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Batra K, Xi Y, Bhagwat S, Espino A, Peshock RM. Radiologist Worklist Reprioritization Using Artificial Intelligence: Impact on Report Turnaround Times for CTPA Examinations Positive for Acute Pulmonary Embolism. AJR Am J Roentgenol 2023; 221:324-333. [PMID: 37095668 DOI: 10.2214/ajr.22.28949] [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] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND. In patients with acute pulmonary embolism (PE), timely intervention (e.g., initiation of anticoagulation) is critical for optimizing clinical outcomes. OBJECTIVE. The purpose of this study was to evaluate the effect of artificial intelligence (AI)-based radiologist worklist reprioritization on report turnaround times for pulmonary CTA (CTPA) examinations positive for acute PE. METHODS. This retrospective single-center study included patients who underwent CTPA before (October 1, 2018-March 31, 2019 [pre-AI period]) and after (October 1, 2019-March 31, 2020 [post-AI period]) implementation of an AI tool that reprioritized CTPA examinations to the top of radiologists' reading worklists if acute PE was detected. EMR and dictation system timestamps were used to determine the wait time (time from examination completion to report initiation), read time (time from report initiation to report availability), and report turnaround time (sum of wait and read times) for the examinations. Times for reports positive for PE, with final radiology reports as reference, were compared between periods. RESULTS. The study included 2501 examinations of 2197 patients (1307 women, 890 men; mean age, 57.4 ± 17.0 [SD] years), including 1335 examinations from the pre-AI period and 1166 from the post-AI period. The frequency of acute PE, based on radiology reports, was 15.1% (201/1335) during the pre-AI period and 12.3% (144/1166) during the post-AI period. During the post-AI period, the AI tool reprioritized 12.7% (148/1166) of examinations. For PE-positive examinations, the post-AI period, compared with the pre-AI period, had significantly shorter mean report turnaround time (47.6 vs 59.9 minutes; mean difference, 12.3 minutes [95% CI, 0.6-26.0 minutes]) and mean wait time (21.4 vs 33.4 minutes; mean difference, 12.0 minutes [95% CI, 0.9-25.3 minutes]) but no significant difference in mean read time (26.3 vs 26.5 minutes; mean difference, 0.2 minutes [95% CI, -2.8 to 3.2 minutes]). During regular operational hours, wait time was significantly shorter in the post-AI than in the pre-AI period for routine-priority examinations (15.3 vs 43.7 minutes; mean difference, 28.4 minutes [95% CI, 2.2-64.7 minutes]) but not for stat- or urgent-priority examinations. CONCLUSION. AI-driven worklist reprioritization yielded reductions in report turnaround time and wait time for PE-positive CTPA examinations. CLINICAL IMPACT. By assisting radiologists in providing rapid diagnoses, the AI tool has potential for enabling earlier interventions for acute PE.
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Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Siddharth Bhagwat
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Adriana Espino
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Ronald M Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Dweik A, Sheth R, Cheeran DD, Araj FG, Amin AA, Drazner MH, Zaha VG, Peshock RM, Mammen PP. LONGITUDINAL TRENDS IN LEFT VENTRICULAR MASS IN MUSCULAR DYSTROPHIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Peshock RM. MRI of the Aortic Wall to Assess Cardiovascular Risk and Prognosis. Radiology 2022; 304:551-552. [PMID: 35638931 DOI: 10.1148/radiol.221063] [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: 11/11/2022]
Affiliation(s)
- Ronald M Peshock
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Ng YS, Quadri B, Baker C, Foster C, McColl RW, Fetzer DT, Peshock RM, Browning T. Use of Web-Based Calculator for the Implementation of ACR TI-RADS Risk-Stratification System. J Digit Imaging 2022; 35:21-28. [PMID: 34997374 PMCID: PMC8854452 DOI: 10.1007/s10278-021-00542-2] [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] [Received: 10/08/2020] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023] Open
Abstract
In this article, we demonstrate the use of a software-based radiologist reporting tool for the implementation of American College of Radiology Thyroid Imaging, Reporting and Data System thyroid nodule risk-stratification. The technical details are described with emphasis on addressing the information security and patient privacy issues while allowing it to integrate with the electronic health record and radiology reporting dictation software. Its practical implementation is assessed in a quality improvement project in which guideline adherence and recommendation congruence were measured pre and post implementation. The descriptions of our solution and the release of the open-sourced codes may be helpful in future implementation of similar web-based calculators.
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Affiliation(s)
- Yee Seng Ng
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Bilal Quadri
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Chris Baker
- grid.267313.20000 0000 9482 7121Heath System Information Resources, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Christopher Foster
- grid.267313.20000 0000 9482 7121Heath System Information Resources, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Roderick W. McColl
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - David T. Fetzer
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Ronald M. Peshock
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Travis Browning
- grid.267313.20000 0000 9482 7121Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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Tejani AS, Fielding JR, Peshock RM. What Should Radiology Residency and Fellowship Training in Artificial Intelligence Include? A Trainee's Perspective- Radiology In Training. Radiology 2021; 299:E243-E245. [PMID: 33687289 DOI: 10.1148/radiol.2021204406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ali S Tejani
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235
| | - Julia R Fielding
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235
| | - Ronald M Peshock
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235
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O'Neill TJ, Xi Y, Stehel E, Browning T, Ng YS, Baker C, Peshock RM. Active Reprioritization of the Reading Worklist Using Artificial Intelligence Has a Beneficial Effect on the Turnaround Time for Interpretation of Head CT with Intracranial Hemorrhage. Radiol Artif Intell 2020; 3:e200024. [PMID: 33937858 DOI: 10.1148/ryai.2020200024] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/02/2020] [Accepted: 09/25/2020] [Indexed: 11/11/2022]
Abstract
Purpose To determine how to optimize the delivery of machine learning techniques in a clinical setting to detect intracranial hemorrhage (ICH) on non-contrast-enhanced CT images to radiologists to improve workflow. Materials and Methods In this study, a commercially available machine learning algorithm that flags abnormal noncontrast CT examinations for ICH was implemented in a busy academic neuroradiology practice between September 2017 and March 2019. The algorithm was introduced in three phases: (a) as a "pop-up" widget on ancillary monitors, (b) as a marked examination in reading worklists, and (c) as a marked examination for reprioritization based on the presence of the flag. A statistical approach, which was based on a queuing theory, was implemented to assess the impact of each intervention on queue-adjusted wait and turnaround time compared with historical controls. Results Notification with a widget or flagging the examination had no effect on queue-adjusted image wait (P > .99) or turnaround time (P = .6). However, a reduction in queue-adjusted wait time was observed between negative (15.45 minutes; 95% CI: 15.07, 15.38) and positive (12.02 minutes; 95% CI: 11.06, 12.97; P < .0001) artificial intelligence-detected ICH examinations with reprioritization. Reduced wait time was present for all order classes but was greatest for examinations ordered as routine for both inpatients and outpatients because of their low priority. Conclusion The approach used to present flags from artificial intelligence and machine learning algorithms to the radiologist can reduce image wait time and turnaround times.© RSNA, 2021See also the commentary by O'Connor and Bhalla in this issue.
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Affiliation(s)
- Thomas J O'Neill
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Yin Xi
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Edward Stehel
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Travis Browning
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Yee Seng Ng
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Chris Baker
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
| | - Ronald M Peshock
- Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235
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Peshock RM. Clearing the Path to Optimal Care in Patients with Non-MRI-conditional Cardiac Devices. Radiol Cardiothorac Imaging 2020; 2:e200560. [PMID: 33779664 PMCID: PMC7977869 DOI: 10.1148/ryct.2020200560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Ronald M. Peshock
- From the Departments of Radiology and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390
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Biavati M, Kozlitina J, Alder AC, Foglia R, McColl RW, Peshock RM, Kelly RE, Kim Garcia C. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS One 2020; 15:e0232575. [PMID: 32379835 PMCID: PMC7205298 DOI: 10.1371/journal.pone.0232575] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. METHODS AND FINDINGS Radiographic indices of chest wall shape were analyzed for participants of the first (n = 2687) and second (n = 1780) phases of the population-based Dallas Heart Study and compared to clinical cases of pectus (n = 297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller index >3.25, Correction index >10%, or both, respectively. Radiographic measures of pectus are more common in females than males and there is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n = 992) demonstrated decreases in the mean Haller and Correction indices over seven years, suggesting change to a more circular axial thorax, with less sternal depression, over time. CONCLUSIONS To our knowledge, this is the first study estimating the prevalence of pectus in an unselected adult population. Despite the higher reported prevalence of pectus cases in adolescent boys, this study demonstrates a higher prevalence of radiographic indices of pectus in adult females.
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Affiliation(s)
- Mikaela Biavati
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Adam C. Alder
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert Foglia
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Roderick W. McColl
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ronald M. Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert E. Kelly
- Department of Surgery and Pediatrics, Eastern Virginia Medical Center and Children’s Hospital of the King’s Daughters, Norfolk, VA, United States of America
| | - Christine Kim Garcia
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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Kay FU, Abbara S, Joshi PH, Garg S, Khera A, Peshock RM. Identification of High-Risk Left Ventricular Hypertrophy on Calcium Scoring Cardiac Computed Tomography Scans: Validation in the DHS. Circ Cardiovasc Imaging 2020; 13:e009678. [PMID: 32066275 DOI: 10.1161/circimaging.119.009678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Coronary artery calcium scoring only represents a small fraction of all information available in noncontrast cardiac computed tomography (CAC-CT). We hypothesized that an automated pipeline using radiomics and machine learning could identify phenotypic information about high-risk left ventricular hypertrophy (LVH) embedded in CAC-CT. METHODS This was a retrospective analysis of 1982 participants from the DHS (Dallas Heart Study) who underwent CAC-CT and cardiac magnetic resonance. Two hundred twenty-four participants with high-risk LVH were identified by cardiac magnetic resonance. We developed an automated adaptive atlas algorithm to segment the left ventricle on CAC-CT, extracting 107 radiomics features from the volume of interest. Four logistic regression models using different feature selection methods were built to predict high-risk LVH based on CAC-CT radiomics, sex, height, and body surface area in a random training subset of 1587 participants. RESULTS The respective areas under the receiver operating characteristics curves for the cluster-based model, the logistic regression model after exclusion of highly correlated features, and the penalized logistic regression models using least absolute shrinkage and selection operators with minimum or one SE λ values were 0.74 (95% CI, 0.67-0.82), 0.74 (95% CI, 0.67-0.81), 0.76 (95% CI, 0.69-0.83), and 0.73 (95% CI, 0.66-0.80) for detecting high-risk LVH in a distinct validation subset of 395 participants. CONCLUSIONS Ventricular segmentation, radiomics features extraction, and machine learning can be used in a pipeline to automatically detect high-risk phenotypes of LVH in participants undergoing CAC-CT, without the need for additional imaging or radiation exposure. Registration: URL http://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
| | - Suhny Abbara
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
| | - Parag H Joshi
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Sonia Garg
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Amit Khera
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Ronald M Peshock
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
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Browning T, O’Neill T, Ng Y, Fielding JR, Peshock RM. Special Considerations for Integrating Artificial Intelligence Solutions in Urban Safety-Net Hospitals. J Am Coll Radiol 2020; 17:171-174. [DOI: 10.1016/j.jacr.2019.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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Alame AJ, Garg S, Kozlitina J, Ayers C, Peshock RM, Matulevicius SA, Drazner MH. Association of African Ancestry With Electrocardiographic Voltage and Concentric Left Ventricular Hypertrophy: The Dallas Heart Study. JAMA Cardiol 2019; 3:1167-1173. [PMID: 30427995 DOI: 10.1001/jamacardio.2018.3804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Compared with white individuals, black individuals have increased electrocardiographic voltage and an increased prevalence of concentric left ventricular (LV) hypertrophy. Whether environmental or genetic factors lead to these racial differences is unknown. Objective To determine whether proportion of genetically determined African ancestry among self-reported black individuals is associated with increased electrocardiographic voltage and concentric LV hypertrophy (LVH). Design, Setting, and Participants The Dallas Heart Study is a probability-based cohort study of English- or Spanish-speaking Dallas County, Texas, residents, with deliberate oversampling of black individuals. Participants underwent extensive phenotyping, which included electrocardiography (ECG), cardiac magnetic resonance imaging (CMR), and dual-energy radiography absorptiometry (DEXA) at a single center. Participants aged 18 to 65 years who enrolled in the Dallas Heart Study between July 2000 and December 2002, self-identified as black (n = 1251) or white (n = 826), and had ECG, CMR, and DEXA data were included in this analysis. Data were analyzed from June 2017 to September 2018. Exposures Proportion of African ancestry. Main Outcomes and Measures Electrocardiographic voltage (12-lead and 9-lead) and markers of concentric LVH as assessed by CMR (LV concentricity0.67 [LV mass/end-diastolic volume0.67], LV wall thickness [LVWT], and prevalent LVH [defined by LV mass/height2.7]). Results Of the 2077 participants included in the study, 1138 (54.8%) were women, and the mean (SD) age was 45.2 (9.9) years. Black race and African ancestry were individually associated with increased ECG voltage, LV concentricity0.67, LVWT, and prevalent LVH in multivariable analyses adjusting for age, sex, systolic blood pressure, antihypertensive medication use, and body composition. When African ancestry and black race were entered together into multivariable models, African ancestry but not black race remained associated with ECG voltage, LVWT, LV concentricity0.67, and prevalent LVH. Among black participants, African ancestry remained associated with these 4 phenotypes (12-lead voltage: β, 0.05; P = .04; LVWT: β, 0.05; P = .02; LV concentricty0.67: β, 0.05; P = .045; prevalent LVH: odds ratio, 1.2; 95% CI, 1.03-1.4; P = .02). Conclusions and Relevance Genetically determined African ancestry was associated with electrocardiographic voltage, measures of concentric LV remodeling, and prevalent LVH. These data support a genetic basis related to African ancestry for the increased prevalence of these cardiovascular traits in black individuals.
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Affiliation(s)
- Aya J Alame
- University of Texas Southwestern Medical School, Dallas
| | - Sonia Garg
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Julia Kozlitina
- McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Ronald M Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Susan A Matulevicius
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas
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Garg S, de Lemos JA, Matulevicius SA, Ayers C, Pandey A, Neeland IJ, Berry JD, McColl R, Maroules C, Peshock RM, Drazner MH. Association of Concentric Left Ventricular Hypertrophy With Subsequent Change in Left Ventricular End-Diastolic Volume: The Dallas Heart Study. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003959. [PMID: 28775115 DOI: 10.1161/circheartfailure.117.003959] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/30/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the conventional paradigm of the progression of left ventricular hypertrophy, a thick-walled left ventricle (LV) ultimately transitions to a dilated cardiomyopathy. There are scant data in humans demonstrating whether this transition occurs commonly without an interval myocardial infarction. METHODS AND RESULTS Participants (n=1282) from the Dallas Heart Study underwent serial cardiac magnetic resonance ≈7 years apart. Those with interval cardiovascular events and a dilated LV (increased LV end-diastolic volume [EDV] indexed to body surface area) at baseline were excluded. Multivariable linear regression models tested the association of concentric hypertrophy (increased LV mass and LV mass/volume0.67) with change in LVEDV. The study cohort had a median age of 44 years, 57% women, 43% black, and 11% (n=142) baseline concentric hypertrophy. The change in LVEDV in those with versus without concentric hypertrophy was 1 mL (-9 to 12) versus -2 mL (-11 to 7), respectively, P<0.01. In multivariable linear regression models, concentric hypertrophy was associated with larger follow-up LVEDV (P≤0.01). The progression to a dilated LV was uncommon (2%, n=25). CONCLUSIONS In the absence of interval myocardial infarction, concentric hypertrophy was associated with a small, but significantly greater, increase in LVEDV after 7-year follow-up. However, the degree of LV enlargement was minimal, and few participants developed a dilated LV. These data suggest that if concentric hypertrophy does progress to a dilated cardiomyopathy, such a transition would occur over a much longer timeframe (eg, decades) and perhaps less common than previously thought. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Affiliation(s)
- Sonia Garg
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas.
| | - James A de Lemos
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Susan A Matulevicius
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Ian J Neeland
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Roderick McColl
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Christopher Maroules
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Ronald M Peshock
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- From the Division of Cardiology, Department of Internal Medicine (S.G., J.A.d.L., S.A.M., A.P., I.J.N., J.D.B., M.H.D.), Department of Clinical Science (C.A., J.D.B.), and Department of Radiology (R.M., C.M., R.M.P.), University of Texas Southwestern Medical Center, Dallas
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Paixao ARM, Neeland IJ, Ayers CR, Xing F, Berry JD, de Lemos JA, Abbara S, Peshock RM, Khera A. Defining coronary artery calcium concordance and repeatability - Implications for development and change: The Dallas Heart Study. J Cardiovasc Comput Tomogr 2017; 11:347-353. [PMID: 28732689 DOI: 10.1016/j.jcct.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 11/16/2016] [Revised: 05/14/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Development and change of coronary artery calcium (CAC) are associated with coronary heart disease. Interpretation of serial CAC measurements will require better understanding of changes in CAC beyond the variability in the test itself. METHODS Dallas Heart Study participants (2888) with duplicate CAC scans obtained minutes apart were analyzed to determine interscan concordance and 95% confidence bounds (ie: repeatability limits) for each discrete CAC value. These data derived cutoffs were then used to define change above measurement variation and determine the frequency of CAC development and change among 1779 subjects with follow up CAC scans performed 6.9 years later. RESULTS Binary concordance (0 vs. >0) was 91%. The value of CAC denoting true development of CAC by exceeding the 95% confidence bounds for a single score of 0 was 2.7 Agatston units (AU). Among those with scores >0, the 95% confidence bounds for CAC change were determined by the following formulas: for CAC≤100AU: 5.6√CAC + 0.3*CAC - 3.1; for CAC>100AU: 12.4√CAC - 67.7. Using these parameters, CAC development occurred in 15.0% and CAC change occurred in 48.9%. Although 225 individuals (24.9%) had a decrease in CAC over follow up, only 1 (0.1%) crossed the lower confidence bound. Compared with prior reported definition of CAC development (ie: >0), the novel threshold of 2.7AU resulted in better measures of model performance. In contrast, for CAC change, no consistent differences in performance metrics were observed compared with previously reported definitions. CONCLUSION There is significant interscan variability in CAC measurement, including around scores of 0. Incorporating repeatability estimates may help discern true differences from those due to measurement variability, an approach that may enhance determination of CAC development and change.
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Affiliation(s)
- Andre R M Paixao
- Arkansas Heart Hospital, Little Rock, AR, USA; University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ian J Neeland
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Frank Xing
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jarett D Berry
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ronald M Peshock
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Garg S, de Lemos JA, Ayers C, Khouri MG, Pandey A, Berry JD, Peshock RM, Drazner MH. Association of a 4-Tiered Classification of LV Hypertrophy With Adverse CV Outcomes in the General Population. JACC Cardiovasc Imaging 2015; 8:1034-1041. [PMID: 26298074 DOI: 10.1016/j.jcmg.2015.06.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 05/13/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study was performed to determine whether a 4-tiered classification of left ventricular hypertrophy (LVH) defines subgroups in the general population that are at variable risks of adverse cardiovascular (CV) outcomes. BACKGROUND We recently proposed a 4-tiered classification of LVH where eccentric LVH is subdivided into "indeterminate hypertrophy" and "dilated hypertrophy" and concentric LVH into "thick hypertrophy" and "both thick and dilated hypertrophy," based on the presence of increased left ventricular (LV) end-diastolic volume. METHODS Participants from the Dallas Heart study who underwent cardiac magnetic resonance and did not have LV dysfunction or a history of heart failure (HF) (n = 2,458) were followed for a median of 9 years for the primary outcome of HF or CV death. Multivariable Cox proportional hazards models were used to adjust for age, sex, African-American race, hypertension, diabetes, and history of CV disease. RESULTS In the cohort, 70% had no LVH, 404 (16%) had indeterminate hypertrophy, 30 (1%) had dilated hypertrophy, 289 (12%) had thick hypertrophy, and 7 (0.2%) had both thick and dilated hypertrophy. The cumulative incidence of HF or CV death was 2% with no LVH, 1.7% with indeterminate, 16.7% with dilated, 11.1% with thick, and 42.9% with both thick and dilated hypertrophy (log-rank p < 0.0001). Compared with participants without LVH, those with dilated (hazard ratio [HR]: 7.3; 95% confidence interval [CI]: 2.8 to 18.8), thick (HR: 2.4; 95% CI: 1.4 to 4.0), and both thick and dilated (HR: 5.8; 95% CI: 1.7 to 19.5) hypertrophy remained at increased risk for HF or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not (HR: 0.9; 95% CI: 0.4 to 2.2). CONCLUSIONS In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes.
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Affiliation(s)
- Sonia Garg
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Colby Ayers
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michel G Khouri
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ronald M Peshock
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Garg S, de Lemos J, Ayers C, Khouri M, Pandey A, Berry JD, Peshock RM, Drazner MH. Association of 4-Tiered Classification of Left Ventricular Hypertrophy With Adverse Cardiovascular Outcomes in the General Population. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.256] [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: 10/23/2022]
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16
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Srinivasa RN, Rossetti HC, Gupta MK, Rosenberg RN, Weiner MF, Peshock RM, McColl RW, Hynan LS, Lucarelli RT, King KS. Cardiovascular Risk Factors Associated with Smaller Brain Volumes in Regions Identified as Early Predictors of Cognitive Decline. Radiology 2015. [PMID: 26218598 DOI: 10.1148/radiol.2015142488] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine in a large multiethnic cohort the cardiovascular and genetic risk factors associated with smaller volume in the hippocampus, precuneus, and posterior cingulate, and their association with preclinical deficits in cognitive performance in patients younger and older than 50 years. MATERIALS AND METHODS The institutional review board approved the study and all participants provided written informed consent. Eligible for this study were 1629 participants (700 men and 929 women; mean age, 50.0 years ± 10.2 [standard deviation]) drawn from the population-based Dallas Heart Study who underwent laboratory and clinical analysis in an initial baseline visit and approximately 7 years later underwent brain magnetic resonance imaging with automated volumetry and cognitive assessment with the Montreal Cognitive Assessment (MoCA). Regression analysis showed associations between risk factors and segmental volumes, and associations between these volumes with cognitive performance in participants younger and older than 50 years. RESULTS Lower hippocampal volume was associated with previous alcohol consumption (standardized estimate, -0.04; P = .039) and smoking (standardized estimate, -0.04; P = .048). Several risk factors correlated with lower total brain, posterior cingulate, and precuneus volumes. Higher total (standardized estimate, 0.06; P = .050), high-density lipoprotein (standardized estimate, 0.07; P = .003), and low-density lipoprotein (standardized estimate, 0.04; P = .037) cholesterol levels were associated with larger posterior cingulate volume, and higher triglyceride levels (standardized estimate, 0.06; P = .004) were associated with larger precuneus volume. Total MoCA score was associated with posterior cingulate volume (standardized estimate, 0.13; P = .001) in younger individuals and with hippocampal (standardized estimate, 0.06; P < .05) and precuneus (standardized estimate, 0.08; P < .023) volumes in older adults. CONCLUSION Smaller volumes in specific brain regions considered to be early markers of dementia risk were associated with specific cardiovascular disease risk factors and cognitive deficits in a predominantly midlife multiethnic population-based sample. Additionally, the risk factors most associated with these brain volumes differed in participants younger and older than 50 years, as did the association between brain volume and MoCA score.
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Affiliation(s)
- Rajiv N Srinivasa
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Heidi C Rossetti
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Mohit K Gupta
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Roger N Rosenberg
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Myron F Weiner
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Ronald M Peshock
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Roderick W McColl
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Linda S Hynan
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Richard T Lucarelli
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Kevin S King
- From the University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
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Howden EJ, Perhonen M, Peshock RM, Zhang R, Arbab-Zadeh A, Adams-Huet B, Levine BD. Females have a blunted cardiovascular response to one year of intensive supervised endurance training. J Appl Physiol (1985) 2015; 119:37-46. [PMID: 25930024 DOI: 10.1152/japplphysiol.00092.2015] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/23/2015] [Indexed: 12/22/2022] Open
Abstract
Cross-sectional studies in athletes suggest that endurance training augments cardiovascular structure and function with apparently different phenotypes in athletic males and females. It is unclear whether the longitudinal response to endurance training leads to similar cardiovascular adaptations between sexes. We sought to determine whether males and females demonstrate similar cardiovascular adaptations to 1 yr of endurance training, matched for training volume and intensity. Twelve previously sedentary males (26 ± 7, n = 7) and females (31 ± 6, n = 5) completed 1 yr of progressive endurance training. All participants underwent a battery of tests every 3 mo to determine maximal oxygen uptake (V̇o2max) and left ventricle (LV) function and morphology (cardiac magnetic resonance imaging). Pulmonary artery catheterization was performed before and after 1 yr of training, and pressure-volume and Starling curves were constructed during decreases (lower-body negative pressure) and increases (saline infusion) in cardiac volume. Males progressively increased V̇o2max, LV mass, and mean wall thickness, before reaching a plateau from month 9 to 12 of training. In contrast, despite exactly the same training, the response in females was markedly blunted, with V̇o2max, LV mass, and mean wall thickness plateauing after only 3 mo of training. The response of LV end-diastolic volume was not influenced by sex (males +20% and females +18%). After training Starling curves were shifted upward and left, but the effect was greatest in males (interaction P = 0.06). We demonstrate for the first time clear sex differences in response to 1 yr of matched endurance training, such that the development of ventricular hypertrophy and increase in V̇o2max in females is markedly blunted compared with males.
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Affiliation(s)
- Erin J Howden
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Merja Perhonen
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and
| | | | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Armin Arbab-Zadeh
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and
| | | | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
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Gupta M, King KS, Srinivasa R, Weiner MF, Hulsey K, Ayers CR, Whittemore A, McColl RW, Rossetti HC, Peshock RM. Association of 3.0-T brain magnetic resonance imaging biomarkers with cognitive function in the Dallas Heart Study. JAMA Neurol 2015; 72:170-5. [PMID: 25485570 DOI: 10.1001/jamaneurol.2014.3418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding the relationships between age-related changes in brain structure and cognitive function has been limited by inconsistent methods for assessing brain imaging, small sample sizes, and racially/ethnically homogeneous cohorts with biased selection based on risk factors. These limitations have prevented the generalizability of results from brain morphology studies. OBJECTIVE To determine the association of 3.0-T structural brain magnetic resonance (MR) imaging measurements with cognitive function in the multiracial/multiethnic, population-based Dallas Heart Study. DESIGN, SETTING, AND PARTICIPANTS Whole-brain, 2-dimensional, fluid-attenuated inversion recovery and 3-dimensional, magnetization-prepared, rapid acquisition with gradient echo MR imaging at 3.0 T was performed in 1645 Dallas Heart Study participants (mean [SD] age, 49.9 [10.5] years; age range, 19-85 years) who received both brain MR imaging and cognitive screening with the Montreal Cognitive Assessment between September 18, 2007, and December 28, 2009. Measurements were obtained for white matter hyperintensity volume, total brain volume, gray matter volume, white matter volume, cerebrospinal fluid volume, and hippocampal volume. Linear regression and a best predictive model were developed to determine the association of MR imaging biomarkers with the Montreal Cognitive Assessment total score and domain-specific questions. MAIN OUTCOMES AND MEASURES High-resolution anatomical MR imaging was used to quantify brain volumes. Scores on the screening Montreal Cognitive Assessment were used for cognitive assessment in participants. RESULTS After adjustment for demographic variables, total brain volume (P < .0001, standardized estimate [SE] = .1069), gray matter volume (P < .0001, SE = .1156), white matter volume (P = .008, SE = .0687), cerebrospinal fluid volume (P = .012, SE = -.0667), and hippocampal volume (P < .0001) were significantly associated with cognitive performance. A best predictive model identified gray matter volume (P < .001, SE = .0021), cerebrospinal fluid volume (P = .01, SE = .0024), and hippocampal volume (P = .004, SE = .1017) as 3 brain MR imaging biomarkers significantly associated with the Montreal Cognitive Assessment total score. Questions specific to the visuospatial domain were associated with the most brain MR imaging biomarkers (total brain volume, gray matter volume, white matter volume, cerebrospinal fluid volume, and hippocampal volume), while questions specific to the orientation domain were associated with the least brain MR imaging biomarkers (only hippocampal volume). CONCLUSIONS AND RELEVANCE Brain MR imaging volumes, including total brain volume, gray matter volume, cerebrospinal fluid volume, and hippocampal volume, were independently associated with cognitive function and may be important early biomarkers of risk for cognitive insult in a young multiracial/multiethnic population. A best predictive model indicated that a combination of multiple neuroimaging biomarkers may be more effective than a single brain MR imaging volume measurement.
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Affiliation(s)
- Mohit Gupta
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Kevin S King
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Rajiv Srinivasa
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Myron F Weiner
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas
| | - Keith Hulsey
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Colby R Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, The University of Texas Southwestern Medical Center, Dallas
| | - Anthony Whittemore
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Roderick W McColl
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas
| | - Heidi C Rossetti
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas
| | - Ronald M Peshock
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas3Donald W. Reynolds Cardiovascular Clinical Research Center, The University of Texas Southwestern Medical Center, Dallas4Department of Internal Medicine, The University of
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King KS, Kozlitina J, Rosenberg RN, Peshock RM, McColl RW, Garcia CK. Effect of leukocyte telomere length on total and regional brain volumes in a large population-based cohort. JAMA Neurol 2015; 71:1247-54. [PMID: 25090243 DOI: 10.1001/jamaneurol.2014.1926] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Telomere length has been associated with dementia and psychological stress, but its relationship with human brain size is unknown. OBJECTIVE To determine if peripheral blood telomere length is associated with brain volume. DESIGN, SETTING, AND PARTICIPANTS Peripheral blood leukocyte telomere length and brain volumes were measured for 1960 individuals in the Dallas Heart Study, a population-based, probability sample of Dallas County, Texas, residents, with a median (25th-75th percentile) age of 50 (42-58) years. Global and 48 regional brain volumes were assessed from the automated analysis of magnetic resonance imaging. MAIN OUTCOMES AND MEASURES Telomere length and global and regional brain volumes. RESULTS Leukocyte telomere length was associated with total cerebral volume (β [SE], 0.06 [0.01], P <.001) including white and cortical gray matter volume (β [SE], 0.04 [0.01], P = .002; β [SE], 0.07 [0.02], P <.001, respectively), independent of age, sex, ethnicity, and total intracranial volume. While age was associated with the size of most subsegmental regions of the cerebral cortex, telomere length was associated with certain subsegmental regions. Compared with age, telomere length (TL) explained a sizeable proportion of the variance in volume of the hippocampus, amygdala, and inferior temporal region (hippocampus: βTL [SE], 0.08 [0.02], R2, 0.91% vs βage [SE], -0.16 [0.02], R2, 3.80%; amygdala: βTL [SE], 0.08 [0.02], R2, 0.78% vs βage [SE],-0.19 [0.02], R2,4.63%; inferior temporal: βTL [SE], 0.07 [0.02], R2, 0.92% vs βage [SE], -0.14 [0.02], R2, 3.98%) (P <.001 for all). The association of telomere length and the size of the inferior and superior parietal, hippocampus, and fusiform regions was stronger in individuals older than 50 years than younger individuals (inferior parietal: β>50 [SE], 0.13 [0.03], P <.001 vs β≤50 [SE], 0.02 [0.02], P = .51, P for interaction = .001; superior parietal: β>50 [SE], 0.11 [0.03], P <.001 vs β≤50 [SE], 0.01 [0.02], P = .71, P for interaction = .004; hippocampus: β>50 [SE], 0.10 [0.03], P = .004 vs β≤50 [SE], 0.05 [0.02], P = .07, P for interaction = .04; fusiform: β>50 [SE], 0.09 [0.03], P = .002, β≤50 [SE], 0.03 [0.02], P = .31, P for interaction = .03). The volume of the hippocampus, amygdala, superior and inferior temporal, precuneus, lateral orbitofrontal, posterior cingulate, thalamus and ventral diencephalon were independently associated with telomere length after adjustment for all covariates (age, gender, ethnicity, total intracranial volume, body mass index, blood pressure, diabetes, smoking status, and APOE genotype). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first population-based study to date to evaluate telomere length as an independent predictor of global and regional brain size. Future studies are needed to determine how telomere length and anatomic structural changes are related to cognitive function, dementia, and psychological disease.
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Affiliation(s)
- Kevin S King
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas3Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Roger N Rosenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas5Editor, JAMA Neurology
| | - Ronald M Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Roderick W McColl
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Christine K Garcia
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas3Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Arbab-Zadeh A, Perhonen M, Howden E, Peshock RM, Zhang R, Adams-Huet B, Haykowsky MJ, Levine BD. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation 2014; 130:2152-61. [PMID: 25281664 DOI: 10.1161/circulationaha.114.010775] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [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: 11/16/2022]
Abstract
BACKGROUND It is unclear whether, and to what extent, the striking cardiac morphological manifestations of endurance athletes are a result of exercise training or a genetically determined characteristic of talented athletes. We hypothesized that prolonged and intensive endurance training in previously sedentary healthy young individuals could induce cardiac remodeling similar to that observed cross-sectionally in elite endurance athletes. METHODS AND RESULTS Twelve previously sedentary subjects (aged 29±6 years; 7 men and 5 women) trained progressively and intensively for 12 months such that they could compete in a marathon. Magnetic resonance images for assessment of right and left ventricular mass and volumes were obtained at baseline and after 3, 6, 9, and 12 months of training. Maximum oxygen uptake ( max) and cardiac output at rest and during exercise (C2H2 rebreathing) were measured at the same time periods. Pulmonary artery catheterization was performed before and after 1 year of training, and pressure-volume and Starling curves were constructed during decreases (lower body negative pressure) and increases (saline infusion) in cardiac volume. Mean max rose from 40.3±1.6 to 48.7±2.5 mL/kg per minute after 1 year (P<0.00001), associated with an increase in both maximal cardiac output and stroke volume. Left and right ventricular mass increased progressively with training duration and intensity and reached levels similar to those observed in elite endurance athletes. In contrast, left ventricular volume did not change significantly until 6 months of training, although right ventricular volume increased progressively from the outset; Starling and pressure-volume curves approached but did not match those of elite athletes. CONCLUSIONS One year of prolonged and intensive endurance training leads to cardiac morphological adaptations in previously sedentary young subjects similar to those observed in elite endurance athletes; however, it is not sufficient to achieve similar levels of cardiac compliance and performance. Contrary to conventional thinking, the left ventricle responds to exercise with initial concentric but not eccentric remodeling during the first 6 to 9 months after commencement of endurance training depending on the duration and intensity of exercise. Thereafter, the left ventricle dilates and restores the baseline mass-to-volume ratio. In contrast, the right ventricle responds to endurance training with eccentric remodeling at all levels of training.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Merja Perhonen
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Erin Howden
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Ronald M Peshock
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Rong Zhang
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Beverly Adams-Huet
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Mark J Haykowsky
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Benjamin D Levine
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.).
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Maroules CD, Khera A, Ayers C, Goel A, Peshock RM, Abbara S, King KS. Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study. J Cardiovasc Magn Reson 2014; 16:33. [PMID: 24886531 PMCID: PMC4031496 DOI: 10.1186/1532-429x-16-33] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/02/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) has been validated for the noninvasive assessment of total arterial compliance and aortic stiffness, but their associations with cardiovascular outcomes is unknown. The purpose of this study was to evaluate associations of CMR measures of total arterial compliance and two CMR measures of aortic stiffness with respect to future cardiovascular events. METHODS The study consisted of 2122 Dallas Heart Study participants without cardiovascular disease who underwent CMR at 1.5 Tesla. Aortic stiffness was measured by CMR-derived ascending aortic distensibility and aortic arch pulse wave velocity. Total arterial compliance was calculated by dividing left ventricular stroke volume by pulse pressure. Participants were monitored for cardiovascular death, non-fatal cardiac events, and non-fatal extra-cardiac vascular events over 7.8 ± 1.5 years. Cox proportional hazards regression was used to assess for associations between CMR measures and cardiovascular events. RESULTS Age, systolic blood pressure, and resting heart rate were independently associated with changes in ascending aortic distensibility, arch pulse wave velocity, and total arterial compliance (all p < .0001). A total of 153 participants (6.9%) experienced a cardiovascular event. After adjusting for traditional risk factors, total arterial compliance was modestly associated with increased risk for composite events (HR 1.07 per 1SD, p = 0.03) while the association between ascending aortic distensibility and composite events trended towards significance (HR 1.18 per 1SD, p = 0.08). Total arterial compliance and aortic distensibility were independently associated with nonfatal cardiac events (HR 1.11 per 1SD, p = 0.001 and HR 1.45 per 1SD, p = 0.0005, respectively), but not with cardiovascular death or nonfatal extra-cardiac vascular events. Arch pulse wave velocity was independently associated with nonfatal extra-cardiac vascular events (HR 1.18 per 1SD, p = 0.04) but not with cardiovascular death or nonfatal cardiac events. CONCLUSIONS In a multiethnic population free of cardiovascular disease, CMR measures of arterial stiffness are associated with future cardiovascular events. Total arterial compliance and aortic distensibility may be stronger predictors of nonfatal cardiac events, while pulse wave velocity may be a stronger predictor of nonfatal extra-cardiac vascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Amit Khera
- Division of Cardiology, Internal Medicine, and Clinical Sciences, Dallas, TX, USA
| | - Colby Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Akshay Goel
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Ronald M Peshock
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
- Division of Cardiology, Internal Medicine, and Clinical Sciences, Dallas, TX, USA
| | - Suhny Abbara
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Kevin S King
- Departments of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
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King KS, Peshock RM, Rossetti HC, McColl RW, Ayers CR, Hulsey KM, Das SR. Effect of normal aging versus hypertension, abnormal body mass index, and diabetes mellitus on white matter hyperintensity volume. Stroke 2013; 45:255-7. [PMID: 24203844 DOI: 10.1161/strokeaha.113.003602] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The natural history of white matter hyperintensity (WMH) progression resulting from normal aging versus comorbid vascular insults remains unclear. Therefore we investigated age-related differences in WMH volumes among a group with comorbid hypertension, abnormal body mass index, and diabetes mellitus to a normal aging group drawn from the same population lacking any of these comorbidities. METHODS WMH volumes were acquired using 3T MRI for 2011 Dallas Heart Study participants. The slope of the WMH versus age regression was compared between normal and comorbidity groups<50 and ≥50 years of age where a change in slope was demonstrated. RESULTS Aging was linearly associated with greater log WMH volume for both normal (P=0.02) and comorbidity (P<0.0001) groups. Beyond 50 years of age, more rapid increases in WMH volumes for age were seen in the group with comorbidities (P<0.0001) but not in the normal group (P=0.173). The between-group difference in slope of expected WMH for age was significantly greater in the comorbidity groups≥50 years of age (P=0.0008) but not <50 years of age (P=0.752). CONCLUSIONS After 50 years of age, but not before, comorbid hypertension, obesity, and diabetes mellitus were associated with significantly larger WMH volumes for age compared with a normal aging group lacking these conditions. These results support the assertion that age-related differences in WMH volumes are significantly increased in the presence of comorbidities, but the effect is only detectable after 50 years of age.
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Affiliation(s)
- Kevin S King
- From the Departments of Radiology (K.S.K., R.M.P., R.W.M., K.M.H.), Internal Medicine (R.M.P., C.R.A., S.R.D.), and Psychiatry (H.C.R.), University of Texas Southwestern Medical Center, Dallas, TX
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Goel A, McColl R, King KS, Whittemore A, Peshock RM. Fully automated tool to identify the aorta and compute flow using phase-contrast MRI: validation and application in a large population based study. J Magn Reson Imaging 2013; 40:221-8. [PMID: 24115597 DOI: 10.1002/jmri.24338] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/16/2013] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess if fully automated localization of the aorta can be achieved using phase contrast (PC) MR images. MATERIALS AND METHODS PC cardiac-gated MR images were obtained as part of a large population-based study. A fully automated process using the Hough transform was developed to localize the ascending aorta (AAo) and descending aorta (DAo). The study was designed to validate this technique by determining: (i) its performance in localizing the AAo and DAo; (ii) its accuracy in generating AAo flow volume and DAo flow volume; and (iii) its robustness on studies with pathological abnormalities or imaging artifacts. RESULTS The algorithm was applied successfully on 1884 participants. In the randomly selected 50-study validation set, linear regression shows an excellent correlation between the automated (A) and manual (M) methods for AAo flow (r = 0.99) and DAo flow (r = 0.99). Bland-Altman difference analysis demonstrates strong agreement with minimal bias for: AAo flow (mean difference [A-M] = 0.47 ± 2.53 mL), and DAo flow (mean difference [A-M] = 1.74 ± 2.47 mL). CONCLUSION A robust fully automated tool to localize the aorta and provide flow volume measurements on phase contrast MRI was validated on a large population-based study.
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Affiliation(s)
- Akshay Goel
- Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Maroules CD, Rosero E, Ayers C, Peshock RM, Khera A. Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study. Radiology 2013; 269:84-91. [PMID: 23781118 DOI: 10.1148/radiol.13122707] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. MATERIALS AND METHODS This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. RESULTS Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). CONCLUSION MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, Anesthesiology, Clinical Sciences, and Internal Medicine, Division of Cardiology and the Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Lucarelli RT, Peshock RM, McColl R, Hulsey K, Ayers C, Whittemore AR, King KS. MR imaging of hippocampal asymmetry at 3T in a multiethnic, population-based sample: results from the Dallas Heart Study. AJNR Am J Neuroradiol 2013; 34:752-7. [PMID: 23139080 DOI: 10.3174/ajnr.a3308] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Asymmetry of the hippocampus is regarded as an important clinical finding, but limited data on hippocampal asymmetry are available for the general population. Here we present hippocampal asymmetry data from the Dallas Heart Study determined by automated methods and its relationship to age, sex, and ethnicity. MATERIALS AND METHODS 3D magnetization-prepared rapid acquisition of gradient echo MR imaging was performed in 2082 DHS-2 participants. The MR images were analyzed by using 2 standard automated brain-segmentation programs, FSL-FIRST and FreeSurfer. Individuals with imaging errors, self-reported stroke, or major structural abnormalities were excluded. Statistical analyses were performed to determine the significance of the findings across age, sex, and ethnicity. RESULTS At the 90th percentile, FSL-FIRST demonstrated hippocampal asymmetry of 9.8% (95% CI, 9.3%-10.5%). The 90th percentile of hippocampal asymmetry, measured by the difference in right and left hippocampi volume and the larger hippocampus, was 17.9% (95% CI, 17.0%-19.1%). Hippocampal asymmetry increases with age (P=.0216), men have greater asymmetry than women as shown by FSL-FIRST (P=.0036), but ethnicity is not significantly correlated with asymmetry. To confirm these findings, we used FreeSurfer. FreeSurfer showed asymmetry of 4.4% (95% CI, 4.3%-4.7%) normalized to total volume and 8.5% (95% CI, 8.3%-9.0%) normalized by difference/larger hippocampus. FreeSurfer also showed that hippocampal asymmetry increases with age (P=.0024) and that men had greater asymmetry than women (P=.03). CONCLUSIONS There is a significant degree of hippocampal asymmetry in the population. The data provided will aid in the research, diagnosis, and treatment of temporal lobe epilepsy and other neurologic disease.
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Affiliation(s)
- R T Lucarelli
- Department of Radiology, Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8896, USA
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Ranganathan D, Bell M, Willett D, Peshock RM. Creating a Research and Clinical Care Partnership through EMR and Clinical Research System Integration. AMIA Jt Summits Transl Sci Proc 2013; 2013:209-13. [PMID: 24303266 PMCID: PMC3845779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
EMRs are essential in modern healthcare. At the same time there has been the rapid development of clinical research systems (CRS) which offer specific tools to facilitate research protocol development, execution and management. However, examples of integrating a commercial EMR and CRS are rare. We describe our experience in the analysis, resolution of issues, design, and implementation of EMR/CR integration in a large academic medical center with affiliated hospitals. Our initial results suggest that (1) neither the EMR nor CRS system alone will suffice to facilitate clinical research, (2) there are important benefits to integration of the EMR and CRS systems and (3) this integration can be leveraged across multiple institutions.
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King KS, Chen KX, Hulsey KM, McColl RW, Weiner MF, Nakonezny PA, Peshock RM. White matter hyperintensities: use of aortic arch pulse wave velocity to predict volume independent of other cardiovascular risk factors. Radiology 2013; 267:709-17. [PMID: 23392429 DOI: 10.1148/radiol.13121598] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the relationship between pulse wave velocity (PWV) from the aortic arch and subsequent cerebral microvascular disease independent of other baseline cardiovascular risk factors among the participants in the multiethnic Dallas Heart Study. MATERIALS AND METHODS Each subject gave written consent to participate in this HIPAA-compliant, institutional review board-approved prospective study. Aortic arch PWV was measured with phase-contrast magnetic resonance (MR) imaging in a population sample (n = 1270) drawn from the probability-based Dallas Heart Study. Seven years later, the volume of white matter hyperintensities (WMHs) was determined from brain MR images. Linear regression was conducted with aortic arch PWV, 15 other cardiovascular risk factors, and age, sex, and ethnicity included as predictors of WMH. The authors implemented a smoothly clipped absolute deviation-penalized variable selection method to evaluate an optimal predictive risk factor model. RESULTS Aortic arch PWV helped predict WMH volume independent of the other demographic and cardiovascular risk factors (regression coefficient: 0.29; standard error: 0.06; 95% confidence interval: 0.17, 0.42; P < .0001). The optimal predictor variables of subsequent WMH volume adjusted for sex and ethnicity included aortic arch PWV, age, systolic blood pressure, hypertension treatment, and congestive heart failure. The authors estimated that a 1% increase in aortic arch PWV (in meters per second) is related to a 0.3% increase in subsequent WMH volume (in milliliters) when all other variables in the model are held constant. CONCLUSION Aortic arch PWV measured with phase-contrast MR imaging is a highly significant independent predictor of subsequent WMH volume, with a higher standardized effect than any other cardiovascular risk factor assessed except for age. In an optimal predictive model of subsequent WMH burden, aortic arch PWV provides a distinct contribution along with systolic blood pressure, hypertension treatment, congestive heart failure, and age.
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Affiliation(s)
- Kevin S King
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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Lucarelli RT, Khera A, Peshock RM, McColl R, Ayers C, Weiner MF, King KS. Abstract 171: CRP, IL-18, and BNP are Associated with Regional Brain Atrophy: Results from the Dallas Heart Study. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.a171] [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
Purpose:
Multiple biomarkers have been associated with total brain atrophy. However, little is known about their relationship to segmental atrophy in a large, multi-ethnic, population-based sample.
Materials and Methods:
3D-MPRAGE brain images obtained at 3T from 2082 participants of the Dallas Heart Study (DHS) 2 were analyzed with Freesurfer and outlier analysis was performed. Divisive eigenvalue clustering of 89 brain segments yielded 24 groups with linked atrophy patterns. Plasma C-reactive protein (CRP), IL-18, homocsysteine and B-type natriuretic peptide (BNP) obtained 7 years prior during DHS 1 were available for 1343, 840, 1333 and 1331 participants, respectively. Multivariate linear regression analysis with adjustments for age, ethnicity, and gender were used to demonstrate associations between biomarkers and atrophy clusters.
Results:
Nine atrophy clusters were associated with CRP, three atrophy clusters were associated with IL-18, and six atrophy clusters were associated with BNP (Table 1). Homocysteine did not have any significant correlations.
Conclusions:
The markers studied had associations with distinct patterns of segmental atrophy indicating they may have unique interactions in different brain regions. This suggests that distinct inflammatory and other pathways may be at work in specific regions of the brain and that their localized effects may be obscured by approaches evaluating solely total brain volumes. Table 1:
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Affiliation(s)
| | - Amit Khera
- Univeristy of Texas Southwestern Med Sch, Dallas, TX
| | | | | | - Colby Ayers
- Univeristy of Texas Southwestern Med Sch, Dallas, TX
| | | | - Kevin S King
- Univeristy of Texas Southwestern Med Sch, Dallas, TX
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King KS, Peshock RM, Warren MW, Alhilali L, Hulsey K, McColl R, Weiner MF, Ayers C, Whittemore A. Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location. AJNR Am J Neuroradiol 2012; 34:797-801. [PMID: 23079403 DOI: 10.3174/ajnr.a3283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Age-related white matter hyperintensities have prognostic implications, but no accepted clinical standard exists for their assessment. We propose a simple objective visual rating system by using 3T brain MR imaging. MATERIALS AND METHODS MR imaging from 559 participants was processed by using an automated method to determine WMH volumes and evaluated with a new visual rating scale based on the single largest WMH lesion diameter regardless of location. The reproducibility of the visual system was assessed. The association of WMH visual scores and automated volumes was then compared with cognitive scores from the Montreal Cognitive Assessment, which was available for 510 participants. RESULTS Inter-reader reproducibility was good for subsamples with both high (n=52) and low (n=40) prevalence of large automated WMH volumes (agreement of 67% and 87.5%, κ=0.71 and 0.76, respectively). Correlation between increased WMH and cognitive deficit measurements was equal for our visual ratings and automated volumes (Spearman ρ=0.118 and 0.109; P values=0.008 and 0.014, respectively). The visual scale retained a significant association with MoCA score after adjusting for age, sex, and education (standardized β=-0.087, P=.042). CONCLUSIONS We propose a simple visual WMH scoring system suitable for use as a baseline evaluation in clinical practice.
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Affiliation(s)
- K S King
- Department of Radiology, Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Gupta S, Matulevicius SA, Ayers CR, Berry JD, Patel PC, Markham DW, Levine BD, Chin KM, de Lemos JA, Peshock RM, Drazner MH. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J 2012; 34:278-85. [PMID: 22782941 DOI: 10.1093/eurheartj/ehs188] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS Left atrial (LA) structural and functional abnormalities may be subclinical phenotypes, which identify individuals at increased risk of adverse outcomes. METHODS AND RESULTS Maximum LA volume (LAmax) and LA emptying fraction (LAEF) were measured via cardiac magnetic resonance imaging in 1802 participants in the Dallas Heart Study. The associations of LAEF and LAmax indexed to body surface area (LAmax/BSA) with traditional risk factors, natriuretic peptide levels, and left ventricular (LV) structure [end-diastolic volume (EDV) and concentricity(0.67) (mass/EDV(0.67))] and function (ejection fraction) were assessed using linear regression analysis. The incremental prognostic value of LAmax/BSA and LAEF beyond traditional risk factors, LV ejection fraction, and LV mass was assessed using the Cox proportional-hazards model. Both increasing LAmax/BSA and decreasing LAEF were associated with hypertension and natriuretic peptide levels (P < 0.05 for all). In multivariable analysis, LAmax/BSA was most strongly associated with LV end-diastolic volume/BSA, while LAEF was strongly associated with LV ejection fraction and concentricity(0.67). During a median follow-up period of 8.1 years, there were 81 total deaths. Decreasing LAEF [hazard ratio (HR) per 1 standard deviation (SD) (8.0%): 1.56 (1.32-1.87)] but not increasing LAmax/BSA [HR per 1 SD (8.6 mL/m(2)): 1.14 (0.97-1.34)] was independently associated with mortality. Furthermore, the addition of LAEF to a model adjusting Framingham risk score, diabetes, race, LV mass, and ejection fraction improved the c-statistic (c-statistics: 0.78 vs. 0.77; P < 0.05, respectively), whereas the addition of LAmax/BSA did not (c-statistics: 0.76, P = 0.20). CONCLUSION In the general population, both LAmax/BSA and LAEF are important subclinical phenotypes but LAEF is superior and incremental to LAmax/BSA.
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Affiliation(s)
- Sachin Gupta
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390-9047, USA
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Hulsey KM, Gupta M, King KS, Peshock RM, Whittemore AR, McColl RW. Automated quantification of white matter disease extent at 3 T: comparison with volumetric readings. J Magn Reson Imaging 2012; 36:305-11. [PMID: 22517404 DOI: 10.1002/jmri.23659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 03/07/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop and validate an algorithm to automatically quantify white matter hyperintensity (WMH) volume. MATERIALS AND METHODS Images acquired as part of the Dallas Heart Study, a multiethnic, population-based study of cardiovascular health, were used to develop and validate the algorithm. 3D magnetization prepared rapid acquisition gradient echo (MP-RAGE) and 2D fluid-attenuated inversion recovery (FLAIR) images were acquired from 2082 participants. Images from 161 participants (7.7% of the cohort) were used to set an intensity threshold to maximize the agreement between the algorithm and a qualitative rating made by a radiologist. The resulting algorithm was run on the entire cohort and outlier analyses were used to refine the WMH volume measurement. The refined, automatic WMH burden estimate was then compared to manual quantitative measurements of WMH volume in 28 participants distributed across the range of volumes seen in the entire cohort. RESULTS The algorithm showed good agreement with the volumetric readings of a trained analyst: the Spearman's Rank Order Correlation coefficient was r = 0.87. Linear regression analysis showed a good correlation WMHml[automated] = 1.02 × WMHml[manual] - 0.48. Bland-Altman analysis showed a bias of 0.34 mL and a standard deviation of 2.8 mL over a range of 0.13 to 41 mL. CONCLUSION We have developed an algorithm that automatically estimates the volume of WMH burden using an MP-RAGE and a FLAIR image. This provides a tool for evaluating the WMH burden of large populations to investigate the relationship between WMH burden and other health factors.
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Affiliation(s)
- Keith M Hulsey
- Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
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Matulevicius S, Huff LC, Szczepaniak LS, Ayers CR, Budoff M, McColl R, Khera A, Peshock RM. Potential of electron beam computed tomography for coronary artery calcium screening to evaluate fatty liver: comparison with 1H magnetic resonance spectroscopy in the Dallas Heart Study. J Investig Med 2012; 59:780-6. [PMID: 21441828 DOI: 10.2310/jim.0b013e318216ad1d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Electron beam computed tomography (EBCT) for coronary artery calcification can potentially evaluate liver fat, another marker of cardiovascular risk. We compared quantitative estimates of hepatic steatosis measured by EBCT with those obtained by a well-validated, accurate-measure, magnetic resonance spectroscopy ((1)H MRS). METHODS EBCT and (1)H MRS were performed in 2159 subjects from the Dallas Heart Study. Forty subjects were randomly selected from each of 5 subgroups of liver fat percent by (1)H MRS (n = 200). EBCT average liver attenuation (HU) was determined in a 1- to 2-cm circular region of interest over the liver lobes. Pearson correlation coefficients were calculated. Using a previously defined (1)H MRS hepatic steatosis cut point (>5.5%), an optimized EBCT liver attenuation cut point was determined by receiver operating characteristic analysis. RESULTS (1)H MRS liver fat content and EBCT average right lobe liver attenuation were moderately negatively correlated (r = -0.64, P < 0.0001) in all subjects and in those with (1)H MRS hepatic steatosis (r = -0.71, P < 0.0001). This correlation did not improve with attenuation correction of the EBCT data using a standard calcium phantom or statistical transformation. Using an optimized receiver operating characteristic EBCT cut point (64.5 HU), sensitivity was 78% and specificity was 72% for detecting (1)H MRS hepatic steatosis, with a high false negative rate. Risk factors for hepatic steatosis (obesity, diabetes mellitus, insulin resistance, metabolic syndrome) were more strongly correlated with (1)H MRS than EBCT liver fat measures. CONCLUSIONS Liver attenuation on EBCT acquired for coronary artery calcification screening correlates modestly with (1)H MRS measures of liver fat content, with a high false negative rate.
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Affiliation(s)
- Susan Matulevicius
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center at Dallas, 75390-9047, USA.
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Bhella PS, Gandhi N, Hastings JL, Carrick-Ranson GC, Fujimoto N, Shibata S, Peshock RM, Levine BD. LIFELONG EXERCISE TRAINING DEMONSTRATES A DOSE DEPENDENT EFFECT ON MRI DERIVED LEFT VENTRICULAR MASS: IMPLICATIONS FOR DEFINING POPULATION NORMS AND LEFT VENTRICULAR HYPERTROPHY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosero EB, Peshock RM, Khera A, Clagett P, Lo H, Timaran CH. Sex, race, and age distributions of mean aortic wall thickness in a multiethnic population-based sample. J Vasc Surg 2011; 53:950-7. [PMID: 21211932 DOI: 10.1016/j.jvs.2010.10.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reference values and age-related changes of the wall thickness of the abdominal aorta have not been described in the general population. We characterized age-, race-, and gender-specific distributions, and yearly rates of change of mean aortic wall thickness (MAWT), and associations between MAWT and cardiovascular risk factors in a multi-ethnic population-based probability sample. METHODS Magnetic resonance imaging measurements of MAWT were performed on 2466 free-living white, black, and Hispanic adult subjects. MAWT race/ethnicity- and gender-specific percentile values across age were estimated using regression analyses. RESULTS MAWT was greater in men than in women and increased linearly with age in all the groups and across all the percentiles. Hispanic women had the thinnest and black men the thickest aortas. Black men had the highest and white women the lowest age-related MAWT increase. Age, gender, ethnicity, smoking status, systolic blood pressure, low-density lipoprotein-cholesterol levels, high-density lipoprotein-cholesterol levels, and fasting glucose levels were independent predictors of MAWT. CONCLUSIONS Age, gender, and racial/ethnic differences in MAWT distributions exist in the general population. Such differences should be considered in future investigations assessing aortic atherosclerosis and the effects of anti-atherosclerotic therapies.
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Affiliation(s)
- Eric B Rosero
- Division of Vascular and Endovascular Surgery, Department of Surgery, Donald W. Reynolds Cardiovascular Clinical Research Center, University Of Texas Southwestern Medical School, Dallas, TX 75390-9157, USA
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Patel PC, Reimold SC, Araj FG, Ayers CR, Kaiser PA, Peshock RM, Yancy CW, Ring WS, Gupta S, Mishkin JD, Mammen PP, Markham DW, Drazner MH. Concentric left ventricular hypertrophy as assessed by cardiac magnetic resonance imaging and risk of death in cardiac transplant recipients. J Heart Lung Transplant 2010; 29:1369-79. [DOI: 10.1016/j.healun.2010.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/04/2010] [Accepted: 05/09/2010] [Indexed: 11/26/2022] Open
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Gupta S, Berry JD, Ayers CR, Matulevicius SA, Peshock RM, Patel PC, Markham DW, Drazner MH. Association of Health Aging and Body Composition (ABC) Heart Failure score with cardiac structural and functional abnormalities in young individuals. Am Heart J 2010; 159:817-24. [PMID: 20435191 DOI: 10.1016/j.ahj.2010.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 12/08/2009] [Accepted: 02/02/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Health ABC Heart Failure score has recently been shown to predict 5-year risk of incident heart failure in the elderly. We tested whether this risk score is associated with subclinical phenotypes of heart failure in a younger population. METHODS We stratified participants in the Dallas Heart Study aged 30 to 65 years who had a cardiac magnetic resonance imaging and no self-reported history of heart failure or cardiomyopathy into 4 previously defined Health ABC Heart Failure risk groups: low (<5%), average (5%-10%), high (10%-20%), and very high (>20% risk for heart failure within 5 years). We compared left ventricular (LV) structural and functional parameters and levels of B-type natriuretic peptide (BNP) and N-terminal proBNP among the 4 groups. RESULTS In the study cohort (N = 2,540), the percentage of subjects in the low-, average-, high-, and very high risk groups was 78%, 15%, 6%, and 1%, respectively. Indexed LV mass (80 +/- 15 vs 90 +/- 20 vs 95 +/- 25 vs 116 +/- 41 g/m(2)), concentricity (1.6 +/- 0.3 vs 1.8 +/- 0.4 vs 2.0 +/- 0.5 vs 2.2 +/- 0.7 g/mL), median BNP (2.8 vs 3.7 vs 4.9 vs 7.5 pg/mL) and N-terminal proBNP (26 vs 30 vs 40 vs 58 pg/mL), and prevalent LV systolic dysfunction and LV hypertrophy progressively increased across risk groups (P < .001 for all) independent of gender or method of indexing LV mass. CONCLUSIONS The Health ABC Heart Failure score was associated with subclinical cardiac structural changes in the general population 30 to 65 years of age, suggesting that it may be a valid tool for identification of young individuals at increased risk for heart failure.
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Affiliation(s)
- Sachin Gupta
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390-9047, USA
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Maroules CD, Chang AY, Kontak A, Dimitrov I, Kotys M, Peshock RM. Measurement of coronary flow response to cold pressor stress in asymptomatic women with cardiovascular risk factors using spiral velocity-encoded cine MRI at 3 Tesla. Acta Radiol 2010; 51:420-6. [PMID: 20302399 DOI: 10.3109/02841851003645736] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Coronary sinus (CS) flow in response to a provocative stress has been used as a surrogate measure of coronary flow reserve, and velocity-encoded cine (VEC) magnetic resonance imaging (MRI) is an established technique for measuring CS flow. In this study, the cold pressor test (CPT) was used to measure CS flow response because it elicits an endothelium-dependent coronary vasodilation that may afford greater sensitivity for detecting early changes in coronary endothelial function. PURPOSE To investigate the feasibility and reproducibility of CS flow reactivity (CSFR) to CPT using spiral VEC MRI at 3 Tesla in a sample of asymptomatic women with cardiovascular risk factors. MATERIAL AND METHODS Fourteen asymptomatic women (age 38 years +/- 10) with cardiovascular risk factors were studied using 3D spiral VEC MRI of the CS at 3 T. The CPT was utilized as a provocative stress to measure changes in CS flow. CSFR to CPT was calculated from the ratio of CS flow during peak stress to baseline CS flow. RESULTS CPT induced a significant hemodynamic response as measured by a 45% increase in rate-pressure product (P<0.01). A significant increase in CS volume flow was also observed (baseline, 116 +/- 26 ml/min; peak stress, 152 +/- 34 ml/min, P=0.01). CSFR to CPT was 1.31 +/- 0.20. Test-retest variability of CS volume flow was 5% at baseline and 6% during peak stress. CONCLUSION Spiral CS VEC MRI at 3 T is a feasible and reproducible technique for measuring CS flow in asymptomatic women at risk for cardiovascular disease. Significant changes in CSFR to CPT are detectable, without demanding pharmacologic stress.
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Affiliation(s)
| | - Alice Y. Chang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew Kontak
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ivan Dimitrov
- Department of Philips Medical Systems, Cleveland, OH, USA
| | - Melanie Kotys
- Department of Philips Medical Systems, Cleveland, OH, USA
| | - Ronald M. Peshock
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Matulevicius S, Huff LC, Ayers CR, McColl R, Sczcepaniak L, Khera A, Peshock RM. THE POTENTIAL OF EBCT FOR CORONARY ARTERY CALCIUM SCREENING TO EVALUATE FATTY LIVER: DALLAS HEART STUDY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khouri MG, Peshock RM, Ayers CR, de Lemos JA, Drazner MH. A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study. Circ Cardiovasc Imaging 2010; 3:164-71. [PMID: 20061518 DOI: 10.1161/circimaging.109.883652] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric, based on the ratio of LV wall thickness to chamber dimension. We propose a 4-tiered LVH classification based on LV concentricity(0.67) (mass/end-diastolic volume(0.67)) and indexed LV end-diastolic volume (EDV). METHODS AND RESULTS Cardiac MRI was performed in 2803 subjects and LVH (n=895) was defined by increased LV mass/height(2.7). Increased concentricity(0.67) and indexed EDV were defined at the 97.5th percentile of a healthy subpopulation. Four geometric patterns resulted: increased concentricity without increased EDV ("thick hypertrophy," n=361); increased EDV without increased concentricity ("dilated hypertrophy," n=53); increased concentricity with increased EDV ("both thick and dilated hypertrophy," n=13); and neither increased concentricity nor increased EDV ("indeterminate hypertrophy," n=468). Compared with subjects with isolated thick hypertrophy, those with both thick and dilated hypertrophy had a lower LV ejection fraction and higher NT-pro-BNP and BNP levels (P</=0.001 for all). Subjects with dilated hypertrophy had a lower LV ejection fraction and higher troponin T, NT-pro-BNP, and BNP levels versus those with indeterminate hypertrophy (P<0.001 for all). Subjects with indeterminate LVH versus those without LVH had increased LV mass (by definition) but also a higher LV ejection fraction and no increase in troponin or natriuretic peptide levels. CONCLUSIONS Concentric or eccentric LVH can each be subclassified into 2 subgroups, yielding 4 distinct geometric patterns. Many subjects currently classified with eccentric LVH can be reclassified into an indeterminate subgroup that has better LV function and comparable levels of biomarkers reflecting cardiac stress as compared with those without LVH.
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Affiliation(s)
- Michel G Khouri
- Donald W. Reynolds Cardiovascular Clinical Research Center and Divisions of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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Matulevicius SA, Ayers CR, McColl R, Peshock RM. Systematic method for cleaning circumferential strain from raw harmonic phase magnetic resonance imaging (HARP) analyzed data. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p233] [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: 11/10/2022] Open
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Rosero EB, Peshock RM, Khera A, Clagett GP, Lo H, Timaran C. Agreement between methods of measurement of mean aortic wall thickness by MRI. J Magn Reson Imaging 2009; 29:576-82. [DOI: 10.1002/jmri.21697] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Matulevicius S, Rohatgi A, Khera A, Das SR, Owens A, Ayers CR, Timaran CH, Rosero EB, Drazner MH, Peshock RM, de Lemos JA. The association between plasma caspase-3, atherosclerosis, and vascular function in the Dallas Heart Study. Apoptosis 2008; 13:1281-9. [PMID: 18763039 DOI: 10.1007/s10495-008-0254-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Caspase-3, an apoptosis protease, is expressed in atherosclerotic plaques. We examined the relationship between plasma caspase-3 levels, aortic compliance, and atherosclerosis. METHODS Caspase-3 was measured in 3,221 subjects from the Dallas Heart Study. Electron beam computed tomography measures of coronary calcium (CAC) (n = 2,404) and magnetic resonance imaging (MRI) measures of abdominal aortic wall thickness (AWT) (n = 2,208) and aortic compliance (AC) (n = 2,328) were obtained. Multivariate analyses were performed, adjusting for age, sex, ethnicity, body mass index (BMI), traditional cardiovascular risk factors, and cardiac medications. RESULTS In univariable analysis, caspase-3 associated with CAC (P < 0.0001), AWT (P = 0.002), and AC (P < 0.0001). After multivariable adjustment, 4th quartile caspase-3 (compared to 1st quartile) was significantly associated with CAC (P = 0.004), AWT (P = 0.02), and AC (P < 0.0001) with similar findings for caspase-3 as a continuous variable. CONCLUSIONS Caspase-3 independently associates with CAC, AWT, and AC, suggesting a link between apoptosis and atherosclerosis.
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Affiliation(s)
- Susan Matulevicius
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Markham DW, Dries DL, King LP, Leonard D, Yancy CW, Peshock RM, Willett D, Cooper RS, Drazner MH. Blacks and whites have a similar prevalence of reduced left ventricular ejection fraction in the general population: the Dallas Heart Study (DHS). Am Heart J 2008; 155:876-82. [PMID: 18440335 DOI: 10.1016/j.ahj.2007.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 08/10/2007] [Accepted: 11/29/2007] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective of the study was to evaluate racial differences in the prevalence of left ventricular (LV) dysfunction. Few data compare the relative frequency of reduced LV ejection fraction (EF) (LVEF) in blacks and whites. Because of the higher prevalence of risk factors for heart failure in blacks, including hypertension, obesity, and LV hypertrophy, we hypothesized that LV dysfunction would also be more common in this ethnic group. METHODS In the DHS, a probability-based sample of Dallas County, we performed cardiac magnetic resonance imaging on 1335 black and 858 white participants aged 30 to 67 years to measure LVEF and volumes. We compared the prevalence of reduced LV EF and distribution of ventricular volumes in the 2 ethnic groups. RESULTS The prevalence of a reduced LVEF, whether defined as < 50%, < 55%, or < 60%, did not appear to be different between black versus white women (P > or = .7 for each) or men (P > or = .4 for each). Similar findings were seen using a recently defined sex-specific threshold (men < 55% and women < 61%) for low EF (P = .1). Mean LV end-diastolic and end-systolic volumes indexed to body surface area were also comparable in black and white men (P > or = .3) and women (P > or = .1). CONCLUSIONS Despite having a higher prevalence of risk factors for heart failure, blacks as compared with whites did not have a higher prevalence of reduced LVEF in the general population.
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Affiliation(s)
- David W Markham
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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Dorfman TA, Rosen BD, Perhonen MA, Tillery T, McColl R, Peshock RM, Levine BD. Diastolic suction is impaired by bed rest: MRI tagging studies of diastolic untwisting. J Appl Physiol (1985) 2008; 104:1037-44. [PMID: 18239079 DOI: 10.1152/japplphysiol.00858.2006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bed rest deconditioning leads to physiological cardiac atrophy, which may compromise left ventricular (LV) filling during orthostatic stress by reducing diastolic untwisting and suction. To test this hypothesis, myocardial-tagged magnetic resonance imaging (MRI) was performed, and maximal untwisting rates of the endocardium, midwall, and epicardium were calculated by Harmonic Phase Analysis (HARP) before and after -6 degrees head-down tilt bed rest for 18 days with (n = 14) and without exercise training (n = 10). LV mass and LV end-diastolic volume were measured using cine MRI. Exercise subjects cycled on a supine ergometer for 30 min, three times per day at 75% maximal heart rate (HR). After sedentary bed rest, there was a significant reduction in maximal untwisting rates of the midwall (-46.8 +/- 14.3 to -35.4 +/- 12.4 degrees /s; P = 0.04) where untwisting is most reliably measured, and to a lesser degree of certainty in the endocardium (-50.3 +/- 13.8 to -40.1 +/- 18.5 degrees /s; P = 0.09); the epicardium was unchanged. In contrast, when exercise was performed in bed, untwisting rates were enhanced at the endocardium (-48.4 +/- 20.8 to -72.3 +/- 22.3 degrees /ms; P = 0.05) and midwall (-39.2 +/- 12.2 to -59.0 +/- 19.6 degrees /s; P = 0.03). The differential response was significant between groups at the endocardium (interaction P = 0.02) and the midwall (interaction P = 0.004). LV mass decreased in the sedentary group (156.4 +/- 30.3 to 149.5 +/- 27.9 g; P = 0.07), but it increased slightly in the exercise-trained subjects (156.4 +/- 34.3 to 162.3 +/- 40.5 g; P = 0.16); (interaction P = 0.03). We conclude that diastolic untwisting is impaired following sedentary bed rest. However, exercise training in bed can prevent the physiological cardiac remodeling associated with bed rest and preserve or even enhance diastolic suction.
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Affiliation(s)
- Todd A Dorfman
- Institute for Exercise and Environmental Medicine, 7232 Greenville Ave., Suite 435, Dallas, TX 75231, USA
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Maroules CD, McColl R, Khera A, Peshock RM. Interstudy reproducibility of SSFP cine magnetic resonance: Impact of magnetic field strength and parallel imaging. J Magn Reson Imaging 2008; 27:1139-45. [DOI: 10.1002/jmri.21343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rajasekaran NS, Connell P, Christians ES, Yan LJ, Taylor RP, Orosz A, Zhang XQ, Stevenson TJ, Peshock RM, Leopold JA, Barry WH, Loscalzo J, Odelberg SJ, Benjamin IJ. Human alpha B-crystallin mutation causes oxido-reductive stress and protein aggregation cardiomyopathy in mice. Cell 2007; 130:427-39. [PMID: 17693254 PMCID: PMC2962423 DOI: 10.1016/j.cell.2007.06.044] [Citation(s) in RCA: 335] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 04/26/2007] [Accepted: 06/22/2007] [Indexed: 11/23/2022]
Abstract
The autosomal dominant mutation in the human alphaB-crystallin gene inducing a R120G amino acid exchange causes a multisystem, protein aggregation disease including cardiomyopathy. The pathogenesis of cardiomyopathy in this mutant (hR120GCryAB) is poorly understood. Here, we show that transgenic mice overexpressing cardiac-specific hR120GCryAB recapitulate the cardiomyopathy in humans and find that the mice are under reductive stress. The myopathic hearts show an increased recycling of oxidized glutathione (GSSG) to reduced glutathione (GSH), which is due to the augmented expression and enzymatic activities of glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase, and glutathione peroxidase. The intercross of hR120GCryAB cardiomyopathic animals with mice with reduced G6PD levels rescues the progeny from cardiac hypertrophy and protein aggregation. These findings demonstrate that dysregulation of G6PD activity is necessary and sufficient for maladaptive reductive stress and suggest a novel therapeutic target for abrogating R120GCryAB cardiomyopathy and heart failure in humans.
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Affiliation(s)
- Namakkal S. Rajasekaran
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Patrice Connell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
| | - Elisabeth S. Christians
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
- Centre for Developmental Biology UMR5547, 118 route de Narbonne, 31062 Toulouse, France
| | - Liang-Jun Yan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
| | - Ryan P. Taylor
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Andras Orosz
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Xia Q. Zhang
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Tamara J. Stevenson
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Ronald M. Peshock
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
| | - Jane A. Leopold
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur Boston, MA 02115, USA
| | - William H. Barry
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Joseph Loscalzo
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur Boston, MA 02115, USA
| | - Shannon J. Odelberg
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
| | - Ivor J. Benjamin
- Center for Cardiovascular Translational Biomedicine and Division of Cardiology, University of Utah, Salt Lake City, Utah 84132
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8573
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Mehta SK, Rame JE, Khera A, Murphy SA, Canham RM, Peshock RM, de Lemos JA, Drazner MH. Left ventricular hypertrophy, subclinical atherosclerosis, and inflammation. Hypertension 2007; 49:1385-91. [PMID: 17404181 DOI: 10.1161/hypertensionaha.107.087890] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [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: 01/15/2023]
Abstract
To elucidate mechanisms by which left ventricular (LV) hypertrophy (LVH) increases the risk of atherosclerotic heart disease, we sought to determine whether LVH is independently associated with coronary artery calcium (CAC) and serum C-reactive protein (CRP) levels in the general population. The Dallas Heart Study is a population-based sample in which 2633 individuals underwent cardiac MRI to measure LV structure, electron beam CT to measure CAC, and measurement of plasma CRP. We used univariate and multivariable analyses to determine whether LV mass and markers of concentric LV hypertrophy or dilation were associated with CAC and CRP. Increasing quartiles of LV mass indexed to fat-free mass, LV wall thickness, and concentricity, but not LV volume, were associated with CAC in both men and women (P<0.001). After adjustment for traditional cardiovascular risk factors and statin use, LV wall thickness and concentricity remained associated with CAC in linear regression (P<0.001 for each). These associations were particularly robust in blacks. LV wall thickness and concentricity were also associated with elevated CRP levels (P=0.001 for both) in gender-stratified univariate analyses, although these associations did not persist in multivariable analysis. In conclusion, concentric LVH is an independent risk factor for subclinical atherosclerosis. LVH is also associated with an inflammatory state as reflected in elevated CRP levels, although this relationship appears to be mediated by comorbid conditions. These data likely explain in part why individuals with LVH are at increased risk for myocardial infarction.
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Affiliation(s)
- Sameer K Mehta
- Donald W. Reynolds Cardiovascular Clinical Research Center and Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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Dorfman TA, Levine BD, Tillery T, Peshock RM, Hastings JL, Schneider SM, Macias BR, Biolo G, Hargens AR. Cardiac atrophy in women following bed rest. J Appl Physiol (1985) 2007; 103:8-16. [PMID: 17379748 DOI: 10.1152/japplphysiol.01162.2006] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Both chronic microgravity exposure and long-duration bed rest induce cardiac atrophy, which leads to reduced standing stroke volume and orthostatic intolerance. However, despite the fact that women appear to be more susceptible to postspaceflight presyncope and orthostatic hypotension than male astronauts, most previous high-resolution studies of cardiac morphology following microgravity have been performed only in men. Because female athletes have less physiological hypertrophy than male athletes, we reasoned that they also might have altered physiological cardiac atrophy after bed rest. Magnetic resonance imaging was performed in 24 healthy young women (32.1 +/- 4 yr) to measure left ventricular (LV) and right ventricular (RV) mass, volumes, and morphology accurately before and after 60 days of 6 degrees head-down tilt (HDT) bed rest. Subjects were matched and then randomly assigned to sedentary bed rest (controls, n = 8) or two treatment groups consisting of 1) exercise training using supine treadmill running within lower body negative pressure plus resistive training (n = 8), or 2) protein (0.45 g x kg(-1) x day(-1) increase) plus branched-chain amino acid (BCAA) (7.2 g/day) supplementation (n = 8). After sedentary bed rest without nutritional supplementation, there were significant reductions in LV (96 +/- 26 to 77 +/- 25 ml; P = 0.03) and RV volumes (104 +/- 33 to 86 +/- 25 ml; P = 0.02), LV (2.2 +/- 0.2 to 2.0 +/- 0.2 g/kg; P = 0.003) and RV masses (0.8 +/- 0.1 to 0.6 +/- 0.1 g/kg; P < 0.001), and the length of the major axis of the LV (90 +/- 6 to 84 +/- 7 mm. P < 0.001), similar to what has been observed previously in men (8.0%; Perhonen MA, Franco F, Lane LD, Buckey JC, Blomqvist Zerwekh JE, Peshock RM, Weatherall PT, Levine BD. J Appl Physiol 91: 645-653, 2001). In contrast, there were no significant reductions in LV or RV volumes in the exercise-trained group, and the length of the major axis was preserved. Moreover, there were significant increases in LV (1.9 +/- 0.4 to 2.3 +/- 0.3 g/kg; P < 0.001) and RV masses (0.7 +/- 0.1 to 0.8 +/- 0.2 g/kg; P = 0.002), as well as mean wall thickness (9 +/- 2 to 11 +/- 1 mm; P = 0.02). The interaction between sedentary and exercise LV and RV masses was highly significant (P < 0.0001). Protein and BCAA supplementation led to an intermediate phenotype with no change in LV or RV mass after bed rest, but there remained a significant reduction in LV volume (103 +/- 14 to 80 +/- 16 ml; P = 0.02) and major-axis length (91 +/- 5 to 88 +/- 7 mm; P = 0.003). All subjects lost an equivalent amount of body mass (3.4 +/- 0.2 kg control; 3.1 +/- 0.04 kg exercise; 2.8 +/- 0.1 kg protein). Cardiac atrophy occurs in women similar to men following sedentary 60 days HDT bed rest. However, exercise training and, to a lesser extent, protein supplementation may be potential countermeasures to the cardiac atrophy associated with chronic unloading conditions such as in spaceflight and prolonged bed rest.
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Affiliation(s)
- Todd A Dorfman
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, Dallas, TX 75231, USA
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Markham DW, Dries DL, King LP, Yancy CW, Peshock RM, Willett D, Cooper RS, Drazner MH. Blacks as Compared to Whites Do Not Have an Increased Prevalence of Reduced Left Ventricular Ejection Fraction in the General Population. J Card Fail 2006. [DOI: 10.1016/j.cardfail.2006.06.309] [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: 11/29/2022]
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