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Alashi A, Vermillion BC, Sinusas AJ. The Potential Role of PET in the Management of Peripheral Artery Disease. Curr Cardiol Rep 2023; 25:831-839. [PMID: 37314651 DOI: 10.1007/s11886-023-01904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW Current non-invasive tests for evaluating patients with peripheral artery disease (PAD) have significant limitations for early detection and management of patients with PAD and are generally focused on the evaluation of large vessel disease. PAD often involves disease of microcirculation and altered metabolism. Therefore, there is a critical need for reliable quantitative non-invasive tools that can assess limb microvascular perfusion and function in the setting of PAD. RECENT FINDINGS Recent developments in positron emission tomography (PET) imaging have enabled the quantification of blood flow to the lower extremities, the assessment of the viability of skeletal muscles, and the evaluation of vascular inflammation and microcalcification and angiogenesis in the lower extremities. These unique capabilities differentiate PET imaging from current routine screening and imaging methods. The purpose of this review is to highlight the promising role of PET in the early detection and management of PAD providing a summary of the current preclinical and clinical research related to PET imaging in patients with PAD and related advancement of PET scanner technology.
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Affiliation(s)
- Alaa Alashi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, DANA 3, New Haven, CT, 06520-8017, USA
| | - Billy C Vermillion
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, DANA 3, New Haven, CT, 06520-8017, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, DANA 3, New Haven, CT, 06520-8017, USA.
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2
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Hutt E, Mentias A, Alashi A, Wadhwa R, Fava A, Lever HM, Thamilarasan M, Popovic ZB, Smedira NG, Desai MY. Prognostic value of age-sex adjusted NT-proBNP ratio in obstructive hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2022; 74:11-18. [PMID: 35952727 DOI: 10.1016/j.pcad.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND We sought to determine the incremental prognostic value of age-sex adjusted N-terminal prohormone brain natriuretic peptide (NT-pro BNP) ratio in obstructive hypertrophic cardiomyopathy (oHCM) patients. METHODS The study included 2119 consecutive oHCM patients (age 55 ± 13 years, 53% men, maximal LVOT ≥30 mmHg) evaluated between 6/2002-12/2018 with BNP or NT-pro BNP measured at baseline. NT-pro BNP ratio was calculated as: NT-proBNP/ upper limit of normal NT-proBNP derived from age-sex matched controls. Septal reduction therapy (SRT) during follow-up was recorded. Primary endpoint was death, need for cardiac transplantation or appropriate internal cardioverter defibrillator (ICD) discharge. RESULTS Median NT-proBNP ratio was 5.4 (IQR 2.1-12.3). Using spline analysis, log-transformed NT-pro BNP ratio of 2 (corresponding to NT-pro BNP ratio of 6) was the optimal value where primary endpoint hazards crossed 1; there were 966 patients with high and 1153 patients with low NT-pro BNP ratio. 1665 (79%) patients underwent SRT at 47 days (IQR 7-128 days). At 5.4 years of follow-up (IQR 2.8-9.2 years), the primary outcome occurred in 315 (15%) patients (deaths = 270). High NT-pro BNP ratio was associated with higher risk of primary outcome in unadjusted (30.1 vs. 17.2 events/1000 person-year, hazard ratio or (HR) 1.73, 1.37-2.17, P < 0.001) and adjusted analysis (aHR 1.69, 95% 1.19-2.38, P = 0.003) vs. low NT-pro BNP ratio. Even in asymptomatic patients, NT-pro BNP ratio remained associated with primary outcome (aHR 1.28, 95% CI 1.06-1.54, P = 0.01). CONCLUSIONS Age-sex adjusted NT-pro BNP ratio is independently associated with long-term outcomes in oHCM patients, including in a subgroup of asymptomatic patients.
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Affiliation(s)
- Erika Hutt
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amgad Mentias
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Alaa Alashi
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Raoul Wadhwa
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Agostina Fava
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Harry M Lever
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Maran Thamilarasan
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Zoran B Popovic
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Nicholas G Smedira
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Milind Y Desai
- From the Hypertrophic Cardiomyopathy Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Fadah K, Lopes J, Chaudhry MR, Alashi A, Deoker A, Borges J, Mukherjee D. DEMOGRAPHIC AND CLINICAL DIFFERENCES IN PATENT FORAMEN OVALE AND RELATED CLOSURE PROCEDURES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Cardiovascular disease secondary to diabetes continues to threaten the survivability of many people all over the world. We assess the most recent findings of synergistic effects of combined glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in lowering cardiac complications in the diabetic population. We describe drug therapies' mechanism of action, postulated cardioprotective process, the additive value of conjugated therapy, and analyze recently reported study and its limitation. RECENT FINDINGS SGLT2 inhibitors and GLP-1RAs have gained popularity due to their ability to reduce major adverse cardiovascular events in diabetic patients. There is emerging evidence of the additional cardiovascular benefit from the combined application of SGLT2 inhibitors and GLP-1RAs therapy demonstrated by a recent real-world cohort study. Reducing cardiac mortality in patients with diabetes by administering dual antihyperglycemic therapies (GLP-1Rs and SGLT2 inhibitors) might play a key role in the future treatment of the diabetic population.
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Affiliation(s)
- Kahtan Fadah
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX, 79905, USA
| | - Alaa Alashi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX, 79905, USA
| | - Abhizith Deoker
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
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Desai MY, Alashi A, Popovic ZB, Wierup P, Griffin BP, Thamilarasan M, Johnston D, Svensson LG, Lever HM, Smedira NG. Outcomes in Patients With Obstructive Hypertrophic Cardiomyopathy and Concomitant Aortic Stenosis Undergoing Surgical Myectomy and Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e018435. [PMID: 34533040 PMCID: PMC8649531 DOI: 10.1161/jaha.120.018435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. We sought to report the characteristics and longer-term outcomes of patients with severe obstructive HCM who also had concomitant moderate or severe aortic stenosis requiring surgical myectomy and aortic valve replacement. Methods and Results We studied 191 consecutive patients (age 67±6 years, 52% men) who underwent myectomy and aortic valve (AV) replacement (90% bioprosthesis) at our center between June 2002 and June 2018. Clinical and echo data including left ventricular outflow tract gradient and indexed AV area were recorded. The primary outcome was death. Prevalence of hypertension (63%) and hyperlipidemia (75%) were high, with a Society of Thoracic Surgeons score of 5±4, and 70% of participants had no HCM-related sudden death risk factors. Basal septal thickness and indexed AV area were 1.9±0.4 cm and 0.72±0.2 cm2/m2, respectively, while 100% of patients had dynamic left ventricular outflow tract gradient >50 mm Hg. At 6.5±4 years, 52 (27%) patients died (1.5% in-hospital deaths). One-, 2-, and 5-year survival in the current study sample was 94%, 91%, and 83%, respectively, similar to an age-sex-matched general US population. On multivariate Cox survival analysis, age (hazard ratio [HR], 1.65; 95% CI, 1.24-2.18), chronic kidney disease (HR, 1.58; 95% CI, 1.21-2.32), and right ventricular systolic pressure on preoperative echocardiography (HR, 1.28; 95% CI, 1.05-1.57) were associated with longer-term mortality, but traditional HCM risk factors did not. Conclusions In symptomatic patients with severely obstructive HCM and moderate or severe aortic stenosis undergoing a combined surgical myectomy and AV replacement at our center, the observed postoperative mortality was significantly lower than the expected mortality, and the longer-term survival was similar to a normal age-sex-matched US population.
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Affiliation(s)
- Milind Y Desai
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Alaa Alashi
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Brian P Griffin
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Douglas Johnston
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Lars G Svensson
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
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Raizada V, Sato K, Alashi A, Kumar A, Kwon D, Ramchand J, Dillenbeck A, Zumwalt RE, Vangala AS, Earley TD, Klein A. Depressed right ventricular systolic function in heart failure due to constrictive pericarditis. ESC Heart Fail 2021; 8:3119-3129. [PMID: 34137193 PMCID: PMC8318427 DOI: 10.1002/ehf2.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Heart failure in constrictive pericarditis (CP) is attributed to impaired biventricular diastolic filling. However, diseases that cause CP due to myocardial infiltration and fibrosis can also impair biventricular systolic function (sf) and contribute to heart failure. This study of patients with CP examined biventricular sf and the effect of myocardial infiltration by pericardial diseases and the resulting fibrosis on ventricular sf. Methods and results Histopathologic examinations of right ventricular (RV) and left ventricular (LV) myocardia and pericardia were performed on three autopsied hearts of patients with pericardial diseases. Additionally, in 40 adults with clinical heart failure and 40 healthy adults (controls), sf of both ventricles was examined by echocardiography, including strain measurements, and biventricular diastolic filling and pulmonary artery pressures were assessed by cardiac catheterization. Cardiac histopathology indicated thickening of the pericardium with fibrosis, disease infiltrating the myocardium, greater infiltration of the RV than the LV, and an association of pericardial thickness with myocardial infiltrations. Functional analysis indicated that RVsf was impaired on all echo indices, including strain measurement, but LVsf was preserved. Conclusions Diseases causing CP are not restricted to the pericardium but also infiltrate the biventricular myocardium and affect the thin‐walled RV more than the thick‐walled LV, resulting in depressed RVsf. The present results help explain clinical heart failure in the presence of restricted diastolic filling in CP. Depression of RVsf due to progression of fibrosis in the RV myocardium may increase the risk of delayed pericardiectomy.
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Affiliation(s)
- Veena Raizada
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Blvd, Albuquerque, NM, 87131, USA
| | - Kimi Sato
- Department of Internal Medicine, Cardiology Division, University of Tsukuba, Tsukuba, Japan
| | - Alaa Alashi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Jay Ramchand
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Amy Dillenbeck
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Ross E Zumwalt
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Blvd, Albuquerque, NM, 87131, USA
| | - Adarsh S Vangala
- Department of Internal Medicine, Arizona Health Sciences Center, Tucson, AZ, USA
| | - Tyler D Earley
- Department of Internal Medicine, Samaritan Health Services, Corvallis, OR, USA
| | - Allan Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
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Hutt E, Mentias A, Alashi A, Fava A, Popovic Z, Thamilarasan M, Wierup P, Smedira N, Lever H, Desai M. INCREMENTAL PROGNOSTIC VALUE OF NT-PROBNP IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY PATIENTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Smolka S, Alashi A, Marwan M, Fava A, Hutt E, Schoenhagen P, Popovic Z, Cremer P, Rodriguez LL, Flamm S, Achenbach S, Desai M. INCREMENTAL PROGNOSTIC UTILITY OF CT-FFR IN PATIENTS WITHOUT KNOWN CORONARY ARTERY DISEASE UNDERGOING CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alashi A, Svensson L, Klein J, Zahka K, Smedira NG, Najm H, Lever HM, Aziz P, Desai MY. Characteristics and Longer-Term Outcomes of Contemporary Patients <18 Years of Age With Hypertrophic Cardiomyopathy. Am J Cardiol 2021; 140:110-117. [PMID: 33159906 DOI: 10.1016/j.amjcard.2020.10.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
We describe characteristics and outcomes of contemporary pediatric hypertrophic cardiomyopathy (PHC) patients. We studied 398 consecutive pediatric HC patients (<18 years, median 14 years, 65% boys) seen at our center between 2002 and 2018. Baseline clinical and pediatric echocardiographic data was collected. Left ventricular outflow tract gradient (LVOTG), LV fractional shortening and Z-score for left ventricular (LV) wall thickness were calculated. Sudden cardiac death (SCD), appropriate internal defibrillator discharge (ICD), myectomy, and orthotopic heart transplant (OHT) were composite primary endpoint. A total of 133 (33%) had symptoms (71 [18%] dyspnea, 77 [19%] angina, and 19 [5%] syncope), 109 (27%) were on beta-blockers; 179 (45%) had family history of HC. A total of 146 (37%) underwent genetic testing (of which 91 (62%) were HC-gene positive). Basal septal LV thickness, septal LV z-score and fractional shortening were 1.2 ± 0.6 cm, 4.8 ± 5.6, and 42% ± 8, whereas 23% had extreme LV hypertrophy (z-score > 6) and 8% had LVOTG >30 mm Hg (range 0 to 139 mm Hg). At a median of 5.9 years (interquartile range 2.4, 9), there were 23 (6%) ICD's placed, and 47 (12%) primary composite events (9 [2%] deaths, 3 [1%] appropriate ICD discharge, 29 [7%] myectomy, and 8 [2%] OHT). There were no in hospital deaths following myectomy/OHT. Presence of symptoms (Hazard ratio or HR 2.45), ventricular tachycardia (HR 1.52), and higher basal septal LV z-score (HR 1.10) were independently associated with primary composite outcomes. LV septal z-score >4 was independently associated with events on spline analysis. Rate of SCD/appropriate ICD discharge was 0.5%/year. In conclusion, contemporary PHC patients seen at an experienced center have excellent outcomes with presence of symptoms and higher LV septal thickness associated with primary composite events.
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Alashi A, Smedira NG, Popovic ZB, Fava A, Thamilarasan M, Kapadia SR, Wierup P, Lever HM, Desai MY. Characteristics and Outcomes of Elderly Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2021; 10:e018527. [PMID: 33506683 PMCID: PMC7955450 DOI: 10.1161/jaha.120.018527] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background We report characteristics and outcomes of elderly patients with hypertrophic cardiomyopathy (HCM) with basal septal hypertrophy and dynamic left ventricular outflow tract obstruction. Methods and Results We studied 1110 consecutive elderly patients with HCM (excluding moderate or greater aortic stenosis or subaortic membrane, age 80±5 years [range, 75–92 years], 66% women), evaluated at our center between June 2002 and December 2018. Clinical and echocardiographic data, including maximal left ventricular outflow tract gradient, were recorded. The primary outcome was death and appropriate internal defibrillator discharge. Hypertension was observed in 72%, with a Society of Thoracic Surgeons (STS) score (8.6±6); while 80% had no HCM‐related sudden cardiac death risk factors. Left ventricular mass index, basal septal thickness, and maximal left ventricular outflow tract gradient were 127±43 g/m2, 1.7±0.4 cm, and 49±31 mm Hg, respectively. A total of 597 (54%) had a left ventricular outflow tract gradient >30 mm Hg, of which 195 (33%) underwent septal reduction therapy (SRT; 79% myectomy and 21% alcohol ablation). At 5.1±4 years, 556 (50%) had composite events (273 [53%] in nonobstructive, 220 [55%] in obstructive without SRT, and 63 [32%] in obstructive subgroup with SRT). One‐ and 5‐year survival, respectively were 93% and 63% in nonobstructive, 90% and 63% in obstructive subgroup without SRT, and 94% and 84% in the obstructive subgroup with SRT. Following SRT, there were 5 (2.5%) in‐hospital deaths (versus an expected Society of Thoracic Surgeons mortality of 9.2%). Conclusions Elderly patients with HCM have a high prevalence of traditional cardiovascular rather than HCM risk factors. Longer‐term outcomes of the obstructive SRT subgroup were similar to a normal age‐sex matched US population.
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Affiliation(s)
- Alaa Alashi
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Agostina Fava
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
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Alashi A, Smedira NG, Hodges K, Popovic ZB, Thamilarasan M, Wierup P, Lever HM, Desai MY. Outcomes in Guideline-Based Class I Indication Versus Earlier Referral for Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy. J Am Heart Assoc 2020; 10:e016210. [PMID: 33342243 PMCID: PMC7955478 DOI: 10.1161/jaha.120.016210] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background In patients with obstructive hypertrophic cardiomyopathy, surgical myectomy (SM) is indicated for severe symptoms. We sought to compare long‐term outcomes of patients with obstructive hypertrophic cardiomyopathy where SM was based on guideline‐recommended Class I indication (Functional Class or FC ≥3 or angina/exertional syncope despite maximal medical therapy) versus earlier (FC 2 and/or impaired exercise capacity on exercise echocardiography with severe obstruction). Methods and Results We studied 2268 consecutive patients (excluding <18 years, ≥ moderate aortic stenosis and subaortic membrane, 56±14 years, 55% men), who underwent SM at our center between June 2002 and March 2018. Clinical data, including left ventricular outflow tract gradient, were recorded. Death and/or appropriate internal defibrillator discharge were primary composite end points. One thousand three hundred eighteen (58%) patients met Class I indication and 950 (42%) underwent earlier surgery; 222 (10%) had a history of obstructive coronary artery disease. Basal septal thickness, and resting and maximal left ventricular outflow tract gradient were 2.0±0.3 cm, 61±44 mm Hg, and 100±31 mm Hg, respectively. At 6.2±4 years after SM, 248 (11%) had composite events (13 [0.6%] in‐hospital deaths). Age (hazard ratio [HR], 1.61; 95% CI, 1.26–1.91), obstructive coronary artery disease (HR, 1.46; 95% CI, 1.06–1.91), and Class I versus earlier SM (HR, 1.61; 95% CI, 1.14–2.12) were associated with higher primary composite events (all P<0.001). Earlier surgery had better longer‐term survival (similar to age‐sex‐matched normal population) versus surgery for Class I indication (76 [8%] versus 193 [15%], P<0.001). Conclusions In patients with obstructive hypertrophic cardiomyopathy, earlier versus surgery for Class I indication had a better long‐term survival, similar to the age‐sex‐matched US population.
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Affiliation(s)
- Alaa Alashi
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Kevin Hodges
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
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12
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Isaza N, Alashi A, Faulx J, Popovic ZB, Menon V, Ellis SG, Faulx M, Kapadia SR, Griffin BP, Desai MY. Impact of Temporal Changes in Left Ventricular Systolic Function on Outcomes in Takotsubo Cardiomyopathy. JACC Cardiovasc Imaging 2020; 14:1273-1274. [PMID: 33341418 DOI: 10.1016/j.jcmg.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
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Fava A, Sande Mathias I, Alashi A, Saijo Y, Popovic Z, Thamilarasan M, Lever H, Desai M. Diastolic stress test echocardiography in patients with hypertrophy cardiomyopathy: association with exercise capacity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diastolic dysfunction (DD) is a frequent occurrence in hypertrophic cardiomyopathy (HCM) patients. Symptoms of DD are often unmasked only during exercise, as left ventricular (LV) filling pressure is normal at rest.
Purpose
We sought to establish if abnormal DST parameters are associated with reduced exercise capacity in HCM patients.
Methods
We examined 590 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) with HCM by echocardiography at rest & maximal exercise. Septal and lateral [e'] mitral annular velocity, peak early [E] and late [A] mitral inflow velocity, Mitral E/e' and left atrial volume index (LAVI) was recorded. Exercise functional capacity was stablished as age-gender predicted metabolic equivalents (AGP-METs).
Results
Echocardiography at rest had LVEF of 62±6, wall thickness of 16.7±0.5 mm, LVMI of 111±43 g m–2, LVOT gradient of 26±33 mmHg, LAVI 34.5±17 mm, E/A ratio of 1.2±0.6, and average E/e' ratio 12.7±0.6. Following maximal exercise had a mean LVOT gradient of 61±59 mmHg, E/A ratio of 1.2±1.0 and average E/e' ratio 12.7±1.0. Only 42% had >85% of age-sex predicted METs. Logistic regression analysis testing the association between various predictors and 85% AGP-METs are shown in table 1.
Conclusion
There is a significant association between abnormal diastolic response to exercise and reduced exercise capacity in patients with HCM.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.M Fava
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - I Sande Mathias
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Saijo
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Thamilarasan
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Lever
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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14
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Fava A, Alashi A, Saijo Y, Sande Mathias I, Popovic Z, Thamilarasan M, Lever H, Desai M. Exercise capacity is associated with rest and peak-exercise left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) frequently have reduced exercise capacity, which can be associated with subclinical cardiac dysfunction. Left ventricle global myocardial strain (LV-GLS) is a sensitive index to detect subclinical myocardial dysfunction. However, the clinical utility of LV-GLS during exercise test remains uncertain.
Purpose
We assessed the association of functional capacity with LV-GLS at rest and at the peak of stress in HCM patients.
Methods
We examined 566 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) by echo at rest and following maximal exercise. We recorded clinical, echo variables (LV ejection fraction [LVEF], LV thickness, left ventricle mass index [LVMI], left ventricle outflow tract [LVOT] gradient, LV-GLS at rest and at peak stress), and exercise variables (percent of age-gender predicted metabolic equivalents [AGP-METs]).
Results
Echo parameters were as follows: LVEF at rest of 62±6%, wall thickness of 16.9±0.4 mm, LVMI of 117±47 g/m2, LVOT gradient at rest of 27±33 mmHg, LV-GLS at rest of −15.9±3.6%, LV-GLS at peak of stress of −17.4±4.3%, and change in LV strain from rest to stress of −1.9±2.3%. Only 41% of patients achieved >85% of AGP-METs. Logistic regression demonstrating an association between AGP-METs less than 85% and various predictors are shown in Table 1.
Conclusion
Impaired deformation at peak of stress assessed by LV-GLS was associated with reduced exercise capacity measured as AGP-METs less than 85%. These findings suggest that early systolic cardiac deterioration should be considered as a cause of exercise impairment in patients with HCM.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.M Fava
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Saijo
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - I Sande Mathias
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Thamilarasan
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Lever
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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15
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Kotanidis C, Akawi N, Thomas S, Siddique M, Oikonomou E, Alashi A, Akoumianakis I, Antonopoulos A, Krasopoulos G, Sayeed R, Neubauer S, Channon K, Desai M, Antoniades C. A novel arterial redox-specific machine learning-derived radiomic signature of perivascular adipose tissue predicts cardiac mortality from routine CCTA. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vascular oxidative stress is involved in inflammation and atherogenesis. Vascular inflammation induces spatial changes in perivascular adipose tissue (PVAT) composition, which can be detected by radiomic analysis of coronary computed tomography angiography (CCTA) images.
Purpose
To explore the association of arterial oxidative stress with long-term risk of major adverse cardiovascular events (MACE). To develop a radiomic signature to identify high oxidative stress non-invasively using CCTA. Finally, to assess the ability of this signature to predict future cardiac risk.
Methods
Arm 1 included 272 patients undergoing cardiac surgery. Segments of internal mammary artery (IMA) were used for ex-vivo quantification of NADPH-stimulated and Vas2870 (pan-NOX inhibitor) inhibitable superoxide production by lucigenin-enhanced chemiluminescence. Eighty-two of these patients with CCTA scans available constituted Arm 2. Peri-IMA PVAT was segmented and used to extract 1,616 radiomic features, which, after filtering (40 final features), were utilised to train extreme gradient boosting, a machine learning algorithm, to predict high arterial oxidative stress. Arm 3 included a nested cohort of 308 participants (41 suffering cardiac death and 267 matched controls) from the CRISP-CT (Cardiovascular RISk Prediction using Computed Tomography) study to externally validate the redox-specific signature developed in Arm 2 for cardiac risk prediction.
Results
Over a median follow-up of 40 months, 18 (6.6%) MACE (cardiovascular death, non-fatal myocardial infarction, and stroke) occurred in Arm 1. High arterial NADPH-stimulated superoxide was independently associated with MACE risk (Adj. HR[95% CI]: 1.61 [1.04–2.53] per SD, p=0.03, adjusted for age, sex, diabetes, hypertension, hyperlipidemia, smoking, obesity, and plasma TNFa). Unsupervised hierarchical clustering of radiomic features from peri-IMA PVAT segments in Arm 2 identified two distinct clusters (A) that differed in NADPH stimulated (p=0.01) and Vas2870 inhibitable (p=0.04) IMA superoxide (B), supporting the hypothesis that PVAT mapping can capture changes corresponding to differential levels of underlying vascular redox state. This prompted the development of a radiomic signature specific to PVAT alterations associated with high vascular oxidative stress, which was validated in Arm 3 (AUC:0.61, p=0.026, C). The novel signature was able to stratify cardiac risk in the validation set, independently of the Fat Attenuation Index, epicardial adipose tissue volume, high-risk plaque features, and obstructive CAD (Adj. HR [95% CI]:2.56 [1.35–4.87], p=0.004, D).
Conclusion
Increased arterial oxidative stress predicts cardiac risk in patients with advanced atherosclerosis. We present for the first time a novel, non-invasive CCTA imaging biomarker reflecting changes in vascular redox state by radiomic phenotyping of perivascular space, which stratifies cardiac risk beyond standard and newer risk assessment methods.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation, National Institute of Health Research, Oxford Biomedical Research Centre
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Affiliation(s)
- C.P Kotanidis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - N Akawi
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Thomas
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Siddique
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - E.K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - I Akoumianakis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A.S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - G Krasopoulos
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiothoracic Surgery, Oxford, United Kingdom
| | - R Sayeed
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiothoracic Surgery, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K.M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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16
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Dunn AN, Donnellan E, Johnston DR, Alashi A, Reed GW, Jellis C, Krishnaswamy A, Gillinov AM, Svensson LG, Ellis S, Griffin BP, Kapadia SR, Pettersson GB, Desai MY. Long-Term Outcomes of Patients With Mediastinal Radiation-Associated Coronary Artery Disease Undergoing Coronary Revascularization With Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting. Circulation 2020; 142:1399-1401. [PMID: 33017210 DOI: 10.1161/circulationaha.120.046575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine, OH (A.N.D.)
| | - Eoin Donnellan
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Douglas R Johnston
- Cardiothoracic Surgery (D.R.J., A.M.G., L.G.S.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Alaa Alashi
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Grant W Reed
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Christine Jellis
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Amar Krishnaswamy
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - A Marc Gillinov
- Cardiothoracic Surgery (D.R.J., A.M.G., L.G.S.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Lars G Svensson
- Cardiothoracic Surgery (D.R.J., A.M.G., L.G.S.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Stephen Ellis
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Brian P Griffin
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Samir R Kapadia
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Gosta B Pettersson
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y Desai
- Departments of Cardiovascular Medicine (E.D., A.A., G.W.R., C.J., A.K.., S.E., B.P.G., S.R.K., G.B.P., M.Y.D.), Heart and Vascular Institute, Cleveland Clinic, OH
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17
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Riaz H, Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Cremer P, Jaber W, Griffin BP, Desai MY. Exaggerated blood pressure response on exercise treadmill testing and longer term outcomes in primary prevention. Eur Heart J Qual Care Clin Outcomes 2020; 6:343-344. [PMID: 32514546 DOI: 10.1093/ehjqcco/qcaa043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/30/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Haris Riaz
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alaa Alashi
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Richard Lang
- Department of Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Raul Seballos
- Department of Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Feinleib
- Department of Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Roxanne Sukol
- Department of Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Leslie Cho
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Paul Cremer
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wael Jaber
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Brian P Griffin
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Milind Y Desai
- Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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18
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Alashi A, Isaza N, Faulx J, Popovic ZB, Menon V, Ellis SG, Faulx M, Kapadia SR, Griffin BP, Desai MY. Characteristics and Outcomes of Patients With Takotsubo Syndrome: Incremental Prognostic Value of Baseline Left Ventricular Systolic Function. J Am Heart Assoc 2020; 9:e016537. [PMID: 32755253 PMCID: PMC7660826 DOI: 10.1161/jaha.120.016537] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background We sought to determine (1) long‐term outcomes in patients presenting with documented Takotsubo syndrome (TS), (2) whether left ventricular global longitudinal strain (LV‐GLS) provides incremental prognostic value, and (3) prognostic cutoffs of LV ejection fraction (LVEF) and LV‐GLS during an acute TS episode. Methods and Results We studied 650 patients with TS (aged 66±14 years, 88% women) who were diagnosed clinically and angiographically between 2006 and 2018. Baseline LVEF and LV‐GLS (using velocity vector imaging) were recorded. The primary end point was all‐cause mortality. TS triggers were unknown (34%), emotional (16%), physical (41%), and neurologic (10%). Mean LVEF and LV‐GLS were 36±10% and −11.6±0.4%; in addition, 94% patients had LVEF <52%, and 80% had apical ballooning. No patient had obstructive coronary artery disease. At a median of 2.2 years (interquartile range, 0.7–4.4), 175 (27%) had died (9% in‐hospital deaths). Multivariate Cox survival analysis revealed that higher age (hazard ratio [HR], 1.35), male sex (HR, 1.75), lower baseline LVEF (HR, 1.02), worse LV‐GLS (HR, 1.04), neurologic trigger (HR, 2.66), and physical trigger (HR, 2.64) were associated with mortality, whereas aspirin (HR, 0.70) and β‐blockers (HR, 0.73) improved survival (all P<0.049). The addition of LVEF and LV‐GLS to clinical markers (age, sex, cardiogenic shock at presentation, and peak troponin I) significantly increased log‐likelihood ratios: clinical (−521.48), clinical plus LVEF (−511.32, P<0.001), and clinical plus LVEF and LV‐GLS (−500.68, P<0.001). On penalized spline analysis, LVEF of 38% and LV‐GLS of −10% were cutoffs below which survival was significantly worse. Conclusions Patients with TS with a neurologic or physical trigger had significantly worse survival than those without such a trigger, with baseline LVEF and LV‐GLS providing incremental prognostic value.
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Affiliation(s)
- Alaa Alashi
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Nicolas Isaza
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Jackson Faulx
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Zoran B Popovic
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Venu Menon
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Michael Faulx
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
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19
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Etiwy M, Akras Z, Gillinov L, Alashi A, Wang R, Blackburn G, Gillinov SM, Phelan D, Gillinov AM, Houghtaling PL, Javadikasgari H, Desai MY. Erratum to accuracy of wearable heart rate monitors in cardiac rehabilitation. Cardiovasc Diagn Ther 2020; 10:644-645. [PMID: 32695646 DOI: 10.21037/cdt.2019.10.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/cdt.2019.04.08.].
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Affiliation(s)
- Muhammad Etiwy
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zade Akras
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alaa Alashi
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Wang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gordon Blackburn
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Dermot Phelan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, Alahdab F, Alashi A, Alipour V, Arabloo J, Azari S, Barthelemy CM, Benziger CP, Berman AE, Bijani A, Carrero JJ, Carvalho F, Daryani A, Durães AR, Esteghamati A, Farid TA, Farzadfar F, Fernandes E, Filip I, Gad MM, Hamidi S, Hay SI, Ilesanmi OS, Naghibi Irvani SS, Jürisson M, Kasaeian A, Kengne AP, Khan AR, Kisa A, Kisa S, Kolte D, Manafi N, Manafi A, Mensah GA, Mirrakhimov EM, Mohammad Y, Mokdad AH, Negoi RI, Thi Nguyen HL, Nguyen TH, Nixon MR, Otto CM, Patel S, Pilgrim T, Radfar A, Rawaf DL, Rawaf S, Rawasia WF, Rezapour A, Roever L, Saad AM, Saadatagah S, Senthilkumaran S, Sliwa K, Tesfay BE, Tran BX, Ullah I, Vaduganathan M, Vasankari TJ, Wolfe CDA, Yonemoto N, Roth GA. Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017. Circulation 2020; 141:1670-1680. [PMID: 32223336 DOI: 10.1161/circulationaha.119.043391] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.
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Affiliation(s)
- Simon Yadgir
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle
| | - Catherine Owens Johnson
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France (V. Aboyans).,Institute of Epidemiology, University of Limoges, France (V. Aboyans)
| | - Oladimeji M Adebayo
- College of Medicine, University College Hospital, College of Medicine, University College Hospital, Ibadan, Oyo, Nigeria (O.M.A.)
| | - Rufus Adesoji Adedoyin
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria (R.A.A.)
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (M.A., A.E.), Tehran University of Medical Sciences, Iran
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN (F.A.)
| | - Alaa Alashi
- Department of Cardiovascular Medicine (A.A., M.M.G.), Cleveland Clinic, OH
| | - Vahid Alipour
- Health Management and Economics Research Center (V. Alipour, J.A., S.A., A. Rezapour), Iran University of Medical Sciences, Tehran.,Health Economics Department (V. Alipour), Iran University of Medical Sciences, Tehran
| | - Jalal Arabloo
- Health Management and Economics Research Center (V. Alipour, J.A., S.A., A. Rezapour), Iran University of Medical Sciences, Tehran
| | - Samad Azari
- Health Management and Economics Research Center (V. Alipour, J.A., S.A., A. Rezapour), Iran University of Medical Sciences, Tehran
| | - Celine M Barthelemy
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle
| | | | - Adam E Berman
- Department of Medicine, Medical College of Georgia at Augusta University (A.E.B.)
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Mazandaran, Iran (A.B.)
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (J.J.C.)
| | - Félix Carvalho
- Applied Molecular Biosciences Unit (F.C.), University of Porto, Portugal.,Institute of Public Health (F.C.), University of Porto, Portugal
| | | | - Andre R Durães
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran (A.D.).,School of Medicine, Federal University of Bahia, Salvador, Brazil (A.R.D.)
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (M.A., A.E.), Tehran University of Medical Sciences, Iran
| | - Talha A Farid
- Division of Cardiovascular Medicine, University of Louisville, KY (T.A.F., A.R.K.)
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center (F.F.), Tehran University of Medical Sciences, Iran
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA (I.F.).,Department of Health Sciences, A.T. Still University, Mesa, AZ (I.F.)
| | - Mohamed M Gad
- Department of Cardiovascular Medicine (A.A., M.M.G.), Cleveland Clinic, OH.,Gillings School of Global Public Health, University of North Carolina Chapel Hill (M.M.G.)
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates (S.H.)
| | - Simon I Hay
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle.,School of Medicine (S.I.H.), University of Washington, Seattle.,Department of Cardiology, Dupuytren University Hospital, Limoges, France (V. Aboyans)
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran (S.S.N.I.)
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartumaa, Estonia (M.J.)
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center (A. Kasaeian), Tehran University of Medical Sciences, Iran.,Hematologic Malignancies Research Center (A. Kasaeian), Tehran University of Medical Sciences, Iran
| | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town (A.P.K.).,Department of Medicine, University of Cape Town, South Africa (A.P.K., G.A.M., K.S.)
| | - Abdur Rahman Khan
- Division of Cardiovascular Medicine, University of Louisville, KY (T.A.F., A.R.K.)
| | - Adnan Kisa
- Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway (A. Kisa).,Department of Health Services Policy and Management, University of South Carolina, Columbia (A. Kisa)
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway (S.K.)
| | - Dhaval Kolte
- Department of Medicine, Brown University, Providence, RI (D.K.)
| | - Navid Manafi
- Ophthalmology Department (N.M.), Iran University of Medical Sciences, Tehran.,Ophthalmology Department, University of Manitoba, Winnipeg, Canada (N.M.)
| | - Amir Manafi
- Department of Surgery, University of Virginia, Charlottesville (A.M.)
| | - George A Mensah
- Department of Medicine, University of Cape Town, South Africa (A.P.K., G.A.M., K.S.).,Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Erkin M Mirrakhimov
- Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan (E.M.M.).,Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan (E.M.M.)
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia (Y.M.)
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle.,Department of Health Metrics Sciences (A.H.M., G.A.R.), University of Washington, Seattle
| | - Ruxandra Irina Negoi
- Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (R.I.N.).,Department of Cardiology, Cardio-Aid, Bucharest, Romania (R.I.N.)
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam (H.L.T.N.)
| | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam (T.H.N.)
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle
| | - Catherine M Otto
- Division of Cardiology (C.M.O., G.A.R.), University of Washington, Seattle
| | - Shanti Patel
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY (S.P.)
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Switzerland (T.P.)
| | - Amir Radfar
- College of Graduate Health Sciences, A.T. Still University, Mesa, AZ (A. Radfar).,Medichem, Barcelona, Spain (A. Radfar)
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training (D.L.R.), Imperial College London, United Kingdom.,University College London Hospitals, United Kingdom (D.L.R.)
| | - Salman Rawaf
- Department of Primary Care and Public Health (S.R.), Imperial College London, United Kingdom.,Public Health England, London, United Kingdom (S.R.)
| | | | - Aziz Rezapour
- Health Management and Economics Research Center (V. Alipour, J.A., S.A., A. Rezapour), Iran University of Medical Sciences, Tehran
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberl ândia, Brazil (L.R.)
| | - Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt (A.M.S.)
| | | | | | - Karen Sliwa
- Department of Medicine, University of Cape Town, South Africa (A.P.K., G.A.M., K.S.)
| | - Berhe Etsay Tesfay
- Department of Public Health, Adigrat University, Tigray, Ethiopia (B.E.T.)
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Vietnam (B.X.T.)
| | - Irfan Ullah
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Faisalabad, Pakistan (I.U.).,TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan (I.U.)
| | | | | | - Charles D A Wolfe
- School of Population Health & Environmental Sciences, King's College London, United Kingdom (C.D.A.W.).,Biomedical Research Council, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (C.D.A.W.)
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.)
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation (S.Y., C.O.J., C.M.B., S.I.H., A.H.M., M.R.N., G.A.R.), University of Washington, Seattle.,Department of Health Metrics Sciences (A.H.M., G.A.R.), University of Washington, Seattle.,Division of Cardiology (C.M.O., G.A.R.), University of Washington, Seattle
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21
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Klein J, Alashi A, Svensson LM, Komarlu R, Saarel E, Aziz P, Najm H, Lever H, Zahka K, Desai MY. CLINICAL AND ECHOCARDIOGRAPHIC PARAMETERS IN PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: RELATIONSHIP TO LV GLOBAL LONGITUDINAL STRAIN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Dunn A, Donnellan E, Alashi A, Johnston D, Jellis CL, Pettersson G, Svensson LG, Reed GW, Ellis S, Griffin BP, Desai M. LONG-TERM OUTCOMES AMONG PATIENTS WITH MEDIASTINAL RADIATION-INDUCED CORONARY ARTERY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFTING. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Desai MY, Kalahasti V, Hutt Centeno E, Chen K, Alashi A, Rivas CG, Roselli EE, Johnston DR, Griffin BP, Svensson LG. Adult Patients With Marfan Syndrome and Ascending Aortic Surgery. J Am Coll Cardiol 2020; 73:733-734. [PMID: 30765040 DOI: 10.1016/j.jacc.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022]
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24
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Oikonomou EK, Williams MC, Kotanidis CP, Desai MY, Marwan M, Antonopoulos AS, Thomas KE, Thomas S, Akoumianakis I, Fan LM, Kesavan S, Herdman L, Alashi A, Centeno EH, Lyasheva M, Griffin BP, Flamm SD, Shirodaria C, Sabharwal N, Kelion A, Dweck MR, Van Beek EJR, Deanfield J, Hopewell JC, Neubauer S, Channon KM, Achenbach S, Newby DE, Antoniades C. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. Eur Heart J 2019; 40:3529-3543. [PMID: 31504423 PMCID: PMC6855141 DOI: 10.1093/eurheartj/ehz592] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/14/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronary inflammation induces dynamic changes in the balance between water and lipid content in perivascular adipose tissue (PVAT), as captured by perivascular Fat Attenuation Index (FAI) in standard coronary CT angiography (CCTA). However, inflammation is not the only process involved in atherogenesis and we hypothesized that additional radiomic signatures of adverse fibrotic and microvascular PVAT remodelling, may further improve cardiac risk prediction. METHODS AND RESULTS We present a new artificial intelligence-powered method to predict cardiac risk by analysing the radiomic profile of coronary PVAT, developed and validated in patient cohorts acquired in three different studies. In Study 1, adipose tissue biopsies were obtained from 167 patients undergoing cardiac surgery, and the expression of genes representing inflammation, fibrosis and vascularity was linked with the radiomic features extracted from tissue CT images. Adipose tissue wavelet-transformed mean attenuation (captured by FAI) was the most sensitive radiomic feature in describing tissue inflammation (TNFA expression), while features of radiomic texture were related to adipose tissue fibrosis (COL1A1 expression) and vascularity (CD31 expression). In Study 2, we analysed 1391 coronary PVAT radiomic features in 101 patients who experienced major adverse cardiac events (MACE) within 5 years of having a CCTA and 101 matched controls, training and validating a machine learning (random forest) algorithm (fat radiomic profile, FRP) to discriminate cases from controls (C-statistic 0.77 [95%CI: 0.62-0.93] in the external validation set). The coronary FRP signature was then tested in 1575 consecutive eligible participants in the SCOT-HEART trial, where it significantly improved MACE prediction beyond traditional risk stratification that included risk factors, coronary calcium score, coronary stenosis, and high-risk plaque features on CCTA (Δ[C-statistic] = 0.126, P < 0.001). In Study 3, FRP was significantly higher in 44 patients presenting with acute myocardial infarction compared with 44 matched controls, but unlike FAI, remained unchanged 6 months after the index event, confirming that FRP detects persistent PVAT changes not captured by FAI. CONCLUSION The CCTA-based radiomic profiling of coronary artery PVAT detects perivascular structural remodelling associated with coronary artery disease, beyond inflammation. A new artificial intelligence (AI)-powered imaging biomarker (FRP) leads to a striking improvement of cardiac risk prediction over and above the current state-of-the-art.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Cres, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, 47 Little France Cres, Edinburgh, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Ioannis Akoumianakis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Lampson M Fan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Sujatha Kesavan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Alaa Alashi
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Erika Hutt Centeno
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Maria Lyasheva
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Scott D Flamm
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Cheerag Shirodaria
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Caristo Diagnostics Ltd, Whichford House, Parkway Court, John Smith Dr, Oxford, UK
| | - Nikant Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Andrew Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Cres, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, 47 Little France Cres, Edinburgh, UK
| | - Edwin J R Van Beek
- Edinburgh Imaging Facility QMRI, University of Edinburgh, 47 Little France Cres, Edinburgh, UK
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, 1 St Martins Le Grand, London, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, BHF Centre for Research Excellence, Big Data Institute, Old Road Campus, Roosevelt Drive, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Cres, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, 47 Little France Cres, Edinburgh, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- Oxford Academic Cardiovascular CT Core Laboratory, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK
- British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford, UK
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25
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Donnellan E, Alashi A, Johnston DR, Gillinov AM, Pettersson GB, Svensson LG, Griffin BP, Desai MY. Outcomes of Patients With Mediastinal Radiation-Associated Mitral Valve Disease Undergoing Cardiac Surgery. Circulation 2019; 140:1288-1290. [DOI: 10.1161/circulationaha.119.040546] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eoin Donnellan
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Alaa Alashi
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Douglas R. Johnston
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - A. Marc Gillinov
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Gosta B. Pettersson
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Lars G. Svensson
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Brian P. Griffin
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y. Desai
- Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, OH
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26
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Oikonomou EK, Marwan M, Mancio J, Kotanidis CK, Thomas KE, Alashi A, Hutt Centeno E, Antonopoulos AS, Shirodaria C, Neubauer S, Channon KM, Achenbach S, Desai MY, Antoniades C. 3258Perivascular fat attenuation index stratifies the cardiac risk associated with high-risk plaque features on coronary computed tomography angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Qualitative high-risk plaque (HRP) features detected on coronary computed tomography angiography (CCTA) are associated with increased risk of adverse cardiac events. Coronary inflammation is a key determinant of plaque progression and instability and can now be captured on routine CCTA as inflammation-induced changes in perivascular adipose tissue composition, detectable by the perivascular Fat Attenuation Index (FAI).
Purpose
To explore the ability of perivascular FAI phenotyping to stratify the cardiac risk associated with the presence of adverse plaque morphology on routine CCTA.
Methods
This was a post-hoc analysis of the CRISP-CT (Cardiovascular RISk Prediction using Computed Tomography) study, which involved 3912 patients (mean age 55.7±13.7 years, 41.1% females) undergoing clinically-indicated CCTA in two centres (Erlangen, Germany & Cleveland, USA). Perivascular FAI mapping was performed around the proximal 10–50 mm of the right coronary artery and defined as the weighted mean attenuation of the perivascular adipose tissue, as previously validated. HRP features were defined as the presence of ≥1 of the following: positive remodelling, low-attenuation plaque, spotty calcification or napkin-ring sign (A). Cox regression models (adjusted for age, sex, epicardial fat volume and coronary artery disease [≥50% stenosis]) were used to explore the association between FAI, HRP, and future major adverse cardiac events (MACE: defined as the composite of cardiac mortality and non-fatal myocardial infarction).
Results
At baseline the prevalence of HRP and high FAI (≥-70.1 Hounsfield Units, as previously validated) was 23.6% (n=923) and 24.3% (n=952) respectively. Over a median follow-up period of 5.6 years (25th-75th percentile: 4.0–7.0 years) there were 91 confirmed MACE. Patients with both HRP features (HRP+) and high FAI (FAI+) had a 6.3-fold (P<0.001) higher adjusted risk of MACE compared to individuals with neither of these risk features (HRP-/FAI-) (B). Furthermore, patients without HRP features but with high FAI (HRP-/FAI+) had a 4.9-fold (P<0.001) higher adjusted risk of MACE compared to the reference (HRP-/FAI-) group. However, among patients with low FAI, there was no significant difference in the prospective risk of MACE between HRP+ and HRP- patients (P=0.87).
Conclusion
FAI is associated with an increased risk of adverse events in both patients with and without high-risk plaques, highlighting coronary inflammation as a major determinant of plaque vulnerability, independent of adverse plaque morphology. Non-invasive characterization of coronary inflammation using CCTA-derived FAI can improve risk stratification by supplementing the traditional anatomical assessment of the coronary vasculature with a functional marker of disease activity.
Acknowledgement/Funding
British Heart Foundation, National Institute of Health Research, Oxford Biomedical Research Centre
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Affiliation(s)
- E K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Marwan
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - J Mancio
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C K Kotanidis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K E Thomas
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - E Hutt Centeno
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - A S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Shirodaria
- Oxford University Hospitals NHS Trust, Department of Cardiology, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Achenbach
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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Isaza N, Alashi A, Faulx J, Popovic ZB, Menon V, Faulx M, Griffin BP, Desai MY. P1951Serial left ventricular global longitudinal strain and mortality in patients with Takotsubo cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies on Takotsubo cardiomyopathy (TC) have challenged the common conception that it is a relatively benign condition with functional recovery observed in the majority of cases. However, it is important to recognize that overt functional recovery might not reflect the true regional recovery, which might have an adverse impact on survival.
Objective
We sought to assess baseline and follow-up left ventricular function characteristics and their impact on longer-term mortality in patients presenting with documented Takotsubo cardiomyopathy (TC) at a tertiary centre.
Methods
339 patients (66±14 years, 88% women) presented to our centre between 2006 and 2018 with acute anginal symptoms and were subsequently diagnosed with TC following clinical and angiographic evaluation. All patients returned for a follow-up evaluation including transthoracic echocardiography (TTE). Baseline and follow-up (3–6 months after TC diagnosis) LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS using velocity vector imaging) were recorded on TTE. The primary endpoint was longer-term mortality.
Results
Hypertension, dyslipidaemia, and diabetes were present in 71%, 56%, and 26% of patients. Baseline mean troponin I peak, LVEF and LV-GLS were 0.9±7 ng/ml, 36±9%, and 11±3%; respectively. 94% had baseline LVEF<50%, 272 (80%) had apical ballooning, and 94% had LV-GLS worse than −18%. No patient had angiographically obstructive coronary artery disease. At 3–6 months follow-up, mean LVEF, and LV-GLS improved to 57±9% and 16±3%, respectively. 87% of patients had LVEF >50%, but in 70% LV-GLS remained worse than −18%. After 3.3±3 years, 72 patients (21%) died. On multivariable Cox survival analysis (adjusted for age, gender, baseline troponin peak and follow up LVEF), follow up LV-GLS was independently associated with longer-term mortality (hazard ratio 1.12 [95% confidence interval 1.05, 1.20], p<0.001). Significantly more patients with follow up LV-GLS worse than −18% died vs. those with LV-GLS better than −18% (57/237 [24%] vs. 15/102 [15%], log-rank statistic p-value 0.01, Kaplan-Meier figure 1).
Kaplan-Meier curve of freedom from death
Conclusions
In this large single-centre study of patients with documented TC (majority women), 87% recovered LVEF at 3–6 months, but in 70% LV-GLS remained worse than −18%, which was independently associated with higher longer-term mortality.
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Affiliation(s)
- N Isaza
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - J Faulx
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z B Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - V Menon
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Faulx
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - B P Griffin
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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28
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Alashi A, Smedira NG, Hodges K, Popovic ZB, Thamilarasan M, Wierup P, Lever HM, Desai MY. 226Earlier surgical myectomy vs. waiting for a Class I indication is associated with improved long-term survival in symptomatic hypertrophic obstructive cardiomyopathy patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with severe hypertrophic obstructive cardiomyopathy (HOCM), surgical myectomy (SM) is typically indicated for severe symptoms despite maximal medical therapy.
Aims
We sought to compare long-term outcomes of severe HOCM patients where decision for SM was based on guideline-recommended Class I indication (functional Class or FC ≥3 or exertional syncope despite maximal medical therapy) vs. earlier (FC II and/or impaired exercise capacity on exercise echo with medication intolerance).
Methods
The study included 2268 HOCM patients (excluding <18 years, at least moderate aortic stenosis requiring valve replacement and subaortic membrane, age 56±14 years, 55% men), who underwent SM at our center between 1/02–3/18. Clinical and echo data, including left ventricular outflow tract gradient (LVOTG) were recorded. Cardiac death and/or appropriate internal defibrillator discharge were recorded as composite endpoints.
Results
1318 (58%) patients met Class I indication for SM, while the rest underwent SM for FC II (due to medicine intolerance) or impaired exercise capacity. 535 (24%) and 408 (18%) had history of atrial fibrillation and a family history of HCM. All patients were on maximally tolerated medical therapy. European 5-year sudden death risk score was 3.7±2%. Baseline basal septal thickness, resting and maximal LVOTG were 2.0±0.3 cm, 61±44 mm Hg and 100±31 mm Hg. At 6.2±4 years of follow-up after SM, 248 (11%) had composite events (13 [0.6%] in-hospital deaths). Competing risk survival analysis for composite endpoint is shown in Figure 1a. Patients operated for Class I indication had significantly higher longer-term event rate vs. those operated earlier (182 [14%] vs. 66 [7%], p<0.001, Figure 1B).
Conclusions
In patients with severe HOCM undergoing SM at an experienced center performed by experienced surgeons, delaying surgery till reaching Class I indication was associated with much worse survival than operating earlier for milder symptoms or impaired exercise tolerance on exercise echo.
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Affiliation(s)
- A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - N G Smedira
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Hodges
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z B Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Thamilarasan
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Wierup
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H M Lever
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Alashi A, Huttcenteno E, Schoenhagen P, Popovic ZB, Cremer P, Kalahasti V, Jellis C, Renapurkar R, Rodriguez LL, Flamm SD, Desai MY. P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood.
Aims
We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA.
Methods
We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded.
Results
188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively.
Conclusion
In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.
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Affiliation(s)
- A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - E Huttcenteno
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Schoenhagen
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z B Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Cremer
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - V Kalahasti
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - C Jellis
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Renapurkar
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L L Rodriguez
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S D Flamm
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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30
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Alashi A, Desai RM, Khullar T, Hodges K, Rodriguez ER, Tan C, Popovic ZB, Thamilarasan M, Wierup P, Lever HM, Smedira NG, Desai MY. Different Histopathologic Diagnoses in Patients With Clinically Diagnosed Hypertrophic Cardiomyopathy After Surgical Myectomy. Circulation 2019; 140:344-346. [PMID: 31329486 DOI: 10.1161/circulationaha.119.040129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alaa Alashi
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ria M Desai
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Tamanna Khullar
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Kevin Hodges
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - E Rene Rodriguez
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Carmela Tan
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, OH
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Schoenhagen P, Griffin BP, Flamm SD, Desai MY. Reclassification of coronary heart disease risk in a primary prevention setting: traditional risk factor assessment vs. coronary artery calcium scoring. Cardiovasc Diagn Ther 2019; 9:214-220. [PMID: 31275811 DOI: 10.21037/cdt.2019.04.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background In a primary prevention screening program of asymptomatic middle-aged subjects, we sought to assess the degree of risk-reclassification provided by traditional risk assessment vs. coronary artery calcification scoring (CACS). Methods A total of 1,806 consecutive asymptomatic subjects (age 55 years, 76% men), who underwent comprehensive screening in a primary prevention clinic between 3/2016 and 9/2017 were included. Standard risk factors, C-reactive protein (CRP) and CAC scoring were performed. % 10-year coronary heart disease (CHD) risk was calculated using Reynolds Risk Score (RRS), atherosclerotic cardiovascular disease (ASCVD) score and multiethnic study on subclinical atherosclerosis (MESA) CACS were calculated. % 10-year CHD risk for all scores was categorized as follows: <1%, 1-5%, 6-10% and >10%. Results Mean CRP, RRS, ASCVD and MESA-CACS were 2.1±4.2, 3.7±4, 4.9±6, 4.9±5; 54% had CAC of 0, while 21% had CAC >75th percentile. There was a significant, but modest correlation between MESA-CAC score and (I) RRS (r=0.62) and (II) ASCVD scores (r=0.65, both P<0.001). Compared to MESA-CAC, for RRS, (I) 188 (10%) patients had a downgrade in risk and (II) 538 (30%) patients had an upgrade in risk (40% reclassification of risk). Similarly, compared to MESA-CAC, for ASCVD score, (I) 412 (23%) patients had a downgrade in risk and (II) 329 (18%) patients had a downgrade in risk (41% reclassification of risk). Conclusions In a primary prevention screening program of asymptomatic middle-aged patients, RRS overestimates and ASCVHD underestimates 10-year CHD risk vs. MESA-CACS. Addition of CACS results in significant risk reclassification.
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Affiliation(s)
- Alaa Alashi
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Lang
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raul Seballos
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Roxanne Sukol
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leslie Cho
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
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Hodges K, Rivas CG, Aguilera J, Borden R, Alashi A, Blackstone EH, Desai MY, Smedira NG. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J Thorac Cardiovasc Surg 2019; 157:2289-2299. [DOI: 10.1016/j.jtcvs.2018.11.148] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 11/01/2018] [Accepted: 11/23/2018] [Indexed: 11/30/2022]
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Gentry JL, Parikh PK, Alashi A, Gillinov AM, Pettersson GB, Rodriguez LL, Popovic ZB, Sato K, Grimm RA, Kapadia SR, Tuzcu EM, Svensson, LG, Griffin BP, Desai MY. Characteristics and Outcomes in a Contemporary Group of Patients With Suspected Significant Mitral Stenosis Undergoing Treadmill Stress Echocardiography. Circ Cardiovasc Imaging 2019; 12:e009062. [DOI: 10.1161/circimaging.119.009062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In contemporary patients with suspected significant mitral stenosis (MS) undergoing rest and treadmill stress echocardiography, we assessed characteristics and factors associated with longer-term survival.
Methods:
We studied 515 consecutive patients (asymptomatic/atypical symptoms, mean left ventricular ejection fraction 58±2%; 43% male) with suspected at least moderate MS ([1] native mitral valve [MV]: resting mean MV gradient ≥5 mm Hg or area ≤1.5 cm
2
and [2] prosthetic valve: resting mean MV gradient ≥5 mm Hg or effective orifice area ≤2 cm) who underwent rest and treadmill stress echocardiography between 1/2003 and 12/2013. MS was categorized as rheumatic (n=170, 33%), postsurgical (prior mitral repair/replacement, n=245, 48%), and primary nonrheumatic (n=100, 19%). Primary outcome was all-cause mortality.
Results:
Mean resting MV gradient and right ventricular systolic pressure were 8.5±3 and 39±13 mm Hg. Patients achieved 95±29% age-sex predicted metabolic equivalents; peak-stress MV gradient and right ventricular systolic pressure were 17±7 and 61±14 mm Hg, respectively. At 54 days (median), 224 (44%) underwent invasive mitral procedure. At 6±4 years, 76 (15%) died. On survival analysis, primary nonrheumatic MS (hazard ratio [HR], 4.92), higher Society of Thoracic Surgeons score (HR, 1.92), lower % age-sex predicted metabolic equivalents (HR, 1.22), and higher peak-stress right ventricular systolic pressure (HR, 1.35), was associated with higher mortality, while invasive mitral procedures were associated with improved survival (HR, 0.67; all
P
<0.01).
Conclusions:
In asymptomatic patients (or with atypical symptoms) with significant MS undergoing treadmill stress echocardiography, higher mortality was associated with primary nonrheumatic MS, lower % age-sex predicted metabolic equivalents, and higher peak-stress right ventricular systolic pressure, while invasive MV procedures were associated with survival.
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Affiliation(s)
- James L. Gentry
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Parth K. Parikh
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Alaa Alashi
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - A Marc Gillinov
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | | | | | - Zoran B. Popovic
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Kimi Sato
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Richard A. Grimm
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Samir R. Kapadia
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - E Murat Tuzcu
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Lars G. Svensson,
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Brian P. Griffin
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y. Desai
- Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH
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Etiwy M, Akhrass Z, Gillinov L, Alashi A, Wang R, Blackburn G, Gillinov SM, Phelan D, Gillinov AM, Houghtaling PL, Javadikasgari H, Desai MY. Accuracy of wearable heart rate monitors in cardiac rehabilitation. Cardiovasc Diagn Ther 2019; 9:262-271. [PMID: 31275816 DOI: 10.21037/cdt.2019.04.08] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To assess the accuracy of four wearable heart rate (HR) monitors in patients with established cardiovascular disease enrolled in phase II or III cardiac rehabilitation (CR). Methods Eighty adult patients enrolled in phase II or III CR were monitored during a CR session that included exercise on a treadmill and/or stationary cycle. Participants underwent HR monitoring with standard ECG limb leads, an electrocardiographic (ECG) chest strap monitor (Polar H7), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, TomTom Spark Cardio), one on each wrist. HR was recorded at rest and at 3, 5, and 7 minutes of steady-state exercise on the treadmill and stationary cycle. Results Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (rc=0.99) followed by the Apple Watch (rc=0.80), Fitbit Blaze (rc=0.78), TomTom Spark (rc=0.76) and Garmin Forerunner (rc=0.52). There was variability in accuracy under different exercise conditions. On the treadmill, only the Fitbit Blaze performed well (rc=0.76), while on the stationary cycle, Apple Watch (rc=0.89) and TomTom Spark (rc=0.85) were most accurate. Conclusions In cardiac patients, the accuracy of wearable, optically based HR monitors varies, and none of those tested was as accurate as an electrode-containing chest monitor. This observation has implications for in-home CR, as electrode-containing chest monitors should be used when accurate HR measurement is imperative.
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Affiliation(s)
- Muhammad Etiwy
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zade Akhrass
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alaa Alashi
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Wang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gordon Blackburn
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Dermot Phelan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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35
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Alashi A, Svensson L, Klein J, Zahka K, Smedira N, Najm H, Stewart R, Lever H, Aziz P, Saarel E, Desai M. CHARACTERISTICS AND LONGER-TERM OUTCOMES OF PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A TERTIARY CARE CENTER EXPERIENCE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Alashi A, Faulx J, Menon V, Kapadia S, Ellis S, Faulx M, Griffin B, Desai M. CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH DOCUMENTED STRESS INDUCED (TAKOTSUBO) CARDIOMYOPATHY: A TERTIARY CARE CENTER EXPERIENCE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Roselli EE, Svensson LG, Kalahasti V, Schoenhagen P, Flamm SD, Griffin BP, Desai MY. Dilation of the Proximal Thoracic Aorta in an Asymptomatic Primary Prevention Population Undergoing Noncontrast Chest Computed Tomography. Circulation 2019; 139:557-558. [PMID: 30586688 DOI: 10.1161/circulationaha.118.036191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alaa Alashi
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Richard Lang
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Raul Seballos
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Steven Feinleib
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Roxanne Sukol
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Eric E Roselli
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Lars G Svensson
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Vidyasagar Kalahasti
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Paul Schoenhagen
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Scott D Flamm
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Brian P Griffin
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Milind Y Desai
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, De Courten B, De La Hoz FP, De Leo D, De Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, 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Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7] [Citation(s) in RCA: 7041] [Impact Index Per Article: 1173.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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C, Zaidi Z, Zaman SB, Zamani M, Zavala-Arciniega L, Zhang AL, Zhang H, Zhang K, Zhou M, Zimsen SRM, Zodpey S, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1923-1994. [PMID: 30496105 PMCID: PMC6227755 DOI: 10.1016/s0140-6736(18)32225-6] [Citation(s) in RCA: 2618] [Impact Index Per Article: 436.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING Bill & Melinda Gates Foundation.
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Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, Perico N, Pesudovs K, Pham HQ, Phillips MR, Pigott DM, Pillay JD, Piradov MA, Pirsaheb M, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Popova S, Postma MJ, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prakash V, Purcell CA, Purwar MB, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Ram U, Ranjan P, Ranta A, Rao PC, Rawaf DL, Rawaf S, Reddy KS, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro ALP, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Roy A, Rubagotti E, Sachdev PS, Sadat N, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salama JS, Salamati P, Saleem K, Saleem Z, Salimi Y, Salomon JA, Salvi SS, Salz I, Samy AM, Sanabria J, Sang Y, Santomauro DF, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Saylan M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shishani K, Shiue I, Shokraneh F, Shoman H, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak ELN, Sliwa K, Smith DL, Smith M, Soares Filho AM, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Soosaraei M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan MB, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 08/12/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, Thomas S, Herdman L, Kotanidis CP, Thomas KE, Griffin BP, Flamm SD, Antonopoulos AS, Shirodaria C, Sabharwal N, Deanfield J, Neubauer S, Hopewell JC, Channon KM, Achenbach S, Antoniades C. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018; 392:929-939. [PMID: 30170852 PMCID: PMC6137540 DOI: 10.1016/s0140-6736(18)31114-0] [Citation(s) in RCA: 532] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Milind Y Desai
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Jennifer Mancio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alaa Alashi
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | | | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Brian P Griffin
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Scott D Flamm
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Cheerag Shirodaria
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Caristo Diagnostics, Oxford, UK
| | - Nikant Sabharwal
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Deanfield
- University College London Institute of Cardiovascular Science, London, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK.
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Schoenhagen P, Griffin BP, Flamm SD, Desai MY. P622Reclassification of 10-year coronary heart disease risk in a primary prevention setting: traditional risk factor assessment vs. coronary artery calcium scoring. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Lang
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Seballos
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Feinleib
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Sukol
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L Cho
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Schoenhagen
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - B P Griffin
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S D Flamm
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Gentry JL, Parikh PK, Alashi A, Gillinov AM, Pettersson GB, Rodriguez LL, Popovic ZB, Grimm RA, Kapadia SR, Tuzcu EM, Svensson LG, Griffin BP, Desai MY. P5450Characteristics and outcomes in a contemporary group of patients with at least moderate mitral stenosis undergoing treadmill stress echocardiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J L Gentry
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - P K Parikh
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - A M Gillinov
- Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - G B Pettersson
- Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - L L Rodriguez
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - Z B Popovic
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - R A Grimm
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - S R Kapadia
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - E M Tuzcu
- Cleveland Clinic, Cardiovascular Medicine, Abu Dhabi, United Arab Emirates
| | - L G Svensson
- Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - B P Griffin
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, United States of America
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Alashi A, Young L, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Cremer PC, Jaber W, Griffin BP, Desai MY. 3136Incremental and synergistic prognostic value of exercise stress testing and standard risk factor assessment in asymptomatic executives: a primary prevention study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L Young
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Lang
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Seballos
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Feinleib
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Sukol
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L Cho
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P C Cremer
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - W Jaber
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - B P Griffin
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Mentias A, Alashi A, Naji P, Gillinov AM, Rodriguez LL, Mihaljevic T, Suri RM, Grimm RA, Svensson LG, Griffin BP, Desai MY. Exercise capacity in asymptomatic patients with significant primary mitral regurgitation: independent effect of global longitudinal left ventricular strain. Cardiovasc Diagn Ther 2018; 8:460-468. [PMID: 30214861 DOI: 10.21037/cdt.2018.05.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Despite preserved left ventricular ejection fraction (LVEF), patients with significant primary mitral regurgitation (MR) often have reduced exercise capacity. In asymptomatic patients with ≥3+ primary MR undergoing rest-stress echocardiography (RSE), we sought to evaluate the incremental impact of left ventricular global longitudinal strain (LV-GLS) on exercise capacity. Methods A total of 660 asymptomatic patients with ≥3+ primary MR, non-dilated LV and LVEF ≥60% (mean age, 57±14 years, 66% men, body mass index or BMI 25±4 kg/m2) who underwent RSE at our center between 2001 and 2013 were included. Standard RSE data were obtained. Average resting LV-GLS was measured using Velocity Vector Imaging. Results Mean mitral effective regurgitant orifice, resting right ventricular systolic pressure (RVSP) and LV-GLS were 0.45±0.2 cm2, 31±12 mmHg and -21.7%±2%, respectively; 28% had flail mitral leaflet. Mean metabolic equivalents (METs) and post-stress RVSP were 9.9±3, and 46±15 mmHg; 28% achieved <100% age-gender predicted METs. No patient had ischemia or significant arrhythmias. On logistic regression, resting LV-GLS [odds ratio (OR), 1.40, 95% confidence interval (CI): 1.21-1.55, BMI (OR, 1.11, 95% CI: 1.06-1.17)] and resting RVSP 1.22 (1.02-1.49) were independent predictors of exercise capacity. Area under the curve for association between 100% age-gender predicted METs and various factors were as follows: (I) BMI (0.60, 95% CI: 0.55-0.65, P<0.001); (II) resting RVSP (0.57, 95% CI: 0.52-0.62, P=0.006) and LV-GLS (0.66, 95% CI: 0.61-0.70, P<0.001). Conclusions In asymptomatic patients with ≥3+ primary MR, non-dilated LV and preserved LVEF, LV-GLS is independently associated with exercise capacity, beyond known predictors.
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Affiliation(s)
- Amgad Mentias
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alaa Alashi
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peyman Naji
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Marc Gillinov
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Leonardo Rodriguez
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tomislav Mihaljevic
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rakesh M Suri
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Grimm
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Huded CP, Kusunose K, Shahid F, Goodman AL, Alashi A, Grimm RA, Gillinov AM, Johnston DR, Rodriguez LL, Popovic ZB, Sato K, Svensson LG, Griffin BP, Desai MY. Novel Echocardiographic Parameters in Patients With Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Surgical Aortic Valve Replacement. Am J Cardiol 2018; 122:284-293. [PMID: 29751954 DOI: 10.1016/j.amjcard.2018.03.359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 11/25/2022]
Abstract
We sought to study the incremental prognostic impact of baseline valvuloarterial impedance (Zva) and left ventricular global longitudinal strain (LV-GLS) in patients with severe aortic stenosis and preserved left ventricular ejection fraction (LVEF) treated with surgical aortic valve replacement (AVR). We included 961 consecutive patients (68 ± 13 years; 63% men) with severe aortic stenosis (indexed aortic valve area <0.6 cm2) and LVEF >50% who underwent surgical AVR at our institution between January 2007 and December 2008. The analysis is based on derivation (n = 637) and validation (n = 324) subgroups. Society of Thoracic Surgeons (STS) score was calculated. Zva (systolic arterial pressure + mean aortic valve gradient)/left ventricular stroke volume index and LV-GLS (measured offline using Velocity Vector Imaging; Siemens Medical Solutions, Mountain View, California) were calculated. The primary outcome was death. Median Zva and LV-GLS were 4.5 mm Hg × ml-1 × m2 and -14.5%, respectively. AVR was performed at a median of 34 days from initial evaluation (isolated AVR in 46%, bioprosthetic AVR in 93%). At 7.5 ± 3 years, 320 patients died (33%; 30 days/in-hospital death in 0.5%). In the derivation subgroup, on multivariate Cox survival analysis, higher STS score (hazard ratio [HR] 1.06), higher Zva (HR 1.13), and worse LV-GLS (HR 1.07) were independently associated with long-term survival (all p <0.01). When Zva and LV-GLS were sequentially added to STS score, the c-statistic improved from 0.63 [0.55 to 0.77] to 0.70 [0.60 to 0.81] and 0.78 [0.69 to 0.83], respectively, all p <0.001). Findings were confirmed in the validation subgroup. In conclusion, in patients with severe aortic stenosis and preserved LVEF treated with surgical AVR, baseline Zva and LV-GLS provide improved risk stratification with synergistic prognostic value.
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Donnellan E, Griffin BP, Johnston DR, Popovic ZB, Alashi A, Kapadia SR, Tuzcu EM, Krishnaswamy A, Mick S, Svensson LG, Desai MY. Rate of Progression of Aortic Stenosis and its Impact on Outcomes in Patients With Radiation-Associated Cardiac Disease: A Matched Cohort Study. JACC Cardiovasc Imaging 2018; 11:1072-1080. [PMID: 29909108 DOI: 10.1016/j.jcmg.2018.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to study differences in progression of aortic stenosis (AS) in patients with mediastinal radiotherapy (XRT)-associated moderate AS versus a matched cohort during the same time frame, and to ascertain need for aortic valve replacement (AVR) and longer-term survival. BACKGROUND Rate of progression of XRT-associated moderate AS and its impact on outcomes is not well-described. METHODS We included 81 patients (age 61 ± 13 years; 57% female) with at least XRT-associated moderate AS (aortic valve area [AVA] 1.05 ± 0.3 cm2; mean gradient 24 ± 10 mm Hg) who had ≥2 transthoracic echocardiograms (TTEs) 1 year apart and matched them in a 1:2 fashion on the basis of age, sex, and AVA with those without prior XRT. Serial aortic valve gradients and AVA were recorded. AVR and longer-term all-cause mortality during follow-up were recorded. RESULTS A total of 100% of patients had 1, a total of 71% had 2, and 39% had 3 follow-up TTEs. Before AVR, mean AVG and AVA were not significantly different between XRT and comparison groups. At 3.6 ± 2.0 years from baseline TTE, 146 (60%) underwent AVR (16% transcatheter), with significantly more patients in the XRT group undergoing AVR (80% vs. 50%; p < 0.01), at a much shorter time (2.9 ± 1.6 years vs. 4.1 ± 2.4 years; p < 0.01). At 6.6 ± 4.0 years from the initial TTE, 49 (20%) patients died, with a significantly higher mortality in the XRT group (40% vs. 11%; p < 0.01), with prior XRT associated with increased longer-term mortality, whereas AVR was associated with improved longer-term survival. CONCLUSIONS In patients with moderate AS, those with prior XRT have a similar rate of progression of AS versus a comparison group. A higher proportion of patients in the XRT group were referred for AVR at a shorter time from baseline TTE. Despite that, the XRT patients had significantly higher longer-term mortality, and prior exposure to XRT was associated with significantly increased longer-term mortality.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popovic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alaa Alashi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Raizada V, Sato K, Alashi A, Kumar A, Agler D. DEPRESSED RIGHT VENTRICULAR SYSTOLIC FUNCTION IN CONSTRICTIVE PERICARDITIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Huded C, Kusunose K, Goodman A, Alashi A, Shahid F, Grimm R, Gillinov A, Johnston D, Rodriguez L, Svensson L, Griffin B, Desai M. P187Long-term mortality after surgical aortic valve replacement in patients with normal left ventricular systolic function: incremental utility of valvuloarterial impedence and left ventricular strain. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shah S, Alashi A, Pettersson G, Rodriguez L, Gillinov M, Grimm R, Navia J, Kapadia S, Svensson L, Griffin B, Desai M. 4111Outcomes of paravalvular leak after aortic and mitral valve surgery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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