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Domain G, Biscond M, Dognin N, Strube C, Mondoly P, Réant P, Sarrazin JF, Galinier M, Champagne J, Rollin A, Carrié D, Cochet H, Lairez O, Philippon F, Ferrières J, Maury P, Steinberg C. The D-HCM score, a new diagnostic tool for distinguishing hypertrophic cardiomyopathy from hypertensive cardiopathy. ESC Heart Fail 2024. [PMID: 39041575 DOI: 10.1002/ehf2.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024] Open
Abstract
AIM The diagnosis of hypertrophic cardiomyopathy (HCM) with moderate hypertrophy is challenging. Hypertensive heart disease (HHD) is the most common differential diagnosis that mimics the LVH of HCM. The aim of this study was to compare the QRS duration in HCM and HHD to create a novel diagnostic tool to identify primary HCM. METHODS AND RESULTS We conducted an international retrospective multicentre study enrolling patients with true HCM and HHD. A total of 547 individuals with HCM and 139 with HHD were included. The median QRS duration was significantly shorter in HCM than in HHD (88 ms [80-94] vs. 98 ms [88-108]; P < 0.01). Multivariable logistic regression identified for the novel diagnostic HCM (D-HCM) score: absence of antihypertensive drugs (+2); family history of unexplained sudden death (+2); QRS duration [<95 ms] = +1; maximum wall thickness (mm) [≥17] = +1. A cumulative QRS-HCM score ≥2 supports the diagnostic certainty of true HCM with a sensitivity of 79%, specificity of 99%, negative predictive value (NPV) of 55%, and positive predictive value (PPV) of 99%. CONCLUSION The QRS duration in patient with HCM is significantly shorter compared with patients with HHD-related LVH. QRS duration can be used as a diagnosis marker to distinguish between HCM and HHD. The D-HCM score is a novel, simple, and accurate diagnosis tool for HCM patients with mild to moderate phenotypes.
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Affiliation(s)
- G Domain
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - M Biscond
- Collège des Sciences Humaines, Université de Bordeaux, Bordeaux, France
| | - N Dognin
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - C Strube
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - P Mondoly
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - P Réant
- Hôpital Haut-Lévêque, Bordeaux University, Bordeaux, France
| | - J F Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - M Galinier
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - J Champagne
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - A Rollin
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - D Carrié
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - H Cochet
- Hôpital Haut-Lévêque, Bordeaux University, Bordeaux, France
| | - O Lairez
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - F Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - J Ferrières
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - P Maury
- Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - C Steinberg
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
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2
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Lai B, Huang B, Li L. Causal relationship between inflammatory markers and left ventricle geometry and function: A 2-sample Mendelian randomization study. Medicine (Baltimore) 2024; 103:e38735. [PMID: 38996142 PMCID: PMC11245243 DOI: 10.1097/md.0000000000038735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/07/2024] [Indexed: 07/14/2024] Open
Abstract
Studies have shown that some inflammatory markers can predict the risk of cardiovascular disease (CVD) and affect the structure and function of the heart. However, a causal relationship between inflammatory markers and the cardiac structure and function has not yet been established. Thus, we conducted a 2-sample Mendelian randomization (MR) study to explore the potential causal relationship between inflammatory markers and prognostically-related left ventricular (LV) parameters. Instrumental variables (IVs) for C-reactive protein (CRP), interleukin-6 (IL-6), and myeloperoxidase (MPO) levels were selected from the databases of large genome-wide association studies (GWAS). Summary statistics for LV parameters, including LV mass, ejection fraction, end-diastolic and systolic volumes, and the ratio of LV mass to end-diastolic volume, were obtained from cardiovascular magnetic resonance studies of the UK Biobank (n = 16923). The inverse-variance weighted (IVW) method was the primary analytical method used, and was complemented with the MR-Egger, weighted median, simple mode, weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. Sensitivity analysis was performed to evaluate the robustness of the results. CRP was significantly associated with the LV mass in the IVW method (β = -0.13 g [95% confidence interval [CI], 0.78 g-1.00 g], P = .046). A higher standard deviation of genetically-predicted CRP levels was associated with a 0.13 ± 0.06 g lower LV mass. No causal relationships of IL-6 and MPO with LV parameters were found. No evidence of heterogeneity and pleiotropy was detected. Sensitivity analyses confirmed the robustness of the results. Two-sample MR analysis revealed a causal association between increased CRP level and decreased LV mass, whereas IL-6 and MPO levels did not influence the LV parameters. However, further research is required to validate our findings.
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Affiliation(s)
- Bolin Lai
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Bin Huang
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Li Li
- Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
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3
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Chen C, Liu L, Liu S, Ju M, Yu W, Song Q, Li M, Tang Y, Wang C. 24-h central pressure is a valuable predictor for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease. Hypertens Res 2024; 47:1697-1706. [PMID: 38553645 DOI: 10.1038/s41440-024-01654-2] [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: 09/01/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024]
Abstract
The current research on the relationship between 24-h central pressure and 24-h brachial pressure with left ventricular hypertrophy (LVH) is characterised by limited sample size and inconsistent findings. Furthermore, the association has never been explored in chronic kidney disease (CKD). A multicentre, cross-sectional study among non-dialysis patients with CKD was conducted. All participants underwent brachial and central ambulatory blood pressure monitoring using MobilO-Graph PWA, while trained cardiologists performed echocardiography. In this study, 2117 non-dialysis patients with CKD were examined. 24-h central systolic blood pressure with c2 calibration (24-h c2SBP) demonstrated a stronger association with left ventricular mass index and LVH compared with 24-h brachial systolic blood pressure (24-h bSBP) in the univariate and multivariate regression analyses. The multivariate net reclassification index (NRI) analysis revealed that 24-h c2SBP exhibited greater discriminatory power over 24-h bSBP (NRI = 0.310, 95% CI [0.192-0.429], P < 0.001). Applying 130/135 mmHg as the threshold for 24-h bSBP/c2SBP to cross-classify, the patients were divided into concordant normotension (1509 individuals), isolated brachial hypertension (155 individuals), isolated central hypertension (11 individuals), and concordant hypertension (442 individuals). With concordant normotension as the reference, the multivariable-adjusted ORs were 0.954 (95% CI, 0.534-1.640; P = 0.870) for isolated brachial hypertension and 2.585 (95%CI, 1.841-3.633; P < 0.001) for concordant hypertension. Among non-dialysis patients with CKD, 24-h c2SBP exhibits greater efficacy in identifying the presence of LVH compared with 24-h bSBP. The presence of LVH was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension.
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Affiliation(s)
- Cheng Chen
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Lingling Liu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Sirui Liu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Menglei Ju
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Wenjuan Yu
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China
| | - Qirong Song
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Ying Tang
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China.
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
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4
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Kawasoe S, Ohishi M. Regression of left ventricular hypertrophy. Hypertens Res 2024; 47:1225-1226. [PMID: 38467796 DOI: 10.1038/s41440-024-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Shin Kawasoe
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima, Kagoshima, Japan.
| | - Mitsuru Ohishi
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima, Kagoshima, Japan
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5
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Wang H, Zhang B, Wu WC, Zhu ZH, Wang H. Change of Left Ventricular Geometric Pattern in Patients with Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting. J Cardiovasc Transl Res 2022; 15:1444-1454. [PMID: 35543834 DOI: 10.1007/s12265-022-10249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
Left ventricular (LV) remodeling and geometric patterns are associated with variations in prognosis. Two hundred twenty-eight patients who underwent selective isolated coronary artery bypass grafting (CABG) were included, divided into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at baseline. More than half participants with normal geometry at baseline remained in that category, and similar ratio of concentric remodeling reverted to normal geometry on follow-up. The concentric hypertrophy at baseline tended to progress to eccentric geometry rather than normal geometry, while changes from eccentric to concentric hypertrophy was uncommon. iLVEDD had a significant association with an increased risk of developing an abnormal geometric pattern from a normal or concentric remodeling pattern, and iLVESD and LAScd involved in the regression from an abnormal geometric pattern. Thus, dynamic changes in LV geometric pattern are common on 1-year follow-up after CABG and LA strain has an incremental role for early detection in this process.
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Affiliation(s)
- Han Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Bing Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Zhen-Hui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China.
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6
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Park BE, Lee JH, Jang SY, Lee H, Lee J, Shin H, Park K, Lee S, Lee H, Kim K, Kang S, Lee J, Kim KH, Cho JY, Park J, Park SK, Bak JK, Lee JY. Comparison of the efficiency between electrocardiogram and echocardiogram for left ventricular hypertrophy evaluation in patients with hypertension: Insight from the Korean Hypertension Cohort Study. J Clin Hypertens (Greenwich) 2022; 24:1451-1460. [PMID: 36268774 PMCID: PMC9659871 DOI: 10.1111/jch.14583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/04/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
In patients with hypertension, left ventricular hypertrophy (LVH) represents a risk factor for cardiovascular disease and asymptomatic organ damage. Currently, electrocardiography (ECG) and two-dimensional echocardiography (Echo) are the most widely used methods for LVH evaluation. This study aimed to compare the long-term outcomes of LVH, as evaluated by ECG and Echo, in patients with hypertension. Patients diagnosed with hypertension as a primary disease between 2006 and 2011 were enrolled in the Korean Hypertension Cohort study. The study finally included 1743 patients who underwent both ECG and Echo. The primary endpoint was defined as the composite of major adverse cardiovascular events (MACEs) or death. Overall, LVH was identified in 747 patients. The patients were categorized into four groups according to the detection of LVH by ECG or Echo: No LVH (n = 996), LVH diagnosed by ECG alone (n = 181), LVH diagnosed by Echo alone (n = 415), LVH diagnosed by both ECG and Echo (n = 151). After adjusting for variables, the incidence of MACEs or death was significantly greater in patients with LVH diagnosed by ECG alone (hazards ratio [HR]: 1.69; 95% confidence interval [CI]: 1.22-2.35; P = .001), LVH diagnosed by Echo alone (HR: 1.54; 95% CI: 1.16-2.05; P = .002), and LVH diagnosed by both ECG and Echo (HR: 1.87; 95% CI: 1.18-2.94; P = .002) than in those with no LVH. Both ECG and Echo are efficient diagnostic tools for LVH and useful for long-term risk stratification. Additional Echo evaluation for LVH is helpful for predicting long-term outcomes only in patients without LVH diagnosis by ECG.
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Affiliation(s)
- Bo Eun Park
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
| | - Jang Hoon Lee
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea,School of MedicineKyungpook National UniversityDaeguKorea
| | - Se Yong Jang
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea,School of MedicineKyungpook National UniversityDaeguKorea
| | - Hae‐Young Lee
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Ju‐Yeon Lee
- College of PharmacySeoul National UniversitySeoulKorea
| | - Ho‐Gyun Shin
- National Evidence‐based Healthcare Collaborating Agency (NECA)SeoulKorea
| | - Kyun‐Ik Park
- National Evidence‐based Healthcare Collaborating Agency (NECA)SeoulKorea
| | - Seung‐Pyo Lee
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Hee‐Sun Lee
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Kwang‐Il Kim
- Department of Internal MedicineSeoul National University Bundang HospitalSungnamKorea
| | - Si‐Hyuck Kang
- Department of Internal MedicineSeoul National University Bundang HospitalSungnamKorea
| | - Ju‐Hee Lee
- Division of CardiologyDepartment of Internal MedicineChungbuk National University HospitalChungbuk National University College of MedicineCheongjuKorea
| | - Kye Hun Kim
- Department of Cardiovascular MedicineChonnam National University Medical School/HospitalGwangjuKorea
| | - Jae Yeong Cho
- Department of Cardiovascular MedicineChonnam National University Medical School/HospitalGwangjuKorea
| | - Jae‐Hyeong Park
- Department of Internal MedicineChungnam National University College of MedicineDaejeonKorea
| | - Sue K. Park
- Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
| | - Jean Kyung Bak
- National Evidence‐based Healthcare Collaborating Agency (NECA)SeoulKorea
| | - Jin Young Lee
- Department of StatisticsChung‐ang UniversitySeoulKorea
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7
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Jordan AN, Fulford J, Gooding K, Anning C, Wilkes L, Ball C, Pamphilon N, Mawson D, Clark CE, Shore AC, Sharp ASP, Bellenger NG. Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study. J Cardiovasc Magn Reson 2021; 23:122. [PMID: 34689818 PMCID: PMC8543888 DOI: 10.1186/s12968-021-00805-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis. METHODS We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment. RESULTS We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (- 20.8 ± 4.9 to - 19.1 ± 3.7, p = 0.02), apical circumferential strain (- 26.0 ± 5.3 to - 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003). CONCLUSIONS LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes. TRIAL REGISTRATION ISRCTN registry number: 57475376 (assigned 25/06/2015).
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Affiliation(s)
- Andrew N Jordan
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK.
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.
- Diabetes and Vascular Research Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - Jon Fulford
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Kim Gooding
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Christine Anning
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Lindsay Wilkes
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Claire Ball
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Nicola Pamphilon
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - David Mawson
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Christopher E Clark
- Primary Care Research Group, Exeter College of Medicine and Health, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Angela C Shore
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Andrew S P Sharp
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Nicholas G Bellenger
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
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8
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Mohan M, Dihoum A, Mordi IR, Choy AM, Rena G, Lang CC. Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. Front Cardiovasc Med 2021; 8:746382. [PMID: 34660744 PMCID: PMC8513785 DOI: 10.3389/fcvm.2021.746382] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.
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Affiliation(s)
- Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Adel Dihoum
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.,UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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9
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Edwards NC, Price AM, Mehta S, Hiemstra TF, Kaur A, Greasley PJ, Webb DJ, Dhaun N, MacIntyre IM, Farrah T, Melville V, Herrey AS, Slinn G, Wale R, Ives N, Wheeler DC, Wilkinson I, Steeds RP, Ferro CJ, Townend JN. Effects of Spironolactone and Chlorthalidone on Cardiovascular Structure and Function in Chronic Kidney Disease: A Randomized, Open-Label Trial. Clin J Am Soc Nephrol 2021; 16:1491-1501. [PMID: 34462286 PMCID: PMC8499017 DOI: 10.2215/cjn.01930221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES In a randomized double-blind, placebo-controlled trial, treatment with spironolactone in early-stage CKD reduced left ventricular mass and arterial stiffness compared with placebo. It is not known if these effects were due to BP reduction or specific vascular and myocardial effects of spironolactone. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A prospective, randomized, open-label, blinded end point study conducted in four UK centers (Birmingham, Cambridge, Edinburgh, and London) comparing spironolactone 25 mg to chlorthalidone 25 mg once daily for 40 weeks in 154 participants with nondiabetic stage 2 and 3 CKD (eGFR 30-89 ml/min per 1.73 m2). The primary end point was change in left ventricular mass on cardiac magnetic resonance imaging. Participants were on treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and had controlled BP (target ≤130/80 mm Hg). RESULTS There was no significant difference in left ventricular mass regression; at week 40, the adjusted mean difference for spironolactone compared with chlorthalidone was -3.8 g (95% confidence interval, -8.1 to 0.5 g, P=0.08). Office and 24-hour ambulatory BPs fell in response to both drugs with no significant differences between treatment. Pulse wave velocity was not significantly different between groups; at week 40, the adjusted mean difference for spironolactone compared with chlorthalidone was 0.04 m/s (-0.4 m/s, 0.5 m/s, P=0.90). Hyperkalemia (defined ≥5.4 mEq/L) occurred more frequently with spironolactone (12 versus two participants, adjusted relative risk was 5.5, 95% confidence interval, 1.4 to 22.1, P=0.02), but there were no patients with severe hyperkalemia (defined ≥6.5 mEq/L). A decline in eGFR >30% occurred in eight participants treated with chlorthalidone compared with two participants with spironolactone (adjusted relative risk was 0.2, 95% confidence interval, 0.05 to 1.1, P=0.07). CONCLUSIONS Spironolactone was not superior to chlorthalidone in reducing left ventricular mass, BP, or arterial stiffness in nondiabetic CKD.
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Affiliation(s)
- Nicola C. Edwards
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Green Lane Cardiovascular Unit, Auckland, New Zealand
| | - Anna M. Price
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Samir Mehta
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Thomas F. Hiemstra
- Cambridge Clinical Trials Unit, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom,GlaxoSmithKline, England, United Kingdom
| | - Amreen Kaur
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Peter J. Greasley
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - David J. Webb
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom
| | - Neeraj Dhaun
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Iain M. MacIntyre
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Tariq Farrah
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom,Department of Nephrology, National Health Services Lothian, Edinburgh, United Kingdom
| | - Vanessa Melville
- Center for Cardiovascular Science and Clinical Research Center, University of Edinburgh, United Kingdom
| | - Anna S. Herrey
- UCL Institute of Cardiovascular Science and Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Gemma Slinn
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Rebekah Wale
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - David C. Wheeler
- Department of Renal Medicine, University College London, United Kingdom,George Institute for Global Health, Sydney, Australia
| | - Ian Wilkinson
- Cambridge Clinical Trials Unit, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom,GlaxoSmithKline, England, United Kingdom
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - Charles J. Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom,Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom
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10
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Curcumin, an Inhibitor of p300-HAT Activity, Suppresses the Development of Hypertension-Induced Left Ventricular Hypertrophy with Preserved Ejection Fraction in Dahl Rats. Nutrients 2021; 13:nu13082608. [PMID: 34444769 PMCID: PMC8397934 DOI: 10.3390/nu13082608] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 12/21/2022] Open
Abstract
We found that curcumin, a p300 histone acetyltransferase (HAT) inhibitor, prevents cardiac hypertrophy and systolic dysfunction at the stage of chronic heart failure in Dahl salt-sensitive rats (DS). It is unclear whether curcumin suppresses the development of hypertension-induced left ventricular hypertrophy (LVH) with a preserved ejection fraction. Therefore, in this study, we randomized DS (n = 16) and Dahl salt-resistant (DR) rats (n = 10) at 6 weeks of age to either curcumin or vehicle groups. These rats were fed a high-salt diet and orally administrated with 50 mg/kg/d curcumin or its vehicle for 6 weeks. Both curcumin and vehicle treatment groups exhibited similar degrees of high-salt diet-induced hypertension in DS rats. Curcumin significantly decreased hypertension-induced increase in posterior wall thickness and LV mass index, without affecting the systolic function. It also significantly reduced hypertension-induced increases in myocardial cell diameter, perivascular fibrosis and transcriptions of the hypertrophy-response gene. Moreover, it significantly attenuated the acetylation levels of GATA4 in the hearts of DS rats. A p300 HAT inhibitor, curcumin, suppresses the development of hypertension-induced LVH, without affecting blood pressure and systolic function. Therefore, curcumin may be used for the prevention of development of LVH in patients with hypertension.
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11
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Lyngbakken MN, Kvisvik B, Aagaard EN, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Røsjø H, Omland T. B-Type Natriuretic Peptide Is Associated with Indices of Left Ventricular Dysfunction in Healthy Subjects from the General Population: The Akershus Cardiac Examination 1950 Study. Clin Chem 2021; 67:204-215. [PMID: 33279958 DOI: 10.1093/clinchem/hvaa257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/12/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Concentrations of B-type natriuretic peptide (BNP) reflect myocardial distension and stress, and are associated with poor prognosis in patients with cardiovascular disease. Accordingly, we hypothesized that concentrations of BNP would be associated with indices of adverse left ventricular (LV) remodeling and early stages of LV systolic and diastolic dysfunction in healthy participants from the general population. METHODS We measured BNP in 1757 women and 1677 men free from known coronary heart disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive cardiovascular phenotyping at baseline, including detailed echocardiography with assessment of indexed LV mass (LVMI), diastolic [tissue Doppler e', E/e' ratio, indexed left atrial volume (LAVI), maximal tricuspid regurgitation velocity (TRVmax), and E/A ratio], and systolic [global longitudinal strain (GLS) and LV ejection fraction (LVEF)] function. RESULTS Study participants with the highest BNP concentrations had higher GLS, LVMI, e', E/e' ratio, LAVI, TRVmax, and E/A ratio. In adjusted analyses, both GLS and LVEF exhibited significant nonlinear associations with BNP, with reduced LV systolic function observed in both the low and high concentration range of BNP. CONCLUSIONS In healthy participants recruited from the general population, concentrations of BNP exhibit nonlinear associations with LV systolic function, and both low and high concentrations are associated with reduced LV systolic function. This supports the notion that natriuretic peptides are beneficial and elicit cardioprotective effects, and may have important implications for the interpretation of BNP measurements in the general population.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Verdecchia P, Reboldi G, Mazzotta G, Angeli F. The Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) Study. Panminerva Med 2021; 63:464-471. [PMID: 33988329 DOI: 10.23736/s0031-0808.21.04383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study is a prospective registry of morbidity and mortality in initially untreated patients with essential hypertension whose initial diagnostic evaluation included 24-hour ambulatory blood pressure monitoring according to a standardized protocol. The present article summarizes the main results of the PIUMA study. METHODS the PIUMA study is conducted in three Hospitals in Umbria, Central Italy. After their initial assessment at entry, patients are followed in the outpatient clinic of the referring hospital and in collaboration with their family doctors. Telephone interviews with patients and meetings with family doctors are periodically conducted to ascertain the incidence of major complications of hypertension. RESULTS the PIUMA study gave us a tremendous opportunity to investigate several aspects related to hypertension: (1) Cross sectional studies focused on the association between clinic and 24-hour ABP and organ damage; (2) Longitudinal studies focused on the association between 24-hour ABP and hypertensive organ damage at cardiac level and other levels with the subsequent incidence of major cardiovascular events and mortality; (3) Longitudinal studies exploring the prognostic impact of other risk factors in hypertensive patients (i.e., diabetes, dyslipidemia, atrial fibrillation, left ventricular dysfunction, etc). The PIUMA study provided the first ever evidence of the prognostic value of (a) 24-hour ambulatory blood pressure monitoring; (b) regression of echocardiographic left ventricular hypertrophy in hypertensive patients. CONCLUSIONS the PIUMA registry gave us an enormous opportunity for investigating several pathophysiologic, diagnostic and therapeutic aspects related to management of hypertensive patients. Some of our studies have been mentioned in several Hypertension Guidelines to support some specific statements.
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Affiliation(s)
- Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, Perugia, Italy -
| | | | - Giovanni Mazzotta
- Division of Cardiology, Hospital C. G. Mazzoni, Ascoli Piceno, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Tradate, Varese, Italy
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13
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Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications. Pediatr Cardiol 2021; 42:331-339. [PMID: 33079265 PMCID: PMC7907012 DOI: 10.1007/s00246-020-02487-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/08/2020] [Indexed: 12/17/2022]
Abstract
Left ventricular hypertrophy (LVH) is independently associated with a higher risk of cardiovascular morbidity and mortality in adults. Adiposity is a risk factor for LVH, independent of blood pressure. Potential causes of this nonhemodynamic pathogenesis identified in adults include adverse body fat distribution, insulin resistance, dyslipidemia, and obstructive sleep apnea syndrome (OSA). In severely obese adolescents, the determinants of obesity-induced changes in left ventricular structure are poorly characterized. Cardiac ultrasonographic, demographic, anthropometric, and comorbidity-related data were prospectively collected in adolescents with severe obesity refractory to conservative treatment who presented for surgical therapy. Differences between adolescents with LVH and without LVH were evaluated using independent samples t, chi-square, or Fisher's exact test. Multivariable linear regression analysis was performed to evaluate associations with left ventricular structural changes, corrected for body mass index (BMI) z score. Forty-three patients entered analysis, of whom 24 (55.8%) showed LVH. The most common geometrical change was eccentric LVH (eLVH), occurring in 21 subjects (48.8%). Demographic and anthropometric variables did not differ between patients with and without LVH. Independent of BMI z score, left ventricular mass index was significantly associated with apnea-hypopnea index (AHI) (regression parameter B = 0.8; 95% CI 0.3 to 1.2). Interventricular septum thickness (IVST) was significantly associated with HOMA-IR values (B = 0.1; 95% CI 0.04 to 0.2), HDL-cholesterol (B = - 1.2; 95% CI - 2.2 to 0.1), and triglyceride levels (B = 0.5; 95% CI 0.001 to 0.9). LVH, especially eLVH, is highly prevalent amongst severely obese adolescents. Adverse changes in cardiac structure, increased IVST in particular, are independently associated with several nonhemodynamic comorbidities that are common in this population, namely OSA, insulin resistance, and dyslipidemia.
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14
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Brown AJM, Gandy S, McCrimmon R, Houston JG, Struthers AD, Lang CC. A randomized controlled trial of dapagliflozin on left ventricular hypertrophy in people with type two diabetes: the DAPA-LVH trial. Eur Heart J 2020; 41:3421-3432. [PMID: 32578850 PMCID: PMC8202417 DOI: 10.1093/eurheartj/ehaa419] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/11/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
AIM We tested the hypothesis that dapagliflozin may regress left ventricular hypertrophy (LVH) in people with type 2 diabetes (T2D). METHODS AND RESULTS We randomly assigned 66 people (mean age 67 ± 7 years, 38 males) with T2D, LVH, and controlled blood pressure (BP) to receive dapagliflozin 10 mg once daily or placebo for 12 months. Primary endpoint was change in absolute left ventricular mass (LVM), assessed by cardiac magnetic resonance imaging. In the intention-to-treat analysis, dapagliflozin significantly reduced LVM compared with placebo with an absolute mean change of -2.82g [95% confidence interval (CI): -5.13 to -0.51, P = 0.018]. Additional sensitivity analysis adjusting for baseline LVM, baseline BP, weight, and systolic BP change showed the LVM change to remain statistically significant (mean change -2.92g; 95% CI: -5.45 to -0.38, P = 0.025). Dapagliflozin significantly reduced pre-specified secondary endpoints including ambulatory 24-h systolic BP (P = 0.012), nocturnal systolic BP (P = 0.017), body weight (P < 0.001), visceral adipose tissue (VAT) (P < 0.001), subcutaneous adipose tissue (SCAT) (P = 0.001), insulin resistance, Homeostatic Model Assessment of Insulin Resistance (P = 0.017), and high-sensitivity C-reactive protein (hsCRP) (P = 0.049). CONCLUSION Dapagliflozin treatment significantly reduced LVM in people with T2D and LVH. This reduction in LVM was accompanied by reductions in systolic BP, body weight, visceral and SCAT, insulin resistance, and hsCRP. The regression of LVM suggests dapagliflozin can initiate reverse remodelling and changes in left ventricular structure that may partly contribute to the cardio-protective effects of dapagliflozin. CLINICALTRIALS.GOV IDENTIFIER NCT02956811.
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Affiliation(s)
- Alexander J M Brown
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells
Hospital & Medical School, University of Dundee, Dundee DD1 9SY,
UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital & Medical
School, Dundee DD1 9SY, UK
| | - Rory McCrimmon
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells
Hospital & Medical School, University of Dundee, Dundee DD1 9SY,
UK
| | - John Graeme Houston
- Department of Radiology, Ninewells Hospital & Medical School,
Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells
Hospital & Medical School, University of Dundee, Dundee DD1 9SY,
UK
| | - Chim C Lang
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells
Hospital & Medical School, University of Dundee, Dundee DD1 9SY,
UK
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15
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Huang D, Wessler BS. Echocardiogram Assessment of Left Ventricular Mass for Hemodialysis Patients. Kidney Med 2020; 2:523-525. [PMID: 33090121 PMCID: PMC7568075 DOI: 10.1016/j.xkme.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment? Hypertens Res 2020; 43:1015-1027. [PMID: 32572170 DOI: 10.1038/s41440-020-0496-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023]
Abstract
Renovascular hypertension (RVH) is one of the most common causes of secondary hypertension and can result in resistant hypertension. RVH is associated with an increased risk for progressive decline in renal function, cardiac destabilization syndromes including "flash" pulmonary edema, recurrent congestive heart failure, and cerebrocardiovascular disease. The most common cause of renal artery stenosis (RAS) is atherosclerotic lesions, followed by fibromuscular dysplasia. The endovascular technique of percutaneous transluminal renal angioplasty (PTRA) with or without stenting is one of the standard treatments for RAS. Randomized controlled trials comparing medical therapy with PTRA to medical therapy alone have failed to show a benefit of PTRA; however, the subjects of these randomized clinical trials were limited to atherosclerotic RAS patients, and patients with the most severe RAS, who would be more likely to benefit from PTRA, might not have been enrolled in these trials. This review compares international guidelines related to PTRA, reevaluates the effects of PTRA treatment on blood pressure and renal and cardiac function, discusses strategies for the management of RVH patients, and identifies factors that may predict which patients are most likely to benefit from PTRA.
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18
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Niiranen TJ, Enserro DM, Larson MG, Vasan RS. Multisystem Trajectories Over the Adult Life Course and Relations to Cardiovascular Disease and Death. J Gerontol A Biol Sci Med Sci 2020; 74:1778-1785. [PMID: 30358808 DOI: 10.1093/gerona/gly249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Comprehensive conjoint characterization of long-term trajectories representing several biological systems is lacking. METHODS We measured serially indicators representing 14 distinct biological systems in up to 3,453 participants attending four Framingham Study examinations: bone mineral density, body mass index (BMI), C-reactive protein, glomerular filtration rate, forced vital capacity (FVC), 1 second forced expiratory volume/FVC ratio (FEV1/FVC), gait speed, grip strength, glycosylated hemoglobin (HbA1c), heart rate, left ventricular mass, Mini-Mental State Examination (MMSE), pulse pressure, and total/high-density lipoprotein cholesterol ratio (TC/HDL). RESULTS We observed that correlations among the 14 sex-specific trajectories were modest (r < .30 for 169 of 182 sex-specific correlations). During follow-up (median 8 years), 232 individuals experienced a cardiovascular disease (CVD) event and 393 participants died. In multivariable regression models, CVD incidence was positively related to trajectories of BMI, HbA1c, TC/HDL, gait time, and pulse pressure (p < .06); mortality risk was related directly to trajectories of gait time, C-reactive protein, heart rate, and pulse pressure but inversely to MMSE and FEV1/FVC (p < .006). A unit increase in the trajectory risk score was associated with a 2.80-fold risk of CVD (95% confidence interval [CI], 2.04-3.84; p < .001) and a 2.71-fold risk of death (95% CI, 2.30-3.20; p < .001). Trajectory risk scores were suggestive of a greater increase in model c-statistic compared with single occasion measures (delta-c compared with age- and sex-adjusted models: .032 vs .026 for CVD; .042 vs .030 for mortality). CONCLUSIONS Biological systems age differentially over the life course. Longitudinal data on a parsimonious set of biomarkers reflecting key biological systems may facilitate identification of high-risk individuals.
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Affiliation(s)
- Teemu J Niiranen
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Department of Public Health Solutions, National Institute for Health and Welfare, Turku, Finland.,Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Danielle M Enserro
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Department of Medicine, Section of Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Medicine, Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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19
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Iwashima Y, Fukuda T, Horio T, Kusunoki H, Hayashi SI, Kamide K, Kawano Y, Ishimitsu T, Yoshihara F. Impact of Percutaneous Revascularization on Left Ventricular Mass and Its Relationship to Outcome in Hypertensive Patients With Renal Artery Stenosis. Am J Hypertens 2020; 33:570-580. [PMID: 32161950 DOI: 10.1093/ajh/hpaa036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We investigated the effects of percutaneous transluminal renal angioplasty on left ventricular (LV) mass, and the impact of LV mass reduction on outcomes. METHODS A total of 144 hypertensive patients with renal artery stenosis (RAS) (mean age 69 years; 22.2% fibromuscular dysplasia (FMD)) who underwent angioplasty were included. Echocardiography was performed at baseline and after 1 year, and patients were thereafter followed up for a median of 5.6 years for primary composite outcomes. RESULTS In both the FMD and atherosclerotic stenosis (ARAS) groups, LV mass decreased after angioplasty, but the decrease in LV mass index (-15.4 ± 18.3% vs. -0.8 ± 27.8%, P < 0.01) as well as the regression rate of LV hypertrophy was greater in FMD. Multiple logistic regression analysis indicated that FMD (odds ratio (OR) 2.94, P < 0.01), severe RAS (≥90%) (OR 2.94, P < 0.05), and higher LV mass index at baseline (OR 2.94 for 1 SD increase, P < 0.001) were independent predictors of LV mass index decrease of at least 20%. The primary composite outcomes occurred in 45 patients (31.3%). In FMD, lower LV mass index after 1 year (hazard ratio 2.81 for 1 SD increase, P < 0.05) or regression of LV mass (hazard ratio 0.75 for 5% decrease, P = 0.054) showed a tendency to be associated with better outcomes; however, these associations were not found in ARAS. CONCLUSIONS Hypertensive patients with ARAS have less regression of LV mass in response to angioplasty than those with FMD, and LV mass regression is less useful as a surrogate marker of outcomes especially in ARAS.
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Affiliation(s)
- Yoshio Iwashima
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Horio
- Department of Internal Medicine, Ishikiriseiki Hospital, Osaka, Japan
| | - Hiroshi Kusunoki
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shin-ichiro Hayashi
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kei Kamide
- Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuhei Kawano
- Department of Medical Technology, Teikyo University Fukuoka, Fukuoka, Japan
| | - Toshihiko Ishimitsu
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Fumiki Yoshihara
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
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20
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Left Ventricular Mass is Independently Related to Coronary Artery Atherosclerotic Burden. J Thorac Imaging 2020; 36:181-188. [DOI: 10.1097/rti.0000000000000511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Joseph G, Marott JL, Biering-Sørensen T, Johansen MN, Saevereid HA, Nielsen G, Schnohr P, Prescott E, Søgaard P, Mogelvang R. Level of Physical Activity, Left Ventricular Mass, Hypertension, and Prognosis. Hypertension 2020; 75:693-701. [DOI: 10.1161/hypertensionaha.119.14287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular hypertrophy is a strong predictor of prognosis in hypertension. Physical activity is associated with higher left ventricular mass but also reduced risk of cardiovascular outcomes. The aims were to explore whether (1) presence of hypertension modifies the association between physical activity and left ventricular mass; (2) the beneficial association between physical activity and prognostic outcome is modified by left ventricular hypertrophy. Randomly selected number of 3078 persons from the general population underwent echocardiogram. Left ventricular mass was indexed to body surface area. Level of physical activity was self-reported: inactivity, light activity, and moderate/high activity. Blood pressure was measured in rest: normal BP (<140/90 mm Hg) and hypertension (≥140/90 mm Hg or in pharmacological treatment for hypertension). Presence of hypertension modified the association between physical activity and left ventricular mass index significantly (test for interaction:
P
=0.01): in normal BP, higher levels of physical activity were associated with significantly higher left ventricular mass index (
P
<0.001), but this was not present in hypertension (
P
=0.90). Level of physical activity was associated with reduction in mortality and cardiovascular outcome independent of the presence of LVH (Persons with LVH: light activity HR, 0.77 [0.52–1.15], moderate/high activity HR, 0.61 [0.38–0.97]; test for interaction between LVH and level of physical activity
P
=0.71). In conclusion, persons with normal BP had higher left ventricular mass index at increased levels of physical activity, whereas this association was not present among persons with hypertension. Level of physical activity was associated with better prognosis independent of whether left ventricular hypertrophy was present or not.
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Affiliation(s)
- Gowsini Joseph
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Clinical Medicine, Aalborg University, Denmark (G.J., P. Søgaard)
- Department of Cardiology and Centre for Clinical Research, North Denmark Regional Hospital, Hjorring, Denmark (G.J., G.N.)
- Department of Cardiology, Rigshospitalet (G.J., R.M.), University of Copenhagen, Denmark
| | - Jacob Louis Marott
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
| | - Tor Biering-Sørensen
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences (T.B.-S.), University of Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (T.B.-S.)
| | | | - Hans A. Saevereid
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital (H.A.S., E.P.), University of Copenhagen, Denmark
| | - Gitte Nielsen
- Department of Cardiology and Centre for Clinical Research, North Denmark Regional Hospital, Hjorring, Denmark (G.J., G.N.)
| | - Peter Schnohr
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Aalborg University Hospital, Denmark (M.N.J, P.S.)
| | - Eva Prescott
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital (H.A.S., E.P.), University of Copenhagen, Denmark
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Denmark (G.J., P. Søgaard)
| | - Rasmus Mogelvang
- From the The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (G.J., J.L.M., T.B.-S., P. Schnohr, E.P., R.M.)
- Department of Cardiology, Rigshospitalet (G.J., R.M.), University of Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Svendborg, Denmark (R.M.)
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Lyngbakken MN, Aagaard EN, Kvisvik B, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Røsjø H, Omland T. Cardiac Troponin I and T Are Associated with Left Ventricular Function and Structure: Data from the Akershus Cardiac Examination 1950 Study. Clin Chem 2020; 66:567-578. [DOI: 10.1093/clinchem/hvaa023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Concentrations of cardiac troponin I (cTnI) and T (cTnT) are associated with clinical cardiac outcomes, but do not correlate closely in subjects recruited from the general population. Accordingly, we hypothesized that cTnI and cTnT concentrations would be influenced by different cardiovascular (CV) and non-CV risk factors and reflect different CV phenotypes.
Methods
We measured cTnI and cTnT with last generation assays in 1236 women and 1157 men with no known CV disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive CV phenotyping at baseline, including detailed echocardiography.
Results
Concentrations of cTnI were measurable in 60.3% and cTnT in 72.5% of study participants (P < 0.001), and correlated moderately (r = 0.53; P < 0.001). cTnI was more strongly associated with male sex (P = 0.018), higher education (P < 0.001), history of hypertension (P < 0.001), and age (P < 0.001), whereas cTnT was more strongly associated with eGFR (P = 0.015). Both cTnI and cTnT were inversely associated with global longitudinal strain and positively associated with LV mass index (LVMI) in analyses adjusted for CV risk factors. The association between cTnI and LVMI was stronger than the association between cTnT and LVMI (P = 0.035). Concentrations of cTnI improved diagnostic accuracy for LV hypertrophy when added to established CV risk factors, but concentrations of cTnT did not improve these models further.
Conclusions
In a large community-based cohort examined with extensive echocardiography, concentrations of cTnI and cTnT are associated with subclinical LV hypertrophy and dysfunction. Concentrations of cTnI appear superior to cTnT in predicting subclinical LV hypertrophy.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hypertensive Mediated Organ Damage and Hypertension Management. How to Assess Beneficial Effects of Antihypertensive Treatments? High Blood Press Cardiovasc Prev 2020; 27:9-17. [DOI: 10.1007/s40292-020-00361-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/11/2020] [Indexed: 12/15/2022] Open
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Abstract
Background It is debated whether echocardiography should be part of the diagnostic workup in all hypertensive patients. We identified some factors potentially associated with left ventricular hypertrophy (LVH) at echocardiography in untreated hypertensive patients. Methods and Results We studied 2150 patients without LVH at ECG. All patients underwent standard 12‐lead ECG and echocardiography. Mean age was 48.7 years, and mean office blood pressure was 154/97 mm Hg. Prevalence of echocardiographic LVH (LV mass >47.0 g/m2.7 in women and >50.0 g/m2.7 in men) was 37.1%. We developed a nomogram based on 7 items (age, smoking, body mass index, office systolic and diastolic blood pressure, Cornell voltage, and chronic kidney disease) on the basis of a multivariable logistic regression analysis. We internally validated the model by bootstrap recalibration and obtained a calibration curve to assess agreement in the validation data set. Probability of LVH at echocardiography ranged from <10% (score, ≤100 points) to >90% (score, ≥180 points). Proportion of patients with LVH progressively increased with the total score (χ2=444.8; P<0.001). Prevalence of LVH was <2% and 90% at the lower 5th and upper 95th percentile of its distribution, respectively. Conclusions We developed and validated a novel score to assess the probability of LVH at echocardiography in hypertensive patients without LVH at ECG. The score may guide the appropriateness of echocardiographic study in low‐risk hypertensive patients. Echocardiography appears most appropriate for score values >136 in men and >124 in women.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical SciencesUniversity Federico II of NaplesNapoliItaly
| | - Fabio Angeli
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
- Maugeri Care and Research InstituteIRCCS TradateTradateItaly
| | | | | | - Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical SciencesUniversity Federico II of NaplesNapoliItaly
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25
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Lee TC, Jin Z, Homma S, Nakanishi K, Elkind MSV, Rundek T, Tugcu A, Matsumoto K, Sacco RL, Di Tullio MR. Changes in Left Ventricular Mass and Geometry in the Older Adults: Role of Body Mass and Central Obesity. J Am Soc Echocardiogr 2019; 32:1318-1325. [PMID: 31311705 DOI: 10.1016/j.echo.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is an independent risk factor for cardiovascular outcomes. There are limited data about modifiable factors associated with progression of LV hypertrophy in older adults. Our objective is to describe the changes in LV mass and geometry over time in a predominantly older multiethnic cohort and to identify possible predictors of changes over time. METHODS We analyzed data from participants in the Northern Manhattan Study who underwent serial echocardiographic studies, comparing the baseline and the most recent echocardiograms. We recorded changes in LV mass and geometry and correlated them with baseline characteristics using linear regression models. RESULTS There were 826 participants (mean age, 64.2 ± 8.0 years) included in the analysis (time between measurements, 8.5 ± 2.7 years). Overall, LV mass index increased from 45.0 ± 12.7 to 50.3 ± 14.6 g/m2.7 (P < .001). There were 548 participants (66.3%) with LV mass increase; 258 individuals (31.2%) showed worsening LV geometry. Multivariable analysis showed that change in LV mass index was independently associated with baseline LV mass index (β estimate, -17.000 [standard error, 1.508]; P < .001), hypertension (2.094 [0.816], P = .011), body mass index (0.503 [0.088], P < .001), and waist-to-hip ratio (1.031 [0.385], P = .008). Both waist-to-hip ratio and waist-to-height ratio remained significantly associated with LV mass increase even after adjusting for body mass index (P = .008 and P = .036, respectively). CONCLUSIONS Regardless of race/ethnicity, LV mass progressed over time in older adults. We also observed that worsening geometry was frequent. Assessment of central obesity in the older population is important because indicators of central obesity add prognostic value over body mass index for the risk of LV mass increase.
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Affiliation(s)
- Tetz C Lee
- Department of Medicine, Columbia University, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Koki Nakanishi
- Department of Medicine, Columbia University, New York, New York
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, New York
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, New York
| | - Kenji Matsumoto
- Department of Medicine, Columbia University, New York, New York
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida; Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
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The regulatory mechanisms of Yulangsan MHBFC reversing cardiac remodeling in rats based on eNOS-NO signaling pathway. Biomed Pharmacother 2019; 117:109141. [PMID: 31228800 DOI: 10.1016/j.biopha.2019.109141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 11/20/2022] Open
Abstract
Millettia pulchra Kurz var-laxior (Dunn) Z. Wei, a wild-growing plant of the family Fabaceae is known to possess multifarious medicinal properties. 17-Methoxyl-7-hydroxy-benzene-furanchalcone (MHBFC) is a flavonoid monomer extracted from its root, which has been used in traditional Chinese medicine, with a long history as a remedy of hypertension and cardiovascular remodeling. The present study was conducted to further investigate the regulatory mechanisms of MHBFC based on the endothelial nitric oxide synthase-nitric oxide (eNOS-NO) signaling pathway. The abdominal aorta of the male Sprague-Dawley rats was narrowed to induce cardiac remodeling, and the rats were given corresponding drugs for 6 weeks after operation. At the end of the experiment, the relevant indexes were detected. The results showed that Nω-nitro-L-arginine methyl ester (L-NAME) could increase the myocardial cell cross-section area, myocardial fibrosis, and the cardiac collagen volume fraction. The serum NO and eNOS levels and the expression of p-eNOS, p-PI3K and p-Akt protein were decreased, and myocardial microvascular endothelial cell (MMVEC) apoptosis increased. However, the above changes were reversed after treatment with MHBFC. These results indicated that MHBFC could increase eNOS protein phosphorylation by increasing PI3K and Akt protein phosphorylation, and activated the eNOS-NO signaling pathway, increased eNOS enzyme activity, catalyzed the generation of protective NO, and counteracted MMVEC apoptosis induced by cardiac remodeling, thereby protecting against myocardial damage and reversing cardiac remodeling.
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Verdecchia P, Angeli F, Cavallini C, Aita A, Turturiello D, De Fano M, Reboldi G. Sudden Cardiac Death in Hypertensive Patients. Hypertension 2019; 73:1071-1078. [DOI: 10.1161/hypertensionaha.119.12684] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Paolo Verdecchia
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Fabio Angeli
- Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Hospital S. Maria della Misericordia, Perugia, Italy (F.A., D.T.)
| | - Claudio Cavallini
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Adolfo Aita
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Dario Turturiello
- Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Hospital S. Maria della Misericordia, Perugia, Italy (F.A., D.T.)
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Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi C, Teliewubai J, Li J, Blacher J, Zhang Y, Xu Y. Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: the Northern Shanghai Study. Clin Interv Aging 2019; 14:549-556. [PMID: 30880935 PMCID: PMC6417007 DOI: 10.2147/cia.s180723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Left ventricular hypertrophy (LVH) is one of the preclinical manifestations of hypertensive target organ damage (TOD). However, it remains unclear which electrocardiographic criterion perform better in diagnosing LVH. Purpose To investigate the consistency of LVH diagnosed by electrocardiography (ECG) and echocardiography (ECHO). Taking LVH by ECHO as reference, to compare three different ECG criteria (Sokolow-Lyon, Cornell and Cornell Product criteria) and find the best ECG indicator for identifying LVH in community-based elderly Chinese. Patients and methods Echocardiography and electrocardiography were applied to define LVH in 1789 elderly Chinese aged >65 years old in communities located at the northern Shanghai. Echocardiographic LVH (ECHO-LVH) was defined by left ventricular mass indexed for Body Surface Area (LVM/BSA) or for height2.7 (LVM/height2.7). Electrocardiographic LVH (ECG-LVH) was defined by Sokolow-Lyon (SL), Cornell and Cornell Product (CP) criteria. ECHO-LVH was defined by LVM/BSA≥125 g/m2 in male or ≥110 g/m2 in female (LVH1); LVM/BSA≥115 g/m2 in male, or ≥95 g/m2 in female (LVH2) and LVM/height2.7 ≥51 g/m2.7 in male or ≥47 g/m2.7 in female (LVH3). Results As compared with SL and Cornell criteria, CP had the greatest correlation coefficient in the association with echocardiography-defined LVH, except for LVM/BSA in men. Of note, CP criterion had the greatest area under curve of ROC than Cornell criterion and the SL index, not only in total population but also in subgroups classified by blood pressure. Conclusion In ECG-LVH criteria, CP criterion complies better than SL index and Cornell criterion in assessing cardiac hypertrophy.
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Affiliation(s)
- Wei Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Yiwu Zhou
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Bin Bai
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Jiadela Teliewubai
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Jue Li
- Department of Prevention, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris Descartes University, AP-HP, Paris, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China, ;
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Nomsawadi V, Krittayaphong R. Diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy among various body mass index groups compared to diagnosis by cardiac magnetic resonance imaging. Ann Noninvasive Electrocardiol 2019; 24:e12635. [PMID: 30719815 DOI: 10.1111/anec.12635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Presence of left ventricular hypertrophy (LVH) increases the risk for cardiovascular event. Many electrocardiographic (ECG) criteria can be used to diagnose LVH; however, high body mass index (BMI) may reduce ECG amplitudes.The aim of this study was to investigate the diagnostic performance of ECG criteria for diagnosing LVH among various BMI groups compared to diagnosis by cardiac magnetic resonance (CMR) imaging. METHODS Patients who were referred for CMR were enrolled. CMR and ECG were performed on the same day. Left ventricular function, volume, and mass were calculated from CMR. Standard ECG criteria were measured, including: Cornell voltage, Cornell product, Romhilt-Estes point score system, Sokolow-Lyon index, and Sokolow-Lyon-Rappaport index. Diagnostic performance of each ECG criterion was calculated and analyzed in the following four BMI groups: underweight (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23-24.9 kg/m2 ), and obese (≥25 kg/m2 ). RESULTS Of the 1,882 patients that were included, 67 were underweight, 459 were normal weight, 434 were overweight, and 922 were obese. LVH was diagnosed in 34 (50.7%) underweight, 144 (31.4%) normal weight, 100 (23.0%) overweight, and 181 (19.6%) obese patients. Overall specificity of ECG was high (0.89-0.95), and overall sensitivity was low (0.25-0.37). The specificity of each ECG criterion was similar among BMI groups; however, the sensitivity of ECG criteria demonstrated a decreasing trend in the higher BMI groups. CONCLUSION All ECG criteria demonstrated relatively high specificity and relatively low sensitivity. Although the specificity across groups remained similar, higher BMI was found to be associated with decreased sensitivity.
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Affiliation(s)
- Veerawat Nomsawadi
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Department of Medicine, Division of Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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30
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Ferrer‐Curriu G, Redondo‐Angulo I, Guitart‐Mampel M, Ruperez C, Mas‐Stachurska A, Sitges M, Garrabou G, Villarroya F, Fernández‐Solà J, Planavila A. Fibroblast growth factor‐21 protects against fibrosis in hypertensive heart disease. J Pathol 2019; 248:30-40. [DOI: 10.1002/path.5226] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/16/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Gemma Ferrer‐Curriu
- Departament de Bioquímica i Biologia MolecularInstitut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona Barcelona Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Barcelona Spain
| | - Ibon Redondo‐Angulo
- Departament de Bioquímica i Biologia MolecularInstitut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona Barcelona Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Barcelona Spain
| | - Mariona Guitart‐Mampel
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPS, Faculty of Medicine and Health Science, University of Barcelona, Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona and CIBERER Barcelona Spain
| | - Celia Ruperez
- Departament de Bioquímica i Biologia MolecularInstitut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona Barcelona Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Barcelona Spain
| | - Aleksandra Mas‐Stachurska
- Cardiology DepartmentThorax Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Barcelona Spain
| | - Marta Sitges
- Cardiology DepartmentThorax Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona Barcelona Spain
| | - Gloria Garrabou
- Muscle Research and Mitochondrial Function LaboratoryCellex‐IDIBAPS, Faculty of Medicine and Health Science, University of Barcelona, Internal Medicine Service, Hospital Clínic of Barcelona, Barcelona and CIBERER Barcelona Spain
| | - Francesc Villarroya
- Departament de Bioquímica i Biologia MolecularInstitut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona Barcelona Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Barcelona Spain
| | | | - Anna Planavila
- Departament de Bioquímica i Biologia MolecularInstitut de Biomedicina de la Universitat de Barcelona (IBUB), Universitat de Barcelona Barcelona Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Barcelona Spain
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31
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Yang X, Yang G, Li W, Zhang Y, Wang J. Therapeutic Effect of Ilex hainanensis Merr. Extract on Essential Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2018; 9:424. [PMID: 29867454 PMCID: PMC5953335 DOI: 10.3389/fphar.2018.00424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/11/2018] [Indexed: 12/24/2022] Open
Abstract
With a rapidly aging population, the prevalence of hypertension in adults continues to rise, placing a substantial and escalating social and economic burden. Ilex hainanensis Merr. is commonly used as a folk remedy for treating hypertension, dyslipidemia, and inflammation in China. This systematic review aims to evaluate current evidence for the therapeutic effect of Ilex hainanensis Merr. extract (EIH) on essential hypertension. Six electronic databases (Pubmed, MEDLINE, The Cochrane Central Register of Controlled Trials, Chinese Scientific Journals Database, Wanfang and CNKI) were searched to identify eligible randomized controlled trials (RCTs) relevant to EIH on essential hypertension up to Jan 2018. Six RCTs including 772 participants met eligibility criteria. Methodological quality of the trials was generally low. Meta-analysis showed that EIH demonstrated a beneficial effect for lowering systolic and diastolic blood pressure (SBP/DBP), left ventricular mass (LVM) in participants with essential hypertension. There was no significant difference between EIH and antihypertensive drugs in SBP (WMD: -0.44 [-2.30, 1.43]; P = 0.65), DBP (WMD: WMD: -0.02 [-1.13, 1.09]; P = 0.98) and LVM (WMD: -1.36 [-4.99, 2.26]; P = 0.46). Moreover, one trial showed that EIH combined with antihypertensive drugs was more effective in lowering blood pressure than those antihypertensive drugs used alone. However, the findings were limited by the small sample sizes, duration and low methodological quality of the trials. This is the first systematic review of EIH on essential hypertension. More rigorous RCTs with high quality are still needed to prove the effectiveness and safety of EIH and its preparations for essential hypertension.
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Affiliation(s)
- Xiaochen Yang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoyan Yang
- Centre for Complementary Medicine Research, University of Western Sydney, Sydney, NSW, Australia
| | - Weina Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun Zhang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Zhou D, Huang Y, Fu M, Cai A, Tang S, Feng Y. Prognostic value of tissue Doppler E/e' ratio in hypertension patients with preserved left ventricular ejection fraction. Clin Exp Hypertens 2018; 40:554-559. [PMID: 29400582 DOI: 10.1080/10641963.2017.1407332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aims to investigate the association of tissue Doppler E/e' with cardiac events in hypertension patients, independent of and incremental to clinical and left ventricular geometric patterns. METHODS We retrospectively enrolled 222 asymptomatic nonischemic patients with hypertension who had echocardiogram in 2012 to evaluate tissue Doppler E/e'. Patients were followed up for cardiac events (cardiac events were defined as myocardial infarction, coronary revascularization procedures, new-onset angina (stable or unstable), heart failure). A cox regression was used to assess the association of the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') with cardiac events. RESULTS A total of 222 patients were included in analysis. There were 10 primary cardiac events during 3.2 ± 0.4 years follow-up. The E/e' ratio was the strongest predictor of cardiac events in Cox-proportional hazards models. Following adjustment for covariates, a unit rise in the E/e' ratio was associated with a 26% increment in risk of a cardiac event (HR 1.26, CI 1.06-1.50, p = 0.008). When E/e' >14 the hazard ratio of cardiac event was significantly increased compared with E/e' ≤ 14 in Kaplan-Meier analysis (log-rank ratio, 16.26; p < 0.001). CONCLUSIONS E/e', a non-invasive estimate of left ventricular filling pressure, predicts cardiac events in hypertensive population with preserved left ventricular ejection fraction, independent of and incremental to clinical and left ventricular geometric patterns. E/e' represents an early, effective tool for cardiovascular risk stratification in hypertension population.
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Affiliation(s)
- Dan Zhou
- a Southern Medical University , Guangzhou , China.,b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Yuqing Huang
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Ming Fu
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Anping Cai
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Songtao Tang
- c Community Health Center of Liaobu County , Dongguan , China
| | - Yingqing Feng
- a Southern Medical University , Guangzhou , China.,b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
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Okin PM, Hille DA, Kjeldsen SE, Devereux RB. Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.007564. [PMID: 29151037 PMCID: PMC5721804 DOI: 10.1161/jaha.117.007564] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with hypertension with ECG left ventricular hypertrophy (LVH) have higher cardiovascular morbidity and mortality, but single ECG criteria may underestimate risk. Whether continued presence or new development of ECG LVH by 2 criteria can further concentrate risk during blood pressure lowering is unclear. METHODS AND RESULTS Incident stroke, myocardial infarction, cardiovascular death, the composite of these outcomes, and all-cause mortality were examined in relation to the presence of on-treatment ECG LVH by Cornell product and/or Sokolow-Lyon voltage during a mean of 4.8±0.9 years follow-up in 9193 patients with hypertension randomized to losartan- or atenolol-based regimens. Patients were categorized into 4 groups according to the presence or absence of ECG LVH by each criterion at baseline and yearly during the study. At baseline, LVH by both criteria was present in 960 patients (10.4%). Compared with the absence of ECG LVH by both criteria, persistence or development of ECG LVH by both criteria entered as a time-varying covariate was associated with >3-fold increased risks of events in multivariable Cox analyses adjusting for randomized treatment, baseline risk factors, and on-treatment heart rate and systolic and diastolic blood pressures. Patients with ECG LVH by either Cornell product or Sokolow-Lyon voltage had 45% to 140% higher risks of all end points. CONCLUSIONS Persistence or development of ECG LVH by both Cornell product and Sokolow-Lyon voltage criteria during antihypertensive therapy is associated with markedly increased risks of cardiovascular end points and all-cause mortality. Further study is indicated to determine whether additional therapy in these patients can reduce their risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
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Affiliation(s)
- Peter M Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY
| | | | - Sverre E Kjeldsen
- Department of Cardiology, Ullevål Hospital, University of Oslo, Norway.,Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY
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de Cleva R, Araujo VA, Buchalla CCO, de Oliveira Costa F, Cardoso AF, Pajecki D, Santo MA. Cardiac Remodeling Patterns in Severe Obesity According to Arterial Hypertension Grade. Obes Surg 2017; 28:1047-1054. [DOI: 10.1007/s11695-017-2968-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Brown AJ, Lang C, McCrimmon R, Struthers A. Does dapagliflozin regress left ventricular hypertrophy in patients with type 2 diabetes? A prospective, double-blind, randomised, placebo-controlled study. BMC Cardiovasc Disord 2017; 17:229. [PMID: 28835229 PMCID: PMC5569551 DOI: 10.1186/s12872-017-0663-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with diabetes have a two to fourfold increased risk for development of and death from cardiovascular disease [CVD]. The current oral hypoglycaemic agents result in limited reduction in this cardiovascular risk. Sodium glucose linked co-transporter type 2 [SGLT2] inhibitors are a relatively new class of antidiabetic agent that have been shown to have potential cardiovascular benefits. In support of this, the EMPA-REG trial showed a striking 38% and 35% reduction in cardiovascular mortality and heart failure [HF] hospitalisation respectively. The exact mechanism (s) responsible for these effects remain (s) unclear. One potential mechanism is regression of Left ventricular hypertrophy (LVH). METHODS The DAPA-LVH trial is a prospective, double-blind, randomised, placebo-controlled 'proof of concept' single-centre study that has been ongoing since January 2017. It is designed specifically to assess whether the SGLT2 inhibitor dapagliflozin regresses left ventricular [LV] mass in patients with diabetes and left ventricular hypertrophy [LVH]. We are utilising cardiac and abdominal magnetic resonance imaging [MRI] and ambulatory blood pressure monitoring to quantify the cardiovascular and systemic effects of dapagliflozin 10 mg once daily against standard care over a 1 year observation period. The primary endpoint is to detect the changes in LV mass. The secondary outcomes are to assess the changes in, LV volumes, blood pressure, weight, visceral and subcutaneous fat. DISCUSSION This trial will be able to determine if SGLT2 inhibitor therapy reduces LV mass in patient with diabetes and LVH thereby strengthening their position as oral hypoglycaemic agents with cardioprotective benefits. TRIAL REGISTRATION Clinical Trials.gov: NCT02956811 . Registered November 2016.
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MESH Headings
- Administration, Oral
- Benzhydryl Compounds/administration & dosage
- Benzhydryl Compounds/adverse effects
- Blood Pressure Monitoring, Ambulatory
- Clinical Protocols
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetic Cardiomyopathies/diagnostic imaging
- Diabetic Cardiomyopathies/etiology
- Diabetic Cardiomyopathies/physiopathology
- Diabetic Cardiomyopathies/prevention & control
- Disease Progression
- Double-Blind Method
- Glucosides/administration & dosage
- Glucosides/adverse effects
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Magnetic Resonance Imaging
- Proof of Concept Study
- Prospective Studies
- Research Design
- Risk Factors
- Scotland
- Time Factors
- Treatment Outcome
- Ventricular Function, Left/drug effects
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Alexander J.M. Brown
- Cardiovascular Medicine, Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Mailbox 2, Dundee, DD1 9SY UK
| | - Chim Lang
- Cardiology, Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Mailbox 2, Dundee, DD1 9SY UK
| | - Rory McCrimmon
- Experimental Diabetes and Metabolism, Division of Molecular and Clinical Medicine, School of Medicine, Level 5, Ninewells Hospital and Medical School, Mailbox 12, Dundee, DD1 9SY UK
| | - Allan Struthers
- Cardiovascular Medicine and Therapeutics, Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Mailbox 2, Dundee, DD1 9SY UK
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Kamimura D, Loprinzi PD, Wang W, Suzuki T, Butler KR, Mosley TH, Hall ME. Physical Activity Is Associated With Reduced Left Ventricular Mass in Obese and Hypertensive African Americans. Am J Hypertens 2017; 30:617-623. [PMID: 28369190 DOI: 10.1093/ajh/hpx044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/01/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Physical activity (PA) has been associated with decreased left ventricular (LV) hypertrophy in previous studies. However, little is known about the relationship between PA and LV structure and factors which influence this relationship among African Americans. METHODS We evaluated 1,300 African Americans with preserved LV ejection fraction (EF > 50%) from the Genetic Epidemiology Network of Arteriopathy (GENOA) Study (mean age 62.4 years, 73% women). PA index was calculated as 3 * heavy activity hours + 2 * moderate activity hours + slight activity hours/day. The relationship between PA index and LV structure was evaluated using generalized estimating equation. The association between PA index and LV mass index by age group, sex, body mass index (BMI), history of hypertension, diabetes or coronary heart disease, estimated glomerular filtration rate, and current smoking status were plotted. RESULTS After adjustment for these factors, higher PA index was independently associated with lower LV mass index (P < 0.05). There were significant interactions between PA index and obesity (BMI ≥ 30) and history of hypertension on LV mass index (P for interaction <0.05, for both). Higher PA index was associated with lower LV mass index more in obese or hypertensive participants compared with nonobese or nonhypertensive participants. CONCLUSIONS Higher PA index was associated with reduced LV hypertrophy in obese and hypertensive African Americans. Prospective studies aimed at assessing whether increasing PA prevents LV hypertrophy and potentially reduces the risk of heart failure in these at risk groups are warranted.
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Affiliation(s)
- Daisuke Kamimura
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul D. Loprinzi
- Center for Health Behavior Research, University of Mississippi, University, Mississippi, USA
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Takeki Suzuki
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kenneth R. Butler
- Division of Geriatrics and Gerontology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas H. Mosley
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael E. Hall
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Verdecchia P, Angeli F, Mazzotta G, Bartolini C, Garofoli M, Aita A, Poltronieri C, Pinzagli MG, Valecchi F, Martone S, Ramundo E, Turturiello D, Reboldi G. Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.005948. [PMID: 28539381 PMCID: PMC5669190 DOI: 10.1161/jaha.117.005948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear. METHODS AND RESULTS We studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24-hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow-up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient-years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log-rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24-hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model. CONCLUSIONS In initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.
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Affiliation(s)
| | - Fabio Angeli
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
| | | | | | | | - Adolfo Aita
- Department of Medicine, Hospital of Assisi, Italy
| | | | | | | | | | | | - Dario Turturiello
- Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy
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The association of endothelial function and tone by digital arterial tonometry with MRI left ventricular mass in African Americans: the Jackson Heart Study. ACTA ACUST UNITED AC 2017; 11:258-264. [DOI: 10.1016/j.jash.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/12/2017] [Accepted: 03/18/2017] [Indexed: 11/20/2022]
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Sarr SA, Babaka K, Mboup MC, Fall PD, Dia K, Bodian M, Ndiaye MB, Kane A, Diao M, Ba SA. [Clinical, electrocardiographic and echocardiographic aspects in elderly hypertensive patients in Senegal]. Pan Afr Med J 2017; 25:77. [PMID: 28292040 PMCID: PMC5324146 DOI: 10.11604/pamj.2016.25.77.10086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction L’hypertension artérielle (HTA) du sujet âgé est un facteur indépendant de maladie cardio-vasculaire. Nos objectifs étaient de décrire les aspects cliniques, électrocardiographique et échocardiographiques de l’HTA du sujet âgé. Méthodes Nous avons mené une étude descriptive et transversale de Janvier à Septembre 2013. Etaient inclus les sujets hypertendus âgés d’au moins 60 ans suivis en ambulatoire au service de cardiologie de l’Hôpital Principal de Dakar. Les données statistiques étaient analysées par le logiciel Epi Info 7 et une valeur de p < 0,05 était retenue comme significative. Résultats Au total, 208 patients étaient inclus. L’âge moyen était de 69,9 ans avec une prédominance féminine (sex-ratio de 0,85). La pression artérielle moyenne était de 162/90mmHg. L’HTA était contrôlée dans 13% des cas. A l’électrocardiogramme, on notait un trouble du rythme (17,78%), une hypertrophie auriculaire gauche (45,19%), une hypertrophie ventriculaire gauche (28,85%) et 2 cas de bloc auriculo-ventriculaire complet. Le Holter ECG révélait 4 cas de tachycardie ventriculaire non soutenue (IVb de Lown), 6 cas de fibrillation atriale paroxystique et 1 cas de flutter atrial paroxystique. L’échocardiographie réalisée chez 140 patients retrouvait une HVG à prédominance concentrique chez 25 patients, plus fréquente chez les hommes (p=0,04) et une dilatation de l’oreillette gauche dans 56,42% des cas, plus fréquente chez les patients plus âgés (p= 0,01). Conclusion Les aspects électrocardiographiques et échocardiographiques dans la population hypertendue âgée sont caractérisés par l’hypertrophie ventriculaire gauche notamment concentrique, la fréquence des arythmies révélées quelques fois par l’enregistrement électrocardiographique de longue durée.
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Affiliation(s)
- Simon Antoine Sarr
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | - Kana Babaka
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | | | | | | | - Malick Bodian
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | - Mouhamadou Bamba Ndiaye
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | - Adama Kane
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | - Maboury Diao
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
| | - Serigne Abdou Ba
- Service de Cardiologie, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar Etoile, Senegal
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Kuwabara M, Sato Y, Kanbay M, Johnson RJ. Uric Acid and Left Ventricular Hypertrophy: A Potentially New Modifiable Target? Am J Hypertens 2017; 30:229-231. [PMID: 28096149 DOI: 10.1093/ajh/hpw195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Masanari Kuwabara
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
- Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | - Yuka Sato
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
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Losi MA, Izzo R, Canciello G, Giamundo A, Manzi MV, Strisciuglio T, Stabile E, De Luca N, de Simone G, Trimarco B. Atrial Dilatation Development in Hypertensive Treated Patients: The Campania-Salute Network. Am J Hypertens 2016; 29:1077-84. [PMID: 27170030 DOI: 10.1093/ajh/hpw043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/08/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left atrial (LA) dilatation is associated with unfavorable outcome in hypertension. However, there are few data on clinical, demographic, and echocardiographic findings correlated with LA dilatation development. METHODS From the Campania-Salute Network registry, we identified 5,375 hypertensive patients (52±11 years, 38% women) in normal sinus rhythm, with normal LA diameter (parasternal short-axis <24.0 in women and <25.4mm/m in men), with normal left ventricular (LV) ejection fraction, and with at least 12 months of echocardiographic follow-up. We included in the clinic evaluation type of antihypertensive drugs. RESULTS Follow-up duration was of 70±48 months. During follow-up, 647 patients (12%) showed LA dilatation. Patients with incident LA dilatation were older, most likely to be women, more obese, more diabetics, with lower Modification of Diet in Renal Disease, higher total cholesterol, lower uric acid, higher pulse pressure, lower heart rate, higher LV mass, concentric geometry and lower E/A ratio at mitral level, longer E deceleration time, and higher intima-media carotid thickness. They take more drugs, and follow-up was longer (overall P < 0.05). In the Cox analysis, age, female gender, obesity, higher LV mass, LA diameter at baseline, and longer E deceleration time were determinants of LA dilatation. Furthermore, the use of diuretics protected against LA dilatation. CONCLUSIONS Our data identify a risk profile for LA dilatation, characterized by older age, female sex, obesity, higher LV mass, and worse diastolic function. In this subgroup of patients, the use of diuretics seems to protect against LA dilatation.
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Affiliation(s)
- Maria-Angela Losi
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Raffaele Izzo
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Translational Medicine, University Federico II of Naples, Napoli, Italy
| | - Grazia Canciello
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Alessandra Giamundo
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Maria V Manzi
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy
| | - Teresa Strisciuglio
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Eugenio Stabile
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Nicola De Luca
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Giovanni de Simone
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Translational Medicine, University Federico II of Naples, Napoli, Italy.
| | - Bruno Trimarco
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
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Barrios V, Escobar C, Calderón A, Tomás JP, Ruiz S, Moya JL, Megías A, Vegazo O, Fernandez R. Regression of left ventricular hypertrophy by a candesartan-based regimen in clinical practice The VIPE study. J Renin Angiotensin Aldosterone Syst 2016; 7:236-42. [PMID: 17318794 DOI: 10.3317/jraas.2006.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The VIPE study was a prospective, non-comparative, open-label clinical evaluation of 97 hypertensive patients (69.1% female; 68.9±9.5 years; mean blood pressure (BP) 160±12/90±9 mmHg) with echocardiographic evidence of left ventricular hypertrophy (LVH). Patients were treated for six months with a candesartan-based regimen (8 mg/16 mg + HCTZ 12.5 mg + additional drugs to lower BP < 140/90 mmHg). After six months, systolic/diastolic BP was decreased by 19.3±8/9.4±5 mmHg (p<0.001 for both), and left ventricular mass index (LVMI) decreased 17.01 g/m2 (95%CI: -13.2 to -20.99; p<0.001). During treatment with the candesartan-based regimen all echocardiographic parameters related to LVMI were significantly reduced and 28% achieved a target LVMI [< 134 g/m2 (men) and < 110 g/m2 (women) ]. No significant changes were observed in ejection fraction, shortening fraction or LV diastolic function. Univariate analysis showed that both age (p=0.03) and diabetes (p=0.029) were predictive of LVH regression. Thus, a candesartan-based regimen for six months significantly reduced echocardiographic LVH in hypertensive patients in general practice. The drug was very well tolerated and no serious adverse events were reported.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. Colmenar km. 9.100, Madrid 28034, Spain.
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Chowdhury EK, Jennings GLR, Dewar E, Wing LMH, Reid CM. Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive Patients. Am J Hypertens 2016; 29:821-31. [PMID: 27114424 DOI: 10.1093/ajh/hpw035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/16/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure. METHODS Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height(2.7): >115/95g/m(2) (LVH-BSA(115/95)) or ≥49/45g/m(2.7) (LVH-ht(49/45)) in males/females, respectively, and ≥125g/m(2) (LVH-BSA(125)) or ≥51g/m(2.7) (LVH-ht(51)) for both sexes. RESULTS In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%-70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA(115/95) predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA(115/95) (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12-3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21-3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height(2.7) predicted cardiovascular events over both short and longer term. CONCLUSIONS In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA(115/95) is a reliable predictor of future cardiovascular outcomes in the elderly.
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Affiliation(s)
- Enayet K Chowdhury
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
| | | | - Elizabeth Dewar
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Lindon M H Wing
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
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Anderson C. Rationale and Design of the Cardiac Magnetic Resonance Imaging Substudy of the ONTARGET Trial Programme. J Int Med Res 2016; 33 Suppl 1:50A-57A. [PMID: 16222900 DOI: 10.1177/14732300050330s107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Angiotensin-converting enzyme (ACE) inhibitors have been shown to improve cardiovascular disease outcomes in high-risk patients, but evidence for the cardioprotective effects of angiotensin II receptor blockers (ARBs) is less extensive. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and the parallel Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND) - which together form The ONTARGET Trial Programme – are long-term, large-scale, double-blind, multinational outcome studies with the primary objectives of determining if the combination of the ARB telmisartan 80 mg and the ACE inhibitor ramipril 10 mg is more effective than ramipril 10 mg alone, and if telmisartan is at least as effective as ramipril (in the case of ONTARGET), and if telmisartan is superior to placebo (in the case of TRANSCEND), in providing cardiovascular protection for high-risk patients. A pre-defined substudy is being conducted within The ONTARGET Trial Programme to compare the effects of these agents, alone and in combination, on cardiac structure and function. The substudy overcomes criticisms of many previous studies, which have been performed in small numbers of patients using suboptimal methodology, by evaluating changes in left ventricular structure and function using sophisticated technology provided by magnetic resonance imaging (MRI). Some 300 randomized patients within ONTARGET, recruited from selected centres in Australia, Canada, Germany, Hong Kong, New Zealand and Thailand, will have MRI undertaken at baseline and at 2-year follow-up. As this method of assessing left ventricular dysfunction is somewhat time-consuming, expensive and complex, and in the light of current interest in the role of B-type natriuretic peptide (BNP) as a simple, inexpensive diagnostic and prognostic tool, the substudy will also examine whether changes in BNP during follow-up correlated with changes in left ventricular dysfunction.
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Affiliation(s)
- C Anderson
- The George Institute for International Health, University of Sydney, Sydney, NSW, Australia.
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Abstract
Risk factors such as hypertension and diabetes are known to augment the activity and tissue expression of angiotensin II (Ang II), the major effector peptide of the renin-angiotensin system (RAS). Overstimulation of the RAS has been implicated in a chain of events that contribute to the pathogenesis of cardiovascular (CV) disease, including the development of cardiac remodelling. This chain of events has been termed the CV continuum. The concept of CV disease existing as a continuum was first proposed in 1991 and it is believed that intervention at any point within the continuum can modify disease progression. Treatment with antihypertensive agents may result in regression of left ventricular hypertrophy, with different drug classes exhibiting different degrees of efficacy. The greatest decrease in left ventricular mass is observed following treatment with angiotensin converting enzyme inhibitors (ACE-Is), which inhibit Ang II formation. Although ACE-Is and angiotensin receptor blockers (ARBs) provide significant benefits in terms of CV events and stroke, mortality remains high. This is partly due to a failure to completely suppress the RAS, and, as our knowledge has increased, an escape phenomenon has been proposed whereby the human sequence of the 12 amino acid substrate angiotensin-(1-12) is converted to Ang II by the mast cell protease, chymase. Angiotensin-(1-12) is abundant in a wide range of organs and has been shown to increase blood pressure in animal models, an effect abolished by the presence of ACE-Is or ARBs. This review explores the CV continuum, in addition to examining the influence of the RAS. We also consider novel pathways within the RAS and how new therapeutic approaches that target this are required to further reduce Ang II formation, and so provide patients with additional benefits from a more complete blockade of the RAS.
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Affiliation(s)
- Carlos M Ferrario
- Wake Forest University Health Science Center, Winston Salem, NC 27157, USA
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Horgan SJ, Watson CJ, Glezeva N, Collier P, Neary R, Tea IJ, Corrigan N, Ledwidge M, McDonald K, Baugh JA. Serum Amyloid P-Component Prevents Cardiac Remodeling in Hypertensive Heart Disease. J Cardiovasc Transl Res 2015; 8:554-66. [PMID: 26577946 DOI: 10.1007/s12265-015-9661-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023]
Abstract
The potential for serum amyloid P-component (SAP) to prevent cardiac remodeling and identify worsening diastolic dysfunction (DD) was investigated. The anti-fibrotic potential of SAP was tested in an animal model of hypertensive heart disease (spontaneously hypertensive rats treated with SAP [SHR - SAP] × 12 weeks). Biomarker analysis included a prospective study of 60 patients with asymptomatic progressive DD. Compared with vehicle-treated Wistar-Kyoto rats (WKY-V), the vehicle-treated SHRs (SHR-V) exhibited significant increases in left ventricular mass, perivascular collagen, cardiomyocyte size, and macrophage infiltration. SAP administration was associated with significantly lower left ventricular mass (p < 0.01), perivascular collagen (p < 0.01), and cardiomyocyte size (p < 0.01). Macrophage infiltration was significantly attenuated in the SHR-SAP group. Biomarker analysis showed significant decreases in SAP concentration over time in patients with progressive DD (p < 0.05). Our results indicate that SAP prevents cardiac remodeling by inhibiting recruitment of pro-fibrotic macrophages and that depleted SAP levels identify patients with advancing DD suggesting a role for SAP therapy.
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Affiliation(s)
- Stephen J Horgan
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Chris J Watson
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Nadia Glezeva
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Pat Collier
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Roisin Neary
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Isaac J Tea
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Niamh Corrigan
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Mark Ledwidge
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ken McDonald
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Baugh
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
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48
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Cho JY, Sun JS, Sur YK, Park JS, Kang DK. Relationship between left ventricular mass and coronary artery disease in young adults: a single-center study using cardiac computed tomography. Int J Cardiovasc Imaging 2015; 31 Suppl 2:187-96. [DOI: 10.1007/s10554-015-0772-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
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49
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Althurwi HN, Tse MMY, Abdelhamid G, Zordoky BNM, Hammock BD, El-Kadi AOS. Soluble epoxide hydrolase inhibitor, TUPS, protects against isoprenaline-induced cardiac hypertrophy. Br J Pharmacol 2015; 168:1794-807. [PMID: 23176298 DOI: 10.1111/bph.12066] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 09/12/2012] [Accepted: 11/13/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE We have previously shown that isoprenaline-induced cardiac hypertrophy causes significant changes in the expression of cytochromes P450 (CYP) and soluble epoxide hydrolase (sEH) genes. Therefore, it is important to examine whether the inhibition of sEH by 1-(1-methanesulfonyl-piperidin-4-yl)-3-(4-trifluoromethoxy-phenyl)-urea (TUPS) will protect against isoprenaline-induced cardiac hypertrophy. EXPERIMENTAL APPROACH Male Sprague-Dawley rats were treated with TUPS (0.65 mg kg(-1) day(-1), p.o.), isoprenaline (5 mg kg(-1) day(-1), i.p.) or the combination of both. In vitro H9c2 cells were treated with isoprenaline (100 μM) in the presence and absence of either TUPS (1 μM) or 11,12 EET (1 μM). The expression of hypertrophic, fibrotic markers and different CYP genes were determined by real-time PCR. KEY RESULTS Isoprenaline significantly induced the hypertrophic, fibrotic markers as well as the heart to body weight ratio, which was significantly reversed by TUPS. Isoprenaline also caused an induction of CYP1A1, CYP1B1, CYP2B1, CYP2B2, CYP4A3 and CYP4F4 gene expression and TUPS significantly inhibited this isoprenaline-mediated effect. Moreover, isoprenaline significantly reduced 5,6-, 8,9-, 11,12- and 14,15-EET and increased their corresponding 8,9-, 11,12- and 14,15-dihydroxyeicosatrienoic acid (DHET) and the 20-HETE metabolites. TUPS abolished these isoprenaline-mediated changes in arachidonic acid (AA) metabolites. In H9c2 cells, isoprenaline caused a significant induction of ANP, BNP and EPHX2 mRNA levels. Both TUPS and 11,12-EET significantly decreased this isoprenaline-mediated induction of ANP, BNP and EPHX2. CONCLUSIONS AND IMPLICATIONS TUPS partially protects against isoprenaline-induced cardiac hypertrophy, which confirms the role of sEH and CYP enzymes in the development of cardiac hypertrophy.
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Affiliation(s)
- Hassan N Althurwi
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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50
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Ratto E, Viazzi F, Verzola D, Bonino B, Gonnella A, Parodi EL, Bezante GP, Leoncini G, Pontremoli R. Metabolic syndrome is associated with left ventricular dilatation in primary hypertension. J Hum Hypertens 2015; 30:158-63. [PMID: 26108365 DOI: 10.1038/jhh.2015.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 12/11/2022]
Abstract
Metabolic syndrome (MS) has been shown to predict cardiovascular events in hypertension. Recently, a new four-group left ventricular (LV) hypertrophy classification based on both LV dilatation and concentricity was proposed. This classification has been shown to provide a more accurate prediction of cardiovascular events, suggesting that the presence of LV dilatation may add prognostic information. We investigated the relationship between MS and the new classification of LV geometry in patients with primary hypertension. A total of 372 untreated hypertensive patients were studied. Four different patterns of LV hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The overall prevalence of MS and LV hypertrophy (LVH) was 29% and 61%, respectively. Patients with MS showed a higher prevalence of LVH (P=0.0281) and dilated LV geometries, namely eccentric dilated and concentric dilated hypertrophy (P=0.0075). Moreover, patients with MS showed higher LV end-diastolic volume (P=0.0005) and prevalence of increased LV end-diastolic volume (P=0.0068). The prevalence of LV chamber dilatation increased progressively with the number of components of MS (P=0.0191). Logistic regression analysis showed that the presence of MS entails a three times higher risk of having LV chamber dilatation even after adjusting for several potential confounding factors. MS is associated with LV dilatation in hypertension. These findings may, in part, explain the unfavourable prognosis observed in patients with MS.
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Affiliation(s)
- E Ratto
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - F Viazzi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - D Verzola
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - B Bonino
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - A Gonnella
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - E L Parodi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - G P Bezante
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - G Leoncini
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - R Pontremoli
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
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