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Xu J, Tang W, Song L, Huang Y, Xiao L, Cheng F, Guan Q, Xu M, Ma C, Chen J, Ke J. Increased indexed proximal aortic diameter is a predictor of poor prognosis in maintenance hemodialysis patients. Ren Fail 2024; 46:2355352. [PMID: 38785291 PMCID: PMC11132612 DOI: 10.1080/0886022x.2024.2355352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Recent studies have shown that the baseline values of absolute aortic root diameter (ARD) and indexed diameter are associated with all-cause mortality and cardiovascular events in the general population, even in the absence of aneurysmal aortic disease. However, there is limited available data on the association between ARD and prognosis in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD). Accordingly, the purpose of this study is to investigate the predictive value of ARD for all-cause mortality and cardiovascular events in this specific population.Methods: ARD was measured by echocardiography at the level of the sinuses of Valsalva at end diastole and indexed to body surface area (BSA). The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction and stroke. Cox proportional hazards models were conducted to evaluate the association between baseline ARD/BSA and clinical outcomes.Results: A total of 391 patients were included in this study. The primary endpoint occurred in 95 (24.3%) patients while the secondary endpoint occurred in 71 (18.2%) patients. Multivariate Cox regression analysis showed that ARD/BSA was an independent prognostic factor for all-cause mortality (HR, per 1-SD increase, 1.403; 95% CI, 1.118-1.761; p = 0.003) as well as MACE (HR, per 1-SD increase, 1.356; 95% CI, 1.037-1.772; p = 0.026).Conclusions: Our results show that ARD/BSA is predictive of all-cause mortality and MACE in MHD patients with ESRD and support the view that assessment of ARD/BSA may refine risk stratification and preventive strategies in this population.
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Affiliation(s)
- Junwei Xu
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Wenyi Tang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Lizheng Song
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Yuxi Huang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Li Xiao
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Fangyuan Cheng
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Qianglin Guan
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Mei Xu
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Chuoxin Ma
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, China
| | - Jian Chen
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
- Center for Interventional Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, China
- Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-sen University, China
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2
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Zhou Z, Wang W, Tian L, Peng Y, Lei L, Li J, Pu B, Zhang L, Zheng X. Correlation of aortic root dimensions and mortality in acute heart failure: A nationwide prospective cohort study. Heliyon 2024; 10:e37026. [PMID: 39296088 PMCID: PMC11407952 DOI: 10.1016/j.heliyon.2024.e37026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/18/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Background An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited. Methods In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes. Results A total of 2125 participants with ARD were included in the final analysis, among of 38.4 % were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.58 to 0.87; P < 0.001) and all-cause mortality (HR, 0.68; 95 % CI, 0.56 to 0.81; P < 0.001). Similarly, the middle tertile group also had a lower risk of cardiovascular mortality (HR, 0.78; 95 % CI, 0.65 to 0.93; P = 0.007) and all-cause mortality (HR, 0.75; 95 % CI, 0.63 to 0.89; P < 0.001). Considering the competing risks, the lowest BMI-indexed ARD groups showed a significant mortality risk of cardiovascular mortality in all populations, and both sexes. Moreover, the relationship between BMI-indexed ARD and mortality was linear in males, while a "J" shaped relationship was observed in females. Conclusion Lower BMI-indexed ARD was associated with a decreased risk of all-cause and cardiovascular mortality than those with higher BMI-indexed ARD in AHF. Additionally, a discrepancy was observed between the sexes in the relationship between BMI-indexed ARD and mortality. These findings contribute to the prompt identification of potential mortality risks in patients with AHF.
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Affiliation(s)
- Zeming Zhou
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Lili Tian
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
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3
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Pedersen MW, Duch K, Lindgren FL, Lundgren NLO, Tayal B, Hagendorff A, Jensen GB, Biering-Sørensen T, Schnohr P, Møgelvang R, Høst N, Kragholm K, Andersen NH, Søgaard P. Aortic Root Dimension Using Transthoracic Echocardiography: Results from the Copenhagen City Heart Study. Am J Cardiol 2024; 218:86-93. [PMID: 38452843 DOI: 10.1016/j.amjcard.2024.02.031] [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: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.
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Affiliation(s)
- Maria W Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Filip L Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils L O Lundgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Nordsjællands Hospital, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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4
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Chinawa JM, Chukwu B, Chinawa A. Estimation of z-scores of cardiac structures in healthy children in Southeast Nigeria. Ir J Med Sci 2024; 193:689-698. [PMID: 37861940 DOI: 10.1007/s11845-023-03542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The z-scoring system shows the mean deviation of cardiac dimensions from age-specific population. The use of the European-based z-score studies has resulted in misdiagnosis and late treatment of Nigerian children with heart diseases leading to increased mortality and morbidity. OBJECTIVES This study aimed to determine the z‑scores for various cardiac structures and functions among healthy children in Southeast Nigeria. MATERIALS AND METHODS This is a cross-sectional observational study where z-scores of the cardiac structure and function of three hundred healthy children were estimated using echocardiography and compared with the standard Detroit values. RESULT There was a significant positive correlation between age and cardiac valve diameter. The aortic valve strongly correlated positively with age with the Pearson correlation coefficient (ρ) of 0.8 and probability value (P-value) of 0.00. None of the ventricular function variables deviated beyond the +2 or -2 z-score. There was a positive correlation between the z-scores of ventricular function parameters and participants' age, although the strength of the correlation varied. Comparing these values with that of Detroit values, there was a significant difference in the deviation of the mean of the mitral valve and left pulmonary artery diameters from the Detroit values between the males and the females. While the mean z-score mitral valve was 0.8 in males, it was 0.6 in females (P = 0.02). CONCLUSION Z-scores of cardiac structures and function are derived from children in this locale. These values were similar to that of Detroit values except for the mitral valve and left pulmonary artery.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Bartholomew Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Awoere Chinawa
- Department of Community Medicine, ESUCOM, Parklane, Enugu, Nigeria
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5
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Yang J, Yu J, Wang Y, Liao M, Ji Y, Li X, Wang X, Chen J, Qi B, Yang F. Development of hypertension models for lung cancer screening cohorts using clinical and thoracic aorta imaging factors. Sci Rep 2024; 14:6862. [PMID: 38514739 PMCID: PMC10957886 DOI: 10.1038/s41598-024-57396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/18/2024] [Indexed: 03/23/2024] Open
Abstract
This study aims to develop and validate nomogram models utilizing clinical and thoracic aorta imaging factors to assess the risk of hypertension for lung cancer screening cohorts. We included 804 patients and collected baseline clinical data, biochemical indicators, coexisting conditions, and thoracic aorta factors. Patients were randomly divided into a training set (70%) and a validation set (30%). In the training set, variance, t-test/Mann-Whitney U-test and standard least absolute shrinkage and selection operator were used to select thoracic aorta imaging features for constructing the AIScore. Multivariate logistic backward stepwise regression was utilized to analyze the influencing factors of hypertension. Five prediction models (named AIMeasure model, BasicClinical model, TotalClinical model, AIBasicClinical model, AITotalClinical model) were constructed for practical clinical use, tailored to different data scenarios. Additionally, the performance of the models was evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analyses (DCA). The areas under the ROC curve for the five models were 0.73, 0.77, 0.83, 0.78, 0.84 in the training set, and 0.77, 0.78, 0.81, 0.78, 0.82 in the validation set, respectively. Furthermore, the calibration curves and DCAs of both sets performed well on accuracy and clinical practicality. The nomogram models for hypertension risk prediction demonstrate good predictive capability and clinical utility. These models can serve as effective tools for assessing hypertension risk, enabling timely non-pharmacological interventions to preempt or delay the future onset of hypertension.
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Affiliation(s)
- Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liao
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Ji
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Xuechun Wang
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Jun Chen
- Precision Healthcare Institute, GE Healthcare, Shanghai, China
| | - Benling Qi
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Cuspidi C, Faggiano A, Mancia G, Grassi G. Echocardiographic Phenotypes of Subclinical Organ Damage: Clinical and Prognostic Value in the General Population. Findings from the Pamela Study. High Blood Press Cardiovasc Prev 2023; 30:497-511. [PMID: 38032423 DOI: 10.1007/s40292-023-00610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of established adverse prognostic significance such as left ventricular hypertrophy (LVH), alterations of LV geometry, left atrial (LA) enlargement, and aortic root (AR) dilatation. The excess cardiovascular (CV) risk associated with these phenotypes has been consistently demonstrated in different clinical settings such in patients with systemic hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, heart failure and in geneal population samples. The Pressioni Monitorate e Loro Associazioni (PAMELA), a longitudinal population-based study originally designed to assess the normality values, prognostic significance of office, home and 24-hour blood pressure, including among the many clinical and laboratory variables the collection of echocardiographic data, allowed to gather important information on the clinical prognostic significance of subclinical cardiac damage during a long follow-up period. This article summarizes the original findings provided by the PAMELA study on the clinical correlates and prognostic significance of echocardiographic markers of subclinical organa damage namely LVH, left atrial enlargement (LA) and AR dilatation at the community level.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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7
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Zuo X, Liu L, Liu K, Zhang X, Ye R, Yang C, Ma J, Jia S, Yang X, Liu X, Sun L, Huo X, Chen X. Proximal aorta dilatation in hypertension. J Hypertens 2023; 41:1511-1520. [PMID: 37642588 DOI: 10.1097/hjh.0000000000003518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Dilation of the proximal aorta is a common clinical manifestation in hypertensive patients. Although it is straightforward to link hypertension with proximal aortic dilation, previous studies on their interrelation have yielded controversial results. Cross-sectional design, methodology of blood pressure assessment, confounding factors like medications, and inconsistent reference values may lead to the paradoxical conclusions. Recently, advances have been made in the exploration of determinants and clinical value of proximal aortic dilatation. Thus, we reviewed these findings and summarized that aortic dilatation may be the consequence of hemodynamic and nonhemodynamic co-factors' combined action. Moreover, proximal aortic dilatation tends to be a predictor for aortic aneurysm dissection or rupture, hypertensive target organ damage as well as cardiovascular events. The present review contributes to a comprehensive understanding of the pathological process of proximal aortic dilatation in hypertension.
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Affiliation(s)
- Xianghao Zuo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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8
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Al-Mosawi AA, Nafakhi H, Hameed HK. Aortic root diameter, main pulmonary artery diameter/aortic root diameter and pericardial fat volume as predictors of occlusive coronary artery disease. Monaldi Arch Chest Dis 2023; 94. [PMID: 37702440 DOI: 10.4081/monaldi.2023.2655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
The clinical relevance of aortic root diameter (ARD), main pulmonary artery diameter (MPAd), or pericardial fat volume (PFV) in the assessment of coronary artery disease (CAD) is largely unknown. We aimed to assess the relationship of PFV, ARD, MPAd, and MPAd/ARD ratio with occlusive CAD (stenosis >50%).This cross-sectional study included patients who had chest pain suggestive of CAD and underwent a 64-multislice multi-detector computed tomography angiography exam to exclude occlusive CAD presence. A total of 145 patients were enrolled in this study. The mean age was 54±10 years, and 51% were males. The mean PFV, ARD, MPAd, and MPAd/ARD ratio in all patients were 155 cm3, 29.9 mm, 23.4 mm, and 0.8, respectively. On univariate analysis, PFV [odds ratio (OR) (confidence interval, CI)=1.1 (1.01-1.3), p<0.01], ARD [OR (CI)=1.2 (1.1-1.4), p<0.01], and MPAd/ARD ratio [OR (CI)= 0.2 (0.1-0.5), p=0.02] showed significant association with occlusive CAD presence. After adjusting for cardiac risk factors, only PFV [OR (CI)=1.1 (1.02-1.3), p<0.01], but not ARD [OR (CI)=0.9(0.3-2), p=0.85] or MPAd/ARD ratio [OR (CI)=0.1(0.1-2), p=0.69], was independently associated with occlusive CAD. In conclusion, increased PFV, but not ARD or MPAd/ARD ratio, showed a significant and independent association with occlusive CAD presence in patients with chest pain suggestive of CAD.
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Affiliation(s)
| | - Hussein Nafakhi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf.
| | - Hadeel K Hameed
- Radiology Department, Medicine College, University of Kufa, Najaf.
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9
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Airale L, Borrelli F, Arrivi A, Baracchi A, Bertacchini F, Cartella I, Curcio R, Izzo R, Lembo M, Mancusi C, Manzi MV, Milani M, Moreo A, Paini A, Pucci G, Ruscelli F, Salvetti M, Soldati M, Milan A. Ascending aorta dilatation is associated to hard cardiovascular events, follow-up from multicentric ARGO-Perspective project. Hypertens Res 2023; 46:2016-2023. [PMID: 37328694 DOI: 10.1038/s41440-023-01340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/18/2023]
Abstract
Aortic root dilatation has been proposed as hypertension-mediated organ damage (HMOD). Nevertheless, the role of the aortic root dilatation as a possible additional HMOD is still unclear since studies conducted so far are quite heterogeneous regarding the type of population analyzed, the aortic tract considered, and the type of outcomes accounted for. The aim of the present study is to assess whether the presence of aortic dilatation is associated with strong cardiovascular (CV) events (MACE: heart failure, CV death, stroke, acute coronary syndrome, myocardial revascularization) in a population of patients affected by essential hypertension. Four hundred forty-five hypertensive patients from six Italian hospitals were recruited as part of ARGO-SIIA study1. For all centers, follow-up was obtained by re-contacting all patients by telephone and through the hospital's computer system. Aortic dilatation (AAD) was defined through absolute sex-specific thresholds as in previous studies (41 mm for males, 36 mm for females). Median follow-up was 60 months. AAD was found to be associated with the occurrence of MACE (HR = 4.07 [1.81-9.17], p < 0.001). This result was confirmed after correction for main demographic characteristics such as age, sex and BSA (HR = 2.91 [1.18-7.17], p = 0.020). At penalized Cox regression, age, left atrial dilatation, left ventricular hypertrophy and AAD were identified as best predictor of MACEs and AAD resulted a significant predictor of MACEs even after correction for these confounders (HR = 2.43 [1.02-5.78], p = 0.045). The presence of AAD was found to be associated with an increased risk of MACE independently of for major confounders, including established HMODs. AAD ascending aorta dilatation, LAe left atrial enlargement, LVH left ventricular hypertrophy, MACEs major adverse cardiovascular events, SIIA Società Italiana dell'Ipertensione Arteriosa (Italian Society for Arterial Hypertension).
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Affiliation(s)
- Lorenzo Airale
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Borrelli
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessio Arrivi
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Alessandro Baracchi
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio Bertacchini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Iside Cartella
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Rosa Curcio
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Lembo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Virgina Manzi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Martina Milani
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Antonella Moreo
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Anna Paini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giacomo Pucci
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Federico Ruscelli
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Salvetti
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Soldati
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy.
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10
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Tadic M, Gherbesi E, Sala C, Carugo S, Cuspidi C. Is Thoracic Aortic Diameter an Independent Predictor of Cardiovascular Disease and Mortality? A Narrative Review. Front Cardiovasc Med 2022; 9:867026. [PMID: 35571154 PMCID: PMC9098814 DOI: 10.3389/fcvm.2022.867026] [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: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of recognized adverse prognostic values, such as left ventricular hypertrophy (LVH), concentric remodeling, systolic/diastolic dysfunction, left atrial dilatation, and alterations of LV geometry. The excess cardiovascular risk associated with these markers has been documented in multiple clinical settings, such as the general population, hypertensive cohorts, patients with coronary heart disease, diabetes mellitus, chronic heart failure, and chronic kidney disease. On the contrary, the value of aortic root (AR) and ascending aortic diameter in predicting cardiovascular outcomes and all-cause mortality in populations free from overt aortic pathology is still debated. The present review, aimed at pointing out the prognostic implications of thoracic aortic dimensions in populations free from known connective and aortic diseases, suggests that available evidence supporting an association between aortic diameter and cardiovascular events, and all-cause mortality is based on the limited number of studies, conducted with different imaging techniques and definition of the aortic phenotype.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital “Dr. Dragisa Misovic-Dedinje”, Belgrade, Serbia
- *Correspondence: Marijana Tadic, ;
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore, IRCCS Policlinico di Milano, University of Milano, Milan, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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11
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Wenzel JP, Petersen E, Nikorowitsch J, Senftinger J, Sinning C, Theissen M, Petersen J, Reichenspurner H, Girdauskas E. Transthoracic echocardiographic reference values of the aortic root: results from the Hamburg City Health Study. Int J Cardiovasc Imaging 2021; 37:3513-3524. [PMID: 34324091 PMCID: PMC8604854 DOI: 10.1007/s10554-021-02354-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022]
Abstract
Here we generate up-to-date reference values of transthoracic echocardiographic aortic root dimensions matched by sex, age, and body surface area (BSA) derived from the population-based Hamburg City Health Study (HCHS) cohort. In 1687 healthy subjects (mean age 57.1 ± 7.7, 681 male and 1006 female), derived from the first prospectively-recruited 10,000 HCHS participants, dimensions of the aortic root were measured in systole and diastole using state-of-the-art 2-dimensional transthoracic echocardiography. Diameters were assessed at four levels: aortic annulus, Sinus of Valsalva, sinotubular junction, and ascending aorta. Female sex was associated with significantly smaller absolute aortic root dimensions, while indexing for BSA resulted in a reverse effect at all levels. There was a strong age dependency of all aortic root diameters as well as aortic annulus/sinotubular junction ratio for both sexes. Multivariate analysis revealed age, sex, weight, height, and BSA to be significant determinants of aortic root size. Finally, formulas were generated for the calculation of individual aortic root reference values considering age, sex, weight, and height. We provide population-based reference values of aortic root diameters based on a standardized transthoracic echocardiographic protocol of the population-based HCHS which may support the diagnosis, monitoring, and treatment of aortic root disease.
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Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- Epidemiological Study Centre, Hamburg, Germany
| | | | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Matthias Theissen
- Department of Cardiovascular Surgery, University Heart Centre Hamburg, Hamburg, Germany
| | - Johannes Petersen
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart Centre Hamburg, Hamburg, Germany
| | | | - Evaldas Girdauskas
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart Centre Hamburg, Hamburg, Germany
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12
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Chinawa JM, Chinawa AT, Ossai EN, Chukwu BF, Ndu IK, Asinobi IN. Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria. Malawi Med J 2021; 33:127-134. [PMID: 34777708 PMCID: PMC8560357 DOI: 10.4314/mmj.v33i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations. Objectives The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography. Methods A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls. Results A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). Conclusion This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Awore T Chinawa
- Consultant Community Physician and Lecturer Enugu state University Teaching hospital, Enugu State
| | - Edmund N Ossai
- Department of community Medicine College of Health Sciences Ebonyi State University Abakaliki, Nigeria
| | - Bartholomew F Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
| | - Isaac N Asinobi
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
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13
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Aortic Root Dilatation Is Attenuated with Diabetes but Is Not Associated with Renal Progression in Chronic Kidney Disease. J Pers Med 2021; 11:jpm11100972. [PMID: 34683112 PMCID: PMC8537293 DOI: 10.3390/jpm11100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with chronic kidney disease (CKD) often have cardiac functional and structural abnormalities which can lead to adverse cardiovascular outcomes. In this study, we investigated associations between diabetes mellitus (DM) and cardiac functional and structural parameters in patients with CKD focusing on aortic root diameter (ARD). We also investigated associations of renal outcomes with DM and cardiac functional and structural characteristics. We enrolled 419 patients with CKD stage 3–5 were enrolled. ARD was normalized to body surface area (BSA) (ARD/BSA), and the rate of decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope (mL/min/1.73 m2/year). ARD/BSA ≥2.1 cm/m2 in men or ≥2.2 cm/m2 in women was defined as indicating aortic root dilatation. The patients with DM had lower ARD/BSA, higher left atrial dimension (LAD), lower left ventricular ejection fraction, lower ratio of peak early transmitral filling wave velocity to peak late transmitral filling wave velocity, and higher left ventricular relative wall thickness, than those without DM. After multivariable analysis, DM (vs. non-DM; coefficient β, −0.060; p = 0.018) was significantly associated with low ARD/BSA. Significantly fewer patients with DM had aortic root dilatation compared to those without DM (14.3% vs. 23.1%, p = 0.022). In the patients with DM, there were significant associations between a high left ventricular mass index (LVMI) (per 1 g/m2, β, −0.016; p = 0.040) and high LAD (per 1 cm; β, −1.965; p < 0.001) with a low eGFR slope. However, other parameters, including ARD/BSA, were not associated with eGFR slope. Furthermore, there were no associations between eGFR slope and any of the echocardiographic parameters in the patients without DM. Aortic root dilatation was attenuated in the patients with DM, but it was not associated with a decline in renal function. However, high LAD and LVMI were associated with rapid renal function decline in the CKD patients with DM.
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14
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Fernandes LP, Barreto ATF, Neto MG, Câmara EJN, Durães AR, Roever L, Aras-Júnior R. Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2754. [PMID: 34190849 PMCID: PMC8221562 DOI: 10.6061/clinics/2021/e2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 01/19/2023] Open
Abstract
Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.
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Affiliation(s)
- Luciana Pereira Fernandes
- Programa de Pos Graduacao em Medicina e Saude, Universidade Federal da Bahia, Salvador, BA, BR
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
- *Corresponding author. E-mail:
| | - Ana Terra Fonseca Barreto
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
| | - Mansueto Gomes Neto
- Grupo de Pesquisa em Fisioterapia, Universidade Federal da Bahia, Salvador, BA, BR
| | | | | | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Roque Aras-Júnior
- Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA, BR
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15
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Kwan AC, Salto G, Demosthenes E, Lehman BT, Osypiuk E, Stantchev P, Vasan RS, Cheng S. High-throughput digitization of analog human echocardiography data. MethodsX 2020; 7:101159. [PMID: 33665148 PMCID: PMC7897705 DOI: 10.1016/j.mex.2020.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022] Open
Abstract
Echocardiographic imaging has been acquired in historical longitudinal cohorts of cardiovascular disease. Many cohorts were established prior to digital recording of echocardiography, and thus have preserved their archival imaging on Video Home System (VHS) tapes. These tapes require large physical storage space, are affected by physical degradation, and cannot be analyzed using modern digital techniques. We have designed and implemented a standardized methodology for digitizing analog data in historical longitudinal cohorts. The methodology creates a pipeline through critical steps of initial review, digitization, anonymization, quality control, and storage. The methodology has been implemented in the Framingham Offspring Study, a community-based epidemiological cohort study with echocardiography performed during serial examinations between 1987 and 1998. We present this method as an accessible pipeline for preserving and repurposing historical imaging data acquired from large cohort studies. The described technique:Outlines a generalizable pipeline for digitization of analog recordings of echocardiography stored on VHS tapes Addresses research concerns including quality control, anonymization, and storage Expresses the authors’ individual experience regarding observed image quality, training needs, and potential limitations to help readers understand the costs and benefits of this method
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Affiliation(s)
- Alan C Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Gerran Salto
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Emmanuella Demosthenes
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Birgitta T Lehman
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Ewa Osypiuk
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Plamen Stantchev
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States
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16
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Liu LYM, Yun CH, Kuo JY, Lai YH, Sung KT, Yuan PJ, Tsai JP, Huang WH, Lin YH, Hung TC, Chen YJ, Su CH, Tsai CT, Yeh HI, Hung CL. Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography. Diagnostics (Basel) 2020; 10:diagnostics10090712. [PMID: 32961874 PMCID: PMC7555013 DOI: 10.3390/diagnostics10090712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, p < 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all p < 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (p for ∆AUROC: < 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.
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Affiliation(s)
- Lawrence Yu-min Liu
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Department of Radiology, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Yau-Huei Lai
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Po-Jung Yuan
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Yueh-Hung Lin
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Ying-Ju Chen
- Telehealth Center, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan;
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Cheng-Ting Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
- Correspondence: (C.-T.T.); (C.-L.H.)
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (L.Y.-m.L.); (C.-H.Y.); (J.-Y.K.); (Y.-H.L.); (K.-T.S.); (P.-J.Y.); (J.-P.T.); (W.-H.H.); (Y.-H.L.); (T.-C.H.); (C.-H.S.); (H.-I.Y.)
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan
- Telehealth Center, MacKay Memorial Hospital, Zhongshan North Road, Taipei City 10449, Taiwan;
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 25245, Taiwan
- Correspondence: (C.-T.T.); (C.-L.H.)
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17
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Ye M, Zhang J, Li J, Liu Y, He W, Lin H, Fan R, Li C, Li W, Liu D, Yao F. Diabetes attenuated age-related aortic root dilatation in end-stage renal disease patients receiving peritoneal dialysis. J Diabetes Investig 2019; 10:1550-1557. [PMID: 30943331 PMCID: PMC6825943 DOI: 10.1111/jdi.13055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/21/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION Recently, some data have supported the concept that diabetes is negatively associated with aortic aneurysm. In the present study, we aimed to investigate the relationship between diabetes and cardiac structural and functional characteristics, in particular, aortic root dimensions, in end-stage renal disease (ESRD) patients. METHODS ESRD patients receiving peritoneal dialysis for >3 months were consecutively enrolled. Clinical features and echocardiographic parameters were analyzed according to the presence of diabetes history. Correlation analyses were carried out for diabetes mellitus and aortic root dilatation. Multiple logistic regression analysis was carried out to identify variables correlated with aortic root dilatation. RESULTS A total of 218 ESRD patients receiving peritoneal dialysis were enrolled. Patients with diabetes showed lower left ventricular internal measurements in end-diastole, left ventricular internal measurements in end-systole and aortic root diameter (ARD)/body surface area (BSA). Worse cardiac diastolic function was also observed in these patients. In addition, the age-related increase of ARD/BSA and ARD/height was attenuated in patients with diabetes. With the increase of ARD/BSA, lower levels of serum creatinine, phosphorus and serum glucose, as well as higher serum high-density lipoprotein cholesterol and apolipoprotein A-1 were also observed. Increased normalized left ventricular internal measurements were shown in patients with greater ARD/BSA. Multiple regression analysis showed that diabetes (odds ratio 0.353, P = 0.015) was an independent correlate of aortic root dilatation, even after correction for age, sex and other clinical confounders in the enrolled patients. CONCLUSIONS The present findings shown an inverse association between diabetes and age-related aortic root dilatation in ESRD patients. Diabetes remained to be independently correlated with aortic root dilatation even after adjustment for age, sex and other clinical confounders in ESRD patients.
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Affiliation(s)
- Min Ye
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Jingwei Zhang
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Jianbo Li
- Department of NephrologyThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
- Key Laboratory of NephrologyMinistry of Health and Guangdong ProvinceGuangzhouChina
| | - Yanqiu Liu
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Wei He
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Hong Lin
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Rui Fan
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Cuiling Li
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Wei Li
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Donghong Liu
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Fengjuan Yao
- Department of UltrasoundInstitute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
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Chien KL. Mini-Review of the Chin-Shan Community Cardiovascular Cohort Study in Population Health Research in Taiwan. ACTA CARDIOLOGICA SINICA 2017; 33:226-232. [PMID: 28559652 PMCID: PMC5445239 DOI: 10.6515/acs20161021a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/21/2016] [Indexed: 01/07/2023]
Abstract
Preventing and controlling non-communicable diseases (NCDs) is a growing global public health concern, and evidence-based data from population-based health studies are needed in order to develop appropriate public health policies for controlling NCDs. The Chin-Shan Community Cardiovascular Cohort (CCCC) study is a prospective cohort consisting of participants from one community in China in 1990-1991, and has provided substantial evidence-based data on domestic and global health issues in preventive cardiology fields. The present study is a mini-review of the CCCC study. In this review, we have described the historical background of the cardiovascular disease burden and related risk factors, especially lifestyle factors, subclinical disease markers, biomarkers and prediction models, and related international collaborative projects. In addition, this mini-review study provides a measure of insight into future plans for 21st century epidemiological research in cardiovascular diseases, suggesting possible areas of focus for future research.
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Affiliation(s)
- Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Luo JL, Chien KL, Hsu HC, Su TC, Lin HJ, Chen PC, Chen MF, Lee YT. Association between plasma homocysteine concentration and the risk of all-cause death in adults with diastolic dysfunction in a community: A 13-year cohort study. Medicine (Baltimore) 2017; 96:e6716. [PMID: 28445283 PMCID: PMC5413248 DOI: 10.1097/md.0000000000006716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is still unknown that serum homocycsteine level was useful in predicting the outcome in patients with diastolic dysfunction. We conducted a cohort study to determine if HHCYS was associated with poor prognosis in diastolic dysfunction patients. The Chin-Shan Community Cardiovascular Cohort (CCCC) study was designated to investigate the trends of cardiovascular morbidity and mortality in a community. Individuals who were 35 years and above were enrolled. Participants were categorized by homocysteine concentration quartiles. We used multivariate Cox proportional hazards models to calculate the hazard ratio (HR) of the 4th quartiles versus the 1st quartile. Area under the receiver-operating characteristic (ROC) curve was to compare prediction measures. A total of 2020 participants had completed the echocardiography examination, and 231 individuals were diagnosed as diastolic dysfunction. A total 75 participants had died during follow-up period. HHCYS was found to be significantly associated with poor prognosis. The adjusted HR for homocysteine level was 1.07 (95% confidence interval [CI], 1.01-1.14). Participants in the highest quartile had a 1.90 (95% CI, 0.88-4.12, P for trend, .026) fold risk for all cause death, compared with those in the lowest quartiles. The HR was 1.88 (95% CI, 1.07-3.29) using 11.11 μmol/L as cut point for hyperhomocysteine. HHCYS was significantly associated with poor prognosis in diastolic dysfunction participants in the community.
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Affiliation(s)
- Jing-Ling Luo
- Division of Cardiology, Department of Internal Medicine, Min-sheng Hospital, Taoyuan county
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public School, National Taiwan University
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiung-Ching Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Ju Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Fong Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Teh Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Nardi E, Mulè G, Nardi C, Geraci G, Averna M. Inverse association between type 2 diabetes and aortic root dimension in hypertensive patients. Int J Cardiol 2016; 228:233-237. [PMID: 27865191 DOI: 10.1016/j.ijcard.2016.11.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Some data support the concept that aortic root diameter (ARD) in hypertension may be regarded as a marker of subclinical organ damage. The impact of type 2 diabetes mellitus (DM) on cardiac structure and function is known, although the relationship between DM and ARD is not clear. The aim of our study was to evaluate the influence of DM on ARD in hypertensive patients. METHODS We enrolled 1693 hypertensive patients (aged 63.7±9.6years). The population was divided into two groups: the first one with DM (n=747) and the second one without DM (n=946). ARD was measured by echocardiography at level of Valsalva's sinuses using echocardiography M-mode tracings. It was considered as absolute measure and normalized to height (ARD/H) and body surface area (ARD/BSA). Left ventricular mass index (LVMI) and some parameters of systolic and diastolic function have been valued by means of echocardiography and tissue Doppler imaging. RESULTS The DM group was characterized by more elevated values of LVMI and a worst systolic and diastolic function. ARD value was significantly lower in DM group in comparison to patients without DM only when indexed for BSA (ARD/BSA=18.7±2.3mm/m2 vs 18.3±2.0mm/m2, p=0.01). This difference remained statistically significant, even after correction by age, sex and BMI (p=0.01). A multivariate linear regression analysis demonstrated an inverse relationship between DM and ARD/BSA after correction for potential confounders (β=0.10, p<0.001). CONCLUSIONS Our results confirm the hypothesis of a protective role of DM on aortic root dilatation.
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Affiliation(s)
- Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Chiara Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Maurizio Averna
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
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Vizzardi E, Maffessanti F, Lorusso R, Sciatti E, Bonadei I, Gelsomino S, Metra M, Pepi M. Ascending Aortic Dimensions in Hypertensive Subjects: Reference Values for Two-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29:827-37. [DOI: 10.1016/j.echo.2016.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 12/13/2022]
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22
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Konety SH, Koene RJ, Norby FL, Wilsdon T, Alonso A, Siscovick D, Sotoodehnia N, Gottdiener J, Fox ER, Chen LY, Adabag S, Folsom AR. Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging 2016; 9:e004431. [PMID: 27496550 PMCID: PMC5010094 DOI: 10.1161/circimaging.115.004431] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/23/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. METHODS AND RESULTS Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. CONCLUSIONS In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.
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Affiliation(s)
- Suma H Konety
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Faye L Norby
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Tony Wilsdon
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Alvaro Alonso
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - David Siscovick
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Nona Sotoodehnia
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - John Gottdiener
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Ervin R Fox
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Lin Y Chen
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Aaron R Folsom
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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23
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Relationship between aortic root size and glomerular filtration rate in hypertensive patients. J Hypertens 2016; 34:495-504; discussion 505. [DOI: 10.1097/hjh.0000000000000819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mulè G, Nardi E, Morreale M, Castiglia A, Geraci G, Altieri D, Cacciatore V, Schillaci M, Vaccaro F, Cottone S. The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:427-445. [PMID: 27873227 DOI: 10.1007/5584_2016_86] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques.An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation.Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial. The use of different methods for indexation of ARD may have in part contributed to the heterogeneous findings obtained in the investigations exploring the relationships between ARD and BP. Indeed, the best methods for ARD indexation, as well as the normal values of aortic root size, are still a matter of debate.Several non-hemodynamic factors influence ARD, including age, gender, and anthropometric variables, such as height, weight and their derivatives body surface area (BSA) and body mass index. Of these factors, anthropometric variables have the greatest impact.Several studies documented an association between ARD enlargement, assessed by echocardiography, and some indices of hypertensive target organ damage such as left ventricular hypertrophy, diastolic dysfunction, and carotid intima-media thickening. Recently, we found that ARD, expressed either as absolute values or normalized for BSA (ARD/BSA) or height (ARD/H), was significantly greater in hypertensive subjects with chronic kidney disease (CKD) when compared to their counterparts with normal renal function. Moreover, at univariate analyses estimated glomerular filtration rate (eGFR) showed significant inverse correlations with ARD not indexed and with ARD/BSA and ARD/H. Taking into account the effect of age, sex, duration of hypertension and other potentially confounding factors, in multiple regression analyses, only the association of GFR with ARD/H and that between GFR and ARD/BSA remained statistically significant. The receiver-operating characteristic curve analysis revealed that an estimated GFR of about 50 ml/min/1.73 m2 represents the better threshold to distinguish hypertensive patients with dilated aortic root from those with a normal one.Some population-based studies showed that an enlarged ARD might predict an adverse prognosis, even in absence of aneurysmatic alterations.In the Cardiovascular Health Study, a dilated aortic root was independently associated with an increased risk for stroke, cardiovascular and total mortality in both sexes and with incident congestive heart failure only in men. The relationship between ARD and heart failure has been observed also in the Framingham Heart Study. More recently, the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study demonstrated an independent relationship of ARD/H with incident cardiovascular morbidity and mortality.Although the relationship between BP and aortic root size is still a matter of debate, increasing evidence seems to support the notion that aortic root dilatation, even in absence of aneurysmatic alterations, may be regarded as an hypertensive organ damage paralleling other preclinical markers whose unfavourable prognostic significance is firmly established. Future studies are needed to assess whether or not antihypertensive therapy is able to reduce aortic root dimension and the increased risk associated with its enlargement.
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Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Massimiliano Morreale
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Antonella Castiglia
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Dario Altieri
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Valentina Cacciatore
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Margherita Schillaci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Francesco Vaccaro
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Son MK, Chang SA, Kwak JH, Lim HJ, Park SJ, Choi JO, Lee SC, Park SW, Kim DK, Oh JK. Comparative measurement of aortic root by transthoracic echocardiography in normal Korean population based on two different guidelines. Cardiovasc Ultrasound 2013; 11:28. [PMID: 23941562 PMCID: PMC3751523 DOI: 10.1186/1476-7120-11-28] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/12/2013] [Indexed: 12/01/2022] Open
Abstract
Background Aortic root size is an important parameter in vascular diseases and can be easily assessed by transthoracic echocardiography. However, measurements values may vary according to cardiac cycle and the definition used for edge. This study aimed to define normal values according to the measurement method specified by two different guidelines to determine the influence of the different methods on echocardiographic measurements. Methods Healthy Korean adults were enrolled. The aortic root diameters were measured twice at four levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta) by the 2005 American Society of Echocardiography (ASE) guidelines (measured from leading edge to leading edge during diastole) and the 2010 ASE pediatric guidelines (measured from inner edge to inner edge during systole). Results One hundred twelve subjects aged 20–69 years were enrolled. The aortic diameters (cm) determine by the aforementioned two guidelines showed significant difference. Measurements were larger in 2005 ASE guideline at aortic annuls, sinuses of Valsalva, and sinotubular junction level, but smaller at ascending aortic level with 2-3mm of differences. Intraobserver variability was similarly good, but interobserver variability was slightly higher than intraobserver variability in both measurement methods. BSA and age was most important determinant for aortic root size. Conclusions The measurement method of aortic root can affect the echocardiographic result. The measurement method should be noted when assessing clinical significance of aortic root measurement.
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Affiliation(s)
- Myoung Kyun Son
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Lai CL, Chien KL, Hsu HC, Su TC, Chen MF, Lee YT. Left atrial dimension and risk of stroke in women without atrial fibrillation: the Chin-Shan Community Cardiovascular Cohort study. Echocardiography 2011; 28:1054-60. [PMID: 21988172 DOI: 10.1111/j.1540-8175.2011.01489.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence on the relationship between left atrial dimension and cardiovascular events is inconclusive. We explored the association between left atrial dimension and stroke and all-cause death in an ethnic Chinese population. METHODS We recruited 1,937 subjects undertaking echocardiographic examination without prior atrial fibrillation/stroke in the Chin-Shan Community Cardiovascular Cohort study. Left atrial dimension indexed by body mass index was used as left atrial dimension index (LADI) for analysis. The end points were stroke and all-cause death. A multivariate Cox regression analysis was used to estimate the relative risks between participants stratified by tertile of LADI within each gender. RESULTS During a median follow-up of 11.9 years, 21,733 person-years were accrued and 114 subjects with stroke and 364 all-cause deaths were identified. The adjusted relative risk of stroke was 2.44 (95% CI, 1.11 to 5.36, P for trend = 0.029) among women in the upper tertile of LADI compared with women in the lower tertile of LADI. Further adjusting for left ventricular mass index attenuated the relationship of LADI to stroke (adjusted relative risk 2.11, 95% CI, 0.88 to 5.02, P for trend = 0.09). In men, tertile of LADI was not associated with stroke. LADI was not associated with risk of all-cause death in both genders. CONCLUSIONS We found an association between increased LADI and incident stroke in women but not in men in this ethnic Chinese population. LADI was not associated with all-cause death in both genders.
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Affiliation(s)
- Chao-Lun Lai
- Cardiovascular Center, Far Eastern Memorial Hospital, Taiwan
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