Association of left atrial enlargement with ventricular remodeling in hypertensive Chinese elderly

Development and Validation of a Nomogram for Predicting Lacunar Infarction in Patients with Hypertension

Background

A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.

Methods

Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively.

Results

The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198, P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets.

Conclusion

Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.

Sex, gender, and subclinical hypertensiveorgan damage-heart

Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. Although the risk of cardiac HMOD is related with the severity of BP elevation, the interaction of numerous non-hemodynamic factors plays a relevant role in this unfavorable dynamic process. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described. The objective of the present review is to provide comprehensive, updated information on sex-related differences in cardiac HMOD, focusing on the most important manifestations of subclinical hypertensive heart disease such as left ventricular hypertrophy (LVH), LV systolic and diastolic dysfunction, left atrial and aortic dilatation. Current evidence, based on cross-sectional and longitudinal observational studies as well as real-world registries and randomized controlled trials, suggests that women are more at risk of developing (and maintaining) LVH, concentric remodeling and subclinical LV dysfunction, namely the morpho-functional features of heart failure with preserved ejection fraction. It should be pointed out, however, that further studies are needed to fill the gap in defining gender-based optimal therapeutic strategies in order to protect women's hearts.

Impact of baseline blood pressure on all-cause mortality in patients with atrial fibrillation: results from a multicenter registry study

BACKGROUND

The ideal blood pressure (BP) target for patients with atrial fibrillation (AF) is still unclear. The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.

METHODS

This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011. All participants were followed for 1 year ± 1 month. The primary endpoint was all-cause mortality.

RESULTS

During the follow-up, 276 (13.9%) all-cause deaths occurred. Kaplan-Meier curves showed that a systolic blood pressure (SBP) ≤110 mmHg or >160 mmHg was associated with a higher risk of all-cause mortality (log-rank test, P  = 0.014), and a diastolic blood pressure (DBP) <70 mmHg was associated with the highest risk of all-cause mortality (log-rank test, P  = 0.002). After adjusting for confounders, the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP ≤110 mmHg (hazard ratio [HR], 1.963; 95% confidence interval [CI], 1.306-2.951), and DBP <70 mmHg (HR, 1.628; 95% CI, 1.163-2.281). In the restricted cubic splines, relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations (non-linear P <0.001 and P  = 0.010, respectively). The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.

CONCLUSIONS

Having a baseline SBP ≤110 mmHg or DBP <70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF. An excessively low BP may not be an optimal target for patients with AF.

Low body mass is associated with reduced left ventricular mass in Chinese elderly with severe COPD

There is limited information on the association of body mass index (BMI) with left ventricular (LV) remodeling corresponding to severity of reduced lung function in patients with chronic obstructive pulmonary disease (COPD). Therefore, we investigated whether BMI is associated with cardiac atrial and ventricular dimensions according to severity of lung functional impairment in Chinese COPD elderly. A total of 563 hospitalized COPD patients with lung function impairment and 184 patients with non-COPD (aged 65–92 years) were collected retrospectively in a cross-sectional study in a university affiliated tertiary hospital in China. BMI and cardiac echocardiographic parameters were compared according to severity of lung functional impairment in COPD patients. BMI was 22.9 ± 3.9 kg/m² in COPD patients, 24.0 ± 4.1 kg/m² in non-COPD patients respectively. Reduced BMI, LV mass index, LV wall thickness and left atrial diameter, and dilated right ventricle (RV) existed in COPD patients with severe lung dysfunction as compared the COPD patients with mild to moderate lung functional reduction and non-COPD patients (P < 0.05), while there were no differences in BMI and echocardiographic parameters between the COPD patients with mild to moderate lung functional decline and non-COPD patients (P > 0.05). Logistic regression analysis showed that low BMI (BMI < 18.5 kg/m²) was correlated with reduced LV mass and wall thickness, dilated RV and reduced lung function in the COPD patients with severe lung dysfunction. In conclusion, this study demonstrates that lower BMI is associated not only with dilated RV and impaired pulmonary function, but also it is related to reduced LV mass in Asian COPD elderly with severe lung dysfunction.

Relation between left atrial structure and lacunar infarction in patients with hypertension

A lacunar infarction (LACI) can cause damage to the surrounding brain tissue and place an individual at greater risk for future major stroke. LACI is associated with hypertension and hypertension is associated with left atrial enlargement. It is important to identify a high-risk patient who is more vulnerable to suffering a LACI in hypertensive group. So, we studied whether left atrium size is an independent risk predictor for LACI in hypertensive patients. We performed cross-sectional analysis of 365 patients with hypertension at Shanghai Ninth People's Hospital from January 2016 to January 2017. The results showed that left atrial diameter(LAD), left atrial volume (LAV) and the ratio of left atrial diameter to left ventricular diameter (LAD/LVD) were significantly associated with LACI in hypertensive patients. Based on the ROC curve analysis, the area under the ROC curve (AUC) of LAV used to predict LACI was 0.737 (95% CI: 0.686 - 0.788), and the AUC of LAD/LVD was 0.784 (95% CI: 0.737 - 0.830). The optimal cut-off value for LAV was 30.14, and the sensitivity and specificity were 72% and 63%, respectively. The optimal cut-off value for LAD/LVD was 0.757, and the sensitivity and specificity were 77% and 70%, respectively. LAV or LAD/LVD played an important role in LACI with hypertension and could be an independent risk factor in hypertensive patients.

Overweight and obesity are associated with cardiac adverse structure remodeling in Chinese elderly with hypertension

There is limited information on the association of overweight and obesity with cardiac remodeling in elderly population. Therefore, we investigated whether overweight and obesity are associated with cardiac geometric structures and function in Chinese elderly. A total of 1183 hospitalized patients (aged 65–99 years) with primary hypertension were collected retrospectively in a cross-sectional study, and divided into underweight, normal weight, overweight and obesity patient groups according to their body mass index (BMI). Cardiac echocardiographic parameters were compared between the groups. BMI was 17.2 ± 1.2, 21.4 ± 1.2, 25.1 ± 1.2, 30.2 ± 2.6 kg/m² in underweight, normal weight, overweight and obesity groups respectively. Aortic and left atrial diameter, interventricular septal and left ventricular (LV) posterior wall thickness, LV end-diastolic and end-systolic diameter, and indexed LV mass, and prevalence of E/A reversal were higher, while LV ejection fraction and fractional shortening were lower in elderly with overweight or obesity, as compared with whose with underweight or normal weight separately (All P < 0.05). However, multivariable regression analysis showed that overweight and obesity are independently related to increased LV wall thickness, end-diastolic diameter and mass (All P < 0.05). In conclusions, this study demonstrates that overweight and obesity are associated with increased LV wall thickness, end-diastolic diameter and mass in Asian elderly.