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Mannina C, Kini A, Carbone A, Neibart E, Bossone E, Prandi FR, Tadros R, Esposito G, Erbel R, Sharma SK, Lerakis S. Management of Systemic Inflammatory Response Syndrome after Cardiovascular Interventions. Diagnostic, Prognostic and Therapeutic Implications. Am J Cardiol 2024:S0002-9149(24)00270-4. [PMID: 38649128 DOI: 10.1016/j.amjcard.2024.04.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
A substantial number of patients may experience a systemic inflammatory response syndrome (SIRS) and related adverse events after transcatheter aortic valve implantation and endovascular aortic aneurysm repair. Although a clear etiology has not been established, endothelial disruption and tissue-ischemic response secondary to the foreign material may represent the trigger events. A latency period (0-48 hours) may occur between the initial injury and onset of symptoms mirroring an initial local response followed by a systemic response. Clinical presentation can be mild or severe depending on external triggers and patient's characteristics. Diagnosis is challenging because it simulates an infection, but lack of response to antibiotics, negative cultures are supportive of SIRS. Increased in-hospital stay, readmissions, major cardiovascular events, and reduced durability of the device used are the main complications. Treatment includes non-steroidal anti-inflammatory drugs or corticosteroids. In conclusion, further studies are warranted to fully explore pathophysiologic mechanisms underpinning SIRS as well as the possibility to enhance device material immune compatibility in order to reduce the host tissue's inflammatory reaction.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Andreina Carbone
- Unit of Cardiology, University Hospital "Luigi Vanvitelli", Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Eric Neibart
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Eduardo Bossone
- Department of Public Health, Federico II University, Naples, Italy
| | - Francesca Romana Prandi
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
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Chopra L, Mannina C, Ueyama H, Mirza J, Maenza J, Dalsania A, Prandi FR, Argulian E, Sharma S, Kini A, Lerakis S. Outcomes in patients with low-flow very low-gradient aortic stenosis: A long-term follow-up. Cardiovasc Revasc Med 2024:S1553-8389(24)00167-2. [PMID: 38616462 DOI: 10.1016/j.carrev.2024.04.015] [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] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/03/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Lakshay Chopra
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Mannina
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Jacqueline Mirza
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Maenza
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ankur Dalsania
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Francesca R Prandi
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Edgar Argulian
- Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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Sillett C, Razeghi O, Lee AWC, Solis Lemus JA, Roney C, Mannina C, de Vere F, Ananthan K, Ennis DB, Haberland U, Xu H, Young A, Rinaldi CA, Rajani R, Niederer SA. A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation. Front Cardiovasc Med 2024; 11:1359715. [PMID: 38596691 PMCID: PMC11002108 DOI: 10.3389/fcvm.2024.1359715] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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Affiliation(s)
- Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Angela W. C. Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felicity de Vere
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kiruthika Ananthan
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, United States
| | | | - Hao Xu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster: Digital Twins, The Alan Turing Institute, London, United Kingdom
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Yoshida Y, Jin Z, Mannina C, Homma S, Nakanishi K, Leibowitz D, Elkind MS, Rundek T, Di Tullio MR. Aortic Arch Plaques and the Long-Term Risk of Stroke and Cardiovascular Events in the Statin Era. Stroke 2024; 55:69-77. [PMID: 38063018 PMCID: PMC10752266 DOI: 10.1161/strokeaha.123.044546] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Aortic arch plaques are associated with an increased risk of ischemic stroke in patients with cryptogenic stroke or prior embolic events. However, this relationship is unclear in the community. We investigated (1) the long-term risk of stroke and cardiovascular events associated with arch plaques and (2) whether statin therapy prescribed for any indication modified the association. METHODS A total of 934 stroke-free participants (72±9 years; 37% men) from the CABL study (Cardiovascular Abnormalities and Brain Lesion) were evaluated. Arch plaques were assessed by suprasternal transthoracic echocardiography; plaques ≥4 mm in thickness were classified as large plaques. The primary outcome was ischemic stroke; the secondary outcome was combined cardiovascular events (ischemic stroke, myocardial infarction, and cardiovascular death). The plaque-related risk of outcomes was also analyzed according to the presence of statin treatment. No plaque was used as a reference. RESULTS Aortic arch plaques were present in 645 participants (69.1%), with large plaques in 114 (12.2%). During a mean follow-up of 11.3±3.6 years, 236 (25.3%) cardiovascular events occurred (76 ischemic strokes, 27 myocardial infarctions, and 133 cardiovascular deaths). Large arch plaques were independently associated with combined events (adjusted hazard ratio, 2.19 [95% CI, 1.40-3.43]) but not stroke alone (adjusted hazard ratio, 1.09 [95% CI, 0.50-2.38]). The association between large plaques and cardiovascular events was significant in participants receiving statins (adjusted hazard ratio, 2.57 [95% CI, 1.52-4.37]) but not in others; however, participants on statin treatment also had a worse risk profile (higher body mass index, greater frequencies of hypertension, diabetes, and coronary artery disease). CONCLUSIONS Aortic arch plaques may be a marker of cardiovascular risk rather than a direct embolic stroke source in older adults without prior stroke. The efficacy of broader cardiovascular risk factors control, beyond cholesterol levels alone, for primary prevention of cardiovascular events in individuals with aortic arch plaques may require further investigation.
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Affiliation(s)
- Yuriko Yoshida
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Carlo Mannina
- Department of Medicine, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - David Leibowitz
- Department of Medicine, Columbia University, New York, NY
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
- Department of Public Health Sciences, University of Miami, FL
- Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL
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Mannina C, Hopkins K, Love B, Zaidi AN. Massive Right Ventricle Enlargement in Unrepaired Sinus Venosus Atrial Septal Defect: Repair or Not? JACC Case Rep 2023; 28:102091. [PMID: 38204531 PMCID: PMC10774777 DOI: 10.1016/j.jaccas.2023.102091] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 01/12/2024]
Abstract
Sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous return is a rare congenital heart defect that may present in adulthood when right heart enlargement has already occurred. We describe a case of unrepaired sinus venosus atrial septal defect and partial anomalous pulmonary venous return with massive right heart enlargement and recurrent atrial arrhythmias.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Kali Hopkins
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barry Love
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ali N. Zaidi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mannina C, Ito K, Jin Z, Yoshida Y, Russo C, Nakanishi K, Elkind MSV, Rundek T, Homma S, Di Tullio MR. Left Atrial Strain and Incident Atrial Fibrillation in Older Adults. Am J Cardiol 2023; 206:161-167. [PMID: 37708746 PMCID: PMC10592022 DOI: 10.1016/j.amjcard.2023.08.060] [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] [Received: 06/24/2023] [Revised: 08/05/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
Atrial fibrillation (AF) is frequent in older adults and associated with left atrial (LA) dysfunction. LA strain (LAε) and LA strain rate (LASR) may detect subclinical LA disease. We investigated whether reduced LAε and LASR predict new-onset AF in older adults without history of AF or stroke. LAε and LASR were assessed by speckle-tracking echocardiography in 824 participants from the community-based Cardiovascular Abnormalities and Brain Lesions study. Positive longitudinal LAε and LASR during ventricular systole, LASR during early ventricular diastole, and LASR during LA contraction were measured. Cause-specific hazards regression model evaluated the association of LAε and LASR with incident AF, adjusting for pertinent covariates. The mean age was 71.1 ± 9.2 years (313 men, 511 women). During a mean follow-up of 10.9 years, new-onset AF occurred in 105 participants (12.7%). Lower LAε and LASR at baseline were observed in patients with new-onset AF (all p <0.01). In multivariable analysis, positive longitudinal LAε (adjusted hazard ratio [HR] per SD decrease 2.05, confidence interval [CI] 1.24 to 3.36) and LASR during LA contraction (HR per SD increase 2.24, CI 1.37 to 3.65) remained associated with new-onset AF, independently of LA volumes and left ventricular function. Along with positive longitudinal LAε, reduced LASR during ventricular systole predicted AF in participants with LA volume below the median value (HR 2.54, CI 1.10 to 6.09), whereas reduced LASR during LA contraction predicted AF in participants with larger LA (HR 2.35, CI 1.31 to 4.23). In conclusion, reduced positive longitudinal LAε and LASR predict new-onset AF in older adults regardless of LA size and may improve AF risk stratification.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Kazato Ito
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Zhezhen Jin
- Department of Cardiovascular Medicine, the University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cesare Russo
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Koki Nakanishi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mitchell S V Elkind
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Shunichi Homma
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marco R Di Tullio
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
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Yoshida Y, Jin Z, Nakanishi K, Matsumoto K, Homma S, Mannina C, Shames S, Elkind MSV, Rundek T, Di Tullio MR. Subclinical Left Ventricular Dysfunction and Ventricular Arrhythmias in Older Adults With Normal Ejection Fraction. J Am Heart Assoc 2023; 12:e030274. [PMID: 37577940 PMCID: PMC10492955 DOI: 10.1161/jaha.123.030274] [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] [Received: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
Background Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are known to be associated with reduced left ventricular (LV) ejection fraction and adverse outcomes in patients with structural heart disease. The relationship between subclinical LV dysfunction and ventricular arrhythmias in the general population is not established. Methods and Results Participants in the SAFARIS (Subclinical Atrial Fibrillation and Risk of Ischemic Stroke) study with normal left ventricular ejection fraction (n=503; mean age 77 years, 63% women) underwent 14-day electrocardiographic monitoring and 2-dimensional echocardiography. Frequent PVCs were defined as PVCs >500 per 24 hours and NSVT as ≥4 consecutive ventricular ectopic beats. Reduced LV global longitudinal strain (GLS) was used as an indicator of subclinical LV dysfunction. Seventy-six participants (15.1%) had PVCs >500/d, 117 (23.3%) had NSVT episodes. LV GLS was significantly reduced in both frequent PVCs and NSVT groups (P<0.01). In multivariable analyses, lower LV GLS was associated with frequent PVCs (adjusted odds ratio [aOR], 1.19 [95% CI, 1.09-1.30 per unit reduction]; P<0.001) and NSVT (aOR, 1.09 [95% CI, 1.01-1.17]; P=0.036) independently of established risk factors and other echocardiographic parameters. Abnormal LV GLS (>-15.8%) carried a 2-fold increase in risk of ventricular arrhythmias (aOR, 2.18, P=0.029 for PVCs; aOR, 2.09, P=0.026 for NSVT). Conclusions PVCs and NSVT episodes were frequent in this community-based elderly cohort with normal left ventricular ejection fraction and were independently associated with lower LV GLS. The association between LV dysfunction and ventricular arrhythmias is present at an early, subclinical stage, an observation that carries possible preventative implications.
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Affiliation(s)
| | - Zhezhen Jin
- Department of BiostatisticsColumbia UniversityNew YorkNY
| | - Koki Nakanishi
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | | | | | | | - Sofia Shames
- Department of MedicineColumbia UniversityNew YorkNY
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNY
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of MedicineUniversity of MiamiFL
- Department of Public Health SciencesUniversity of MiamiFL
- Clinical and Translational Science Institute, Miller School of MedicineUniversity of MiamiFL
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Leibowitz D, Yoshida Y, Jin Z, Mannina C, Homma S, Nakanishi K, Elkind MS, Rundek T, Di Tullio MR. Long term aortic arch plaque progression in older adults. Atheroscler Plus 2023; 52:18-22. [PMID: 37250431 PMCID: PMC10220301 DOI: 10.1016/j.athplu.2023.05.001] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
Background and aims The presence of aortic arch plaques (AAP) is significantly associated with increased cardiovascular morbidity and mortality. Few studies have examined the incidence of AAP progression and factors which may contribute to it using transthoracic echocardiography (TTE). The objective of this study was to utilize sequential imaging of the aortic arch using TTE to examine the rate of AAP progression and its risk factors in a cohort of older adults. Methods Participants enrolled in both the Cardiovascular Abnormalities and Brain Lesion study (years 2005-2010) and the Subclinical Atrial Fibrillation and Risk of Ischemic Stroke study (2014-2019) who underwent TTE with assessment of aortic arch plaques at both time points represent the study cohort. Results 300 participants were included in the study. Mean age was 67.8 ± 7.5 years at baseline, and 76.7 ± 6.8 years at follow-up; 197 (65.7%) were women. At baseline, 87 (29%) had no significant AAP, 182 (60.7%) had evidence of small AAP (2.0-3.9 mm) and 31 (10.3%) had evidence of large (≥4 mm) AAP. At the time of follow-up assessment, 157 (52.3%) of participants exhibited progression of AAP with 70 (23.3%) having mild progression and 87 (29%) having severe progression. There were no significant demographic or clinical predictors of AAP progression except baseline plaque thickness itself which was significantly lower in the group with AAP progression. Conclusions Our study demonstrates a high prevalence of AAP on TTE exam in a population-based cohort of older adults with a high incidence of AAP progression. TTE is a useful test for baseline and follow up imaging of AAP, even in subjects with no or little AAP at baseline.
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Affiliation(s)
- David Leibowitz
- Department of Medicine, New York, NY, USA
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL, USA
- Department of Public Health Sciences, USA
- Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL, USA
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Leibowitz D, Yoshida Y, Jin Z, Nakanishi K, Mannina C, Elkind MSV, Rundek T, Homma S, Sacco RL, Di Tullio MR. Factors associated with the progression of aortic valve calcification in older adults. Int J Cardiol 2023; 381:76-80. [PMID: 37030403 PMCID: PMC10161393 DOI: 10.1016/j.ijcard.2023.03.059] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Aortic valve calcification (AVC) is a common valvular abnormality that predisposes to stenosis; AVC progression and factors associated with it remain unclear. We investigated the association of clinical factors and serum biomarkers with AVC progression in a population-based cohort of older adults. METHODS Participants enrolled in both the Cardiovascular Abnormalities and Brain Lesion study (CABL; years 2005-2010) and the Subclinical Atrial Fibrillation And Risk of Ischemic Stroke study (SAFARIS;2014-2019) represent the study cohort. AVC was defined as bright dense echoes >1 mm in size on ≥1 cusps; each cusp was graded on a scale of 0 (normal) to 3 (severe calcification) at baseline and follow up. Serum biomarkers were measured at the time of follow-up assessment. RESULTS 373 participants (mean 68.1 ± 7.6 years of age, 146 M/ 227F) were included. 139 (37%) had AVC progression;93 (25%) had mild progression (1 grade), and 46 (12%) had moderate-severe progression (≥2 grades). The only significant clinical predictor of any progression was the use of anti-hypertensive medication which was associated with older age, higher BMI and more frequent hypertension, diabetes and hyperlipidemia. In multivariable analysis including biomarkers, transforming growth factor beta 1 (TGF-β1) was significantly associated with both all and moderate-severe AVC progression. CONCLUSIONS A significant number of elderly subjects with AVC show progression of their valve disease; individual vascular risk factors are not associated with AVC progression, although a combined effect may exist. Higher levels of TGF-β1 are observed in individuals with AVC progression.
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Affiliation(s)
- David Leibowitz
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuriko Yoshida
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Carlo Mannina
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL, USA; Department of Public Health Sciences; Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL, USA; Department of Public Health Sciences; Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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10
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Mannina C, Ito K, Jin Z, Yoshida Y, Matsumoto K, Shames S, Russo C, Elkind MSV, Rundek T, Yoshita M, DeCarli C, Wright CB, Homma S, Sacco RL, Di Tullio MR. Association of Left Atrial Strain With Ischemic Stroke Risk in Older Adults. JAMA Cardiol 2023; 8:317-325. [PMID: 36753086 PMCID: PMC9909576 DOI: 10.1001/jamacardio.2022.5449] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023]
Abstract
Importance The risk of ischemic stroke is higher among patients with left atrial (LA) enlargement. Left atrial strain (LAε) and LA strain rate (LASR) may indicate LA dysfunction when LA volumes are still normal. The association of LAε with incident ischemic stroke in the general population is not well established. Objective To investigate whether LAε and LASR are associated with new-onset ischemic stroke among older adults. Design The Cardiovascular Abnormalities and Brain Lesions study was conducted from September 29, 2005, to July 6, 2010, to investigate cardiovascular factors associated with subclinical cerebrovascular disease. A total of 806 participants in the Northern Manhattan Study who were aged 55 years or older without history of prior stroke or atrial fibrillation (AF) were included, and annual follow-up telephone interviews were completed May 22, 2022. Statistical analysis was performed from June through November 2022. Exposures Left atrial strain and LASR were assessed by speckle-tracking echocardiography. Global peak positive longitudinal LAε and positive longitudinal LASR during ventricular systole, global peak negative longitudinal LASR during early ventricular diastole, and global peak negative longitudinal LASR during LA contraction were measured. Brain magnetic resonance imaging was used to detect silent brain infarcts and white matter hyperintensities at baseline. Main Outcomes and Measures Risk analysis with cause-specific Cox proportional hazards regression modeling was used to assess the association of positive longitudinal LAε and positive longitudinal LASR with incident ischemic stroke, adjusting for other stroke risk factors, including incident AF. Results The study included 806 participants (501 women [62.2%]) with a mean (SD) age of 71.0 (9.2) years; 119 participants (14.8%) were Black, 567 (70.3%) were Hispanic, and 105 (13.0%) were White. During a mean (SD) follow-up of 10.9 (3.7) years, new-onset ischemic stroke occurred in 53 participants (6.6%); incident AF was observed in 103 participants (12.8%). Compared with individuals who did not develop ischemic stroke, participants with ischemic stroke had lower positive longitudinal LAε and negative longitudinal LASR at baseline. In multivariable analysis, the lowest (ie, closest to zero) vs all other quintiles of positive longitudinal LAε (adjusted hazard ratio [HR], 3.12; 95% CI, 1.56-6.24) and negative longitudinal LASR during LA contraction (HR, 2.89; 95% CI, 1.44-5.80) were associated with incident ischemic stroke, independent of left ventricular global longitudinal strain and incident AF. Among participants with a normal LA size, the lowest vs all other quintiles of positive longitudinal LAε (HR, 4.64; 95% CI, 1.55-13.89) and negative longitudinal LASR during LA contraction (HR, 11.02; 95% CI 3.51-34.62) remained independently associated with incident ischemic stroke. Conclusions and Relevance This cohort study suggests that reduced positive longitudinal LAε and negative longitudinal LASR are independently associated with ischemic stroke in older adults. Assessment of LAε and LASR by speckle-tracking echocardiography may improve stroke risk stratification in elderly individuals.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
| | - Kazato Ito
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Yuriko Yoshida
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kenji Matsumoto
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Sofia Shames
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cesare Russo
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Now with Novartis Institutes for BioMedical Research
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
- Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis
| | - Clinton B. Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Shunichi Homma
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ralph L. Sacco
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
- Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Marco R. Di Tullio
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
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11
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Yoshida Y, Jin Z, Russo C, Homma S, Nakanishi K, Ito K, Mannina C, Elkind MSV, Rundek T, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Subclinical left ventricular systolic dysfunction and incident stroke in the elderly: long-term findings from Cardiovascular Abnormalities and Brain Lesions. Eur Heart J Cardiovasc Imaging 2023; 24:522-531. [PMID: 35900282 PMCID: PMC10226754 DOI: 10.1093/ehjci/jeac145] [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] [Received: 04/28/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart disease is associated with an increased risk for ischaemic stroke. However, the predictive value of reduced left ventricular ejection fraction (LVEF) for stroke is controversial and only observed in patients with severe reduction. LV global longitudinal strain (LV GLS) can detect subclinical LV systolic impairment when LVEF is normal. We investigated the prognostic role of LV GLS for incident stroke in a predominantly elderly cohort. METHODS AND RESULTS Two-dimensional echocardiography with speckle tracking was performed in the Cardiac Abnormalities and Brain Lesions (CABL) study. Among 708 stroke-free participants (mean age 71.4 ± 9.4 years, 60.9% women), abnormal LV GLS (>-14.7%: 95% percentile of the subgroup without risk factors) was detected in 133 (18.8%). During a mean follow-up of 10.8 ± 3.9 years, 47 participants (6.6%) experienced an ischaemic stroke (26 cardioembolic or cryptogenic, 21 other subtypes). The cumulative incidence of ischaemic stroke was significantly higher in participants with abnormal LV GLS than with normal LV GLS (P < 0.001). In multivariate stepwise logistic regression analysis, abnormal LV GLS was associated with ischaemic stroke independently of cardiovascular risk factors including LVEF, LV mass, left atrial volume, subclinical cerebrovascular disease at baseline, and incident atrial fibrillation [hazard ratio (HR): 2.69, 95% confidence interval (CI): 1.47-4.92; P = 0.001]. Abnormal LV GLS independently predicted cardioembolic or cryptogenic stroke (adjusted HR: 3.57, 95% CI: 1.51-8.43; P = 0.004) but not other subtypes. CONCLUSION LV GLS was a strong independent predictor of ischaemic stroke in a predominantly elderly stroke-free cohort. Our findings provide insights into the brain-heart interaction and may help improve stroke primary prevention strategies.
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Affiliation(s)
- Yuriko Yoshida
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Zhezhen Jin
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Cesare Russo
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Koki Nakanishi
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Kazato Ito
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Carlo Mannina
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Mitchell S V Elkind
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Tatjana Rundek
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Mitsuhiro Yoshita
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Charles DeCarli
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Clinton B Wright
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Ralph L Sacco
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia university Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
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12
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Mannina C, Di Tullio MR. Screening for atrial fibrillation in the elderly. Int J Cardiol 2022; 347:73. [PMID: 34740716 DOI: 10.1016/j.ijcard.2021.10.160] [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] [Received: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Carlo Mannina
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
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13
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Matsumoto K, Jin Z, Homma S, Elkind MSV, Schwartz JE, Rundek T, Mannina C, Ito K, Sacco RL, Di Tullio MR. Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study. Hypertension 2021; 78:851-858. [PMID: 34247509 DOI: 10.1161/hypertensionaha.121.17308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kenji Matsumoto
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics (Z.J.), Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (M.S.V.E.)
| | - Joseph E Schwartz
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY.,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S.)
| | - Tatjana Rundek
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Carlo Mannina
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Kazato Ito
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Clinical and Translational Science Institute (R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Marco R Di Tullio
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
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14
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Mannina C, Jin Z, Matsumoto K, Ito K, Biviano A, Elkind MSV, Rundek T, Homma S, Sacco RL, Di Tullio MR. Frequency of cardiac arrhythmias in older adults: Findings from the Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. Int J Cardiol 2021; 337:64-70. [PMID: 33965468 DOI: 10.1016/j.ijcard.2021.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/07/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prolonged monitoring of cardiac rhythm has been used to screen for subclinical atrial fibrillation (AF); little is known about other arrhythmias in the general population, especially in the elderly, who are at higher risk of arrhythmias. METHODS We evaluated the frequency of arrhythmias in the tri-ethnic (white, Black, Hispanic), community-based Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study using a patch-based recorder for up to 14 days in 527 participants free of AF, congestive heart failure (CHF) or history of stroke. Differences according to gender, age, ethnicity and presence of hypertension, diabetes and pertinent ECG and echocardiographic variables were examined. RESULTS Mean age was 77.2 ± 6.8 years (37.2% men, 62.8% women). AF was present in 10 participants (1.9%), only 2 of them symptomatic. Supraventricular tachycardia (SVT) and ventricular tachycardia (VT) episodes were observed in 84.4% and 25.0% but only 13.5% and 10.6% of participants reported symptoms, respectively. Severe bradycardia (<40 bpm) was present in 12.5%. Sinus pauses and high-degree atrioventricular blocks were infrequent (2.1% and 1.5%, respectively). Most arrhythmias were more frequent in participants > 75 years; ventricular arrhythmias and severe bradycardia were more common in men. Whites had significantly more episodes of AF than Hispanics, SVT than Blacks and VT ≥ 10 beats than Hispanics and Blacks. Hypertensives had more episodes of severe bradycardia. LV hypertrophy or LVEF <55% were associated with more frequent ventricular and supraventricular arrhythmias. CONCLUSIONS Prolonged cardiac rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing arrhythmias. Ventricular arrhythmias were relatively frequent, whereas severe bradyarrhythmias were infrequent.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Department of Internal Medicine, University of Palermo, Italy
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kenji Matsumoto
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Kazato Ito
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Angelo Biviano
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL, United States of America; Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL, United States of America
| | - Shunichi Homma
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL, United States of America; Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL, United States of America; Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL, United States of America
| | - Marco R Di Tullio
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
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15
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Mannina C, Jin Z, Russo C, Homma S, Elkind MS, Rundek T, Lee TC, Matsumoto K, Shames S, Sacco RL, Tullio MRD. Effect of hypertension and diabetes on subclinical left ventricular systolic dysfunction in a predominantly elderly population-based cohort. Eur J Prev Cardiol 2020; 27:2173-2175. [PMID: 31446789 DOI: 10.1177/2047487319872571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/22/2022]
Affiliation(s)
- Carlo Mannina
- Department of Medicine, Columbia University, New York, USA.,Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro', University of Palermo, Italy
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, USA
| | - Cesare Russo
- Department of Medicine, Columbia University, New York, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, USA
| | - Mitchell Sv Elkind
- Department of Neurology, Columbia University, New York, USA.,Department of Epidemiology, Columbia University, New York, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, USA.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Tetz C Lee
- Department of Medicine, Columbia University, New York, USA
| | | | - Sofia Shames
- Department of Medicine, Columbia University, New York, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, USA.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA.,Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, USA
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16
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Mannina C, Jin Z, Matsumoto K, Ito K, Biviano A, Elkind M, Rundek T, Homma S, Sacco R, Di Tullio M. Frequency of cardiac arrhythmias in older adults: findings from the subclinical atrial fibrillation and risk of ischemic stroke (SAFARIS) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0356] [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
Prolonged monitoring of cardiac rhythm has been used in patients with symptomatic arrhythmias and to assess for atrial fibrillation (AF) after cryptogenic stroke, but not in the general population and especially in older adults.
Purpose
To evaluate the frequency of arrhythmias in a community-based cohort of older adults through 14-days continuous cardiac monitoring using a patch-based device.
Methods
Cardiac rhythm was analyzed in 533 participants free of AF and congestive heart failure (CHF) from the tri-ethnic (white, black, Hispanic) Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. AF, supraventricular tachycardia (SVT, defined as 4 beats or more), premature atrial (PACs) and ventricular (PVCs) contractions, ventricular tachycardia (VT, defined as 4 beats or more), sinus pauses (SP) and atrio-ventricular blocks (AVB) were analyzed. Gender, age and race-ethnic differences were examined.
Results
Mean age was 77.2±6.8 years (198 men, 335 women). Recording duration was over 10 days in 91%, and over 13 days in 84%. AF was present in 10 participants (1.9%), atrial flutter in 1 (0.2%). Other arrhythmias are reported in the Table. SP (1.9%) and high-degree AVB (Mobitz II: 0.6%; 3rd degree: 0.9%) were rare. No significant race-ethnic differences were observed.
Conclusion
In older adults without history of stroke or CHF, prolonged rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing conditions such as SVT and frequent PACs. VT episodes were relatively frequent, whereas SP and AVB were less frequent than commonly believed. Most arrhythmias were more frequent in the oldest; ventricular arrhythmias were more common in men than in women.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NINDS R01 NS083874
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Affiliation(s)
- C Mannina
- University of Palermo, Palermo, Italy
| | - Z Jin
- Columbia University, New York, United States of America
| | - K Matsumoto
- Columbia University, New York, United States of America
| | - K Ito
- Columbia University, New York, United States of America
| | - A Biviano
- Columbia University, New York, United States of America
| | - M Elkind
- Columbia University, New York, United States of America
| | - T Rundek
- University of Miami Leonard M. Miller School of Medicine, Miami, United States of America
| | - S Homma
- Columbia University, New York, United States of America
| | - R Sacco
- University of Miami Leonard M. Miller School of Medicine, Miami, United States of America
| | - M Di Tullio
- Columbia University, New York, United States of America
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17
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Mannina C, Tugcu A, Jin Z, Russo C, Matsumoto K, Ito K, Homma S, Elkind MSV, Rundek T, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Left Atrial Strain and Subclinical Cerebrovascular Disease in Older Adults. JACC Cardiovasc Imaging 2020; 14:508-510. [PMID: 33011124 DOI: 10.1016/j.jcmg.2020.08.008] [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] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
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18
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Matsumoto K, Jin Z, Homma S, Elkind MSV, Rundek T, Mannina C, Lee TC, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Association Between Central Blood Pressure and Subclinical Cerebrovascular Disease in Older Adults. Hypertension 2019; 75:580-587. [PMID: 31865782 DOI: 10.1161/hypertensionaha.119.13478] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Elevated blood pressure (BP) level is one of the most consistently identified risk factors for silent brain disease. BP values obtained at the proximal segment of the aorta (central BP) are more directly involved than brachial BP in the pathogenesis of cardiovascular disease. However, the association between central BP and silent cerebrovascular disease has not been clearly established. Participants in the CABL (Cardiovascular Abnormalities and Brain Lesions) study (n=993; mean age, 71.7±9.3 years; 37.9% men) underwent 2-dimensional echocardiography, arterial wave reflection analysis for determination of central BPs, and brain magnetic resonance imaging. Central BPs were calculated from the radial pulse waveform. Subclinical silent cerebrovascular disease was defined as silent brain infarction and white matter hyperintensity volume. Both brachial (P=0.014) and central pulse pressure (P=0.026) were independently associated with silent brain infarctions after adjustment for clinical variables, but not adjusting for each other. None of the brachial BP values was associated with upper quartile of white matter hyperintensity volume in multivariable analysis. Both central systolic BP (P<0.001) and central pulse pressure (P<0.001) were significantly associated with upper quartile of white matter hyperintensity volume in multivariable analysis, even after adjustment for brachial BP. In a predominantly older population-based cohort, both brachial and central pulse pressure were independently associated with silent brain infarction. However, higher central systolic BP and central pulse pressure, but not brachial BP, were significantly associated with white matter hyperintensity volume.
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Affiliation(s)
- Kenji Matsumoto
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Zhezhen Jin
- Department of Biostatistics (Z.J.), Columbia University, New York
| | - Shunichi Homma
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Mitchell S V Elkind
- Department of Neurology (M.S.V.E.), Columbia University, New York.,Department of Epidemiology (M.S.V.E.), Columbia University, New York
| | - Tatjana Rundek
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Carlo Mannina
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Tetz C Lee
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Mitsuhiro Yoshita
- Department of Neurology, Hokuriku National Hospital, Nanto, Japan (M.Y.)
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Sacramento (C.D.)
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Clinical and Translational Science Institute (R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Marco R Di Tullio
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
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19
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Patti AM, Al-Rasadi K, Giglio RV, Nikolic D, Mannina C, Castellino G, Chianetta R, Banach M, Cicero AF, Lippi G, Montalto G, Rizzo M, Toth PP. Natural approaches in metabolic syndrome management. Arch Med Sci 2018; 14:422-441. [PMID: 29593818 PMCID: PMC5868676 DOI: 10.5114/aoms.2017.68717] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/25/2022] Open
Abstract
Metabolic syndrome (MetS) is characterized as a group of cardiometabolic risk factors that raise the risk for heart disease and other health problems, such as diabetes mellitus and stroke. Treatment strategies include pharmacologic interventions and supplementary (or "alternative") treatments. Nutraceuticals are derived from food sources (isolated nutrients, dietary supplements and herbal products) that are purported to provide health benefits, in addition to providing basic nutritional value. Nutraceuticals are claimed to prevent chronic diseases, improve health, delay the aging process, increase life expectancy, and support the structure and function of the body. The study of the beneficial effects of nutraceuticals in patients with MetS, including product standardization, duration of supplementation and definition of optimal dosing, could help better define appropriate treatment. This review focuses on widely marketed nutraceuticals (namely polyphenols, omega-3 fatty acids, macroelements and vitamins) with clinically demonstrated effects on more than one component of MetS.
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Affiliation(s)
- Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University, Muscat, Oman
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Carlo Mannina
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Giuseppa Castellino
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Roberta Chianetta
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Maccora S, Mannina C, Bolognini N, Paladino P, Baschi R, Cosentino G, Fierro B, Vallar G, Brighina F. O069. Menstrual cycle affects cortical excitability differently in females with migraine and in healthy controls: a new perspective by cross modal sound induced flash illusions. J Headache Pain 2015; 16:A141. [PMID: 28132247 PMCID: PMC4759051 DOI: 10.1186/1129-2377-16-s1-a141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Simona Maccora
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy.
| | - Carlo Mannina
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Nadia Bolognini
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy.,Laboratorio di Neuropsicologia, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Piera Paladino
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Roberta Baschi
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Giuseppe Cosentino
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Brigida Fierro
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Giuseppe Vallar
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy.,Laboratorio di Neuropsicologia, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Filippo Brighina
- Dipartimento di Biomedicine Sperimentali e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
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