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Kamel H, Longstreth WT, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, Aragón García R, Plummer P, Sabagha N, Pauls Q, Cassarly C, Dillon CR, Di Tullio MR, Hod EA, Soliman EZ, Gladstone DJ, Healey JS, Sharma M, Chaturvedi S, Janis LS, Krishnaiah B, Nahab F, Kasner SE, Stanton RJ, Kleindorfer DO, Starr M, Winder TR, Clark WM, Miller BR, Elkind MSV. Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy: The ARCADIA Randomized Clinical Trial. JAMA 2024; 331:573-581. [PMID: 38324415 PMCID: PMC10851142 DOI: 10.1001/jama.2023.27188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
Importance Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation. Objective To compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy. Design, Setting, and Participants Multicenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2 or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization. Enrollment and follow-up occurred from February 1, 2018, through February 28, 2023, at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium. Interventions Apixaban, 5 mg or 2.5 mg, twice daily (n = 507) vs aspirin, 81 mg, once daily (n = 508). Main Outcomes and Measures The primary efficacy outcome in a time-to-event analysis was recurrent stroke. All participants, including those diagnosed with atrial fibrillation after randomization, were analyzed according to the groups to which they were randomized. The primary safety outcomes were symptomatic intracranial hemorrhage and other major hemorrhage. Results With 1015 of the target 1100 participants enrolled and mean follow-up of 1.8 years, the trial was stopped for futility after a planned interim analysis. The mean (SD) age of participants was 68.0 (11.0) years, 54.3% were female, and 87.5% completed the full duration of follow-up. Recurrent stroke occurred in 40 patients in the apixaban group (annualized rate, 4.4%) and 40 patients in the aspirin group (annualized rate, 4.4%) (hazard ratio, 1.00 [95% CI, 0.64-1.55]). Symptomatic intracranial hemorrhage occurred in 0 patients taking apixaban and 7 patients taking aspirin (annualized rate, 1.1%). Other major hemorrhages occurred in 5 patients taking apixaban (annualized rate, 0.7%) and 5 patients taking aspirin (annualized rate, 0.8%) (hazard ratio, 1.02 [95% CI, 0.29-3.52]). Conclusions and Relevance In patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, apixaban did not significantly reduce recurrent stroke risk compared with aspirin. Trial Registration ClinicalTrials.gov Identifier: NCT03192215.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - W. T. Longstreth
- Department of Neurology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | | | | | - Randolph S. Marshall
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebeca Aragón García
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Pamela Plummer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Noor Sabagha
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Qi Pauls
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Catherine R. Dillon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Marco R. Di Tullio
- Division of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Eldad A. Hod
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David J. Gladstone
- Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland, and Baltimore VA Hospital, Baltimore
| | - L. Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Balaji Krishnaiah
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis
| | - Fadi Nahab
- Departments of Neurology and Pediatrics, Emory University, Atlanta, Georgia
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert J. Stanton
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Matthew Starr
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Wayne M. Clark
- Department of Neurology, Oregon Health & Science University, Portland
| | | | - 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
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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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Hirose K, Nakanishi K, Di Tullio MR, Homma S, Sawada N, Yoshida Y, Hirokawa M, Koyama K, Kimura K, Nakao T, Daimon M, Morita H, Kurano M, Komuro I. Association between non-alcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population. Eur Heart J Open 2023; 3:oead108. [PMID: 37941727 PMCID: PMC10630098 DOI: 10.1093/ehjopen/oead108] [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: 08/29/2023] [Revised: 09/20/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
Aims Emerging evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and heart failure (HF). We investigated the relationship between NAFLD and left ventricular (LV) functional remodelling in a general population sample without overt cardiac and liver disease. Methods and results We included 481 individuals without significant alcohol consumption who voluntarily underwent an extensive cardiovascular health check. The fatty liver index (FLI) was calculated for each participant, and NAFLD was defined as FLI ≥ 60. All participants underwent 2D transthoracic echocardiography; LV global longitudinal strain (LVGLS) was assessed with speckle-tracking analysis. Univariable and multivariable linear regression models were constructed to investigate the possible association between NAFLD and LVGLS. Seventy-one (14.8%) participants were diagnosed with NAFLD. Individuals with NAFLD exhibited larger LV size and LV mass index than those without NAFLD, although left atrial size and E/e' ratio did not differ between groups. Left ventricular global longitudinal strain was significantly reduced in participants with vs. without NAFLD (17.1% ± 2.4% vs. 19.5% ± 3.1%, respectively; P < 0.001). The NAFLD group had a significantly higher frequency of abnormal LVGLS (<16%) than the non-NAFLD group (31.0% vs. 10.7%, respectively; P < 0.001). Multivariable linear regression analysis demonstrated that higher FLI score was significantly associated with impaired LVGLS independent of age, sex, conventional cardiovascular risk factors, and echocardiographic parameters (standardized β -0.11, P = 0.031). Conclusion In the general population without overt cardiac and liver disease, the presence of NAFLD was significantly associated with subclinical LV dysfunction, which may partly explain the elevated risk of HF in individuals with NAFLD.
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Affiliation(s)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, NewYork, NY, USA
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuriko Yoshida
- Department of Medicine, Columbia University, NewYork, NY, USA
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Katsuhiro Koyama
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koichi Kimura
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- International University of Health and Welfare, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- International University of Health and Welfare, Tokyo, Japan
- Department of Frontier Cardiovascular Science, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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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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Schilling J, Lin JP, Mankad SV, Krishnam MS, Ning M, Patel PM, Kim CK, Kapoor R, Di Tullio MR, Jung J, Kim JK, Fisher MJ. The 2022 FASEB Virtual Catalyst Conference on the Cardiac Interatrial Septum and Stroke Risk, December 7, 2022. FASEB J 2023; 37:e23122. [PMID: 37606555 DOI: 10.1096/fj.202300897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/09/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
There is emerging evidence that the cardiac interatrial septum has an important role as a thromboembolic source for ischemic strokes. There is little consensus on treatment of patients with different cardiac interatrial morphologies or pathologies who have had stroke. In this paper, we summarize the important background, diagnostic, and treatment considerations for this patient population as presented during the Federation of American Societies for Experimental Biology (FASEB) Virtual Catalytic Conference on the Cardiac Interatrial Septum and Stroke Risk, held on December 7, 2022. During this conference, many aspects of the cardiac interatrial septum were discussed. Among these were the embryogenesis of the interatrial septum and development of anatomic variants such as patent foramen ovale and left atrial septal pouch. Also addressed were various mechanisms of injury such as shunting physiologies and the consequences that can result from anatomic variants, as well as imaging considerations in echocardiography, computed tomography, and magnetic resonance imaging. Treatment options including anticoagulation and closure were addressed, as well as an in-depth discussion on whether the left atrial septal pouch is a stroke risk factor. These issues were discussed and debated by multiple experts from neurology, cardiology, and radiology.
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Affiliation(s)
- Jonathan Schilling
- Department of Medicine, University of California, Irvine, California, USA
| | - Jeannette P Lin
- Department of Cardiology, University of California, Los Angeles, California, USA
| | - Sunil V Mankad
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Stanford, California, USA
| | - MingMing Ning
- Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Ruchi Kapoor
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York, USA
| | - Jinman Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Jin Kyung Kim
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Mark J Fisher
- Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, University of California, Irvine, California, USA
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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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8
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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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9
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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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10
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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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11
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Hirose K, Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome and Normal Left Ventricular Ejection Fraction. Am J Cardiol 2023; 187:30-37. [PMID: 36459745 DOI: 10.1016/j.amjcard.2022.10.030] [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] [Received: 07/15/2022] [Revised: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Patients with chronic coronary syndrome (CCS), even when they have complete revascularization and normal left ventricular (LV) systolic function, experience subsequent cardiovascular disease (CVD), highlighting the importance of surrogate markers to prevent adverse consequences. Speckle-tracking echocardiography-derived left atrial (LA) reservoir strain has emerged as a sensitive marker for CVD in various clinical settings. The present study investigated the prevalence, determinants, and prognostic value of LA dysfunction in CCS. We included 278 consecutive patients with CCS with completed percutaneous coronary intervention and preserved LV ejection fraction who underwent follow-up echocardiography. Speckle-tracking analysis was performed to assess LA reservoir strain, and LA dysfunction was defined as LA reservoir strain ≤24%. The primary outcome comprised new-onset atrial fibrillation, heart failure hospitalization, acute coronary syndrome, stroke, or all-cause death. At baseline, 28 patients (10.1%) had LA dysfunction. Multivariable analysis identified age, hypertension, LV ejection fraction, and multivessel disease as independent determinants of LA reservoir strain (all p <0.05). During a median follow-up of 4.8 years, the primary outcome occurred in 60 patients (21.6%). LA dysfunction carried a significant risk for primary outcome independent of traditional risk factors, LV parameters, and LA size (adjusted hazard ratio 3.10, p = 0.003); the risk increase remained significant even after excluding atrial fibrillation from the primary outcome (adjusted hazard ratio 2.27, p = 0.043). In conclusion, approximately 10% of patients with CCS with normal LV ejection fraction had LA dysfunction associated with adverse cardiovascular outcomes. Further studies are needed to explore whether therapeutic interventions affecting LA remodeling may help prevent CVD events.
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Affiliation(s)
- Kazutoshi Hirose
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Departments of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Medicine, Columbia University, New York, New York
| | - Jumpei Ishiwata
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Departments of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Issei Komuro
- Departments of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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12
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Seki H, Nakanishi K, Daimon M, Hirose K, Mukai Y, Yoshida Y, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Epicardial fat accumulation and left heart remodelling in patients with chronic coronary syndrome. Eur Heart J Open 2023; 3:oeac082. [PMID: 36632475 PMCID: PMC9825801 DOI: 10.1093/ehjopen/oeac082] [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: 09/29/2022] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
AIMS Patients with chronic coronary syndrome (CCS) suffer from subsequent cardiovascular events, even after complete revascularization; thus, elucidation of the underlying pathophysiological mechanisms is required. Epicardial adipose tissue (EAT) is increasingly recognized as a metabolically active organ with a key role in the pathogenesis of metabolic-related cardiac diseases. The present study investigated the association between EAT burden and left heart remodelling in patients with CCS. METHODS AND RESULTS We studied 267 CCS patients (210 men; 71 ± 9 years) with complete revascularization and normal left ventricular (LV) ejection fraction who underwent follow-up echocardiography. All patients underwent the measurement of EAT thickness and speckle-tracking analysis to evaluate LV global longitudinal strain (LVGLS) and left atrial (LA) phasic strain. The mean EAT thickness was 5.0 ± 1.8 mm. Age, sex, body mass index, and diabetes mellitus were independently associated with EAT thickness (all P < 0.05). Multivariable linear regression analysis demonstrated that EAT thickness was significantly associated with LV mass index, early diastolic mitral annular velocity, and LA conduit strain independent of age, sex, and cardiovascular risk factors (all P < 0.05). On the other hand, there was no relationship between EAT thickness and LV systolic parameters including LV ejection fraction and LVGLS. CONCLUSION CCS patients with increased EAT thickness had unfavourable left heart remodelling. The assessment of EAT thickness by echocardiography may have clinical utility as a simple surrogate to aid in risk stratification for impaired left heart function in CCS patients.
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Affiliation(s)
- Hikari Seki
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koki Nakanishi
- Corresponding author. Tel: #81 3 3815 5411 Fax: #81 3 5800 9171,
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuhiro Mukai
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Medicine, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 630 W 168th St, New York, NY 10032, USA
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13
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Mukai Y, Nakanishi K, Daimon M, Sawada N, Hirose K, Iwama K, Yamamoto Y, Yoshida Y, Ishiwata J, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Association of arterial properties with left ventricular morphology and function in the community. J Hypertens 2022; 40:2423-2429. [PMID: 35983866 DOI: 10.1097/hjh.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Arterial structural and functional remodeling is recognized as a key determinant of incident heart failure, although the contribution of arterial properties on left ventricular (LV) remodeling is not fully studied. Aortic dilatation is an early manifestation of arterial remodeling and estimated pulse wave velocity (ePWV) is emerging as a simple measure of arterial stiffness. This study aimed to characterize the association of aortic size and ePWV with LV morphology and function. METHODS The study cohort consisted of 539 participants without overt cardiac disease who underwent extensive cardiovascular examination. Aortic root diameter was measured by two-dimensional echocardiography and ePWV was calculated from a regression equation using age and mean blood pressure. LV global longitudinal strain (LVGLS) was obtained by speckle-tracking echocardiography. RESULTS Aortic root diameter and ePWV were correlated with LV mass index and LVGLS, while only ePWV was related to E / e' ratio. In multivariable analysis, aortic root diameter and ePWV were significantly related to LV mass index and LVGLS (all P < 0.05), and the association of aortic root size and ePWV with LVGLS was independent of LV mass index and E / e' ratio. Individuals with both aortic root enlargement and increased ePWV had significantly larger LV mass index and reduced LVGLS compared with those either or those with normal aortic size and ePWV (both P < 0.05). CONCLUSION Aortic root size and ePWV were independently associated with unfavorable LV remodeling in individuals free of cardiac disease, which might provide useful information into the pathogenesis-linking arterial remodeling and heart failure.
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Affiliation(s)
| | | | - Masao Daimon
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Yuriko Yoshida
- Department of Cardiovascular Medicine
- Department of Medicine, Columbia University, New York, New York, USA
| | | | | | - Tomoko Nakao
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | - Marco R Di Tullio
- Department of Medicine, Columbia University, New York, New York, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York, USA
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14
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Yoshida Y, Nakanishi K, Daimon M, Hirose K, Ishiwata J, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Aortic valve sclerosis and subclinical LV dysfunction in the general population with normal LV geometry. Eur J Prev Cardiol 2022; 30:zwac279. [PMID: 36416216 DOI: 10.1093/eurjpc/zwac279] [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: 07/21/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
AIMS Aortic valve sclerosis (AVS) without hemodynamically significant obstruction is related to cardiovascular morbidity and mortality independent of left ventricular (LV) hypertrophy, although the underlying mechanisms remain unknown. This study investigated the prevalence of AVS and its association with subclinical LV systolic and diastolic dysfunction in individuals with normal LV geometry free of cardiovascular disease. METHODS We examined 962 participants with normal LV geometry and free from significant AV stenosis who underwent standard and speckle-tracking echocardiography. AVS was categorized into 4 groups as follows: no AVS, AV thickening, calcification on one leaflet and calcification on ≥2 leaflets. RESULTS Among the 962 participants, 767 (79.7%) individuals were classified as no AVS, 74 (7.7%) as AV thickening, 87 (9.0%) as calcification on one leaflet, and 34 (3.5%) as calcification on ≥2 leaflets. The prevalence of subclinical LV diastolic dysfunction (E/e' ratio ≥13) and systolic dysfunction (LV global longitudinal strain (GLS) > -17.0% for men and > -18.0% for women) were greater in AVS groups than those in no AVS group. Subclinical LV diastolic impairment was evident from AV thickening and systolic dysfunction was observed at AV calcification. Multivariable logistic regression analysis demonstrated that AV thickening as well as calcification were independently associated with subclinical LV diastolic impairment (all p < 0.05), while only AV calcification on ≥2 leaflets conferred significant increased risk of impaired LVGLS. CONCLUSIONS AVS was observed in approximately 20% individuals without cardiac disease and was associated with subclinical LV diastolic and systolic function even in the absence of LV morphological change.
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Affiliation(s)
| | | | - Masao Daimon
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | | | | | - Tomoko Nakao
- Department of Cardiovascular Medicine
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | | | | | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
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15
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Itoh H, Kaneko H, Okada A, Suzuki Y, Fujiu K, Matsuoka S, Michihata N, Jo T, Nakanishi K, Takeda N, Morita H, Node K, Di Tullio MR, Homma S, Yasunaga H, Komuro I. Age-Specific Relation of Cardiovascular Health Metrics With Incident Cardiovascular Disease. Am J Cardiol 2022; 177:34-39. [PMID: 35773045 DOI: 10.1016/j.amjcard.2022.04.046] [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] [Received: 01/21/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
We examined the age-related differences in cardiovascular health (CVH) metrics for incident cardiovascular disease (CVD). Analyses were conducted using data from the JMDC Claims Database from 2005 to 2020 (n = 2,728,427; mean age 44.9 ± 11.0 years; 56.2% men). Participants were categorized on the basis of age: 20 to 49 years (n = 1,800,161), 50 to 59 years (n = 644,703), and 60 to 75 years (n = 283,563). Ideal CVH metrics included nonsmoking, body mass index <25 kg/m2, physical activity at goal, not skipping breakfast, blood pressure <120/80 mm Hg, fasting plasma glucose <100 mg/dL, and total cholesterol <200 mg/dL. Over a mean follow-up of 1,194 ± 917 days, 5,988 myocardial infarction (MI), 53,409 angina pectoris, 26,530 stroke, and 52,712 heart failure (HF) events were recorded. Number of the nonideal CVH metrics was associated with incident MI, angina pectoris, stroke, and HF in all age categories. However, the association of the number of nonideal CVH metrics with incident CVD was modified by age categories and was more pronounced in participants aged 20 to 49 years. Similarly, the relative risk reduction at 1 year for each CVD event under the virtual condition that an individual with 2 nonideal CVH metrics has decreased them to zero, decreased with age. For example, relative risk reduction for MI was 0.51 in participants aged 20 to 49 years, 0.48 in those aged 50 to 59 years, and 0.40 in those aged 60 to 75 years. In conclusion, CVH metrics were more strongly associated with incident CVD including HF among younger individuals suggesting the importance of optimizing modifiable risk factors and lifestyles in young participants for the primary CVD prevention.
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Affiliation(s)
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine; Department of Advanced Cardiology.
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine
| | - Yuta Suzuki
- Department of Cardiovascular Medicine; Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine; Department of Advanced Cardiology
| | | | | | | | | | | | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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16
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Khasiyev F, Rundek T, Di Tullio MR, Wright CB, Sacco RL, Elkind MSV, Gutierrez J. Systemic Arterial Correlates of Cervical Carotid Artery Tortuosity : The Northern Manhattan Study. Clin Neuroradiol 2022; 32:435-443. [PMID: 34132845 PMCID: PMC8720277 DOI: 10.1007/s00062-021-01044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/25/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The association between cervical internal carotid artery (cICA) tortuosity and atherosclerosis is a matter of debate. Additionally, some genetic syndromes characterized by connective tissue remodeling are associated with arterial tortuosity, raising the possibility that cICA tortuosity may not only be atherosclerotic. In this study, we hypothesized that cICA tortuosity is not associated with imaging biomarkers of atherosclerosis. METHODS The Northern Manhattan Study (NOMAS) was a prospective, multiethnic cohort of stroke-free individuals who underwent brain MRA, carotid ultrasound and transthoracic echocardiogram from 2003-2008. The cICA tortuosity was scored in each carotid as 0 = no tortuosity, 1 = tortuosity <90°, 2 = tortuosity ≥90°. A summary cICA tortuosity score (possible range 0-4) was created by adding up the tortuosity score from each carotid. Participants were assessed for atherosclerotic markers by using B‑mode carotid sonography and transthoracic echocardiography. RESULTS Of 558 participants 178 (31.9%) had any cervical ICA tortuosity (tortuosity score >0). The cICA tortuosity score was higher in women and was associated with diastolic and systolic blood pressures and height (all P < 0.05). In models adjusted for demographics and risk factors, only the association with diastolic blood pressure remained significant (β = 0.002, P = 0.02). Similarly, cICA tortuosity was associated with larger aortic root diameter (B = 1.03 ± 0.36, P = 0.004) but not with other markers of carotid or aortic atherosclerosis. CONCLUSION Cervical ICA tortuosity is associated with a higher diastolic blood pressure and larger aortic root diameter but not with other measures of atherosclerosis. Determining the risks of vascular events associated with this non-atherosclerotic phenotype may help for a better risk stratification for individuals with cICA tortuosity.
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Affiliation(s)
- Farid Khasiyev
- Department of Neurology, St. Louis University, St. Louis, MO, USA.
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Jose Gutierrez
- Department of Neurology, Columbia University, New York, NY, USA
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17
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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Blood pressure categorization and subclinical left ventricular dysfunction in antihypertensive medication-naive subjects. ESC Heart Fail 2022; 9:1766-1774. [PMID: 35199967 PMCID: PMC9065812 DOI: 10.1002/ehf2.13860] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 01/14/2023] Open
Abstract
Aims The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex‐specific difference remains unclarified. This study investigated the relationship between BP categories given in the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and subclinical LV dysfunction in subjects free of cardiac disease. Methods and results We examined antihypertensive medication‐naive 858 individuals who underwent extensive cardiovascular health check‐up. LV global longitudinal (LVGLS) and circumferential strain (LVGCS) were assessed by two‐dimensional speckle‐tracking echocardiography. Participants were categorized into four groups: normal BP, elevated BP, isolated diastolic hypertension (IDH), and systolic hypertension (SH). Among the 858 participants, 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (>−18.6%) was greatest in SH (19.0%), followed by IDH (17.5%), elevated BP (14.2%), and normal BP (7.1%, P < 0.001); no significant differences were observed for LVGCS (P = 0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS [adjusted odds ratio (OR) 2.69 and 2.66, P < 0.001], and borderline significance was observed for elevated BP (adjusted OR 1.90, P = 0.060); there was no significant association between any of the BP groups and LVGCS. In sex‐stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women. Conclusions Isolated diastolic hypertension and SH redefined by ACC/AHA guideline carried significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.
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Affiliation(s)
- Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Medicine, Columbia University, New York, NY, USA
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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18
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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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Adams HP, Adeoye O, Albers GW, Alexandrov AV, Amin-Hanjani S, An H, Anderson CS, Anrather J, Aparicio HJ, Arai K, Aronowski J, Atchaneeyasakul K, Audebert H, Auer RN, Awad IA, Ay H, Baltan S, Balu R, Behbahani M, Benavente OR, Bershad EM, Berthaud JV, Blackburn SL, Bonati LH, Bösel J, Bousser MG, Broderick JP, Brown MM, Brown W, Brust JC, Bushnell C, Canhão P, Caplan LR, Carrión-Penagos J, Castellanos M, Caunca MR, Chabriat H, Chamorro A, Chen J, Chen J, Chopp M, Christorforids G, Connolly ES, Cramer SC, Cucchiara BL, Czap AL, Dannenbaum MJ, Davis PH, Dawson TM, Dawson VL, Day AL, De Silva TM, de Sousa DA, Del Brutto VJ, del Zoppo GJ, Derdeyn CP, Di Tullio MR, Diener HC, Diringer MN, Dobkin BH, Dzialowski I, Elkind MS, Elm J, Feigin VL, Ferro JM, Field TS, Fischer M, Fornage M, Furie KL, Garcia-Bonilla L, Giannotta SL, Gobin YP, Goldberg MP, Goldstein LB, Gonzales NR, Greer DM, Grotta JC, Guo R, Gutierrez J, Harmel P, Howard G, Howard VJ, Hwang JY, Iadecola C, Jahan R, Jickling GC, Joutel A, Kasner SE, Katan M, Kellner CP, Khan M, Kidwell CS, Kim H, Kim JS, Kircher CE, Krings T, Krishnamurthi RV, Kurth T, Lansberg MG, Levy EI, Liebeskind DS, Liew SL, Lin DJ, Lisle B, Lo EH, Lyden PD, Maki T, Maragkos GA, Marosfoi M, McCullough LD, Meckler JM, Meschia JF, Messé SR, Mocco J, Mokin M, Mooney MA, Morgenstern LB, Moskowitz MA, Mullen MT, Nägel S, Nedergaard M, Neira JA, Newman S, Nicholson PJ, Norrving B, O’Donnell M, Ofengeim D, Ogata J, Ogilvy CS, Orrù E, Ortega-Gutiérrez S, Padrick MM, Parsha K, Parsons M, Patel NV, Patel VI, Pawlikowska L, Pérez A, Perez-Pinzon MA, Picard JM, Polster SP, Powers WJ, Puetz V, Putaala J, Rabinovich M, Ransom BR, Roa JA, Rosenberg GA, Rossitto CP, Rundek T, Russin JJ, Sacco RL, Safouris A, Samaniego EA, Sansing LH, Satani N, Sattenberg RJ, Saver JL, Savitz SI, Schmidt C, Seshadri S, Sharma VK, Sharp FR, Sheth KN, Siddiqi OK, Singhal AB, Sobey CG, Sommer CJ, Spetzler RF, Stapleton CJ, Strickland BA, Su H, Suarez JI, Takayama H, Tarsia J, Tatlisumak T, Thomas AJ, Thompson JW, Tsivgoulis G, Tournier-Lasserve E, Vidal G, Wakhloo AK, Weksler BB, Willey JZ, Wintermark M, Wong LK, Xi G, Xu J, Yaghi S, Yamaguchi T, Yang T, Yasaka M, Zahuranec DB, Zhang F, Zhang JH, Zheng Z, Zukin RS, Zweifler RM. Contributors. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.01002-4] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Yoshida Y, Nakanishi K, Daimon M, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Atrioventricular and Ventricular Functional Interdependence in Individuals Without Overt Cardiac Disease. J Am Heart Assoc 2021; 10:e021624. [PMID: 34775816 PMCID: PMC9075392 DOI: 10.1161/jaha.121.021624] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Left atrial (LA) and right ventricular (RV) performance play an integral role in the pathophysiology and prognosis of heart failure. We hypothesized that subclinical left ventricular dysfunction adversely affects LA/RV geometry and function even in a preclinical setting. This study aimed to investigate the atrioventricular and ventricular functional interdependence in a community‐based cohort without overt cardiovascular disease. Methods and Results Left ventricular global longitudinal strain (LVGLS), RV free‐wall longitudinal strain and LA phasic strain were assessed by speckle‐tracking echocardiography in 1080 participants (600 men; 62±12 years) between 2014 and 2018. One hundred and forty‐three participants (13.2%) had an abnormal LVGLS (>−18.6%). LA reservoir strain, conduit strain, and RV free‐wall longitudinal strain were significantly decreased in abnormal LVGLS group compared with normal LVGLS group (all P<0.001). LA and RV dysfunction (LA reservoir strain<31.4% and RVLS>−19.2%) were present in 18.9% and 19.6% of participants with abnormal LVGLS. Decreased LVGLS was associated with worse LA reservoir strain, conduit strain and RV free‐wall longitudinal strain (standardized β=−0.20, −0.19 and 0.11 respectively, all P<0.01) independent of cardiovascular risk factors. LA and/or RV dysfunction concomitant with abnormal LVGLS carried significantly increased risk of elevated B‐type natriuretic peptide levels (>28.6 pg/mL for men and >44.4 pg/mL for women) compared with normal LVGLS (odds ratio, 2.01; P=0.030). Conclusions LA/RV dysfunction was present in 20% individuals with abnormal LVGLS and multi‐chamber impairment was associated with elevated B‐type natriuretic peptide level, which may provide valuable insights for a better understanding of atrioventricular and ventricular interdependence and possibly heart failure preventive strategies.
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Affiliation(s)
- Yuriko Yoshida
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine The University of Tokyo Japan.,Department of Clinical Laboratory The University of Tokyo Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine The University of Tokyo Japan
| | | | | | - Issei Komuro
- Department of Cardiovascular Medicine The University of Tokyo Japan
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21
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Sawada N, Nakanishi K, Daimon M, Hirose K, Yoshida Y, Ishiwata J, Hirokawa M, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Independent effect of visceral fat on left atrial phasic function in the general population. Nutr Metab Cardiovasc Dis 2021; 31:3426-3433. [PMID: 34674907 DOI: 10.1016/j.numecd.2021.08.044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Obesity increases the risk for atrial fibrillation (AF), although the impact of abdominal fat distribution on left atrial (LA) morphology and functional remodeling remains unclear. This study aimed to investigate whether increased abdominal adiposity is independently associated with impaired LA function and/or LA enlargement in a sample of the general population and to evaluate the role of adipokines in this association. METHODS AND RESULTS The study cohort consisted of 527 participants (362 men; 57 ± 10 years) without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain. LA reservoir and conduit strain decreased with increasing VFA quartiles (both p < 0.05), whereas no significant differences were observed in LA volume index and pump strain. When stratified by SFA, there were no significant differences in LA size and function across the quartiles. In multivariable analysis, VFA was significantly associated with LA conduit strain independent of cardiovascular risk factors, and pertinent laboratory and echocardiographic parameters (standardized β = -0.136, p = 0.019). VFA was correlated with serum adiponectin level (r = -0.51, p < 0.001), but there was no association between adiponectin level and three LA phasic strains. CONCLUSION In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.
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Affiliation(s)
- Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhiro Koyama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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22
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Iwama K, Nakanishi K, Daimon M, Yoshida Y, Sawada N, Hirose K, Yamamoto Y, Ishiwata J, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Chronic kidney disease and subclinical abnormalities of left heart mechanics in the community. European Heart Journal Open 2021; 1:oeab037. [PMID: 35919881 PMCID: PMC9263886 DOI: 10.1093/ehjopen/oeab037] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/25/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022]
Abstract
Aims Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients, although the pathophysiological mechanisms are not fully studied. This study aimed to determine whether CKD could adversely affect subclinical left heart function in a sample of the general population without cardiac disease. Methods and results We examined 1158 participants who voluntarily underwent extensive cardiovascular examination including laboratory test and two-dimensional speckle-tracking echocardiography to assess left ventricular global longitudinal strain (LVGLS) and left atrial (LA) reservoir, conduit, and pump strain. According to the estimated glomerular filtration rate (eGFR), participants were classified into four groups; Stage 1 (n = 112; eGFR ≥90 mL/min/1.73 m2), Stage 2 (n = 818; 60–89 mL/min/1.73 m2), Stage 3a (n = 191; 45–59 mL/min/1.73 m2), and Stage 3b–5 (n = 37; eGFR <45 mL/min/1.73 m2). Progressive declines of LVGLS, LA reservoir, and conduit strain were observed according to the severity of CKD (P < 0.001), while LA pump strain did not differ between the groups. In multivariable analyses, eGFR was associated with LVGLS (standardized β = −0.068, P = 0.019) as well as LA reservoir (standardized β = 0.117, P < 0.001) and conduit strain (standardized β = 0.130, P < 0.001), independent of traditional cardiovascular risk factors, pertinent biomarkers, and LV geometry and diastolic function. The independent association between eGFR and LA strain persisted even after adjustment for LVGLS. Conclusion Worsening renal function was independently associated with impaired LV/LA strain in an unselected community-based cohort. The assessment of LV and LA strain may allow better risk stratification in CKD patients.
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Affiliation(s)
- Kentaro Iwama
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo , Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuko Yamamoto
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University , New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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23
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Ito K, Li S, Homma S, Thompson JLP, Buchsbaum R, Matsumoto K, Anker SD, Qian M, Di Tullio MR. Left ventricular dimensions and cardiovascular outcomes in systolic heart failure: the WARCEF trial. ESC Heart Fail 2021; 8:4997-5009. [PMID: 34545701 PMCID: PMC8712869 DOI: 10.1002/ehf2.13560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/23/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Aims There is limited information on the association between left ventricular (LV) dimensions and cardiovascular (CV) outcomes in patients with heart failure (HF) with reduced LV ejection fraction (HFrEF) receiving recommended HF treatment. We investigated the association between LV dimensions and CV outcomes in HFrEF patients receiving recommended HF treatment. Methods and results We investigated the association between LV echocardiographic dimensions and CV outcomes using conventional Cox models in 1138 HFrEF patients in sinus rhythm randomized to warfarin or aspirin treatment in the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. LV enlargement, whether by diameter [LV end‐diastolic diameter index (LVEDDI) and LV end‐systolic diameter index (LVESDI)] or volume [LV end‐diastolic volume index (LVEDVI) and LV end‐systolic volume index (LVESVI)], was independently associated with all‐cause death [LVEDDI: hazard ratio (HR) per cm/m2 1.53, LVESDI: HR per cm/m2 1.65, LVEDVI: HR per 10 mL/m2 1.07, and LVESVI: HR per 10 mL/m2 1.10; all P values < 0.001], CV death (HR 1.68, 1.79, 1.09, and 1.12, respectively; all P values < 0.001), and HF hospitalization (HR 1.59, 1.79, 1.06, and 1.08, respectively; all P values < 0.001). No association was observed with myocardial infarction or stroke. The associations were independent of LV ejection fraction values, and incremental to them. LV volumes conferred additional predictive value over LV diameters. Conclusions Left ventricular enlargement is an independent predictor of CV events in patients with HFrEF and recommended HF treatment. LV dimensions should be considered in the risk assessment.
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Affiliation(s)
- Kazato Ito
- Department of Medicine, Columbia University Irving Medical Center, PH3-342, 622 West 168th Street, New York, NY, 10032, USA
| | - Siyuan Li
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University Irving Medical Center, PH3-342, 622 West 168th Street, New York, NY, 10032, USA
| | - John L P Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kenji Matsumoto
- Department of Medicine, Columbia University Irving Medical Center, PH3-342, 622 West 168th Street, New York, NY, 10032, USA
| | - Stefan D Anker
- Department of Cardiology, Berlin Institute of Health Center for Regenerative Therapies, and German Centre for Cardiovascular Research partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Irving Medical Center, PH3-342, 622 West 168th Street, New York, NY, 10032, USA
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Di Tullio MR. Prevention of Patent Foramen Ovale-Related Stroke: An Evolving Concept. Stroke 2021; 52:3427-3429. [PMID: 34455824 DOI: 10.1161/strokeaha.121.035735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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25
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Yoshida Y, Nakanishi K, Daimon M, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Sex-specific difference in the association between arterial stiffness and subclinical left ventricular dysfunction. Eur Heart J Cardiovasc Imaging 2021; 22:817-823. [PMID: 32594106 DOI: 10.1093/ehjci/jeaa156] [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: 03/17/2020] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS Increased arterial stiffness is one of the key mechanisms of heart failure with preserved ejection fraction (HFpEF). However, the possible association between arterial stiffness and subclinical left ventricular (LV) dysfunction and its sex-specific difference remains unclarified. LV strain is emerging as a highly sensitive tool to unmask early LV abnormalities. METHODS AND RESULTS We examined 1155 participants free of overt cardiovascular disease who underwent extensive cardiovascular examination. Speckle-tracking echocardiography was employed to assess LV global longitudinal strain (LVGLS) and circumferential strain (GCS), and arterial stiffness was assessed by cardio-ankle vascular index (CAVI). Mean age was 62 ± 12 years, and 56% were men. CAVI as continuous variable was associated with abnormal LVGLS (>-18.6%) independent of cardiovascular risk factors and echocardiographic parameters [adjusted odds ratio (OR) 1.23, P = 0.027] but not with LVGCS. In sex-stratified analysis, more pronounced association between quartiles of CAVI and abnormal LVGLS was observed in women than in men (unadjusted OR = 6.43 in women and 2.46 in men for upper quartile vs. lower quartile; both P < 0.01). CAVI was significantly associated with abnormal LVGLS independent of cardiovascular risk factors in both sexes. However, after further adjustment for LV mass index and diastolic parameters, the independent association persisted only in women (adjusted OR 1.67, P = 0.007), but not in men (adjusted OR 1.14, P = 0.227). CONCLUSION Increased arterial stiffness was independently associated with decreased LVGLS even without overt cardiovascular disease; a sex-specific pattern exists in the alteration of vascular-ventricular coupling, which might partially explain the greater susceptibility to HFpEF in women.
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Affiliation(s)
- Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.,Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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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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27
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Hirose K, Nakanishi K, Daimon M, Sawada N, Yoshida Y, Ishiwata J, Hirokawa M, Koyama K, Nakao T, Fujiu K, Morita H, Di Tullio MR, Homma S, Komuro I. Correlation Between the Cohorts for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation Risk Score and Left Atrial Remodeling in the General Population. Circ Arrhythm Electrophysiol 2021; 14:e009826. [PMID: 34187163 DOI: 10.1161/circep.121.009826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan.,Department of Clinical Laboratory (M.D.), The University of Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | | | - Tomoko Nakao
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, New York, NY (M.R.D.T., S.H.)
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY (M.R.D.T., S.H.)
| | - Issei Komuro
- Department of Cardiovascular Medicine (K.H., K.N., M.D., N.S., Y.Y., J.I., M.H., K.K., T.N., K.F., H.M., I.K.), The University of Tokyo, Japan
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28
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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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29
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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Relation of Body Mass Index to Adverse Right Ventricular Mechanics. Am J Cardiol 2021; 144:137-142. [PMID: 33385349 DOI: 10.1016/j.amjcard.2020.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
Although higher body mass index (BMI) is associated with adverse left ventricular morphology and functional remodeling, its possible association with right ventricular (RV) dysfunction has not been extensively evaluated. RV free wall longitudinal strain (RVLS) is emerging as an important tool to detect early RV dysfunction. This study aimed to investigate the independent effect of increased BMI on RVLS in a large sample of the general population without overt cardiac disease. We examined 1,085 participants (603 men, mean age 62 years) who voluntarily underwent an extensive cardiovascular health check-up. This included laboratory tests and speckle-tracking echocardiography to assess RVLS. The association between BMI and RVLS was determined by logistic regression analyses. The prevalence of abnormal RVLS (>-19.2%) was greatest in obese individuals (29.7%), followed by overweight (16.3%), and normal weight (10.6%, p <0.001). In multivariable analyses, BMI was significantly associated with abnormal RVLS (adjusted odds ratio [OR] = 1.07 per 1 kg/m2, p = 0.033) independent of traditional cardiovascular risk factors, pertinent laboratory and echocardiographic parameters including RV size and pulmonary artery systolic pressure. In subgroup analyses, BMI was significantly associated with abnormal RVLS in men (adjusted OR 1.10 per 1 kg/m2, p = 0.032) and younger (<65 years) participants (adjusted OR 1.13 per 1 kg/m2, p = 0.011), but not in women and the elderly. In a sample of the general population, higher BMI was independently associated with subclinical RV dysfunction. Furthermore, an increased BMI may carry different risk for impaired RVLS depending on the age and sex.
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30
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Nakanishi K, Daimon M, Yoshida Y, Sawada N, Hirose K, Iwama K, Yamamoto Y, Ishiwata J, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Subclinical Hypothyroidism as an Independent Determinant of Left Atrial Dysfunction in the General Population. J Clin Endocrinol Metab 2021; 106:e1859-e1867. [PMID: 33049040 DOI: 10.1210/clinem/dgaa730] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Although subclinical hypothyroidism (SCH) is a common clinical entity and carries independent risk for incident heart failure (HF), its possible association with subclinical cardiac dysfunction is unclear. Left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic strain can unmask subclinical left heart abnormalities and are excellent predictors for HF. This study aimed to investigate the association between the presence of SCH and subclinical left heart dysfunction in a sample of the general population without overt cardiac disease. METHODS We examined 1078 participants who voluntarily underwent extensive cardiovascular health check-ups, including laboratory tests and 2-dimensional speckle-tracking echocardiography to assess LVGLS and LA reservoir, conduit, and pump strain. SCH was defined as an elevated serum thyroid-stimulating hormone level with normal concentration of free thyroxine. RESULTS Mean age was 62 ± 12 years, and 56% were men. Seventy-eight (7.2%) participants exhibited SCH. Individuals with SCH had significantly reduced LA reservoir (37.1 ± 6.6% vs 39.1 ± 6.6%; P = 0.011) and conduit strain (17.3 ± 6.3% vs 19.3 ± 6.6%; P = 0.012) compared with those with euthyroidism, whereas there was no significant difference in left ventricular ejection fraction, LA volume index, LVGLS, and LA pump strain between the 2 groups. In multivariable analyses, SCH remained associated with impaired LA reservoir strain, independent of age, traditional cardiovascular risk factors, and pertinent laboratory and echocardiographic parameters. including LVGLS (standardized β -0.054; P = 0.032). CONCLUSIONS In an unselected community-based cohort, individuals with SCH had significantly impaired LA phasic function. This association may be involved in the higher incidence of HF in subjects with SCH.
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Affiliation(s)
- Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Iwama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Yamamoto
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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31
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Hirose K, Nakanishi K, Daimon M, Sawada N, Yoshida Y, Iwama K, Yamamoto Y, Ishiwata J, Hirokawa M, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Impact of insulin resistance on subclinical left ventricular dysfunction in normal weight and overweight/obese japanese subjects in a general community. Cardiovasc Diabetol 2021; 20:22. [PMID: 33478525 PMCID: PMC7818760 DOI: 10.1186/s12933-020-01201-6] [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] [Received: 10/20/2020] [Accepted: 12/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Insulin resistance carries increased risk of heart failure, although the pathophysiological mechanisms remain unclear. LV global longitudinal strain (LVGLS) assessed by speckle-tracking echocardiography has emerged as an important tool to detect early LV systolic abnormalities. This study aimed to investigate the association between insulin resistance and subclinical left ventricular (LV) dysfunction in a sample of the general population without overt cardiac disease. METHODS We investigated 539 participants who voluntarily underwent extensive cardiovascular health check including laboratory test and speckle-tracking echocardiography. Glycemic profiles were categorized into 3 groups according to homeostatic model assessment of insulin resistance (HOMA-IR): absence of insulin resistance (HOMA-IR < 1.5), presence of insulin resistance (HOMA-IR ≥ 1.5) and diabetes mellitus (DM). Multivariable logistic regression models were conducted to evaluate the association between abnormal glucose metabolism and impaired LVGLS (> - 16.65%). RESULTS Forty-five (8.3%) participants had DM and 66 (12.2%) had abnormal HOMA-IR. LV mass index and E/e' ratio did not differ between participants with and without abnormal HOMA-IR, whereas abnormal HOMA-IR group had significantly decreased LVGLS (- 17.6 ± 2.6% vs. - 19.7 ± 3.1%, p < 0.05). The prevalence of impaired LVGLS was higher in abnormal HOMA-IR group compared with normal HOMA-IR group (42.4% vs. 14.0%) and similar to that of DM (48.9%). In multivariable analyses, glycemic abnormalities were significantly associated with impaired LVGLS, independent of traditional cardiovascular risk factors and pertinent laboratory and echocardiographic parameters [adjusted odds ratio (OR) 2.38, p = 0.007 for abnormal HOMA-IR; adjusted OR 3.02, p = 0.003 for DM]. The independent association persisted even after adjustment for waist circumference as a marker of abdominal adiposity. Sub-group analyses stratified by body mass index showed significant association between abnormal HOMA-IR and impaired LVGLS in normal weight individuals (adjusted OR 4.59, p = 0.001), but not in overweight/obese individuals (adjusted OR 1.62, p = 0.300). CONCLUSIONS In the general population without overt cardiac disease, insulin resistance carries independent risk for subclinical LV dysfunction, especially in normal weight individuals.
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Affiliation(s)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Iwama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Yamamoto
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhiro Koyama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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32
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Matsumoto K, Xiao Y, Homma S, Thompson JLP, Buchsbaum R, Ito K, Anker SD, Qian M, Di Tullio MR. Prognostic impact of 6 min walk test distance in patients with systolic heart failure: insights from the WARCEF trial. ESC Heart Fail 2020; 8:819-828. [PMID: 33377631 PMCID: PMC8006715 DOI: 10.1002/ehf2.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/19/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aimed to investigate the impact of baseline 6 min walk test distance (6MWTD) on time to major cardiovascular (CV) events in heart failure with reduced ejection fraction (HFrEF) and its impact in clinically relevant subgroups. METHODS AND RESULTS In the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, 6MWTD at baseline was available in 2102 HFrEF patients. Median follow-up was 3.4 years. All-cause death and heart failure hospitalization (HFH) exhibited a significant non-linear relationship with 6MWTD (P = 0.023 and 0.032, respectively), whereas a significant association between 6MWTD and CV death was shown in a linear model [hazard ratio (HR) per 10 m increase, 0.989; P = 0.011]. In linear splines with the best cut-off point at 200 m, the positive effect of a longer 6MWTD on all-cause death and HFH was only observed for 6MWTD > 200 m (HR per 10 m increase, 0.987; P = 0.0036 and 0.986; P = 0.0022, respectively). The associations between 6MWTD and CV outcomes were consistent across clinical subgroups; for age, a significant relationship between 6MWTD and HFH was observed in patients ≥60 years (HR per 10 m increase, 0.98; P < 0.001), but not in patients <60 years (HR per 10 m increase, 1.00; P = 0.98; P = 0.02 for the interaction). CONCLUSIONS In HFrEF, 6MWTD is independently associated with all-cause death, CV death, and HFH. 6MWTD of 200 m is the best cut-off point for predicting these adverse events. The prognostic impact of 6MWTD for HFH was only observed in older patients.
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Affiliation(s)
- Kenji Matsumoto
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Yi Xiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - John L P Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kazato Ito
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marco R Di Tullio
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
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Lee TC, Qian M, Liu Y, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Matsumoto K, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Di Tullio MR. Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF. JACC Heart Fail 2020; 7:1042-1053. [PMID: 31779926 DOI: 10.1016/j.jchf.2019.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF). BACKGROUND Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established. METHODS This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis). RESULTS A total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p < 0.0001), older age (p < 0.0001), nonwhite race/ethnicity (p < 0.0001), and lower education (p < 0.0001). In logistic regression, CD was independently associated with higher baseline MMSE scores (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07 to 1.20]; p < 0.001), older age (OR: 1.37; 95% CI: 1.24 to 1.50; p < 0.001), nonwhite race/ethnicity (OR: 2.32; 95% CI: 1.72 to 3.13 for black; OR: 1.94; 95% CI: 1.40 to 2.69 for Hispanic vs. white; p < 0.001), lower education (p < 0.001), and New York Heart Association functional class II or higher (p = 0.03). Warfarin and other medications were not associated with CD. Similar trends were seen in the sensitivity analysis (n = 1,439). CONCLUSIONS CD in HF is predicted by baseline cognitive status, demographic variables, and NYHA functional class. The possibility of intervening on some of its predictors suggests the need for the frequent assessment of cognitive function in patients with HF. (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction [WARCEF]; NCT00041938).
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Affiliation(s)
- Tetz C Lee
- Columbia University Medical Center, New York, NY
| | - Min Qian
- Columbia University Medical Center, New York, NY
| | - Yutong Liu
- Columbia University Medical Center, New York, NY
| | - Susan Graham
- Department of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Douglas L Mann
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Ralph L Sacco
- Department of Neurology, University of Miami, Miami, Florida
| | - Jay P Mohr
- Columbia University Medical Center, New York, NY
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, the Netherlands
| | | | - Conrado Estol
- Stroke Unit, Sanatorio Guemes, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, and Berlin-Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin; Charité Universitätsmedizin Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Medical Center, New York, NY
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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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Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Schwartz JE, Lee TC, Tugcu A, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study. Eur Heart J Cardiovasc Imaging 2020; 20:765-771. [PMID: 30649236 DOI: 10.1093/ehjci/jey221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/02/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS Although ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke. METHODS AND RESULTS Eight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI [odds ratio (OR) 1.15 per 10 mmHg, P = 0.042], independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P < 0.05), night-time SBP showed the strongest association (OR 1.21 per 10 mmHg, P = 0.003) and was the sole independent predictor when tested against the other BP parameters. Office BP measures, MS, and BP variability were not associated with subclinical cerebrovascular disease in adjusted analyses. CONCLUSION Elevated night-time SBP is strongly associated with subclinical cerebrovascular disease. Night-time SBP by ABPM allows to identify individuals at higher risk of hypertensive brain injury.
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Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, 722 West 168th Street, New York, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY, USA.,Department of Epidemiology, Columbia University, 722 West 168th Street, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
| | - Tetz C Lee
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
| | - Aylin Tugcu
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
| | - Mitsuhiro Yoshita
- Department of Neurology, Hokuriku National Hospital, 5963 Nobusue, Nanto, Toyama, Japan
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, 2315 Stockton Blvd, Sacramento, CA, USA
| | - Clinton B Wright
- Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA.,Clinical & Translational Science Institute, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, PH 3-342, 622 West 168th Street, New York, NY, USA
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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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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Carotid intima-media thickness and subclinical left heart dysfunction in the general population. Atherosclerosis 2020; 305:42-49. [DOI: 10.1016/j.atherosclerosis.2020.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/01/2020] [Accepted: 05/28/2020] [Indexed: 01/27/2023]
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Jain SS, Liu Q, Raikhelkar J, Fried J, Elias P, Poterucha TJ, DeFilippis EM, Rosenblum H, Wang EY, Redfors B, Clerkin K, Griffin JM, Wan EY, Abdalla M, Bello NA, Hahn RT, Shimbo D, Weiner SD, Kirtane AJ, Kodali SK, Burkhoff D, Rabbani LE, Schwartz A, Leon MB, Homma S, Di Tullio MR, Sayer G, Uriel N, Anstey DE. Indications for and Findings on Transthoracic Echocardiography in COVID-19. J Am Soc Echocardiogr 2020; 33:1278-1284. [PMID: 32782131 PMCID: PMC7298489 DOI: 10.1016/j.echo.2020.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
Background Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. Methods A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. Results Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = −0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. Conclusions This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.
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Affiliation(s)
- Sneha S Jain
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Qi Liu
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Justin Fried
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Pierre Elias
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Timothy J Poterucha
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Hannah Rosenblum
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth Y Wang
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Bjorn Redfors
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Kevin Clerkin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jan M Griffin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marwah Abdalla
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daichi Shimbo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shepard D Weiner
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ajay J Kirtane
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daniel Burkhoff
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - LeRoy E Rabbani
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - D Edmund Anstey
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Serum uric acid level and subclinical left ventricular dysfunction: a community-based cohort study. ESC Heart Fail 2020; 7:1031-1038. [PMID: 32253826 PMCID: PMC7261553 DOI: 10.1002/ehf2.12691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/17/2019] [Revised: 02/16/2020] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Although serum uric acid (SUA) level is correlated with oxidative stress and serves as a marker of poor prognosis in heart failure patients, its possible association with subclinical left ventricular (LV) dysfunction has not been evaluated. This study aimed to investigate the association between SUA and subclinical LV dysfunction in a sample of a general population without overt cardiac disease. METHODS AND RESULTS We examined 1175 participants who underwent extensive cardiovascular health check-up including laboratory tests and speckle-tracking echocardiography to assess LV global longitudinal strain (GLS). The association of SUA concentration, as a continuous variable and a categorical variable using quartiles, with the presence of abnormal LVGLS was assessed. Mean age was 62 ± 12 years, and 656 (56%) were male participants. Mean SUA was 5.6 ± 1.3 mg/dL (25th-75th percentile, 4.6-6.5 mg/dL). The prevalence of abnormal LVGLS (greater than -18.6%) was greatest in the upper quartile of SUA. In multivariable analysis, SUA as a continuous variable was significantly associated with abnormal LVGLS [adjusted odds ratio (OR), 1.26 per 1 mg/dL; P = 0.008] independent of traditional cardiovascular risk factors, pertinent laboratory parameters and echocardiographic measures, and medications. In the categorical analysis, the upper quartile of SUA was independently associated with abnormal LVGLS in a fully adjusted model (adjusted OR, 2.28 vs. lowest quartile; P = 0.020). CONCLUSIONS In a sample of the general population, an elevated SUA was independently associated with subclinical LV dysfunction. Assessment of LVGLS may add important prognostic information in individuals with elevated SUA, even in the absence of overt cardiac disease.
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Affiliation(s)
- Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Patel N, Chakraborty S, Bandyopadhyay D, Amgai B, Hajra A, Atti V, Das A, Ghosh RK, Deedwania PC, Aronow WS, Lavie CJ, Di Tullio MR, Vaduganathan M, Fonarow GC. Association between depression and readmission of heart failure: A national representative database study. Prog Cardiovasc Dis 2020; 63:585-590. [PMID: 32224112 DOI: 10.1016/j.pcad.2020.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Depression is a recognized predictor of adverse outcomes in patients with heart failure (HF) and is associated with poor quality of life, functional limitation, increased morbidity and mortality, decreased adherence to treatment, and increased rehospitalization. To understand the impact of depression on HF readmission, we conducted a retrospective cohort study using the Nationwide Readmission Database (NRD) 2010-2014. METHODS We identified all patients with the primary discharge diagnosis of HF by ICD-9-CM codes. The primary outcome of the study was to identify 30-day all-cause readmission and causes of readmission in patients with and without depression. Multivariate Cox regression analysis was used to estimate the adjusted hazard ratio for the primary and secondary outcomes. RESULTS Among, 3,500,570 patients admitted with HF, 9.7% had concomitant depression. Patients with depression were more likely to be readmitted within 30 days (19.7% vs. 18.5%; P < 0.001). Concomitant depression was associated with higher risk of all-cause readmissions within 30 days and 90 days [P < 0.001] but was not associated with increased readmissions due to cardiovascular (CV) cause at 30 days and 90 days. The hazard of psychiatric causes of readmission was higher in patients with depression, both at 30 days [P < 0.001], and 90 days [P < 0.001]. Most of the readmissions were due to CV causes, with HF being the most common cause. CONCLUSION Among patients hospitalized with HF, the presence of depression is associated with increased all-cause readmission driven mainly by psychiatric causes but not CV-related readmission. Standard interventions targeted toward HF are unlikely to modify this portion of all-cause readmission.
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Affiliation(s)
| | | | | | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Avash Das
- University of Texas Southwestern Medical Center, TX, USA
| | - Raktim K Ghosh
- Case Western Reserve University, Heart and Vascular Institute, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Wilbert S Aronow
- Westchester Medical Center and New York Medical College, New York, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
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Gutierrez J, Di Tullio MR, Rundek T, Sacco RL, Wright CB, Elkind MS. Response by Gutierrez et al to Letter Regarding Article, "Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events". Stroke 2020; 51:e82. [PMID: 32200758 DOI: 10.1161/strokeaha.120.028937] [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] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Tatjana Rundek
- Department of Neurology, University of Miami, Miller School of Medicine, FL
| | - Ralph L Sacco
- Department of Neurology, University of Miami, Miller School of Medicine, FL
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Sur NB, Koch S, Wang K, Di Tullio MR, Gutierrez C, Dong C, Gardener H, Garcia-Rivera EJ, Zevallos JC, Burgin WS, Rose DZ, Goldberger J, Romano JG, Sacco RL, Rundek T. Abstract TP426: Factors Associated With Oral Anticoagulant Non-Use for Patients With Atrial Fibrillation-Related Stroke: The Florida Puerto Rico Atrial Fibrillation Stroke Study. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp426] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF) are largely underutilized. We identified pre-admission OAC utilization patterns and factors predictive of OAC non-use in patients hospitalized for AF-related stroke.
Methods:
We included 22,220 patients with ischemic stroke due to previously diagnosed AF enrolled in the Florida Stroke Registry from 2010-2017. A multivariable-adjusted logistic regression model was used to identify factors associated with pre-stroke OAC use for patients with AF-related stroke.
Results:
A total of 16,246 (73%) patients with AF-related stroke were not on OAC pre-stroke. Compared to patients on OAC, non-OAC patients were more likely to be ≥80 years old, have Medicaid/no insurance, lower CHA
2
DS
2
-VASc scores and greater stroke severity at presentation. After adjustment for age, sex, race-ethnicity, insurance status and vascular risk factors, baseline OAC non-use was higher for patients with Medicaid/no insurance (vs. private insurance, (OR 1.34 [95% CI 1.08-1.67]), smokers (OR 1.29 [1.09-1.52] and patients with NIHSS ≥6 (vs. NIHSS≤5, OR 1.18 [1.11-1.26]). A trend towards greater odds of OAC non-use was seen in women (vs. men, OR 1.07 [0.99-1.14, P=0.07]).
Conclusion:
The majority of AF-related stroke patients with known AF were not anticoagulated prior to hospitalization for stroke in our study. Insurance status and smoking status had the greatest influence on pre-stroke OAC use. Anticoagulated patients had lower stroke severity on admission. Further efforts are needed to increase OAC use to reduce the burden of stroke for patients with AF, especially for vulnerable populations.
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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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44
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Sawada N, Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Hirokawa M, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community. Eur J Prev Cardiol 2019; 27:2006-2015. [PMID: 31795766 DOI: 10.1177/2047487319891286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/23/2022]
Abstract
AIMS Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain. METHODS We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS). RESULTS Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were -19.1 ± 3.0% and -25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS (r = 0.46 and r = 0.15, both p < 0.01) and RVLS (r = 0.38 and r = 0.12, both p < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both p < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS (r = -0.34, p < 0.001) and RVLS (r = -0.25, p < 0.001), although it lost statistical significance following multivariable adjustment. CONCLUSION In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.
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Affiliation(s)
- Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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45
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Gutierrez J, Gil-Guevara A, Ramaswamy S, DeRosa J, Di Tullio MR, Cheung K, Rundek T, Sacco RL, Wright CB, Elkind MSV. Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. Stroke 2019; 51:90-98. [PMID: 31766980 DOI: 10.1161/strokeaha.119.026068] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/16/2022]
Abstract
Background and Purpose- To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods- We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results- At the time of magnetic resonance imaging, 236 participants (18%) had CBI (144 [61%] distal cryptogenic, 29 [12%] distal cardioembolic, 26 [11%] large artery atherosclerosis, and 37 [16%] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8-0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1-0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31%) died (162 [13%] of vascular death) and 117 (9%) had a stroke (99 [85%]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3-3.7]) and vascular death (hazard ratio, 2.24 [1.29-3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions- CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.
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Affiliation(s)
- Jose Gutierrez
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | | | - Srinath Ramaswamy
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Janet DeRosa
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Marco R Di Tullio
- Department of Cardiology (M.R.D.T.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ken Cheung
- Division of Biostatistics (K.C.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- Departments of Neurology (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Evelyn F. McKnight Brain Institute (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- Departments of Neurology (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Evelyn F. McKnight Brain Institute (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY.,Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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46
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Dong C, Wang K, Di Tullio MR, Gutierrez C, Koch S, García EJ, Zevallos JC, Nobo U, Martin RC, Burgin WS, Rose DZ, Romano JG, Goldberger JJ, Sacco RL, Rundek T. Disparities and Temporal Trends in Stroke Care Outcomes in Patients with Atrial Fibrillation: The FLiPER-AF Stroke Study. ACTA ACUST UNITED AC 2019; 2. [PMID: 33313602 DOI: 10.29011/2688-8734.100017] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and Purpose Atrial Fibrillation (AF) is the most common cardiac cause of ischemic stroke. However, the relation between AF and stroke care outcomes in diverse populations is understudied. We aimed to evaluate sex and race-ethnic disparities associated with AF in hospital stroke outcomes utilizing data from the FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study. Methods The study included 104,308 ischemic stroke cases with available information on AF status enrolled in a state-wide stroke registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the association between AF and stroke outcomes and the modification effects on the associations by sex and by race-ethnicity, adjusted for socio-demographic status, vascular risk factors and stroke severity. Results AF was present in 23% of ischemic stroke cases. AF was associated with worse disability at discharge (OR=1.11, 95% CI, 1.04-1.18), less discharge to home (OR=0.89, 0.85-0.92), and longer length of hospital stay (LOS>6 days, OR=1.53, 1.46-1.60). Interaction analyses showed that the association between AF and less discharge to home was stronger in women than men (p for interaction <0.001), as well as in FL-whites than in FL-blacks, FL-Hispanics or PR-Hispanics (p for interaction=0.002). The association between AF and prolonged LOS was more prominent in PR-Hispanics than in FL-blacks, FL-Hispanics, or FL-whites (p for interaction <0.001). From 2010 to 2016, the effects of AF on hospital length of stay attenuated (p for interaction<0.001). Conclusions AF was associated with poor disability at discharge, less discharge to home, and prolonged hospital length of stay for acute stroke care. The effect of AF on length of stay attenuated over time. Sex and race-ethnic disparities were observed in the effect of AF on being less discharge to home and prolonged hospital stay. Further research is needed to identify and modify the biologic and systems of care contributors to these disparities.
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Affiliation(s)
- Chuanhui Dong
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA.,Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Florida, USA
| | - Kefeng Wang
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA
| | - Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, USA
| | - Carolina Gutierrez
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA
| | - Sebastian Koch
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA
| | - Enid J García
- Endowed Health Services Research Center, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Juan Carlos Zevallos
- Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Florida, USA
| | - Ulises Nobo
- Hospital HIMA San Pablo, Caguas, Puerto Rico
| | - Ryan C Martin
- Department of Cardiology, University of Washington-Seattle School of Medicine, Washington, USA
| | - W Scott Burgin
- Department of Neurology, University of South Florida Morsani School of Medicine, Florida, USA
| | - David Z Rose
- Department of Neurology, University of South Florida Morsani School of Medicine, Florida, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, University of Miami Miller School of Medicine, Florida, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA.,Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Florida, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Florida, USA.,Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Florida, USA
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47
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Lee TC, Jin Z, Homma S, Nakanishi K, Elkind MSV, Rundek T, Tugcu A, Matsumoto K, Sacco RL, Di Tullio MR. Changes in Left Ventricular Mass and Geometry in the Older Adults: Role of Body Mass and Central Obesity. J Am Soc Echocardiogr 2019; 32:1318-1325. [PMID: 31311705 DOI: 10.1016/j.echo.2019.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/22/2019] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is an independent risk factor for cardiovascular outcomes. There are limited data about modifiable factors associated with progression of LV hypertrophy in older adults. Our objective is to describe the changes in LV mass and geometry over time in a predominantly older multiethnic cohort and to identify possible predictors of changes over time. METHODS We analyzed data from participants in the Northern Manhattan Study who underwent serial echocardiographic studies, comparing the baseline and the most recent echocardiograms. We recorded changes in LV mass and geometry and correlated them with baseline characteristics using linear regression models. RESULTS There were 826 participants (mean age, 64.2 ± 8.0 years) included in the analysis (time between measurements, 8.5 ± 2.7 years). Overall, LV mass index increased from 45.0 ± 12.7 to 50.3 ± 14.6 g/m2.7 (P < .001). There were 548 participants (66.3%) with LV mass increase; 258 individuals (31.2%) showed worsening LV geometry. Multivariable analysis showed that change in LV mass index was independently associated with baseline LV mass index (β estimate, -17.000 [standard error, 1.508]; P < .001), hypertension (2.094 [0.816], P = .011), body mass index (0.503 [0.088], P < .001), and waist-to-hip ratio (1.031 [0.385], P = .008). Both waist-to-hip ratio and waist-to-height ratio remained significantly associated with LV mass increase even after adjusting for body mass index (P = .008 and P = .036, respectively). CONCLUSIONS Regardless of race/ethnicity, LV mass progressed over time in older adults. We also observed that worsening geometry was frequent. Assessment of central obesity in the older population is important because indicators of central obesity add prognostic value over body mass index for the risk of LV mass increase.
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Affiliation(s)
- Tetz C Lee
- Department of Medicine, Columbia University, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York
| | - Koki Nakanishi
- Department of Medicine, Columbia University, New York, New York
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, New York
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, New York
| | - Kenji Matsumoto
- Department of Medicine, Columbia University, New York, New York
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida; Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
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48
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Shah N, Qian M, Di Tullio MR, Graham S, Mann DL, Sacco RL, Lip GYH, Labovitz AJ, Ponikowski P, Lok DJ, Anker SD, Teerlink JR, Thompson JLP, Homma S, Freudenberger RS. Pulse pressure and prognosis in patients with heart failure with reduced ejection fraction. Eur J Clin Invest 2019; 49:e13092. [PMID: 30801690 DOI: 10.1111/eci.13092] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/25/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND A high pulse pressure (PP) is associated with adverse cardiovascular (CV) outcomes; however, this relationship may be reversed in patients with heart failure with reduced ejection fraction (HFREF). METHODS Patients from the WARCEF trial with left ventricular ejection fraction ≤35% were included. PP was divided into tertiles: ≤42, 42-54 and >54 mm Hg. Age and ejection fraction adjusted Kaplan-Meier curves were generated to evaluate the relationship between PP and outcomes [mortality, CV mortality, stroke and HF hospitalizations (HFH)]. Cox proportional hazards models were created incorporating PP as a continuous variable. The interaction of PP with New York Heart Association (NYHA) functional class was examined. Linear and restricted cubic splines were used to study nonlinear association between PP and outcomes. RESULTS We included 2,299 patients with a mean(±SD) follow-up of 3.5 ± 1.8 years. The lowest tertile of PP (≤42 mm Hg) was associated with significantly higher CV mortality and HFH. Cox proportional hazards models showed a reduction in CV death and HFH with higher PP, with adjusted hazard ratios (HR) of 0.91 (P = 0.02) and 0.93 (P = 0.04) per 10 mm Hg increase in PP. This relationship was more pronounced in subjects with NYHA functional class III-IV. Spline analysis showed that the association between PP and CV mortality and HFH was only seen at PP values lower than 40 mm Hg. CONCLUSIONS In patients with advanced HFREF, a low PP (<40 mm Hg) portends a worse prognosis, whereas a high PP (>50 mm Hg) predicts a relatively favourable prognosis.
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Affiliation(s)
- Neeraj Shah
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Min Qian
- Columbia University Medical Center, New York, New York
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, New York
| | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | | | - Dirk J Lok
- Hospital Deventer, Deventer, the Netherlands
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - John R Teerlink
- University of California San Francisco, San Francisco, California
| | | | | | - Ronald S Freudenberger
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.,The University of South Florida, Tampa, Florida
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49
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Sur NB, Wang K, Di Tullio MR, Gutierrez CM, Dong C, Koch S, Gardener H, García-Rivera EJ, Zevallos JC, Burgin WS, Rose DZ, Goldberger JJ, Romano JG, Sacco RL, Rundek T. Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation. Stroke 2019; 50:1452-1459. [PMID: 31084325 DOI: 10.1161/strokeaha.118.023959] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 01/24/2023]
Abstract
Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.
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Affiliation(s)
- Nicole B Sur
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Kefeng Wang
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (M.R.D.T.)
| | - Carolina M Gutierrez
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Chuanhui Dong
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Sebastian Koch
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Hannah Gardener
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Enid J García-Rivera
- Endowed Health Services Research Center, University of Puerto Rico School of Medicine, San Juan (E.J.G.-R.)
| | - Juan Carlos Zevallos
- Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami (J.C.Z.)
| | - W Scott Burgin
- Department of Neurology, University of South Florida Morsani School of Medicine, Tampa (W.S.B., D.Z.R.)
| | - David Z Rose
- Department of Neurology, University of South Florida Morsani School of Medicine, Tampa (W.S.B., D.Z.R.)
| | - Jeffrey J Goldberger
- Division of Cardiology (J.J.G.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- From the Department of Neurology (N.B.S., K.W., C.M.G., C.D., S.K., H.G., J.G.R., R.L.S., T.R.), University of Miami Miller School of Medicine, FL
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Lee TC, Qian M, Mu L, Di Tullio MR, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Ye S. Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial. ESC Heart Fail 2019; 6:297-307. [PMID: 30816013 PMCID: PMC6437435 DOI: 10.1002/ehf2.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/26/2018] [Accepted: 12/12/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is debate on whether the beneficial effect of implantable cardioverter‐defibrillators (ICDs) is attenuated in patients with non‐ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity‐matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow‐up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all‐cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
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Affiliation(s)
- Tetz C Lee
- Columbia University Irving Medical Center, New York, NY, USA
| | - Min Qian
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lan Mu
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, NY, USA
| | - Douglas L Mann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Koki Nakanishi
- Columbia University Irving Medical Center, New York, NY, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Jay P Mohr
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, The Netherlands
| | - Conrado Estol
- Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Shunichi Homma
- Columbia University Irving Medical Center, New York, NY, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, NY, USA
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