) in at least 1 apical segment. qRASP was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS); qRASP ≥ 1 was defined as positive. Patients were followed up to determine outcomes, which included sudden cardiac death or unexpected admission due to heart failure, over a median of 1.9 years. Results sRASP and qRASP were assessed in all patients, but 24 and 42 patients fulfilled the criteria for sRASP and qRASP, respectively. Both assessments were significantly associated with outcomes (n = 44; 28%). Furthermore, sRASP was significantly associated with outcome after adjusting for EuroSCORE, NYHA ≥ II, or global longitudinal strain. A model based on these covariates for predicting outcomes significantly improved by adding sRASP. Conclusion RASP is observed in some patients with severe AS and provides additive prognostic information over conventional parameters.
Collapse
Affiliation(s)
- Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Misaki Imai
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Daisuke Wake
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Rieko Higaki
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Yasuhisa Nakao
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.,Department of Cardiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hiroe Morioka
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | | | - Katsuji Inoue
- Department of Cardiology, Ehime University Graduate School of Medicine, Toon, Japan
| |
Collapse
|
31
|
Nwabuo CC, Betoko AS, Reis JP, Moreira HT, Vasconcellos HD, Guallar E, Cox C, Sidney S, Ambale-Venkatesh B, Lewis CE, Schreiner PJ, Lloyd-Jones D, Kiefe CI, Gidding SS, Lima JAC. Coffee and tea consumption in the early adult lifespan and left ventricular function in middle age: the CARDIA study. ESC Heart Fail 2020; 7:1510-1519. [PMID: 32449612 PMCID: PMC7373924 DOI: 10.1002/ehf2.12684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/01/2020] [Accepted: 03/08/2020] [Indexed: 01/12/2023] Open
Abstract
Aims The long‐term impact of coffee or tea consumption on subclinical left ventricular (LV) systolic or diastolic function has not been previously studied. We examined the association between coffee or tea consumption beginning in early adulthood and cardiac function in midlife. Methods and results We investigated 2735 Coronary Artery Risk Development in Young Adults (CARDIA) study participants with long‐term total caffeine intake, coffee, and tea consumption data from three visits over a 20 year interval and available echocardiography indices at the CARDIA Year‐25 exam (2010–2011). Linear regression models were used to assess the association between caffeine intake, tea, and coffee consumption (independent variables) and echocardiography outcomes [LV mass, left atrial volume, and global longitudinal strain (GLS), LV ejection fraction (LVEF), and transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e´)]. Models were adjusted for standard cardiovascular risk factors, socioeconomic status, physical activity, alcohol use, and dietary factors (calorie intake, whole and refined grain intake, and fruit and vegetable consumption). Mean (standard deviation) age was 25.2 (3.5) years at the CARDIA Year‐0 exam (1985–1986), 57.4% were women, and 41.9% were African‐American. In adjusted multivariable linear regression models assessing the relationship between coffee consumption and GLS, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.30%, P < 0.05; β = −0.35%, P < 0.05; β = −0.32%, P < 0.05; β = −0.40%, P > 0.05; respectively (more negative values implies better systolic function). In adjusted multivariable linear regression models assessing the relationship between coffee consumption and E/e´, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.29, P < 0.05; β = −0.38, P < 0.01; β = −0.20, P > .05; and β = −0.37, P > 0.05, respectively (more negative values implies better diastolic function). High daily coffee consumption (>4 cups/day) was associated with worse LVEF (β = −1.69, P < 0.05). There were no associations between either tea drinking or total caffeine intake and cardiac function (P > 0.05 for all). Conclusions Low‐to‐moderate daily coffee consumption from early adulthood to middle age was associated with better LV systolic and diastolic function in midlife. High daily coffee consumption (>4cups/day) was associated with worse LV function. There was no association between caffeine or tea intake and cardiac function.
Collapse
Affiliation(s)
- Chike C Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aisha S Betoko
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henrique T Moreira
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Henrique D Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eliseo Guallar
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher Cox
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Cora E Lewis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Samuel S Gidding
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
32
|
Doria de Vasconcellos H, Betoko A, Ciuffo LA, Moreira HT, Nwabuo CC, Ambale-Venkatesh B, Reis JP, Allen N, Lloyd-Jones DM, Colangelo LA, Schreiner PJ, Lewis CE, Shikany JM, Sidney S, Cox C, Gidding SS, Lima JAC. Sex Differences in the Association of Cumulative Body Mass Index from Early Adulthood to Middle Age and Left Atrial Remodeling Evaluated by Three-Dimensional Echocardiography: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2020; 33:878-887.e3. [PMID: 32336609 PMCID: PMC7388576 DOI: 10.1016/j.echo.2020.02.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
Background: The relationship between long-term obesity and left atrial (LA) structure and function is not entirely understood. We examined the association of cumulative body mass index (cBMI) with LA remodeling using three-dimensional (3D) speckle-tracking echocardiography (STE). Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a community-based cohort of black and white, men and women, ages 18–30 years at baseline in 1985–86 from four U.S. centers. This study included 2,144 participants who had satisfactory image quality and body mass index measurements during the entire follow-up period. The 3D STE-derived LA parameters were maximum, minimum, and pretrial contraction volumes; total, passive, and active emptying fraction; maximum systolic longitudinal strain; and early and late diastolic longitudinal strain rates. Multivariable linear regression analyses stratified by sex assessed the relationship between cBMI and 3D STE-derived LA parameters, adjusting for demographics and traditional cardiovascular. Results: The mean age of the cohort was 55 ± 3.6 years; 54.8% were women, and 46.5% were black. There were statistically significant additive sex interactions for the association between cBMI and LA minimum contraction value, maximum systolic longitudinal strain, and early and late diastolic longitudinal strain rates. In the fully adjusted model, greater cBMI was associated with lower magnitude LA longitudinal deformation (maximum systolic longitudinal strain and early and late diastolic longitudinal strain rates) in men and with higher LA emptying fraction in women. In addition, greater cBMI was associated with higher LA phasic volumes indices in both men and women. Conclusions: This study showed that while greater cBMI from early adulthood throughout middle age was associated with higher LA volumes in both genders, differences were found for LA function, with lower longitudinal deformation in men and higher reservoir and active LA function in women. (J Am Soc Echocardiogr 2020;33:878–87.)
Collapse
Affiliation(s)
- Henrique Doria de Vasconcellos
- Johns Hopkins University, Baltimore, Maryland; Universidade Federal do Vale do Sao Francisco/School of Medicine, Petrolina, Pernambuco
| | | | | | - Henrique T Moreira
- Johns Hopkins University, Baltimore, Maryland; University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Patel RB, Colangelo LA, Reiner AP, Gross MD, Jacobs DR, Launer LJ, Lima JAC, Lloyd-Jones DM, Shah SJ. Cellular Adhesion Molecules in Young Adulthood and Cardiac Function in Later Life. J Am Coll Cardiol 2020; 75:2156-2165. [PMID: 32194198 DOI: 10.1016/j.jacc.2020.02.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND E-selectin and intercellular adhesion molecule (ICAM)-1 are biomarkers of endothelial activation, which has been implicated in the pathogenesis of heart failure (HF) with preserved ejection fraction (HFpEF). However, the temporal associations between E-selectin and ICAM-1 with subclinical cardiac dysfunction are unclear. OBJECTIVES This study sought to assess the longitudinal associations of E-selectin and ICAM-1 with subclinical alterations in cardiac function. METHODS In the Coronary Artery Disease Risk Development in Young Adults study, a cohort of black and white young adults, we evaluated the associations of E-selectin and ICAM-1, obtained at year (Y) 7 (Y7) and Y15 examinations, with cardiac function assessed at Y30 after adjustment for key covariates. RESULTS Higher E-selectin (n = 1,810) and ICAM-1 (n = 1,548) at Y7 were associated with black race, smoking, hypertension, and higher body mass index. After multivariable adjustment, higher E-selectin at Y7 (β coefficient per 1 SD higher: 0.22; SE: 0.06; p < 0.001) and Y15 (β coefficient per 1 SD higher: 0.19; SE: 0.06; p = 0.002) was associated with worse left ventricular (LV) global longitudinal strain (GLS). Additionally, higher Y15 ICAM-1 (β coefficient per 1 SD higher: 0.18; SE: 0.06; p = 0.004) and its increase from Y7 to Y15 (β coefficient per 1 SD higher: 0.16; SE: 0.07; p = 0.03) were also independently associated with worse LV GLS. E-selectin and ICAM-1 partially mediated the associations between higher body mass index and black race with worse GLS. Neither E-selectin nor ICAM-1 was associated with measures of LV diastolic function after multivariable adjustment. CONCLUSION Circulating levels of E-selectin and ICAM-1 and increases in ICAM-1 over the course of young adulthood are associated with worse indices of LV systolic function in midlife. These findings suggest associations of endothelial activation with subclinical HF with preserved ejection fraction.
Collapse
Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
34
|
Moreira HT, Armstrong AC, Nwabuo CC, Vasconcellos HD, Schmidt A, Sharma RK, Ambale-Venkatesh B, Ostovaneh MR, Kiefe CI, Lewis CE, Schreiner PJ, Sidney S, Ogunyankin KO, Gidding SS, Lima JAC. Association of smoking and right ventricular function in middle age: CARDIA study. Open Heart 2020; 7:e001270. [PMID: 32201592 PMCID: PMC7061887 DOI: 10.1136/openhrt-2020-001270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age. Methods This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS'), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE'). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score. Results A total of 3424 participants were included. The mean age was 50±4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (β=-0.082, SE=0.031, p=0.008), RVS' (β=-0.343, SE=0.156, p=0.028) and RVE' (β=-0.715, SE=0.195, p<0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (β=-0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers. Conclusions In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions.
Collapse
Affiliation(s)
- Henrique T Moreira
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Cardiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Chike C Nwabuo
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Andre Schmidt
- Division of Cardiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ravi K Sharma
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Division of Research, Oakland, California, USA
| | - Kofo O Ogunyankin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel S Gidding
- Chief Medical Officer, The FH Foundation, Passadena, California, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
35
|
VanWagner LB, Wilcox JE, Ning H, Lewis CE, Carr JJ, Rinella ME, Shah SJ, Lima JAC, Lloyd-Jones DM. Longitudinal Association of Non-Alcoholic Fatty Liver Disease With Changes in Myocardial Structure and Function: The CARDIA Study. J Am Heart Assoc 2020; 9:e014279. [PMID: 32067588 PMCID: PMC7070184 DOI: 10.1161/jaha.119.014279] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Non‐alcoholic fatty liver disease (NAFLD) is associated with high cardiovascular morbidity/mortality, including heart failure. Abnormalities in left ventricular (LV) structure/function are associated with heart failure risk. Methods and Results Participants from the population‐based CARDIA (Coronary Artery Risk Development in Young Adults) study year 25 exam (2010–2011, aged 43–55 years, 61% women, 48% black) with computed tomography measured liver fat and comprehensive echocardiography were included. Echocardiography was repeated at year 30 follow‐up (aged 47–62 years, N=1827). NAFLD was defined as liver attenuation ≤40 HU after exclusions. LV geometry was classified into normal and abnormal by integrating relative wall thickness and LV mass index. Diastolic function was defined using Doppler and tissue Doppler imaging. Systolic function was assessed with myocardial strain measured by speckle tracking. NAFLD prevalence was 8.7% (n=159). NAFLD participants had higher LV mass, relative wall thickness, incident LV hypertrophy and abnormal LV geometry versus non‐NAFLD (P<0.02). NAFLD participants had impaired LV relaxation (E/A ratio 1.1 versus 1.2), higher LV filling pressures (E/e′ ratio 7.9 versus 7.2), worse longitudinal strain (−13.9% versus −15.3%), and lower LV ejection fraction (58.9% versus 60.2%, P<0.01). In multivariable analyses adjusted for heart failure risk factors, NAFLD was independently associated with incident LV hypertrophy (odds ratio: 1.9, 95% CI: 1.1–3.4), abnormal LV geometry (odds ratio: 1.9, 1.1–3.3) and greater change in strain (odds ratio: 2.2, 1.1–4.7). Adjustment for body mass index attenuated associations to non‐significance. Conclusions NAFLD is associated with subclinical changes over time in LV structure/function and obesity explains much of the association. Presence of obesity in mid‐life may identify an important at‐risk population in whom to focus preventive heart failure strategies.
Collapse
Affiliation(s)
- Lisa B VanWagner
- Division of Gastroenterology & Hepatology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Jane E Wilcox
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Medicine Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Hongyan Ning
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Cora E Lewis
- Department of Epidemiology University of Alabama Birmingham School of Public Health Birmingham AL
| | - John Jeffrey Carr
- Departments of Radiology, Cardiovascular Medicine and Biomedical Informatics Vanderbilt University School of Medicine Nashville TN
| | - Mary E Rinella
- Division of Gastroenterology & Hepatology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sanjiv J Shah
- Department of Medicine Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Joao A C Lima
- Departments of Medicine and Radiology Johns Hopkins University School of Medicine Baltimore MD
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Medicine Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| |
Collapse
|
36
|
Bello NA, Jaeger BC, Booth JN, Abdalla M, Anstey DE, Pugliese DN, Lewis CE, Gidding SS, Lloyd-Jones D, Shah SJ, Schwartz JE, Shikany JM, Muntner P, Shimbo D. Associations of awake and asleep blood pressure and blood pressure dipping with abnormalities of cardiac structure: the Coronary Artery Risk Development in Young Adults study. J Hypertens 2020; 38:102-110. [PMID: 31464800 PMCID: PMC6941789 DOI: 10.1097/hjh.0000000000002221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the associations of high awake blood pressure (BP), high asleep BP, and nondipping BP, determined by ambulatory BP monitoring (ABPM), with left ventricular hypertrophy (LVH) and geometry. METHODS Black and white participants (n = 687) in the Coronary Artery Risk Development in Young Adults study underwent 24-h ABPM and echocardiography at the Year 30 Exam in 2015-2016. The prevalence and prevalence ratios of LVH were calculated for high awake SBP (≥130 mmHg), high asleep SBP (≥110 mmHg), the cross-classification of high awake and asleep SBP, and nondipping SBP (percentage decline in awake-to-asleep SBP < 10%). Odds ratios for abnormal left ventricular geometry associated with these phenotypes were calculated. RESULTS Overall, 46.0 and 49.1% of study participants had high awake and asleep SBP, respectively, and 31.1% had nondipping SBP. After adjustment for demographics and clinical characteristics, high awake SBP was associated with a prevalence ratio for LVH of 2.79 [95% confidence interval (95% CI) 1.63-4.79]. High asleep SBP was also associated with a prevalence ratio for LVH of 2.19 (95% CI 1.25-3.83). There was no evidence of an association between nondipping SBP and LVH (prevalence ratio 0.70, 95% CI 0.44-1.12). High awake SBP with or without high asleep SBP was associated with a higher odds ratio of concentric remodeling and hypertrophy. CONCLUSION Awake and asleep SBP, but not the decline in awake-to-asleep SBP, were associated with increased prevalence of cardiac end-organ damage.
Collapse
Affiliation(s)
- Natalie A Bello
- Department of Medicine, Columbia University, New York, New York Department of Biostatistics Department of Epidemiology Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Familial Hypercholesterolemia Foundation, Pasadena, California Department of Preventive Medicine Department of Medicine, Northwestern University, Chicago, Illinois Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Gidding SS, Lloyd-Jones D, Lima J, Ambale-Venkatesh B, Shah SJ, Shah R, Lewis CE, Jacobs DR, Allen NB. Prevalence of American Heart Association Heart Failure Stages in Black and White Young and Middle-Aged Adults: The CARDIA Study. Circ Heart Fail 2019; 12:e005730. [PMID: 31505940 DOI: 10.1161/circheartfailure.118.005730] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Staging criteria for heart failure (HF) range from stage 0 (without risk) to being at risk (stage A) to presence of cardiac structural/functional abnormalities (stage B) to symptomatic/end stage (stages C/D). There are limited data on the prevalence of these stages in early adulthood and predictors of HF stage and symptoms in middle age. METHODS AND RESULTS The CARDIA study (Coronary Artery Risk Development in Young Adults)-a cohort of generally healthy black and white men and women-collected phenotypic, echocardiographic, and outcomes data at the year 5 and year 30 examinations when participants were 22 to 37 and 47 to 62 years of age. Prevalence of HF stages was calculated and relationship of year 5 stage to year 30 classification and outcomes was assessed. At year 5, 2189 participants had complete data. Prevalence of HF stage A/B increased from 24% to 76% in black men, from 13% to 64% in white men, from 34% to 81% in black women, and from 13% to 56% in white women. Blacks were more likely to be in any stage or with morbidity at both time points because of higher risk factor prevalence. Of 33 participants with HF or HF deaths by year 30, 21 (64%) had been in stage A or B at year 5. Only 6 participants at year 5 in stage A (at risk) improved risk status at year 30. CONCLUSIONS Risk for HF increased in participants from 1990 (age 22-37 years) to 2015 (age 47-62 years). Symptomatic HF or death from HF is associated with HF stage at 22 to 37 years of age. Blacks are disproportionately affected.
Collapse
Affiliation(s)
- Samuel S Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, DE (S.S.G.)
| | - Donald Lloyd-Jones
- Department of Preventive Medicine (D.L.-J., N.B.A.), Feinberg Medical School, Northwestern University, Chicago, IL
| | - Joao Lima
- Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD (J.L., B.A.-V.)
| | - Bharat Ambale-Venkatesh
- Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD (J.L., B.A.-V.)
| | - Sanjiv J Shah
- Department of Internal Medicine (S.J.S.), Feinberg Medical School, Northwestern University, Chicago, IL
| | - Ravi Shah
- Division of Cardiology, Massachusetts General Hospital, Boston (R.S.)
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - David R Jacobs
- School of Public Health University of Minnesota, Minneapolis (D.R.J.)
| | - Norrina B Allen
- Department of Preventive Medicine (D.L.-J., N.B.A.), Feinberg Medical School, Northwestern University, Chicago, IL
| |
Collapse
|
38
|
Leclerc S, Smistad E, Pedrosa J, Ostvik A, Cervenansky F, Espinosa F, Espeland T, Berg EAR, Jodoin PM, Grenier T, Lartizien C, Dhooge J, Lovstakken L, Bernard O. Deep Learning for Segmentation Using an Open Large-Scale Dataset in 2D Echocardiography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2198-2210. [PMID: 30802851 DOI: 10.1109/tmi.2019.2900516] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Delineation of the cardiac structures from 2D echocardiographic images is a common clinical task to establish a diagnosis. Over the past decades, the automation of this task has been the subject of intense research. In this paper, we evaluate how far the state-of-the-art encoder-decoder deep convolutional neural network methods can go at assessing 2D echocardiographic images, i.e., segmenting cardiac structures and estimating clinical indices, on a dataset, especially, designed to answer this objective. We, therefore, introduce the cardiac acquisitions for multi-structure ultrasound segmentation dataset, the largest publicly-available and fully-annotated dataset for the purpose of echocardiographic assessment. The dataset contains two and four-chamber acquisitions from 500 patients with reference measurements from one cardiologist on the full dataset and from three cardiologists on a fold of 50 patients. Results show that encoder-decoder-based architectures outperform state-of-the-art non-deep learning methods and faithfully reproduce the expert analysis for the end-diastolic and end-systolic left ventricular volumes, with a mean correlation of 0.95 and an absolute mean error of 9.5 ml. Concerning the ejection fraction of the left ventricle, results are more contrasted with a mean correlation coefficient of 0.80 and an absolute mean error of 5.6%. Although these results are below the inter-observer scores, they remain slightly worse than the intra-observer's ones. Based on this observation, areas for improvement are defined, which open the door for accurate and fully-automatic analysis of 2D echocardiographic images.
Collapse
|
39
|
Yared GS, Moreira HT, Venkatesh BA, Vasconcellos HD, Nwabuo CC, Ostovaneh MR, Reis JP, Lloyd-Jones DM, Schreiner PJ, Lewis CE, Sidney S, Carr JJ, Gidding SS, Lima JA. Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function. Circ Cardiovasc Imaging 2019; 12:e009228. [PMID: 31195818 PMCID: PMC6582968 DOI: 10.1161/circimaging.119.009228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/14/2019] [Indexed: 11/16/2022]
Abstract
Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular (LV) function. Methods CAC score was measured by computed tomography at CARDIA study (Coronary Artery Risk Development in Young Adults) year-15 examination and at year-25 examination (Y25) in 3043 and 3189 participants, respectively. CAC score was assessed as a continuous variable and log-transformed to account for nonlinearity. Change in CAC from year-15 examination to Y25 was evaluated as the absolute difference of log-transformed CAC from year-15 examination to Y25. LV structure and function were evaluated by echocardiography at Y25. Results At Y25, mean age was 50.1±3.6 years, 56.6% women, 52.4% black. In the multivariable analysis at Y25, higher CAC was related to higher LV mass (β=1.218; adjusted P=0.007), higher LV end-diastolic volume (β=0.811; adjusted P=0.007), higher LV end-systolic volume (β=0.350; adjusted P=0.048), higher left atrial volume (β=0.214; adjusted P=0.009), and higher E/e' ratio (β=0.059; adjusted P=0.014). CAC was measured at both year-15 examination and Y25 in 2449 individuals. Higher change in CAC score during follow-up was independently related to higher LV mass index in blacks (β=4.789; adjusted P<0.001), but not in whites (β=1.051; adjusted P=0.283). Conclusions Higher CAC in middle age is associated with higher LV mass and volumes and worse LV diastolic function. Being free of CAC from young adulthood to middle age correlates to better LV function at middle age. Higher change in CAC score during follow-up is independently related to higher LV mass index in blacks.
Collapse
Affiliation(s)
| | - Henrique T. Moreira
- Johns Hopkins University, Baltimore, MD, USA
- University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | | | - Jared P. Reis
- National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | | | - Cora E. Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Sidney
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | | | | |
Collapse
|
40
|
Bancks MP, Carnethon MR, Chow LS, Gidding SS, Jacobs DR, Kishi S, Lima J, Lloyd-Jones D, Reis JP, Schreiner PJ, Zmora R, Allen NB. Fasting glucose and insulin resistance trajectories during young adulthood and mid-life cardiac structure and function. J Diabetes Complications 2019; 33:356-362. [PMID: 30885553 PMCID: PMC6451883 DOI: 10.1016/j.jdiacomp.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/02/2019] [Accepted: 01/22/2019] [Indexed: 12/31/2022]
Abstract
AIMS We assessed whether fasting glucose (FG) and insulin resistance (IR) trajectories during young adulthood are associated with changes in cardiac structure and function. METHODS We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study (baseline: 1985-1986). Echocardiography was performed after 25 (Y25) and 30 years of follow-up. Group-based modeling was used to determine 25-year trajectories in FG and IR. We assessed differences at Y25 and 5-year longitudinal change in cardiac structure and function after adjustment for demographics, cumulative exposure to traditional cardiovascular risk factors, and baseline FG or IR. RESULTS We identified five FG trajectory groups among 2414 individuals and three IR trajectory groups among 2358 individuals. Moderate-increasing FG trajectory was associated with lower lateral E' velocity (difference: -0.9 cm/s, 95%CI: -0.3, -1.5) and with greater left ventricular (LV) mass index (difference: 2.7 g/m2.7, 95%CI: 0.7, 4.7) at Y30 compared to low-stable FG. High-increasing IR trajectory was associated with lower lateral E' velocity and septal E' velocity at Y30 compared to low-decreasing IR trajectory. CONCLUSIONS Trajectories in FG and IR over 25 years before the development of diabetes are associated with unfavorable differences in LV structure and diastolic function beyond single values of FG and IR.
Collapse
Affiliation(s)
- Michael P Bancks
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Northwestern University, Chicago, IL, United States of America.
| | | | - Lisa S Chow
- University of Minnesota, Minneapolis, MN, United States of America
| | - Samuel S Gidding
- Familial Hypercholesterolemia Foundation, Pasadena, CA, United States of America
| | - David R Jacobs
- University of Minnesota, Minneapolis, MN, United States of America
| | - Satoru Kishi
- Mitsui Memorial Hospital, Tokyo, Japan; Johns Hopkins University, Baltimore, MD, United States of America
| | - Joao Lima
- Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Jared P Reis
- National Heart Lung and Blood Institute, Bethesda, MD, United States of America
| | | | - Rachel Zmora
- University of Minnesota, Minneapolis, MN, United States of America
| | - Norrina B Allen
- Northwestern University, Chicago, IL, United States of America
| |
Collapse
|
41
|
O’Gara PT, Sun YP. Timing of Valve Interventions in Patients With Chronic Aortic Regurgitation. J Am Coll Cardiol 2019; 73:1753-1755. [DOI: 10.1016/j.jacc.2018.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 01/29/2023]
|
42
|
Kelly A, Gidding SS, Walega R, Cochrane C, Clauss S, Townsend RR, Xanthopoulos M, Pipan ME, Zemel BS, Magge SN, Cohen MS. Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome. Pediatr Cardiol 2019; 40:421-430. [PMID: 30386863 PMCID: PMC6399030 DOI: 10.1007/s00246-018-2014-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10-20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E'); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min-max]): DS had lower height (cm) (144.5 [116.7-170.3] vs. 163.3 [134.8-186.7]; p < 0.0001); LBM (kg) (33.48 [14.5-62.3] vs 41.8 [18.07-72.46], p < 0.0001); and LVM (g) (68.3 [32.1-135] vs 94.0 [43.9-164.6], p < 0.0001); similar EF (%) (65 [54-77] vs 64 [53-77], p = 0.59); and higher E/E' (8.41 [5.54-21.4] vs 5.81 [3.44-9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = - 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = - 15.1, p < 0.0001), a finding not explained by MVPA. E/E' remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown.Clinical Trial Registration: NCT01821300.
Collapse
Affiliation(s)
- Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA, USA. .,Division of Endocrinology & Diabetes, Roberts Center for Pediatric Research, Room 14363, 2716 South Street, Philadelphia, PA, 19146, USA.
| | - Samuel S. Gidding
- Samuel S. Gidding M.D., Familial Hypercholesterolemia Foundation, Pasadena, CA
| | - Rachel Walega
- Division of Endocrinology and Diabetes, Center for Translational Science, Children’s National Health System, Washington, D.C
| | - Claire Cochrane
- Division of Endocrinology & Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Clauss
- Division of Cardiology, Children’s National Health System, Washington, D.C
| | - Ray R. Townsend
- Department of Medicine, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA
| | - Melissa Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary E. Pipan
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Babette S. Zemel
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Gastroenterology, Hepatology, & Nutrition, The Children’s Hospital of Philadelphia
| | - Sheela N. Magge
- Division of Endocrinology and Diabetes, Center for Translational Science, Children’s National Health System, Washington, D.C
| | - Meryl S. Cohen
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
43
|
Poulidakis E, Aggeli C, Sideris S, Sfendouraki E, Koutagiar I, Katsaros A, Giannoulis E, Koukos M, Margioula E, Lagoudakou S, Gatzoulis K, Dilaveris P, Kallikazaros I, Couloheri S, Stefanadis C, Tousoulis D. Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices. Int J Cardiovasc Imaging 2019; 35:285-294. [PMID: 30623352 DOI: 10.1007/s10554-018-01520-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/24/2018] [Indexed: 12/28/2022]
Abstract
Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.
Collapse
Affiliation(s)
- Emmanouil Poulidakis
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece.
- Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Constantina Aggeli
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Skevos Sideris
- Cardiology Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Eliza Sfendouraki
- Cardiology Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Iosif Koutagiar
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Andreas Katsaros
- Cardiosurgery Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Evangelos Giannoulis
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Markos Koukos
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Eleni Margioula
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Stavroula Lagoudakou
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Kostas Gatzoulis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Polychronis Dilaveris
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Ioannis Kallikazaros
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Stavroula Couloheri
- Department of Biological Chemistry, Medical School, University of Athens, 75 M. Asias st, 115 27, Athens, Greece
| | - Christodoulos Stefanadis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| |
Collapse
|
44
|
Laughlin-Tommaso SK, Fuchs EL, Wellons MF, Lewis CE, Calderon-Margalit R, Stewart EA, Schreiner PJ. Uterine Fibroids and the Risk of Cardiovascular Disease in the Coronary Artery Risk Development in Young Adult Women's Study. J Womens Health (Larchmt) 2019; 28:46-52. [PMID: 30412447 PMCID: PMC6343187 DOI: 10.1089/jwh.2018.7122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine fibroids, the most common reproductive tract tumor in women, have been associated with hypertension and atherosclerotic cardiovascular disease (CVD). Prior studies of fibroids and CVD have examined the subset of women with symptomatic fibroids who undergo hysterectomy, itself a risk factor for CVD. We aimed to study the risk of subclinical CVD, as determined by coronary artery calcification (CAC), carotid intima media thickness (CIMT), and left ventricular (LV) mass, in women with ultrasound-diagnosed uterine fibroids. MATERIALS AND METHODS Participants were 972 women from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort recruited in 1985-1986. CARDIA screened black and white women aged 35-49 years by ultrasound for fibroids at 16 years of follow-up (2002-2004). Demographics and CVD risk factors were collected in 2000-2001 at 15 years of follow-up (baseline for this analysis). Women were tested at years 15, 20, and 25 for CAC, at year 20 for CIMT, and at year 25 for echocardiographic LV mass. Multivariable logistic regression was used to estimate the odds of CAC, CIMT, and LV mass. RESULTS Fifty-two percent of women had fibroids (61.7% in black, 38.3% in white women). Most CVD risk factors were more common in women with fibroids. Adjusted odds of subclinical CVD, such as elevated CIMT and elevated LV mass, were not different for women with fibroids compared with those without (CIMT odds ratio [OR] = 1.03; confidence interval [95% CI] 0.7-1.5 and LV mass OR = 1.14; 95% CI 0.77-1.68), when adjusted for confounders. CONCLUSIONS Although women with fibroids had more CVD risk factors, presence of fibroids was not associated with subclinical CVD.
Collapse
Affiliation(s)
- Shannon K. Laughlin-Tommaso
- Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erika L. Fuchs
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Melissa F. Wellons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Elizabeth A. Stewart
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Pamela J. Schreiner
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
45
|
Khan SS, Shah SJ, Colangelo LA, Panjwani A, Liu K, Lewis CE, Shay CM, Goff DC, Reis J, Vasconcellos HD, Lima JAC, Lloyd-Jones D, Allen NB. Association of Patterns of Change in Adiposity With Diastolic Function and Systolic Myocardial Mechanics From Early Adulthood to Middle Age: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2018; 31:1261-1269.e8. [PMID: 30181008 PMCID: PMC6286208 DOI: 10.1016/j.echo.2018.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to determine whether long-term patterns of change in adiposity throughout young adulthood are associated with systolic and diastolic function in midlife. METHODS Participants in the Coronary Artery Risk Development in Young Adults study, a multicenter, population-based cohort, underwent repeated anthropometric assessment (body mass index [BMI], waist circumference, and waist-to-hip ratio) from examination years 0 to 25. At year 25, longitudinal, circumferential, and radial strain and tissue Doppler velocities were assessed by echocardiography. Group-based trajectory modeling was used to identify 25-year trajectories of change in anthropometric measures and to examine associations between trajectories of adiposity change and indices of cardiac mechanics. RESULTS Among 3,310 participants, four distinct trajectories of BMI change were identified: stable BMI (36% of the cohort; mean ΔBMI, 1.6 kg/m2), mild increase (40%; mean ΔBMI, 6.0 kg/m2), moderate increase (18%; mean ΔBMI, 10.8 kg/m2), and major increase (6%; mean ΔBMI, 15.5 kg/m2). Trajectories of greater BMI increase were associated with lower adjusted e' velocity and higher E/e' ratio compared with the stable BMI group, independent of year 0 or year 25 BMI. Participants in increasing BMI trajectory groups compared with the stable BMI group had lower absolute longitudinal strain and greater odds of diastolic dysfunction, independent of year 0 BMI but not year 25 BMI. Similar patterns were observed for change in waist circumference and waist-to-hip ratio trajectory groups. CONCLUSIONS Steeper trajectories of BMI increase from young adulthood to middle age, a vulnerable period for weight gain, are independently associated with lower e' velocity and higher E/e' ratio, but not systolic dysfunction, in midlife.
Collapse
Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anita Panjwani
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina M Shay
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David C Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Henrique D Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donald Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
46
|
Maria-Claudia-Berenice S, Andrei-Dumitru M, Ramona B, Calin S, Dragos V. Regional Mechanical Changes Assessed by 2D Speckle-Tracking Longitudinal Strain do not Parallel Electrical Post-Pacing Cardiac Memory. MAEDICA 2018; 13:189-195. [PMID: 30568738 PMCID: PMC6290181 DOI: 10.26574/maedica.2018.13.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cardiac memory (CM) refers to persistent T-wave changes that appear after cessation of a period of abnormal ventricular activation, such as ventricular pacing. Prior animal studies using tagged magnetic resonance imaging have suggested that CM is associated with prolonged action potential duration and increased strain of late-activated myocardial segments. OBJECTIVE The aim of the present study is to determine whether CM induced by ventricular pacing in human subjects is accompanied by regional mechanical changes in late-activated myocardial segments, assessed by left ventricular (LV) longitudinal strain (peak LS) and time-to-peak longitudinal strain (TTP-LS), using 2D-speckle tracking echocardiography (2DSE). MATERIAL AND METHODS We included 20 patients (16 women, age 71±11 years), with DDD pacemakers and with normal AV conduction and QRS/T morphology at baseline. CM was induced by DDD pacing with a short AV delay. ECGs and 2DSE were performed before pacing (baseline), at peak CM (immediately after two weeks of pacing), and at CM washout (4 weeks after cessation of pacing). We measured by echocardiography: left ventricular (LV) ejection fraction, LV diastolic function (E, A, E/E'), peak LS and TTP-LS for the earliest (i.e. adjacent to the pacing site) and latest (i.e. latest-activated during ventricular pacing) segments, using an 18-segment LV model. RESULTS All patients had electrical (ECG) CM changes, which disappeared by CM washout. LV global systolic and diastolic functions, as well as regional LS (peak LS for both the latest and earliest activated segments) were similar between evaluations. TTP for the latest and earliest activated segments, as well as mean TTP-LS, increased from baseline to peak CM, but did not decrease at CM washout. The dispersion of TTP-LS was not changed. CONCLUSION These results suggest that regional mechanical changes, as can be assessed by 2DSE longitudinal strain, do not overlap electrical CM.
Collapse
Affiliation(s)
| | | | - Bruja Ramona
- Department of Cardiology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Siliste Calin
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Vinereanu Dragos
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| |
Collapse
|
47
|
Gutiérrez OM, Limou S, Lin F, Peralta CA, Kramer HJ, Carr JJ, Bibbins-Domingo K, Winkler CA, Lewis CE, Kopp JB. APOL1 nephropathy risk variants do not associate with subclinical atherosclerosis or left ventricular mass in middle-aged black adults. Kidney Int 2018; 93:727-732. [PMID: 29042080 PMCID: PMC5826778 DOI: 10.1016/j.kint.2017.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/29/2022]
Abstract
Prior studies reported associations of APOL1 nephropathy risk variants with subclinical atherosclerosis. However, these findings were limited to older individuals with high comorbidities. To evaluate this in younger individuals, we calculated associations of APOL1 risk variants (high risk [2 risk variants] vs. low risk [0-1 risk variant]) with prevalent, incident, or progressive coronary artery calcification, a carotid intima media thickness over the 90th percentile, and left ventricular hypertrophy in 1315 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. The mean age of this cohort was 44.6 years and their mean estimated glomerular filtration rate was 102.5 ml/min/1.73m2. High-risk participants were found to be younger and have a higher prevalence of albuminuria than low-risk participants. In Poisson regression models adjusted for comorbidities and kidney function, the risk of prevalent coronary artery calcification (relative risk [95% confidence interval] 1.12 [0.72,1.71]), the incident coronary artery calcification (1.50 [0.87,2.59]), and the progression of coronary artery calcification (1.40 [0.88,2.23]) did not significantly differ in high vs. low-risk participants. Furthermore, the risk of carotid intima media thickness over the 90th percentile (1.28 [0.78,2.10]) and left ventricular hypertrophy (1.02[0.73,1.43]) did not significantly differ in high vs. low-risk participants in fully-adjusted models. Thus, APOL1 risk variants did not associate with subclinical markers of atherosclerosis or left ventricular hypertrophy in middle-aged black adults with preserved kidney function.
Collapse
Affiliation(s)
| | - Sophie Limou
- Institute for Transplantation in Urology and Nephrology and Ecole Centrale de Nantes, Nantes, France
| | - Feng Lin
- University of California, San Francisco, San Francisco, California, USA
| | - Carmen A Peralta
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| |
Collapse
|
48
|
Echocardiography for the management of patients with biventricular pacing: Possible roles in cardiac resynchronization therapy implementation. Hellenic J Cardiol 2018; 59:306-312. [PMID: 29452309 DOI: 10.1016/j.hjc.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/03/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF), and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow-up visits.
Collapse
|
49
|
Nwabuo CC, Moreira HT, Vasconcellos HD, Ambale-Venkatesh B, Yoneyama K, Ohyama Y, Sharma RK, Armstrong AC, Ostovaneh MR, Lewis CE, Liu K, Schreiner PJ, Ogunyankin KO, Gidding SS, Lima JAC. Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study. J Am Soc Echocardiogr 2017; 30:1172-1179. [PMID: 28927559 PMCID: PMC5716838 DOI: 10.1016/j.echo.2017.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The human aorta dilates with advancing age. However, the association between progressive aortic dilation with aging and cardiac remodeling has not been established in studies of community-dwelling adults. The aim of this study was to test the hypothesis that there would be a relationship between aortic size increase over the early adult life span with left ventricular (LV) structural remodeling and subclinical LV dysfunction in middle age, even in the absence of overt cardiovascular and valvular disease. METHODS Included were Coronary Artery Risk Development in Young Adults study participants (N = 2,933) aged 23 to 35 years with available transthoracic echocardiographic measurements during 20 years of follow-up. Multivariate linear regression models assessed sex-specific associations between 20-year change in aortic root diameter with LV structure and function. RESULTS Larger aortic root diameter at 20-year follow-up was associated with greater LV mass (2.77 vs 2.18 g/mm in men and women, respectively, P < .001). In longitudinal analyses, increase in aortic root diameter over 20-year follow-up was associated with a greater 20-year increase in LV mass and ratio of LV mass to LV end-diastolic volume ratio in both sexes. In women but not in men, increased aortic root diameter over 20 years was associated with increased left atrial dimension, impaired E/E', and impaired early diastolic longitudinal and circumferential strain rates assessed by speckle-tracking echocardiography. CONCLUSIONS Progressive increase in aortic root diameter from early adulthood to middle age was associated with increased LV mass and LV concentric remodeling in both sexes and impaired diastolic function predominantly in women.
Collapse
Affiliation(s)
- Chike C Nwabuo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kihei Yoneyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yoshiaki Ohyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi K Sharma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kiang Liu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kofo O Ogunyankin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - João A C Lima
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
50
|
Appiah D, Schreiner PJ, Nwabuo CC, Wellons MF, Lewis CE, Lima JA. The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Menopause 2017; 24:1269-1276. [PMID: 28697037 PMCID: PMC5659880 DOI: 10.1097/gme.0000000000000919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition. METHODS We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points. RESULTS During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e' ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. CONCLUSION In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.
Collapse
Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Chike C. Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Melissa F. Wellons
- Division of Diabetes, Endocrinology, and Metabolism, School of Medicine, Vanderbilt University, Nashville, TN
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joao A. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| |
Collapse
|