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Kawasoe S, Ohishi M. Regression of left ventricular hypertrophy. Hypertens Res 2024:10.1038/s41440-024-01634-6. [PMID: 38467796 DOI: 10.1038/s41440-024-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Shin Kawasoe
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima, Kagoshima, Japan.
| | - Mitsuru Ohishi
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima, Kagoshima, Japan
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Gallo-Fernández I, López-Aguilera J, González-Manzanares R, Pericet-Rodriguez C, Carmona-Rico MJ, Perea-Armijo J, Castillo-Domínguez JC, Anguita-Sánchez M. [Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease]. Med Clin (Barc) 2024; 162:205-212. [PMID: 38044190 DOI: 10.1016/j.medcli.2023.10.006] [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] [Received: 05/15/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. MATERIALS AND METHODS We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. RESULTS A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). CONCLUSIONS In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.
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Affiliation(s)
- Ignacio Gallo-Fernández
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - José López-Aguilera
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España.
| | - Rafael González-Manzanares
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - Cristina Pericet-Rodriguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | | | - Jorge Perea-Armijo
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España; Universidad de Córdoba, Córdoba, España
| | - Juan Carlos Castillo-Domínguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
| | - Manuel Anguita-Sánchez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto de Investigación Biomédica de Córdoba, IMIBIC, Córdoba, España
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Wei N, Liu MH, Song YH. Causal associations between gastroesophageal reflux disease and essential hypertension: A bidirectional Mendelian randomization study. World J Clin Cases 2024; 12:880-890. [PMID: 38414595 PMCID: PMC10895642 DOI: 10.12998/wjcc.v12.i5.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Clinical studies have reported that patients with gastroesophageal reflux disease (GERD) have a higher prevalence of hypertension. AIM To performed a bidirectional Mendelian randomization (MR) analysis to investigate the causal link between GERD and essential hypertension. METHODS Eligible single nucleotide polymorphisms (SNPs) were selected, and weighted median, inverse variance weighted (IVW) as well as MR egger (MR-Egger) regression were used to examine the potential causal association between GERD and hypertension. The MR-Pleiotropy RESidual Sum and Outlier analysis was used to detect and attempt to reduce horizontal pleiotropy by removing outliers SNPs. The MR-Egger intercept test, Cochran's Q test and "leave-one-out" sensitivity analysis were performed to evaluate the horizontal pleiotropy, heterogeneities, and stability of single instrumental variable. RESULTS IVW analysis exhibited an increased risk of hypertension (OR = 1.46, 95%CI: 1.33-1.59, P = 2.14E-16) in GERD patients. And the same result was obtained in replication practice (OR = 1.002, 95%CI: 1.0008-1.003, P = 0.000498). Meanwhile, the IVW analysis showed an increased risk of systolic blood pressure (β = 0.78, 95%CI: 0.11-1.44, P = 0.021) and hypertensive heart disease (OR = 1.68, 95%CI: 1.36-2.08, P = 0.0000016) in GERD patients. Moreover, we found an decreased risk of Barrett's esophagus (OR = 0.91, 95%CI: 0.83-0.99, P = 0.043) in essential hypertension patients. CONCLUSION We found that GERD would increase the risk of essential hypertension, which provided a novel prevent and therapeutic perspectives of essential hypertension.
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Affiliation(s)
- Ning Wei
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ming-Hui Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Yu-Hu Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Chu HW, Hwang IC, Kim HM, Park J, Choi H, Choi HM, Yoon YE, Cho GY. Age-dependent implications of left ventricular hypertrophy regression in patients with hypertension. Hypertens Res 2024:10.1038/s41440-023-01571-w. [PMID: 38238511 DOI: 10.1038/s41440-023-01571-w] [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: 03/15/2023] [Revised: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 03/13/2024]
Abstract
Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular mortality and morbidity in patients with hypertension. However, the effect of age on LVH regression or persistence and its differential prognostic value remain unclear. Therefore, we investigated the clinical implications of LVH regression in 1847 patients with hypertension and echocardiography data (at baseline and during antihypertensive treatment at an interval of 6-18 months) according to age. LVH was defined as a left ventricular mass index (LVMI) > 115 g/m2 and >95 g/m2 in men and women, respectively. LVH prevalence at baseline was not different according to age (age < 65 years: 42.6%; age ≥65 years: 45.7%; p = 0.187), but LVH regression was more frequently observed in the younger group (36.4% vs. 27.5%; p = 0.008). Spline curves and multiple linear regression analysis showed a significant relationship between reductions in systolic blood pressure and LVMI in the younger group (β = 0.425; p < 0.001), but not the elderly group (β = 0.044; p = 0.308). LVH regression was associated with a lower risk of the study outcome (composite of cardiovascular death and hospitalization for heart failure) regardless of age. In conclusion, the association between the reduction in blood pressure and LVH regression was prominent in patients with age < 65 years, but not in those with age ≥65 years. However, an association between LVH regression and lower risk of cardiovascular death and hospitalization for heart failure was observed regardless of patient age, suggesting the prognostic value of the LVH regression not only in the younger patients but also in elderly patients.
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Affiliation(s)
- Hyun-Wook Chu
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea.
| | - Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Hyejung Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Hong-Mi Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Lu M, Li D, Hu Y, Zhang L, Li Y, Zhang Z, Li C. Persistence of severe global inequalities in the burden of Hypertension Heart Disease from 1990 to 2019: findings from the global burden of disease study 2019. BMC Public Health 2024; 24:110. [PMID: 38184560 PMCID: PMC10771693 DOI: 10.1186/s12889-023-17573-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
AIMS Assessing the global burden and health inequalities of Hypertension Heart Disease (HHD) during the period from 1990 to 2019. METHODS Secondary analysis of the Global Burden of Disease (GBD) study in 2019, focusing on the burden of diseases, injuries, and risk factors worldwide. Disability-Adjusted Life Years (DALYs) data related to HHD are extracted from the 2019 GBD. Inequality Slope Index (SII) and Concentration Index are calculated to assess health inequalities across regions and countries. RESULTS The total DALYs for HHD reached 21.51 million, demonstrating a substantial increase of 54.25% compared to the figures recorded in 1990, while the age-standardized DALY rates per 100,000 population for HHD in 2019 showed a notable decline to 268.19 (95% UI 204.57, 298.07), reflecting a significant decrease of 26.4% compared to the rates observed in 1990. The DALYs rate of hypertensive heart disease increases with age. Countries with moderate SDI accounted for 38.72% of the global burden of HHD in terms of DALYs. The highest age-standardized DALY rates (per 100,000) are predominantly concentrated in underdeveloped areas. In 1990 and 2019, the SII (per 100,000 population) for DALYs were - 121.6398 (95% CI -187.3729 to -55.90684) and - 1.592634 (95% CI -53.11027 to 49.925) respectively. The significant decline suggests a reduction in the inequality of age-standardized burden of HHD between high-income and low-income countries during this period. CONCLUSION The unequal prevalence of HHD across different populations can hinder the achievement of the "health for all" objective. Persistent disparities in HHD have been observed globally over the past thirty years. It is crucial to prioritize efforts towards reducing avoidable health inequalities associated with hypertension-related heart disease, particularly in low-income and middle-income countries.
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Affiliation(s)
- Mengkai Lu
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Dongxiao Li
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Yuanlong Hu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Lei Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Yuan Li
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Zhiyuan Zhang
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Chao Li
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
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Lu WL, Yuan JH, Liu ZY, Su ZH, Shen YC, Li SJ, Zhang H. Worldwide trends in mortality for hypertensive heart disease from 1990 to 2019 with projection to 2034: data from the Global Burden of Disease 2019 study. Eur J Prev Cardiol 2024; 31:23-37. [PMID: 37665956 DOI: 10.1093/eurjpc/zwad262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
AIMS This study aims to analyse the worldwide trends in hypertensive heart disease (HHD) mortality and associations with age, period, and birth cohort and predict the future burden of HHD deaths. METHODS AND RESULTS Mortality estimates were obtained from Global Burden of Disease 2019 study. We used age-period-cohort (APC) model to examine the age, period, and cohort effects on HHD mortality between 1990 and 2019. Bayesian APC model was utilized to predict HHD deaths to 2034. The global HHD deaths were 1.16 million in 2019 and were projected to increase to 1.57 million in 2034, with the largest increment in low- and middle-income countries (LMICs). Between 1990 and 2019, middle/high-middle socio-demographic index (SDI) countries had the largest mortality reductions (annual percentage change = -2.06%), whereas low SDI countries saw a lagging performance (annual percentage change = -1.09%). There was a prominent transition in the age distribution of deaths towards old-age population in middle/high-middle SDI countries, while the proportion of premature deaths (aged under 60 years) remained at 24% in low SDI countries in 2019. Amongst LMICs, Brazil, China, and Ethiopia showed typically improving trends both over time and in recent birth cohorts, whereas 63 countries including Indonesia, the Philippines, and Pakistan had unfavourable or worsening risks for recent periods and birth cohorts. CONCLUSION The HHD death burden in 2019 is vast and is expected to increase rapidly in the next decade, particularly for LMICs. Limited progress in HHD management together with high premature mortality would exact huge human and medical costs in low SDI countries. The examples from Brazil, China, and Ethiopia suggest that efficient health systems with action on improving hypertension care can reduce HHD mortality effectively in LMICs.
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Affiliation(s)
- Wen-Long Lu
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 167, North Lishi Road, Xi Cheng District, Beijing 100037, China
| | - Jian-Hui Yuan
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 167, North Lishi Road, Xi Cheng District, Beijing 100037, China
| | - Ze-Ye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhan-Hao Su
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Chun Shen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 167, North Lishi Road, Xi Cheng District, Beijing 100037, China
| | - Shou-Jun Li
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 167, North Lishi Road, Xi Cheng District, Beijing 100037, China
| | - Hao Zhang
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 167, North Lishi Road, Xi Cheng District, Beijing 100037, China
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai 200125, China
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Hu B, Shi Y, Zhang P, Fan Y, Feng J, Hou L. Global, regional, and national burdens of hypertensive heart disease from 1990 to 2019 :A multilevel analysis based on the global burden of Disease Study 2019. Heliyon 2023; 9:e22671. [PMID: 38213586 PMCID: PMC10782162 DOI: 10.1016/j.heliyon.2023.e22671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
Aim This study aimed to describe the prevalence, deaths, and disability-adjusted life-years (DALYs) of hypertensive heart disease (HHD) at the global, regional, and national levels and analyze epidemiological trends. Method We extracted global estimates of prevalence, deaths, and DALYs related to HHD in 204 countries and regions from the 2019 Global Burden of Diseases Study. Average annual percent change (AAPC) was calculated to represent temporal trends. Joinpoint regression models were used to analyze time trends from 1990 to 2019. Finally, the decomposition analysis showed the driving factors of burden changes. Results From 1990 to 2019, the global prevalence of HHD cases increased by 138 %, reaching 18,598,025 cases (95 % uncertainty interval [UI]: 13,544,365-24,898,411). DALYs also rose by 154 %, reaching 21,508,002 (95 % UI, 16,400,051-23,899,879). The death rate increased to 14.95 (95 % UI, 11.11-16.52) per 100,000 people. Of the five sociodemographic index (SDI) regions, the prevalence rate related to HHD was the highest in the high-middle SDI region. In contrast, the death and DALY rate related to HHD were the highest in the middle SDI region. In other regions, the prevalence rate was the highest in East Asia (548.87 per 100,000 people; 95 % UI, 395.40-747.83), and the death rate was the highest in Central Europe (42.64 per 100,000 people; 95 % UI, 30.58-49.38). At the national level, the Cook Islands had the highest prevalence rate for HHD (703.08 per 100,000 people; 95 % UI, 532.87-920.72), Bulgaria had the highest death rate (75.08 per 100,000 people; 95 % UI, 46.38-92.81), and Afghanistan had the highest DALY rate (1374.12 per 100,000 people; 95 % UI, 467.17-2020.70). High body mass index, a diet high in sodium, alcohol use, lead exposure, high temperature, and low temperature were identified as risk factors for death and DALYs related to HHD in 2019. Aging and population growth were the major drivers of prevalence, death, and DALYs. Finally, over the past 30 years, the global age-standardized prevalence rate (ASPR) of HHD has significantly risen (AAPC = 0.21 %, 95 % confidence interval [CI]: 0.17-0.24; P < 0.001), while the age-standardized deaths rate (ASDR) has shown significant declining trends (AAPC = -0.86 %, 95 % CI: 1.00 to -0.71; P < 0.001), and age-standardized DALY rates (AAPC = -1.08 %, 95 % CI: 1.23 to -0.93; P < 0.001). Conclusion Despite a significant decline in the global ASDR and age-standardized DALY rate of HHD over the past 30 years, the ASPR continues to rise. The burden of HHD is more heavily skewed towards non-high-income economies. Active prevention, control of risk factors, and improvement of medical protection levels to address the disease burden caused by population growth and aging are needed.
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Affiliation(s)
- Ben Hu
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, 230000, Anhui, China
| | - Yihang Shi
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Pengcheng Zhang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230000, Anhui, China
| | - Jun Feng
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Linlin Hou
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, 230000, Anhui, China
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Hao X, Wu J, Zhu L, Li X. Evaluation of myocardial strain in patients with subclinical hypertrophic cardiomyopathy and subclinical Hypertensive Heart Disease using Cardiac magnetic resonance feature tracking. Int J Cardiovasc Imaging 2023; 39:2237-2246. [PMID: 37682417 DOI: 10.1007/s10554-023-02930-x] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
The evaluation of cardiac magnetic resonance feature tracking may have great diagnostic value in hypertrophic cardiomyopathy and hypertensive heart disease. Exploring the diagnostic and clinical research value of cardiac magnetic resonance feature tracks in evaluation of myocardium deformation in patients with subclinical hypertrophic cardiomyopathy(SHCM)and subclinical hypertensive heart disease(SHHD). Cardiovascular Magnetic Resonance (CMR) scans were performed on a 1.5 T MR scanner in 33 patients with SHCM, 31 patients with SHHD, and 27 controls(NS). The CMR image post-processing software was used to analyze the characteristics of routine cardiac function, different global and regional myocardial strain in each group. Analysis of variance (ANOVA) was used to compare age, blood pressure, heart rate, routine cardiac function, body mass index (BMI), as well as the strain between different segments within each of the three groups. Once a significant difference was detected, a least significant difference (LSD) comparison would be performed. The diagnostic efficacy of different parameters in differentiating SHHD from SHCM was evaluated through receiver operating characteristic (ROC) curve analysis, and the best cut-off value was determined. There was no statistical difference among three groups (P>0.05) in routine cardiac function while significant statistical differences were found in the global myocardial strain parameters and the peak strain parameters of some segments (especially basal segments) (P < 0.05). The global radial peak strain (GRPS) was most effective (AUC = 0.885, 95% CI: 0.085-0.971, P<0.001) with a sensitivity and specificity of 84% and 88% at a cut-off value of 40.105, contributing to distinguishing SHCM from SHHD group. Cardiac magnetic resonance feature tracking could detect left ventricular deformation in patients with SHCM and SHHD group. The abnormality of strain has important research value for subclinical diagnosis and clinical evaluation.
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Affiliation(s)
- Xiaoyong Hao
- Department of Magnetic resonance, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Jiang Wu
- Department of Magnetic resonance, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China.
| | - Lina Zhu
- Department of Magnetic resonance, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Xuan Li
- Department of Magnetic resonance, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
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Zhang X, Zhao R, Deng W, Li Y, An S, Qian Y, Liu B, Yu Y, Li X. Left Atrial and Ventricular Strain Differentiates Cardiac Amyloidosis and Hypertensive Heart Disease: A Cardiac MR Feature Tracking Study. Acad Radiol 2023; 30:2521-2532. [PMID: 36925334 DOI: 10.1016/j.acra.2023.02.003] [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: 12/06/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023]
Abstract
RATIONALE AND OBJECTIVES Strain measured by feature tracking technique represents the degree of deformation and reflects the systolic and diastolic function of the heart. Our purpose was to evaluate the differential diagnostic value and correlations of left atrial (LA) strain (LAS) and left ventricular (LV) strain (LVS) in cardiac amyloidosis (CA) and hypertensive heart disease (HHD) patients. MATERIALS AND METHODS We recruited 25 CA patients, 30 sex- and age-matched HHD patients and 20 healthy subjects totally. LAS and LVS were analyzed by CVI42 post-processing software. The efficiency of LAS and LVS in differentiating CA from HHD was compared by receiver operating characteristic curves analysis. Pearson or Spearman's analysis were used to assess the correlation between LAS and LV parameters. RESULTS Both HHD and CA patients had impaired LVS, the gradient of increasing absolute values of longitudinal strain (LS) and radial strain (RS) from the basal to the apical myocardium was most pronounced in the CA group, its relative apical sparing of LS (RASLS) ratio reached 0.91 ± 0.02, significantly higher than other two groups (HHD: 0.72 ± 0.02; controls: 0.56 ± 0.01, all p <0.001). Additionally, except for the booster strain in the HHD group was preserved, all other LAS were reduced in patients' groups. The RASLS had the best differential diagnostic efficacy with an area under the curve (AUC) of 0.930 (p <0.001); The AUCs of LAS all greater than 0.850, above global LS (GLS) (AUC = 0.770, p = 0.001). LAS was notably correlated with LV ejection fraction (LVEF) and GLS, with reservoir strain having the greatest correlation with GLS (r = -0.828, p <0.001). CONCLUSION The RASLS has high efficiency in guiding the differential diagnosis of CA and HHD with similar degree and presentation of LVH. Moreover, LAS values can also provide some useful information and they are closely linked with LV function, CMR feature tracking may provide assistance in the evaluation of LA-LV coupling.
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Affiliation(s)
- Xinna Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Wei Deng
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yuguo Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Shutian An
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China.
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10
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Mansouri A, Khosravi A, Mehrabani-Zeinabad K, Kopec JA, Adawi KI, Lui M, Abdul Rahim HF, Anwar W, Fadhil I, Sulaiman K, Bazargani N, Saade G, Farhan HA, AlMahmeed W, Bokhari SS, Hassen N, Alandejani A, Shirani S, Abdin A, Manla Y, Johnson C, Stark B, Roth GA, Mokdad AH, Shariful Islam SM, Sarrafzadegan N. Trends in the burden and determinants of hypertensive heart disease in the Eastern Mediterranean region, 1990-2019: an analysis of the Global Burden of Disease Study 2019. EClinicalMedicine 2023; 60:102034. [PMID: 37396799 PMCID: PMC10314131 DOI: 10.1016/j.eclinm.2023.102034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Background Hypertensive heart disease (HHD), one of the end-organ damage consequences of hypertension, is an important public health issue worldwide. Data on the HHD burden in the Eastern Mediterranean region (EMR) are scarce. We aimed to investigate the burden of HHD in the EMR, its member countries, and globally from 1990 to 2019. Methods We used 2019 Global Burden of Disease (GBD) data to report the HHD age-standardised prevalence, disability adjusted life years (DALYs), years of life lost (YLLs), and mortality, as well as HHD risk factors attribution percent with their 95% uncertainty interval (UI). Global data are reported alongside EMR data, and its 22 respective countries. We compared the burden of HHD by socio-demographic index (SDI), sex, age groups, and countries. Findings The age-standardised prevalence rate (per 100,000 population) of HHD was higher in the EMR (281.7; 95% UI: 204.5-383.4) in 2019, compared with the global prevalence (233.8; 95% UI: 170.5-312.9). The EMR age-standardised DALYs (per 100,000 population) for HHD in 2019 was 561.9 (361.0-704.1), compared with 268.2 (204.6-298.1) at the global level. There was an increase in HHD prevalence, reduction in mortality, and DALYs between 1990 and 2019 (4.01%, -7.6%, and -6.5%, respectively) in EMR. Among EMR countries, the highest versus lowest rates of age-standardised prevalence, mortality, and DALYs in 2019 [estimate (95% UI)] were in Jordan [561.62 (417.9-747.6)] versus Saudi Arabia [94.9 (69.5-129.0)]; Afghanistan [74.5 (23.7-112.3)] versus Saudi Arabia [4.3 (3.3-5.9)]; and Afghanistan [1374.1 (467.2-2020.7)] versus Qatar [87.11 (64.40-114.29)], respectively. Interpretation HHD remains a significant problem in the EMR, with a higher burden than global levels. Serious efforts toward high-quality management and prevention are strongly recommended. Based on this study, our recommendation for the EMR is to adopt effective preventive strategies. For example, promoting healthy dietary patterns and prompt screening for undiagnosed HTN in public places, promoting regular blood pressure measurements at home, and creating community awareness about early detection of HTN. Funding None.
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Affiliation(s)
- Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Mehrabani-Zeinabad
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jacek A. Kopec
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Karam I.I. Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Michelle Lui
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Hanan F. Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Wagida Anwar
- Community Medicine Department, Faculty of Medicine, Ain Shams University, Egypt and Armed Forces College of Medicine (AFCM), Egypt
| | - Ibtihal Fadhil
- Eastern Mediterranean Non-Communicable Disease Alliance, Kuwait
| | | | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Georges Saade
- Department of Cardiology, Bellevue Medical Center, Beirut, Lebanon
| | - Hasan A. Farhan
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad Heart Center, Baghdad, Iraq
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | | | - Nejat Hassen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amani Alandejani
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Shahin Shirani
- Department of Cardiology, Tehran University of Medical Science, Dr Ali Shariati Hospital, Tehran, Iran
| | - Amr Abdin
- Syrian Cardiovascular Association, Damascus, Syria
| | - Yosef Manla
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Benjamin Stark
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Gregory A. Roth
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, USA
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | | | - Nizal Sarrafzadegan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Heradien M, Mahfoud F, Greyling C, Lauder L, van der Bijl P, Hettrick DA, Stilwaney W, Sibeko S, Jansen van Rensburg R, Peterson D, Khwinani B, Goosen A, Saaiman JA, Ukena C, Böhm M, Brink PA. Renal denervation prevents subclinical atrial fibrillation in patients with hypertensive heart disease: Randomized, sham-controlled trial. Heart Rhythm 2022; 19:1765-1773. [PMID: 35781044 DOI: 10.1016/j.hrthm.2022.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Catheter-based renal denervation (RD), in addition to pulmonary vein isolation (PVI), reduces atrial fibrillation (AF) recurrence in hypertensive patients. Whether RD, without additional PVI, can prevent subclinical atrial fibrillation (SAF) in patients with hypertensive heart disease (HHD) is unknown. OBJECTIVE The purpose of this study was to assess the efficacy of RD in preventing SAF in patients with HHD. METHODS A single-center, randomized, sham-controlled pilot trial, including patients >55 years in sinus rhythm, but with a high risk of developing SAF was conducted. Patients had uncontrolled hypertension despite taking 3 antihypertensive drugs, including a diuretic. The primary endpoint was the first SAF episode lasting ≥6 minutes recorded via an implantable cardiac monitor scanned every 6 months for 24 months. A blinded independent monitoring committee assessed electrocardiographic rhythm recordings. Change in SAF burden (SAFB), and office and 24-hour ambulatory blood pressure (BP) at 6-month follow-up were secondary endpoints. RESULTS Eighty patients were randomly assigned to RD (n = 42) or sham groups (n = 38). After 24 months of follow-up, SAF occurred in 8 RD patients (19%) and 15 sham patients (39.5%) (hazard ratio 0.40; 95% confidence interval 0.17-0.96; P = .031). Median [interquartile range] SAFB was low in both groups but was significantly lower in the RD vs sham group (0% [0-0] vs 0% [0-0.3]; P = .043). Fast AF (>100 bpm) occurred less frequently in the RD than sham group (2% vs 26%; P = .002). After adjusting for baseline values, there were no significant differences in office or 24-hour BP changes between treatment groups. CONCLUSION RD reduced incident SAF events, SAFB, and fast AF in patients with HHD. The observed effects may occur independent of BP lowering.
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Affiliation(s)
- Marshall Heradien
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa.
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Lucas Lauder
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | | | | | - Warren Stilwaney
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | - Siyolise Sibeko
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | | | - Dale Peterson
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa
| | - Bonke Khwinani
- SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Althea Goosen
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Jan A Saaiman
- SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Paul A Brink
- Department of Medicine, Stellenbosch University, Tygerberg, South Africa; SA Endovascular, Netcare Kuils River Hospital, Cape Town, South Africa
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12
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Brown JM, Zhou W, Weber B, Divakaran S, Barrett L, Bibbo CF, Hainer J, Taqueti VR, Dorbala S, Blankstein R, Di Carli MF. Low coronary flow relative to myocardial mass predicts heart failure in symptomatic hypertensive patients with no obstructive coronary artery disease. Eur Heart J 2022; 43:3323-3331. [PMID: 34491335 PMCID: PMC9470377 DOI: 10.1093/eurheartj/ehab610] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 08/20/2021] [Indexed: 01/14/2023] Open
Abstract
AIMS The transition from hypertension to heart failure (HF) remains poorly understood. We hypothesized that insufficient perfusion to match global metabolic demand, reflected by a low ratio of myocardial blood flow to global myocardial mass, may be a HF risk marker. METHODS AND RESULTS A retrospective cohort (n = 346) of patients with hypertension who underwent clinical positron emission tomography (PET) myocardial perfusion imaging for chest pain and/or dyspnoea at Brigham and Women's Hospital (Boston, MA, USA) were studied. Patients without obstructive coronary artery disease by history or PET perfusion (summed stress score <3), HF, cardiomyopathy, or ejection fraction (EF) <40% were followed for HF hospitalization (primary outcome), all-cause death, and their composite. Myocardial blood flow, left ventricular (LV) mass, volumes, and EF were obtained from PET, and a 'flow/mass ratio' was determined as hyperaemic myocardial blood flow over LV mass indexed to body surface area. A lower flow/mass ratio was independently associated with larger end-diastolic (β = -0.44, P < 0.001) and end-systolic volume (β = -0.48, P < 0.001) and lower EF (β = 0.33, P < 0.001). A flow/mass ratio below the median was associated with an adjusted hazard ratio of 2.47 [95% confidence interval (CI) 1.24-4.93; P = 0.01] for HF hospitalization, 1.95 (95% CI 1.12-3.41; P = 0.02) for death, and 2.20 (95% CI 1.39-3.49; P < 0.001) for the composite. CONCLUSION An integrated physiological measure of insufficient myocardial perfusion to match global metabolic demand identifies subclinical hypertensive heart disease and elevated risk of HF and death in symptomatic patients with hypertension but without flow-limiting coronary artery disease.
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Affiliation(s)
- Jenifer M Brown
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Wunan Zhou
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiology Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Brittany Weber
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sanjay Divakaran
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Leanne Barrett
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Courtney F Bibbo
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sharmila Dorbala
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ron Blankstein
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Marcelo F Di Carli
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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13
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Nakamura S, Ishikawa J, Sakurayama C, Shimizu R, Toba A, Yamamoto A, Murata T, Harada K. Minor ST-T changes on electrocardiograms are associated with reduced constructive myocardial work in hypertensive patients with a preserved ejection fraction. Hypertens Res 2022. [PMID: 35715514 DOI: 10.1038/s41440-022-00957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
Minor ST-T changes on electrocardiograms are observed in patients with hypertensive heart disease with a preserved left ventricular ejection fraction (LVEF); however, the relationship between minor ST-T changes and global myocardial work on echocardiograms remains unclear. We evaluated the global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) in 186 hypertensive patients with preserved LVEF (>50%) using an offline analysis system (View Pal, GE). Minor ST-T changes as well as major ST-T changes (depression in ST in lead V5 > 1 mV) were also evaluated by electrocardiography. The mean age was 79.4 ± 8.2 years (men 37.6%). Patients with minor and major ST-changes had a smaller absolute GLS (-20.3 ± 3.1, -18.2 ± 3.7, and -15.2 ± 5.0%, P < 0.001) and a smaller constructive workload [GWI (2148 ± 486, 1938 ± 462, and 1685 ± 701 mmHg%, P = 0.002) and GCW (2419 ± 510, 2185 ± 466, and 1865 ± 702 mmHg%, P < 0.001)] than those with no ST-T changes. Additionally, patients with minor and major ST-T changes had increased wasted myocardial work [GWW (87 ± 61, 105 ± 56, and 127 ± 75 mmHg%, P = 0.045)], which resulted in reductions in the myocardial work efficiency [GWE (95 ± 4, 94 ± 3, and 89 ± 12%, P < 0.001)]. Even after adjustments for confounding factors, including EF, diastolic function parameters, LV hypertrophy, history of heart failure and atrial fibrillation, patients with minor ST-T changes had significantly smaller LV global constructive work in comparison to those without [GWI (2260 ± 33 vs. 2025 ± 76 mmHg%, P = 0.007) and GCW (2501 ± 45 vs. 2210 ± 105 mmHg%, P = 0.003)]. In conclusion, in hypertensive patients with preserved LVEF, minor ST-T changes on electrocardiograms were associated with reduced constructive work in the LV.
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14
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Lu Y, Lan T. Global, regional, and national burden of hypertensive heart disease during 1990-2019: an analysis of the global burden of disease study 2019. BMC Public Health 2022; 22:841. [PMID: 35473603 PMCID: PMC9044894 DOI: 10.1186/s12889-022-13271-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hypertensive heart disease (HHD) is a major public health issue worldwide. We analyzed the global, regional, and national burden of HHD between the years 1990 and 2019 in relation to age, gender, and socioeconomic factors. Methods The prevalence and death rates, the disability adjusted life-years (DALY), and the corresponding age-standardized rates of HHD were extracted from the Global Burden of Disease study 2019. The epidemiological trends were evaluated by calculating the estimated annual percentage changes (EAPC) of the above variates. Results A total of 19.60 million HHD cases were documented in 2019 compared to 7.82 million in 1990, corresponding to an EAPC of 0.17. Contrarily, the global age-standardized death rate (ASDR) and age-standardized DALYs decreased with respective EAPCs of − 0.74 and − 1.02. HHD mostly occurred in people aged over 65. The disease burden of HHD varied considerably between countries, and univariate linear regression indicated that many socioeconomic variables had significantly negative correlations with age-standardized DALY rate. Conclusion HHD cases have increased over the last three decades; however the mortality rate has declined. Multi-faceted improvements in health, education and income could help to alleviate the disease burden of HHD, specially in some regions with lower socio-demographic index and higher ASDR. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13271-0.
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Affiliation(s)
- Yunyan Lu
- Department of Cardiology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Tian Lan
- Department of Breast Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, People's Republic of China.
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Upadhya B, Kozak PM, Stacey RB, Vasan RS. Newer Drugs to Reduce High Blood Pressure and Mitigate Hypertensive Target Organ Damage. Curr Hypertens Rep 2022; 24:1-20. [PMID: 35165832 DOI: 10.1007/s11906-022-01166-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This review aims to investigate the blood pressure (BP)-lowering effects of emerging drugs developed to treat diabetic kidney disease and heart failure (HF). We summarize the potential pathophysiological mechanisms responsible for mitigating hypertensive target organ damage and evaluating the available clinical data on these newer drugs. RECENT FINDINGS Nonsteroidal dihydropyridine-based mineralocorticoid receptor antagonists (MRAs), dual angiotensin II receptor-neprilysin inhibitors (valsartan with sacubitril), sodium-glucose cotransporter 2 inhibitors (SGLT2i), and soluble guanylate cyclase stimulators are new classes of chemical agents that have distinct mechanisms of action and have been shown to be effective for the treatment of cardiovascular (CV) disease (CVD), HF, and type 2 diabetes mellitus (T2D). These drugs can be used either alone or in combination with other antihypertensive and CV drugs. Among these, SGLT2i and valsartan with sacubitril offer new avenues to reduce CVD mortality. SGLT2i have a mild-to-moderate effect on BP lowering with a favorable effect on CV and renal hemodynamics and have been shown to produce a significant reduction in the incidence of major adverse CVD events (as monotherapy or add-on therapy) compared with controls (placebo or non-SGLT2i treatment). Most of the participants in these studies had hypertension (HTN) at baseline and were receiving antihypertensive therapy, including renin-angiotensin system blockers. The combination of valsartan with sacubitril also lowers BP in the short term and has demonstrated a striking reduction in CVD mortality and morbidity in HF patients with a reduced left ventricular ejection fraction. If widely adopted, these novel therapeutic agents hold significant promise for reducing the public health burden posed by HTN and CVD. Based on the results of several clinical trials and considering the high prevalence of HTN and T2D, these new classes of agents have emerged as powerful therapeutic tools in managing and lowering the BP of patients with diabetic kidney disease and HF.
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16
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Alıcı G, Genç Ö. Spectrum of cardiovascular diseases at a referral tertiary care hospital in Somalia, Mogadishu: an echocardiographic study. BMC Cardiovasc Disord 2021; 21:599. [PMID: 34915844 PMCID: PMC8680378 DOI: 10.1186/s12872-021-02417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To investigate the frequencies and patterns of cardiovascular diseases (CVDs), including rheumatic and congenital heart diseases, among patients with abnormal hearts assessed by echocardiographic examination. METHODS This retrospective, descriptive registry reviewed abnormal echocardiographic findings of 1140 patients aged 0-100 years who were admitted to the cardiology outpatient clinic at a tertiary training institution in Mogadishu. RESULTS Hypertensive heart disease (HHD) (n:454, 39.8%), valvular heart disease (VHD) (n:395, 34.6%), and heart failure with reduced ejection fraction (HFrEF) (n:351, 30.8%) were the most frequent comorbidities. Congenital heart diseases (CHDs) were detected in 151 (13.2%) of the patients, with the most common ones including atrial septal defect (ASD) (n:37, 3.2%) and ventricular septal defect (VSD) (n:26, 2.3%). Rheumatic heart disease (RHD) was observed in 84 (7.4%) patients, among whom the most common age range was 16-30 years (40.5%), followed by 31-45 years (31%) and 0-15 years (15.5%). Mitral insufficiency (n:541, 47.5%) was detected as the most frequent VHD, followed by aortic insufficiency (n:437, 38.3%), and tricuspid insufficiency (n:264, 23.2%) and mitral valve stenosis (n:39, 3.4%) was the least common VHD. CONCLUSION In the present study, we found that HHD was the most common comorbidity, followed by VHD, and HFrEF. Moreover, the most common VHD was mitral insufficiency and the most common CHD was ASD.
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Affiliation(s)
- Gökhan Alıcı
- Turkey, Recep Tayyip Erdogan, Somalia Mogadishu Training and Research Hospital, Mogadishu, Somalia
| | - Ömer Genç
- Department of Cardiology, Agri Training and Research Hospital, Agri, Turkey
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Giusca S, Steen H, Montenbruck M, Patel AR, Pieske B, Erley J, Kelle S, Korosoglou G. Multi-parametric assessment of left ventricular hypertrophy using late gadolinium enhancement, T1 mapping and strain-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2021; 23:92. [PMID: 34247623 PMCID: PMC8273957 DOI: 10.1186/s12968-021-00775-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 01/12/2023] Open
Abstract
AIM To evaluate the ability of single heartbeat fast-strain encoded (SENC) cardiovascular magnetic resonance (CMR) derived myocardial strain to discriminate between different forms of left ventricular (LV) hypertrophy (LVH). METHODS 314 patients (228 with hypertensive heart disease (HHD), 45 with hypertrophic cardiomyopathy (HCM), 41 with amyloidosis, 22 competitive athletes, and 33 healthy controls) were systematically analysed. LV ejection fraction (LVEF), LV mass index and interventricular septal (IVS) thickness, T1 mapping and atypical late gadolinium enhancement (LGE) were assessed. In addition, the percentage of LV myocardial segments with strain ≤ - 17% (%normal myocardium) was determined. RESULTS Patients with amyloidosis and HCM exhibited the highest IVS thickness (17.4 ± 3.3 mm and 17.4 ± 6 mm, respectively, p < 0.05 vs. all other groups), whereas patients with amyloidosis showed the highest LV mass index (95.1 ± 20.1 g/m2, p < 0.05 vs all others) and lower LVEF compared to controls (50.5 ± 9.8% vs 59.2 ± 5.5%, p < 0.05). Analysing subjects with mild to moderate hypertrophy (IVS 11-15 mm), %normal myocardium exhibited excellent and high precision, respectively for the differentiation between athletes vs. HCM (sensitivity and specificity = 100%, Area under the curve; AUC%normalmyocardium = 1.0, 95%CI = 0.85-1.0) and athletes vs. HHD (sensitivity = 83%, specificity = 75%, AUC%normalmyocardium = 0.85, 95%CI = 0.78-0.90). Combining %normal myocardial strain with atypical LGE provided high accuracy also for the differentiation of HHD vs. HCM (sensitivity = 82%, specificity = 100%, AUCcombination = 0.92, 95%CI = 0.88-0.95) and HCM vs. amyloidosis (sensitivity = 83%, specificity = 100%, AUCcombination = 0.83, 95%CI = 0.60-0.96). CONCLUSION Fast-SENC derived myocardial strain is a valuable tool for differentiating between athletes vs. HCM and athletes vs. HHD. Combining strain and LGE data is useful for differentiating between HHD vs. HCM and HCM vs. cardiac amyloidosis.
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Affiliation(s)
- Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | | | - Amit R Patel
- Department of Medicine, University of Chicago, Illinois, USA
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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18
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Sung YL, Lin TT, Syu JY, Hsu HJ, Lin KY, Liu YB, Lin SF. Reverse electromechanical modelling of diastolic dysfunction in spontaneous hypertensive rat after sacubitril/valsartan therapy. ESC Heart Fail 2020; 7:4040-4050. [PMID: 32969191 PMCID: PMC7755015 DOI: 10.1002/ehf2.13013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
Aims Hypertension is a significant risk for the development of left ventricular hypertrophy, diastolic dysfunction, followed by heart failure and sudden cardiac death. While therapy with sacubitril/valsartan (SV) reduces the risk of sudden cardiac death in patients with heart failure and systolic dysfunction, the effect on those with diastolic dysfunction remains unclear. We hypothesized that, in the animal model of hypertensive heart disease, treatment with SV reduces the susceptibility to ventricular arrhythmia. Methods and results Young adult female spontaneous hypertensive rats (SHRs) were randomly separated into three groups, which were SHRs, SHRs treated with valsartan, and SHRs treated with SV. In addition, the age‐matched and weight‐matched Wistar Kyoto rats were considered as controls, and there were 12 rats in each group. In vivo ventricular tachyarrhythmia induction and in vitro optical mapping were used to measure the inducibility of ventricular arrhythmias and to characterize the dynamic properties of electrical propagation. The level of small‐conductance Ca2+‐activated potassium channel type 2 (KCNN2) was analysed in cardiac tissue. Compared with SHR with left ventricular hypertrophy, treatment with SV significantly improved cardiac geometry (relative wall thickness, 0.68 ± 0.11 vs. 0.76 ± 0.13, P < 0.05) and diastolic dysfunction (isovolumetric relaxation time, 59.4 ± 3.2 vs. 70.5 ± 4.2 ms, P < 0.05; deceleration time of mitral E wave, 46 ± 4.8 vs. 42 ± 3.8, P < 0.05). The incidence of induced ventricular arrhythmia was significantly reduced in SHR treated with SV compared with SHR (ventricular tachycardia, 1.14 ± 0.32 vs. 2.91 ± 0.5 episodes per 10 stimuli, P < 0.001; ventricular fibrillation, 1.72 ± 0.31 vs. 5.81 ± 0.42 episodes per 10 stimuli, P < 0.001). The prolonged action potential duration (APD) and increase of the maximum slope of APD restitution were observed in SHR, while the treatment of SV improved the arrhythmogeneity (APD, 37.12 ± 6.18 vs. 92.41 ± 10.71 ms at 250 ms pacing cycle length, P < 0.001; max slope 0.29 ± 0.01 vs. 1.48 ± 0.04, P < 0.001). These effects were strongly associated with down‐regulation of KCNN2 (0.38 ± 0.07 vs. 0.74 ± 0.12 ng/ml, P < 0.001). The treatment of SV also decreased the level of N‐terminal pro‐B‐type natriuretic peptide, cardiac bridging integrator‐1, and intramyocardial fibrosis of SHR. Conclusions In conclusion, synergistic blockade of the neprilysin and the renin–angiotensin system by SV in SHRs results in KCNN2‐associated electrical remodelling in ventricle, which stabilizes electrical dynamics and attenuates arrhythmogenesis.
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Affiliation(s)
- Yen-Ling Sung
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan.,Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Ting-Tse Lin
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhen-Yang Syu
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Hung-Jui Hsu
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Kai-Yuan Lin
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Yen-Bin Liu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shien-Fong Lin
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, 300, Taiwan
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19
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Adair T, Lopez AD. The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA. BMC Med 2020; 18:199. [PMID: 32746822 PMCID: PMC7401233 DOI: 10.1186/s12916-020-01666-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35-74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data-direct individual-level evidence from death certificates-and linking the findings to cohort lifetime obesity prevalence. METHODS We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006-2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence. RESULTS Each country's DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts. CONCLUSIONS The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.
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Affiliation(s)
- Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, Building 379, 207 Bouverie Street, Carlton, Victoria, 3010, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, Building 379, 207 Bouverie Street, Carlton, Victoria, 3010, Australia.
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20
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Juliano GR, Skaf MF, Ramalho LS, Juliano GR, Torquato BGS, Oliveira MS, Oliveira FA, Espíndula AP, Cavellani CL, Teixeira VDPA, Ferraz MLDF. Analysis of mast cells and myocardial fibrosis in autopsied patients with hypertensive heart disease. Rev Port Cardiol 2020; 39:89-96. [PMID: 32205013 DOI: 10.1016/j.repc.2019.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 10/07/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To analyze the percentage of collagen fibers and mast cell density in the left ventricular myocardium of autopsied patients with and without hypertensive heart disease. METHODS Thirty fragments of left ventricular myocardium were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period from 1987 to 2017. Individuals were divided into two groups: those with hypertensive heart disease (HD) and those with no heart disease (ND). Subjects were also assessed according to age, gender and race (white and non-white). Collagen fibers were quantified by computed morphometry and mast cell density was assessed by immunohistochemical methods. RESULTS There were significantly more collagen fibers in the left ventricle in the HD group than in the ND group (p<0.001). Mast cell density was significantly higher in the left ventricle of individuals with HD immunolabeled with anti-chymase and anti-tryptase antibodies (p=0.02) and also of those immunolabeled only with anti-tryptase antibodies (p=0.03). Analyzing the HD group, there was a significant positive correlation between the percentage of collagen fibers in the left ventricle and mast cell density immunolabeled by anti-chymase and anti-tryptase antibodies (p=0.04) and also mast cell density immunolabeled only with anti-tryptase antibodies (p=0.02). CONCLUSIONS Mast cells are involved in the development of hypertensive heart disease, contributing to the remodeling of collagen fibers in this disease.
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Affiliation(s)
- Guilherme Ribeiro Juliano
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.
| | - Mariana Fleury Skaf
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Luciana Santos Ramalho
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Gabriela Ribeiro Juliano
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Bianca Gonçalves Silva Torquato
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Mariana Silva Oliveira
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Flávia Aparecida Oliveira
- Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goiás (UFG), Goiânia, GO, Brazil
| | - Ana Paula Espíndula
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Camila Lourencini Cavellani
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Vicente de Paula Antunes Teixeira
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Mara Lúcia da Fonseca Ferraz
- General Pathology Department, Biological and Natural Sciences Institute (ICBN), Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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21
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Ekström M, Hellman A, Hasselström J, Hage C, Kahan T, Ugander M, Wallén H, Persson H, Linde C. The transition from hypertension to hypertensive heart disease and heart failure: the PREFERS Hypertension study. ESC Heart Fail 2020; 7:737-746. [PMID: 32073753 PMCID: PMC7160482 DOI: 10.1002/ehf2.12612] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/28/2019] [Accepted: 12/22/2019] [Indexed: 01/09/2023] Open
Abstract
Aims Despite evidence‐based therapeutic approaches, target blood pressure is obtained by less than half of patients with hypertension. Hypertension is associated with a significant risk for heart failure, in particular heart failure with preserved left ventricular (LV) ejection fraction (HFpEF). Although treatment is suggested to be given early after hypertension diagnosis, there is still no evidence‐based medical treatment for HFpEF. We aim to study the underlying mechanisms behind the transition from uncomplicated hypertension to hypertensive heart disease (HHD) and HFpEF. To this end, we will combine cardiac imaging techniques and measurements of circulating fibrosis markers to longitudinally monitor fibrosis development in patients with hypertension. Methods and results In a prospective cohort study, 250 patients with primary hypertension and 60 healthy controls will be characterized at inclusion and after 1 and 6 years. Doppler echocardiography, cardiac magnetic resonance imaging, and electrocardiogram will be used for measures of cardiac structure and function over time. Blood biomarkers reflecting myocardial fibrosis, inflammation, and endothelial dysfunction will be analysed. As a proxy for HFpEF development, the primary endpoint is to measure echocardiographic changes in LV function and structure (E/e′ and LAVI) and to relate these measures of LV filling to blood pressure, biomarkers, electrocardiogram, and cardiac magnetic resonance. Conclusions We aim to study the timeline and transition from uncomplicated hypertension to HHD and HFpEF. In order to identify subjects prone to develop HHD and HFpEF, we want to find biomarkers and cardiac imaging variables to explain disease progression. Ultimately, we aim at finding new pathways to prevent HFpEF.
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Affiliation(s)
- Mattias Ekström
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden
| | - Anna Hellman
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Solna, Sweden
| | - Camilla Hage
- Department of Medicine, Division of Cardiology, Karolinska Institutet, Solna, Sweden
| | - Thomas Kahan
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden
| | - Martin Ugander
- Department of Molecular Medicine and Surgery, Department of Clinical Physiology, Karolinska Institutet, Solna, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden
| | - Cecilia Linde
- Department of Medicine, Division of Cardiology, Karolinska Institutet, Solna, Sweden
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22
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Abstract
Metabolic syndrome is an increasingly prevalent constellation of disease processes among the global population. Hypertension and obesity are among the contributing etiologies, and obesity increases the likelihood of hypertensive heart disease by creating a proinflammatory state, as well as increasing sympathetic tone and formation of reactive oxygen species. Hypertensive heart disease is characterized by myocardial fibrosis, which portends higher risk of developing reduced ejection fraction, diastolic dysfunction, ischemia, and arrhythmias, making early diagnosis and treatment essential to the prevention of cardiac events.
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Affiliation(s)
- L Joseph Saliba
- Department of Internal Medicine, Ohio State University-Wexner Medical Center, 395 West 12th Avenue, Columbus, OH 43210, USA.
| | - Scott Maffett
- Ohio State University-Wexner Medical Center, 452 West 10th Avenue, Columbus, OH 43210, USA
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23
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Wang X, Zhang Y, Zhang J, Wang YX, Xu XR, Wang H, Zhao WS, Xu L, Zhang L. Multiple Autoantibodies against Cardiovascular Receptors as Biomarkers in Hypertensive Heart Disease. Cardiology 2019; 142:47-55. [PMID: 30982037 DOI: 10.1159/000497189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The pathogenesis of hypertensive heart disease (HHD) remains unclear, which might include autoimmunity. The aim of the present study was to determine whether a relationship exists between the presence of autoantibodies against β1, β2, α1 adrenoreceptors, M2-muscarinic receptors, angiotensin II type1 receptors and HHD. METHODS In the present study, 44 patients diagnosed with HHD, 36 patients with hypertension, and 40 controls were also enrolled. The measurement of these 5 autoantibodies was performed by enzyme-linked immunosorbent assay. RESULTS The frequencies of autoantibodies against β1, β2, α1 adrenoreceptors, autoantibodies against M2-muscarinic receptors and autoantibodies against angiotensin II type1 receptors were significantly higher in patients with HHD, when compared to patients with hypertension and normal controls (all p < 0.001). In addition, the titers of these 5 autoantibodies significantly increased in patients with HHD. Patients who were positive for all 5 autoantibodies had larger left ventricular end-diastolic diameter (60.5 ± 4.9 vs. 57.8 ± 5.0 vs. 52.5 ± 5.3 mm) and worse left ventricular ejection fraction (45.0 ± 11.0 vs. 56.6 ± 10.4 vs. 57.8 ± 5.3%), when compared to patients not positive for all the 5 autoantibodies and patients negative for all the 5 autoantibodies (χ2 = 9.524, p = 0.009 and χ2 = 7.689, p = 0.021). Furthermore, a significant positive correlation was observed between each 2 autoantibodies of these 5 autoantibodies (all p < 0.001). CONCLUSION Multiple autoantibodies of cardiovascular receptors may be involved in the pathogenesis and may be predictive factors of HHD.
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Affiliation(s)
- Xin Wang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Juan Zhang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yu-Xing Wang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Rong Xu
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua Wang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen-Shu Zhao
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lin Xu
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lin Zhang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China, .,HTRM Cardiologist Group, Beijing, China,
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24
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Abstract
PURPOSE OF REVIEW To review recent advances in the imaging of hypertensive heart disease (HHD) with an emphasis on developments in the imaging of diffuse myocardial fibrosis using cardiac magnetic resonance (CMR). RECENT FINDINGS HHD results from long-standing hypertension and is characterized by the development of left ventricular hypertrophy and diffuse interstitial fibrosis. Diffuse fibrosis traditionally required endomyocardial biopsy to diagnose, but recent developments using T1 mapping in CMR allow for noninvasive assessment. Studies using T1 mapping have shown an increase in extracellular volume fraction (ECV) in patients with HHD compared to normal controls, suggesting ECV can be used as a noninvasive marker for fibrosis in HHD. In addition to T1 mapping, other recent advances in HHD imaging include improvements in three-dimensional echocardiography, allowing for accurate real-time volumetric measurements, and the use of speckle tracking echocardiography to detect subclinical systolic dysfunction. Measurement of ECV using T1 mapping in CMR can be used as a noninvasive marker of diffuse myocardial fibrosis in HHD. While further studies are needed to validate this approach with larger patient cohorts, ECV can potentially be used to both monitor disease progression and assess therapeutic interventions in HHD.
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Affiliation(s)
| | - Nicholas R Jaeger
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Christopher M Kramer
- Department of Cardiology, University of Virginia, Charlottesville, VA, USA. .,Department of Radiology, University of Virginia, Charlottesville, VA, USA.
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25
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Taylor AP, Freeman RV, Bartek MA, Shalhub S. Left ventricular hypertrophy is a possible biomarker for early mortality after type B aortic dissection. J Vasc Surg 2018; 69:1710-1718. [PMID: 30552040 DOI: 10.1016/j.jvs.2018.09.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/26/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Data regarding the cardiac abnormalities associated with Stanford type B aortic dissection (TBAD) and whether these abnormalities are related to outcomes are limited. We describe the prevalence of cardiac abnormalities in patients with TBAD as detected by echocardiography. METHODS This retrospective review included patients with TBAD presenting between 1990 and 2016. Echocardiograms performed within 6 weeks of acute TBAD were reviewed. Cardiac function, valve abnormalities, and stigmata of hypertensive heart disease including left ventricular hypertrophy (LVH) were ascertained. Characteristics of patients who did and did not receive echocardiograms were compared. Outcomes of patients with and without evidence of LVH on echocardiography were also compared. RESULTS Of 239 patients with TBAD, 90 had echocardiograms performed within 6 weeks of acute TBAD (74% male; mean age, 57.8 ± 13.2 years). Echocardiograms were obtained at a median of 2 days (range, 0-41 days) from acute TBAD. Patients who had echocardiograms were more likely to present with malperfusion (28% vs 14%; P < .01) and had a trend toward increased operative repair during the subacute phase (17.4% vs 9.5%; P = .07) compared with patients who did not receive an echocardiogram. A majority of patients (57%) had at least mild LVH, including 39% of patients without a prior diagnosis of hypertension. Fibrocalcific changes associated with hypertension, including aortic sclerosis and mitral annular calcification, were noted in 40% and 11% of the patients, respectively. Among patients with LVH, there was a trend toward higher all-cause mortality (35% vs 23%; P = .21) and a younger age at death (58 ± 14 years vs 66 ± 13 years; P = .19) despite a similar age at TBAD onset. In a multivariable analysis controlling for age, sex, and admission estimated glomerular filtration rate, LVH independently predicted all-cause mortality (hazard ratio, 2.38; 95% confidence interval, 1.02-5.56; P = .04). CONCLUSIONS LVH and other findings of hypertensive heart disease are common in patients with TBAD. LVH predicted all-cause mortality after TBAD in this small group of patients. Further exploration of the relationship between the chronic effects of hypertension and using LVH as an objective biomarker to risk stratify patients with TBAD and long-term outcomes after TBAD is warranted.
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Affiliation(s)
- Alexander P Taylor
- Department of Internal Medicine, University of Washington, Seattle, Wash
| | - Rosario V Freeman
- Division of Cardiology, Department of Internal Medicine, University of Washington, Seattle, Wash
| | | | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
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26
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Segawa T, Arita Y, Ogasawara N, Hasegawa S. Hypertensive heart disease associated with methamphetamine abuse. J Cardiol Cases 2019; 19:47-50. [PMID: 31193675 DOI: 10.1016/j.jccase.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022] Open
Abstract
In Japan, methamphetamine accounts for the majority of illicit drug use and dependence is becoming a critical issue. Methamphetamine abuse induces cardiovascular complications, such as cardiomyopathy and heart failure. However, methamphetamine-associated cardiovascular complications are not common in Japan. We report the case of a young patient with hypertensive heart disease associated with habitual methamphetamine abuse. A 37-year-old man was admitted with congestive heart failure. He was a habitual methamphetamine abuser and developed chronic hypertension after he started methamphetamine abuse. His echocardiogram demonstrated left ventricular concentric hypertrophy with diffuse hypokinesis. An endomyocardial biopsy revealed histological evidence of a hypertensive heart. This case shows that habitual methamphetamine use may cause hypertensive heart disease because of chronic hypertension. <Learning objective: Methamphetamine-associated cardiomyopathy and congestive heart failure are uncommon in Japan. However, habitual methamphetamine abuse can be a potential cause of hypertensive heart disease due to chronic hypertension and congestive heart failure associated with hypertrophy.>.
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27
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Eberly LA, Rusingiza E, Park PH, Ngoga G, Dusabeyezu S, Mutabazi F, Harerimana E, Mucumbitsi J, Nyembo PF, Borg R, Gahamanyi C, Mutumbira C, Ntaganda E, Rusangwa C, Kwan GF, Bukhman G. Understanding the Etiology of Heart Failure Among the Rural Poor in Sub-Saharan Africa: A 10-Year Experience From District Hospitals in Rwanda. J Card Fail 2018; 24:849-853. [PMID: 30312764 DOI: 10.1016/j.cardfail.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart failure is a significant cause of morbidity and mortality in sub-Saharan Africa. Our understanding of the heart failure burden in this region has been limited mainly to registries from urban referral centers. Starting in 2006, a nurse-driven strategy was initiated to provide echocardiography and decentralized heart failure care within noncommunicable disease (NCD) clinics in rural district hospitals in Rwanda. METHODS AND RESULTS We conducted a retrospective review of patients with cardiologist-confirmed heart failure treated at 3 district hospital NCD clinics in Rwanda from 2006 to 2017 to determine patient clinical characteristics and disease distribution. Over 10 years, 719 patients with confirmed heart failure were identified. Median age was 27 years overall, and 42 years in adults. Thirty-six percent were children (age <18 years), 68% were female, and 78% of adults were farmers. At entry, 39% were in New York Heart Association functional class III-IV. Among children, congenital heart disease (52%) and rheumatic heart disease (36%) were most common. In adults, cardiomyopathy (40%), rheumatic heart disease (27%), and hypertensive heart disease (13%) were most common. No patients were diagnosed with ischemic cardiomyopathy. CONCLUSIONS The results of the largest single-country heart failure cohort from rural sub-Saharan Africa demonstrate a persistent burden of rheumatic disease and nonischemic cardiomyopathies.
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Affiliation(s)
- Lauren A Eberly
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda; Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Paul H Park
- Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Ryan Borg
- Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | | | - Gene F Kwan
- Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Partners in Health, Boston, Massachusetts; Program in Global Noncommunicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Nkoke C, Makoge C, Dzudie A, Mfeukeu LK, Luchuo EB, Menanga A, Kingue S. A predominance of hypertensive heart disease among patients with cardiac disease in Buea, a semi-urban setting, South West Region of Cameroon. BMC Res Notes 2017; 10:684. [PMID: 29202813 PMCID: PMC5715493 DOI: 10.1186/s13104-017-3034-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 01/09/2023] Open
Abstract
Objective The pattern of heart disease is diverse within and among world regions. The little data on the spectrum of heart disease in Cameroon has been so far limited to major cities. We sought to describe the pattern of heart disease in Buea, the South West Region of Cameroon, a semi-urban setting. This was a descriptive cross-sectional study. Between June 2016 and April 2017 the echocardiography register of the Buea Regional Hospital was surveyed. We extracted data on the age, sex and echocardiographic diagnosis. Results Out of 529 patients who underwent echocardiography, 239 (45.2%) had a definite heart disease. There were 137 (57.3%) females. The mean age was 58 years (range 3–94 years). The most common echocardiographic diagnoses were hypertensive heart disease (43.2%), dilated cardiomyopathies (17.6%), ischemic heart diseases (9.6%), and cor pulmonale (8.8%). Rheumatic heart disease affected 6.7% of the patients. The most common rheumatic heart disease was mitral stenosis followed by mitral regurgitation. Congenital heart disease represented 2.1% and 5 patients (2.1%) had pulmonary hypertension. Hypertensive heart disease is the most common cardiac disease in this semi-urban region in Cameroon. Rheumatic heart disease still affects a sizable proportion of patients. Prevention of cardiac disease in our setting should focus on mass screening, the treatment and control of hypertension.
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Affiliation(s)
- Clovis Nkoke
- Buea Regional Hospital, Buea, South West Region, Cameroon.
| | - Christelle Makoge
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | | | - Liliane Kuate Mfeukeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Engelbert Bain Luchuo
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alain Menanga
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Samuel Kingue
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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Ishizuka M, Yamada S, Maemura S, Yamamoto K, Takizawa M, Uozumi H, Minegishi S, Kobayashi J, Ikenouchi H. Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation). Int Heart J 2017; 58:820-823. [PMID: 28966318 DOI: 10.1536/ihj.16-463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.
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Affiliation(s)
| | | | - Sonoko Maemura
- Department of Cardiology, Japanese Red Cross Medical Center
| | | | | | - Hiroki Uozumi
- Department of Cardiology, Japanese Red Cross Medical Center
| | - Sachito Minegishi
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center
| | - Jotaro Kobayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center
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Zeeb H, Hegewald J, Schubert M, Wagner M, Dröge P, Swart E, Seidler A. Traffic noise and hypertension - results from a large case-control study. Environ Res 2017; 157:110-117. [PMID: 28554004 DOI: 10.1016/j.envres.2017.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 05/09/2023]
Abstract
BACKGROUND Environmental traffic noise is a potential cause of hypertension. We aimed to study the association between hypertension as recorded in health insurance claims data and the exposure to three sources of traffic noise (aircraft, road and rail). METHODS This large case-control study was conducted among persons aged 40 and above in 2010 and living in the region around Frankfurt airport in Germany. Individual residential noise exposure for the index year 2005 was assessed using standard noise algorithms. Cases were all newly diagnosed cases of hypertension recorded in three large health insurances databases in the period 2006-2010. Controls had no hypertension diagnosis. Categorical and continuous analyses were conducted with binary logistic regression models adjusted for sex, age and residential area-based socioeconomic information. RESULTS The main analysis included 137,577 cases and 355,591 controls. There were no associations with any of the traffic noise sources. Odds ratios (OR) per 10dB noise increase were 0.99 (95% confidence interval: 0.98;1.01) for aircraft noise, and 1.00 (0.99;1.01) both for road and railway noise. Similarly, nighttime noise levels showed no associations with hypertension. Odds ratios were increased for the subgroup of newly diagnosed hypertension cases with a subsequent diagnosis of hypertensive heart disease: per 10dB aircraft noise there was a 13.9% OR increase (6.0% for road traffic, 5.4% for rail traffic). Increases were also noted when we analyzed cases with a longer exposure-outcome time window. CONCLUSION Our results are suggestive of an association of noise exposure with clinically more severe hypertension diagnoses, but not with uncomplicated hypertension. The absence of individual confounder data, however, adds to the risk of bias. The results contribute to evidence on traffic noise as a cardiovascular risk factor.
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Affiliation(s)
- Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany; Health Sciences Bremen, University of Bremen, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Mandy Wagner
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Patrik Dröge
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
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Abellán-Huerta J, Prieto-Valiente L, Consuegra-Sánchez L, Montoro-García S, Salguero-Merino AB, Morales-López R, Abellán-Alemán J, Soria-Arcos F. Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients. Hipertens Riesgo Vasc 2017; 34:149-56. [PMID: 28522299 DOI: 10.1016/j.hipert.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. METHODS This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. RESULTS The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. CONCLUSION After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.
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Li S, Wang Z, Yang X, Hu B, Huang Y, Fan S. Association between circulating angiotensin-converting enzyme 2 and cardiac remodeling in hypertensive patients. Peptides 2017; 90:63-68. [PMID: 28223093 DOI: 10.1016/j.peptides.2017.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/12/2016] [Revised: 02/11/2017] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Angiotensin-converting enzyme 2 (ACE2) plays a vital role in the pathogenesis of hypertension-induced cardiac remodeling and exhibits cardioprotective properties in hypertensive animal models. Evidence that ACE2 is an important regulator of hypertensive cardiac remodeling in humans has not been addressed directly yet. METHODS A total of 161 patients with essential hypertension and 47 age- and sex-matched normotensive healthy subjects were consecutively recruited. Serum concentration levels of ACE2 were determined by enzyme-linked immunosorbent assay. Cardiac structural and functional parameters were measured by echocardiography. RESULTS Serum ACE2 concentrations were higher in hypertensive patients compared to healthy subjects (170.31 [83.50-707.12] pg/ml in patients versus 59.28 [39.71-81.81] pg/ml in healthy subjects, P<0.001). After adjustment for confounders, including age, sex, body mass index, snoring, smoking, duration of hypertension, comorbidities, medication use, mean arterial pressure and N-terminal pro-brain natriuretic peptide, serum ACE2 concentrations were positively correlated with left atrial diameter, left ventricular end-diastolic diameter and left ventricular mass in hypertensive patients. Moreover, multiple regression analyses adjusting for covariates revealed that serum ACE2 concentrations were also independently associated with left ventricular ejection fraction and late diastolic filling velocities of the mitral inflow. CONCLUSIONS This study reveals an elevated serum concentration of ACE2 and independent associations between serum ACE2 and echocardiographic parameters in hypertensive patients.
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Affiliation(s)
- Shichao Li
- Department of Cardiology, North China University of Science and Technology Affiliated Hospital, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China
| | - Zhijun Wang
- Department of Cardiology, North China University of Science and Technology Affiliated Hospital, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China.
| | - Xiuhong Yang
- Department of Physiology, School of Basic Medical Sciences, North China University of Science and Technology, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China.
| | - Bo Hu
- School of Public Health, North China University of Science and Technology, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China
| | - Yuling Huang
- Department of Cardiology, North China University of Science and Technology Affiliated Hospital, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China
| | - Sujing Fan
- Department of Physiology, School of Basic Medical Sciences, North China University of Science and Technology, 57 Jianshe South Rd, Tangshan City, Hebei Province, 063000, China
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Abstract
OBJECTIVE Show how lunar catecholamine cardiomyopathy alone, exemplified by Neil Armstrong's single space walk, prior to exposure to inhalation of fine particulate matter, can trigger " Neil Armstrong Syndrome" or by Irwin with coronary, possibly hypertensive heart disease, and catecholamine cardiomyopathy. With space flight, invariably magnesium ion deficits, catecholamine elevations, vicious cycles. Design Use lunar heart rates while configuring rover to show severe tachycardia component of the syndrome. Use Irwin's stress test-" cyanotic fingernails" to support Apollo 15 Space Syndrome. Use Irwin's autobiography to compensate for often incomplete data. Results Paper shows that both Irwin as well as Armstrong meet criteria of my 2nd. Space Syndrome: severe thirst, severe shortness of breath, severe tachycardia, the latter, corrected by replenishing plasma volume. Conclusions Irwin, with a history of hypertension prior to the Apollo 15 mission and classical angina during Earth reentry, may have had coronary as well as hypertensive heart disease whereas there was no evidence that Armstrong had these conditions prior or during his mission. However both, on return to Earth, had abnormal stress tests.
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Affiliation(s)
- William J Rowe
- Medical University of Ohio at Toledo, 1485 Bremerton La., Keswick, VA 22947, United States.
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Abstract
Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction.
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Affiliation(s)
- R Nazário Leão
- Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - P Marques da Silva
- Nova Medical School, Lisboa, Portugal; Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal
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Abstract
Hypertension (HTN) is the most common cause of hypertensive heart disease, which comprises of left ventricular hypertrophy (LVH), left atrial enlargement, diastolic dysfunction, functional mitral regurgitation and neurohormonal changes. All of these lead to significant arrhythmias such as atrial fibrillation (AF) as well as ventricular arrhythmias, and are known risk factors for sudden cardiac death (SCD). The association between LVH and SCD is well established, especially in the presence of myocardial ischemia, fibrosis and scar tissue, and AF. Inflammation, fibrosis and oxidative stress, as well as ischemia play a significant role and are the leading pathways to remodeling, arrhythmias, and SCD. Aggressive HTN control may lead, at least in part, to regression of LVH and thus lower the risk of AF and SCD. Therefore, LVH is a powerful, independent predictor of AF, ventricular arrhythmias and SCD, and is significantly underrecognized. Further investigation of the relationship and management of diastolic dysfunction, LVH and genetic factors and their association with SCD is certainly warranted.
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Affiliation(s)
- Mohammad Shenasa
- Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, 105 North Bascom Ave, Suite 204, San Jose, CA 95128, United States.
| | - Hossein Shenasa
- Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, 105 North Bascom Ave, Suite 204, San Jose, CA 95128, United States
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Moreno MU, Eiros R, Gavira JJ, Gallego C, González A, Ravassa S, López B, Beaumont J, San José G, Díez J. The Hypertensive Myocardium: From Microscopic Lesions to Clinical Complications and Outcomes. Med Clin North Am 2017; 101:43-52. [PMID: 27884234 DOI: 10.1016/j.mcna.2016.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/09/2023]
Abstract
The chronic hemodynamic load imposed by hypertension on the left ventricle leads to lesions in the myocardium that result in structural remodeling, which provides support for alterations in cardiac function, perfusion, and electrical activity that adversely influence the clinical evolution of hypertensive heart disease. Management must include detecting, reducing, and reversing left ventricular hypertrophy, as well as the detection and repair of microscopic lesions responsible for myocardial remodeling. Reducing the burden associated with hypertensive heart disease can be targeted using personalized treatment. The noninvasive, biomarker-mediated identification of subsets of patients with hypertensive heart disease is essential to provide personalized treatment.
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Affiliation(s)
- María U Moreno
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Rocío Eiros
- Department of Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Av. Pío XII, 36, Pamplona 31008, Spain
| | - Juan J Gavira
- Department of Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Av. Pío XII, 36, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Catalina Gallego
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; Programa de Cardiología Clínica, Clínica CardioVID, Universidad Pontificia Bolivariana, Calle 78B 75-21, Medellín, Colombia
| | - Arantxa González
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Begoña López
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Javier Beaumont
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Gorka San José
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Edificio CIMA, Av. Pío XII, 55, Pamplona 31008, Spain; Department of Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Av. Pío XII, 36, Pamplona 31008, Spain; IdiSNA, Navarra Institute for Health Resarch, Pamplona, Spain.
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Seidler A, Wagner M, Schubert M, Dröge P, Römer K, Pons-Kühnemann J, Swart E, Zeeb H, Hegewald J. Aircraft, road and railway traffic noise as risk factors for heart failure and hypertensive heart disease-A case-control study based on secondary data. Int J Hyg Environ Health 2016; 219:749-758. [PMID: 27667192 DOI: 10.1016/j.ijheh.2016.09.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/05/2016] [Accepted: 09/16/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several studies point to an elevated risk for cardiovascular diseases induced by traffic noise. AIMS We examined the association between aircraft, road traffic and railway noise and heart failure or hypertensive heart disease (HHD) in a large case-control study. METHODS The study population consisted of individuals that were insured by three large statutory health insurance funds in the Rhine-Main area of Germany. Based on insurance claims and prescription data, 104,145 cases of heart failure or HHD diagnosed 2006-10 were identified and compared with 654,172 control subjects. Address-specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Odds Ratios were calculated using logistic regression analysis, adjusted for age, sex, local proportion of persons receiving unemployment benefits, and individual socioeconomic status (available for 39% of the individuals). RESULTS A statistically significant linear exposure-risk relationship with heart failure or hypertensive heart disease was found for aircraft traffic noise (1.6% risk increase per 10dB increase in the 24-h continuous noise level; 95% CI 0.3-3.0%), road traffic noise (2.4% per 10dB; 95% CI 1.6-3.2%), and railway noise (3.1% per 10dB; 95% CI 2.2-4.1%). For individuals with 24-h continuous aircraft noise levels <40dB and nightly maximum aircraft noise levels exceeding 50dB six or more times, a significantly increased risk was observed. In general, risks of HHD were considerably higher than the risks of heart failure. CONCLUSIONS Regarding the high prevalence of traffic noise from various sources, even low risk increases for frequent diseases are relevant for the population as a whole.
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Affiliation(s)
- Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
| | - Mandy Wagner
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Patrik Dröge
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Karin Römer
- Institute of Medical Informatics, Justus-Liebig-University Gießen, Germany
| | | | - Enno Swart
- Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology-BIPS GmbH, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
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Horgan SJ, Watson CJ, Glezeva N, Collier P, Neary R, Tea IJ, Corrigan N, Ledwidge M, McDonald K, Baugh JA. Serum Amyloid P-Component Prevents Cardiac Remodeling in Hypertensive Heart Disease. J Cardiovasc Transl Res 2015; 8:554-66. [PMID: 26577946 DOI: 10.1007/s12265-015-9661-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023]
Abstract
The potential for serum amyloid P-component (SAP) to prevent cardiac remodeling and identify worsening diastolic dysfunction (DD) was investigated. The anti-fibrotic potential of SAP was tested in an animal model of hypertensive heart disease (spontaneously hypertensive rats treated with SAP [SHR - SAP] × 12 weeks). Biomarker analysis included a prospective study of 60 patients with asymptomatic progressive DD. Compared with vehicle-treated Wistar-Kyoto rats (WKY-V), the vehicle-treated SHRs (SHR-V) exhibited significant increases in left ventricular mass, perivascular collagen, cardiomyocyte size, and macrophage infiltration. SAP administration was associated with significantly lower left ventricular mass (p < 0.01), perivascular collagen (p < 0.01), and cardiomyocyte size (p < 0.01). Macrophage infiltration was significantly attenuated in the SHR-SAP group. Biomarker analysis showed significant decreases in SAP concentration over time in patients with progressive DD (p < 0.05). Our results indicate that SAP prevents cardiac remodeling by inhibiting recruitment of pro-fibrotic macrophages and that depleted SAP levels identify patients with advancing DD suggesting a role for SAP therapy.
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Affiliation(s)
- Stephen J Horgan
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Chris J Watson
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Nadia Glezeva
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Pat Collier
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Roisin Neary
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Isaac J Tea
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Niamh Corrigan
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Mark Ledwidge
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ken McDonald
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.,Chronic Cardiovascular Disease Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Baugh
- UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
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Sauza-Sosa JC, Romero-Figueroa JA, Sierra-Galán LM, Ferez-Santander SM. [Why is it important to achieve the goals of treatment of hypertension…. About a case that began as ischemic stroke]. Arch Cardiol Mex 2015; 86:157-62. [PMID: 26549152 DOI: 10.1016/j.acmx.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
Systemic arterial hypertension (SAH) is one of the most common conditions seen in primary care of cardiovascular disease and whose consequences; depending on the "target organ" affecting produce ischemic heart disease, cerebral vascular disease or chronic kidney disease. In the pathogenesis of HAS are several physiopathological mechanisms involved; of which currently, to name the most important and frequent play a role in increasing adrenaline levels, the renin-angiotensin-aldosterone system and recently, much the participation of insulin resistance and hyperinsulinemia mentioned. These processes lead to an imbalance between the sympathetic and parasympathetic tone, coupled with hypersensitivity sodium trigger one of the pathophysiologic mechanisms of hypertension. SAH is currently defined as finding numbers of older blood pressure 140/90mm Hg. This is one of the diseases that most affect the world population prevalences found in age and gender groups 45 to 55% in men between 45 and 70 years and 45 to 65% in women of the same age group. In 2013 most recent clinical guidelines for treatment and the recommended goals, which has managed to reduce its complications and mortality were published; among which include vascular diseases such as ischemic heart and brain and kidney. In this paper a case that exemplifies the secondary complications in late diagnosis, damage to "target organ" by long-term exposure and inadequate compliance with therapeutic goals discussed.
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Affiliation(s)
- Julio César Sauza-Sosa
- Servicio de Cardiología, Centro Médico American British Cowdray, Campus Santa Fe, México, D.F., México.
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Yoshida N, Miyoshi T, Ninomaru T, Nagamatsu Y, Tamada N, Hiranuma N, Sasaki Y, Kitamura A, Kanda G, Kobayashi N, Nakagiri K, Fujii T. Left ventricular outflow tract obstruction caused by massive mitral annular calcification in a patient with hypertensive heart disease. J Cardiol Cases 2015; 12:87-90. [PMID: 30524546 PMCID: PMC6262145 DOI: 10.1016/j.jccase.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022] Open
Abstract
Mitral annular calcification (MAC) is frequently observed, but it rarely causes left ventricular outflow tract (LVOT) obstruction (LVOTO). An 83-year-old woman with hypertension, diabetes, and dyslipidemia was admitted to our hospital because of exertional dyspnea. She was diagnosed with hypertensive heart disease. Her symptoms were exacerbated by exertion, and she had no symptoms at rest. Transthoracic echocardiography showed massive posterior MAC, a sigmoid septum, and LVOTO, with a peak gradient of 15.4 mmHg at rest. Systolic anterior motion of the anterior mitral leaflet was not found. Moreover, the LVOT gradient in the stress condition was evaluated, and an increased LVOT gradient (47.3 mmHg) and chest discomfort was noted after 20 μg/kg/min of dobutamine was administered and the Valsalva maneuver was used. Hence, the patient was diagnosed with latent LVOTO. Interestingly, the distance between the septal wall, which was protruding into the left ventricular cavity, and the mitral valve coaptation, which was pushed up by the posterior MAC, had become closer, causing dynamic LVOTO. Since it is difficult to treat LVOTO with medication, ultimately, septal myectomy and mitral valve replacement were performed, which improved her symptoms. Evaluating the LVOT pressure gradient in stress condition is important in patients with MAC. .
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Dong JZ, Li YX. Detection of Helicobacter pylori infection induced changes in pepsinogen Ⅰ/Ⅱ ratio for predicting organ injuries in patients with primary hypertension. Shijie Huaren Xiaohua Zazhi 2015; 23:2501-2506. [DOI: 10.11569/wcjd.v23.i15.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the value of detection of Helicobacter pylori (H. pylori) infection induced changes in pepsinogen (PG) Ⅰ/Ⅱ ratio in predicting organ injuries in patients with primary hypertension.
METHODS: Sixty-eight patients with primary hypertension were included. The correlations between triglycerides, total cholesterol, or high density lipoprotein and PG Ⅰ/Ⅱ ratio were analyzed. The changes in PG Ⅰ/Ⅱ ratio in patients with and without cardiopathy, hypertensive nephropathy, or fundus lesions were compared. The efficiency of PG Ⅰ/Ⅱ ratio in the diagnosis of cardiopathy, nephropathy, and retinopathy was evaluated by receiver operating characteristic (ROC) analysis.
RESULTS: Compared to patients without H. pylori infection, patients with H. pylori infection showed significantly increased triglycerides (190.6 mg/dL ± 72.1 mg/dL vs 141.4 mg/dL ± 56.8 mg/dL), total cholesterol (257.8 mg/dL ± 124.7 mg/dL vs 198.6 mg/dL ± 99.5 mg/dL), and decreased PG Ⅰ/Ⅱ ratio (8.2 ± 3.6 vs 12.4 ± 4.9) (P < 0.05). Triglycerides (r = -0.302) and total cholesterol (r = -0.395) were negatively correlated with PG Ⅰ/Ⅱ ratio (P < 0.05). The rates of H. pylori infection were significantly higher in patients with cardiopathy [81.6% (44/49) vs 40.8% (91/223)], hypertensive nephropathy [84.6% (44/52) vs 45.5% (100/220)], and fundus lesions [67.7% (84/124) vs 40.5% (60/148)] than in those without (P < 0.05). PG Ⅰ/Ⅱ ratio was significantly decreased in patients with cardiopathy (6.9 ± 2.6 vs 11.3 ± 3.2), hypertensive nephropathy (6.3 ± 1.7 vs 10.8 ± 3.4) and fundus lesions (7.4 ± 1.9 vs 12.2 ± 3.5) compared to patients without (P < 0.05). The areas under the ROC curves of PG Ⅰ/Ⅱ ratio for detecting cardiopathy, hypertensive nephropathy and fundus lesions were 0.811, 0.802 and 0.831, respectively.
CONCLUSION: PG Ⅰ/Ⅱ ratio decreases in primary hypertension patients with cardiopathy, hypertensive nephropathy or fundus lesions, suggesting that PG Ⅰ/Ⅱ ratio can be used to screen organ injuries in patients with primary hypertension.
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Magyar K, Gal R, Riba A, Habon T, Halmosi R, Toth K. From hypertension to heart failure. World J Hypertens 2015; 5:85-92. [DOI: 10.5494/wjh.v5.i2.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/08/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is an increasing health problem worldwide especially among the elderly. Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease (HHD) and heart failure with the subsequent higher morbidity and mortality in the population. In HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases, the process can transform into heart failure with firstly preserved and then into reduced ejection fraction (HFpEF, HFrEF). The main characteristics of underlying mechanisms involve cardiomyocyte growth, vessel changes, increased collagen production in all of which several mechanical stress induced neurohumoral agents, signal transduction pathways are involved. According to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ damages. Occasionally, patients are not able to tolerate antihypertensive medication because of side effects, drug intolerance or interactions thus it is more difficult to reach the target blood pressure values. Therefore there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway (e.g., statins), regulation of ROS formation, influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor gene. Hypertension induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1 (PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades. PARP activation promotes the development of HHD, and its transition to heart failure. Therefore inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive patients. The purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into new potential therapies.
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Abstract
Left ventricular hypertrophy (LVH) poses an independent risk of increased morbidity and mortality, including atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death. The most common causes of LVH are hypertension and valvular heart disease. Electrocardiography and echocardiography are the first steps in the diagnosis and evaluation of therapy in patients with LVH. Cardiac MRI is the gold standard in diagnosis and assessment of response to therapy. Management of LVH should be based on etiology, evidence, and guideline adherence. Timely and optimal management of the underlying cause of LVH results in improvement (regression) of LVH and its related complications.
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Yalçin F, Topaloglu C, Kuçukler N, Ofgeli M, Abraham TP. Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease? Int J Cardiol Heart Vasc 2015; 7:141-145. [PMID: 28785662 PMCID: PMC5497240 DOI: 10.1016/j.ijcha.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/02/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regional myocardial performance index (MPI) in a hypertensive patient population. METHODS We evaluated 119 hypertensive patients who were divided into gr. I: 57 patients without left ventricular hypertrophy (LVH), (53.1 ± 10 years), and gr. II: 62 patients with LVH (55.1 ± 9 years) using conventional and tissue doppler imaging. They were compared with gr. III, a sex-age-matched normal control group (37 subjects, 53.0 ± 10 years). RESULTS We detected basal septal and basal lateral contraction time (CT), isovolumetric CT and relaxation time (IVRT) and MPI. EF was 68 ± 5 % in gr. I, 69 ± 5 % in gr. II, 69 ± 4 % in gr. III. LV mass index was 122 ± 11 g/m2 in gr. I, 148 ± 13 g/m2 in gr. II and 118 ± 13 g/m2 in gr. III. Concentric LVH was detected in gr. II (relative wall thickness = 0.49 ± 0.8). LV septal and lateral MPI were abnormal in both hypertensive groups (p < 0.0001). Septal MPI was correlated moderately with septal wall thickness (r = 0.447, p < 0.001). CONCLUSIONS LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness.
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Affiliation(s)
- Fatih Yalçin
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States.,Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Caner Topaloglu
- Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Nagehan Kuçukler
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States.,Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Mehmet Ofgeli
- Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Theodore P Abraham
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States
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Hayashi S, Yamada H, Nishio S, Hotchi J, Bando M, Takagawa Y, Saijo Y, Hirata Y, Sata M. Tricuspid annular motion velocity as a differentiation index of hypertrophic cardiomyopathy from hypertensive heart disease. J Cardiol 2014; 65:519-25. [PMID: 25199979 DOI: 10.1016/j.jjcc.2014.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) are the most frequently encountered entities presenting left ventricular hypertrophy in routine echocardiographic examination, and their differentiation is sometimes difficult. Abnormalities in right ventricular (RV) myocardium have been reported frequently in patients with HCM more than in those with HHD. We therefore hypothesized that tricuspid annular motion (TAM) velocity determined by pulsed tissue Doppler echocardiography can be used to detect RV dysfunction in HCM and discriminate these etiologies. METHODS TAM velocities were compared among clinically stable patients with 60 HCM and 60 HHD patients as well as 60 age-matched healthy controls. Peak systolic, early diastolic (TAM-e'), and atrial systolic velocities were measured. RV myocardial performance index was measured by tissue Doppler method. To more accurately differentiate HCM from HHD, electrocardiographic findings and brain natriuretic peptide levels, which can both be examined simply and noninvasively, were investigated in addition to echocardiography. RESULTS RV wall thickness of the HCM group was greater than the HHD group (p=0.092), while there was no significant difference in RV myocardial performance index between the HCM and HHD groups (p=0.606). TAM-e' was significantly lower in the HCM group than in HHD and control groups (p=0.001). To differentiate HCM from HHD, TAM-e' was a powerful predictor as per multivariate logistic regression analysis (hazard ratio, 0.665; p<0.001) of parameters other than those of left ventricular parameters, and the area under the receiver operating characteristic curve (AUC) was 0.686 and the best cut-off value was ≤8.0cm/s (62% sensitivity, 65% specificity). Multivariate logistic analysis revealed that electrocardiographic ST-T changes were the next most effective marker for differentiating HCM after TAM-e'. When TAM-e' and ST-T changes were combined, the AUC increased to 0.748. CONCLUSIONS TAM-e' is a potentially useful index to differentiate HCM from HHD.
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Affiliation(s)
- Shuji Hayashi
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Junko Hotchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Mika Bando
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yuriko Takagawa
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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46
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Tarsia J, Chang TR, Aysenne A, Boehme AK, Sartor AE, Albright KC, Yalvac EA, Kruse-Jarres R, Leissinger C, Martin-Schild S. Elevated Plasma Factor VIII in Patients with Ischemic Stroke: Does it have any Association with Hypertensive Heart Disease? J Neurol Disord Stroke 2013; 1:1027. [PMID: 25750937 PMCID: PMC4350327] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Elevated factor VIII (FVIII) has been linked with higher risk of vascular events. We aimed to determine the relationship between FVIII and hypertension in patients with acute ischemic stroke. METHODS FVIII levels and transthoracic echocardiogram reports were reviewed in patients with acute ischemic stroke who presented to our stroke center between July 2008 and September 2011. Presenting systolic and diastolic blood pressure, history of hypertention, left ventricular hypertrophy, diastolic dysfunction, and depressed left ventricular function (ejection fraction <50%) were compared in patients with normal and elevated FVIII levels. RESULTS No differences in presenting blood pressure or frequency of hypertension history were found based on FVIII level. Patients with elevated FVIII had demonstrated a statistically significant higher frequency of diastolic dysfunction (64.8 vs. 43.6%, p=0.042) and a trend towards higher frequency of left ventricular hypertrophy (18.5 vs 5.1%, p=0.073). Median FVIII was significantly higher in patients with left ventricular hypertrophy (194.4 vs 152.9%, p=0.042) and diastolic dysfunction (180.5 vs 149.3%, p=0.031) than patients without these findings. CONCLUSIONS Among patients with acute ischemic stroke, FVIII levels were higher when there was evidence of hypertensive heart disease. Synthesis of FVIII may be augmented by the ongoing presence of shear stress and could contribute to the higher risk of vaso-occlusive events in patients with elevated FVIII.
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Affiliation(s)
- Joseph Tarsia
- Stroke Program, Department of Neurology, Tulane University Medical School, USA
| | - Tiffany R. Chang
- Stroke Program, Department of Neurology, Tulane University Medical School, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - Aimee Aysenne
- Stroke Program, Department of Neurology, Tulane University Medical School, USA
| | - Amelia K Boehme
- Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), School of Medicine, University of Alabama at Birmingham, USA
| | - Alton E. Sartor
- Stroke Program, Department of Neurology, Tulane University Medical School, USA
| | - Karen C. Albright
- Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), School of Medicine, University of Alabama at Birmingham, USA
- Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), School of Medicine, University of Alabama at Birmingham, 35294
- Memorial Herman Hospital, USA
| | - Ethan Arda Yalvac
- Stroke Program, Department of Neurology, University of Texas in Houston, USA
| | | | - Cindy Leissinger
- Stroke Program, Department of Neurology, Tulane University Medical School, USA
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