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Pham MHC, Kühl JT, Fuchs A, Sigvardsen PE, Sillesen H, Afzal S, Nordestgaard BG, Køber LV, Kofoed KF. Determinants of thoracic aortic size in normotensive and hypertensive individuals. J Hypertens 2024; 42:1736-1742. [PMID: 39132699 DOI: 10.1097/hjh.0000000000003792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
AIMS Thoracic aortic diameter is modulated by various factors including both physiological and pathological mechanisms. The aim of this study was to explore the determinants of thoracic aortic size focusing on arterial blood pressure and physical activity in normotensive and hypertensive individuals. METHODS Ascending and descending aortic diameters were measured in participants of the Copenhagen General Population Study using thoracic CT angiography. To assess the relation between arterial blood pressure and thoracic aortic diameters, individuals with diabetes, hypercholesterolemia, smoking, and prescribed antihypertensive medication were excluded. Intensity of physical activity was recorded based on self-reported questionnaire data. RESULTS A total of 1214 normotensive and 284 hypertensive individuals were examined. In all individuals, male sex, older age, and body surface area were associated with higher diameters of the ascending and descending aorta ( P < 0.01). In normotensive individuals, hard physical activity > 4 h/week was independently associated with higher thoracic aortic diameters (ascending β:1.09[0.52;1.66] and descending β : 0.47[0.14;0.80], both P < 0.01), whereas higher systolic blood pressure was not associated with thoracic aortic diameters (ascending P = 0.12 and descending p = 0.33). In hypertensive individuals, higher systolic blood pressure (per 10 mmHg) was independently associated with higher thoracic aortic diameters (ascending β : 0.55[0.17;0.94] and descending β : 0.23[0.10;0.37] mm/10 mmHg, both P < 0.01), whereas hard physical activity was not associated with higher aortic diameters (ascending P = 0.11 and descending P = 0.51). CONCLUSION In normotensive individuals hard physical activity, and in hypertensive individuals increasing systolic blood pressure are factors each independently associated with larger thoracic aortic size. These findings suggest a context sensitive mode of aortic vascular response to size modulating adaptation.
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Affiliation(s)
- Michael H C Pham
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Jørgen T Kühl
- Department of Cardiology, Zealand University Hospital, Roskilde
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Henrik Sillesen
- Department of Vascular Surgery, The Heart Center, Copenhagen University Hospital - Rigshospitalet
| | - Shoaib Afzal
- Department of Clinical Biochemistry
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Center
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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van der Stouwe JG, Rossi VA, Ghidoni C, Würzburger L, Wiech P, Schweiger V, Petrasch G, Moser G, Schmied CM, Vontobel J, Caselli S, Niederseer D. Effect of a Hypertensive Response During Exercise on Growth Rates of Aortic Diameters. Am J Hypertens 2024; 37:604-611. [PMID: 38693860 DOI: 10.1093/ajh/hpae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Aortic diameters are related to age, sex, and body size. There is a scarcity of data on the long-term sequelae of a hypertensive response to exercise (HRE) on aortic diameters. In this retrospective cohort study, we aimed to evaluate the relationship between the growth rates of the aorta in individuals with a HRE. METHODS Our analysis included follow-up data of 649 patients recruited between January 2009 and December 2014 with a HRE. Participants with known connective tissue disease or a history of acute aortic syndrome were excluded. Sinus of Valsalva (SoV) and ascending aorta (AscAo) diameters were measured by transthoracic echocardiography using leading edge to leading edge convention at end-diastole. RESULTS At baseline, median age, maximum systolic blood pressure (BP), body mass index (BMI), diameter of the SoV, and AscAo were 62 years, 208 mm Hg, 26.9 kg/m2, 35 mm, and 35 mm respectively. 32% of patients were female and 67% had hypertension. After a median follow-up of 7.1 years, mean yearly growth rates (±SD) of the SoV and AscAo were 0.09 (0.41) mm and 0.13 (0.56) mm, respectively. No significant associations were observed between growth rates of aortic diameters and maximum systolic and diastolic BP or when considering only individuals with a baseline diameter >40 mm. CONCLUSIONS In this large cohort study, maximum systolic and diastolic BP during exercise showed no association with growth rates of aortic diameters. Furthermore, the mean growth rates of aortic diameters in this population were in line with growth rates in a normal population.
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Affiliation(s)
- Jan Gerrit van der Stouwe
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Cardiology, Basel, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Céline Ghidoni
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Laura Würzburger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Wiech
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victor Schweiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Gloria Petrasch
- Hochgebirgsklinik, Medicine Campus Davos, Davos, Switzerland
| | - Georg Moser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Hochgebirgsklinik, Medicine Campus Davos, Davos, Switzerland
| | - Stefano Caselli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Herzgefaesszentrum im Park, Hirslanden Klinik im Park, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Hochgebirgsklinik, Medicine Campus Davos, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Medicine Campus Davos, Davos, Switzerland
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3
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Vacek JL. Assessment and Follow-Up of the Aortic Root by 2-Dimensional Echocardiography. Am J Cardiol 2024; 220:118-119. [PMID: 38604491 DOI: 10.1016/j.amjcard.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Affiliation(s)
- James L Vacek
- Department of Cardiovascular Medicine, University of Kansas School of Medicine and Health Care System, Kansas City, Kansas.
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4
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Kisling A, Gallagher R. Valvular Heart Disease. Prim Care 2024; 51:95-109. [PMID: 38278576 DOI: 10.1016/j.pop.2023.08.003] [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] [Indexed: 01/28/2024]
Abstract
Valvular heart disease is a common abnormality seen in the primary care setting. There are many causes of valvular heart disease including congenital, degenerative, infectious, traumatic, and many more. There is a wide variety of types of valvular heart disease with each valve having the ability to develop both regurgitation and stenosis by multiple mechanisms. All these complexities make diagnosis and management of valvular heart disease complicated, especially in the context of comorbidities. For this reason, it is important for primary care physicians to have a thorough understanding of how these diseases present and when interventions are indicated.
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Affiliation(s)
- Adam Kisling
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814, USA.
| | - Robert Gallagher
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814, USA
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Kirigaya J, Iwahashi N, Abe T, Gohbara M, Hanajima Y, Horii M, Okada K, Matsuzawa Y, Yasuda S, Kosuge M, Ebina T, Takeuchi I, Uchida K, Tamura K, Hibi K. Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e029506. [PMID: 37850479 PMCID: PMC10727378 DOI: 10.1161/jaha.123.029506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Background Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST-elevation-myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2-dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI. Methods and Results This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2 cm above the STJ. Receiver-operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively; P<0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2 mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2 cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C-statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C-statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2 cm above the STJ ranking second in diagnostic significance (C-statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66). Conclusions PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI.
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Affiliation(s)
- Jin Kirigaya
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Takeru Abe
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Mutsuo Horii
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Keiji Uchida
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
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Fan YH, Cheng WM, Huang YC. Lower urinary tract symptoms as an independent predictor of aortic regurgitation in women with cardiac symptoms. J Chin Med Assoc 2023; 86:641-645. [PMID: 37184486 DOI: 10.1097/jcma.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Very few studies have focused on the correlation between structural heart disease and lower urinary tract symptoms. In this study, we applied echocardiography to explore the correlation between lower urinary tract symptoms and structural heart disease. METHODS In this single-center, prospective, cross-sectional study, we enrolled adult women undergoing echocardiography for suspected cardiac abnormalities causing cardiac symptoms between February 1, 2021, and March 31, 2021. All participants completed a questionnaire regarding demographic information and lower urinary tract symptoms, which were assessed according to the International Prostate Symptom Score. RESULTS A total of 165 women aged 69.96 ± 10.20 years were enrolled. The prevalence of moderate-to-severe aortic regurgitation in patients with moderate-to-severe lower urinary tract symptoms was significantly higher than that in patients with mild lower urinary tract symptoms (33.3% vs 13.6%, p = 0.008). The prevalence of other echocardiographic abnormalities was not associated with severity of lower urinary tract symptoms. Multivariable logistic regression analyses revealed that moderate-to-severe lower urinary tract symptoms predicted moderate-to-severe aortic regurgitation ( p = 0.007; odds ratio: 3.560; 95% confidence interval: 1.409-8.993). Furthermore, the International Prostate Symptom Score storage subscore ( p = 0.001; odds ratio: 1.285; 95% confidence interval: 1.111-1.486), except the voiding subscore, was an independent predictor of moderate-to-severe aortic regurgitation. CONCLUSION Moderate-to-severe lower urinary tract symptoms, especially storage symptoms, are an independent predictor of the co-existence of moderate-to-severe aortic regurgitation in women with cardiac symptoms. Early cardiological referral of patients with moderate-to-severe lower urinary tract symptoms and cardiac symptoms may improve their general health.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Ming Cheng
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan, ROC
| | - Yen-Chang Huang
- Division of Cardiology, Department of Medicine, Taipei City Hospital, Taipei, Taiwan, ROC
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Sangwan T, Saini N, Anand A, Bisla A. Thoracic and abdominal aortic alterations in dogs affected with systemic hypertension. Res Vet Sci 2023; 159:133-145. [PMID: 37141684 DOI: 10.1016/j.rvsc.2023.04.017] [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: 02/19/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023]
Abstract
Aortic remodeling is the consequence of untreated systemic hypertension along with aortic dilatation as a marker for target organ damage in human literature. Therefore, the present study was planned to detect the changes in aorta at the level of aortic root via echocardiography, thoracic descending aorta via radiography and abdominal aorta via ultrasonography in healthy (n = 46), diseased normotensive (n = 20) and systemically hypertensive dogs (n = 60). The aortic root dimensions were measured at the level of aortic annulus, sinus of valsalva, sino-tubular junction and proximal ascending aorta via left ventricular outflow tract view of echocardiography. The thoracic descending aorta was subjectively assessed for any disparity in size and shape of aorta via lateral and dorso-ventral view of chest radiography. The abdominal aorta was assessed via left and right paralumbar window for calculating the aortic elasticity along with aortic and caudal venacaval dimensions to calculate the aortic-caval ratio. The aortic root measurements were dilated (p < 0.001) in systemically hypertensive dogs with a positive correlation (p < 0.001) with systolic blood pressure (BP). Thoracic descending aorta was also (p < 0.05) altered in the size and shape (undulation) of systemically hypertensive dogs. Abdominal aorta was markedly stiffened with reduced elasticity (p < 0.05) along with dilatation (p < 0.01) in hypertensive dogs. Also, there was a positive correlation (p < 0.001) of aortic diameters and aortic-caval ratio and negative correlation (p < 0.001) of aortic elasticity with systolic BP. Therefore, it was concluded that aorta could be considered as an important target organ damage of systemic hypertension in dogs.
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Affiliation(s)
- Tanvika Sangwan
- Department of Veterinary Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India.
| | - Neetu Saini
- Department of Veterinary Medicine, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India
| | - Arun Anand
- Department of Veterinary Surgery and Radiology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India
| | - Amarjeet Bisla
- Department of Veterinary Gynaecology and Obstetrics, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India
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8
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Altman J, Rambarat CA, Hamburger R, Dasa O, Dimza M, Kelling M, Clugston JR, Handberg EM, Pepine CJ, Edenfield KM. Relationship between arm span to height ratio, aortic root diameter, and systolic blood pressure in collegiate athletes. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 25:100242. [PMID: 38510494 PMCID: PMC10946030 DOI: 10.1016/j.ahjo.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 03/22/2024]
Abstract
Study objective Sudden cardiac death is the most common cause of non-traumatic death in collegiate athletes. Marfan syndrome poses a risk for sudden cardiac death secondary to aortic root dilation leading to aortic dissection or rupture. Arm span to height ratio (ASHR) > 1.05 has been proposed as a screening tool for Marfan syndrome in pre-participation examinations (PPE) for collegiate athletes but limited data exists on the association between ASHR and aortic root diameter (ARD). This study examines the relationship between ASHR and ARD and assesses for predictors of ARD. Design Retrospective chart review. Setting National Collegiate Athletic Association Division I University. Participants 793 athletes across thirteen sports between 2012 and 2022 evaluated with PPE and screening echocardiogram. Interventions Not applicable. Main outcome measures (1) Relationships between ASHR, SBP, BSA, and ARD amongst all athletes as well as stratified by ASHR >1.05 or ≤1.05 using univariate analysis. (2) Predictors of ARD using multivariate analysis using linear regression. Results 143 athletes (18 %) had ASHRs > 1.05. Athletes with ASHR > 1.05 had higher ARD (2.99 cm) than athletes with ASHR ≤ 1.05 (2.85 cm). Weak correlations were noted between ASHR, ARD, and SBP. Multivariate analysis showed that BSA, male sex, and participation in swimming were predictors of ARD. ASHR was not predictive of ARD in regression analysis. Conclusions These findings showed a tendency towards higher ARD in athletes with ASHR >1.05 but this observation was not statistically significant in multivariate analysis.
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Affiliation(s)
- Joshua Altman
- University of Florida College of Medicine, Department of Emergency Medicine, Department of Orthopaedic Surgery and Sports Medicine, Gainesville, FL, United States of America
| | - Cecil A. Rambarat
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Robert Hamburger
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Osama Dasa
- University of Florida, College of Public Health and Health Professions, Gainesville, FL, United States of America
| | - Michelle Dimza
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Matthew Kelling
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - James R. Clugston
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
| | - Eileen M. Handberg
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Carl J. Pepine
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Katherine M. Edenfield
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
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Chedid M, Kaidbay HD, Wigerinck S, Mkhaimer Y, Smith B, Zubidat D, Sekhon I, Prajwal R, Duriseti P, Issa N, Zoghby ZM, Hanna C, Senum SR, Harris PC, Hickson LJ, Torres VE, Nkomo VT, Chebib FT. Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD. Kidney Int Rep 2022; 7:1991-2005. [PMID: 36090485 PMCID: PMC9459062 DOI: 10.1016/j.ekir.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiovascular disease leads to high morbidity and mortality in patients with kidney failure. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic disease with various cardiac abnormalities. Details on the cardiovascular profile of patients with ADPKD who are undergoing kidney transplantation (KT) and its progression are limited. Methods Echocardiographic data within 2 years before KT (1993-2020), and major adverse cardiovascular events (MACEs) after transplantation were retrieved. The primary outcome is to assess cardiovascular abnormalities on echocardiography at the time of transplantation in ADPKD as compared with patients without ADPKD matched by sex (male, 59.4%) and age at transplantation (57.2 ± 8.8 years). Results Compared with diabetic nephropathy (DN, n = 271) and nondiabetic, patients without ADPKD (NDNA) (n = 271) at the time of KT, patients with ADPKD (n = 271) had lower rates of left ventricular hypertrophy (LVH) (39.4% vs. 66.4% vs. 48.6%), mitral (2.7% vs. 6.3% vs. 7.45) and tricuspid regurgitations (1.8% vs. 6.6% vs. 7.2%). Patients with ADPKD had less diastolic (25.3%) and systolic (5.6%) dysfunction at time of transplantation. Patients with ADPKD had the most favorable post-transplantation survival (median 18.7 years vs. 12.0 for diabetic nephropathy [DN] and 13.8 years for nondiabetic non-ADPKD [NDNA]; P < 0.01) and the most favorable MACE-free survival rate (hazard ratio = 0.51, P < 0.001). Patients with ADPKD had worsening of their valvular function and an increase in the sinus of Valsalva diameter post-transplantation (38.2 vs. 39.9 mm, P < 0.01). Conclusion ADPKD transplant recipients have the most favorable cardiac profile pretransplantation with better patient survival and MACE-free survival rates but worsening valvular function and increasing sinus of Valsalva diameter, as compared with patients with other kidney diseases.
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Affiliation(s)
- Maroun Chedid
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hasan-Daniel Kaidbay
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Lebanese American University, Gilbert and Rose-Mary Chagoury school of medicine, Byblos, Lebanon
| | - Stijn Wigerinck
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yaman Mkhaimer
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Byron Smith
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Dalia Zubidat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Imranjot Sekhon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Reddy Prajwal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Parikshit Duriseti
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naim Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Ziad M. Zoghby
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian Hanna
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah R. Senum
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C. Harris
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of biochemistry and molecular biology, Mayo Clinic, Rochester, Minnesota, USA
| | - LaTonya J. Hickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Vicente E. Torres
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fouad T. Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Canciello G, Mancusi C, Izzo R, Morisco C, Strisciuglio T, Barbato E, Trimarco B, Luca ND, de Simone G, Losi MA. Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network. Eur J Prev Cardiol 2021; 28:1508-1514. [PMID: 32529944 DOI: 10.1177/2047487320931630] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Determinants of changes of aortic root dimension over time are not well defined. DESIGN We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network. METHODS N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution. RESULTS At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0-8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up (p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time (p < 0.05). Anti-renin-angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension. CONCLUSIONS Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
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Affiliation(s)
- Grazia Canciello
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Carmine Morisco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Teresa Strisciuglio
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Emanuele Barbato
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
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11
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Quennelle S, Ovaert C, Cailliez M, Garaix F, Tsimaratos M, El Louali F. Dilatation of the aorta in children with advanced chronic kidney disease. Pediatr Nephrol 2021; 36:1825-1831. [PMID: 33459933 DOI: 10.1007/s00467-020-04887-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/27/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The peculiarity of the cardiovascular risk profile with increased arterial vulnerability is well known in adults with chronic kidney disease (CKD). It is explained by an increased incidence of traditional cardiovascular risk factors together with other comorbidities related to the uremic condition and cardiorenal syndrome (CRS). The present study aimed to determine the cardiovascular impact of the uremic condition in a pediatric population with advanced CKD. METHODS From 2016 to 2018, 39 consecutive patients with advanced CKD who underwent echocardiographic evaluation were included. All echocardiographic examinations were performed by the same operator (FE). Demographic, clinical, biological, and echocardiographic data were collected. RESULTS The mean age at echocardiographic exam was 9.7 ± 4.6 years. Twenty-four (61.5%) patients were on hemodialysis; 17 (43.6%) patients were in a peritoneal dialysis program of whom 11 switched at a later stage to hemodialysis. Eight (20.5%) patients had an arteriovenous fistula (AVF). Hypertension was present in 30 (76.9%) patients while left ventricular hypertrophy (LVH) was described in 13 (33.3%) patients. Dilatation of the ascending aorta (Z-score > 2) was found in 15 (38.4%) patients and was statistically (in univariate analysis) related to gender, hypertension, the presence of an AVF, and the use of hemodialysis after peritoneal dialysis (p = 0.024, p = 0.016, p = 0.006, p = 0.009, respectively). CONCLUSION In addition to classical and predictable abnormalities related to CKD, we found a high prevalence of dilatation of the ascending aorta in children with advanced CKD. Hypertension, AVF, and hemodialysis were associated factors.
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Affiliation(s)
- Sophie Quennelle
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Caroline Ovaert
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Mathilde Cailliez
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Florentine Garaix
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Michel Tsimaratos
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Fedoua El Louali
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France.
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12
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Holland M, Hofmeister E, Hudson J. Echocardiographic changes in the shape and size of the aortic cusps in dogs with confirmed systemic hypertension. Vet Radiol Ultrasound 2021; 62:697-704. [PMID: 34131993 DOI: 10.1111/vru.13004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
Systemic hypertension (SH) in dogs typically occurs secondary to renal disease, diabetes mellitus, hyperadrenocorticism, malignant adrenal tumors, or various medications. Echocardiography performed on people with SH has shown asymmetric dilation of the sinuses at the level of the aortic valves, previously undescribed in canine patients. The objective of this retrospective case-control study was to determine if there was a difference in size and shape of the aortic cusps at the level of the sinus of Valsalva in dogs with SH compared to dogs with normal blood pressure. We reviewed echocardiographic findings in 74 dogs with SH and 37 dogs with normal blood pressure (NBP), defined as less than 150 mmHg. Systemic hypertension was classified as mild (150-159 mm Hg), moderate (160-179 mm Hg), or severe (greater than 180 mm Hg). There was a significant difference (P < .001) in the mean size of the aorta cusps at the level of the sinuses in 67 of 74 dogs with SH and none of 37 dogs with NBP. Of the 74 dogs with SH, 70 had left ventricular hypertrophy (18 asymmetric, 15 concentric, and 37 eccentric). Additionally, there was aortic root dilatation in 15 dogs, aortic insufficiency in 21, mitral regurgitation in 50, and left atrial enlargement in 71. The standard deviation of the three cusp measurements between the dogs with SH and dogs with NBP had a sensitivity of 92% and specificity of 97% for diagnosis of SH. Asymmetric size of the aortic cusps on echocardiography is therefore a reliable indicator of SH in dogs.
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Affiliation(s)
- Merrilee Holland
- Framingham Heart Study clinic, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Erik Hofmeister
- Framingham Heart Study clinic, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Judith Hudson
- Framingham Heart Study clinic, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
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13
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YÜCEL O, GÜNEŞ H, YILMAZ MB. KRONİK AORT YETMEZLİĞİ OLAN HASTALARDA HİPERTANSİYON SIKLIĞI. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.848436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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14
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Trabattoni D, Galli S, Rogacka R, Teruzzi G, Montorsi P. Resistant Hypertension in a Patient With Chronic Type B Aortic Dissection. A Selective Indication for Renal Artery Denervation Treatment. Am J Hypertens 2020; 33:784-787. [PMID: 32307546 DOI: 10.1093/ajh/hpaa059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniela Trabattoni
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefano Galli
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Renata Rogacka
- Divisione di cardiologia, Ospedale di Desio, Milan, Italy
| | - Giovanni Teruzzi
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piero Montorsi
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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15
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Katsi V, Georgiopoulos G, Oikonomou D, Aggeli C, Grassos C, Papadopoulos DP, Thomopoulos C, Marketou M, Dimitriadis K, Toutouzas K, Nihoyannopoulos P, Tsioufis C, Tousoulis D. Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension. Curr Vasc Pharmacol 2020; 17:180-190. [PMID: 29295699 DOI: 10.2174/1570161116666180101165306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. OBJECTIVE To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. METHODS We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. RESULTS Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. CONCLUSION Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.
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Affiliation(s)
- V Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - G Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Oikonomou
- Department of Cardiology, 'Evaggelismos' General Hospital, Athens, Greece
| | - C Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Grassos
- Department of Cardiology, 'KAT' General Hospital, Athens, Greece
| | - D P Papadopoulos
- Department of Cardiology, 'Laiko' General Hospital, Athens, Greece
| | - C Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - M Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - K Dimitriadis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - K Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - P Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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16
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Kim MS, Cho SJ, Park SJ, Cho SW, Choi SH, Kim HS, Carriere K, Kim EK, Chang SA, Lee SC, Park SW. Frequency and Clinical Associating Factors of Valvular Heart Disease in Asymptomatic Korean Adults. Sci Rep 2019; 9:16741. [PMID: 31727975 PMCID: PMC6856181 DOI: 10.1038/s41598-019-53277-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022] Open
Abstract
Limited information is available on the prevalence and clinical determinants of valvular heart disease (VHD) in apparently healthy people. This study sought to assess the frequency and clinical associating factors of aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), mitral regurgitation (MR), tricuspid regurgitation (TR) in asymptomatic individuals with health check-up examination. We included 23,254 subjects ≥50 years of age who underwent a health check-up examination with transthoracic echocardiography (TTE) between 2012 and 2016 in a single tertiary-care hospital in Korea. Among a total of 23,254 subjects, 15,358 men (66.0%) and 7,896 women (34.0%) underwent TTE. Newly identified (predominantly mild) VHD was detected in 9.4% of subjects. The most common VHD were TR (4.6%), AR (3.0%) and MR (2.4%). Clinically significant (more than moderate) VHD was identified in 176 subjects (0.8%). Age ≥75 years was associated with all clinically significant VHD, and female gender was associated with AR, MS and TR. Korea has been very active in the health check-up examination including echocardiography. We find that VHD in apparently healthy people is not uncommon than believed; all VHD except MS were more frequent in elderly over 75 years of age in a large population-based study.
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Affiliation(s)
- Min Sun Kim
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Gangnam CHA Medical Center, CHA university School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Cho
- Department of Medicine, Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Sung Won Cho
- Department of Medicine, Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Medicine, Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Seung Kim
- Biostatistics Team, Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Keumhee Carriere
- Biostatistics Team, Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Charlton PH, Mariscal Harana J, Vennin S, Li Y, Chowienczyk P, Alastruey J. Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. Am J Physiol Heart Circ Physiol 2019; 317:H1062-H1085. [PMID: 31442381 PMCID: PMC6879924 DOI: 10.1152/ajpheart.00218.2019] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022]
Abstract
The arterial pulse wave (PW) is a rich source of information on cardiovascular (CV) health. It is widely measured by both consumer and clinical devices. However, the physical determinants of the PW are not yet fully understood, and the development of PW analysis algorithms is limited by a lack of PW data sets containing reference CV measurements. Our aim was to create a database of PWs simulated by a computer to span a range of CV conditions, representative of a sample of healthy adults. The typical CV properties of 25-75 yr olds were identified through a literature review. These were used as inputs to a computational model to simulate PWs for subjects of each age decade. Pressure, flow velocity, luminal area, and photoplethysmographic PWs were simulated at common measurement sites, and PW indexes were extracted. The database, containing PWs from 4,374 virtual subjects, was verified by comparing the simulated PWs and derived indexes with corresponding in vivo data. Good agreement was observed, with well-reproduced age-related changes in hemodynamic parameters and PW morphology. The utility of the database was demonstrated through case studies providing novel hemodynamic insights, in silico assessment of PW algorithms, and pilot data to inform the design of clinical PW algorithm assessments. In conclusion, the publicly available PW database is a valuable resource for understanding CV determinants of PWs and for the development and preclinical assessment of PW analysis algorithms. It is particularly useful because the exact CV properties that generated each PW are known.NEW & NOTEWORTHY First, a comprehensive literature review of changes in cardiovascular properties with age was performed. Second, an approach for simulating pulse waves (PWs) at different ages was designed and verified against in vivo data. Third, a PW database was created, and its utility was illustrated through three case studies investigating the determinants of PW indexes. Fourth, the database and tools for creating the database, analyzing PWs, and replicating the case studies are freely available.
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Affiliation(s)
- Peter H Charlton
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Jorge Mariscal Harana
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Samuel Vennin
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
- Department of Clinical Pharmacology, King's College London, King's Health Partners, London, United Kingdom
| | - Ye Li
- Department of Clinical Pharmacology, King's College London, King's Health Partners, London, United Kingdom
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King's College London, King's Health Partners, London, United Kingdom
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
- Institute of Personalized Medicine, Sechenov University, Moscow, Russia
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18
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Dong N, Piao H, Li B, Xu J, Wei S, Liu K. Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection. J Clin Hypertens (Greenwich) 2019; 21:804-812. [PMID: 31106981 DOI: 10.1111/jch.13556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 12/22/2022]
Abstract
Hypertension is considered a key risk factor for acute aortic dissection (AAD). However, there is limited evidence demonstrating if hypertension management affects AAD development. The objective of this study was to investigate the role of hypertension management in AAD development in a Chinese population. A total of 825 AAD patients and 3300 age- and sex-matched controls were included. The authors analyzed data on demographics, chronic comorbidities, and hypertension management of all participants. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for the relationship between chronic comorbidities, as well as the management of hypertension and AAD risk. After adjusting for other related factors, multivariate logistic regression identified hypertension, chronic kidney disease, Marfan syndrome, history of cardiovascular surgery, and history of smoking as risk factors for AAD. Among the identified risk factors, hypertension was an important and controllable risk factor for AAD development. Thus, the authors further evaluated how hypertension management affects AAD development. A total of 848 controls and 585 AAD patients with hypertension were enrolled in this part of the study. Hypertensive patients with AAD had a longer history, higher stage, poorer medication compliance, and poor control rates of blood pressure, among which poor medication compliance (Irregular vs Regular P < 0.001; Never treated vs Regular P < 0.001) and uncontrolled hypertension (P < 0.001) significantly increased the risk of AAD development. In conclusion, uncontrolled hypertension and poor medication compliance are important precipitating and controllable factors for AAD development.
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Affiliation(s)
- Ning Dong
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China.,Department of Emergency Medicine, First Hospital of Bethune, Jilin University, Changchun, China
| | - Hulin Piao
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Bo Li
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Jian Xu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Shibo Wei
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
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19
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Cui JZ, Lee L, Sheng X, Chu F, Gibson CP, Aydinian T, Walker DC, Sandor GGS, Bernatchez P, Tibbits GF, van Breemen C, Esfandiarei M. In vivo characterization of doxycycline-mediated protection of aortic function and structure in a mouse model of Marfan syndrome-associated aortic aneurysm. Sci Rep 2019; 9:2071. [PMID: 30765726 PMCID: PMC6376062 DOI: 10.1038/s41598-018-38235-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
Aortic aneurysm is the most life-threatening complication in Marfan syndrome (MFS) patients. Doxycycline, a nonselective matrix metalloproteinases inhibitor, was reported to improve the contractile function and elastic fiber structure and organization in a Marfan mouse aorta using ex vivo small chamber myography. In this study, we assessed the hypothesis that a long-term treatment with doxycycline would reduce aortic root growth, improve aortic wall elasticity as measured by pulse wave velocity, and improve the ultrastructure of elastic fiber in the mouse model of MFS. In our study, longitudinal measurements of aortic root diameters using high-resolution ultrasound imaging display significantly decreased aortic root diameters and lower pulse wave velocity in doxycycline-treated Marfan mice starting at 6 months as compared to their non-treated MFS counterparts. In addition, at the ultrastructural level, our data show that long-term doxycycline treatment corrects the irregularities of elastic fibers within the aortic wall of Marfan mice to the levels similar to those observed in control subjects. Our findings underscore the key role of matrix metalloproteinases during the progression of aortic aneurysm, and provide new insights into the potential therapeutic value of doxycycline in blocking MFS-associated aortic aneurysm.
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Affiliation(s)
- Jason Z Cui
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Ling Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Xiaoye Sheng
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Fanny Chu
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine P Gibson
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Taline Aydinian
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - David C Walker
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Pascal Bernatchez
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Glen F Tibbits
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Cornelis van Breemen
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mitra Esfandiarei
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada. .,Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA.
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20
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Beeson JH, Blackmore HL, Carr SK, Dearden L, Duque-Guimarães DE, Kusinski LC, Pantaleão LC, Pinnock AG, Aiken CE, Giussani DA, Fernandez-Twinn DS, Ozanne SE. Maternal exercise intervention in obese pregnancy improves the cardiovascular health of the adult male offspring. Mol Metab 2018; 16:35-44. [PMID: 30293577 PMCID: PMC6157615 DOI: 10.1016/j.molmet.2018.06.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Obesity during pregnancy is associated with an elevated risk of cardiovascular disease in the offspring. With increased numbers of women entering pregnancy overweight or obese, there is a requirement for targeted interventions to reduce disease risk in future generations. Using an established murine model of maternal obesity during pregnancy, we investigated if a treadmill exercise intervention in the mother could improve offspring cardiac health and explored potential underlying mechanisms. METHODS A 20-minute treadmill exercise intervention protocol was performed 5 days a week in diet-induced obese female C57BL/6 mice 1 week prior to, and up to E17 of pregnancy. All male offspring were weaned onto a control diet and studied at 8 weeks of age when their cardiovascular physiology was assessed by in vivo echocardiography and non-invasive tail cuff plethysmography. Cardiomyocyte cell area, re-expression of fetal genes and the expression of calcium handling and sympathetic activation proteins were determined. RESULTS At 8 weeks, there was no difference in bodyweight or fat mass between groups. Offspring of obese dams developed pathologic cardiac hypertrophy, hypertension and cardiac dysfunction characterized by reduced ejection fraction (p < 0.001). Maternal exercise prevented cardiac hypertrophy and dysfunction but failed to prevent hypertension. These offspring of exercised dams also had enhanced (p < 0.001) levels of calcium handling proteins and a sympathetic-activated inotropic response. CONCLUSIONS Exercise in obese pregnancy was beneficial to offspring cardiac function and structure but did not influence hypertension suggesting they are programmed by separate mechanistic pathways. These data suggest combination interventions in obese pregnancies will be required to improve all aspects of the cardiovascular health of the next generation.
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Affiliation(s)
- Jessica H Beeson
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Heather L Blackmore
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Sarah K Carr
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Laura Dearden
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Daniella E Duque-Guimarães
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Laura C Kusinski
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Lucas C Pantaleão
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Adele G Pinnock
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Catherine E Aiken
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK; Department of Obstetrics and Gynaecology, University of Cambridge, The Rosie Hospital and NIHR Cambridge Comprehensive Biomedical Research Centre, Box 223, Cambridge, CB2 0SW, UK.
| | - Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, CB2 3EG, UK.
| | - Denise S Fernandez-Twinn
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Susan E Ozanne
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Hills Road, Cambridge, CB2 0QQ, UK.
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Vriz O, Bertin N, Bossone E, Palatini P. Aortic Diameters and Mild Functional Aortic Regurgitation in Hypertensive and Normotensive People: Do They Carry the Same Meaning? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2171-2180. [PMID: 29451314 DOI: 10.1002/jum.14567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The association between the aortic root diameter and aortic regurgitation in hypertensive and normotensive people is still disputed, and the underlying mechanisms remain to be clearly elucidated. We aimed to investigate the relationship between the aortic root diameter and trivial to mild functional aortic regurgitation in never-treated hypertensive patients with a new diagnosis compared with healthy normotensive participants. METHODS A total of 182 hypertensives and 232 age-matched normotensives were included in the study. Anthropometric and office blood pressure (BP) measurements, echocardiography, and a carotid stiffness assessment were performed in all of the participants. Aortic measures for the annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta were taken in late diastole according to the leading-edge method. RESULTS The mean age of all participants was 52 years. Hypertensive patients had a significantly higher body surface area, mean arterial pressure, and pulse pressure (P < .0001) than normotensive participants. Annulus and sinotubular junction diameters adjusted for confounders and indexed to the body surface area were significantly higher in normotensives than in hypertensives. The prevalence of functional aortic regurgitation was higher in hypertensives (34.8% versus 15.4%; P < .0001). Among the hypertensives, no difference in aortic diameters was found between patients with or without functional aortic regurgitation, whereas normotensives with functional aortic regurgitation had larger aortic root diameters. Aging and BP among the hypertensives were the main determinants of functional aortic regurgitation. CONCLUSIONS Hypertensive patients had a smaller indexed aortic root diameter than normotensive participants but had a higher prevalence of trivial to mild functional aortic regurgitation. The aging process is the main determinant of functional aortic regurgitation in both groups, but high BP also plays an important role in hypertensives.
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Affiliation(s)
- Olga Vriz
- Cardiology and Emergency Department, Sant'Antonio Hospital, San Daniele del Friuli, Italy
| | - Nicole Bertin
- Cardiology and Emergency Department, Sant'Antonio Hospital, San Daniele del Friuli, Italy
| | - Eduardo Bossone
- Department of Cardiology, Cava de' Tirreni and Amalfi Coast Hospital, Heart Department, University of Salerno, Salerno, Italy
| | - Paolo Palatini
- Department of Internal Medicine, University of Padova, Padua, Italy
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Nardi E, Mulè G, Nardi C, Geraci G, Averna M. Diabetes and aortic root dimension: A controversial subject. Int J Cardiol 2018; 264:190. [DOI: 10.1016/j.ijcard.2018.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
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Fakoya AOJ, Otohinoyi DA, Omole AE, Oladele C, Kalejaiye A, Onuegbu A, Nwalie E, Talukdar D, Erinkitola O. Correlating possible predisposing demographics and systemic conditions with the aortic root. Ann Afr Med 2018; 17:133-139. [PMID: 30185682 PMCID: PMC6126053 DOI: 10.4103/aam.aam_51_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.
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Affiliation(s)
- Adegbenro Omotuyi John Fakoya
- Department of Anatomical Sciences, University of Medicine and Health Sciences, St. Kitts and Nevis, Roseau, Dominica
- Department of Anatomical Sciences, School of Medicine, All Saints University, Roseau, Dominica
| | | | - Adekunle Ebenezer Omole
- Department of Basic Medical Sciences, American University of Antigua, College of Medicine, St. John's, Antigua
| | - Charles Oladele
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Ayoola Kalejaiye
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Angel Onuegbu
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Esther Nwalie
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Debjyoti Talukdar
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
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Abstract
This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons.
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Affiliation(s)
- Zorana Mrsic
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Scott P Hopkins
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Jared L Antevil
- Department of Surgery, Division of and Cardiothoracic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Philip S Mullenix
- Department of Surgery, Division of and Cardiothoracic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA.
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Jiang Z, Lin B, Liu T, Qin S, Huang S, Shao S, Li S, Huang R, Huang J. Visceral fat index/percentage body fat ratio is independently associated with proximal aortic dilatation in a middle-aged and aged Chinese population in Liujiang of Guangxi. Atherosclerosis 2018; 268:19-26. [DOI: 10.1016/j.atherosclerosis.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/15/2017] [Accepted: 11/10/2017] [Indexed: 01/21/2023]
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Nwabuo CC, Moreira HT, Vasconcellos HD, Ambale-Venkatesh B, Yoneyama K, Ohyama Y, Sharma RK, Armstrong AC, Ostovaneh MR, Lewis CE, Liu K, Schreiner PJ, Ogunyankin KO, Gidding SS, Lima JAC. Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study. J Am Soc Echocardiogr 2017; 30:1172-1179. [PMID: 28927559 PMCID: PMC5716838 DOI: 10.1016/j.echo.2017.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The human aorta dilates with advancing age. However, the association between progressive aortic dilation with aging and cardiac remodeling has not been established in studies of community-dwelling adults. The aim of this study was to test the hypothesis that there would be a relationship between aortic size increase over the early adult life span with left ventricular (LV) structural remodeling and subclinical LV dysfunction in middle age, even in the absence of overt cardiovascular and valvular disease. METHODS Included were Coronary Artery Risk Development in Young Adults study participants (N = 2,933) aged 23 to 35 years with available transthoracic echocardiographic measurements during 20 years of follow-up. Multivariate linear regression models assessed sex-specific associations between 20-year change in aortic root diameter with LV structure and function. RESULTS Larger aortic root diameter at 20-year follow-up was associated with greater LV mass (2.77 vs 2.18 g/mm in men and women, respectively, P < .001). In longitudinal analyses, increase in aortic root diameter over 20-year follow-up was associated with a greater 20-year increase in LV mass and ratio of LV mass to LV end-diastolic volume ratio in both sexes. In women but not in men, increased aortic root diameter over 20 years was associated with increased left atrial dimension, impaired E/E', and impaired early diastolic longitudinal and circumferential strain rates assessed by speckle-tracking echocardiography. CONCLUSIONS Progressive increase in aortic root diameter from early adulthood to middle age was associated with increased LV mass and LV concentric remodeling in both sexes and impaired diastolic function predominantly in women.
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Affiliation(s)
- Chike C Nwabuo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kihei Yoneyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yoshiaki Ohyama
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi K Sharma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Kiang Liu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kofo O Ogunyankin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - João A C Lima
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Anatomy of the aortic root: implications for aortic root reconstruction. Gen Thorac Cardiovasc Surg 2017; 65:488-499. [PMID: 28656518 DOI: 10.1007/s11748-017-0792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
Since the introduction of valve-preserving root replacement and aortic annuloplasty, precise understanding of the aortic root anatomy has emerged as a key to successful aortic valve-preservation surgery. Fundamentally, surgeons need to know the precise anatomical definition and structure of the aortic root, including its normal dimensions, know the anatomy of the coronary arteries, and understand the cardiac conduction system. Surgeons must be able to clearly distinguish normal and abnormal structures, and recognize the effects of aortic valve regurgitation or root expansion on dimensions and geometric relationships within the aortic root. Possessing a detailed understanding of the aortic root, surgeons can select appropriately sized grafts and achieve optimum annular fixation. This review covers the essentials of aortic root anatomy and provides tips for correct and safe performance of aortic valve-preservation surgery with a view toward durable late outcomes.
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Clinical and prognostic value of hypertensive cardiac damage in the PAMELA Study. Hypertens Res 2016; 40:329-335. [DOI: 10.1038/hr.2016.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 11/08/2022]
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Nardi E, Mulè G, Nardi C, Geraci G, Averna M. Inverse association between type 2 diabetes and aortic root dimension in hypertensive patients. Int J Cardiol 2016; 228:233-237. [PMID: 27865191 DOI: 10.1016/j.ijcard.2016.11.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Some data support the concept that aortic root diameter (ARD) in hypertension may be regarded as a marker of subclinical organ damage. The impact of type 2 diabetes mellitus (DM) on cardiac structure and function is known, although the relationship between DM and ARD is not clear. The aim of our study was to evaluate the influence of DM on ARD in hypertensive patients. METHODS We enrolled 1693 hypertensive patients (aged 63.7±9.6years). The population was divided into two groups: the first one with DM (n=747) and the second one without DM (n=946). ARD was measured by echocardiography at level of Valsalva's sinuses using echocardiography M-mode tracings. It was considered as absolute measure and normalized to height (ARD/H) and body surface area (ARD/BSA). Left ventricular mass index (LVMI) and some parameters of systolic and diastolic function have been valued by means of echocardiography and tissue Doppler imaging. RESULTS The DM group was characterized by more elevated values of LVMI and a worst systolic and diastolic function. ARD value was significantly lower in DM group in comparison to patients without DM only when indexed for BSA (ARD/BSA=18.7±2.3mm/m2 vs 18.3±2.0mm/m2, p=0.01). This difference remained statistically significant, even after correction by age, sex and BMI (p=0.01). A multivariate linear regression analysis demonstrated an inverse relationship between DM and ARD/BSA after correction for potential confounders (β=0.10, p<0.001). CONCLUSIONS Our results confirm the hypothesis of a protective role of DM on aortic root dilatation.
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Affiliation(s)
- Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Chiara Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Maurizio Averna
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
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Aortic root dimensions are predominantly determined by genetic factors: a classical twin study. Eur Radiol 2016; 27:2419-2425. [PMID: 27659700 DOI: 10.1007/s00330-016-4590-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/22/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Previous studies using transthoracic echocardiography (TTE) observed moderate heritability of aortic root dimensions. Computed tomography angiography (CTA) might provide more accurate heritability estimates. Our primary aim was to assess the heritability of the aortic root with CTA. Our secondary aim was to derive TTE-based heritability and compare this with the CTA-based results. METHODS In the BUDAPEST-GLOBAL study 198 twin subjects (118 monozygotic, 80 dizygotic; age 56.1 ± 9.4 years; 126 female) underwent CTA and TTE. We assessed the diameter of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, sinotubular junction and ascending aorta. Heritability was assessed using ACDE model (A additive genetic, C common environmental, D dominant genetic, E unique environmental factors). RESULTS Based on CTA, additive genetic effects were dominant (LVOT: A = 0.67, E = 0.33; annulus: A = 0.76, E = 0.24; sinus of Valsalva: A = 0.83, E = 0.17; sinotubular junction: A = 0.82, E = 0.18; ascending aorta: A = 0.75, E = 0.25). TTE-derived measurements showed moderate to no genetic influence (LVOT: A = 0.38, E = 0.62; annulus: C = 0.47, E = 0.53; sinus of Valsalva: C = 0.63, E = 0.37; sinotubular junction: C = 0.45, E = 0.55; ascending aorta: A = 0.67, E = 0.33). CONCLUSION CTA-based assessment suggests that aortic root dimensions are predominantly determined by genetic factors. TTE-based measurements showed moderate to no genetic influence. The choice of measurement method has substantial impact on heritability estimates. KEY POINTS • Aortic root dimensions are determined by genetic and environmental effects. • Transthoracic echocardiography (TTE) demonstrated moderate to no genetic effects on aortic root dimensions. • Computed tomography angiography might provide more accurate heritability estimates compared to TTE. • Three-dimensional imaging techniques are needed to reliably quantify aortic root dimensions.
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Tosello F, Leone D, Laurent S, Veglio F, Milan A. Out of proportion proximal aortic remodeling: A subclinical marker of early vascular ageing? A systematic review. Int J Cardiol 2016; 223:999-1006. [PMID: 27591699 DOI: 10.1016/j.ijcard.2016.07.302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Proximal aorta stiffens and dilates with aging. Aortic stiffening is a well known process, carrying prognostic implications. On the contrary, few data are available about proximal aorta dilatation. It is not known if "out of proportion" aortic remodeling, i.e. in excess for age, sex and body size, could be a marker of early vascular ageing; there is controversy on how it would be accelerated by classical risk factors or would associate with validated markers of cardiovascular organ damage. AIM We conducted a systematic review in order to evaluate the determinants of proximal aortic dimensions, focusing on the association with arterial hypertension, cardiovascular risk factors and markers of organ damage. DETERMINANTS OF PROXIMAL AORTA REMODELING Age, gender and body size explain 40-50% of the variability of aortic dimensions; genetic predisposition accounts for nearly 20%. Among cardiovascular risk factors obesity and hypertension seem to be associated with faster outward aortic remodeling. Arterial hypertension would account for a 0.60-0.78 mm greater diameter at the ascending aorta. Moreover, in hypertension, left ventricular mass showed a strict association with aortic diameter in nearly all studies. Other classical risk factors for atherogenesis such as dyslipidemia and smoking showed a weak influence on proximal aortic dimensions. No study reported a greater aortic remodeling in diabetics. CONCLUSIONS "Out of proportion" proximal aortic remodeling, could represent a subclinical marker of early vascular ageing, describing the cumulative influence of genetic predisposition, arterial hypertension and obesity.
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Affiliation(s)
- Francesco Tosello
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Dario Leone
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Stéphane Laurent
- Pharmacology Department and INSERM U 970 Hôpital Européen Georges Pompidou, Paris, France
| | - Franco Veglio
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy
| | - Alberto Milan
- Department of Medical Sciences, Division of Internal Medicine, Hypertension Unit, University Hospital 'S. Giovanni Battista', University of Torino, Italy.
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Reply. J Hypertens 2016; 34:1233-4. [PMID: 27120432 DOI: 10.1097/hjh.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relationship between aortic root size and glomerular filtration rate in hypertensive patients. J Hypertens 2016; 34:495-504; discussion 505. [DOI: 10.1097/hjh.0000000000000819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
INTRODUCTION Dilatation of the ascending aorta is described in Turner's syndrome with variable prevalence (6.8-32%). Reported series typically include patients with associated cardiac anomalies. OBJECTIVE To characterise the prevalence, age of onset, and the progress of dilatation of the ascending aorta in Turner's syndrome patients free of structural cardiac anomalies. Potential risk factors such as karyotype and growth hormone therapy were analysed for correlation with aortic dilatation. METHODS We carried out a retrospective study with data collected from medical records and echocardiography studies. Patients with Tuner's syndrome followed-up between 1992 and 2010 with at least two echocardiography studies were eligible. Patients with previous cardiac surgery or under anti-hypertensive medication were excluded. Ascending aorta diameter measurements were adjusted for body surface area, and dilatation was defined as Z-score>2. RESULTS The study population consisted of 44 patients, aged 11.9±7.4 years at the first echocardiogram and 17.9±7.3 years at the last follow-up, with a follow-up duration of 6.0±3.7 years. A total of 13 (29.5%) patients exhibited aortic dilatation during follow-up, suggesting an actuarial estimate of the freedom from aortic dilatation dropping from 86 to 70% and then to 37% at 10, 20, and 30 years of age, respectively. There was no statistically significant impact of karyotype or growth hormone therapy on aortic Z-score progression. CONCLUSION The prevalence of dilatation of the ascending aorta in Turner's syndrome patients free of structural aortic anomalies is comparable with published data with associated lesions. Growth hormone therapy and karyotype had no significant impact; however, longitudinal follow-up is warranted.
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Dickson D, Caivano D, Patteson M, Rishniw M. The times they are a-changin': Two-dimensional aortic valve measurements differ throughout diastole. J Vet Cardiol 2016; 18:15-25. [PMID: 26810488 DOI: 10.1016/j.jvc.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Diastolic aortic valve measurements are used to obtain weight-independent cardiac ratiometric indices. However, whether clinically important variations in valve measurements occur during diastole remains undetermined. ANIMALS One hundred sixty-three dogs and 40 cats; a mixture of healthy animals and patients with heart disease. MATERIALS AND METHODS Aortic valve diameter and area were measured at three time-points: early diastole {AoMAX}, during the P-wave {AoP} and at end-diastole {AoMIN}. Measurement beat-to-beat variability was determined. Difference plots were generated for each measurement pair. Aortic measurements were compared by repeated measures analysis of variance. RESULTS In dogs, normalised aortic diameters showed a fixed bias of approximately 14% for AoMAX-AoMIN, 6% for AoMAX-AoP and 8% for AoP-AoMIN. In cats, the aortic diameter and area biases were all less than 2.5% and less than 7% respectively. AoMAX was the largest measurement in 78% patients and AoMIN was the smallest measurement in 73% patients. In dogs, AoMAX > AoP > AoMIN (p < 0.0001). Median within-patient measurement variability was 5% for linear dimensions and 8% for area measurements in dogs and 4.5% for linear and 10.4% for area in cats. DISCUSSION Aortic measurements in dogs differ significantly throughout diastole, with Ao(A)MAX > Ao(A)P > Ao(A)MIN. These differences could clinically impact cardiac ratiometric indices. The difference in cats is less than the within-patient measurement variability and unlikely to be of clinical significance. CONCLUSIONS Operators should adopt a single diastolic time-point for measurement of the aorta to ensure consistency in measuring and reporting in echocardiography.
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Affiliation(s)
- D Dickson
- HeartVets, The Animal Hospital, Dursley, Gloucestershire, GL11 6AJ, UK.
| | - D Caivano
- Department of Clinical Sciences, School of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - M Patteson
- HeartVets, The Animal Hospital, Dursley, Gloucestershire, GL11 6AJ, UK
| | - M Rishniw
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
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Mulè G, Nardi E, Morreale M, Castiglia A, Geraci G, Altieri D, Cacciatore V, Schillaci M, Vaccaro F, Cottone S. The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:427-445. [PMID: 27873227 DOI: 10.1007/5584_2016_86] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques.An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation.Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial. The use of different methods for indexation of ARD may have in part contributed to the heterogeneous findings obtained in the investigations exploring the relationships between ARD and BP. Indeed, the best methods for ARD indexation, as well as the normal values of aortic root size, are still a matter of debate.Several non-hemodynamic factors influence ARD, including age, gender, and anthropometric variables, such as height, weight and their derivatives body surface area (BSA) and body mass index. Of these factors, anthropometric variables have the greatest impact.Several studies documented an association between ARD enlargement, assessed by echocardiography, and some indices of hypertensive target organ damage such as left ventricular hypertrophy, diastolic dysfunction, and carotid intima-media thickening. Recently, we found that ARD, expressed either as absolute values or normalized for BSA (ARD/BSA) or height (ARD/H), was significantly greater in hypertensive subjects with chronic kidney disease (CKD) when compared to their counterparts with normal renal function. Moreover, at univariate analyses estimated glomerular filtration rate (eGFR) showed significant inverse correlations with ARD not indexed and with ARD/BSA and ARD/H. Taking into account the effect of age, sex, duration of hypertension and other potentially confounding factors, in multiple regression analyses, only the association of GFR with ARD/H and that between GFR and ARD/BSA remained statistically significant. The receiver-operating characteristic curve analysis revealed that an estimated GFR of about 50 ml/min/1.73 m2 represents the better threshold to distinguish hypertensive patients with dilated aortic root from those with a normal one.Some population-based studies showed that an enlarged ARD might predict an adverse prognosis, even in absence of aneurysmatic alterations.In the Cardiovascular Health Study, a dilated aortic root was independently associated with an increased risk for stroke, cardiovascular and total mortality in both sexes and with incident congestive heart failure only in men. The relationship between ARD and heart failure has been observed also in the Framingham Heart Study. More recently, the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study demonstrated an independent relationship of ARD/H with incident cardiovascular morbidity and mortality.Although the relationship between BP and aortic root size is still a matter of debate, increasing evidence seems to support the notion that aortic root dilatation, even in absence of aneurysmatic alterations, may be regarded as an hypertensive organ damage paralleling other preclinical markers whose unfavourable prognostic significance is firmly established. Future studies are needed to assess whether or not antihypertensive therapy is able to reduce aortic root dimension and the increased risk associated with its enlargement.
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Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Massimiliano Morreale
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Antonella Castiglia
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Dario Altieri
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Valentina Cacciatore
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Margherita Schillaci
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Francesco Vaccaro
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Cattedra di Nefrologia, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Long-Term Changes in Aortic Length after Thoracic Endovascular Aortic Repair. J Vasc Interv Radiol 2015; 27:181-7. [PMID: 26686422 DOI: 10.1016/j.jvir.2015.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study long-term changes to the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for treatment of different aortic pathologic conditions. MATERIALS AND METHODS This retrospective study included 53 consecutive patients (mean age, 58.8 y ± 14; 13 female and 40 male) in whom TEVAR was performed between October 2002 and May 2010. The mean duration of follow-up was 21.1 months (range, 0.5-96 mo). Statistical analysis was performed with the Friedman test and Conover-Iman test. RESULTS Nineteen patients with aortic aneurysm (group 1), 25 patients with type B dissection (group 2), and 9 patients with other pathologic conditions (group 3) were treated with TEVAR. The mean overall aortic lengths (from the origin of the left subclavian artery to the origin of the celiac trunk) before TEVAR were 271.4 mm, 268.6 mm, and 233.6 mm in groups 1, 2, and 3, respectively. At 12-month follow-up, the lengths were 282.8 mm, 294.4 mm, and 237.5 mm in groups 1, 2, and 3, respectively. The changes in aortic lengths following TEVAR were statistically significant (P < .001). A second intervention was required in 14 patients, and 6 patients died during follow-up. CONCLUSIONS A significant change in the overall aortic length was observed following TEVAR. The changes in aortic length reached statistical significance after 12 months.
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de Simone G, Roman MJ, De Marco M, Bella JN, Izzo R, Lee ET, Devereux RB. Hemodynamic Correlates of Abnormal Aortic Root Dimension in an Adult Population: The Strong Heart Study. J Am Heart Assoc 2015; 4:e002309. [PMID: 26416876 PMCID: PMC4845134 DOI: 10.1161/jaha.115.002309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background We evaluated the relationship of aortic root dimension (ARD) with flow output and both peripheral and central blood pressure, using multivariable equations predicting ideal sex‐specific ARD at a given age and body height. Methods and Results We measured echocardiographic diastolic ARD at the sinuses of Valsalva in 3160 adults (aged 42±16 years, 61% women) from the fourth examination of the Strong Heart Study who were free of prevalent coronary heart disease, and we compared measured data with the theoretical predicted value to calculate a z score. Central blood pressure was estimated by applanation tonometry of the radial artery in 2319 participants. ARD z scores were divided into tertiles representing small, normal, and large ARD. Participants with large ARD exhibited greater prevalence of central obesity and higher levels of inflammatory markers and lipids (0.05<P<0.0001). Stroke volume, heart rate, and both cuff and central diastolic blood pressure were progressively greater from small to large ARD (all P<0.0001). Pulse pressure was higher in small ARD (P<0.0001). In multivariable analysis, ARD z score was related positively to stroke volume, either cuff or central diastolic blood pressure, and negatively to pulse pressure. Large ARD was also independently correlated to higher waist circumference and percentages of neutrophils and plasminogen activator inhibitor‐1 (all P<0.01). Conclusions Aortic root dilatation is associated with high diastolic blood pressure, high stroke volume, central fat distribution, and inflammatory status. In contrast, at a given diastolic blood pressure and stroke volume, aortic root dilatation is associated with lower pulse pressure and systolic blood pressure.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
| | - Mary J Roman
- Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
| | - Marina De Marco
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.)
| | - Jonathan N Bella
- Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY (J.N.B.)
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University, Naples, Italy (G.S., M.D.M., R.I.) Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.S., M.D.M., R.I.)
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK (E.T.L.)
| | - Richard B Devereux
- Department of Medicine, Weill-Cornell Medical College, New York, NY (G.S., M.J.R., R.B.D.)
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Prevalence and predictors of aortic dilation as a novel cardiovascular complication in children with end-stage renal disease. Clin Nephrol 2015; 83:262-71. [PMID: 25816808 PMCID: PMC4535175 DOI: 10.5414/cn108489] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Cardiovascular disease is the leading cause of death in children with end-stage renal disease (ESRD). Isolated aortic dilation (AD) is rare in children. We aimed to determine the prevalence and the risk factors for AD in children with ESRD. Methods and study design: We reviewed records of all ESRD patients followed at our institution from January 2007 to October 2012. AD was defined as Z-score > 2 in the dimension of at least one of the following echocardiographic aortic parameters: annulus, root at the sinus, sino-tubular junction, ,or ascending aorta. Results: The records of 78 patients on dialysis and 19 kidney transplant recipients were available. 30 patients (30.9%) had AD. Multivariate analysis revealed independent associations of AD with body mass index (BMI) Z-score (OR = 0.52, 95% confidence interval (CI): 0.35 – 0.78) and ESRD secondary to glomerular disease (OR = 4.58, 95% CI: 1.45 – 14.46). We developed a classification and regression tree (CART) model to identify patients at low vs. high AD risk. Our model classified 62 patients of the cohort (64%) to be high- or low-risk, with a positive predictive value of 89% and a negative predictive value of 100%. Conclusion: Our data suggest that AD, as a possible marker of aortopathy and early aneurysm formation, is a novel and prevalent cardiovascular complication in ESRD children. Glomerular disease and low BMI Z-score appear to be potent predictors. CART modeling helps identify high-risk children, potentially guiding decisions regarding targeted echocardiographic evaluations.
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Abstract
The key for successful valve repair is full understanding of the regurgitant mechanism and sufficient evaluation of the valve. Currently, multidetector computed tomography has been introduced for evaluation. The aortic valve can be analyzed in details preoperatively. The main causes of aortic regurgitation (AR) in the adult population are degenerative leaflet change and annulus dilatation. Restoration to normal structure can be accomplished mainly by plication. Central leaflet plication near the Arantius nodule is a simple technique for redundant tissue. For leaflet deficiency, pericardial patch plasty may be an option. No universal technique exists for plication of the aortic annulus. The valve-sparing aortic root replacement firmly stabilizes the ventriculo-aortic junction (VAJ) and assures repair durability even in patients with mild to moderate root dilatation. Subcommissural annuloplasty (Cabrol stitch) does not seem sufficient for the prevention of VAJ dilatation. Circumferential annuloplasties may have a greater potential. However, convenient device for annular plication is still in development. The bicuspid aortic valve is a congenital heart valve lesion. A basic technique is free margin plication of the fused leaflet. Aortic root dilatation may contribute to AR severity. Valve-sparing aortic root replacement may improve repair durability. Considering the great advances in valve repair, young patients with AR should be informed that valve repair is a promising option for surgical treatment.
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D'Andrea A, Della Corte A, Padalino R, Limongelli G, Scarafile R, Fratta F, Pezzullo E, Fusco A, Pisacane F, Coppola G, Caso P, Calabrò R, Russo MG. The Role of Multimodality Cardiac Imaging for the Assessment of Sports Eligibility in Patients with Bicuspid Aortic Valve. J Cardiovasc Echogr 2015; 25:9-18. [PMID: 28465922 PMCID: PMC5353454 DOI: 10.4103/2211-4122.158418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bicuspid aortic valve (BAV) cannot be considered an innocent finding, but it is not necessarily a life-threatening condition. Athletes with BAV should undergo a thorough staging of the valve anatomy, taking into consideration hemodynamic factors, as well as aortic diameters and looking for other associated significant cardiovascular anomalies by use of a multimodality cardiac imaging approach. Furthermore an accurate follow-up is mandatory with serial cardiological controls in those allowed to continue sports.
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Affiliation(s)
- Antonello D'Andrea
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Roberto Padalino
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaella Scarafile
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Fiorella Fratta
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Enrica Pezzullo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Adelaide Fusco
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Francesca Pisacane
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Guido Coppola
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Pio Caso
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaele Calabrò
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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Campens L, Demulier L, De Groote K, Vandekerckhove K, De Wolf D, Roman MJ, Devereux RB, De Paepe A, De Backer J. Reference values for echocardiographic assessment of the diameter of the aortic root and ascending aorta spanning all age categories. Am J Cardiol 2014; 114:914-20. [PMID: 25092193 DOI: 10.1016/j.amjcard.2014.06.024] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
Thoracic aortic dilatation requires accurate and timely detection to prevent progression to thoracic aortic aneurysm and aortic dissection. The detection of thoracic aortic dilatation necessitates the availability of cut-off values for normal aortic diameters. Tools to evaluate aortic dimension above the root are scarce and inconsistent regarding age groups. The aim of this study was to provide reference values for aortic root and ascending aortic diameters on the basis of transthoracic echocardiographic measurements in a large cohort of children and adults. Diameters at the level of the sinuses of Valsalva (SoV) and ascending aorta (AA) were assessed with transthoracic echocardiography in 849 subjects (453 females, age range 1 to 85 years, mean 40.1 ± 21.3 years) and measured according to published guidelines. Linear regression analysis was applied to create nomograms, as well as equations for upper limits of normal and z-scores. SoV and AA diameters were strongly correlated with age, body surface area (BSA), and weight (r = 0.67 to 0.79, p <0.001 for all). Male subjects had significantly larger aortic dimensions at all levels in adulthood, even after BSA correction (p ≤0.004 for all age intervals). Gender-, age-, and BSA-specific upper limits of normal and z-score equations were developed from a multivariate regression model, which strongly predicts SoV and AA diameters (adjusted R(2) for SoV = 0.84 and 0.67 and for AA = 0.82 and 0.74, for male and female subjects, respectively). In conclusion, this study provides widely applicable reference values for thoracic aortic dilatation screening purposes. Age, BSA, and gender must be taken into account when assessing an individual patient.
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Affiliation(s)
- Laurence Campens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
| | - Laurent Demulier
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Daniël De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Anne De Paepe
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Julie De Backer
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Gupta-Malhotra M, Devereux RB, Dave A, Bell C, Portman R, Milewicz D. Aortic dilatation in children with systemic hypertension. ACTA ACUST UNITED AC 2014; 8:239-45. [PMID: 24507486 DOI: 10.1016/j.jash.2014.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/02/2014] [Accepted: 01/03/2014] [Indexed: 01/15/2023]
Abstract
The aim of the study was to determine the presence of aortic dilatation in hypertensive children, the prevalence of which is 4% to 10% in hypertensive adults. Prospectively enrolled multiethnic children, untreated for their hypertension, underwent an echocardiogram to exclude congenital heart disease and evaluate for end-organ damage and aortic size. The aorta was measured in the parasternal long-axis view at three levels: the sinus of Valsalva, supra-tubular junction, and the ascending aorta. Aortic dilatation was determined by z-score >2 at any one of the levels measured. Hypertension was defined as blood pressure above the 95th percentile based on the Fourth Working Group criteria confirmed by 24-hour ambulatory blood pressure monitoring. Among 142 consecutive hypertensive children (median age, 14 years; 45% females) aortic dilatation was detected in 2.8% (95% confidence interval, 1%-7%; median age, 16 years; 100% females). Children with aortic dilatation, when compared with those without, had significantly more aortic valve insufficiency (P = .005) and left ventricular hypertrophy (P = .018). Prevalence of aortic dilatation was 2.8% and was associated with significantly more aortic insufficiency and left ventricular hypertrophy in comparison to those without aortic dilatation.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA.
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Archana Dave
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Cynthia Bell
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Ronald Portman
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Diana Milewicz
- Division of Medical Genetics, Department of Internal Medicine, Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA
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Iida M, Yamamoto M, Ishiguro YS, Yamazaki M, Ueda N, Honjo H, Kamiya K. Utility of cystatin C as a marker for the severity of aortic regurgitation in hypertensive patients. Clin Chim Acta 2013; 425:259-64. [DOI: 10.1016/j.cca.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/15/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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de Kerchove L, El Khoury G. Anatomy and pathophysiology of the ventriculo-aortic junction: implication in aortic valve repair surgery. Ann Cardiothorac Surg 2013; 2:57-64. [PMID: 23977560 DOI: 10.3978/j.issn.2225-319x.2012.12.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 12/20/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
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Effects of Aging and Body Size on Proximal and Ascending Aorta and Aortic Arch: Inner Edge–to–Inner Edge Reference Values in a Large Adult Population by Two-Dimensional Transthoracic Echocardiography. J Am Soc Echocardiogr 2013; 26:419-27. [DOI: 10.1016/j.echo.2012.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Indexed: 11/21/2022]
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Navarra E, El Khoury G, Glineur D, Boodhwani M, Van Dyck M, Vanoverschelde JL, Noirhomme P, de Kerchove L. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair†. Eur J Cardiothorac Surg 2013; 44:316-22; discussion 322-3. [DOI: 10.1093/ejcts/ezt045] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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