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Gherbesi E, Faggiano A, Sala C, Carugo S, Grassi G, Tadic M, Cuspidi C. Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies. J Hypertens 2024; 42:1449-1459. [PMID: 38780168 DOI: 10.1097/hjh.0000000000003761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ' myocardial strain', 'left ventricular mechanics', 'longitudinal global strain', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular ejection fraction', and 'obesity'. RESULTS Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): -0.86 ± 0.08; confidence interval (CI) -1.02 to -0.69, P < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD -0.27 ± 0.06; CI -0.40 to -0.15, P < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m 2 , data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD -1.24 ± 0.19, CI -1.61/-0.87, P < 0.0001) than by LVEF (SMD -0.54 ± 0.27, CI -1.07 to -0.01, P = 0.046). CONCLUSION The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.
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Affiliation(s)
- Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Department of Clinical Sciences and Community Health, University of Milano
| | - Carla Sala
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Department of Clinical Sciences and Community Health, University of Milano
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico
- Department of Clinical Sciences and Community Health, University of Milano
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marijana Tadic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee, Ulm, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Sedighi P, Doosti-Irani A, Homayounfar S, Khansari N. Cardiac response to hypertension treatment: an advanced echocardiographic evaluation. J Echocardiogr 2024:10.1007/s12574-024-00652-0. [PMID: 39014266 DOI: 10.1007/s12574-024-00652-0] [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: 02/27/2024] [Revised: 04/27/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Hypertension is the most common reversible cause of cardiovascular disease worldwide and more than one billion individuals suffer from the disease. Constant heart exposure to increased afterload progresses to maladaptive remodeling, leading to cardiac dysfunction. In this study, we aimed to evaluate cardiac function in response to hypertension treatment. METHODS One hundred patients diagnosed with hypertension were evaluated two times, with 3 to 6 months intervals, before and after antihypertensive therapy. Patients underwent clinical and echocardiographic evaluation in both visits and the interest effect of antihypertensive therapy on cardiac function was studied. RESULTS 58 men and 42 women with a mean age of 60.81 ± 11.8 years were studied. Mean systolic and diastolic pressure in the first visit was 163.05 ± 20.6 and 95.40 ± 10.4, respectively. On the second visit, mean systolic and diastolic pressure was 129.95 ± 10.4 and 82.35 ± 7.2 respectively (P value for both < 0.001). The mean value of Global Longitudinal Strain as the main parameter for evaluating left ventricular systolic function was -15.54% on the first visit and changed to -16.95% on the second visit (P value 0.025). CONCLUSIONS According to the results of this study, changes in parameters, indicator of systolic and diastolic function, after 3-6 months of antihypertensive therapy are significant. The most important point is that maladaptive remodeling of the heart is reversible if hypertension is diagnosed timely. To follow-up patients under antihypertensive therapy, GLS and parameters indicator of diastolic dysfunction, have the best diagnostic value in terms of detecting early stages of cardiac injury.
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Affiliation(s)
- Parinaz Sedighi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahram Homayounfar
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nakisa Khansari
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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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 PMCID: PMC11255740 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 CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Lin Liu
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Dan Zhou
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
| | - Songtao Tang
- Community Health Center of the Liaobu CountyDongguanChina
| | - Marijana Tadic
- Klinik für Innere Medizin IIUniversitätsklinikum Ulm, Albert‐Einstein Allee 23UlmGermany
| | - Aletta E. Schutte
- School of Population HealthUniversity of New South Wales, The George Institute for Global HealthSydneyAustralia
| | - Yingqing Feng
- Hypertension Research Laboratory, Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouGuangdong ProvinceChina
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González-Del-Hoyo M, Rossello X, Peral V, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Impact of standard modifiable cardiovascular risk factors on 2-year all-cause mortality: Insights from an international cohort of 23,489 patients with acute coronary syndrome. Am Heart J 2023; 264:20-30. [PMID: 37279841 DOI: 10.1016/j.ahj.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Controversial findings have been reported in the literature regarding the impact of the absence of standard modifiable cardiovascular risk factors (SMuRFs) on long-term mortality risk in patients with acute coronary syndrome (ACS). While the prognostic additive value of SMuRFs has been well described, the prognostic role of prior cardiovascular disease (CVD) by sex is less well-known in patients with and without SMuRFs. METHODS EPICOR and EPICOR Asia are prospective, observational registries conducted between 2010 and 2014, which enrolled ACS patients in 28 countries across Europe, Latin America, and Asia. Association between SMuRFs (diabetes, dyslipidaemia, hypertension, and smoking) and 2-year postdischarge mortality was evaluated using adjusted Cox models stratified by geographical region. RESULTS Among 23,489 patients, the mean age was 60.9 ± 11.9 years, 24.3% were women, 4,582 (20.1%) presented without SMuRFs, and 16,055 (69.5%) without prior CVD. Patients with SMuRFs had a higher crude 2-year postdischarge mortality (HR 1.86; 95% CI, 1.56-2.22; P < .001), compared to those without SMuRFs. After adjustment for potential confounding, the association between SMuRFs and 2-year mortality risk was substantially attenuated (HR 1.17, 95% CI 0.98-1.41; P = .087), regardless of the type of ACS. The risk conferred by prior CVD was added to the underlying risk of SMuRFs to provide risk-specific phenotypes (eg, women with SMuRFs and with prior CVD were at higher risk of dying than women without SMuRFs and without CVD; HR 1.67, 95% CI 1.34-2.06). CONCLUSIONS In this large-scale international ACS cohort the absence of SMuRFs was not associated with a lower adjusted 2-year postdischarge mortality risk. Patients with both SMuRFs and prior CVD had a higher mortality irrespective of their sex.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain.
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Stuart Pocock
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain; London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | | | - Jesús Medina
- BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Badmus OO, Hinds TD, Stec DE. Mechanisms Linking Metabolic-Associated Fatty Liver Disease (MAFLD) to Cardiovascular Disease. Curr Hypertens Rep 2023; 25:151-162. [PMID: 37191842 PMCID: PMC10839567 DOI: 10.1007/s11906-023-01242-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Metabolic-associated fatty liver disease (MAFLD) is a condition of fat accumulation in the liver that occurs in the majority of patients in combination with metabolic dysfunction in the form of overweight or obesity. In this review, we highlight the cardiovascular complications in MAFLD patients as well as some potential mechanisms linking MAFLD to the development of cardiovascular disease and highlight potential therapeutic approaches to treating cardiovascular diseases in patients with MAFLD. RECENT FINDINGS MAFLD is associated with an increased risk of cardiovascular diseases (CVD), including hypertension, atherosclerosis, cardiomyopathies, and chronic kidney disease. While clinical data have demonstrated the link between MAFLD and the increased risk of CVD development, the mechanisms responsible for this increased risk remain unknown. MAFLD can contribute to CVD through several mechanisms including its association with obesity and diabetes, increased levels of inflammation, and oxidative stress, as well as alterations in hepatic metabolites and hepatokines. Therapies to potentially treat MAFLD-induced include statins and lipid-lowering drugs, glucose-lowering agents, antihypertensive drugs, and antioxidant therapy.
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Affiliation(s)
- Olufunto O Badmus
- Department of Physiology & Biophysics, Cardiorenal, and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Terry D Hinds
- Department of Pharmacology and Nutritional Sciences, Barnstable Brown Diabetes Center, Markey Cancer Center, University of Kentucky, Lexington, KY, 40508, USA
| | - David E Stec
- Department of Physiology & Biophysics, Cardiorenal, and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
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Szabo L, McCracken C, Cooper J, Rider OJ, Vago H, Merkely B, Harvey NC, Neubauer S, Petersen SE, Raisi-Estabragh Z. The role of obesity-related cardiovascular remodelling in mediating incident cardiovascular outcomes: a population-based observational study. Eur Heart J Cardiovasc Imaging 2023; 24:921-929. [PMID: 36660920 PMCID: PMC10284050 DOI: 10.1093/ehjci/jeac270] [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: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS We examined associations of obesity with incident cardiovascular outcomes and cardiovascular magnetic resonance (CMR) phenotypes, integrating information from body mass index (BMI) and waist-to-hip ratio (WHR). Then, we used multiple mediation to define the role of obesity-related cardiac remodelling in driving obesity-outcome associations, independent of cardiometabolic diseases. METHODS AND RESULTS In 491 606 UK Biobank participants, using Cox proportional hazard models, greater obesity (higher WHR, higher BMI) was linked to significantly greater risk of incident ischaemic heart disease, atrial fibrillation (AF), heart failure (HF), all-cause mortality, and cardiovascular disease (CVD) mortality. In combined stratification by BMI and WHR thresholds, elevated WHR was associated with greater risk of adverse outcomes at any BMI level. Individuals with overweight BMI but normal WHR had weaker disease associations. In the subset of participants with CMR (n = 31 107), using linear regression, greater obesity was associated with higher left ventricular (LV) mass, greater LV concentricity, poorer LV systolic function, lower myocardial native T1, larger left atrial (LA) volumes, poorer LA function, and lower aortic distensibility. Of note, higher BMI was linked to higher, whilst greater WHR was linked to lower LV end-diastolic volume (LVEDV). In Cox models, greater LVEDV and LV mass (LVM) were linked to increased risk of CVD, most importantly HF and an increased LA maximal volume was the key predictive measure of new-onset AF. In multiple mediation analyses, hypertension and adverse LV remodelling (higher LVM, greater concentricity) were major independent mediators of the obesity-outcome associations. Atrial remodelling and native T1 were additional mediators in the associations of obesity with AF and HF, respectively. CONCLUSIONS We demonstrate associations of obesity with adverse cardiovascular phenotypes and their significant independent role in mediating obesity-outcome relationships. In addition, our findings support the integrated use of BMI and WHR to evaluate obesity-related cardiovascular risk.
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Affiliation(s)
- Liliana Szabo
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Jackie Cooper
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, Gibbs Building, 215 Euston Rd, London NW1 2BE, UK
- Alan Turing Institute, British Library, 96 Euston Rd, London NW1 2DB, UK
| | - Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Parve SD, Sineglazova AV. Cardiac Structure and Function in Young Adults With Various Cardiometabolic Profiles. Cureus 2023; 15:e40524. [PMID: 37333045 PMCID: PMC10275507 DOI: 10.7759/cureus.40524] [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: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Cardiovascular diseases are a leading cause of mortality worldwide. Cardiometabolic abnormalities result in alterations in the myocardial structure and function. Limited data are available on these changes in young adults with various cardiometabolic risk profiles. The goal was to study the relationship between cardiometabolic risk and echocardiographic changes in young patients of both sexes in a Russian population, using a risk-based cardiometabolic disease staging (CMDS) system. Methods A total of 191 patients were included. The patients were classified into five groups based on the CMDS system. We gathered patient history and performed a physical exam, biochemical blood analysis, and echocardiography. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results The median age of the participants was 35 (30.0-39.0) years. Elevated systolic and diastolic blood pressure and hypertriglyceridemia were more frequent (p < 0.05) in males than in females. An increase in the end-diastolic volume (EDV) and end-systolic volume (ESV) and a decrease in the ejection fraction were noted from CMDS 0 to 3. The EDV and ESV were associated with most cardiometabolic risk factors and strongly correlated with the visceral fat level, waist circumference, and body mass index. We identified a new subgroup as CMDS 3-overly high in patients with CMDS 3 and an excess level of visceral fat. Conclusion When designing strategies for cardiovascular disease prevention in young adults apart from CMDS parameters, bioimpedance analysis should be considered to assess the level of visceral fat, especially in individuals with CMDS 3 because they are at a higher risk of cardiac chamber enlargements. These results can be used to identify new dominants or phenotypes of heart failure with preserved ejection fraction.
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Affiliation(s)
- Swapnil D Parve
- Primary Care and General Practice, Kazan State Medical University, Kazan, RUS
- Research and Development, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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Hiraldo AT. Speckle-tracking echocardiography in atrial fibrillation: Philosopher's stone or integral tool. Int J Cardiol 2023:S0167-5273(23)00730-1. [PMID: 37245542 DOI: 10.1016/j.ijcard.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Amparo Taveras Hiraldo
- Hospital Santa Caterina, Girona, Spain Grisel Canahuate Rodriguez, FACC, Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic.
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van Mourik MJW, Linz D, Verwijs HJA, Bekkers SCAM, Weerts J, Schotten U, Rocca HBL, Lumens J, Crijns HJGM, Weijs B, Knackstedt C. Evaluating subclinical left ventricular and left atrial dysfunction in idiopathic atrial fibrillation: A speckle-tracking based strain-analysis. Int J Cardiol 2023:S0167-5273(23)00577-6. [PMID: 37088325 DOI: 10.1016/j.ijcard.2023.04.024] [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: 01/05/2023] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE A subset of patients with atrial fibrillation (AF) presents without established AF risk factors and normal left ventricular (LV) systolic function, called idiopathic AF (IAF). Traditionally, echocardiography derived LV dimensions and ejection fraction (EF) are used to exclude LV dysfunction in IAF, but their sensitivity is limited. Our objective is to evaluate the presence of subtle alterations in LV function despite normal LVEF in patients with IAF compared to healthy controls, using speckle-tracking echocardiography (STE) based global longitudinal strain (GLS). METHODS Standard transthoracic echocardiography was performed in 80 patients with IAF and 129 healthy controls. Patients with overt cardiac disease as well as known established AF risk factors were excluded. STE analysis was performed to assess GLS of the LV, and left atrial strain (LAS). RESULTS LVEF was normal and comparable between patients with IAF and healthy controls (63 ± 4% for both groups; p = 0.801). Mean GLS was within normal limits for both groups but statistically significantly more negative in patients with IAF (-20.6 ± 2.5% vs. -19.7 ± 2.5%; p = 0.016), however not when indexed for ventricular cycle length (p = 0.784). No differences in LA volume or non-indexed LAS were seen in patients with IAF compared to healthy controls. CONCLUSIONS In this selected group of IAF patients, STE did not detect any overt LV or LA dysfunction compared to healthy controls. Thus, IAF occurred in these patients not only in the absence of established AF risk factors but also without evidence of ventricular dysfunction.
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Affiliation(s)
- Manouk J W van Mourik
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Katholische Stiftung Marienhospital, Aachen, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Harm J A Verwijs
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ulrich Schotten
- CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Hanspeter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Bob Weijs
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands; CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Chen Y, Zhang Y, Wang Y, Ta S, Shi M, Zhou Y, Li M, Fu J, Wang L, Liu X, Lu Z, Liu L, Li Z, Zhou J, Li X. Assessment of subclinical left ventricular systolic dysfunction in patients with type 2 diabetes: Relationship with HbA1c and microvascular complications. J Diabetes 2023; 15:264-274. [PMID: 36959088 PMCID: PMC10036261 DOI: 10.1111/1753-0407.13369] [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: 10/18/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND We aimed to examine the association between glycated hemoglobin (HbA1c), microvascular complications, and subclinical left ventricular (LV) systolic dysfunction, and to determine the strength of the correlation in asymptomatic patients with type 2 diabetes mellitus (T2DM). METHODS Global longitudinal strain (GLS) was employed to assess the subclinical LV function of 152 enrolled T2DM patients with preserved LV ejection fraction, with the cutoff for subclinical LV systolic dysfunction predefined as GLS < 18%. RESULTS According to univariate analysis, the reduced GLS exhibited association with the clinical features including HbA1c, triglyceride, systolic blood pressure, fasting glucose, heart rate, diabetic retinopathy, and urinary albumin creatinine ratio (UACR) (all p < .05). After the factors of gender, age, and related clinical covariables adjusted, multiple logistic regression analysis revealed the HbA1c (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.30-2.13; p < .001), UACR (OR 2.48; 95% CI 1.12-5.47; p = .025) and triglyceride (OR 1.84; 95% CI 1.12-3.03; p = .017) as the independent risk factors for the reduced GLS. Receiver operating characteristic curve showed a predictive value of the HbA1c for the subclinical LV systolic dysfunction (area under curve: 0.74; p < .001). CONCLUSIONS In asymptomatic T2DM patients, subclinical LV systolic dysfunction was associated with HbA1c, diabetic complications, and triglyceride. More prominently, HbA1c may exert a prognostic significance for the progression of myocardial damage.
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Affiliation(s)
- Yanyan Chen
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Ying Zhang
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Yi Wang
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Shengjun Ta
- Department of Ultrasound, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Min Shi
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Yingni Zhou
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Mengying Li
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Jianfang Fu
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Li Wang
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Xiangyang Liu
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Zuowei Lu
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Liwen Liu
- Department of Ultrasound, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Zeping Li
- Nanchang University Queen Mary SchoolNanchangChina
| | - Jie Zhou
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
| | - Xiaomiao Li
- Department of Endocrinology, Xijing HospitalAir Force Medical UniversityXi'anShaanxiChina
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11
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Pang S, Qi H, Chen S, Liu J, Sheng Y. Muscle Strength, but Not Muscle Mass, Is Associated with Left Ventricular Diastolic Function during Aging in Chinese. Int Heart J 2022; 63:1115-1120. [DOI: 10.1536/ihj.22-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Sisi Pang
- Division of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Hanmei Qi
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
| | - Shu Chen
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
| | - Jin Liu
- Clinical Medicine Research Institution, The First Affiliated Hospital of Nanjing Medical University
| | - Yunlu Sheng
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
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12
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Meng T, Wang P, Ding J, Du R, Gao J, Li A, Yu S, Liu J, Lu X, He Q. Global Research Trends on Ventricular Remodeling: A Bibliometric Analysis From 2012 to 2022. Curr Probl Cardiol 2022; 47:101332. [PMID: 35870550 DOI: 10.1016/j.cpcardiol.2022.101332] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Ventricular remodeling is the progressive pathologic change of the original substance and morphology of the ventricle caused by various injuries and has attracted increasing attention in the past decade. This study aims to conduct a bibliometric analysis of articles on ventricular remodeling published in the Web of Science Core Collection database from 2012 to 2022 to understand the current research state in the field of ventricular remodeling and provide insights for clinicians and researchers. As a result, a total of 1710 articles on ventricular remodeling were included. Annual publications have been gradually increasing and have remained at a high level over the past 10 years. The United States of America contributed the most publications, followed by China. Circulation was the most mainstream and authoritative journal focusing on ventricular remodeling. Research hotspot analysis suggested that myocardial infarction was the primary risk factor for ventricular remodeling, and emerging risk factor studies have focused on pulmonary hypertension, aortic stenosis, and diabetes. The mechanisms in the pathogenesis of ventricular remodeling were mainly closely associated with inflammation, apoptosis, oxidative stress, and myocardial fibrosis. Intensive investigation of the interactions between different mechanisms might be a future research direction. In terms of treatment, cardiac resynchronization therapy was a hot topic of research. These findings can help researchers grasp the research status of ventricular remodeling and determine future research directions.
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Affiliation(s)
- Tiantian Meng
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peng Wang
- Department of Traditional Chinese Medicine, Beijing Jiangong Hospital, Beijing, China
| | - Jingyi Ding
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruolin Du
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Gao
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Anqi Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shanshan Yu
- Graduate School, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jin Liu
- Graduate School, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xinyu Lu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qingyong He
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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13
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Sang Z, Zeng X, Yuan X, Wang X, Fu L, Zhuang W. Association of Office and Ambulatory Blood Pressure with Left Ventricular Structure and Function in Hypertensive Patients. Int J Gen Med 2022; 15:4649-4656. [PMID: 35548589 PMCID: PMC9081003 DOI: 10.2147/ijgm.s357508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Zhuo Sang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
- Correspondence: Zhuo Sang, Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China, Tel +86-752-2288288, Email
| | - Xianli Zeng
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Xiaohui Yuan
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Xiaolin Wang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Liancong Fu
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Wenwen Zhuang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
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14
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Morales MA, Snel GJH, van den Boomen M, Borra RJH, van Deursen VM, Slart RHJA, Izquierdo-Garcia D, Prakken NHJ, Catana C. DeepStrain Evidence of Asymptomatic Left Ventricular Diastolic and Systolic Dysfunction in Young Adults With Cardiac Risk Factors. Front Cardiovasc Med 2022; 9:831080. [PMID: 35479280 PMCID: PMC9035693 DOI: 10.3389/fcvm.2022.831080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate if a fully-automatic deep learning method for myocardial strain analysis based on magnetic resonance imaging (MRI) cine images can detect asymptomatic dysfunction in young adults with cardiac risk factors. Methods An automated workflow termed DeepStrain was implemented using two U-Net models for segmentation and motion tracking. DeepStrain was trained and tested using short-axis cine-MRI images from healthy subjects and patients with cardiac disease. Subsequently, subjects aged 18–45 years were prospectively recruited and classified among age- and gender-matched groups: risk factor group (RFG) 1 including overweight without hypertension or type 2 diabetes; RFG2 including hypertension without type 2 diabetes, regardless of overweight; RFG3 including type 2 diabetes, regardless of overweight or hypertension. Subjects underwent cardiac short-axis cine-MRI image acquisition. Differences in DeepStrain-based left ventricular global circumferential and radial strain and strain rate among groups were evaluated. Results The cohort consisted of 119 participants: 30 controls, 39 in RFG1, 30 in RFG2, and 20 in RFG3. Despite comparable (>0.05) left-ventricular mass, volumes, and ejection fraction, all groups (RFG1, RFG2, RFG3) showed signs of asymptomatic left ventricular diastolic and systolic dysfunction, evidenced by lower circumferential early-diastolic strain rate (<0.05, <0.001, <0.01), and lower septal circumferential end-systolic strain (<0.001, <0.05, <0.001) compared with controls. Multivariate linear regression showed that body surface area correlated negatively with all strain measures (<0.01), and mean arterial pressure correlated negatively with early-diastolic strain rate (<0.01). Conclusion DeepStrain fully-automatically provided evidence of asymptomatic left ventricular diastolic and systolic dysfunction in asymptomatic young adults with overweight, hypertension, and type 2 diabetes risk factors.
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Affiliation(s)
- Manuel A. Morales
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- *Correspondence: Manuel A. Morales
| | - Gert J. H. Snel
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maaike van den Boomen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ronald J. H. Borra
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Vincent M. van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - David Izquierdo-Garcia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Niek H. J. Prakken
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ciprian Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Ciprian Catana
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