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Raisi-Estabragh Z, Szabo L, McCracken C, Bülow R, Aquaro GD, Andre F, Le TT, Suchá D, Condurache DG, Salih AM, Chadalavada S, Aung N, Lee AM, Harvey NC, Leiner T, Chin CWL, Friedrich MG, Barison A, Dörr M, Petersen SE. Cardiovascular Magnetic Resonance Reference Ranges From the Healthy Hearts Consortium. JACC Cardiovasc Imaging 2024:S1936-878X(24)00061-5. [PMID: 38613554 DOI: 10.1016/j.jcmg.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The absence of population-stratified cardiovascular magnetic resonance (CMR) reference ranges from large cohorts is a major shortcoming for clinical care. OBJECTIVES This paper provides age-, sex-, and ethnicity-specific CMR reference ranges for atrial and ventricular metrics from the Healthy Hearts Consortium, an international collaborative comprising 9,088 CMR studies from verified healthy individuals, covering the complete adult age spectrum across both sexes, and with the highest ethnic diversity reported to date. METHODS CMR studies were analyzed using certified software with batch processing capability (cvi42, version 5.14 prototype, Circle Cardiovascular Imaging) by 2 expert readers. Three segmentation methods (smooth, papillary, anatomic) were used to contour the endocardial and epicardial borders of the ventricles and atria from long- and short-axis cine series. Clinically established ventricular and atrial metrics were extracted and stratified by age, sex, and ethnicity. Variations by segmentation method, scanner vendor, and magnet strength were examined. Reference ranges are reported as 95% prediction intervals. RESULTS The sample included 4,452 (49.0%) men and 4,636 (51.0%) women with average age of 61.1 ± 12.9 years (range: 18-83 years). Among these, 7,424 (81.7%) were from White, 510 (5.6%) South Asian, 478 (5.3%) mixed/other, 341 (3.7%) Black, and 335 (3.7%) Chinese ethnicities. Images were acquired using 1.5-T (n = 8,779; 96.6%) and 3.0-T (n = 309; 3.4%) scanners from Siemens (n = 8,299; 91.3%), Philips (n = 498; 5.5%), and GE (n = 291, 3.2%). CONCLUSIONS This work represents a resource with healthy CMR-derived volumetric reference ranges ready for clinical implementation.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Giovanni Donato Aquaro
- Academic Radiology, Department of Surgical, Medical, and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Thu-Thao Le
- National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore
| | - Dominika Suchá
- University Medical Centre Utrecht, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands
| | - Dorina-Gabriela Condurache
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Ahmed M Salih
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Department of Computer Science, Faculty of Science, University of Zakho, Zakho, Kurdistan Region, Iraq
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Aaron Mark Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Nicholas C Harvey
- The Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Tim Leiner
- University Medical Centre Utrecht, Department of Radiology and Nuclear Medicine, Utrecht, the Netherlands; Mayo Clinic, Department of Radiology, Rochester, Minnesota, USA
| | - Calvin W L Chin
- National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore
| | - Matthias G Friedrich
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Andrea Barison
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marcus Dörr
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Health Data Research UK, London, United Kingdom; Alan Turing Institute, London, United Kingdom.
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Parke KS, Brady EM, Alfuhied A, Motiwale RS, Razieh CS, Singh A, Arnold JR, Graham-Brown MPM, Bilak JM, Ayton SL, Dattani A, Yeo JL, McCann GP, Gulsin GS. Ethnic differences in cardiac structure and function assessed by MRI in healthy South Asian and White European people: A UK Biobank Study. J Cardiovasc Magn Reson 2024; 26:100001. [PMID: 38218434 PMCID: PMC11211094 DOI: 10.1016/j.jocmr.2023.100001] [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: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Echocardiographic studies indicate South Asian people have smaller ventricular volumes, lower mass and more concentric remodelling than White European people, but there are no data using cardiac MRI (CMR). We aimed to compare CMR quantified cardiac structure and function in White European and South Asian people. METHODS Healthy White European and South Asian participants in the UK Biobank Imaging CMR sub-study were identified by excluding those with a history of cardiovascular disease, hypertension, obesity or diabetes. Ethnic groups were matched by age and sex. Cardiac volumes, mass and feature tracking strain were compared. RESULTS 121 matched pairs (77 male/44 female, mean age 58 ± 8 years) of South Asian and White European participants were included. South Asian males and females had smaller absolute but not indexed left ventricular (LV) volumes, and smaller absolute and indexed right ventricular volumes, with lower absolute and indexed LV mass and lower LV mass:volume than White European participants. Although there were no differences in ventricular or atrial ejection fractions, LV global longitudinal strain was higher in South Asian females than White European females but not males, and global circumferential strain was higher in both male and South Asian females than White European females. Peak early diastolic strain rates were higher in South Asian versus White European males, but not different between South Asian and White European females. CONCLUSIONS Contrary to echocardiographic studies, South Asian participants in the UK Biobank study had less concentric remodelling and higher global circumferential strain than White European subjects. These findings emphasise the importance of sex- and ethnic- specific normal ranges for cardiac volumes and function.
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Affiliation(s)
- Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rishabh S Motiwale
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Cameron S Razieh
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joanna M Bilak
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Sarah L Ayton
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Rashid A, Shah AA, Rather H, Rasool V, Hafeez I, Ajaz S, Purra S, Lone AA. Echocardiographic Measurements in Normal Healthy Adult Population of North India. Cureus 2023; 15:e47449. [PMID: 38022041 PMCID: PMC10660080 DOI: 10.7759/cureus.47449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND AIM Interpretation of imaging modalities depends on robust normal reference limits. Ethnicity is an essential determinant of cardiac chamber sizes. Though few studies from India have focused on this research, it has yet to include the Kashmiri population. We aimed to study normal echocardiographic values of healthy Kashmiri adults and compare them with Western and Indian studies. METHODS It was a prospective observational study on healthy adults of Kashmir Valley. A comprehensive echocardiographic analysis following standardized protocols was performed. RESULTS A total of 2245 study participants were analyzed. The mean age was 32.52±11.55 years. There were 1100 (49%) males. Males had higher absolute left ventricular volumes and mass, left atrial volumes, right ventricular diameter, and aortic size, while females had higher absolute left ventricular ejection fraction and early and late diastolic mitral inflow velocities. Males had higher indexed left ventricular end-systolic volume, while females had higher indexed left ventricular end diastole diameter, aorta diameter, right ventricle, and left and right atrial sizes. Left ventricular mass and diastolic parameters were significantly associated with age. Compared with the American Society of Echocardiography/European Association of Cardiovascular Imaging, absolute values of left ventricle size, volumes, mass, right ventricle size, aortic size, and left and right atrial size were higher than those in our study. Our study population had a higher left ventricle ejection fraction. Among indexed parameters, left ventricle volumes, left ventricle systolic diameter, aortic annulus, and left and right atrial volumes were still significantly higher in Western data. While comparing with Indian data, we noted significant regional differences. CONCLUSION We provide normal reference values for our local population. We noted significant differences with Western as well as other Indian populations. Our study highlights the need for developing ethnic-specific reference values of various echocardiographic measurements.
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Affiliation(s)
- Aamir Rashid
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aejaz A Shah
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Hilal Rather
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Vamiq Rasool
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Imran Hafeez
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Shahood Ajaz
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sameer Purra
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ajaz A Lone
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Vasan SK, Alex AG, Roy A, Gowri M, Sinha S, Suresh J, Philip RS, Kochumon J, Jaiswal N, Arulappan G, Ramakrishnan L, Sachdev HS, Tandon N, Thomas N, Jebasingh F, Osmond C, Karpe F, Bhargava SK, Antonisamy B, Prabhakaran D, Fall CH, Thomson VS. Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study. Front Cardiovasc Med 2023; 10:1055454. [PMID: 37522075 PMCID: PMC10372793 DOI: 10.3389/fcvm.2023.1055454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. Methods The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Results Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Conclusions Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. ISRCTN registration number 13432279.
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Affiliation(s)
- Senthil K. Vasan
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Sikha Sinha
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Jenifer Suresh
- Department of Cardiology, Christian Medical College, Vellore, India
| | | | | | | | | | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Felix Jebasingh
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H.D. Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
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Miyoshi T, Tanaka H. Standardization of normal values for cardiac chamber size in echocardiography. J Med Ultrason (2001) 2022; 49:21-33. [PMID: 34787741 DOI: 10.1007/s10396-021-01147-6] [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: 05/30/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
Echocardiography is used worldwide to evaluate cardiac size and function. To determine what values are abnormal, it is essential to establish normal reference values for echocardiography. The current guidelines for chamber quantification specify normative values for cardiac chambers and recommend that gender and body size be taken into account. However, these normative data were established using databases for which a variety of measurement methods were used and the majority of subjects consisted of Whites in Europe and the United States. However, several regional studies from other countries suggest that cardiac size varies globally. To overcome these limitations, the Normal Reference Ranges for Echocardiography study and the World Alliance of Societies of Echocardiography Normal Values study have recently been conducted to examine similarities and differences in cardiac chamber size and to establish normal reference values while taking worldwide diversity into account. The results from these studies have demonstrated that standardization of normal reference values for cardiac size is important. This review article aims to summarize the current status of normative echocardiographic values for cardiac chamber size.
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Affiliation(s)
- Tatsuya Miyoshi
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Sung KT, Chen YH, Kuo JY, Lai YH, Lo CI, Huang WH, Chien SC, Liu LYM, Bulwer B, Hou CJY, Su CH, Hung TC, Hung CL, Yeh HI. Prognostic superiority of global longitudinal strain beyond four-tiered ventricular hypertrophy in asymptomatic individuals. J Formos Med Assoc 2021; 121:1414-1424. [PMID: 34688532 DOI: 10.1016/j.jfma.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/21/2021] [Accepted: 09/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study aims to explore the clinical correlates of myocardial deformations using speckle-tracking algorithm and to determine the prognostic utility of such measures in asymptomatic ethnic Chinese population. METHODS Global longitudinal (GLS), circumferential strain (GCS), and torsion were analyzed using featured tissue-tracking algorithm among 4049 symptom-free ethnic Chinese population. Hypertrophy (LVH) was classified into 4 tiers: indeterminate, dilated, thick and thick/dilated, by gender-stratified partition of end-diastolic volume index (EDVi) and LV mass/EDV0.67. RESULTS LVH (7.3%) showed substantially lower GLS (-20.3 ± 1.82% vs. -18.9 ± 2.08%) yet higher torsion (2.20 ± 0.90 vs. 2.39 ± 1.01, p < 0.001) than non-LVH participants. Those with thick LVH (n = 123) were more obese, had higher blood pressure and increased high-sensitivity C-reactive protein (hs-CRP); with dilated/thick LVH (n = 26) group demonstrating highest pro-brain natriuretic peptide (NT-proBNP) and worse GLS compared to indeterminate-/non-LVH groups. There were independent associations among larger EDVi, higher NT-proBNP and decreased torsion, and among greater LV mass/EDV0.67, worse GLS, greater GCS/torsion and hs-CRP. Over a median of 2.3 years (IQR: 1.2-4.8), the dilated, thick, and dilated/thick LVH categorizations were associated with higher risk of composite all-cause death and heart failure (HF) compared to non-LVH (adjusted hazard ratio [HR]: 3.65, 3.72, 6.01, respectively, all p < 0.05). Per 1% GLS reduction was independently associated with higher risk (adjusted HR: 1.31, p < 0.001) and improved risk prediction (p ≤ 0.001 by integrated discrimination improvement [IDI]: 3.5%, 95% CI: 1.5%-5.6%, and continuous net reclassification improvement [NRI]: 42.3%, 95% CI: 24.0%-60.6%) over LVH. CONCLUSION GLS improved risk stratification of four-tiered classification of LVH in asymptomatic ethnic Chinese.
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Affiliation(s)
- Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
| | - Yi-Hsuan Chen
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Yau-Huei Lai
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; 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
| | - Chi-In Lo
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Lawrence Yu-Min Liu
- 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
| | - Bernard Bulwer
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Charles Jia-Yin Hou
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Cheng-Huang Su
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, 30071, Taiwan
| | - Ta-Chuan Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan.
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan.
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, 30071, Taiwan
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Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society. CHILDREN-BASEL 2021; 8:children8060447. [PMID: 34070381 PMCID: PMC8228459 DOI: 10.3390/children8060447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.
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Raisi-Estabragh Z, Kenawy AAM, Aung N, Cooper J, Munroe PB, Harvey NC, Petersen SE, Khanji MY. Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2021; 22:494-504. [PMID: 32460308 PMCID: PMC8081427 DOI: 10.1093/ehjci/jeaa089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS To determine population-related and technical sources of variation in cardiac magnetic resonance (CMR) reference ranges for left ventricular (LV) quantification through a formal systematic review and meta-analysis. METHODS AND RESULTS This study is registered with the International Prospective Register of Systematic Reviews (CRD42019147161). Relevant studies were identified through electronic searches and assessed by two independent reviewers based on predefined criteria. Fifteen studies comprising 2132 women and 1890 men aged 20-91 years are included in the analysis. Pooled LV reference ranges calculated using random effects meta-analysis with inverse variance weighting revealed significant differences by age, sex, and ethnicity. Men had larger LV volumes and higher LV mass than women [LV end-diastolic volume (mean difference = 6.1 mL/m2, P-value = 0.014), LV end-systolic volume (MD = 4 mL/m2, P-value = 0.033), LV mass (mean difference = 12 g/m2, P-value = 7.8 × 10-9)]. Younger individuals had larger LV end-diastolic volumes than older ages (20-40 years vs. ≥65 years: women MD = 14.0 mL/m2, men MD = 14.7 mL/m2). East Asians (Chinese, Korean, Singaporean-Chinese, n = 514) had lower LV mass than Caucasians (women: MD = 6.4 g/m2, P-value = 0.016; men: MD = 9.8 g/m2, P-value = 6.7 × 10-5). Between-study heterogeneity was high for all LV parameters despite stratification by population-related factors. Sensitivity analyses identified differences in contouring methodology, magnet strength, and post-processing software as potential sources of heterogeneity. CONCLUSION There is significant variation between CMR normal reference ranges due to multiple population-related and technical factors. Whilst there is need for population-stratified reference ranges, limited sample sizes and technical heterogeneity precludes derivation of meaningful unified ranges from existing reports. Wider representation of different populations and standardization of image analysis is urgently needed to establish such reference distributions.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Asmaa A M Kenawy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit (MRCLEU), Tremona Rd, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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9
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Sohn SH, Sul HJ, Choi Y, Lee S, Kim BJ, Kim HS, Koh Y, Zang DY. An integrated mRNA–microRNA regulatory network identified INHBA and has-miR-135a-5p as predictors of gastric cancer recurrence. Mol Cell Toxicol 2021. [DOI: 10.1007/s13273-021-00127-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Reference values of electrographic and cardiac ultrasound parameters in Russian healthy children and adolescents. Sci Rep 2021; 11:2916. [PMID: 33536510 PMCID: PMC7858601 DOI: 10.1038/s41598-021-82314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022] Open
Abstract
Between 2009 and 2013, a large cross-sectional study on the health consequences of the Chernobyl nuclear accident was performed in the contaminated and uncontaminated territories of the Bryansk Oblast (Russian Federation). The objective of this work was to confirm or refute a possible association between childhood cardiac arrhythmia and a chronic exposure to caesium-137. As part of this study, a large number of electrocardiographic and cardiac ultrasound parameters were collected from 18,152 children aged 2-18 years including 12,512 healthy ones not contaminated with caesium-137. It seemed therefore relevant for us to share in a second publication these medical data based on healthy and uncontaminated children with the scientific community because of the large quantities and the limited availability of such kind of data. In the present study, relating to electrocardiographic parameters, the measurements performed fully reflect the expected evolution of the paediatric electrocardiogram between 5 and 18 years of age. Thus, the median values were generally quite close to those available in the literature. In contrast, differences in the 2nd and 98th percentiles were notable and could be explained in particular by the type of equipment used, the number of subjects included in the study and racial disparities. As for echocardiographic parameters, the evolution of the measured values in age groups is consistent with what was expected considering factors such as growth. In comparison with other scientific studies that have investigated these echocardiographic parameters, some differences by age groups have been identified. The ethnic factor truly appears to be a relevant feature to consider. In view of the results, it appeared essential to the authors to approach the methodological conditions of the scientific studies already published on the topic to be truly comparable and thus to provide a reliable answer on a topic for which real expectations in terms of medical care are required.
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11
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Chang SN, Sung KT, Huang WH, Lin JW, Chien SC, Hung TC, Su CH, Hung CL, Tsai CT, Wu YW, Chiang FT, Yeh HI, Hwang JJ. Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited. J Formos Med Assoc 2021; 120:2160-2175. [PMID: 33423900 DOI: 10.1016/j.jfma.2020.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/08/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Diastolic dysfunction (DD) has shown to be a hallmark pathological intermediate in the development of heart failure with preserved ejection fraction (HFpEF). We aim to establish age- and sex-stratified normal reference values of diastolic indices and to explore racial-differences. METHODS We explored age- and sex-related structural/functional alterations from 6023 healthy ethnic Asians (47.1 ± 10.9 years, 61.3% men) according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria. Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. RESULTS Age- and sex-based normative ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age was independently associated with cardiac structural remodeling and worsened diastolic parameters including larger indexed LA volume (LAVi), lower e', higher E/e', and higher TR velocity; all p < 0.001), which were more prominent in women (P interaction: <0.05). Broadly, markedly lower e', higher E/e' and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/mL) (Specificity: 99.8%, NPV: 97.6%). CONCLUSION This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with aging played as central role in diastolic dysfunction. Our observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD in Asians.
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Affiliation(s)
- Sheng-Nan Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jou-Wei Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan
| | - Shih-Chieh Chien
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, New Taipei, Taiwan.
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, Fu-Jen Catholic University Hospital and Fu-Jen Catholic University, Taipei, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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12
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van Genuchten WJ, Toemen L, Roest AAW, Vernooij MW, Gaillard R, Helbing WA, Jaddoe VWV. Ethnic differences in childhood right and left cardiac structure and function assessed by cardiac magnetic resonance imaging. Eur J Pediatr 2021; 180:1257-1266. [PMID: 33170364 PMCID: PMC7940261 DOI: 10.1007/s00431-020-03869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life. We examined the ethnic differences in cardiac structure and function in children using cardiac magnetic resonance imaging in a European migrant population, and whether any difference was explained by early life factors. We used a prospective population-based cohort study among 2317 children in Rotterdam, the Netherlands. We compared children from Dutch (73%), Cape Verdean (3.5%), Dutch Antillean (3.3%), Moroccan (6.1%), Surinamese-Creoles (3.9%), Surinamese-Hindustani (3.4%), and Turkish (6.4%) background. Main outcomes were cMRI-measured cardiac structures and function. Cardiac outcomes were standardized on body surface area. Cape Verdean, Surinamese-Hindustani, and Turkish children had smaller right ventricular end-diastolic volume and left ventricular end-diastolic volume relative to their body size than Dutch children (p < 0.05). These results were not fully explained by fetal and childhood factors. Right ventricular ejection fraction and left ventricular ejection fraction did not differ between ethnicities after adjustment for fetal and childhood factors.Conclusion: Right ventricular end-diastolic volume and left ventricular end-diastolic volume differ between ethnic subgroups in childhood, without affecting ejection fraction. Follow-up studies are needed to investigate whether these differences lead to ethnic differences in cardiac disease in adulthood. What is Known: • Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life. • The prevalence of cardiovascular disease differs between ethnic groups. What is New: • We examined ethnic differences in left and right cardiac structure and function in children using cMRI. • Right and left cardiac dimensions differ between ethnic groups in childhood and are only partly explained by fetal and childhood factors.
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Affiliation(s)
- Wouter J. van Genuchten
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Liza Toemen
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Arno A. W. Roest
- grid.10419.3d0000000089452978Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Meike W. Vernooij
- grid.5645.2000000040459992XDepartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Willem A. Helbing
- grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W. V. Jaddoe
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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13
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Yeo JL, Brady EM, McCann GP, Gulsin GS. Sex and ethnic differences in the cardiovascular complications of type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211034297. [PMID: 34408835 PMCID: PMC8365016 DOI: 10.1177/20420188211034297] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus represents a global health concern affecting 463 million adults and is projected to rapidly rise to 700 million people by 2045. Amongst those with type 2 diabetes (T2D), there are recognised differences in the impact of the disease on different sex and ethnic groups. The relative risk of cardiovascular complications between individuals with and without T2D is higher in females than males. People of South Asian heritage are two to four times more likely to develop T2D than white people, but conversely not more likely to experience cardiovascular complications. Differences in the pathophysiological responses in these groups may identify potential areas for intervention beyond glycaemic control. In this review, we highlight key differences of diabetes-associated cardiovascular complications by sex and ethnic background, with a particular emphasis on South Asians. Evidence assessing therapeutic efficacy of new glucose lowering drugs in minority groups is limited and many major cardiovascular outcomes trials do not report ethnic specific data. Conversely, lifestyle intervention and bariatric surgery appear to have similar benefits regardless of sex and ethnic groups. We encourage future studies with better representation of women and ethnic minorities that will provide valuable data to allow better risk stratification and tailored prevention and management strategies to improve cardiovascular outcomes in T2D.
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Affiliation(s)
- Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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14
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Moody WE, Mahmoud-Elsayed HM, Senior J, Gul U, Khan-Kheil AM, Horne S, Banerjee A, Bradlow WM, Huggett R, Hothi SS, Shahid M, Steeds RP. Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race. CJC Open 2021; 3:91-100. [PMID: 32984798 PMCID: PMC7502228 DOI: 10.1016/j.cjco.2020.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. METHODS This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. RESULTS After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. CONCLUSIONS In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.
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Affiliation(s)
- William E. Moody
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Hani M. Mahmoud-Elsayed
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Jonathan Senior
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Uzma Gul
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Ayisha M. Khan-Kheil
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Sebastian Horne
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
| | - William M. Bradlow
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Robert Huggett
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Sandeep S. Hothi
- Heart & Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Muhammad Shahid
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Richard P. Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
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15
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Normative values of cardiac chamber dimensions and global longitudinal strain in Indians: the Indian Normative Data of Echocardiography Analyzed (INDEA) study. Int J Cardiovasc Imaging 2020; 37:871-880. [DOI: 10.1007/s10554-020-02060-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/05/2020] [Indexed: 02/01/2023]
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16
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Saeed S, Kanaya AM, Bennet L, Nilsson PM. Cardiovascular risk assessment in South and Middle-East Asians living in the Western countries. Pak J Med Sci 2020; 36:1719-1725. [PMID: 33235604 PMCID: PMC7674869 DOI: 10.12669/pjms.36.7.3292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Nearly a quarter of the world population lives in the South Asian region (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives). Due to rapid demographic and epidemiological transition in these countries, the burden of non-communicable diseases is growing, which is a serious public health concern. Particularly, the prevalence of pre-diabetes, diabetes and atherosclerotic cardiovascular disease (CVD) is increasing. South Asians living in the West have also substantially higher risk of CVD and mortality compared with white Europeans and Americans. Further, as a result of global displacement over the past three decades, Middle-Eastern immigrants now represent the largest group of non-European immigrants in Northern Europe. This vulnerable population has been less studied. Hence, the aim of the present review was to address cardiovascular risk assessment in South Asians (primarily people from India, Pakistan and Bangladesh), and Middle-East Asians living in Western countries compared with whites (Caucasians) and present results from some major intervention studies. A systematic search was conducted in PubMed to identify major cardiovascular health studies of South Asian and Middle-Eastern populations living in the West, relevant for this review. Results indicated an increased risk of CVD. In conclusion, both South Asian and Middle-Eastern populations living in the West carry significantly higher risk of diabetes and CVD compared with native white Europeans. Lifestyle interventions have been shown to have beneficial effects in terms of reduction in the risk of diabetes by increasing insulin sensitivity, weight loss as well as better glycemic and lipid control.
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Affiliation(s)
- Sahrai Saeed
- Sahrai Saeed, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Alka M Kanaya
- Alka M. Kanaya, Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Louise Bennet
- Louise Bennet, Department of Clinical Sciences, Family Medicine, Lund University Malmo, Sweden
| | - Peter M Nilsson
- Peter M Nilsson, Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
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17
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Miyoshi T, Addetia K, Citro R, Daimon M, Desale S, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Blitz A, Lang RM, Asch FM, Prado AD, Filipini E, Kwon A, Hoschke-Edwards S, Regina Afonso T, Thampinathan B, Sooriyakanthan M, Zhu T, Wang Z, Wang Y, Zhang M, Zhang Y, Yin L, Li S, Alagesan R, Balasubramanian S, Ananth R, Bansal M, Badano LP, Palermo C, Bossone E, Di Vece D, Bellino M, Nakao T, Kawata T, Hirokawa M, Sawada N, Nabeshima Y, Yun HR, Hwang JW, Fasawe D. Left Ventricular Diastolic Function in Healthy Adult Individuals: Results of the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr 2020; 33:1223-1233. [DOI: 10.1016/j.echo.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
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18
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Ihdayhid AR, Thakur U, Yap G, Goeller M, Nerlekar N, Adams D, Isa M, Joshi M, Cameron J, Seneviratne S, Dey D, Achenbach S, Leipsic J, Ko BS. Ethnic differences in coronary anatomy, left ventricular mass and CT-derived fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 15:249-257. [PMID: 33041249 DOI: 10.1016/j.jcct.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies have observed higher incidence of cardiovascular mortality in South Asians (SA), and lower prevalence in East Asians (EA), compared with Caucasians. These observations are not entirely explained by ethnic differences in cardiovascular risk factors and mechanistic factors such as variations in cardiac anatomy and physiology may play a role. This study compared ethnic differences in CT-assessed left ventricular (LV) mass, coronary anatomy and non-invasive fractional flow reserve (FFRCT). METHODS Three-hundred symptomatic patients (age 59 ± 7.9, male 51%) underwent clinically-mandated CT-coronary-angiography (CTA) were matched for age, gender, BMI and diabetes (100 each ethnicity). Assessment of coronary stenosis, luminal dimensions and vessel dominance was performed by independent observers. LV mass, coronary luminal volume and FFRCT were quantified by blinded core-laboratory. A sub-analysis was performed on patients (n = 187) with normal/minimal disease (0-25% stenosis). RESULTS Stenosis severity was comparable across ethnic groups. EA demonstrated less left-dominant circulation (2%) compared with SA (8.2%) and Caucasians (10.1%). SA compared with EA and Caucasians demonstrated smallest indexed LV mass, coronary luminal volumes and dimensions. EA compared with Caucasians had comparable indexed LV mass, coronary luminal dimensions and highest luminal volumes. The latter was driven by higher prevalence of right-dominance including larger and longer right posterior left ventricular artery. FFRCT in the left anterior descending artery (LAD) was lowest in SA (0.87) compared with EA (0.89; P = 0.009) and Caucasians (0.89; P < 0.001), with no difference in other vessels. All observed differences were consistent in patients with minimal disease. CONCLUSION This single-centre study identified significant ethnic differences in CT-assessed LV mass, coronary anatomy and LAD FFRCT. These hypotheses generating results may provide a mechanistic explanation for ethnic differences in cardiovascular outcomes and require validation in larger cohorts.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Grace Yap
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Markus Goeller
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Daniel Adams
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mourushi Isa
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mitwa Joshi
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - Jonathan Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
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Nel S, Khandheria BK, Libhaber E, Peters F, Ferreira dos Santos C, Matioda H, Grinter S, Maharaj N, Essop MR. Prevalence and significance of isolated left ventricular non-compaction phenotype in normal black Africans using echocardiography. IJC HEART & VASCULATURE 2020; 30:100585. [PMID: 32715082 PMCID: PMC7378683 DOI: 10.1016/j.ijcha.2020.100585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Background Several large, prospective screening studies of predominantly Caucasian patients have suggested that hypertrabeculation may not necessarily be pathologic unless there is concomitant left ventricular (LV) dysfunction, LV dilatation, history of arrhythmia, family history, or characteristic gene mutations. This conundrum may be magnified in blacks, in whom hypertrabeculation and LV hypertrophy is more common. We therefore investigated the frequency of hypertrabeculation/isolated LV noncompaction (ILVNC) phenotype in normal black Africans and evaluated LV function using sensitive measures of deformation and twist. Methods Two hundred and fifty-three volunteers were recruited and evaluated according to strict inclusion and exclusion criteria. Their mean age was 36.3 ± 12.2 years. Results Trabeculations were found in 12 (4.74%) participants. Three (1.2%) subjects had ≥ 4 LV trabeculations. The LV apex was the most common anatomical site for the location of trabeculations. Subjects with trabeculations were more likely to be males of a younger age, and had greater LV end-diastolic and end-systolic parameters and lateral e’. However, 0.8% of the population fulfilled the Stollberger criteria, and none fulfilled the Jenni, Milwaukee, or Baragwanath criteria. All subjects in this study had normal rotation patterns with no differences in rotational parameters or net twist. Conclusions Trabeculations may be found as a normal variant in black Africans. Assessing trabeculations alone may infer ILVNC; however, utilizing the more comprehensive ILVNC criteria enables differentiation of a possible LVNC phenotype. Normal individuals with hypertrabeculation have normal LV function and normal rotation patterns, with no differences in rotational parameters or net twist.
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Affiliation(s)
- Samantha Nel
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
- Corresponding author at: Aurora Cardiovascular and Thoracic Services, 2801 W. Kinnickinnic River Parkway, Suite 880, Milwaukee, WI 53215, USA.
| | - Elena Libhaber
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Ferande Peters
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Claudia Ferreira dos Santos
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Hiral Matioda
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Sacha Grinter
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
| | - Nirvathi Maharaj
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
- Cardiovascular Pathophysiology and Genomics unit, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Mohammed R. Essop
- Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa
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20
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Ling HZ, Jara PG, Bisquera A, Poon LC, Nicolaides KH, Kametas NA. Effect of race on longitudinal central hemodynamics in pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:37-43. [PMID: 31692154 DOI: 10.1002/uog.21914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare central hemodynamics between white, black and Asian women in pregnancy. METHODS This was a prospective, longitudinal study of maternal central hemodynamics in white, black and Asian women with a singleton pregnancy, assessed using a bioreactance method at 11 + 0 to 13 + 6, 19 + 0 to 24 + 0, 30 + 0 to 34 + 0 and 35 + 0 to 37 + 0 weeks' gestation. At each visit, cardiac output (CO), stroke volume (SV), heart rate (HR), peripheral vascular resistance (PVR) and mean arterial pressure were recorded. Multilevel linear mixed-effects analysis was performed to compare the repeated measures of the cardiac variables between white, black and Asian women, controlling for maternal characteristics, medical history and medication use. RESULTS The study population included 1165 white, 247 black and 116 Asian women. CO increased with gestational age to a peak at 32 weeks and then decreased; the highest CO was observed in white women and the lowest in Asian women. SV initially increased after the first visit but subsequently declined with gestational age in white women, decreased with gestational age in black women and remained static in Asian women. In all three study groups, HR increased with gestational age until 32 weeks and then remained constant; HR was highest in black women and lowest in white women. PVR showed a reversed pattern to that of CO; the highest values were in Asian women and the lowest in white women. The least favorable hemodynamic profile, which was observed in black and Asian women, was reflected in higher rates of a small-for-gestational-age infant. CONCLUSIONS There are race-specific differences in maternal cardiac adaptation to pregnancy. White women have the most favorable cardiac adaptation by increasing SV and HR, achieving the highest CO and lowest PVR. In contrast, black and Asian women have lower CO and higher PVR than do white women, with CO increasing through a rise in HR due to declining or static SV. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Z Ling
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - P G Jara
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Bisquera
- School of Population Health & Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - L C Poon
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- The Chinese University of Hong Kong, Hong Kong, China
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - N A Kametas
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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21
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Nel S, Nihoyannopoulos P, Libhaber E, Essop MR, Ferreira dos Santos C, Matioda H, Waterworth C, Grinter S, Meel R, Peters F. Echocardiographic Indices of the Left and Right Heart in a Normal Black African Population. J Am Soc Echocardiogr 2020; 33:358-367. [DOI: 10.1016/j.echo.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 10/17/2019] [Indexed: 01/25/2023]
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Wang JS. Response. Med Sci Sports Exerc 2019; 51:2424. [PMID: 31626058 DOI: 10.1249/mss.0000000000002058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jong-Shyan Wang
- Graduate Institute of Rehabilitation Science and Healthy Aging Research Center Chang Gung University Tao-Yuan, TAIWAN
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23
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Sun LY, Kimmoun A, Takagi K, Liu PP, Bader Eddeen A, Mebazaa A. Ethnic differences in acute heart failure outcomes in Ontario. Int J Cardiol 2019; 291:177-182. [PMID: 31153653 DOI: 10.1016/j.ijcard.2019.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous studies have identified ethnic differences in outcomes after episodes of acute heart failure in natives of Asia as compared to those of Europe. Whether these ethnic differences in outcomes would still exist, years after migration to a different geographical and cultural setting remain unclear. We investigated the one-year mortality after an episode of acute heart failure admission in Ontario residents of South Asian and Chinese descent as compared to the General Population. METHODS We conducted a population-based, retrospective cohort study of adult Ontarions who were hospitalized for AHF between April 1, 2010 and March 31, 2016. Ethnicity was categorized using validated surname-based algorithms. The primary outcome was all-cause one-year mortality. Mortality rates were calculated using the Kaplan-Meier method. The relative hazard of death was assessed using a multivariable Cox proportional hazard model. RESULTS Of 82,125 patients, 1287 (1.6%) were Chinese, 1662 (2.0%) were South Asians, and the remaining 79,176 (96.4%) were of the General Population. The risk of mortality was markedly lower amongst South Asians (adjusted HR 0.81, 95% CI [0.73-0.89]) relative to the General Population. There was no statistically significant difference in the risk of mortality between Chinese and the General Population (adjusted HR 1.00 [0.91-1.10]). In addition, guideline-directed medical therapies were associated with similar survival benefit in patients of all three ethnic origins. CONCLUSIONS We found a lower risk of one-year mortality after acute heart failure hospitalization amongst South Asians compared to Chinese and the General Population, and similar benefit of medical therapy in all three groups. Further studies are needed to explore the etiologies of these ethnic disparities to truly improve outcomes at the population level.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
| | - Antoine Kimmoun
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, Vandoeuvre-les-Nancy, France; Inserm U942, Lariboisière University Hospital, Paris, France
| | - Koji Takagi
- Inserm U942, Lariboisière University Hospital, Paris, France
| | - Peter P Liu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Alexandre Mebazaa
- Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital, Paris, France; Université de Paris, France
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Asch FM, Banchs J, Price R, Rigolin V, Thomas JD, Weissman NJ, Lang RM. Need for a Global Definition of Normative Echo Values—Rationale and Design of the World Alliance of Societies of Echocardiography Normal Values Study (WASE). J Am Soc Echocardiogr 2019; 32:157-162.e2. [DOI: 10.1016/j.echo.2018.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 01/10/2023]
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O'Neill J, Jegodzinski L, Tayebjee MH. Incidence of subclinical atrial fibrillation in a South Asian population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1600-1605. [DOI: 10.1111/pace.13516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- James O'Neill
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary; Leeds UK
| | | | - Muzahir H. Tayebjee
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary; Leeds UK
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26
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O'Neill J, Swoboda PP, Plein S, Tayebjee MH. Left atrial size and function in a South Asian population and their potential influence on the risk of atrial fibrillation. Clin Cardiol 2018; 41:1379-1385. [PMID: 30144123 DOI: 10.1002/clc.23064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND South Asians have a low prevalence of atrial fibrillation (AF) compared with Caucasians despite having a higher prevalence of conventional risk factors for the arrhythmia. The reason for this disparity is uncertain but may be due to ethnic differences in atrial morphology. This study examines the association between ethnicity and left atrial (LA) size and function in South Asian and Caucasian subjects using the reference technique of cardiovascular magnetic resonance imaging (MRI). HYPOTHESIS South Asians have smaller LA size and therefore increased LA function. METHODS Retrospective case-control study of 60 South Asian and 60 Caucasian patients who had undergone a clinically indicated MRI between April 2010 and October 2017 and had been found to have a structurally normal heart. LA and left ventricular (LV) volume and function were assessed and compared between the ethnicities. RESULTS In comparison with Caucasians, South Asians had significantly lower minimum (27.7 ± 11.1 mL vs 34.9 ± 12.3 mL, P = 0.002) and maximum LA volumes (64.7 ± 21.1 mL vs 80.9 ± 22.5 mL, P < 0.001), lower LV end-diastolic volume (P < 0.001), lower LV stroke volume (P < 0.001), and lower LV mass (P = 0.022) and these values remained significant after correcting for body surface area. Further analysis revealed that LA volume was independently associated with South Asian ethnicity. There was no difference in LA function between the ethnic groups. CONCLUSIONS South Asians have reduced LA volumes and a proportionally smaller heart size in comparison to Caucasians. Smaller LA size may protect against the development of AF by reducing the risk of reentrant circuit formation and atrial fibrosis development.
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Affiliation(s)
- James O'Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Bhambhani A, John N, Mathew A. Real-time three-dimensional echocardiographic left heart parameters in healthy indian adults. Indian Heart J 2018; 70:642-648. [PMID: 30392502 PMCID: PMC6204452 DOI: 10.1016/j.ihj.2017.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Cardiac chamber dimensions are race and anthropometry dependent. We determined the age and gender specific 3-Dimensional echocardiographic (3DE) reference values for dimensions and function of left ventricle (LV) and left atrium (LA) in normal Indian adults. METHODS This single center prospective study enrolled 133 adult Indians free of heart disease and/or hypertensions, subjecting them to 3DE measurements of left atrial (LA) & left ventricular (LV) volumes, function and left ventricular mass (LVM). The higher limits of normal cut-offs were determined for these parameters and their dependency on age, gender and anthropometry were analyzed. RESULTS The body surface area (BSA) corrected higher limit cut-offs were: 59.37ml/m2 for LV end diastolic volume (59.19ml/m2 and 59.61ml/m2 for men and women, respectively; P=NS); 23.48ml/m2 for LV end systolic volume (23.27ml/m2 and 23.11ml/m2 for men and women, P=NS). Mean LVEF was 64.79%±7.26 (62.99%±6.51 and 67.05%±7.58 in men and women, P=NS). Men had higher LVM than women (119.79g±23.95 vs. 103.26g±23.76, P<0.001), this difference disappeared after BSA indexing. The higher limit cut-offs for normal LA volumes were 20.49ml for minimum volume (21.18ml and 19.46ml for men and women, P=NS) and 39.76ml for maximum volume (39.60ml and 40.03ml in men and women, P=NS). The parameters were smaller compared to western populations but the differences attenuated after BSA indexing. CONCLUSIONS The study reports normal 3DE parameters of size and function of left heart chambers in Indians.
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Affiliation(s)
- Anupam Bhambhani
- Department of Cardiology, Whitefield, Bangalore, 560066, India; Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, 560066, India.
| | - Nelson John
- Department of Community Medicine, Whitefield, Bangalore, 560066, India; Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, 560066, India
| | - Amalu Mathew
- Department of Cardiology, Whitefield, Bangalore, 560066, India; Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, 560066, India
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Wang SS, Hong WJ, Zhang YQ, Chen SB, Huang GY, Zhang HY, Chen LJ, Wu LP, Shen R, Liu YQ, Zhu JX. Regression equations for calculation of z scores for echocardiographic measurements of left heart structures in healthy Han Chinese children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:328-333. [PMID: 29430653 DOI: 10.1002/jcu.22579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/23/2017] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Clinical decision making in children with heart disease relies on detailed measurements of cardiac structures using two-dimensional and M-mode echocardiography. However, no echocardiographic reference values are available for the Chinese children. We aimed to establish z-score regression equations for left heart structures in a population-based cohort of healthy Chinese Han children. METHOD Echocardiography was performed in 545 children with a normal heart. The dimensions of the aortic valve annulus (AVA), aortic sinuses of Valsalva (ASV), sinotubular junction (STJ), ascending aorta (AAO), left atrium (LA), mitral valve annulus (MVA), interventricular septal end-diastolic thickness (IVSd), interventricular septal end-systolic thickness (IVSs), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular posterior wall end-diastolic thickness (LVPWd), left ventricular posterior wall end-systolic thickness (LVPWs) were measured. Regression analyses were conducted to relate the measurements of left heart structures to body surface area (BSA). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were calculated. Several models were used, and the adjusted R2 values were compared for each model. RESULTS AVA, ASV, STJ, AAO, LA, MVA, IVSd, IVSs, LVIDd, LVIDs, LVPWd, and LVPWs had a cubic relationship with BSA. LVEF and LVFS fell within a narrow range. CONCLUSIONS Our results provide reference values for z scores and regression equations for left heart structures in Han Chinese children. These data may help make a quick and accurate judgment of the routine clinical measurement of left heart structures in children with heart disease.
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Affiliation(s)
- Shan-Shan Wang
- Department of Pediatrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Wen-Jing Hong
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Shu-Bao Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Guo-Ying Huang
- Department of Pediatric Cardiology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Hong-Yan Zhang
- Department of Pediatric Cardiology, Tianjin Children's Hospital, Tianjin 300204, China
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Rong Shen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yi-Qing Liu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Jun-Xue Zhu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Vasan SK, Roy A, Samuel VT, Antonisamy B, Bhargava SK, Alex AG, Singh B, Osmond C, Geethanjali FS, Karpe F, Sachdev H, Agrawal K, Ramakrishnan L, Tandon N, Thomas N, Premkumar PS, Asaithambi P, Princy SFX, Sinha S, Paul TV, Prabhakaran D, Fall CHD. IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians. BMJ Open 2018; 8:e019675. [PMID: 29643156 PMCID: PMC5898335 DOI: 10.1136/bmjopen-2017-019675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians. METHODS AND ANALYSIS We propose to study approximately 3000 men and women aged 43-50 years from two birth cohorts established in 1969-1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes. ETHICS AND DISSEMINATION The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN13432279; Pre-results.
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Affiliation(s)
- Senthil K Vasan
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ambuj Roy
- Centre for Chronic Disease Control, New Delhi, India
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Viji Thomson Samuel
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Belavendra Antonisamy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anoop George Alex
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bhaskar Singh
- Department of Paediatrics, Sunder Lal Jain Hospital, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Finney S Geethanjali
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Fredrik Karpe
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Harshpal Sachdev
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Kanhaiya Agrawal
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lakshmy Ramakrishnan
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna S Premkumar
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prrathepa Asaithambi
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sneha F X Princy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sikha Sinha
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Thomas Vizhalil Paul
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis. Int J Rheumatol 2017; 2017:2323410. [PMID: 29348754 PMCID: PMC5733615 DOI: 10.1155/2017/2323410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022] Open
Abstract
This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = −0.28 ± 0.09, p = 0.0002) and lateral e′ (standardised β (SE) = 0.26 ± 0.09, p = 0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = −0.16 ± 0.08, p = 0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p < 0.0001). One SD increase in waist-hip ratio was associated with diastolic dysfunction when applying current criteria (OR = 2.61 (95% CI = 1.51–4.52), p = 0.0006), whereas one SD increase in diastolic blood pressure was inversely related to diastolic dysfunction upon using previous criteria (OR = 0.57 (95% CI = 0.40–0.81), p = 0.002). In conclusion, application of current and previous diastolic dysfunction criteria markedly alters the prevalence and risk factors associated with diastolic dysfunction in RA.
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van Grootel RWJ, Menting ME, McGhie J, Roos-Hesselink JW, van den Bosch AE. Echocardiographic chamber quantification in a healthy Dutch population. Neth Heart J 2017; 25:682-690. [PMID: 29019026 PMCID: PMC5691816 DOI: 10.1007/s12471-017-1035-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim For accurate interpretation of echocardiographic measurements normative data are required, which are provided by guidelines. For this article, the hypothesis was that these cannot be extrapolated to the Dutch population, since in Dutch clinical practice often higher values are found, which may not be pathological but physiological. Therefore this study aimed to 1) obtain and propose normative values for cardiac chamber quantification in a healthy Dutch population and 2) determine influences of baseline characteristics on these measurements. Methods Prospectively recruited healthy subjects, aged 20–72 years (at least 28 subjects per age decade, equally distributed for gender) underwent physical examination and 2D and 3D echocardiography. Both ventricles and atria were assessed and volumes were calculated. Results 147 subjects were included (age 44 ± 14 years, 50% female). Overall, feasibility was good for both linear and volumetric measurements. Linear and volumetric parameters were consistently higher than current guidelines recommend, while functional parameters were in line with the guidelines. This was more so in the older population. 3D volumes were higher than 2D volumes. Gender dependency was seen in all body surface area (BSA) corrected volumes and with increasing age, ejection fractions decreased. Conclusion This study provides 2D and 3D echocardiographic reference ranges for both ventricles and atria derived from a healthy Dutch population. BSA indexed volumes are gender-dependent, age did not influence ventricular volumes and a rise in blood pressure was independently associated with increased right ventricular volumes. The higher volumes found may be indicative for the Dutch population being the tallest in the world.
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Affiliation(s)
| | - M E Menting
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - J McGhie
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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Luo XX, Fang F, So HK, Liu C, Yam MC, Lee APW. Automated left heart chamber volumetric assessment using three-dimensional echocardiography in Chinese adolescents. Echo Res Pract 2017; 4:53-61. [PMID: 28986349 PMCID: PMC5633056 DOI: 10.1530/erp-17-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several studies have reported the accuracy and reproducibility of HeartModel for automated determination of three-dimensional echocardiography (3DE)-derived left heart volumes and left ventricular (LV) ejection fraction (LVEF) in adult patients. However, it remains unclear whether this automated adaptive analytics algorithm, derived from a 'training' population, can encompass adequate echo images in Chinese adolescents. OBJECTIVES The aim of our study was to explore the accuracy of HeartModel in adolescents compared with expert manual three-dimensional (3D) echocardiography. METHODS Fifty-three Chinese adolescent subjects with or without heart disease underwent 3D echocardiographic imaging with an EPIQ system (Philips). 3D cardiac volumes and LVEF obtained with the automated HeartModel program were compared with manual 3D echocardiographic measurements by an experienced echocardiographer. RESULTS There was strong correlation between HeartModel and expert manual 3DE measurements (r = 0.875-0.965, all P < 0.001). Automated LV and left atrial (LA) volumes were slightly overestimated when compared to expert manual measurements, while LVEF showed no significant differences from the manual method. Importantly, the intra- and inter-observer variability of automated 3D echocardiographic model was relatively low (<1%), surpassing the manual approach (3.5-17.4%), yet requiring significantly less analyzing time (20 ± 7 vs 177 ± 30 s, P < 0.001). CONCLUSION Simultaneous quantification of left heart volumes and LVEF with the automated HeartModel program is rapid, accurate and reproducible in Chinese adolescent cohort. Therefore, it has a potential to bring 3D echocardiographic assessment of left heart chamber volumes and function into busy pediatric practice.
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Affiliation(s)
- Xiu-Xia Luo
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, People's Republic of China.,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Fang Fang
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hung-Kwan So
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Chao Liu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Man-Ching Yam
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Why are South Asians seemingly protected against the development of atrial fibrillation? A review of current evidence. Trends Cardiovasc Med 2017; 27:249-257. [DOI: 10.1016/j.tcm.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 01/09/2023]
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Zemrak F, Ambale-Venkatesh B, Captur G, Chrispin J, Chamera E, Habibi M, Nazarian S, Mohiddin SA, Moon JC, Petersen SE, Lima JAC, Bluemke DA. Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 10:e005379. [PMID: 28196797 PMCID: PMC5319802 DOI: 10.1161/circimaging.116.005379] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial (LA) size is a marker of diastolic function and is associated with atrial fibrillation and cardiovascular outcomes. However, there are no large population studies measuring LA structure. The relationship of demographics and cardiovascular risk factors to LA size is largely unknown. This study aimed to determine associations of LA size with demographic factors, cardiac structure and function, and cardiovascular risk factors. METHODS AND RESULTS LA volume indexed to body surface area was measured by cardiovascular magnetic resonance steady-state free precession and fast gradient echo cine long- and short-axis images in 2576 asymptomatic participants of MESA ([Multi-Ethnic Study of Atherosclerosis] 68.7 years, 53.0% women, white 42.2%, Chinese American 12.0%, black 24.5%, and Hispanic 21.2%) using biplane and short-axis images. The mean LA volume index was 36.5±11.4 mL/m2 in the entire cohort and 35.5±10.1 mL/m2 in subjects free of cardiovascular risk factors (n=283). Multivariable analysis included adjustment for demographics, ethnicity, cardiovascular risk factors, serological studies, socioeconomic status, left ventricular structure, and medications. In the adjusted analysis, age (β=0.2 mL/m2 per year, P<0.0001), male sex (β=-4.2 mL/m2, P<0.0001), obesity (β=1.3 mL/m2, P<0.01), end-diastolic volume index (β=0.4 mL/m2, P<0.0001), Chinese American (β=-2.6 mL/m2, P<0.0001), and Hispanic (β=1.1 mL/m2, P<0.05) ethnicities were associated with LA volume index. Diabetes mellitus and smoking were not associated with LA volume index. LA volumes measured by steady-state free precession were 3% larger than by fast gradient echo cine cardiovascular magnetic resonance (P<0.001). CONCLUSIONS Age, sex, ethnicity and left ventricular structural parameters were associated with LA size. Importantly, the study provides reference values of normal LA volume index.
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Affiliation(s)
- Filip Zemrak
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Bharath Ambale-Venkatesh
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Gabriella Captur
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Jonathan Chrispin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Ela Chamera
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Mohammadali Habibi
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saman Nazarian
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saidi A Mohiddin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - James C Moon
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Steffen E Petersen
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - João A C Lima
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - David A Bluemke
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.).
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Left ventricular filling pressure by septal and lateral E/e' equally predict cardiovascular events in the general population. Int J Cardiovasc Imaging 2017; 33:653-661. [PMID: 28066866 DOI: 10.1007/s10554-016-1052-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/24/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE There exists no consensus on the site of E/e' measurement. This study aimed to evaluate the predictive value of septal and lateral E/e' along with the importance of their intra-individual difference. METHODS In 1775 persons from the general population, peak early diastolic velocity (e') was obtained by color tissue Doppler at the septal and lateral mitral annular sites. The endpoint was combined of cardiovascular death or admission due to heart failure or acute myocardial infarction. RESULTS During a median follow-up of 10.9 years, the endpoint occurred in 227 participants. E/e'septal and E/e'lateral were equally strong predictors of cardiac events; in age- and sex-adjusted models they did not differ in AUC (septal: 0.8385, lateral: 0.8389; p = 0.94) or in continuous NRI (p = 0.84). Models using E/e'average did not improve AUC or NRI, and the intra-individual difference between sites had no predictive value (p = 0.79). E/e'septal was generally higher than E/e'lateral, thus age- and sex-specific normal values were reported for both sites for a population free of cardiac events during 10 years of follow-up. CONCLUSIONS Septal and lateral E/e' are equally useful in predicting cardiac events in the general population. Measuring both sites provides no further predictive value than measuring a single site.
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Normal reference range values in adult echocardiography: Further evidence that race matters. Indian Heart J 2016; 68:758-759. [PMID: 27931541 PMCID: PMC5143823 DOI: 10.1016/j.ihj.2016.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/01/2016] [Indexed: 11/24/2022] Open
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El Missiri AM, El Meniawy KAL, Sakr SAS, Mohamed ASED. Normal reference values of echocardiographic measurements in young Egyptian adults. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Weir-McCall JR, Cassidy DB, Belch JJF, Gandy SJ, Houston JG, Lambert MA, Littleford RC, Rowland J, Struthers AD, Khan F. Whole-body cardiovascular MRI for the comparison of atherosclerotic burden and cardiac remodelling in healthy South Asian and European adults. Br J Radiol 2016; 89:20160342. [PMID: 27351693 PMCID: PMC5124930 DOI: 10.1259/bjr.20160342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the feasibility of using whole-body cardiovascular MRI (WB-CVMR) to compare South Asians (SAs)-a population known to have a higher risk of cardiovascular disease (CVD) but paradoxically lower prevalence of peripheral arterial disease-and Western Europeans (WEs). METHODS 19 SAs and 38 age-, gender- and body mass index-matched WEs were recruited. All were aged 40 years and over, free from CVD and with a 10-year risk of CVD <20% as assessed by the adult treatment panel (ATP) III risk score. WB-CVMR was performed, comprising a whole-body angiogram (WBA) and cardiac MR (CMR), on a 3-T MRI scanner (Magnetom(®) Trio; Siemens, Erlangen, Germany) following dual-phase injection of gadolinium-based contrast agent. A standardized atheroma score (SAS) was calculated from the WBA while indexed left ventricular mass and volumes were calculated from the CMR. RESULTS SAs exhibited a significantly lower iliofemoral atheroma burden (regional SAS 0.0 ± 0.0 vs 1.9 ± 6.9, p = 0.048) and a trend towards lower overall atheroma burden (whole-body SAS 0.7 ± 0.8 vs 1.8 ± 2.3, p = 0.1). They had significantly lower indexed left ventricular mass (46.9 ± 11.8 vs 56.9 ± 13.4 ml m(-2), p = 0.008), end diastolic volume (63.9 ± 10.4 vs 75.2 ± 11.4 ml m(-2), p=0.001), end systolic volume (20.5 ± 6.1 vs 24.6 ± 6.8 ml m(-2), p = 0.03) and stroke volume (43.4 ± 6.6 vs 50.6 ± 7.9 ml m(-2), p = 0.001), but with no significant difference in ejection fraction, mass-volume ratio or global functioning index. These differences persisted after accounting for CVD risk factors. CONCLUSION WB-CVMR can quantify cardiac and atheroma burden and can detect differences in these metrics between ethnic groups that, if validated, may suggest that the paradoxical high risk of CVD compared with PVD risk may be due to an adverse cardiac haemodynamic status incurred by the smaller heart rather than atherosclerosis. ADVANCES IN KNOWLEDGE WB-CVMR can be used to stratify and compare disease between ethnicities.
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Affiliation(s)
| | - Deirdre B Cassidy
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Jill J F Belch
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Stephen J Gandy
- 2 NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - J G Houston
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Matthew A Lambert
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Roberta C Littleford
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Janice Rowland
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Allan D Struthers
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Faisel Khan
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
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Ryu DR. Normal Reference Values for Doppler Echocardiography: Influences of Ageing, Gender and Ethnicity. J Cardiovasc Ultrasound 2016; 24:112-4. [PMID: 27358702 PMCID: PMC4925387 DOI: 10.4250/jcu.2016.24.2.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
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Bansal M, Mohan JC, Sengupta SP. Normal echocardiographic measurements in Indian adults: How different are we from the western populations? A pilot study. Indian Heart J 2016; 68:772-775. [PMID: 27931544 PMCID: PMC5143821 DOI: 10.1016/j.ihj.2016.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/24/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023] Open
Abstract
This study sought to gain insights into the magnitude of error resulting in echocardiographic interpretations in Indian subjects by using western data as the reference. Standard transthoracic echocardiographic examination was performed in 100 healthy volunteers (mean age 34.0 ± 8.8 years, 59% males). Compared with the reference values published by the American Society of Echocardiography (ASE), our subjects had much smaller left ventricular (LV) end-diastolic dimension, end-systolic dimension, and end-diastolic volume (only 58%, 61%, and 61% of the subjects were having values within the ASE-defined normal ranges). Indexing to body surface area increased these proportions to 81%, 90%, and 68%, respectively. In contrast, LV ejection fraction and most of the measures of LV diastolic function coincided with the ASE-recommended age- and gender-specific values.
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Affiliation(s)
- Manish Bansal
- Senior Consultant Cardiology, Medanta - The Medicity, Sector 38, Gurgaon 122001, India.
| | - Jagdish C Mohan
- Director of Cardiac Sciences, Fortis Hospital, Shalimar Bagh, New Delhi 110088, India
| | - Shantanu P Sengupta
- Director, Sengupta Hospital and Research Institute, Ravinagar, Nagpur 440033, India
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Mizukoshi K, Takeuchi M, Nagata Y, Addetia K, Lang RM, Akashi YJ, Otsuji Y. Normal Values of Left Ventricular Mass Index Assessed by Transthoracic Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29:51-61. [DOI: 10.1016/j.echo.2015.09.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Indexed: 01/19/2023]
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16:233-70. [PMID: 25712077 DOI: 10.1093/ehjci/jev014] [Citation(s) in RCA: 4852] [Impact Index Per Article: 539.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
- Roberto M Lang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Luigi P Badano
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Victor Mor-Avi
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jonathan Afilalo
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Anderson Armstrong
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Laura Ernande
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Frank A Flachskampf
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Elyse Foster
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Steven A Goldstein
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Tatiana Kuznetsova
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Patrizio Lancellotti
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Denisa Muraru
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Michael H Picard
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Ernst R Rietzschel
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Lawrence Rudski
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Kirk T Spencer
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Wendy Tsang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jens-Uwe Voigt
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
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Huynh QL, Kalam K, Iannaccone A, Negishi K, Thomas L, Marwick TH. Functional and Anatomic Responses of the Left Atrium to Change in Estimated Left Ventricular Filling Pressure. J Am Soc Echocardiogr 2015; 28:1428-1433.e1. [DOI: 10.1016/j.echo.2015.07.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Indexed: 01/12/2023]
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O’Driscoll JM, Rossato C, Gargallo-Fernandez P, Araco M, Giannoglou D, Sharma S, Sharma R. The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients. Cardiovasc Ultrasound 2015; 13:36. [PMID: 26245751 PMCID: PMC4527129 DOI: 10.1186/s12947-015-0028-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/20/2015] [Indexed: 01/20/2023] Open
Abstract
Background The incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK. Methods DSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2 %] Indian Asian, 2219 [41.6 %] European white and 434 [8.1 %] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality. Results There were 849 (15.9 %) NFCE and 1365 (25.6 %) deaths over a median follow-up period of 4.6 years. In total 1174 (22 %) patients had inducible myocardial ischaemia during DSE, 859 (16.1 %) had fixed wall motion abnormalities and 3645 (68.4 %) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups. Conclusions DSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected. Electronic supplementary material The online version of this article (doi:10.1186/s12947-015-0028-1) contains supplementary material, which is available to authorized users.
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Chahal NS, Drakopoulou M, Gonzalez-Gonzalez AM, Manivarmane R, Khattar R, Senior R. Resting Aortic Valve Area at Normal Transaortic Flow Rate Reflects True Valve Area in Suspected Low-Gradient Severe Aortic Stenosis. JACC Cardiovasc Imaging 2015; 8:1133-1139. [DOI: 10.1016/j.jcmg.2015.04.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/23/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. [PMID: 25559473 DOI: 10.1016/j.echo.2014.10.003] [Citation(s) in RCA: 8109] [Impact Index Per Article: 901.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
| | | | | | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Laura Ernande
- INSERM U955 and Hôpital Henri Mondor, Créteil, France
| | | | - Elyse Foster
- University of California, San Francisco, California
| | | | | | | | | | - Michael H Picard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Lawrence Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
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Lang RM, Mor-Avi V. One Size Does Not Fit All. JACC Cardiovasc Imaging 2015; 8:666-8. [DOI: 10.1016/j.jcmg.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 11/26/2022]
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Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function. JACC Cardiovasc Imaging 2015; 8:656-65. [DOI: 10.1016/j.jcmg.2015.02.014] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/29/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
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Echocardiographic Measurements in Normal Chinese Adults Focusing on Cardiac Chambers and Great Arteries: A Prospective, Nationwide, and Multicenter Study. J Am Soc Echocardiogr 2015; 28:570-9. [DOI: 10.1016/j.echo.2015.01.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Indexed: 11/22/2022]
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50
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Van Schinkel LD, Bakker LEH, Jonker JT, De Roos A, Pijl H, Meinders AE, Jazet IM, Lamb HJ, Smit JWA. Cardiovascular flexibility in middle-aged overweight South Asians vs. white Caucasians: response to short-term caloric restriction. Nutr Metab Cardiovasc Dis 2015; 25:403-410. [PMID: 25698153 DOI: 10.1016/j.numecd.2014.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/11/2014] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS South Asians have a higher risk of developing cardiovascular disease than white Caucasians. The underlying cause is unknown, but might be related to higher cardiac susceptibility to metabolic disorders. Short-term caloric restriction (CR) can be used as a metabolic stress test to study cardiac flexibility. We assessed whether metabolic and functional cardiovascular flexibility to CR differs between South Asians and white Caucasians. METHODS AND RESULTS Cardiovascular function and myocardial triglycerides were assessed using a 1.5T-MRI/S-scanner in 12 middle-aged overweight male South Asians and 12 matched white Caucasians before and after an 8-day very low calorie diet (VLCD). At baseline South Asians were more insulin resistant than Caucasians. Cardiac dimensions were smaller, despite correction for body surface area, and pulse wave velocity (PWV) in the distal aorta was higher in South Asians. Systolic and diastolic function, myocardial triglycerides and pericardial fat did not differ significantly between groups. After the VLCD body weight reduced on average by 4.0 ± 0.2 kg. Myocardial triglycerides increased in both ethnicities by 69 ± 18%, and diastolic function decreased although this was not significant in South Asians. However, pericardial fat and PWV in the proximal and total aorta were reduced in Caucasians only. CONCLUSION Myocardial triglyceride stores in middle-aged overweight and insulin resistant South Asians are as flexible and amenable to therapeutic intervention by CR as age-, sex- and BMI-matched but less insulin resistant white Caucasians. However, paracardial fat volume and PWV showed a differential effect in response to an 8-day VLCD in favor of Caucasians. CLINICAL TRIAL REGISTRATION NTR 2473 (URL: http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=2473).
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Affiliation(s)
- L D Van Schinkel
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands.
| | - L E H Bakker
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
| | - J T Jonker
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
| | - A De Roos
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - H Pijl
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
| | - A E Meinders
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
| | - I M Jazet
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - J W A Smit
- Department of Endocrinology, Leiden University Medical Center (LUMC), 2300 RC Leiden, The Netherlands
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