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Cai A, Liu L, Zhou D, Tang S, Tadic M, Schutte AE, Feng Y. Obesity and Risk of Incident Left Ventricular Hypertrophy in Community-Dwelling Populations With Hypertension: An Observational Study. J Am Heart Assoc 2024; 13:e033521. [PMID: 38842284 DOI: 10.1161/jaha.123.033521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the association between obesity and risk of incident left ventricular hypertrophy (LVH) in community-dwelling populations with hypertension and investigate whether this association would be attenuated by a lower achieved systolic blood pressure (SBP). METHODS AND RESULTS We used the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) criteria, which were derived from healthy Chinese populations to define LVH. A total of 2069 participants with hypertension and without LVH (obesity 20.4%) were included. The association between obesity and risk of incident LVH was evaluated using Cox proportional hazard models and stratified by achieved follow-up SBP levels (≥140, 130-139, and <130 mm Hg). These analyses were also assessed using the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria, which were derived from European populations to define LVH. After a median follow-up of 2.90 years, the rates of incident LVH in the normal-weight, overweight, and obese groups were 13.5%, 20.3%, and 27.8%, respectively (P<0.001). In reference to normal weight, obesity was associated with increased risk of incident LVH (adjusted hazard ratio [aHR], 2.51 [95% CI, 1.91-3.29]), which was attenuated when achieved SBP was <130 mm Hg (aHR, 1.78 [95% CI, 0.99-3.19]). This association remained significant when achieved SBP was ≥140 mm Hg (aHR, 3.45 [95% CI, 2.13-5.58]) or at 130 to 139 mm Hg (aHR, 2.32 [95% CI, 1.23-4.36]). Differences in these findings were noted when LVH was defined by the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. CONCLUSIONS Obesity was associated with incident LVH and an SBP target <130 mm Hg might be needed to attenuate this risk in patients with hypertension and obesity.
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Affiliation(s)
- Anping Cai
- Hypertension Research Laboratory, Department of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangdong Province China
| | - Lin Liu
- Hypertension Research Laboratory, Department of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangdong Province China
| | - Dan Zhou
- Hypertension Research Laboratory, Department of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangdong Province China
| | - Songtao Tang
- Community Health Center of the Liaobu County Dongguan China
| | - Marijana Tadic
- Klinik für Innere Medizin II Universitätsklinikum Ulm, Albert-Einstein Allee 23 Ulm Germany
| | - Aletta E Schutte
- School of Population Health University of New South Wales, The George Institute for Global Health Sydney Australia
| | - Yingqing Feng
- Hypertension Research Laboratory, Department of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangdong Province China
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Beeche C, Dib MJ, Zhao B, Azzo JD, Maynard H, Duda J, Gee J, Salman O, Witschey WR, Chirinos JA. Three-dimensional aortic geometry: clinical correlates, prognostic value and genetic architecture. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.09.593413. [PMID: 38798566 PMCID: PMC11118285 DOI: 10.1101/2024.05.09.593413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Aortic structure and function impact cardiovascular health through multiple mechanisms. Aortic structural degeneration increases left ventricular afterload, pulse pressure and promotes target organ damage. Despite the impact of aortic structure on cardiovascular health, aortic 3D-geometry has yet to be comprehensively assessed. Using a convolutional neural network (U-Net) combined with morphological operations, we quantified aortic 3D-geometric phenotypes (AGPs) from 53,612 participants in the UK Biobank and 8,066 participants in the Penn Medicine Biobank. AGPs reflective of structural aortic degeneration, characterized by arch unfolding, descending aortic lengthening and luminal dilation exhibited cross-sectional associations with hypertension and cardiac diseases, and were predictive for new-onset hypertension, heart failure, cardiomyopathy, and atrial fibrillation. We identified 237 novel genetic loci associated with 3D-AGPs. Fibrillin-2 gene polymorphisms were identified as key determinants of aortic arch-3D structure. Mendelian randomization identified putative causal effects of aortic geometry on the risk of chronic kidney disease and stroke.
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Topriceanu CC, Shah M, Webber M, Chan F, Shiwani H, Richards M, Schott J, Chaturvedi N, Moon JC, Hughes AD, Hingorani AD, O'Regan DP, Captur G. APOE ε4 carriage associates with improved myocardial performance from adolescence to older age. BMC Cardiovasc Disord 2024; 24:172. [PMID: 38509472 PMCID: PMC10956279 DOI: 10.1186/s12872-024-03808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Although APOE ε4 allele carriage confers a risk for coronary artery disease, its persistence in humans might be explained by certain survival advantages (antagonistic pleiotropy). METHODS Combining data from ~ 37,000 persons from three older age British cohorts (1946 National Survey of Health and Development [NSHD], Southall and Brent Revised [SABRE], and UK Biobank) and one younger age cohort (Avon Longitudinal Study of Parents and Children [ALSPAC]), we explored whether APOE ε4 carriage associates with beneficial or unfavorable left ventricular (LV) structural and functional metrics by echocardiography and cardiovascular magnetic resonance (CMR). RESULTS Compared to the non-APOE ε4 group, APOE ε4 carriers had similar cardiac phenotypes in terms of LV ejection fraction, E/e', posterior wall and interventricular septal thickness, and LV mass. However, they had improved myocardial performance resulting in greater LV stroke volume generation per 1 mL of myocardium (higher myocardial contraction fraction). In NSHD (n = 1467) and SABRE (n = 1187), ε4 carriers had a 4% higher MCF (95% CI 1-7%, p = 0.016) using echocardiography. Using CMR data, in UK Biobank (n = 32,972), ε4 carriers had a 1% higher MCF 95% (CI 0-1%, p = 0.020) with a dose-response relationship based on the number of ε4 alleles. In addition, UK Biobank ε4 carriers also had more favorable radial and longitudinal strain rates compared to non APOE ε4 carriers. In ALSPAC (n = 1397), APOE ε4 carriers aged < 24 years had a 2% higher MCF (95% CI 0-5%, p = 0.059). CONCLUSIONS By triangulating results in four independent cohorts, across imaging modalities (echocardiography and CMR), and in ~ 37,000 individuals, our results point towards an association between ε4 carriage and improved cardiac performance in terms of LV MCF. This potentially favorable cardiac phenotype adds to the growing number of reported survival advantages attributed to the pleiotropic effects APOE ε4 carriage that might collectively explain its persistence in human populations.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, Pond Street, Hampstead, London, UK
| | - Mit Shah
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Science, Imperial College London, London, UK
| | - Matthew Webber
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Fiona Chan
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Hunain Shiwani
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
| | - Marcus Richards
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Jonathan Schott
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Nishi Chaturvedi
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
| | - Alun D Hughes
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Aroon D Hingorani
- UCL Institute of Cardiovascular Science, University College London, London, UK
- BHF Research Accelerator, University College London, London, UK
- Health Data Research, University College London, London, UK
| | - Declan P O'Regan
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Science, Imperial College London, London, UK
| | - Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
- Cardiac MRI Unit, Barts Heart Centre, London, UK.
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, Pond Street, Hampstead, London, UK.
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Ferreira AF, Saraiva F, Diaz SO, Azevedo MJ, Sousa C, Leite-Moreira A, Sampaio-Maia B, Ramalho C, Barros AS, Falcão-Pires I. The impact of echocardiographic indexation to evaluate cardiac reverse remodeling throughout pregnancy and postpartum. Rev Port Cardiol 2024; 43:107-127. [PMID: 37495102 DOI: 10.1016/j.repc.2023.04.014] [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: 01/27/2023] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Echocardiography guidelines suggest normalizing left ventricular (LV) volumes and mass (LVM) to body size. During pregnancy, continuous weight variation impacts on body surface area (BSA) calculation, limiting the longitudinal analysis of cardiac remodeling (CR) and reverse remodeling (RR) variables. Our aim was to identify the most common indexing methodologies in the literature on pregnant populations through a systematic review; and, to compare four scaling methods: (i) none (absolute values); (ii) indexing to the BSA before pregnancy; (iii) allomeric indexing; and (iv) indexing to BSA measured at the same day of cardiac assessment, using an illustrative example. METHODS We performed a systematic review of CR and RR during pregnancy and post-partum, using two databases. We included studies reporting longitudinal echocardiographic analysis of cardiac chamber volumes in humans. We used a prospective cohort study of healthy pregnant women who underwent four echocardiographic evaluations during pregnancy and postpartum, as an illustrative example. RESULTS Twenty-seven studies were included, most studies indexed to BSA measured at each evaluation moment (n=21). Within-subjects design was the most reported to analyse longitudinal data (n=17). Indexation to the pre-pregnancy BSA or application of allometric indexes revealed a higher effect than BSA measured at each evaluation and an equal effect to not indexing using within-subjects design. The within-subjects designs also revealed a higher effect size value than the between-subjects design for longitudinal analysis of LVM adaptations during pregnancy and postpartum. CONCLUSION(S) This study concludes that indexation methods do not impact the clinical interpretation of longitudinal echocardiographic assessment but highlights the need to harmonize normalization procedures during pregnancy.
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Affiliation(s)
- Ana Filipa Ferreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia Oliveira Diaz
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, The Netherlands
| | - Carla Sousa
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Carla Ramalho
- Center of Prenatal Diagnosis, Obstetrics Department, Centro Hospitalar de São João, Porto, Portugal; Obstetrics, Gynecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal
| | - António Sousa Barros
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
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Hughes D, Aminian A, Tu C, Okushi Y, Saijo Y, Wilson R, Chan N, Kumar A, Grimm RA, Griffin BP, Tang WHW, Nissen SE, Xu B. Impact of Bariatric Surgery on Left Ventricular Structure and Function. J Am Heart Assoc 2024; 13:e031505. [PMID: 38156532 PMCID: PMC10863834 DOI: 10.1161/jaha.123.031505] [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: 06/23/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Obesity leads to an increased risk of cardiovascular disease morbidity and death, including heart failure. Bariatric surgery has been proven to be the most effective long-term weight management treatment. This study investigated the changes in cardiac structure and function after bariatric surgery, including left ventricular global longitudinal strain. METHODS AND RESULTS There were 398 consecutive patients who underwent bariatric surgery with pre- and postoperative transthoracic echocardiographic imaging at a US health system between 2004 and 2019. We compared cardiovascular risk factors and echocardiographic parameters between baseline and follow-up at least 6 months postoperatively. Along with decreases in weight postoperatively, there were significant improvements in cardiovascular risk factors, including reduction in systolic blood pressure levels from 132 mm Hg (25th-75th percentile: 120-148 mm Hg) to 127 mm Hg (115-140 mm Hg; P=0.003), glycated hemoglobin levels from 6.5% (5.9%-7.6%) to 5.7% (5.4%-6.3%; P<0.001), and low-density lipoprotein levels from 97 mg/dL (74-121 mg/dL) to 86 mg/dL (63-106 mg/dL; P<0.001). Left ventricular mass decreased from 205 g (165-261 g) to 190 g (151-236 g; P<0.001), left ventricular ejection fraction increased from 58% (55%-61%) to 60% (55%-64%; P<0.001), and left ventricular global longitudinal strain improved from -15.7% (-14.3% to -17.5%) to -18.6% (-16.0% to -20.3%; P<0.001) postoperatively. CONCLUSIONS This study has shown the long-term impact of bariatric surgery on cardiac structure and function, with reductions in left ventricular mass and improvement in left ventricular global longitudinal strain. These findings support the cardiovascular benefits of bariatric surgery.
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Affiliation(s)
- Diarmaid Hughes
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandOH
| | - Chao Tu
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
| | - Yuichiro Okushi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Yoshihito Saijo
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandOH
| | - Nicholas Chan
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Ashwin Kumar
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Richard A. Grimm
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Brian P. Griffin
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - W. H. Wilson Tang
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Steven E. Nissen
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
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Marwick TH, Flachskampf F, Chandrashekhar Y. The Abnormality of "Normal" Results: Outcomes of People Within Reference Ranges. JACC Cardiovasc Imaging 2023; 16:1637-1639. [PMID: 38056990 DOI: 10.1016/j.jcmg.2023.11.001] [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] [Indexed: 12/08/2023]
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7
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Fung ASY, Soundappan D, Loewenstein DE, Playford D, Strange G, Kozor R, Otton J, Ugander M. Prognostic association supports indexing size measures in echocardiography by body surface area. Sci Rep 2023; 13:19390. [PMID: 37938592 PMCID: PMC10632399 DOI: 10.1038/s41598-023-46183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
Body surface area (BSA) is the most commonly used metric for body size indexation of echocardiographic measures, but its use in patients who are underweight or obese is questioned (body mass index (BMI) < 18.5 kg/m2 or ≥ 30 kg/m2, respectively). We aim to use survival analysis to identify an optimal body size indexation metric for echocardiographic measures that would be a better predictor of survival than BSA regardless of BMI. Adult patients with no prior valve replacement were selected from the National Echocardiography Database Australia. Survival analysis was performed for echocardiographic measures both unindexed and indexed to different body size metrics, with 5-year cardiovascular mortality as the primary endpoint. Indexation of echocardiographic measures (left ventricular end-diastolic diameter [n = 230,109] and mass [n = 224,244], left atrial volume [n = 150,540], aortic sinus diameter [n = 90,805], right atrial area [n = 59,516]) by BSA had better prognostic performance vs unindexed measures (underweight: C-statistic 0.655 vs 0.647; normal weight/overweight: average C-statistic 0.666 vs 0.625; obese: C-statistic 0.627 vs 0.613). Indexation by other body size metrics (lean body mass, height, and/or weight raised to different powers) did not improve prognostic performance versus BSA by a clinically relevant magnitude (average C-statistic increase ≤ 0.02), with smaller differences in other BMI subgroups. Indexing measures of cardiac and aortic size by BSA improves prognostic performance regardless of BMI, and no other body size metric has a clinically meaningful better performance.
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Affiliation(s)
- Angus S Y Fung
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Dhnanjay Soundappan
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Daniel E Loewenstein
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Geoffrey Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
| | - James Otton
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia.
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
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8
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Zhang X, Li G, Zhang D, Sun Y. Influence of hypertension and global or abdominal obesity on left ventricular hypertrophy: A cross-sectional study. J Clin Hypertens (Greenwich) 2023. [PMID: 37794691 DOI: 10.1111/jch.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023]
Abstract
Although hypertension and obesity are both risk factors for left ventricular hypertrophy (LVH), the extent of their impact on LVH in the general population is still unclear, and the predictive value of obesity indicators for LVH remains to be elucidated. In this study, obesity-related indicators, including waist circumference (WC), waist-height ratio (WHTR), and waist-hip ratio (WHR), were used to define abdominal obesity (AO), whereas body mass index (BMI) was used to measure general obesity (GO). The effects of hypertension and obesity on LVH were estimated using logistic regression analysis, as was the relative risk of LVH based on the presence of obesity, hypertension, or both. Subgroup analyses were performed based on sex and age. Of the 9134 participants (≥35 years old), 915 (10.0%) developed LVH. After adjusting for covariates, the odds ratios (95% confidence intervals) for LVH were 3.94 (3.27-4.75) in patients with hypertension, 1.90 (1.60-2.26) in those with GO, and 1.45 (1.25-1.69), 1.69 (1.43-2.00), and 1.54 (1.33-4.75) in individuals with AO defined based on WC, WHTR, and WHR, respectively. Analysis by sex showed similar values in women, but AO based on WC and WHR were not significantly associated with LVH in men. Further, after adjusting for potential confounding factors, concomitant hypertension and obesity had an increased risk of developing LVH in all age ranges, particularly in patients aged 35-45 years (risk increased 14.14-fold, 10.84-fold, 7.97-fold, and 9.95-fold for BMI-based GO and WC-, WHTR-, and WHR-based AO, respectively), and in both men and women but particularly in men (risk increased 7.71-fold, 4.67-fold, 5.83-fold, and 5.58-fold, respectively). In summary, all obesity indicators (BMI, WC, WHTR, and WHR) had predictive value for LVH in women; however, only BMI and WHTR should be considered for men. Furthermore, monitoring for the occurrence and progression of LVH is imperative for rural Chinese patients with concomitant hypertension and obesity, especially men and those aged 35-45 years.
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Affiliation(s)
- Xueyao Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management, First Hospital of China Medical University, Shenyang, China
| | - Dongyuan Zhang
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS), Comparative Medicine Center, Peking, Union Medical College (PUMC), Beijing, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
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9
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Kawabori M, Critsinelis AC, Patel S, Nordan T, Thayer KL, Chen FY, Couper GS. Total ventricular mass oversizing +50% or greater was a predictor of worse 1-year survival after heart transplantation. J Thorac Cardiovasc Surg 2023; 166:1145-1154.e9. [PMID: 35688717 DOI: 10.1016/j.jtcvs.2022.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/13/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Current donor-recipient size matching guidelines rely primarily on body weight, with no specified oversizing cutoff values. Recent literature has explored predicted total ventricular mass matching over body weight matching. We aim to explore the impact of total ventricular mass oversizing on heart transplant outcomes. METHODS The United Network for Organ Sharing database was queried for adults who underwent primary heart transplant from 1997 to 2017. By using validated equations, donor-recipient total ventricular mass mismatch was calculated. Donor-recipient pairs were divided into 3 groups by total ventricular mass mismatch. Post-heart transplant 1-year survival was analyzed using the Kaplan-Meier method and Cox proportional hazards models. We also investigated post-heart transplant complications, independent predictors for mortality, donor-recipient sex mismatch, and donor-recipient body habitus in total ventricular mass mismatch greater than +50%. RESULTS A total of 34,455 donor-recipient pairs were included. Fractional polynomial regression demonstrated increased the risk of mortality with higher total ventricular mass mismatch. Total ventricular mass mismatch of +48.3% maximized the Youden Index. Donor-recipient pairs were subsequently grouped by total ventricular mass mismatch as -20% to +30%, +30% to +50%, and greater than +50%. Total ventricular mass mismatch greater than +50% was an independent risk factor for 1-year mortality (hazard ratio, 1.40, P = .004) and was associated with increased postoperative stroke (P = .002). Some 80.3% of these recipients were smaller female patients with male donors. Total ventricular mass mismatch from +30% to +50% was not associated with worse survival (P = .17). CONCLUSIONS Total ventricular mass mismatch greater than +50% is associated with worse 1-year survival, although this group comprises a small portion of heart transplant. total ventricular mass mismatch from +30% to +50% is not associated with worse survival. These outcomes should be considered in selecting donors and in efforts to expand the potential donor pool.
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Affiliation(s)
- Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass.
| | | | - Sagar Patel
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Taylor Nordan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Katherine L Thayer
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Frederick Y Chen
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Gregory S Couper
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
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10
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Chirinos JA. Left Ventricular Mass, Sex and Body Size: Rectifying the Methods. Hypertension 2023; 80:2043-2045. [PMID: 37729637 PMCID: PMC10516506 DOI: 10.1161/hypertensionaha.123.21778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia, PA, USA
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11
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Taylor HCM, Chaturvedi N, Davey Smith G, Ferreira DLS, Fraser A, Howe LD, Hughes AD, Lawlor DA, Timpson NJ, Park CM. Is Height 2.7 Appropriate for Indexation of Left Ventricular Mass in Healthy Adolescents? The Importance of Sex Differences. Hypertension 2023; 80:2033-2042. [PMID: 37548044 PMCID: PMC10510825 DOI: 10.1161/hypertensionaha.121.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Left ventricular mass (LVM) is an important predictor of cardiovascular risk. In adolescence, LVM is commonly indexed to height2.7, although some evidence suggests that this may not fully account for sex differences. METHODS We investigated appropriate allometric scaling of LVM to height, total lean mass, and body surface area, in a UK birth cohort of 2039 healthy adolescents (17±1 years). Allometric relationships were determined by linear regression stratified by sex, following log transformation of x and y variables [log(y)=a+b×log(x)], b is the allometric exponent. RESULTS Log (LVM) showed linear relationships with log(height) and log(lean mass). Biased estimates of slope resulted when the sexes were pooled. The exponents were lower than the conventional estimate of 2.7 for males (mean [95% CI]=1.66 [1.30-2.03]) and females (1.58 [1.27-1.90]). When LVM was indexed to lean mass, the exponent was 1.16 (1.05-1.26) for males and 1.07 (0.97-1.16) for females. When LVM was indexed to estimated body surface area, the exponent was 1.53 (1.40-1.66) for males and 1.34 (1.24-1.45) for females. CONCLUSIONS Allometric exponents derived from pooled data, including men and women without adjustment for sex were biased, possibly due to sex differences in body composition. We suggest that when assessing LVM, clinicians should consider body size, body composition, sex, and age. Our observations may also have implications for the identification of young individuals with cardiac hypertrophy.
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Affiliation(s)
- Hannah C M Taylor
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
- Oxford Population Health (NDPH), University of Oxford, United Kingdom (H.C.M.T.)
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (H.C.M.T.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Diana L S Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Nic J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Chloe M Park
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
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12
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Vandroux D, Houehanou YC, Magne J, Saka D, Sonou A, Amidou S, Houinato D, Preux PM, Aboyans V, Lacroix P. Normal reference values of cardiac chamber sizes and functional parameters in a beninese community population: the TAHES study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1729-1739. [PMID: 37354384 DOI: 10.1007/s10554-023-02892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
Reported ranges of normal values for echocardiographic measurements are mostly issued from studies performed in Caucasians. This study is a part of TAHES, a population-based prospective cohort study in Benin and aims to establish normal reference values for echocardiographic cardiac chambers dimensions and Doppler parameters in a Sub-Saharan African population. We included 486 healthy (non-diabetic, non-obese and normotensive) individuals (202 men and 284 women, age 37[30-47] years, BSA 1.58 (1.47-1.67) m2). End-diastolic interventricular septal wall thickness, left ventricular (LV) internal diameter, posterior wall thicknesses, and systolic LV internal diameter were respectively at 10[9-12], 45[43-49], 9[8-11], 29[26-34] mm for male and 9[7-10], 43[41-46], 8[7-], 29[27-32] mm for females. LV mass was significantly greater in males even after normalization for the body surface area (98[85-117] vs. 82[71-96] g/m2). Upper limits of BSA-indexed LV mass were 145 g/m2 for males and 124 g/m2 for females. The allometric exponent that described the LV mass-Height relationship were 2.5 in both sexes but 1.2 for males and 1.8 for females separately. E-wave velocity was 0.79 [0.65-0.90] cm/sec in males and 0.88 [0.78-0.99]cm/sec in females (p < 0.0001) but without significant gender differences in E/A ratio (limits: 0.75 and 2.1). The e'-wave velocity (lower limit = 8 cm/sec) decreased and E/e' ratio (Upper limit = 9) increased with aging. Upper limit of BSA-indexed left atrium volume was 38 mL/m2 for both sexes. In conclusion, normal values from a general population in West Africa differ from those established in Caucasian populations with greater LV mass and wall thicknesses.
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Affiliation(s)
- David Vandroux
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France.
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
- Cardio-surgical Intensive Care Unit, CHU Limoges, 2 Avenue Martin Luther King, Limoges, 87042, France.
| | - Yessito Corine Houehanou
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, CHU Limoges, Limoges, France
| | - Dominique Saka
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Arnaud Sonou
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Salmane Amidou
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
| | - Dismand Houinato
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
| | - Pierre Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Victor Aboyans
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, CHU Limoges, Limoges, France
| | - Philippe Lacroix
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Vascular Medicine Unit, CHU Limoges, Limoges, France
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13
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Gard EK, Beale AL, Telles F, Silvestry FE, Hanff T, Hummel SL, Litwin SE, Petrie MC, Shah SJ, Borlaug BA, Burkhoff D, Komtebedde J, Kaye DM, Nanayakkara S. Left atrial enlargement is associated with pulmonary vascular disease in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:806-814. [PMID: 36847073 PMCID: PMC10625803 DOI: 10.1002/ejhf.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF. METHODS AND RESULTS Data from 85 patients (aged 69 ± 8 years) who underwent exercise right heart catheterization and echocardiography were retrospectively analysed. All had symptoms of heart failure, left ventricular ejection fraction ≥50% and haemodynamic features of HFpEF. Patients were divided into LA volume index-based tertiles (≤34 ml/m2 , >34 to ≤45 ml/m2 , >45 ml/m2 ). A subgroup analysis was performed in patients with recorded LA global reservoir strain (n = 60), with reduced strain defined as ≤24%. Age, sex, body surface area and left ventricular ejection fraction were similar between volume groups. LA volume was associated with blunted increases in cardiac output with exercise (padjusted <0.001), higher resting mean pulmonary artery pressure (padjusted = 0.003), with similar wedge pressure (padjusted = 1). Pulmonary vascular resistance (PVR) increased with increasing LA volume (padjusted <0.001). Larger LA volumes featured reduced LA strain (padjusted <0.001), with reduced strain associated with reduced PVR-compliance time (0.34 [0.28-0.40] vs. 0.38 [0.33-0.43], p = 0.03). CONCLUSION Increasing LA volume may be associated with more advanced pulmonary vascular disease in HFpEF, featuring higher PVR and pulmonary pressures. Reduced LA function, worse at increasing LA volumes, is associated with a disrupted PVR-compliance relationship, further augmenting impaired pulmonary haemodynamics.
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Affiliation(s)
| | | | - Fernando Telles
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Thomas Hanff
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott L. Hummel
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Dan Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - David M. Kaye
- Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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14
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Ismail TF, Frey S, Kaufmann BA, Winkel DJ, Boll DT, Zellweger MJ, Haaf P. Hypertensive Heart Disease-The Imaging Perspective. J Clin Med 2023; 12:jcm12093122. [PMID: 37176563 PMCID: PMC10179093 DOI: 10.3390/jcm12093122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.
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Affiliation(s)
- Tevfik F Ismail
- King's College London & Cardiology Department, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Simon Frey
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - David J Winkel
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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15
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Hortegal RA, Valeri R, Grizante M, Cancellier R, Uemoto V, Gun C, Assef J, Moriya H, Meneghelo R, Feres F, Franchini KG. Afterload increase challenge unmasks systolic abnormalities in heart failure with preserved ejection fraction. Int J Cardiol 2023; 380:20-27. [PMID: 36958396 DOI: 10.1016/j.ijcard.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/26/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Provocative maneuvers have the potential to overcome the low sensitivity of resting echocardiography and biomarkers in the detection of heart failure with preserved ejection fraction (HFpEF). We investigate the mechanical response of the left ventricle to an afterload challenge in patients with preclinical and early-stage HFpEF (es-HFpEF). METHODS Three groups of patients (non-HFpEF - n = 42, pre-HFpEF - n = 43, and es-HFpEF - n = 39) underwent echocardiography at rest and during an afterload challenge induced by handgrip maneuver combined with pneumatic constriction of limbs. RESULTS Patients in the non-HF group displayed a median ΔLPSS = -4% (IQR: -10%, +2%), LPSS rest<16% in 3/42(7%) and LPSS stress<16% in 6/43(14%). Subjects in the pre-HFpEF group displayed median ΔLPSS = -3% (IQR: -10%, +5%) LPSS rest<16% in 13/43(30%) and LPSS stress<16% in 19/43 (44%). 11/43 (25%) subjects in this group increased at least one absolute point in LPSS during stress. Patients in es-HFpEF group displayed a median ΔLPSS = -10% (IQR: -18%, -1%), LPSS rest<16% in 15/39(38%) and LPSS stress<16% in 25/39(64%). Changes in LPSS (ΔLPSS) were significantly greater in es-HFpEF than pre-HFpEF (p = 0.022). In multivariate analysis, this group effect was maintained after adjustment of the LPSS for systolic blood pressure, use of β-blockers, LV mass, RWT, age, and sex. CONCLUSION Our data suggest that patients with HFpEF have a marked decrease in peak strain during acute pressure overload. Longitudinal studies are needed to test and compare the clinical impact of each pattern in early and long-term follow-ups.
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Affiliation(s)
| | - Renata Valeri
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | | | | | - Vinícius Uemoto
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Carlos Gun
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Jorge Assef
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Henrique Moriya
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil; Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Romeu Meneghelo
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Fausto Feres
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil
| | - Kleber G Franchini
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil; Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
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16
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Udora NC, Ejim EC, Young EE, C Onwubere BJ. Assessment of left ventricular geometry in normotensive type II diabetic patients. Niger J Clin Pract 2023; 26:194-200. [PMID: 36876608 DOI: 10.4103/njcp.njcp_424_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Abnormalities of glucose metabolism are associated with abnormal left ventricular geometry (LV) independent of atherosclerosis. Abnormal LV geometry, a predictor of premature cardiovascular events, indicates presence of subclinical target organ damages. Screening for abnormal LV geometry in diseases of abnormal glucose metabolism is desirable as part of their management protocol. Aim To assess the left ventricular geometry in normotensive type II diabetic patients. Cross-sectional, descriptive, hospital-based study. One hundred normotensive type II diabetic patients drawn from the Endocrinology and Family Medicine Clinics of a tertiary hospital were age- and gender-matched with 100 apparently healthy controls. Participants meeting the criteria and informed consent proceeded for clinical evaluation, biochemical assessment, electrocardiography, and echocardiography using the American Society of Echocardiography guideline. Materials and Methods Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 25.0 (Chicago Illinois, USA). Results Mean age of study and control groups was (55.56 ± 9.89 versus 55.47 ± 10.7) years (χ2 = 0.062, P = 0.951). The mean duration of diabetes illness was 6.57 ± 6.26 years. Prevalence of abnormal LV geometry was 51% (study) versus 18% (control) FT, P < 0.001). Concentric remodeling was the predominant geometry in 36% of study versus 11% of controls, followed by eccentric hypertrophy in 11% (study) versus 4% (control) and concentric hypertrophy in 4% (study) versus 3% (control). Geometry was normal in 49% of study against 82% in the controls (FT, P < 0.001). Significant association existed between LV geometry and duration of diabetes (χ2 = 10.793, P = 0.005). Conclusion Abnormal LV geometry is highly prevalent in normotensive diabetic patients.
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Affiliation(s)
- N C Udora
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - E C Ejim
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla; Department of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - E E Young
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla; Department of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - B J C Onwubere
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
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17
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Gomes B, Hedman K, Kuznetsova T, Cauwenberghs N, Hsu D, Kobayashi Y, Ingelsson E, Oxborough D, George K, Salerno M, Ashley E, Haddad F. Defining left ventricular remodeling using lean body mass allometry: a UK Biobank study. Eur J Appl Physiol 2023; 123:989-1001. [PMID: 36617359 DOI: 10.1007/s00421-022-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The geometric patterns of ventricular remodeling are determined using indexed left ventricular mass (LVM), end-diastolic volume (LVEDV) and concentricity, most often measured using the mass-to-volume ratio (MVR). The aims of this study were to validate lean body mass (LBM)-based allometric coefficients for scaling and to determine an index of concentricity that is independent of both volume and LBM. METHODS Participants from the UK Biobank who underwent both CMR and dual-energy X-ray absorptiometry (DXA) during 2014-2015 were considered (n = 5064). We excluded participants aged ≥ 70 years or those with cardiometabolic risk factors. We determined allometric coefficients for scaling using linear regression of the logarithmically transformed ventricular remodeling parameters. We further defined a multiplicative allometric relationship for LV concentricity (LVC) adjusting for both LVEDV and LBM. RESULTS A total of 1638 individuals (1057 female) were included. In subjects with lower body fat percentage (< 25% in males, < 35% in females, n = 644), the LBM allometric coefficients for scaling LVM and LVEDV were 0.85 ± 0.06 and 0.85 ± 0.03 respectively (R2 = 0.61 and 0.57, P < 0.001), with no evidence of sex-allometry interaction. While the MVR was independent of LBM, it demonstrated a negative association with LVEDV in (females: r = - 0.44, P < 0.001; males: - 0.38, P < 0.001). In contrast, LVC was independent of both LVEDV and LBM [LVC = LVM/(LVEDV0.40 × LBM0.50)] leading to increased overlap between LV hypertrophy and higher concentricity. CONCLUSIONS We validated allometric coefficients for LBM-based scaling for CMR indexed parameters relevant for classifying geometric patterns of ventricular remodeling.
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Affiliation(s)
- Bruna Gomes
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany.
- Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Kristofer Hedman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Clinical Physiology in Linköping, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David Hsu
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Erik Ingelsson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - David Oxborough
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 9UT, UK
| | - Keith George
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 9UT, UK
| | - Michael Salerno
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford University School of Medicine, Falk Building 870 Quarry Rd, Stanford, CA, 94304, USA.
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18
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Interpretation of pre-morbid cardiac 3T MRI findings in overweight and hypertensive young adults. PLoS One 2022; 17:e0278308. [PMID: 36454872 PMCID: PMC9714856 DOI: 10.1371/journal.pone.0278308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
In young adults, overweight and hypertension possibly already trigger cardiac remodeling as seen in mature adults, potentially overlapping non-ischemic cardiomyopathy findings. To this end, in young overweight and hypertensive adults, we aimed to investigate changes in left ventricular mass (LVM) and cardiac volumes, and the impact of different body scales for indexation. We also aimed to explore the presence of myocardial fibrosis, fat and edema, and changes in cellular mass with extracellular volume (ECV), T1 and T2 tissue characteristics. We prospectively recruited 126 asymptomatic subjects (51% male) aged 27-41 years for 3T cardiac magnetic resonance imaging: 40 controls, 40 overweight, 17 hypertensive and 29 hypertensive overweight. Myocyte mass was calculated as (100%-ECV) * height2.7-indexed LVM. Absolute LVM was significantly increased in overweight, hypertensive and hypertensive overweight groups (104 ± 23, 109 ± 27, 112 ± 26 g) versus controls (87 ± 21 g), with similar volumes. Body surface area (BSA) indexation resulted in LVM normalization in overweights (48 ± 8 g/m2) versus controls (47 ± 9 g/m2), but not in hypertensives (55 ± 9 g/m2) and hypertensive overweights (52 ± 9 g/m2). BSA-indexation overly decreased volumes in overweight versus normal-weight (LV end-diastolic volume; 80 ± 14 versus 92 ± 13 ml/m2), where height2.7-indexation did not. All risk groups had lower ECV (23 ± 2%, 23 ± 2%, 23 ± 3%) than controls (25 ± 2%) (P = 0.006, P = 0.113, P = 0.039), indicating increased myocyte mass (16.9 ± 2.7, 16.5 ± 2.3, 18.1 ± 3.5 versus 14.0 ± 2.9 g/m2.7). Native T1 values were similar. Lower T2 values in the hypertensive overweight group related to heart rate. In conclusion, BSA-indexation masks hypertrophy and causes volume overcorrection in overweight subjects compared to controls, height2.7-indexation therefore seems advisable.
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Lertlaksameewilai P, Songsangjinda T, Kaolawanich Y, Yindeengam A, Krittayaphong R. Extracellular volume and left ventricular hypertrophy by cardiac magnetic resonance are independent predictors of cardiovascular outcome in obesity. Sci Rep 2022; 12:18758. [PMID: 36335162 PMCID: PMC9637172 DOI: 10.1038/s41598-022-23672-1] [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] [Received: 02/22/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
Abstract
This retrospective cohort study investigated for association between increased extracellular volume (ECV) and left ventricular hypertrophy (LVH) by cardiac magnetic resonance (CMR) and cardiovascular composite outcomes in obesity. Native T1 was measured at the ventricular septum. ECV was calculated from native and post-contrast T1 and hematocrit. Cardiovascular (CV) composite outcomes included acute myocardial infarction, unstable angina requiring hospitalization, myocardial revascularization (excluding early revascularization), heart failure, and CV death. A total of 456 patients with a mean follow-up of 2.1 ± 0.4 years were enrolled. LGE and LVH was detected in 30.5% and 9.2%. 107 patients (23.5%) had the composite outcomes. Multivariable analysis revealed that LGE, LVH, and high ECV as independent predictors for cardiovascular composite outcomes The event rate in the LVH and high ECV, the LVH alone, the high ECV alone, and the no-LVH with lower ECV group was 57.1%, 38.1%, 32.6%, and 17.7%, respectively. Assessment of incremental prognostic value by comparing global chi-square showed that high ECV had additional prognostic value on top of LGE, and LVH. LVH and high ECV are independent predictors of CV composite outcomes in obesity. This is the first study that demonstrate the prognostic value of ECV in obese population.
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Affiliation(s)
- Panuwat Lertlaksameewilai
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Thammarak Songsangjinda
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Yodying Kaolawanich
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Ahthit Yindeengam
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Rungroj Krittayaphong
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
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Tadic M, Cuspidi C, Marwick TH. Phenotyping the hypertensive heart. Eur Heart J 2022; 43:3794-3810. [DOI: 10.1093/eurheartj/ehac393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
Abstract
Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling—especially LV hypertrophy—is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm , Albert-Einstein Allee 23, 89081 Ulm , Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca , Milano 20126 , Italy
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute , Melbourne, VIC 3004 , Australia
- Baker Department of Cardiometabolic Health, University of Melbourne , VIC 3004 , Australia
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21
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Zuo X, Xu Z, Jia H, Mu Y, Zhang M, Yuan M, Wu C. Co-simulation of hypertensive left ventricle based on computational fluid dynamics and a closed-loop network model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106649. [PMID: 35124478 DOI: 10.1016/j.cmpb.2022.106649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/03/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Hypertension is one of the most common chronic and cardiovascular diseases, with the largest number of deaths. According to clinical experience, long-term hypertension will cause cardiac hypertrophy and other complications, and heart structure remodeling will significantly change the energy characteristics of the heart chambers, and impair heart function. Research shows that, early hypertension can be diagnosed by the blood flow and energy loss in the left ventricle. Therefore, it is important to choose an appropriate method to simulate and predict the flow domain of this ventricle. METHODS This study took the left ventricular flow field of patients with hypertensive myocardial hypertrophy as the research object, used MATLAB-SIMULINK to establish a closed-loop network cardiovascular model, provided flow boundary conditions for the computational fluid dynamics (CFD) numerical simulation method, and, finally, completed a co-simulation. RESULTS This article compared the degree of agreement between the energy loss in different phases of the heart cavity and clinical experimental data and summarized the characteristics of the flow field in patients with hypertensive myocardial hypertrophy. The analysis of three simulation groups (control group, non-left ventricular hypertrophy group, and left ventricular hypertrophy [LVH] group) showed that the vortices in the LVH group were irregular and not fully developed, accompanied by significant energy loss. CONCLUSION The simulation method used in this study is basically consistent with the clinical data. Myocardial hypertrophy has a significant influence on the blood flow of the left ventricle. Changes in the blood flow make the left ventricular vortex distribution abnormal during the rapid systole and rapid ejection periods, leading to a series of dangerous factors, including increased energy loss and a low cardiac ejection fraction.
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Affiliation(s)
- Xiaowen Zuo
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China.
| | - Zhike Xu
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, China
| | - Huaping Jia
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China.
| | - Yang Mu
- Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing 100089, China
| | - Mingming Zhang
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China
| | - Manli Yuan
- Department of Ultrasound Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing 100020, China
| | - Chengwei Wu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian 106024, China
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Cicco S, Calvanese C, Susca N, Inglese G, Nardiello E, Ciampi S, Tedesco PA, Cirulli A, Panettieri I, Vacca A, Ranieri G. Right atrium enlargement is related to increased heart damage and mortality in well-controlled hypertension. Nutr Metab Cardiovasc Dis 2022; 32:420-428. [PMID: 34893418 DOI: 10.1016/j.numecd.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Left heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension. We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk. METHODS AND RESULTS We studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm2 (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm2 (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006). CONCLUSION Group 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality.
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Affiliation(s)
- Sebastiano Cicco
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy; Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Chiara Calvanese
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Nicola Susca
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Inglese
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Esther Nardiello
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Saverio Ciampi
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Pietro A Tedesco
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Anna Cirulli
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Immacolata Panettieri
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Angelo Vacca
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Ranieri
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
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Vidula MK, Chirinos JA. Adverse cardiac remodelling: discerning the normal from the pathologic using ethnic-specific echocardiographic thresholds. Eur Heart J Cardiovasc Imaging 2022; 23:175-176. [PMID: 34792126 PMCID: PMC8788011 DOI: 10.1093/ehjci/jeab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
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Smiianov VA, Fartushok TV, Rudenko LA, Fartushok NV. THE ROLE OF LEPTINRESISTANCE IN THE PATHOGENESIS OF OBESITY IN PREGNANT WOMEN. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1274-1283. [PMID: 35758443 DOI: 10.36740/wlek202205208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To investigate the relationship between leptin resistance, lipid and carbohydrate metabolism, blood pressure in obese pregnant women. PATIENTS AND METHODS Materials and methods: Under observation were 65 women (main group) with obesity (I degree -27 women, II degree - 24 women, III degree - 14 women) in the II trimester of pregnancy, who were hospitalized in the Department of Pathology of Pregnancy KNP «Maternity Clinical house №1 "in Lviv during 2017-2020 on preeclampsia of varying severity, which were sent for inpatient treatment by women's clinics. The control group consisted of 30 healthy pregnant women without obesity. RESULTS Results: Serum leptin in obese women was directly correlated with BMI (r = 0.66, p<0.001), body weight (r = 0.29, p<0.05), total cholesterol (cholesterol) (r = 0, 37, p<0,009), low density lipoproteins (LDL cholesterol) (r = 0.33, p<0.05) and inversely with high density particles (HDL cholesterol) (r = -0.37, p<0.02 ). Studies of carbohydrate metabolism indicate the following correlation coefficients of BMI with glucose level r = 0.351; p<0,001, BMI with the level of C-peptide r = 0,450; p<0,001, BMI with HOMA index r = 0,1504; p = 0.036. Inverse correlations of C-peptide were detected with the level of P (r = -0.169; p = 0.025). CONCLUSION Conclusions: The discovery of the relationship between leptin resistance, lipid and carbohydrate metabolism, blood pressure indicates the possibility of using signs of leptin resistance to prevent complications during pregnancy in the second trimester.
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Heart failure with preserved ejection fraction assessed by cardiac magnetic resonance: From clinical uses to emerging techniques. Trends Cardiovasc Med 2021; 33:141-147. [PMID: 34933114 DOI: 10.1016/j.tcm.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) account for approximately 50% of those with heart failure (HF) and have increased morbidity and mortality when compared to those with HF with reduced ejection fraction. Currently, the pathophysiology and diagnostic criteria for HFpEF remain unclear, contributing significantly to delays in creating a beneficial and tailored treatment that can improve the prognosis of HFpEF. A multitude of studies have exclusively tested and illustrated the diagnostic value of echocardiography imaging in HFpEF; however, a widely-accepted criterion to identify HFpEF using cardiovascular magnetic resonance (CMR) imaging has not been established. As the gold standard for cardiac structural, functional measurement, and tissue characterization, CMR holds great potential for the early discovery of the pathophysiology, diagnosis, and risk stratification of HFpEF. This review aims to comprehensively discuss the diagnostic and prognostic role of CMR parameters in the setting of HFpEF through validated routine and prospective emerging techniques, and provide clinical perspectives for CMR imaging application in HFpEF.
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26
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Hoit BD, Litwin SE. The New Normal: How Should We Assess Cardiac Chamber Sizes and Proportionality across the Full Spectrum of Body Sizes with Varying Degrees of Adiposity? J Am Soc Echocardiogr 2021; 35:151-153. [PMID: 34875314 DOI: 10.1016/j.echo.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sheldon E Litwin
- Division of Cardiology Medical University of South Carolina and Ralph H. Johnson, Veterans Affairs Medical Center, Charleston, South Carolina.
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Bello H, Norton GR, Peterson VR, Libhaber CD, Mmopi KN, Mthembu N, Masiu M, Da Silva Fernandes D, Bamaiyi AJ, Peters F, Sareli P, Woodiwiss AJ. Hemodynamic and Functional Correlates of Concentric vs. Eccentric LVH in a Community-Based Sample With Prevalent Volume-Dependent Hypertension. Am J Hypertens 2021; 34:1300-1310. [PMID: 34379750 DOI: 10.1093/ajh/hpab128] [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: 02/12/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (P < 0.0001) and eccentric (P < 0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial, or 24-hour blood pressures (BP), but neither increases in SVR or Zc nor decreases in TAC. LV RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall shortening and s') (P < 0.05 to <0.005) and decreases in LV systolic function were noted in concentric (P < 0.05), but not eccentric LVH. CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH.
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Affiliation(s)
- Hamza Bello
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vernice R Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe N Mmopi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Mthembu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohlabani Masiu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Da Silva Fernandes
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adamu J Bamaiyi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sheng Y, Li M, Xu M, Zhang Y, Xu J, Huang Y, Li X, Yao G, Sui W, Zhang M, Zhang Y, Zhang C, Zhang Y, Zhang M. Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data. Eur Heart J Cardiovasc Imaging 2021; 23:166-174. [PMID: 34718487 DOI: 10.1093/ehjci/jeab216] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. METHODS AND RESULTS LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7. CONCLUSION Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.
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Affiliation(s)
- Yuanyuan Sheng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China.,The Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 1017 Dongmen north Road, Shenzhen 518020, China
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Mingjun Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Yu Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Jinfeng Xu
- The Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 1017 Dongmen north Road, Shenzhen 518020, China
| | - Yuxiang Huang
- The Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 1017 Dongmen north Road, Shenzhen 518020, China
| | - Xiaoyi Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Guihua Yao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Wenhai Sui
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Meng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Yuan Zhang
- Department of Clinical Epidemiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, China.,Clinical Research Center, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Cheng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China.,Cardiovascular Disease Research Center of Shandong First Medical University, Central Hospital Affiliated to Shandong First Medical University, 105 Jiefang Road, Jinan 250012, China
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan 250012, China
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Brimble KS, Ganame J, Margetts P, Jain A, Perl J, Walsh M, Bosch J, Yusuf S, Beshay S, Su W, Zimmerman D, Lee SF, Gangji AS. Impact of Bioelectrical Impedance-Guided Fluid Management and Vitamin D Supplementation on Left Ventricular Mass in Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial. Am J Kidney Dis 2021; 79:820-831. [PMID: 34656640 DOI: 10.1053/j.ajkd.2021.08.022] [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: 02/14/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVES Hypervolemia and vitamin D (Vit D) deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular hypertrophy (LVH). The effect of bioimpedance analysis-guided volume management or Vit D supplementation on LV mass among those receiving peritoneal dialysis is uncertain. STUDY DESIGN Two-by-two factorial randomized controlled trial. SETTING & PARTICIPANTS Sixty-five patients receiving chronic peritoneal dialysis. INTERVENTION BIA-guided volume management versus usual care and oral cholecalciferol 50,000u weekly for 8 weeks followed by 10,000u weekly for 44 weeks or matching placebo. OUTCOMES Change in left ventricular mass at one-year measured by cardiac magnetic resonance imaging. RESULTS Total body water decreased by 0.9L (standard deviation: 2.4) in the BIA group compared to a 1.5L (± 3.4) increase in the usual care group (adjusted between group difference: -2.4L [95% confidence interval: -4.1, -0.68], p=0.01). Left ventricular mass increased by 1.3g (± 14.3) in the BIA group and decreased by 2.4g (±37.7) in the usual care group (between group difference; +2.2g [-13.9, 18.3], p=0.78). Serum 25-OH Vit D concentration increased by a mean of 17.2 nmol/L (standard deviation: 30.8 nmol/L) in the cholecalciferol group and declined by 8.2 nmol/L (±24.3 nmol/L) in the placebo group (between group difference: 28.3 nmol/L [95% confidence interval 17.2, 39.4]; p<0.001). Left ventricular mass decreased by 3.0g (± 28.1g) in the cholecalciferol group and increased by 2.0g (±31.2g) in the placebo group (between group difference; -4.5g [-20.4, 11.5], p=0.58). LIMITATIONS Relatively small sample size with larger than expected variation in change in left ventricular mass. CONCLUSIONS BIA-guided volume management had a modest impact on volume status with no effect on the change in LV mass. Vitamin D supplementation increased serum Vit D concentration but had no effect on left ventricular mass.
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Affiliation(s)
- K Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada.
| | - Javier Ganame
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Peter Margetts
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Arsh Jain
- Department of Medicine, Western University, London, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Salim Yusuf
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Samy Beshay
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Winnie Su
- University of Buffalo, Buffalo, New York, United States
| | - Deborah Zimmerman
- Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences / McMaster University, Canada
| | - Azim S Gangji
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
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30
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Topriceanu CC, Moon JC, Hardy R, Hughes AD, Captur G. Childhood Bradycardia Associates With Atrioventricular Conduction Defects in Older Age: A Longitudinal Birth Cohort Study. J Am Heart Assoc 2021; 10:e021877. [PMID: 34569262 PMCID: PMC8649134 DOI: 10.1161/jaha.121.021877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study explored the association between childhood bradycardia and later‐life cardiac phenotype using longitudinal data from the 1946 National Survey of Health and Development (NSHD) birth cohort. Methods and Results Resting heart rate was recorded at 6 and 7 years of age to provide the bradycardia exposure defined as a childhood resting heart rate <75 bpm. Three outcomes were studied: (1) echocardiographic data at 60 to 64 years of age, consisting of ejection fraction, left ventricular mass index, myocardial contraction fraction index, and E/e′; (2) electrocardiographic evidence of atrioventricular or ventricular conduction defects by 60 to 64 years of age; and (3) all‐cause and cardiovascular mortality. Generalized linear models or Cox regression models were used, and adjustment was made for relevant demographic and health‐related covariates, and for multiple testing. Mixed generalized linear models and fractional polynomials were used as sensitivity analyses. One in 3 older adults with atrioventricular conduction defects had been bradycardic in childhood, with defects being serious (Mobitz type II second‐degree atrioventricular block or higher) in 12%. In fully adjusted models, childhood bradycardia was associated with 2.91 higher odds of atrioventricular conduction defects (95% CI, 1.59–5.31; P=0.0005). Associations persisted in random coefficients mixed generalized linear models (odds ratio, 2.50; 95% CI, 1.01–4.31). Fractional polynomials confirmed a linear association between the log odds of atrioventricular conduction defects at 60 to 64 years of age and resting heart rate at 7 years of age. There was no association between bradycardia in childhood and mortality outcomes or with echocardiographic parameters and ventricular conduction defects in older age. Conclusions Longitudinal birth cohort data indicate that childhood bradycardia trebles the odds of having atrioventricular conduction defects in older age, 88% of which are benign. In addition, it does not influence mortality or heart size and function. Future research should concentrate on identifying children at risk.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- University College London (UCL) Medical Research Council (MRC) Unit for Lifelong Health and AgeingUniversity College London London United Kingdom
| | - James C Moon
- UCL Institute of Cardiovascular Science University College London London United Kingdom.,Cardiac MRI Unit Barts Heart Centre London United Kingdom
| | - Rebecca Hardy
- CLOSER Social Research Institute London United Kingdom
| | - Alun D Hughes
- University College London (UCL) Medical Research Council (MRC) Unit for Lifelong Health and AgeingUniversity College London London United Kingdom.,UCL Institute of Cardiovascular Science University College London London United Kingdom
| | - Gabriella Captur
- University College London (UCL) Medical Research Council (MRC) Unit for Lifelong Health and AgeingUniversity College London London United Kingdom.,UCL Institute of Cardiovascular Science University College London London United Kingdom.,Cardiology Department Centre for Inherited Heart Muscle Conditions Royal Free Hospital London United Kingdom
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31
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Huynh QL, Venn AJ, Magnussen CG, Yang H, Dwyer T, Marwick TH. Risk factors for left ventricular dysfunction in adulthood: role of low birth weight. ESC Heart Fail 2021; 8:5403-5414. [PMID: 34612017 PMCID: PMC8712853 DOI: 10.1002/ehf2.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/04/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022] Open
Abstract
Aims This study aimed to determine the relationship of low birth weight (LBW) with adult cardiac structure and function and investigate potential causal pathways. Methods and results A population‐based sample of 925 Australians (41.3% male) were followed from childhood (aged 7–15 years) to young adulthood (aged 26–36 years) and mid‐adulthood (aged 36–50 years). Left ventricular (LV) global longitudinal strain (GLS, %), LV mass index (LVMi, g/m2.7), LV filling pressure (E/e′), and left atrial volume index (g/m2) were measured by transthoracic echocardiography in mid‐adulthood. Birth weight category was self‐reported in young adulthood and classified as low (≤5 lb or ≤2270 g), normal (5–8 lb or 2271–3630 g), and high (>8 lb or >3630 g). Of the 925 participants, 7.5% (n = 69) were classified as LBW. Compared with participants with normal birth weight, those with LBW had 2.01‐fold (95% confidence interval: 1.19, 3.41, P = 0.009) higher risks of impaired GLS (GLS > −18%) and 2.63‐fold (95% confidence interval: 0.89, 7.81, P = 0.08) higher risks of LV hypertrophy (LVMi > 48 g/m2.7 in men or >44 g/m2.7 in women) in adulthood, independent of age, sex, and any socio‐economic factors. Participants with LBW significantly increased body fat from childhood to adulthood relative to their peers and had greater levels of triglycerides, fasting glucose, and arterial stiffness in adulthood. These risk factors were the strongest mediators and explained 54% of the LBW effect size on adult GLS and 33% of the LBW effect size on LVMi. The remaining of these associations was independent of any of the measured risk factors. Conclusions Low birth weight was associated with impaired cardiac structure and function in mid‐adulthood. This association was only partially explained by known risk factors.
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Affiliation(s)
- Quan L Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic, 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hong Yang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic, 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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32
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Cardiac computed tomography for left ventricular remodeling assessment: does it mean echocardiography moves for the past? J Hypertens 2021; 39:602-603. [PMID: 33649280 DOI: 10.1097/hjh.0000000000002741] [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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33
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Singh A, Carvalho Singulane C, Miyoshi T, Prado AD, Addetia K, Bellino M, Daimon M, Gutierrez Fajardo P, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Schreckenberg M, Blankenhagen M, Degel M, Hitschrich N, Mor-Avi V, Asch FM, Lang RM. Normal Values of Left Atrial Size and Function and the Impact of Age: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2021; 35:154-164.e3. [PMID: 34416309 DOI: 10.1016/j.echo.2021.08.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous studies have yielded mixed conclusions regarding the effects of age, sex, and/or race. The present report from the World Alliance Societies of Echocardiography study focuses on two-dimensional (2D) and three-dimensional (3D) measures of LA structure and function, with subgroup analysis by age, sex, and race. METHODS Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 men, 864 women) evenly distributed among age subgroups: 18 to 40 years (n = 745), 41 to 65 years (n = 618), and >65 years (n = 402); the racial distribution was 38.4% white, 39.9% Asian, and 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS Three-dimensional maximum and minimum LA volumes adjusted for body surface area were nearly identical for men and women, but women demonstrated higher 3D total and passive emptying fractions (EFs). Two-dimensional reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF and reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EFs decreased with age. Interracial differences were noted in LA volumes, without substantial differences in functional indices. CONCLUSION Although similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age, with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EFs. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathologic processes.
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Affiliation(s)
| | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | - Aldo D Prado
- Centro Privado de Cardiologia, Tucumán, Argentina
| | | | | | | | | | | | | | | | - Denisa Muraru
- University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Seung Woo Park
- Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Anita Sadeghpour
- Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Yun Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | | | | | - Markus Degel
- TomTec Imaging Systems, Unterschleissheim, Germany
| | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database. Pediatr Cardiol 2021; 42:1284-1292. [PMID: 33877418 PMCID: PMC8684290 DOI: 10.1007/s00246-021-02609-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Normalizing cardiovascular measurements for body size allows for comparison among children of different ages and for distinguishing pathologic changes from normal physiologic growth. Because of growing interest to use height for normalization, the aim of this study was to develop height-based normalization models and compare them to body surface area (BSA)-based normalization for aortic and left ventricular (LV) measurements. The study population consisted of healthy, non-obese children between 2 and 18 years of age enrolled in the Pediatric Heart Network Echo Z-Score Project. The echocardiographic study parameters included proximal aortic diameters at 3 locations, LV end-diastolic volume, and LV mass. Using the statistical methodology described in the original project, Z-scores based on height and BSA were determined for the study parameters and tested for any clinically significant relationships with age, sex, race, ethnicity, and body mass index (BMI). Normalization models based on height versus BSA were compared among underweight, normal weight, and overweight (but not obese) children in the study population. Z-scores based on height and BSA were calculated for the 5 study parameters and revealed no clinically significant relationships with age, sex, race, and ethnicity. Normalization based on height resulted in lower Z-scores in the underweight group compared to the overweight group, whereas normalization based on BSA resulted in higher Z-scores in the underweight group compared to the overweight group. In other words, increasing BMI had an opposite effect on height-based Z-scores compared to BSA-based Z-scores. Allometric normalization based on height and BSA for aortic and LV sizes is feasible. However, height-based normalization results in higher cardiovascular Z-scores in heavier children, and BSA-based normalization results in higher cardiovascular Z-scores in lighter children. Further studies are needed to assess the performance of these approaches in obese children with or without cardiac disease.
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35
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Prognostic Significance of Echocardiographic Measures of Cardiac Remodeling in the Community. Curr Cardiol Rep 2021; 23:86. [PMID: 34081212 DOI: 10.1007/s11886-021-01512-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Echocardiography is a noninvasive tool of choice for evaluating cardiac structure and function in numerous cardiac conditions ranging from congenital heart disease, myocardial diseases, coronary artery disease (CAD), valvulopathies, arrhythmias, and pericardial disorders. We review the prognostic significance of echocardiographic indices of cardiac remodeling in the general population. RECENT FINDINGS Recent meta-analyses have confirmed the prognostic significance of echocardiographic measurements (left ventricular mass/hypertrophy, systolic and diastolic dysfunction, left atrial dimensions and function, and strain rate measures) in asymptomatic people in the community for adverse clinical outcomes including CAD, stroke, heart failure, atrial fibrillation, sudden death, and all-cause mortality. The clinical utility of screening echocardiography has been examined comprehensively in hypertensive patients, where it is challenged by measurement variability. Echocardiographic measures predict cardiovascular disease outcomes consistently in multiple community-based epidemiological studies. However, the clinical utility of screening asymptomatic individuals with echocardiography in population-based settings is limited.
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Abstract
The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive in heart failure with reduced ejection. Left ventricular remodeling promotes the development and progression of heart failure with preserved and reduced ejection fraction. However, different stimuli mediate left ventricular remodeling that is commonly concentric in heart failure with preserved ejection fraction and eccentric in heart failure with reduced ejection. The stimuli that promote concentric left ventricular remodeling may account for the neutral findings of neuhormonal modulation in heart failure with preserved ejection fraction. Low‐grade systemic inflammation‐induced microvascular endothelial dysfunction is currently the leading hypothesis behind the development and progression of heart failure with preserved ejection fraction. The hypothesis provided the rationale for several randomized controlled trials that have led to neutral findings. The trials and their limitations are reviewed.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology John W. Deming Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Thierry H Le Jemtel
- Section of Cardiology John W. Deming Department of Medicine Tulane University School of Medicine New Orleans LA
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37
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Jeyaprakash P, Moussad A, Pathan S, Sivapathan S, Ellenberger K, Madronio C, Thomas L, Negishi K, Pathan F. A Systematic Review of Scaling Left Atrial Size: Are Alternative Indexation Methods Required for an Increasingly Obese Population? J Am Soc Echocardiogr 2021; 34:1067-1076.e3. [PMID: 34023453 DOI: 10.1016/j.echo.2021.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left atrial (LA) size indexed to body surface area (BSA) is a clinically important marker of cardiovascular prognosis. However, indexation using a scaling variable such as BSA has inherent flaws, particularly in an obese population. The aim of this study was to determine whether alternative indexation methods may more accurately scale for LA size. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to execute a structured search of medical databases, to identify articles discussing alternative methods of LA indexation in echocardiography. Articles that stratified indexed LA size by obesity class were also included. Two independent reviewers identified relevant articles and extracted baseline characteristics, alternative indexation methods, scaling variables, obesity class characteristics, and correlation coefficients. RESULTS A total of 3,804 articles were found in the database search after removing duplicates. After abstract and full-text screening, 13 relevant articles were identified. Twelve studies used alternative methods of LA indexation, of which nine reported allometric indices. Seven of the included studies reported LA size by obesity class, of which six reported alternative indices. Correlation coefficients plotted for indexed LA size against absolute measured LA size showed that allometric indices (specifically to height) were more likely to maintain proportionality to body size compared with isometric indices such as BSA. Allometric indices were less likely to overcorrect for body size compared with isometric indices. CONCLUSIONS Compared with isometric indexation to BSA, allometric indexation (specifically to height) improves scaling of LA volumes to maintain proportionality and avoid overcorrection for body size.
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Affiliation(s)
- Prajith Jeyaprakash
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Andrew Moussad
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Shahab Pathan
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia; Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Shanthosh Sivapathan
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Katherine Ellenberger
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Christine Madronio
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, Australia; Sydney Medical School Westmead, Faculty of Medicine and Health, Charles Perkins Centre Westmead, Sydney, Australia
| | - Kazuaki Negishi
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia.
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Lin SL, Lin M, Wang KL, Kuo HW, Tak T. l -Arginine Can Enhance the Beneficial Effect of Losartan in Patients with Chronic Aortic Regurgitation and Isolated Systolic Hypertension. Int J Angiol 2021; 30:122-131. [PMID: 34054270 DOI: 10.1055/s-0041-1723948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Information about the effects of angiotensin II receptor blocker (ARB) therapy on the hemodynamic and cardiac structure in patients with chronic aortic regurgitation (CAR) and isolated systolic hypertension (ISH) is limited. This study planned to test the hypothesis that l -arginine could further enhance the beneficial effect of an ARB, losartan, and provide a favorable effect on the natural history of CAR and ISH. Sixty patients with CAR and ISH were enrolled in a randomized, double-blind trial comparing hemodynamic and ultrasonic change in two treatment arms: losartan + l -arginine and losartan-only treated groups. Serial echocardiographic and hemodynamic studies were evaluated before and after treatment. Both groups had a significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP), left ventricular end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESVI), LV mass index (LVMI), and LV mean wall stress after 6- and 12-month treatment ( p <0.01 in all comparisons). Both groups had a significant increase in LV ejection fraction and exercise duration after 6- and 12-month treatment ( p < 0.01 in all comparisons). Using multivariate linear regression analysis, only losartan + l -arginine therapy achieved a significantly lower LVESVI (38.89 ± 0.23 mL/m 2 ), LVEDVI (102.3 ± 0.3 mL/m 2 ), LVMI (107.6 ± 0.3 g/m 2 ), SBP (123.5 ± 1.0 mm Hg), and greater exercise duration (7.38 ± 0.02 minutes) than those of the losartan-only treated groups ( p <0.01 in all comparisons). These findings suggest that early co-administrative strategy provides a beneficial approach to favorably influence the natural history of CAR.
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Affiliation(s)
- Shoa-Lin Lin
- Division of Cardiology, Yuan's General Hospital, Kaohsiung City, Taiwan
| | - Mike Lin
- Department of Medicine, Gou-Zen Hospital, Pingtong City, Taiwan
| | | | - Hsien-Wen Kuo
- Institute of Occupation and Environment Health Science, National Yang-Ming University, Taipei, Taiwan
| | - Tahir Tak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Countouris ME, Villanueva FS, Berlacher KL, Cavalcante JL, Parks WT, Catov JM. Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life. J Am Coll Cardiol 2021; 77:1057-1068. [PMID: 33632480 PMCID: PMC10544734 DOI: 10.1016/j.jacc.2020.12.051] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied. OBJECTIVES This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected. METHODS Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit. RESULTS The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results. CONCLUSIONS Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention.
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Affiliation(s)
- Malamo E Countouris
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
| | - Flordeliza S Villanueva
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Kathryn L Berlacher
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kelly SC, Rau CD, Ouyang A, Thorne PK, Olver TD, Edwards JC, Domeier TL, Padilla J, Grisanti LA, Fleenor BS, Wang Y, Rector RS, Emter CA. The right ventricular transcriptome signature in Ossabaw swine with cardiometabolic heart failure: implications for the coronary vasculature. Physiol Genomics 2021; 53:99-115. [PMID: 33491589 PMCID: PMC7988741 DOI: 10.1152/physiolgenomics.00093.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
Heart failure (HF) patients with deteriorating right ventricular (RV) structure and function have a nearly twofold increased risk of death compared with those without. Despite the well-established clinical risk, few studies have examined the molecular signature associated with this HF condition. The purpose of this study was to integrate morphological, molecular, and functional data with the transcriptome data set in the RV of a preclinical model of cardiometabolic HF. Ossabaw swine were fed either normal diet without surgery (lean control, n = 5) or Western diet and aortic-banding (WD-AB; n = 4). Postmortem RV weight was increased and positively correlated with lung weight in the WD-AB group compared with CON. Total RNA-seq was performed and gene expression profiles were compared and analyzed using principal component analysis, weighted gene co-expression network analysis, module enrichment analysis, and ingenuity pathway analysis. Gene networks specifically associated with RV hypertrophic remodeling identified a hub gene in MAPK8 (or JNK1) that was associated with the selective induction of the extracellular matrix (ECM) component fibronectin. JNK1 and fibronectin protein were increased in the right coronary artery (RCA) of WD-AB animals and associated with a decrease in matrix metalloproteinase 14 protein, which specifically degrades fibronectin. RCA fibronectin content was correlated with increased vascular stiffness evident as a decreased elastin elastic modulus in WD-AB animals. In conclusion, this study establishes a molecular and transcriptome signature in the RV using Ossabaw swine with cardiometabolic HF. This signature was associated with altered ECM regulation and increased vascular stiffness in the RCA, with selective dysregulation of fibronectin.
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Affiliation(s)
- Shannon C Kelly
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - Christoph D Rau
- Department of Computational Medicine and Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - An Ouyang
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pamela K Thorne
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - T Dylan Olver
- Department of Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jenna C Edwards
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - Timothy L Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
| | - Laurel A Grisanti
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
| | - Bradley S Fleenor
- Human Performance Laboratory, School of Kinesiology, Ball State University, Muncie, Indiana
| | - Yibin Wang
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
- Department of Medicine-Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri
- Research Service, Harry S. Truman Memorial VA Hospital, University of Missouri, Columbia, Missouri
| | - Craig A Emter
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri
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Mukherjee A, Halder SK, Nandi S, Mandal M, Khanra D, Biswas K. A study on normal reference values of echocardiographic chamber dimensions in young eastern Indian adults. Indian Heart J 2020; 73:77-84. [PMID: 33714414 PMCID: PMC7961241 DOI: 10.1016/j.ihj.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Various studies have shown racial differences in adult cardiac chamber measurements by echocardiography. There is lack of any large scale data from India regarding the echocardiographic chamber measurements in cardiologically healthy individuals. In this study we present the normal reference values of echocardiographic chamber dimensions in young eastern Indian adults and compare it with the data in present guidelines and recent studies involving Indian subjects. METHODS This study was performed on 1377 healthy adults aged 18-35 years. Standard transthoracic echocardiographies were performed to obtain basic measurements. All measurements were indexed to body surface area. RESULTS The mean maximal aortic valve cusp separation (ACS) and indexed ACS were significantly more in females (p = 0.002, p = 0.03). Mean left ventricular (LV) ejection fraction (LVEF) and LV fractional shortening were marginally higher in females. Upper normal reference limit of LV end diastolic dimension (LVEdD) is slightly more for males. Comparing to ASE data, LVEdD, LV end systolic dimension, LV end diastolic volume, indexed LV end systolic volume, left atrial anteroposterior dimension, aortic root dimension and right ventricle outflow diameter were significantly lower in study population while LVEF was significantly higher (p < 0.0001). CONCLUSION The study reconfirms that Indian subjects have smaller cardiac chamber measurements compared to western population where as LVEF is higher in the Indian population and also demonstrates the wide variation of normal echocardiographic measurements within Indian subcontinent. No previous data from eastern India makes this research a singular experience.
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Affiliation(s)
| | | | - Saumen Nandi
- Department of Chest Medicine, NRS Medical College, Kolkata, India.
| | | | - Dibbendhu Khanra
- Fellow of Electrophysiology and Devices, Royal Wolverhampton NHS Trust, UK.
| | - Kaushik Biswas
- Department of Cardiology, NRS Medical College, Kolkata, India.
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42
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Sinha A, Zheng Y, Nannini D, Qu Y, Hou L, Shah SJ, Yancy CW, McNally EM, Fornage M, Lima J, Lloyd-Jones DM, Rasmussen-Torvik LJ, Khan SS. Association of the V122I Transthyretin Amyloidosis Genetic Variant With Cardiac Structure and Function in Middle-aged Black Adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Cardiol 2020; 6:2773977. [PMID: 33355618 PMCID: PMC7758832 DOI: 10.1001/jamacardio.2020.6623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The variant V122I is commonly enriched in the transthyretin (TTR) gene in individuals of African ancestry and associated with greater risk of heart failure (HF) in older adulthood, after age 65 years. Prevention of HF may be most effective earlier in life, but whether screening with echocardiography can identify subclinical cardiac abnormalities during middle age to risk-stratify individuals appears to be unknown. OBJECTIVE To examine the association between the V122I TTR variant and cardiac structure and function during middle age in those without prevalent HF. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study of 875 Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort was conducted at 4 urban sites across the US. Recruiting was completed in 1985-1986, and follow-up examinations occurred 25 and 30 years later. A subset of Black adults from the CARDIA cohort who underwent TTR genotyping was included. Data analysis was completed from January 2020 to October 2020. EXPOSURES The V122I TTR genotype. MAIN OUTCOMES AND MEASURES Echocardiographic left ventricular (LV) circumferential and longitudinal systolic strain and LV structure, measured at years 25 and 30 of follow-up. The analyses were adjusted for age, sex, echocardiography quality, genetic ancestry, and field center. RESULTS Among the 875 Black adults (mean [SD] age, 49.4 [3.8] years at year 25; 543 women [62.1%]), there were 31 individuals who were heterozygous and 1 who was homozygous for the V122I TTR variant. Of the adults who had an echocardiogram at year 25, rates of hypertension (312 [46%]), diabetes (102 [15%]), and current smoking (128 [19%]) were not significantly different between those who did and did not carry V122I TTR. At year 25, there was no difference in LV circumferential strain, longitudinal strain, or LV structure between those who did vs did not carry V122I TTR. At year 30, those who carried V122I TTR had significantly lower absolute LV circumferential strain (mean [SD], 12.4 [4.2] percentage units) compared with those who did not carry the variant (mean [SD], 14.5 [3.7] percentage units). Those who carried V122I TTR also had significantly higher LV mass index values (mean [SD], 97.5 [34.1] g/m2) compared with those who did not (mean [SD], 83.7 [22.6] g/m2) at year 30. CONCLUSIONS AND RELEVANCE Carrier status for the V122I TTR variant is associated with subclinical cardiac abnormalities in middle age (worse LV systolic function and higher LV mass) that have been associated with increased risk of incident HF. Midlife screening of individuals who carry V122I TTR with echocardiography may prognosticate risk of symptomatic HF and inform prevention strategies.
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Affiliation(s)
- Arjun Sinha
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Drew Nannini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yishu Qu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J. Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Cardiology
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor for Translational Science, JAMA Cardiology
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston
| | - Joao Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura J. Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S. Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Carey RM, Marwick TH. Which Blood Pressure Measurement Best Predicts Cardiovascular Outcomes? J Am Coll Cardiol 2020; 76:2923-2925. [PMID: 33334419 DOI: 10.1016/j.jacc.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Kawabori M, Critsinelis AC, Hironaka CE, Chen FY, Zhan Y, Thayer KL, Couper GS. Right ventricular undersizing is associated with increased 1-year mortality. J Thorac Cardiovasc Surg 2020; 161:1048-1059.e3. [PMID: 33485653 DOI: 10.1016/j.jtcvs.2020.11.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Right heart hemodynamic management is critical, because many post-heart transplantation (HTx) complications are related to right ventricular (RV) failure. However, current guidelines on size and sex matching rely primarily on weight matching, with recent literature using total ventricular mass (TVM), which places less emphasis on the impact of RV mass (RVM) matching. The aim of the present study was to analyze the relationship of RVM matching and survival after HTx. METHODS We performed the retrospective analysis using the UNOS database of adult HTx performed between January 1997 and December 2017. Previously validated equations were used to calculate TVM and RVM. The percent difference in ventricular mass in the donor and recipient pair was used for the size mismatch. All donor-recipient pairs were divided into 4 RVM groups by their mismatch ratio. We analyzed RVM matching and explored how RVM undersizing impacted outcomes. The primary outcome measure was 1-year survival; secondary outcomes measured included stroke and dialysis within 1 year and functional status. RESULTS A total of 38,740 donor-recipient pairs were included in our study. The 4 RVM match groupings were as follows: <0%, 0% to 20%, 20% to 40%, and >40%. Utilization of donors who were older and of female sex resulted in greater RVM undersizing. Survival analysis demonstrated patients with RVM undersizing had worse 1-year survival (P < .001). RVM undersizing was an independent predictor of higher 1-year mortality (hazard ratio, 1.23; 95% confidence interval, 1.11 to 1.34; P < .001). RVM undersizing was also associated with higher rates of dialysis within 1-year of transplantation and poorer postoperative functional status. CONCLUSIONS RVM undersizing is an independent predictor for worse 1-year survival. Donors who are older and female have lower absolute predicted RVM and may be predisposed to RVM undersizing. RVM-undersized transplantation requires careful risk/benefit considerations.
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Affiliation(s)
- Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass.
| | | | - Camille E Hironaka
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Frederick Y Chen
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Yong Zhan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Katherine L Thayer
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Mass
| | - Gregory S Couper
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass
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45
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Wu TJ, Lin GM, Lin CS, Liu PY, Su KJ, Lin CC, Lin TC, Cheng SM, Lin SH, Takimoto E, Komuro I, Lin WS. Sex Differences in the Mortality Risk of Elderly Patients with Systolic Heart Failure in Taiwan. ACTA CARDIOLOGICA SINICA 2020; 36:611-619. [PMID: 33235417 DOI: 10.6515/acs.202011_36(6).20200512a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sex differences in heart failure mortality might be affected by age, race, and treatment response. Many large studies in Western countries have shown conflicting results, however few studies have been conducted in Asian patients. Objectives We prospectively investigated the mortality risk in a multicenter cohort of 1,093 male and 416 female heart failure patients with reduced ejection fraction (HFrEF) hospitalized for worsening symptoms in Taiwan between 2013 and 2015. Methods Kaplan-Meier curve and Cox proportional regression analyses were used to determine the one-year mortality risk by sex. Results There were no significant differences in major adverse cardiovascular events, re-admission rate, and mortality between sexes in the overall cohort and the young subgroup during one-year of follow-up. In the elderly subgroup, the overall and cardiac mortality rate of the male patients were higher than those of the female patients (p = 0.035, p = 0.049, respectively). We found that the prognostic effect of old age on overall mortality rate appeared to be stronger in the male patients (p < 0.0001) than in the female patients (p = 0.69) in Cox regression analysis and Kaplan-Meier survival curves. Male sex was a risk factor for all-cause mortality in the elderly (hazard ratio: 1.50, 95% confidence interval 1.02-2.25) independently of systolic blood pressure, diabetes mellitus, hemoglobin concentration, kidney function, and medications. Conclusions In the Taiwan HFrEF registry, the highest mortality risk was observed in male patients aged 65 years or more. Clinicians need to pay more attention to these patients.
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Affiliation(s)
- Tsung-Jui Wu
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien.,Division of Nephrology
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien.,Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Chin-Sheng Lin
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pang-Yen Liu
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kuan-Jen Su
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung
| | - Chia-Chang Lin
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Tzu-Chiao Lin
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Eiki Takimoto
- Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wei-Shiang Lin
- Division of Cardiology, Departments of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Mohan M, Al-Talabany S, McKinnie A, Mordi IR, Singh JSS, Gandy SJ, Baig F, Hussain MS, Bhalraam U, Khan F, Choy AM, Matthew S, Houston JG, Struthers AD, George J, Lang CC. A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial. Eur Heart J 2020; 40:3409-3417. [PMID: 30993313 PMCID: PMC6823615 DOI: 10.1093/eurheartj/ehz203] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/01/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Aim We tested the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes. Methods and results We randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study. Conclusion Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials. ![]()
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Affiliation(s)
- Mohapradeep Mohan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shaween Al-Talabany
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Angela McKinnie
- NHS Tayside Clinical Radiology, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jagdeep S S Singh
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Stephen J Gandy
- Department of Medical Physics, NHS Tayside, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Fatima Baig
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Muhammad S Hussain
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - U Bhalraam
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Faisel Khan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shona Matthew
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - John Graeme Houston
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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Huang Z, Wang L, Liu Y, Huang K, Xu Y, Chen P, Luo J, Li G, Chen J. Impact of obstructive sleep apnea on left ventricular mass index in men with coronary artery disease. J Clin Sleep Med 2020; 16:1675-1682. [PMID: 32620193 PMCID: PMC7954001 DOI: 10.5664/jcsm.8642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES Left ventricular hypertrophy (LVH) is associated with augmented risk for mortality in patients with coronary artery disease (CAD). These patients often have obstructive sleep apnea (OSA). We aimed to evaluate the relationship between OSA and the left ventricular mass index (LVMI) in men with CAD. METHODS Consecutive patients with CAD were recruited and underwent overnight portable monitoring for the assessment of OSA. LVMI was ascertained using high-resolution echocardiography. Univariate and multivariate regression analyses were conducted to explore the associations between the OSA parameters and the LVMI levels. RESULTS Of the 1,053 examined male patients with CAD, 425 (40.4%) had moderate-to-severe OSA (respiratory event index ≥ 15 events/h). The prevalence of LVH (LVMI > 125 g/m²) was 36.0% (n = 379). The mean LVMI values increased with increasing OSA severity (P < .001). Patients with respiratory event index ≥ 30 events/h had 2.30 (95% confidence interval 1.50-3.54, P < .001) times increased risk of LVH than those without OSA (respiratory event index < 5 events/h) independent of confounders. The minimum oxygen saturation levels were the strongest factor correlated with LVMI (β = -0.299, P = .004) of several OSA indices. Patients with minimum oxygen saturation < 70% had an adjusted odds ratio of 3.62 (95% confidence interval 1.81-7.25, P < .001) for LVH development compared with those with minimum oxygen saturation ≥ 90%. CONCLUSIONS OSA severity was associated with a higher likelihood of LVH in men with CAD, which is partially related to severe nocturnal intermittent hypoxemia. Aggressive effort at managing OSA among patients with CAD may further reduce the cardiovascular risk.
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Affiliation(s)
- Zhihua Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ling Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kaizhuang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ying Xu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Clinical Significance of Papillary Muscles on Left Ventricular Mass Quantification Using Cardiac Magnetic Resonance Imaging: Reproducibility and Prognostic Value in Fabry Disease. J Thorac Imaging 2020; 36:242-247. [PMID: 32852417 DOI: 10.1097/rti.0000000000000556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Accurate and reproducible assessment of left ventricular mass (LVM) is important in Fabry disease. However, it is unclear whether papillary muscles should be included in LVM assessed by cardiac magnetic resonance imaging (MRI). The purpose of this study was to evaluate the reproducibility and predictive value of LVM in patients with Fabry disease using different analysis approaches. MATERIALS AND METHODS A total of 92 patients (44±15 y, 61 women) with confirmed Fabry disease who had undergone cardiac MRI at a single tertiary referral hospital were included in this retrospective study. LVM was assessed at end-diastole using 2 analysis approaches, including and excluding papillary muscles. Adverse cardiac events were assessed as a composite end point, defined as ventricular tachycardia, bradycardia requiring device implantation, severe heart failure, and cardiac death. Statistical analysis included Cox proportional hazard models, Akaike information criterion, intraclass correlation coefficients, and Bland-Altman analysis. RESULTS Left ventricular end-diastolic volume, end-systolic volume, ejection fraction, and LVM all differed significantly between analysis approaches. LVM was significantly higher when papillary muscles were included versus excluded (157±71 vs. 141±62 g, P<0.001). Mean papillary mass was 16±11 g, accounting for 10%±3% of total LVM. LVM with pap illary muscles excluded had slightly better predictive value for the composite end point compared with LVM with papillary muscles included based on the model goodness-of-fit (Akaike information criterion 140 vs. 142). Interobserver agreement was slightly better for LVM with papillary muscles excluded compared with included (intraclass correlation coefficient 0.993 [95% confidence interval: 0.985, 0.996] vs. 0.989 [95% confidence interval: 0.975, 0.995]) with less bias and narrower limits of agreement. CONCLUSIONS Inclusion or exclusion of papillary muscles has a significant effect on LVM quantified by cardiac MRI, and therefore, a standardized analysis approach should be used for follow-up. Exclusion of papillary muscles from LVM is a reasonable approach in patients with Fabry disease given slightly better predictive value and reproducibility.
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Pedersen LR, Kristensen AMD, Petersen SS, Vaduganathan M, Bhatt DL, Juel J, Byrne C, Leósdóttir M, Olsen MH, Pareek M. Prognostic implications of left ventricular hypertrophy diagnosed on electrocardiogram vs echocardiography. J Clin Hypertens (Greenwich) 2020; 22:1647-1658. [DOI: 10.1111/jch.13991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Line Reinholdt Pedersen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Centre for Individualized Medicine in Arterial Diseases (CIMA) Odense University Hospital Odense Denmark
| | | | - Søren Sandager Petersen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Centre for Individualized Medicine in Arterial Diseases (CIMA) Odense University Hospital Odense Denmark
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart & Vascular Center Harvard Medical School Boston MA USA
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center Harvard Medical School Boston MA USA
| | - Jacob Juel
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Christina Byrne
- Department of Cardiology The Heart Centre Rigshospitalet –Copenhagen University Hospital Copenhagen Denmark
| | - Margrét Leósdóttir
- Department of Cardiology Skåne University Hospital Malmö Sweden
- Department of Clinical Sciences Lund University, Skåne University Hospital Malmö Sweden
| | - Michael H. Olsen
- Cardiology Section Department of Internal Medicine Holbæk Hospital Holbæk Denmark
| | - Manan Pareek
- Department of Cardiology North Zealand Hospital Hillerød Denmark
- Brigham and Women’s Hospital Heart & Vascular Center Harvard Medical School Boston MA USA
- Department of Internal Medicine Yale New Haven Hospital, Yale University School of Medicine New Haven CT USA
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50
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Paneni F, Costantino S, Hamdani N. Regression of left ventricular hypertrophy with SGLT2 inhibitors. Eur Heart J 2020; 41:3433-3436. [DOI: 10.1093/eurheartj/ehaa530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Switzerland
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland
| | - Nazha Hamdani
- Institute of Physiology, Ruhr University, Bochum, Germany
- Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany
- Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany
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