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Abdollahi A, Kato Y, Bakhshi H, Varadarajan V, Chehab O, Zeitoun R, Ostovaneh MR, Wu CO, Bertoni AG, Shah SJ, Ambale-Venkatesh B, Bluemke DA, Lima JAC, Panzer A. Differential Stroke Volume between Left and Right Ventricles as a Predictor of Clinical Outcomes: The MESA Study. Radiology 2024; 312:e232973. [PMID: 39041933 PMCID: PMC11294760 DOI: 10.1148/radiol.232973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/09/2023] [Accepted: 04/15/2023] [Indexed: 07/24/2024]
Abstract
Background Valvular heart disease and intracardiac shunts can disrupt the balance between left ventricular (LV) and right ventricular (RV) stroke volumes. However, the prognostic value of such imbalances has not been established among asymptomatic individuals. Purpose To assess the association between differential ventricular stroke volumes quantified using cardiac MRI and clinical outcomes in individuals without cardiovascular disease. Materials and Methods This secondary analysis of a prospective study included participants without cardiovascular disease at enrollment (July 2000 to July 2002) who underwent cardiac MRI. Differences in stroke volume were calculated as LV stroke volume minus RV stroke volume, and participants were categorized as having balanced (greater than or equal to -30 mL to ≤30 mL), negative (less than -30 mL), or positive (>30 mL) differential stroke volumes. Multivariable Cox proportional hazard regression models were used to test the association between differences in stroke volume and adverse outcomes. Results A cohort of 4058 participants (mean age, 61.4 years ± 10 [SD]; 2120 female) were included and followed up for a median of 18.4 years (IQR, 18.3-18.5 years). During follow-up, 1006 participants died, 235 participants developed heart failure, and 764 participants developed atrial fibrillation. Compared with participants who had a balanced differential stroke volume, those with an increased differential stroke volume showed a higher risk of mortality (hazard ratio [HR], 1.73 [95% CI: 1.12, 2.67]; P = .01), heart failure (HR, 2.40 [95% CI: 1.11, 5.20]; P = .03), and atrial fibrillation (HR, 1.89 [95% CI: 1.16, 3.08]; P = .01) in adjusted models. Participants in the negative group, with a decreased differential stroke volume, showed an increased risk of heart failure compared with those in the balanced group (HR, 2.09 [95% CI: 1.09, 3.99]; P = .03); however, this was no longer observed after adjusting for baseline LV function (P = .34). Conclusion Participants without cardiovascular disease at the time of study enrollment who had an LV stroke volume exceeding the RV stroke volume by greater than 30 mL had an increased risk of mortality, heart failure, and atrial fibrillation compared with those with balanced stroke volumes. ClinicalTrials.gov Identifier: NCT00005487 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Almeida in this issue.
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Affiliation(s)
- Ashkan Abdollahi
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Yoko Kato
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Hooman Bakhshi
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Vinithra Varadarajan
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Omar Chehab
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Ralph Zeitoun
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Mohammad R. Ostovaneh
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Colin O. Wu
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Alain G. Bertoni
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Sanjiv J. Shah
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Bharath Ambale-Venkatesh
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - David A. Bluemke
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - João A. C. Lima
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Ariane Panzer
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
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Almeida AG. Differences in Ventricular Stroke Volumes at Cardiac MRI: A Prompt to Search for Volume Overload. Radiology 2024; 312:e241350. [PMID: 39041934 DOI: 10.1148/radiol.241350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Affiliation(s)
- Ana G Almeida
- From the Heart and Vessels Department, Cardiology, University Hospital Santa Maria, CCUL@RISE, Faculty of Medicine of Lisbon University, Av Professor Egas Moniz, 1649-028 Lisbon, Portugal
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Shearer GC, Block RC, Huang S, Liu L, Herrington DM, Tsai MY, Tintle N, O’Connell TD. Eicosapentaenoic acid and Arachidonic acid Protection Against Left Ventricle Pathology: the Multi-Ethnic Study of Atherosclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.05.24308494. [PMID: 38883788 PMCID: PMC11177919 DOI: 10.1101/2024.06.05.24308494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background We have shown that ω3 polyunsaturated fatty acids (PUFAs) reduce risk for heart failure, regardless of ejection fraction status. Ventricular remodeling and reduced ventricular performance precede overt hear failure, however there is little insight into how PUFAs contribute to maladaptive signaling over time. PUFAs are agonists for regulatory activity at g-protein coupled receptors such as Ffar4, and downstream as substrates for monooxygenases (e.g lipoxygenase, cytochrome p450, or cyclooxygenase (COX)) which mediate intracellular adaptive signaling. Methods Plasma phospholipid PUFA abundance at Exam 1 as mass percent EPA, DHA, and arachidonic acid (AA) from the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated using pathway modeling to determine the association with time-dependent changes in left ventricular (LV) mass (LVM), end-diastolic LV volume (EDV), and end-systolic volume (ESV) measured by cardiac MRI at Exams 1 and 5. Ejection fraction (EF) and mass:volume (MV) were calculated posteriorly from the first three. Results 2,877 subjects had available MRI data. Participants with low AA and EPA had accelerated age-dependent declines in LVM. Males with low AA and EPA also had accelerated declines in EDV, but among females there was no PUFA association with EDV declines and exam 5 EDV status was positively associated with AA. Both sexes had nearly the same positive association of AA with changes in ESV. Conclusion Plasma phospholipid AA and EPA are prospectively associated with indices of heart remodeling, including ventricular remodeling and performance. Combined AA and EPA scarcity was associated with the most accelerated age-related changes and exam 5 status, while the greatest benefits were found among participants with both PUFAs. This suggests that both PUFAs are required for optimal slowing of age-related declines in ventricular function.
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Affiliation(s)
| | - Robert C. Block
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Cardiology Division, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Shue Huang
- Department of Nutritional Sciences, Pennsylvania State University
| | - Linxi Liu
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota
| | - Nathan Tintle
- Fatty Acid Research Institute, Sioux Falls, South Dakota
- Department of Statistics, Dordt College, Sioux Center, Iowa
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Wang L, Yi J, Zhou Z, Liu J, Li Y, Tian A, Ren X, Zheng X. Left ventricular hypertrophy phenotype to predict incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Nutr Metab Cardiovasc Dis 2024; 34:1399-1406. [PMID: 38402001 DOI: 10.1016/j.numecd.2024.01.012] [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: 09/25/2023] [Revised: 11/21/2023] [Accepted: 01/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIM Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF. METHODS AND RESULTS This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001). CONCLUSIONS The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.
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Affiliation(s)
- Lili Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiayi Yi
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zeming Zhou
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xiangpeng Ren
- Department of Biochemistry, Medical College, Jiaxing University, Jiaxing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Diasease Center, Fuwai hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China.
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5
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Agyemang C, van der Linden EL, Chilunga F, van den Born BH. International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe. J Am Heart Assoc 2024; 13:e030228. [PMID: 38686900 PMCID: PMC11179927 DOI: 10.1161/jaha.123.030228] [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: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 05/02/2024]
Abstract
Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Eva L. van der Linden
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Vascular Medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Felix Chilunga
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Bert‐Jan H. van den Born
- Department of Public and Occupational Health, Amsterdam UMCUniversity of Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Vascular Medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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Espe E, Schneider JE. Editorial for "Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3T MRI Study". J Magn Reson Imaging 2024; 59:823-824. [PMID: 37461182 DOI: 10.1002/jmri.28901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 02/08/2024] Open
Abstract
Level of Evidence5Technical Efficacy Stage2
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Affiliation(s)
- Emil Espe
- Institute for Experimental Medical Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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7
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Xu Z, Li W, Wang J, Wang F, Sun B, Xiang S, Luo X, Meng Y, Wang X, Wang X, Song J, Zhang M, Xu D, Zhou X, Ju Z, Sun J, Han Y, Chen Y. Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study. J Magn Reson Imaging 2024; 59:812-822. [PMID: 37530736 DOI: 10.1002/jmri.28903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) reference ranges for ventricular morphology and function in the Chinese population are lacking. PURPOSE To establish the MRI reference ranges of left and right ventricular (LV and RV) morphology and function based on a large multicenter cohort. STUDY TYPE Prospective. POPULATION One thousand and twelve healthy Chinese Han adults. FIELD STRENGTH/SEQUENCE Balanced steady-state free procession cine sequence at 3.0 T. ASSESSMENT Biventricular end-diastolic, end-systolic, stroke volume, and ejection fraction (EDV, ESV, SV, and EF), LV mass (LVM), end-diastolic and end-systolic dimension (LVEDD and LVESD), anteroseptal wall thickness (AS), and posterolateral wall thickness (PL) were measured. Body surface area (BSA) and height were used to index biventricular parameters. Parameters were compared between age groups and sex. STATISTICAL TESTS Independent-samples t-tests or Mann-Whitney U test to compare mean values between sexes; ANOVA or Kruskal-Wallis test to compare mean values among age groups; linear regression to assess the relationships between cardiac parameters and age (correlation coefficient, r). A P value <0.05 was considered statistically significant. RESULTS The biventricular volumes, LVM, LVEDD, RVEDV/LVEDV ratio, LVESD, AS, and PL were significantly greater in males than in females, even after indexing to BSA or height, while LVEF and RVEF were significantly lower in males than in females. For both sexes, age was significantly negatively correlated with biventricular volumes (male and female: LVEDV [r = -0.491; r = -0.373], LVESV [r = -0.194; r = -0.184], RVEDV [r = -0.639; r = -0.506], RVESV [r = -0.270; r = -0.223]), with similar correlations after BSA normalization. LVEF (r = 0.043) and RVEF (r = 0.033) showed a significant correlation with age in females, but not in males (P = 0.889; P = 0.282). DATA CONCLUSION MRI reference ranges for biventricular morphology and function in Chinese adults are presented and show significant associations with age and sex. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Wang
- Department of Radiology, Anqing Municipal Hospital, Anqing, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shifeng Xiang
- Department of Radiology, Handan Central Hospital, Handan, China
| | - Xiao Luo
- Department of Radiology, Maanshan People's Hospital, Maanshan, China
| | - Yanfeng Meng
- Department of Radiology, Taiyuan Central Hospital, Taiyuan, China
| | - Xiang Wang
- Department of Radiology, Wuhan Central Hospital, Wuhan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Jinan, China
| | - Jianxun Song
- Department of Radiology, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Min Zhang
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Dinghu Xu
- Department of Radiology, Nanjing Jiangning Hospital, Nanjing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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8
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Hughes-Austin JM, Katz R, Majka DS, Criqui MH, Robinson WH, Firestein GS, Hundley WG, Ix JH. Serum reactivity to citrullinated protein/peptide antigens and left ventricular structure and function in the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One 2023; 18:e0291967. [PMID: 37874814 PMCID: PMC10597499 DOI: 10.1371/journal.pone.0291967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Antibodies to citrullinated protein antigens have been linked to altered left ventricular (LV) structure and function in patients with rheumatoid arthritis (RA). Serum reactivity to several citrullinated protein/peptide antigens has been identified in RA, which are detectable years before RA onset and in individuals who may never develop RA. Among community-living individuals without heart failure (HF) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated associations between serum reactivity to citrullinated protein/peptide antigens, LV mass, LV ejection fraction (LVEF), and incident HF. METHODS Among 1232 MESA participants, we measured serum reactivity to 28 different citrullinated proteins/peptides using a multiplex bead-based array. Each antibody was defined as having extremely high reactivity (EHR) if >95th percentile cut-off in MESA. Number of EHR antibody responses to citrullinated protein/peptide antigens were summed for each participant (range 0-28). LV mass(g) and LVEF(%) were measured on cardiac MRI. Associations between EHR antibodies and LV mass and LVEF were evaluated using linear regression. Cox proportional hazards models were used to evaluate associations between EHR antibodies and incident HF during 11 years of follow-up, adjusting for age, gender, race/ethnicity, smoking status, systolic blood pressure, use of anti-hypertensive medications, self-reported arthritis, IL-6, body surface area, and estimated glomerular filtration rate. RESULTS Mean age was 65±10, 50% were female, 40% were White, 21% were Black, 26% were Hispanic/Latino, and 14% were Chinese. Twenty-seven percent of MESA participants had extremely high reactivity to ≥ 1 citrullinated protein/peptide antigen. In fully adjusted analysis, every additional EHR antibody was significantly associated with 0.1% lower LVEF (95% CI: -0.17%, -0.02%). No association was observed with LV mass (β per additional EHR antibody) = 0.13±0.15 (p = 0.37)). Neither the presence nor number of EHR antibodies was associated with incident HF during follow-up (HR per additional EHR antibody = 1.008 (95% CI: 0.97, 1.05)). CONCLUSION Greater number of extremely highly reactive antibodies was associated with lower LVEF, but not with LV mass or incident HF. Thus, serum reactivity to citrullinated protein/peptide antigens was associated with subtle subclinical changes in myocardial contractility, but the significance in relation to clinically apparent HF is uncertain.
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Affiliation(s)
- Jan M. Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, United States of America
| | - Ronit Katz
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Darcy S. Majka
- Division of Rheumatology, DuPage Medical Group, Chicago, Illinois, United States of America
| | - Michael H. Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - William H. Robinson
- Division of Immunology and Rheumatology, Stanford University, Stanford, California, United States of America
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Gary S. Firestein
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
| | - W. Gregory Hundley
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
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9
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Lam CSP, Myhre PL. Left ventricular ejection fraction in women: when normal isn't normal. Heart 2023; 109:1584-1585. [PMID: 37438053 DOI: 10.1136/heartjnl-2023-322924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore, Singapore
| | - Peder Langeland Myhre
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
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10
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Ferkh A, Pathan F, Kizana E, Elhindi J, Singh A, Singulane CC, Miyoshi T, Asch FM, Lang RM, Thomas L. Variations in indexation of left atrial volume across different races. Heliyon 2023; 9:e20334. [PMID: 37810843 PMCID: PMC10550615 DOI: 10.1016/j.heliyon.2023.e20334] [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: 11/14/2022] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Left atrial volume (LAV) has prognostic value. Guidelines propose indexation to body surface area (BSA), however studies demonstrate this can overcorrect for body size. Limited studies investigate indexation across different ethnicities. We sought to evaluate the effect of ethnicity on indexation. Methods Using data from the World Alliance of Societies of Echocardiography (WASE) cohort, healthy subjects were classified by race as White, Black, Asian, or Other. Biplane LAV was indexed to traditional isometric measurements (BSA, height, weight, ideal body weight (IBW) and IBW derived BSA (IBSA)), as well as previously-derived allometric height exponents (2.7 and 1.72). Additionally, an allometric height exponent for our cohort was derived (linear regression of the logarithmic transformation of LAV = a(height)b) as 1.87. All indices were then assessed using Spearman correlation, with a good index retaining correlation of LAV/index to raw LAV (r∼1), while avoiding overcorrection by the index (r∼0). Results There were 1366 subjects (White: 524, Black: 149, Asian: 523, Other: 170; median age 44 years, 653 females (47.8%)). In the entire group, BSA, IBSA, height1.87 and height1.72 performed well with retaining correlation to raw LAV (r > 0.9 for all), and minimising overcorrection to body size (r < 0.1 for all). On race-specific analysis, BSA overcorrected for body size in the White population (r = 0.128). Height1.72 minimised overcorrection for body size in all populations (r ≤ 0.1 for all races). Conclusion Despite a cohort with normal BMI, there was still disparity in LAV indexation with BSA across races. Allometric height indexation, particularly using height1.72, is a possible solution, although further validation studies in BMI extremes are required.
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Affiliation(s)
- Aaisha Ferkh
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Nepean, NSW, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | - James Elhindi
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | | | | | | | | | | | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
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11
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Yuan Y, Herrington D, Lima JA, Stacey RB, Zhao D, Thomas J, Garcia M, Pu M. Assessment of Prevalence, Clinical Characteristics, and Risk Factors Associated With "Low Flow State" Using Cardiac Magnetic Resonance. Mayo Clin Proc Innov Qual Outcomes 2023; 7:443-451. [PMID: 37818141 PMCID: PMC10562103 DOI: 10.1016/j.mayocpiqo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Objective To assess prevalence, clinical characteristics, and risk factors associated with low flow state (LFS) in a multiethnic population with normal left ventricular ejection fraction (LVEF). Patients and Methods The study included 4398 asymptomatic participants undergoing cardiac magnetic resonance from July 17, 2000, to August 29, 2002. Left ventricular (LV) mass, volume, and myocardial contraction fraction were assessed. Low flow state was defined as stroke volume index (SVi of <35 mL/m2). Clinical characteristics, cardiac risk factors, and cardiac magnetic resonance findings were compared between LFS and normal flow state (NFS) groups (NFS: SVi of ≥35 mL/m2). Results There were significant differences in the prevalence of LFS in different ethnic groups. Individuals with LFS were older (66±9.6 vs 61±10 years; P<.0001). The prevalence of LFS was 19% in the group aged older than 70 years. The logistic multivariable regression analysis found that age was independently associated with LFS. The LFS group had significantly higher prevalence of diabetes (30% vs 24%; P=.001), LV mass-volume ratio (1.13±0.22 vs 0.91±0.15; P<.0001), inflammatory markers, a lower LV mass index (59±10 vs 65±11 kg/m2; P<.001), lower myocardial contraction fraction (58.1±10.6% vs 75.7±13%; P<.001), and a lower left atrial size index (32.2±4.6 vs 36.7±5.9 mm/m2; P<.0001) than NFS. Conclusion Low flow state may be considered an under-recognized clinical entity associated with increasing age, multiple risk factors, increased inflammatory markers, a lower LV mass index, and suboptimal myocardial performance despite the presence of normal LVEF and absence of valvular disease.
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Affiliation(s)
- Yifang Yuan
- Section on Cardiology, Wake Forest University Cardiology, Johns Hopkins University, Winston-Salem, NC
| | - David Herrington
- Section on Cardiology, Wake Forest University Cardiology, Johns Hopkins University, Winston-Salem, NC
| | - Joao A.C. Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, ML
| | - R. Brandon Stacey
- Section on Cardiology, Wake Forest University Cardiology, Johns Hopkins University, Winston-Salem, NC
| | - David Zhao
- Section on Cardiology, Wake Forest University Cardiology, Johns Hopkins University, Winston-Salem, NC
| | - James Thomas
- Division of Cardiology, Northwestern University, School of Medicine, Chicago, IL
| | - Mario Garcia
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Min Pu
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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12
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Husain-Syed F, DiFrancesco MF, Deo R, Barr RG, Scialla JJ, Bluemke DA, Kronmal RA, Lima JAC, Praestgaard A, Tracy RP, Shlipak M, Kawut SM, Kim JS. Associations between eGFR and albuminuria with right ventricular measures: the MESA-Right Ventricle study. Clin Kidney J 2023; 16:1508-1520. [PMID: 37664568 PMCID: PMC10469092 DOI: 10.1093/ckj/sfad096] [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: 12/31/2022] [Indexed: 09/05/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with an increased risk of pulmonary hypertension, which may lead to right ventricular (RV) pressure overload and RV dysfunction. However, the presence of subclinical changes in RV structure or function in early CKD and the influence of these changes on mortality are not well studied. We hypothesized that early CKD, as indicated by elevated albuminuria or mild reductions in estimated glomerular filtration rate (eGFR), is associated with greater RV dilation and RV mass. Methods We included 4063 participants (age 45-84 years) without baseline clinical cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis. The associations of baseline creatinine-cystatin C-based eGFR and albuminuria with cardiac magnetic resonance-derived RV measures (2000-02) were examined cross-sectionally with linear regression models. Cox regression models were used to examine whether RV parameters modified the associations of eGFR and albuminuria with all-cause mortality. Results Participants with reductions in eGFR primarily within the 60-89 mL/min/1.73 m2 category had smaller RV end-diastolic and end-systolic volumes and stroke volume (all adjusted P-trends <.001) than those with eGFR ≥90 mL/min/1.73 m2, an association that was predominantly seen in participants with albuminuria below 30 mg/g creatinine. Albuminuria was more strongly associated with death among those with lower RV volumes (P-values for interaction <.03). Conclusions Among community-dwelling adults, reductions in eGFR primarily within the normal range were associated with smaller RV volumes and the association of albuminuria with worse survival was stronger among those with smaller RV volumes. Further studies are needed to elucidate the underlying mechanistic pathways that link kidney measures and RV morphology.
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Affiliation(s)
- Faeq Husain-Syed
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Matthew F DiFrancesco
- Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Rajat Deo
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Julia J Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard A Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Russell P Tracy
- Department of Pathology and Laboratory Medicine and Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Michael Shlipak
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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13
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Wettersten N, Katz R, Greenberg JH, Gutierrez OM, Lima JAC, Sarnak MJ, Schrauben S, Deo R, Bonventre J, Vasan RS, Kimmel PL, Shlipak M, Ix JH. Association of Kidney Tubule Biomarkers With Cardiac Structure and Function in the Multiethnic Study of Atherosclerosis. Am J Cardiol 2023; 196:11-18. [PMID: 37086700 PMCID: PMC10204591 DOI: 10.1016/j.amjcard.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 04/24/2023]
Abstract
Markers of glomerular disease, estimated glomerular filtration rate (eGFR) and albuminuria, are associated with cardiac structural abnormalities and incident cardiovascular disease (CVD). We aimed to determine whether biomarkers of kidney tubule injury, function, and systemic inflammation are associated with cardiac structural abnormalities. Among 393 Multi-Ethnic Study of Atherosclerosis participants without diabetes, CVD, or chronic kidney disease, we assessed the association of 12 biomarkers of kidney tubule injury, function, and systemic inflammation with the left ventricular mass/volume ratio (LVmvr) and left ventricular ejection fraction (LVEF) on cardiac magnetic resonance imaging using linear regression. The average age was 60 ± 10 years; 48% were men; mean eGFR was 96±16 ml/min/1.73 m2; mean LVmvr was 0.93±0.18 g/ml, and mean LVEF was 62±6%. Each twofold greater concentration of plasma soluble urokinase plasminogen activator receptor was associated with a 0.04 g/ml (95% confidence interval [CI] 0.01 to 0.08 g/ml) higher LVmvr and 2.1% (95% CI 0.6 to 3.5%) lower LVEF, independent of risk factors for CVD, eGFR, and albuminuria. Each twofold greater plasma monocyte chemoattractant protein 1 was associated with higher LVmvr with a similar coefficient to that of plasma soluble urokinase plasminogen activator receptor. Each twofold greater concentration of plasma chitinase-3-like protein 1 and urine alpha-1-microglobulin was associated with a 1.1% (95% CI 0.4 to 1.7%) and 1.2% (95% CI 0.2 to 2.2%) lower LVEF, respectively. In conclusion, abnormal kidney tubule health may lead to cardiac dysfunction above and beyond eGFR and albuminuria.
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Affiliation(s)
- Nicholas Wettersten
- Cardiology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California; Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
| | - Ronit Katz
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Orlando M Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Sarah Schrauben
- Renal-Electrolyte and Hypertension Division, and Department of Epidemiology, Biostatistics and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bonventre
- Division of Renal Medicine and Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramachandran S Vasan
- Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Michael Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Health Care System, University of California, San Francisco, California
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
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14
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Islam SJ, Kim JH, Li X, Ko YA, Baltrus P, Mitchell GF, Fox ER, Mujahid MS, Vaccarino V, Lewis TT, Taylor HA, Sims M, Quyyumi AA. Neighborhood characteristics and arterial stiffness among Black adults - Results from the Jackson Heart Study and Morehouse-Emory Cardiovascular Center for Health Equity. Vasc Med 2023; 28:188-196. [PMID: 36597615 DOI: 10.1177/1358863x221136163] [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] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Poor quality neighborhood environments are independent risk factors for cardiovascular disease (CVD) but are understudied in Black adults, who face large CVD health disparities. Arterial stiffness, a marker of early vascular aging, precedes development of hypertension and adverse CVD events but the effect of neighborhood on arterial stiffness among Black adults remains unknown. OBJECTIVE We compared the association between neighborhood environment and arterial stiffness among Black adults in Jackson, MS and Atlanta, GA. METHODS We studied 1582 Black adults (mean age 53 ± 10, 35% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Black adults (mean age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. Arterial stiffness was measured as pulse wave velocity (PWV) using magnetic resonance imaging in JHS and as PWV and augmentation index (AIx) using applanation tonometry (SphygmoCor, Inc.) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and arterial stiffness, adjusting for potential confounders. RESULTS Improved social characteristics, measured as social cohesion in JHS (β = -0.32 [-0.63, -0.02], p = 0.04) and activity with neighbors (β = -0.23 [-0.40, -0.05], p = 0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = -1.74 [-2.92, - 0.56], p = 0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA, better food access (β = -1.18 [-2.35, - 0.01], p = 0.05) was associated with lower AIx and, in JHS, lower neighborhood problems (β = -0.33 [-0.64, - 0.02], p = 0.04) and lower violence (β = -0.30 [-0.61, 0.002], p = 0.05) were associated with lower PWV. CONCLUSION Neighborhood social characteristics show an independent association with the vascular health of Black adults, findings that were reproducible in two distinct American cities.
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Affiliation(s)
- Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Xiaona Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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15
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Tucker W, McClelland RL, Allison MA, Szklo M, Rye KA, Ong KL. The association of circulating fibroblast growth factor 21 levels with incident heart failure: The Multi-Ethnic Study of Atherosclerosis. Metabolism 2023; 143:155535. [PMID: 36931558 DOI: 10.1016/j.metabol.2023.155535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Fibroblast growth factor 21 (FGF21) levels are often elevated in heart failure (HF), although this has not been assessed using a longitudinal study design. Therefore, we investigated the association between baseline plasma FGF21 levels and incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS A total of 5408 participants, free of clinically apparent cardiovascular disease, were included in the analysis, of which 342 developed HF over a median follow-up period of 16.7 years. Multivariable Cox regression analysis was performed and the additive value of FGF21 in the performance of risk prediction over other well-established cardiovascular biomarkers was assessed. RESULTS The mean age of the participants was 62.6 years with 47.6 % male. Regression spline analysis demonstrated a significant association of FGF21 levels with incident HF among participants with FGF21 levels ≥239.0 pg/mL (hazard ratio = 1.84 [95 % confidence interval 1.21, 2.80] per SD increase in ln-transformed levels) after adjustment for traditional cardiovascular risk factors and biomarkers, but not in participants with FGF21 levels <239.0 pg/mL (p for heterogeneity = 0.004). Among participants with FGF21 levels ≥239.0 pg/mL, FGF21 levels were associated with HF with preserved ejection fraction (HR [95 % CI] = 2.57 [1.51, 4.37]), but not HF with reduced ejection fraction. CONCLUSIONS The present study suggests baseline FGF21 levels could predict the development of incident HF with preserved ejection fraction, among participants with elevated FGF21 levels at baseline. This study may suggest a pathophysiological role of FGF21 resistance in HF with preserved ejection fraction.
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Affiliation(s)
- William Tucker
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, La Jolla, CA, United States
| | - Moyses Szklo
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kerry-Anne Rye
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kwok Leung Ong
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
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16
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Ferraro RA, Ogunmoroti O, Zhao D, Ndumele CE, Lima JA, Varadarajan V, Subramanya V, Pandey A, Larson NB, Bielinski SJ, Michos ED. Hepatocyte Growth Factor and 10-year Change in Left Ventricular Structure: The Multi-Ethnic Study of Atherosclerosis. CJC Open 2023. [DOI: 10.1016/j.cjco.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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17
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Mauger CA, Gilbert K, Suinesiaputra A, Bluemke DA, Wu CO, Lima JAC, Young AA, Ambale-Venkatesh B. Multi-Ethnic Study of Atherosclerosis: Relationship between Left Ventricular Shape at Cardiac MRI and 10-year Outcomes. Radiology 2023; 306:e220122. [PMID: 36125376 PMCID: PMC9870985 DOI: 10.1148/radiol.220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
Background Left ventricular (LV) subclinical remodeling is associated with adverse outcomes and indicates mechanisms of disease development. Standard metrics such as LV mass and volumes may not capture the full range of remodeling. Purpose To quantify the relationship between LV three-dimensional shape at MRI and incident cardiovascular events over 10 years. Materials and Methods In this retrospective study, 5098 participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinical cardiovascular disease underwent cardiac MRI from 2000 to 2002. LV shape models were automatically generated using a machine learning workflow. Event-specific remodeling signatures were computed using partial least squares regression, and random survival forests were used to determine which features were most associated with incident heart failure (HF), coronary heart disease (CHD), and cardiovascular disease (CVD) events over a 10-year follow-up period. The discrimination improvement of adding LV shape to traditional cardiovascular risk factors, coronary artery calcium scores, and N-terminal pro-brain natriuretic peptide levels was assessed using the index of prediction accuracy and time-dependent area under the receiver operating characteristic curve (AUC). Kaplan-Meier survival curves were used to illustrate the ability of remodeling signatures to predict the end points. Results Overall, 4618 participants had sufficient three-dimensional MRI information to generate patient-specific LV models (mean age, 60.6 years ± 9.9 [SD]; 2540 women). Among these participants, 147 had HF, 317 had CHD, and 455 had CVD events. The addition of LV remodeling signatures to traditional cardiovascular risk factors improved the mean AUC for 10-year survival prediction and achieved better performance than LV mass and volumes; HF (AUC, 0.83 ± 0.01 and 0.81 ± 0.01, respectively; P < .05), CHD (AUC, 0.77 ± 0.01 and 0.75 ± 0.01, respectively; P < .05), and CVD (AUC, 0.78 ± 0.0 and 0.76 ± 0.0, respectively; P < .05). Kaplan-Meier analysis demonstrated that participants with high-risk HF remodeling signatures had a 10-year survival rate of 56% compared with 95% for those with low-risk scores. Conclusion Left ventricular event-specific remodeling signatures were more predictive of heart failure, coronary heart disease, and cardiovascular disease events over 10 years than standard mass and volume measures and enable an automatic personalized medicine approach to tracking remodeling. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Avan Suinesiaputra
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - David A. Bluemke
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Colin O. Wu
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - João A. C. Lima
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Alistair A. Young
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
| | - Bharath Ambale-Venkatesh
- From the Department of Anatomy and Medical Imaging, Faculty of
Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton,
Auckland 1023, New Zealand (C.A.M.); Auckland Bioengineering Institute,
University of Auckland, Auckland, New Zealand (C.A.M., K.G.); Department of
Biomedical Engineering, King’s College London, London, UK (A.S., A.A.Y.);
Department of Radiology, University of Wisconsin School of Medicine and Public
Health, Madison, Wis (D.A.B.); and Department of Cardiology, Johns Hopkins
Medical Center, Baltimore, Md (C.O.W., J.A.C.L., B.A.V.)
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Hammond MM, Pool LR, Krefman AE, Ning H, Lima JAC, Shah SJ, Yeboah J, Lloyd-Jones DM, Allen NB, Khan SS. Cardiac Structure and Function Phenogroups and Risk of Incident Heart Failure (from the Multi-ethnic Study of Atherosclerosis). Am J Cardiol 2023; 187:54-61. [PMID: 36459748 DOI: 10.1016/j.amjcard.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
Indices of cardiac structure and function, such as left ventricular (LV) mass and ejection fraction, have been associated with risk of incident heart failure (HF), but the clinical relevance of data-driven grouping of a comprehensive set of cardiac parameters is unclear. In Multi-Ethnic Study of Atherosclerosis participants, latent class analysis was applied in the sample stratified by gender to define phenogroups on the basis of cardiovascular magnetic resonance imaging parameters of right ventricular and LV structure and function at baseline. Cox proportional hazard models in gender-stratified analyses were used to assess the association between phenogroup membership and risk of HF subtypes adjusting for potential confounders. In the 4,204 participants (mean age 61 ± 10 years, 53% women), the mean follow-up time was 14 ± 4 years for men and 15 ± 4 years for women. For both genders, 4 distinct phenogroups were identified: (1) ideal cardiac mechanics; (2) higher output/hypertrophied LV; (3) impaired ejection fraction/dilated LV; and (4) higher output/hyperdynamic (LV). Men in phenogroups 4 (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.60 to 5.31, p = 0.0005), 3 (HR 3.52, 95% CI 1.90 to 6.53, p <0.0001), and 2 (HR 3.49, 95% CI 1.94 to 6.28, p <0.0001) had higher rates of incident HF than did men in phenogroup 1, in fully adjusted models. No significant associations were found between phenogroup membership and incident HF in women. In conclusion, phenogroup membership based on cardiac structure and function in men was significantly associated with incident HF. Integration of cardiac magnetic resonance imaging variables may help identify differential risk for HF in men.
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Affiliation(s)
- Michael M Hammond
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lindsay R Pool
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy E Krefman
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joao A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph Yeboah
- and Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Yin L, Mei J, Dong J, Qu X, Jiang Y. Association of sodium intake with adverse left atrial function and left atrioventricular coupling in Chinese. J Hypertens 2023; 41:159-170. [PMID: 36453659 PMCID: PMC9794161 DOI: 10.1097/hjh.0000000000003317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES High sodium intake is strongly associated with hypertension and obesity. This study aims to investigate the relationship between 24-h urinary sodium (a surrogate measure of sodium intake), ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling. Further, we intend to examine whether blood pressure and BMI might be mediators of the relationship between 24-h urinary sodium and subclinical cardiac function. METHODS Our study had 398 participants, all of whom were subjected to 24-h urine collection, 24-h ambulatory blood pressure measurement, and cardiac magnetic resonance imaging. RESULTS The average age of the participants was 55.70 ± 11.30 years old. The mean urinary sodium of the participants was 172.01 ± 80.24 mmol/24 h. After adjusting for age, sex, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-h urinary sodium was correlated with multiple ambulatory blood pressure parameters, BMI, left atrial function, and the left atrioventricular coupling index (LACI) (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-h urinary sodium and left atrial function and 30% of the indirect effect of LACI. Independent of the mediator, 24-h urinary sodium had a significant direct effect on left atrial function and left atrioventricular coupling. CONCLUSIONS Higher 24-h urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-h urinary sodium and subclinical left cardiac function. Furthermore, and more importantly, 24-h urinary sodium may have directly affected the left atrial function and left atrioventricular coupling independent of intermediary factors.
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Affiliation(s)
- Lili Yin
- Second Affiliated Hospital of Dalian Medical University
| | - Jiajie Mei
- Second Affiliated Hospital of Dalian Medical University
| | - Jianli Dong
- Second Affiliated Hospital of Dalian Medical University
| | - Xiaofeng Qu
- Second Affiliated Hospital of Dalian Medical University
| | - Yinong Jiang
- First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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20
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Rim D, Henderson LA, Macefield VG. Brain and cardiovascular-related changes are associated with aging, hypertension, and atrial fibrillation. Clin Auton Res 2022; 32:409-422. [PMID: 36409380 DOI: 10.1007/s10286-022-00907-9] [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: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The neural pathways in which the brain regulates the cardiovascular system is via sympathetic and parasympathetic control of the heart and sympathetic control of the systemic vasculature. Various cortical and sub-cortical sites are involved, but how these critical brain regions for cardiovascular control are altered in healthy aging and other risk conditions that may contribute to cardiovascular disease is uncertain. METHODS Here we review the functional and structural brain changes in healthy aging, hypertension, and atrial fibrillation - noting their potential influence on the autonomic nervous system and hence on cardiovascular control. RESULTS Evidence suggests that aging, hypertension, and atrial fibrillation are each associated with functional and structural changes in specific areas of the central nervous system involved in autonomic control. Increased muscle sympathetic nerve activity (MSNA) and significant alterations in the brain regions involved in the default mode network are commonly reported in aging, hypertension, and atrial fibrillation. CONCLUSIONS Further studies using functional and structural magnetic resonance imaging (MRI) coupled with autonomic nerve activity in healthy aging, hypertension, and atrial fibrillation promise to reveal the underlying brain circuitry modulating the abnormal sympathetic nerve activity in these conditions. This understanding will guide future therapies to rectify dysregulation of autonomic and cardiovascular control by the brain.
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Affiliation(s)
- Donggyu Rim
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Luke A Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Vaughan G Macefield
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia. .,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia. .,Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC, 3010, Australia.
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21
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Pezel T, Michos ED, Varadarajan V, Shabani M, Venkatesh BA, Vaidya D, Kato Y, De Vasconcellos HD, Heckbert SR, Wu CO, Post WS, Bluemke DA, Allison MA, Henry P, Lima JAC. Prognostic value of a left atrioventricular coupling index in pre- and post-menopausal women from the Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 9:1066849. [DOI: 10.3389/fcvm.2022.1066849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BackgroundSex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in women, but the association of menopause status with left atrioventricular coupling is not established.AimTo assess the prognostic value of a left atrioventricular coupling index (LACI) in peri-menopausal women without a history of cardiovascular disease (CVD).Materials and methodsIn all women participating in MESA study with baseline cardiovascular MRI, the LACI was measured as the ratio of the LA end-diastolic volume to the LV end-diastolic volume. Cox models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD.ResultsAmong the 2,087 women participants (61 ± 10 years), 485 cardiovascular events occurred (mean follow-up: 13.2 ± 3.3 years). A higher LACI was independently associated with AF (HR 1.70; 95%CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), CHD death (HR 1.36; [1.10–1.68]), and hard CVD (HR 1.30; [1.13–1.51], all p < 0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to traditional models to predict: incident AF (C-statistic: 0.82 vs. 0.79; NRI = 0.325; IDI = 0.036), HF (C-statistic: 0.84 vs. 0.81; NRI = 0.571; IDI = 0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI = 0.506; IDI = 0.012), hard CVD (C-statistic: 0.78 vs. 0.76; NRI = 0.229; IDI = 0.012). The prognostic value of the LACI had a better discrimination and reclassification than individual LA or LV parameters.ConclusionIn a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, CHD death, and hard CVD.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT00005487].
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22
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Bradley CR, Cox EF, Palaniyappan N, Aithal GP, Francis ST, Guha IN. Variability of noninvasive MRI and biological markers in compensated cirrhosis: insights for assessing disease progression. Eur Radiol Exp 2022; 6:52. [PMID: 36274113 PMCID: PMC9588852 DOI: 10.1186/s41747-022-00303-y] [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: 05/08/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background We annually monitored stable compensated cirrhosis (CC) patients to evaluate serial variation in blood serum, liver stiffness, and multiparametric magnetic resonance imaging (mpMRI) measures to provide reference change values (RCV) and sample size measures for future studies. Methods Patients were recruited from a prospectively followed CC cohort, with assessments at baseline and annually over three years. We report on blood markers, transient elastography liver stiffness measures (LSM) and noninvasive mpMRI (volume, T1 mapping, blood flow, perfusion) of the liver, spleen, kidneys, and heart in a stable CC group and a healthy volunteer (HV) group. Coefficient of variation over time (CoVT) and RCV are reported, along with hazard ratio to assess disease progression. Sample size estimates to power future trials of cirrhosis regression on mpMRI are presented. Results Of 60 CC patients enrolled, 28 with stable CC were followed longitudinally and compared to 10 HVs. CoVT in mpMRI measures was comparable between CC and HV groups. CoVT of Enhanced Liver Fibrosis score was low (< 5%) compared to Fibrosis-4 index (17.9%) and Aspartate Aminotransferase-to-Platelet-Ratio Index (19.4%). A large CoVT (20.7%) and RCV (48.3%) were observed for LSM. CoVT and RCV were low for liver, spleen, and renal T1 values (CoVT < 5%, RCV < 8%) and volume (CoVT < 10%, RCV < 16%); haemodynamic measures were high (CoVT 12–25%, RCV 16–47%). Conclusions Evidence of low CoVT and RCV in multiorgan T1 values. RCV and sample size estimates are provided for future longitudinal multiorgan monitoring in CC patients. Trial registration ClinicalTrials.gov identifier: NCT02037867, Registered: 05/01/2013.
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23
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Sörensen J, Nordström J, Baron T, Mörner S, Granstam SO, Lubberink M, Tolbod L, van den Berg J, Flachskampf FA, Kero T, Magnusson P, Harms HJ. Diagnosis of left ventricular hypertrophy using non-ECG-gated 15O-water PET. J Nucl Cardiol 2022; 29:2361-2373. [PMID: 34286452 PMCID: PMC9553817 DOI: 10.1007/s12350-021-02734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion 15O-water positron emission tomography (PET). METHODS We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. 15O-water PET scans (n = 197) were performed with three different PET devices. A low-end scanner (66 scans) was used for method development, and remaining scans with newer devices for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall and calculation of LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n = 47) and WT to 2D-echocardiography (2DE, n = 36). PET accuracy was tested using linear regression, Bland-Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients. RESULTS High correlations were found in the blinded analyses (r ≥ 0.87, P < 0.0001 for all). AUC for detecting increased LVM and WT (> 12 mm and > 15 mm) was ≥ 0.95 (P < 0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P < 0.0001). CONCLUSION 15O-water PET might detect LV hypertrophy with high accuracy and precision.
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Affiliation(s)
- Jens Sörensen
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden.
- PET Center, Entrance 86, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Jonny Nordström
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sven-Olof Granstam
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Tolbod
- Nuclear Medicine and PET, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeffrey van den Berg
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hendrik J Harms
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
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Hundley WG, D'Agostino R, Crotts T, Craver K, Hackney MH, Jordan JH, Ky B, Wagner LI, Herrington DM, Yeboah J, Reding KW, Ladd AC, Rapp SR, Russo S, O'Connell N, Weaver KE, Dressler EV, Ge Y, Melin SA, Gudena V, Lesser GJ. Statins and Left Ventricular Ejection Fraction Following Doxorubicin Treatment. NEJM EVIDENCE 2022; 1:10.1056/evidoa2200097. [PMID: 36908314 PMCID: PMC9997095 DOI: 10.1056/evidoa2200097] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Statins taken for cardiovascular indications by patients with breast cancer and lymphoma during doxorubicin treatment may attenuate left ventricular ejection fraction (LVEF) decline, but the effect of statins on LVEF among patients with no cardiovascular indications is unknown. METHODS A double-blind, placebo-controlled, 24-month randomized trial of 40 mg of atorvastatin per day administered to patients with breast cancer and lymphoma receiving doxorubicin was conducted within the National Cancer Institute Community Oncology Research Program across 31 sites in the United States. At pretreatment and then 6 and 24 months after initiating doxorubicin, we assessed left ventricular (LV) volumes, strain, mass, and LVEF through cardiac magnetic resonance imaging, along with cognitive function and serum markers of inflammation. The primary outcome was the difference in 24-month LVEF between placebo and treatment groups, adjusted for pretreatment LVEF. RESULTS A total of 279 participants were enrolled in the trial. Participants had a mean (±SD) age of 49±12 years; 92% were women; and 83% were White. The mean (±SD) LVEF values were 61.7±5.5% before treatment and 57.4±6.8% at 24 months in the placebo group and 62.6±6.4% before treatment and 57.7±5.6% at 24 months in the atorvastatin group. On the basis of a multiple imputed data set for missing data and adjusted for each individual's pretreatment LVEF, 24-month declines in LVEF averaged 3.3±0.6 percentage points and 3.2±0.7 percentage points, for those randomly assigned to placebo versus statins, respectively (P=0.93). Across both treatment arms, similar percentages of individuals experienced changes of more than 10 percentage points in LVEF, LV strain, LV mass, cognition, and inflammation biomarkers, including among those with greater than 90% drug compliance. CONCLUSIONS In patients with breast cancer and lymphoma with no existing indication for statin therapy, prospective statin administration did not affect LVEF declines 2 years after doxorubicin. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01988571.).
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Affiliation(s)
- W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Teresa Crotts
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Karen Craver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary Helen Hackney
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - Jennifer H Jordan
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond
| | - Bonnie Ky
- Department of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - David M Herrington
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle
| | - Amy C Ladd
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sandra Russo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Nathaniel O'Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina, Charlotte
| | - Susan A Melin
- Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Vinay Gudena
- Division of Hematology and Oncology, Cone Health, Greensboro, NC
| | - Glenn J Lesser
- Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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25
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Vecsey-Nagy M, Szilveszter B, Kolossváry M, Boussoussou M, Vattay B, Gonda X, Rihmer Z, Merkely B, Maurovich-Horvat P, Nemcsik J. Cyclothymic affective temperament is independently associated with left ventricular hypertrophy in chronic hypertensive patients. J Psychosom Res 2022; 160:110988. [PMID: 35863114 DOI: 10.1016/j.jpsychores.2022.110988] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Affective temperaments (depressive, anxious, irritable, hyperthymic, and cyclothymic) are regarded as the stable core of personality and when present in their dominant form, are considered subclinical manifestations and high-risk states for various affective disorders. Furthermore, cumulating evidence supports their relationship with cardiovascular diseases. Our aim was to assess the association between affective temperaments and left ventricular hypertrophy (LVH) in chronic hypertensive patients. METHODS In the present cross-sectional study, 296 patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease were analyzed. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). Left ventricular mass was quantified by CCTA and indexed to the body surface area (LVMi). Logistic regression analysis was used to identify predictors of LVH (men: ≥67.2 g/m2 and women: ≥54.7 g/m2). RESULTS Among our patient cohort (mean age: 59.4 ± 10.6, 44.9% female), the median LVM and LVMi were 115.5 [88.4-140.7] g and 58.4 [47.4-64.2] g/m2, respectively. Elevated BMI (OR = 1.04 CI: 1.01-1.10, p = 0.04) and cyclothymic affective temperament scores (OR = 1.06 CI: 1.00-1.12, p = 0.04) significantly increased the odds of LVH in multivariate logistic regression analysis. CONCLUSION Assessment of affective temperaments may allow for the identification of chronic hypertensive patients with elevated risk for LVH as a potential target for earlier primary intervention.
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Affiliation(s)
- Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary; Health Service of Zugló (ZESZ), Budapest, Hungary
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26
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Shah S, Segar MW, Kondamudi N, Ayers C, Chandra A, Matulevicius S, Agusala K, Peshock R, Abbara S, Michos ED, Drazner MH, Lima JAC, Longstreth WT, Pandey A. Supranormal Left Ventricular Ejection Fraction, Stroke Volume, and Cardiovascular Risk: Findings From Population-Based Cohort Studies. JACC. HEART FAILURE 2022; 10:583-594. [PMID: 35902163 DOI: 10.1016/j.jchf.2022.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)-assessed by cardiac magnetic resonance (CMR)-in healthy, community-dwelling individuals is unknown. OBJECTIVES The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD. METHODS Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index. RESULTS The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume. CONCLUSIONS Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.
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Affiliation(s)
- Sonia Shah
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Susan Matulevicius
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kartik Agusala
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ron Peshock
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
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27
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Cai X, Allison MA, Ambale-Venkatesh B, Jorgensen NW, Lima JAC, Muse ED, McClelland RL, Shea S, Lebeche D. Resistin and risks of incident heart failure subtypes and cardiac fibrosis: the Multi-Ethnic Study of Atherosclerosis. ESC Heart Fail 2022; 9:3452-3460. [PMID: 35860859 DOI: 10.1002/ehf2.14064] [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: 02/07/2022] [Revised: 06/04/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Resistin is a circulating inflammatory biomarker that is associated with cardiovascular disease. We investigated the associations of resistin and incident heart failure (HF) and its subtypes, as well as specific measures of subclinical HF (myocardial fibrosis and relevant biomarkers). METHODS We analysed data from 1968 participants in the Multi-Ethnic Study of Atherosclerosis with measurements of plasma resistin levels at clinic visits from 2002 to 2005. Participants were subsequently followed for a median of 10.5 years for HF events. The associations between resistin levels and incident HF, HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF) were examined using multivariable Cox proportional hazards models. Linear regression models assessed the associations between resistin levels and myocardial fibrosis from cardiac magnetic resonance imaging, as well as hs-cTnT and NT-proBNP. RESULTS The mean age of the cohort was 64.7 years, and 50.0% were female. Seventy-four participants (4%) developed incident HF during follow-up. In a Cox proportional hazards model adjusted for age, gender, education level, race/ethnicity, and traditional risk factors, higher resistin levels were significantly associated with incident HF (HR 1.44, CI 1.18-1.75, P = 0.001) and HFrEF (HR 1.47, CI 1.07-2.02, P = 0.016), but not with HFpEF (HR 1.25, CI 0.89-1.75, P = 0.195). Resistin levels showed no significant associations with myocardial fibrosis, NT-proBNP, or hs-cTnT levels. CONCLUSIONS In a multi-ethnic cohort free of cardiovascular disease at baseline, elevated resistin levels were associated with incident HF, more prominently with incident HFrEF than HFpEF, but not with subclinical myocardial fibrosis or biomarkers of HF.
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Affiliation(s)
- Xinjiang Cai
- Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Specialty Training and Advanced Research (STAR) program, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Bharath Ambale-Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Neal W Jorgensen
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Evan D Muse
- Scripps Research Translational Institute and Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Steven Shea
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Djamel Lebeche
- Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Diabetes, Obesity and Metabolism Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Physiology, University of Tennessee Health Science Center, 318H Translational Research Building, Memphis, TN, 38163, USA
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28
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Ha ET, Ivanov A, Yeboah J, Seals A, Peterson SJ, Parikh M, Aronow WS, Frishman WH. Relation of Left Ventricular Hypertrophy Subtype to Long-Term Mortality in Those With Subclinical Cardiovascular Disease (from the Multiethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2022; 175:131-138. [PMID: 35550820 DOI: 10.1016/j.amjcard.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Abstract
The clinical and biochemical profile of differing Left ventricular hypertrophy phenotypes and its effect on long-term outcomes is ill-defined. The study investigated the differences in risk profiles and prognostic effect of concentric (CH) and eccentric hypertrophy (EH) on long-term adverse outcomes in a contemporary, ethnically diverse cohort. We analyzed follow-up data over 15 years from the Multiethnic Study of Atherosclerosis study. A total of 4,979 participants with cardiac magnetic resonance performed at baseline enrollment were included. Descriptive statistics, Kaplan-Meier curves, and regression models were applied. Independent variables associated with CH were black and Hispanic race/ethnicity, systolic blood pressure, and metabolic syndrome. Independent variables associated with EH were systolic blood pressure and urine creatinine, whereas serum creatinine had an inverse association. The primary end point of all-cause death (n = 1,137, 22.8%) occurred in 21.7%, 47.4%, and 56.6% of participants with no, CH, or EH, respectively (p- < 0.001). Age (hazard ratio [HR] per year = 1.10 [1.09 to 1.11], p <0.001), male gender (HR = 1.48 [1.29 to 1.69], p <0.001), black race (HR = 1.17 [1.005 to 1.36], p = 0.04), fasting glucose (HR = 1.005 [1.003 to 1.007], p <0.001), baseline creatinine (HR per mg/100 ml = 1.29 [1.15 to 1.46], p <0.001), left ventricular ejection fraction (HR per 1% = 0.98 [0.98 to 0.99], p = 0.005), IL-6 (HR per pg/ml = 1.17 [1.12 to 1.22], p <0.001), CH (HR = 1.84 [1.41 to 2.41], p <0.001), and EH (HR = 2.58 [1.77 to 3.76], p <0.001) were significant predictors of all-cause mortality. In conclusion, CH and EH are 2 distinct clinical phenotypes of left ventricular hypertrophy with differing gender and racial predisposition, both of which are associated with worse long-term adverse outcomes.
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Affiliation(s)
- Edward T Ha
- Department of Internal Medicine and Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Alexander Ivanov
- Department of Cardiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina.
| | - Joseph Yeboah
- Department of Cardiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Austin Seals
- Department of Cardiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Stephen J Peterson
- Department of Internal Medicine and Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Manish Parikh
- Department of Internal Medicine and Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Wilbert S Aronow
- Department of Internal Medicine, New York Medical College, Valhalla, New York
| | - William H Frishman
- Department of Internal Medicine, New York Medical College, Valhalla, New York
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29
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Phantom-based correction for standardization of myocardial native T1 and extracellular volume fraction in healthy subjects at 3-Tesla cardiac magnetic resonance imaging. Eur Radiol 2022; 32:8122-8130. [PMID: 35771246 DOI: 10.1007/s00330-022-08936-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the effect of the phantom-based correction method for standardizing myocardial native T1 and extracellular volume fraction (ECV) in healthy subjects. METHODS Seventy-one healthy asymptomatic adult (≥ 20 years) volunteers of five different age groups (34 men and 37 women, 45.5 ± 15.5 years) were prospectively enrolled in three academic hospitals. Cardiac MRI including Modified Look - Locker Inversion recovery T1 mapping sequence was performed using a 3-Tesla system with a different type of scanner for each hospital. Native T1 and ECV were measured in the short-axis T1 map and analyzed for mean values of the 16 entire segments. The myocardial T1 value of each subject was corrected based on the site-specific equation derived from the T1 Mapping and ECV Standardization phantom. The global native T1 and ECV were compared between institutions before and after phantom-based correction, and the variation in native T1 and ECV among institutions was assessed using a coefficient of variation (CoV). RESULTS The global native T1 value significantly differed between the institutions (1198.7 ± 32.1 ms, institution A; 1217.7 ± 39.9 ms, institution B; 1232.7 ± 31.1 ms, institution C; p = 0.002), but the mean ECV did not (26.6-27.5%, p = 0.355). After phantom-based correction, the global native T1 and ECV were 1289.7 ± 32.4 ms and 25.0 ± 2.7%, respectively, and CoV for native T1 between the three institutions decreased from 3.0 to 2.5%. The corrected native T1 value did not significantly differ between institutions (1284.5 ± 31.5 ms, institution A; 1296.5 ± 39.1 ms, institution B; 1291.3 ± 29.3 ms, institution C; p = 0.440), and neither did the ECV (24.4-25.9%, p = 0.078). CONCLUSIONS The phantom-based correction method can provide standardized reference T1 values in healthy subjects. KEY POINTS • After phantom-based correction, the global native T1 of 16 entire myocardial segments on 3-T cardiac MRI is 1289.4 ± 32.4 ms, and the extracellular volume fraction was 25.0 ± 2.7% for healthy subjects. • After phantom - based correction was applied, the differences in the global native T1 among institutions became insignificant, and the CoV also decreased from 3.0 to 2.5%.
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30
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Figliozzi S, Georgiopoulos G, Pateras K, Sianis A, Previtero M, Tondi L, Petropoulos Ι, Bragato RM, Papachristidis A, Condorelli G, Takeuchi M. Normal ranges of left atrial volumes and ejection fraction by 3D echocardiography in adults: a systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1329-1340. [PMID: 34994882 DOI: 10.1007/s10554-021-02520-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Increased sizes and dysfunction of the left atrium have been related to adverse outcomes. 3D-echocardiography is more accurate than 2D-echocardiography in estimating LA volumes and ejection fraction. However, the use of 3DE for LA analysis is limited by the absence of established reference values. We performed a systematic review and meta-analysis to provide reference ranges of LA maximum and minimum volumes indexed for body surface area (LAVi max and LAVi min, respectively), and LA-EF assessed by 3DE in healthy adults. Data search was conducted from inception through September 15, 2021, using the following Medical Subject Heading terms: left atrial/atrium, three-dimensional/3D echocardiography. The study protocol was registered in the PROSPERO database (CRD42021252428). 15 studies including 4,226 healthy adults (51% males) and reporting 3DE values of LAVi max, LAVi min and LA-EF were selected. LAVi max, LAVi min and LA-EF mean and reference values were equal to 25.18 ml/m2 (95% CI 23.10, 27.26), 11.10 ml/m2 (10.01, 12.18) and 55.94% (51.92, 59.96), respectively. No influential studies were identified. Pooled estimates per age group- and sex were also estimated. By meta-regression analyses, we identified variability in LA volumes and LA-EF depending on participants' age, ethnicity and number of heart cycles at 3D multi-beat acquisition. At individual patient data analysis conducted on 374 subjects, a software effect on LA-EF was shown. This systematic review and meta-analysis provides reference values of LAVi max, LAVi min and LA-EF assessed by 3DE in healthy adults, encouraging 3DE evaluation of the LA evaluation in daily practice.
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Affiliation(s)
- Stefano Figliozzi
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kostantinos Pateras
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lara Tondi
- Multimodality Imaging Section IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ιoannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Renato Maria Bragato
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | | | - Gianluigi Condorelli
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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31
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Kianzad A, van Wezenbeek J, Celant LR, Oosterveer FP, Noordegraaf AV, Meijboom LJ, de Man FS, Bogaard HJ, Handoko ML. Idiopathic pulmonary arterial hypertension patients with a high H2FPEF-score: insights from the Amsterdam UMC PAH-cohort. J Heart Lung Transplant 2022; 41:1075-1085. [DOI: 10.1016/j.healun.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
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32
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Berardi C, Bluemke DA, Houston BA, Kolb TM, Lima JA, Pezel T, Tedford RJ, Rayner SG, Cheng RK, Leary PJ. Association of soluble Flt-1 with heart failure and cardiac morphology: The MESA angiogenesis study. J Heart Lung Transplant 2022; 41:619-625. [PMID: 35184966 PMCID: PMC9038636 DOI: 10.1016/j.healun.2022.01.003] [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: 08/20/2021] [Revised: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Soluble Fms-like tyrosine kinase 1 (sFlt-1) may inhibit angiogenesis. Higher levels of sFlt-1 are associated with worse prognosis in prevalent heart failure patients. The aim of this study was to better understand the role of sFlt-1 in heart failure pathogenesis by characterizing relationships between sFlt-1, cardiac morphology, and the composite outcome of incident heart failure or cardiovascular (CV) death in in a multiethnic cohort free of CV disease at baseline. METHODS sFlt-1 was measured in 1,381 participants in the Multi-Ethnic Study of Atherosclerosis Angiogenesis sub-study. Linear regression was used to estimate the association between sFlt-1 and cardiac morphology and Cox proportional hazard regression was used to estimate associations with incident heart failure or CV mortality. RESULTS Over a median follow-up of 13.1 years, higher sFlt-1 levels were associated with incident heart failure or CV mortality independent from CV risk factors or NT-proBNP levels (HR 1.17, 95% CI 1.10-1.26, p < 0.001). Higher sFlt-1 levels were also associated with greater baseline left ventricular (LV) mass by cardiac MRI and increased loss of LV mass over the 10 years following the baseline exam (p-value 0.02 for each), but this association was no longer statistically significant after adjustment for baseline NT-proBNP (p = 0.11 and 0.10 respectively). CONCLUSIONS Baseline sFlt-1 levels are associated with incident heart failure and cardiovascular mortality independent of traditional CV risk factors or NT-proBNP. An association was also found with cardiac mass but was no longer significant after adjustment for NT-proBNP.
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Affiliation(s)
- Cecilia Berardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Brian A Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Todd M Kolb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - João A Lima
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Theo Pezel
- Departments of Medicine and Radiology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Samuel G Rayner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Richard K Cheng
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Peter J Leary
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
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33
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Wegener A, Kaagaard MD, Gomes LC, Holm AE, Matos LO, Lima KO, Vieira IVM, de Souza RM, Olsen FJ, Marinho CRF, Biering-Sørensen T, Silvestre OM, Brainin P. Reference values for left ventricular dimensions, systolic and diastolic function: a study from the Amazon Basin of Brazil. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:813-822. [PMID: 34807316 DOI: 10.1007/s10554-021-02475-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022]
Abstract
Country- and ethnicity-specific reference values for echocardiographic parameters are necessary for decision making. No prior studies have examined reference values in adults from the Amazon Basin of Brazil. We performed echocardiographic examinations in 290 healthy adults (mean age 37 ± 14 years, 40% male) from the Brazilian Amazon. Left ventricular (LV) dimensions and volumes were obtained and indexed to body surface area. We also assessed systolic (LV ejection fraction [LVEF] and global longitudinal strain [GLS]) and diastolic function. LV dimensions and volumes were larger in males compared to females, but after indexation only volumes remained larger (P < 0.001 for all). Parameters of systolic function, were significantly greater in females (LVEF 50 to 68%, GLS - 17 to - 24%) than in males (LVEF 50 to 67%, GLS - 15 to - 23%, P < 0.05). Upper limits of normality for cardiac dimensions (indexed and non-indexed) were markedly higher compared to contemporary guidelines (American Society of Echocardiography) and the Brazilian subgroup in the World Alliance Society of Echocardiography (WASE). Lower limit of normality for LVEF (both sex 50%) and upper limit of normality for the left atrial volume index (LAVI) (male: 31 mL/m2, female: 25 mL/m2) were within normal range but slightly lower compared to guidelines and the WASE study. Other diastolic parameters, including E/A-ratio, E/e' ratio and peak tricuspid regurgitation velocity were compatible with present recommendations. Normal reference ranges of echocardiographic parameters in healthy adults from the Brazilian Amazon Basin may be different compared to international guidelines and data from other regions of Brazil. This applies specifically for LVEF and LAVI.
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Affiliation(s)
- Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Molly D Kaagaard
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Laura Cordeiro Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Engell Holm
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Flemming Javier Olsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | | | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
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Pezel T, Ambale-Venkatesh B, Quinaglia T, Heckbert SR, Kato Y, de Vasconcellos HD, Wu CO, Post WS, Henry P, Bluemke DA, Lima JAC. Change in Left Atrioventricular Coupling Index to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2022; 303:317-326. [PMID: 35191736 PMCID: PMC9081516 DOI: 10.1148/radiol.210315] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leiner in this issue.
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Affiliation(s)
- Théo Pezel
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Bharath Ambale-Venkatesh
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Thiago Quinaglia
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Susan R Heckbert
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Yoko Kato
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Henrique Doria de Vasconcellos
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Colin O Wu
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Wendy S Post
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Patrick Henry
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - David A Bluemke
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - João A C Lima
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
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Quantifying Myocardial Strain of the Left Ventricle in Normal People Using Feature-Tracking Based on Computed Tomography Imaging. Diagnostics (Basel) 2022; 12:diagnostics12020329. [PMID: 35204420 PMCID: PMC8870890 DOI: 10.3390/diagnostics12020329] [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: 12/24/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: The objective was to evaluate the normal value of left ventricular myocardial strain using the computed tomography feature-tracking technique and to explore the correlation between myocardial strains and cardiac function parameters. Methods: Participants suspected of coronary heart disease were selected from 17 August 2020 to 5 November 2020 to undergo coronary computed tomography angiography using a third-generation dual-source CT scanner. Data were imported into a commercial software (Medis) after multiphase reconstruction. The cardiac function parameters, radial (Err), circumferential (Ecc), and longitudinal strain (Ell) of the left ventricle were recorded. Results: A total of 87 normal subjects were enrolled, including 41 males and 46 females. For healthy subjects, the global radial strain (GRS), circumferential strain (GCS), and longitudinal strain (GLS) of the left ventricle were 74.5 ± 15.2%, −22.7 ± 3.0%, and −26.6 ± 3.2%, respectively. The Err and Ecc absolute values (|Ecc|) were the largest at the apex, and the |Ell| gradually increased from the base to the apex. The Err and |Ecc| were the largest in the lateral and inferior wall, respectively. |Ell| showed a clockwise decrease from the lateral wall in the short axis. Meanwhile, the GRS and |GLS| in females were higher than that in males. Multiple linear regression analysis showed that both SV and LVEF were the independent determinants of GRS, GCS, and GLS. BMI and CO were the independent determined factors of GCS. Conclusions: At a reasonable radiation dose, CT feature-tracking is a feasible and reproducible method to analyze left ventricular myocardial strain. Left ventricular myocardial strain in normal subjects varies in gender, segments, levels, and regions.
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Suinesiaputra A, Mauger CA, Ambale-Venkatesh B, Bluemke DA, Dam Gade J, Gilbert K, Janse MHA, Hald LS, Werkhoven C, Wu CO, Lima JAC, Young AA. Deep Learning Analysis of Cardiac MRI in Legacy Datasets: Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 8:807728. [PMID: 35127868 PMCID: PMC8813768 DOI: 10.3389/fcvm.2021.807728] [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: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
The Multi-Ethnic Study of Atherosclerosis (MESA), begun in 2000, was the first large cohort study to incorporate cardiovascular magnetic resonance (CMR) to study the mechanisms of cardiovascular disease in over 5,000 initially asymptomatic participants, and there is now a wealth of follow-up data over 20 years. However, the imaging technology used to generate the CMR images is no longer in routine use, and methods trained on modern data fail when applied to such legacy datasets. This study aimed to develop a fully automated CMR analysis pipeline that leverages the ability of machine learning algorithms to enable extraction of additional information from such a large-scale legacy dataset, expanding on the original manual analyses. We combined the original study analyses with new annotations to develop a set of automated methods for customizing 3D left ventricular (LV) shape models to each CMR exam and build a statistical shape atlas. We trained VGGNet convolutional neural networks using a transfer learning sequence between two-chamber, four-chamber, and short-axis MRI views to detect landmarks. A U-Net architecture was used to detect the endocardial and epicardial boundaries in short-axis images. The landmark detection network accurately predicted mitral valve and right ventricular insertion points with average error distance <2.5 mm. The agreement of the network with two observers was excellent (intraclass correlation coefficient >0.9). The segmentation network produced average Dice score of 0.9 for both myocardium and LV cavity. Differences between the manual and automated analyses were small, i.e., <1.0 ± 2.6 mL/m2 for indexed LV volume, 3.0 ± 6.4 g/m2 for indexed LV mass, and 0.6 ± 3.3% for ejection fraction. In an independent atlas validation dataset, the LV atlas built from the fully automated pipeline showed similar statistical relationships to an atlas built from the manual analysis. Hence, the proposed pipeline is not only a promising framework to automatically assess additional measures of ventricular function, but also to study relationships between cardiac morphologies and future cardiac events, in a large-scale population study.
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Affiliation(s)
- Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Charlène A. Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Josefine Dam Gade
- Department of Biomedical Engineering and Informatics, School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Markus H. A. Janse
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Line Sofie Hald
- Department of Biomedical Engineering and Informatics, School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Conrad Werkhoven
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Colin O. Wu
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Baltimore, MD, United States
| | | | - Alistair A. Young
- Faculty of Life Sciences & Medicine, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- *Correspondence: Alistair A. Young
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Eyeington CT, Canet E, Cutuli SL, Ancona P, Brown AJ, Jenkins E, Taylor DM, Eastwood GM, Bellomo R. COMBED: Rapid non-invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability. Emerg Med Australas 2022; 34:528-538. [PMID: 34981648 DOI: 10.1111/1742-6723.13926] [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: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The application of rapid, non-operator-dependent, non-invasive cardiac output monitoring (COM) may provide early physiological information in ED patients with haemodynamic instability (HI). Our primary objective was to assess the feasibility of measuring pre-intervention (baseline) cardiac index (CI) and associated haemodynamic parameters. METHODS We performed a prospective observational study of adults shortly after presentation to the ED of a large university hospital with tachycardia or hypotension or both. We applied non-invasive COM for 5 min and recorded CI, mean arterial pressure (MAP), stroke volume index (SVI) and systemic vascular resistance index (SVRI). We assessed for differences between those presenting with hypotension or hypotension and tachycardia with tachycardia alone and between those with or without suspected infection. RESULTS We obtained haemodynamic parameters in 46 of 49 patients. In patients with hypotension or hypotension and tachycardia (n = 15) rather than tachycardia alone (n = 31), we observed a lower MAP (60.8 vs 87.7, P < 0.0001), CI (2.8 vs 3.9, P = 0.0167) and heart rate (85.5 vs 115.4, P < 0.0001). There was no difference in SVI (33.7 vs 33.4, P = 0.93) or SVRI (1970 vs 2088, P = 0.67). Patients with suspected infection had similar haemodynamic values except for a lower SVRI (1706 vs 2237, P = 0.011). CONCLUSIONS Rapid, non-operator-dependent, non-invasive COM was possible in >90% of ED patients presenting with HI. Compared with tachycardia alone, patients with hypotension had lower CI, MAP and heart rate, while those with suspected infection had a lower SVRI. This technology provides novel insights into the early state of the circulation in ED patients with HI.
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Affiliation(s)
- Christopher T Eyeington
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Division of Anaesthesia, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Emmanuel Canet
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Salvatore L Cutuli
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Paolo Ancona
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Alistair J Brown
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Emily Jenkins
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia
| | - David McD Taylor
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,ANZIC Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Data Analytics Research and Evaluation Centre (DARE), Austin Hospital and The University of Melbourne, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,ANZIC Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Data Analytics Research and Evaluation Centre (DARE), Austin Hospital and The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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38
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Luu JM, Gebhard C, Ramasundarahettige C, Desai D, Schulze K, Marcotte F, Awadalla P, Broet P, Dummer T, Hicks J, Larose E, Moody A, Smith EE, Tardif JC, Teixeira T, Teo KK, Vena J, Lee DS, Anand SS, Friedrich MG. Normal sex and age-specific parameters in a multi-ethnic population: a cardiovascular magnetic resonance study of the Canadian Alliance for Healthy Hearts and Minds cohort. J Cardiovasc Magn Reson 2022; 24:2. [PMID: 34980185 PMCID: PMC8722350 DOI: 10.1186/s12968-021-00819-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the growing utility of cardiovascular magnetic resonance (CMR) for cardiac morphology and function, sex and age-specific normal reference values derived from large, multi-ethnic data sets are lacking. Furthermore, most available studies use a simplified tracing methodology. Using a large cohort of participants without history of cardiovascular disease (CVD) or risk factors from the Canadian Alliance for Healthy Heart and Minds, we sought to establish a robust set of reference values for ventricular and atrial parameters using an anatomically correct contouring method, and to determine the influence of age and sex on ventricular parameters. METHODS AND RESULTS Participants (n = 3206, 65% females; age 55.2 ± 8.4 years for females and 55.1 ± 8.8 years for men) underwent CMR using standard methods for quantitative measurements of cardiac parameters. Normal ventricular and atrial reference values are provided: (1) for males and females, (2) stratified by four age categories, and (3) for different races/ethnicities. Values are reported as absolute, indexed to body surface area, or height. Ventricular volumes and mass were significantly larger for males than females (p < 0.001). Ventricular ejection fraction was significantly diminished in males as compared to females (p < 0.001). Indexed left ventricular (LV) end-systolic, end-diastolic volumes, mass and right ventricular (RV) parameters significantly decreased as age increased for both sexes (p < 0.001). For females, but not men, mean LV and RVEF significantly increased with age (p < 0.001). CONCLUSION Using anatomically correct contouring methodology, we provide accurate sex and age-specific normal reference values for CMR parameters derived from the largest, multi-ethnic population free of CVD to date. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02220582. Registered 20 August 2014-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02220582 .
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Affiliation(s)
- Judy M Luu
- Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Francois Marcotte
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, 661 University Avenue Suite 510, Toronto, ON, M5G 0A3, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, École de Santé Publique, Université de Montréal, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Research Centre, CHU Sainte Justine, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Trevor Dummer
- School of Population and Public Health, Cancer Control Research, BC Cancer, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Jason Hicks
- Atlantic PATH, Dalhousie University, 1494 Carlton Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Quebec, G1V 4G5, Canada
| | - Alan Moody
- Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Tiago Teixeira
- Cardiology Department, Entre Douro e Vouga Hospital Centre, Santa Maria Feira, Portugal
| | - Koon K Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Suite 1500 Sun Life Place, 10123 99th Street NW, Edmonton, AB, T5J 3H1, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Peter Munk Cardiac Centre University Health Network University of Toronto, Toronto, ON, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Miyoshi T, Tanaka H. Standardization of normal values for cardiac chamber size in echocardiography. J Med Ultrason (2001) 2022; 49:21-33. [PMID: 34787741 DOI: 10.1007/s10396-021-01147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
Echocardiography is used worldwide to evaluate cardiac size and function. To determine what values are abnormal, it is essential to establish normal reference values for echocardiography. The current guidelines for chamber quantification specify normative values for cardiac chambers and recommend that gender and body size be taken into account. However, these normative data were established using databases for which a variety of measurement methods were used and the majority of subjects consisted of Whites in Europe and the United States. However, several regional studies from other countries suggest that cardiac size varies globally. To overcome these limitations, the Normal Reference Ranges for Echocardiography study and the World Alliance of Societies of Echocardiography Normal Values study have recently been conducted to examine similarities and differences in cardiac chamber size and to establish normal reference values while taking worldwide diversity into account. The results from these studies have demonstrated that standardization of normal reference values for cardiac size is important. This review article aims to summarize the current status of normative echocardiographic values for cardiac chamber size.
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Affiliation(s)
- Tatsuya Miyoshi
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Gregor Z, Kiss AR, Szabó LE, Tóth A, Grebur K, Horváth M, Dohy Z, Merkely B, Vágó H, Szűcs A. Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification. PLoS One 2021; 16:e0258362. [PMID: 34637474 PMCID: PMC8509873 DOI: 10.1371/journal.pone.0258362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Methods Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18–29, Group B: 30–39, Group C: 40–49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). Results The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Conclusions Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- * E-mail:
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Kimenai DM, Shah ASV, McAllister DA, Lee KK, Tsanas A, Meex SJR, Porteous DJ, Hayward C, Campbell A, Sattar N, Mills NL, Welsh P. Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population. Clin Chem 2021; 67:1351-1360. [PMID: 34240125 PMCID: PMC8486023 DOI: 10.1093/clinchem/hvab109] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac troponin concentrations differ in women and men, but how this influences risk prediction and whether a sex-specific approach is required is unclear. We evaluated whether sex influences the predictive ability of cardiac troponin I and T for cardiovascular events in the general population. METHODS High-sensitivity cardiac troponin (hs-cTn) I and T were measured in the Generation Scotland Scottish Family Health Study of randomly selected volunteers drawn from the general population between 2006 and 2011. Cox-regression models evaluated associations between hs-cTnI and hs-cTnT and the primary outcome of cardiovascular death, myocardial infarction, or stroke. RESULTS In 19 501 (58% women, mean age 47 years) participants, the primary outcome occurred in 2.7% (306/11 375) of women and 5.1% (411/8126) of men during the median follow-up period of 7.9 (IQR, 7.1-9.2) years. Cardiac troponin I and T concentrations were lower in women than men (P < 0.001 for both), and both were more strongly associated with cardiovascular events in women than men. For example, at a hs-cTnI concentration of 10 ng/L, the hazard ratio relative to the limit of blank was 9.7 (95% CI 7.6-12.4) and 5.6 (95% CI 4.7-6.6) for women and men, respectively. The hazard ratio for hs-cTnT at a concentration of 10 ng/L relative to the limit of blank was 3.7 (95% CI 3.1-4.3) and 2.2 (95% CI 2.0-2.5) for women and men, respectively. CONCLUSIONS Cardiac troponin concentrations differ in women and men and are stronger predictors of cardiovascular events in women. Sex-specific approaches are required to provide equivalent risk prediction.
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Affiliation(s)
| | - Anoop S V Shah
- Usher Institute, University of Edinburgh, Edinburgh, UK
- BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | - Steven J R Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - David J Porteous
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Caroline Hayward
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Archie Campbell
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nicholas L Mills
- Usher Institute, University of Edinburgh, Edinburgh, UK
- BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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42
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Augustine JA, Lefferts WK, DeBlois JP, Barreira TV, Taylor BA, Liu K, Heffernan KS. Sex differences in cardiovascular adaptations in recreational marathon runners. Eur J Appl Physiol 2021; 121:3459-3472. [PMID: 34515867 DOI: 10.1007/s00421-021-04806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are well-established sex differences in central hemodynamic and cardiac adaptations to endurance exercise; however, controversial evidence suggests that excessive endurance exercise may be related to detrimental cardiovascular adaptations in marathoners. PURPOSE To examine left ventricle (LV) structure, LV function, 24-h central hemodynamics and ventricular-vascular coupling in male and female marathoners and recreationally active adults. METHODS 52 marathoners (41 ± 5 years, n = 28 female, completed 6 ± 1 marathons/3 years) and 49 recreationally active controls (42 ± 5 years, n = 25 female) participated in the study. Three-Dimensional Echocardiography (3DE) was used to measure LV mass index and LV longitudinal (LS) circumferential (CS), area (AS), and radial strain (RS). An ambulatory blood pressure (BP) cuff was used to measure 24-h central hemodynamics (BP, pulse wave velocity, PWV, wave reflection index, RIx). Hemodynamic and 3DE measures were combined to derive the ratio of arterial elastance (Ea) to ventricular elastance (Elv) as a global measure of ventricular-vascular coupling. RESULTS There were no sex or group differences in LS, CS, AS, and RS (p > 0.05). Females marathoners had similar aortic BP (116 ± 9 vs. 113 ± 1 mmHg), and PWV (5.9 ± 0.5 vs. 5.9 ± 1.1 m/s) compared to female controls but lower aSBP (116 ± 9 vs. 131 ± 10 mmHg) and PWV (5.9 ± 0.5 vs. 6.2 ± 0.5 m/s) compared to male marathoners (p < 0.05). Female marathoners had lower Ea/Elv than female controls (0.67 ± 0.20 vs. 0.93 ± 0.36) and male marathoners (0.67 ± 0.20 vs. 0.85 ± 0.42, p < 0.05). CONCLUSIONS Women that have completed multiple marathons do not have reduced LV function or increased aortic stiffness and may have better ventricular-vascular coupling compared to male marathoners and their female untrained counterparts.
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Affiliation(s)
- Jacqueline A Augustine
- Kinesiology Department, School of Professional Studies, State University of New York at Cortland, Office 1149, Cortland, NY, 13045, USA. .,Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
| | - Wesley K Lefferts
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA.,Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Jacob P DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Tiago V Barreira
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Kan Liu
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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43
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Pezel T, Venkatesh BA, De Vasconcellos HD, Kato Y, Shabani M, Xie E, Heckbert SR, Post WS, Shea SJ, Allen NB, Watson KE, Wu CO, Bluemke DA, Lima JAC. Left Atrioventricular Coupling Index as a Prognostic Marker of Cardiovascular Events: The MESA Study. Hypertension 2021; 78:661-671. [PMID: 34225471 PMCID: PMC8363553 DOI: 10.1161/hypertensionaha.121.17339] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Theo Pezel
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
- Department of Cardiology, Lariboisiere Hospital - APHP, Inserm UMRS 942, University of Paris, France (T.P.)
| | - Bharath Ambale Venkatesh
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Henrique Doria De Vasconcellos
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Yoko Kato
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Mahsima Shabani
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Eric Xie
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle (S.R.H.)
| | - Wendy S Post
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - Steven J Shea
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, NY (S.J.S.)
| | - Norrina B Allen
- Preventive Medicine (Epidemiology), Institute for Public Health and Medicine (IPHAM) - Center for Epidemiology and Population Health, Chicago (N.B.A.)
| | - Karol E Watson
- Division of Cardiology, University of California, Los Angeles (K.E.W.)
| | - Colin O Wu
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.)
| | - João A C Lima
- From the Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (T.P., B.A.V., H.D.D.V., Y.K., M.S., E.X., W.S.P., C.O.W., J.A.C.L.)
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44
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Zhang Z, Ma Q, Gao Y, Cao L, Zhu C, Zhao Z, Zhao J, Zeng L, Lou M, Pohost GM, Li K. Biventricular Morphology and Function Reference Values Derived From a Large Sample of Healthy Chinese Adults by Magnetic Resonance Imaging. Front Cardiovasc Med 2021; 8:697481. [PMID: 34350219 PMCID: PMC8326328 DOI: 10.3389/fcvm.2021.697481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Quantification of cardiac structure and function is essential for diagnostic interpretation and clinical decision making. We sought to establish cardiovascular magnetic resonance (CMR) reference values of left and right ventricular (LV and RV) morphology and function based on a large sample of healthy Chinese adults. Methods: Five hundred fifty validated healthy Chinese adults (aged 21-70 years; 323 men) free of hypertension, diabetes, and obesity were included in this study. All the subjects were stratified by gender (men and women) and age decades. On cine CMR, measurements of biventricular end-diastolic, end-systolic, and stroke volumes (EDV, ESV, and SV), ejection fraction (EF), and end-diastolic LV wall thickness (LVWT) and mass (LVM) were obtained. Results: Men had greater LVEDV (111.6 ± 19.8 vs. 94.6 ± 15.6 ml), LVESV (36.5 ± 9.8 vs. 28.2 ± 7.9 ml), LVM (121.1 ± 19.9 vs. 86.1 ± 14.5 g), global end-diastolic LVWT (8.1 ± 1.1 vs. 6.7 ± 1.0 mm), RVEDV (128.0 ± 23.6 vs. 101.7 ± 17.0 ml), and RVESV (53.5 ± 13.7 vs. 36.8 ± 8.9 ml), while women had greater LVEF (67.5 ± 5.4 vs. 70.4 ± 5.7%) and RVEF (58.5 ± 5.2 vs. 64.0 ± 5.3%) (all p < 0.001). For both men and women, age was negatively correlated with LVEDV (r = -0.31 and r = -0.32), LVESV (r = -0.37 and r = -0.47), RVEDV (r = -0.31 and r = -0.29), and RVESV (r = -0.33 and r = -0.44), while it was positively correlated with LVEF (r = 0.28 and r = 0.43) and RVEF (r = 0.28 and r = 0.41) (all p < 0.001). Aging was associated with increasing global end-diastolic LVWT and LVM/LVEDV in both sexes (all p < 0.001). Older age was associated with increasing LVM only in women (r = 0.36, p < 0.001), not in men (r = 0.05, p = 0.359). Conclusions: We systematically provide age-, sex-, and body size-specific CMR reference values for biventricular morphology and function based on a large sample of healthy Chinese adults. Biventricular structure and function are significantly associated with age and sex.
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Affiliation(s)
- Zhen Zhang
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qiaozhi Ma
- Department of Radiology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yiyuan Gao
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lizhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Zhiwei Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Jun Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Linan Zeng
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Mingwu Lou
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Gerald M Pohost
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
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45
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Peplinski BS, Houston BA, Bluemke DA, Kawut SM, Kolb TM, Kronmal RA, Lima JAC, Ralph DD, Rayner SG, Steinberg ZL, Tedford RJ, Leary PJ. Associations of Angiopoietins With Heart Failure Incidence and Severity. J Card Fail 2021; 27:786-795. [PMID: 33872759 PMCID: PMC8277723 DOI: 10.1016/j.cardfail.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Angiopoietin-1 and 2 (Ang1, Ang2) are important mediators of angiogenesis. Angiopoietin levels are perturbed in cardiovascular disease, but it is unclear whether angiopoietin signaling is causative, an adaptive response, or merely epiphenomenon of disease activity. METHODS AND RESULTS In a cohort free of cardiovascular disease at baseline (Multi-Ethnic Study of Atherosclerosis [MESA]), relationships between angiopoietins, cardiac morphology, and subsequent incidence of heart failure or cardiovascular death were evaluated. In cohorts with pulmonary arterial hypertension or left heart disease, associations between angiopoietins, invasive hemodynamics, and adverse clinical outcomes were evaluated. In MESA, Ang2 was associated with a higher incidence of heart failure or cardiovascular death (hazard ratio 1.21 per standard deviation, P < .001). Ang2 was associated with increased right atrial pressure (pulmonary arterial hypertension cohort) and increased wedge pressure and right atrial pressure (left heart disease cohort). Elevated Ang2 was associated with mortality in the pulmonary arterial hypertension cohort. CONCLUSIONS Ang2 was associated with incident heart failure or death among adults without cardiovascular disease at baseline and with disease severity in individuals with existing heart failure. Our finding that Ang2 is increased before disease onset and that elevations reflect disease severity, suggests Ang2 may contribute to heart failure pathogenesis.
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Affiliation(s)
| | - Brian A Houston
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - David A Bluemke
- University of Wisconsin, Department of Radiology, Madison, WI
| | - Steven M Kawut
- Perelman School of Medicine at the University of Pennsylvania, Departments of Medicine and Epidemiology, Philadelphia, PA
| | - Todd M Kolb
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD
| | | | - Joao A C Lima
- Johns Hopkins Hospital, Department of Medicine, Baltimore, MD; Johns Hopkins Hospital, Department of Radiology, Baltimore, MD
| | - David D Ralph
- University of Washington, Department of Medicine, Seattle, WA
| | - Samuel G Rayner
- University of Washington, Department of Medicine, Seattle, WA
| | | | - Ryan J Tedford
- Medical University of South Carolina, Department of Medicine, Charleston, SC
| | - Peter J Leary
- University of Washington, Department of Medicine, Seattle, WA; University of Washington, Department of Epidemiology, Seattle, WA.
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van der Ven JPG, Sadighy Z, Valsangiacomo Buechel ER, Sarikouch S, Robbers-Visser D, Kellenberger CJ, Kaiser T, Beerbaum P, Boersma E, Helbing WA. Multicentre reference values for cardiac magnetic resonance imaging derived ventricular size and function for children aged 0-18 years. Eur Heart J Cardiovasc Imaging 2021; 21:102-113. [PMID: 31280290 PMCID: PMC6923680 DOI: 10.1093/ehjci/jez164] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR) imaging is an important tool in the assessment of paediatric cardiac disease. Reported reference values of ventricular volumes and masses in the paediatric population are based on small cohorts and several methodologic differences between studies exist. We sought to create steady-state free precession (SSFP) CMR reference values for biventricular volumes and mass by combining data of previously published studies and re-analysing these data in a standardized manner. Methods and results A total of 141 healthy children (68 boys) from three European centres underwent cine-SSFP CMR imaging. Cardiac structures were manually contoured for end-diastolic and end-systolic phases in the short-axis orientation according to current standardized CMR post-processing guidelines. Volumes and masses were derived from these contours. Age-related reference curves were constructed using the lambda mu sigma method. Median age was 12.7 years (range 0.6–18.5). We report biventricular volumes and masses, unindexed and indexed for body surface area, stratified by age groups. In general, boys had approximately 15% higher biventricular volumes and masses compared with girls. Only in children aged <6 years old no gender differences could be observed. Left ventricle ejection fraction was slightly higher in boys in this study population (median 67% vs. 65%, P = 0.016). Age-related reference curves showed non-linear relations between age and cardiac parameters. Conclusion We report volumetric SSFP CMR imaging reference values for children aged 0–18 years old in a relatively large multi-centre cohort. These references can be used in the follow-up of paediatric cardiac disease and for research purposes.
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Affiliation(s)
- J P G van der Ven
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Netherlands Heart Institute, Moreelsepark 1, EP, Utrecht, The Netherlands
| | - Z Sadighy
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
| | | | - S Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - D Robbers-Visser
- Department of Cardiology, Amsterdam Medical Center, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
| | - C J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - T Kaiser
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - P Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Center, Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
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47
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Rapid cardiac MRI protocol for cardiac assessment in paediatric and young adult patients undergoing haematopoietic stem cell transplant: a feasibility study. Cardiol Young 2021; 31:973-978. [PMID: 33504397 DOI: 10.1017/s1047951120004990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Haematopoietic stem cell transplantation is an important and effective treatment strategy for many malignancies, marrow failure syndromes, and immunodeficiencies in children, adolescents, and young adults. Despite advances in supportive care, patients undergoing transplant are at increased risk to develop cardiovascular co-morbidities. METHODS This study was performed as a feasibility study of a rapid cardiac MRI protocol to substitute for echocardiography in the assessment of left ventricular size and function, pericardial effusion, and right ventricular hypertension. RESULTS A total of 13 patients were enrolled for the study (age 17.5 ± 7.7 years, 77% male, 77% white). Mean study time was 13.2 ± 5.6 minutes for MRI and 18.8 ± 5.7 minutes for echocardiogram (p = 0.064). Correlation between left ventricular ejection fraction by MRI and echocardiogram was good (ICC 0.76; 95% CI 0.47, 0.92). None of the patients had documented right ventricular hypertension. Patients were given a survey regarding their experiences, with the majority both perceiving that the echocardiogram took longer (7/13) and indicating they would prefer the MRI if given a choice (10/13). CONCLUSION A rapid cardiac MRI protocol was shown feasible to substitute for echocardiogram in the assessment of key factors prior to or in follow-up after haematopoietic stem cell transplantation.
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Free fatty acids and heart failure in the Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Lipidol 2021; 15:608-617. [PMID: 34244123 DOI: 10.1016/j.jacl.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Free fatty acids (FFAs) may be associated with heart failure (HF) risk, but prospective research is lacking. OBJECTIVE This study investigated associations between fasting FFAs and HF incidence overall and by ejection fraction (EF) subtypes [HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF)] to evaluate FFAs as a potential biomarker for HF risk prediction. METHODS This study was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort among 6,667 participants with complete baseline (2000-2002) FFAs and HF follow-up (through 2015). Associations between FFAs and HF incidence were evaluated with Cox proportional hazards regression. Cross-sectional associations between FFAs and HF risk markers were also evaluated using linear regression [N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular (LV) mass index] and logistic regression [LV hypertrophy (LVH)]. Stratification and cross-product terms were utilized to evaluate differences by age, sex, race/ethnicity and diabetes. RESULTS FFAs were not associated with HF overall or with HFrEF. FFAs were not associated with HFpEF in the overall population or among males, but were borderline positively associated with risk among females (fully-adjusted tertile 3 vs. 1 HR=2.17, 95% CI: 1.06, 4.42) (sex P-interaction=0.05). FFAs were not associated with NT-proBNP, but were inversely associated with LV mass index and LVH with stronger associations among females (P-interaction≥0.10). Associations did not differ by age, race/ethnicity or diabetes status. CONCLUSIONS FFAs generally do not appear to be an independent predictor for HF risk. Additional research is needed to confirm findings particularly studies evaluating associations by sex and EF subtypes.
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Balu N, Ordovas KG. Editorial for "Myocardial T1 Values at 1.5 T: Normal Values for General Electric Scanners and Sex-Related Differences". J Magn Reson Imaging 2021; 54:1501-1502. [PMID: 33949735 DOI: 10.1002/jmri.27675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Karen G Ordovas
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Vasan RS, Musani SK, Matsushita K, Beard W, Obafemi OB, Butler KR, Chang PP, Mosley TH, Fox E. Epidemiology of Heart Failure Stages in Middle-Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2021; 10:e016524. [PMID: 33880930 PMCID: PMC8200743 DOI: 10.1161/jaha.120.016524] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993-1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0: no risk factors; (2) Stage A: presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B: presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D: prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all-cause mortality on follow-up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow-up (median 19.0 years), 309 participants developed overt HF, 390 incurred new-onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person-years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5- to 2-fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community-based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.
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Affiliation(s)
- Ramachandran S. Vasan
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Section of CardiologyDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Solomon K. Musani
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Kunihiro Matsushita
- Department of EpidemiologyJohn Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Walter Beard
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | | | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Patricia P. Chang
- Division of CardiologyDepartment of MedicineUniversity of North Carolina at Chapel HillNC
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Ervin Fox
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
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