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Ferreira RM, Ferron FVF, Borges VTM, Peraçoli JC, Ferron AJT, Roscani MG, Hueb JC, Bazan R, Martin LC, Bazan SGZ. Association of cardiovascular risk factors and myocardial hypertrophy in women with preeclampsia history. Life Sci 2024; 346:122646. [PMID: 38614304 DOI: 10.1016/j.lfs.2024.122646] [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: 02/18/2024] [Revised: 03/31/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
AIMS A historic of preeclampsia (PE) has been associated with cardiovascular disease (CVD) in women. There are substantial evidences that cardiovascular changes resulting from PE can persist even after pregnancy end. Therefore, the aims was to evaluate the prevalence of myocardial hypertrophy in young women 12 months after PE event as well as try to identify risk factors for these changes. MATERIALS AND METHODS Single-center observational prospective cross-sectional study that included 118 consecutive patients after 12 months of PE. Clinical and laboratory evaluations, echocardiogram were performed. Myocardial hypertrophy (LVH) was defined as an index myocardial mass ≥ 45 g/m2.7, for women. Classical risk factors for CVD were considered. Analysis included linear or logistic regression and Spearman's correlation coefficient. Significance level of 5 %. KEY FINDINGS Systemic arterial hypertension (SAH) was identified in 52 patients (44 %), overweight/obesity (OOB) in 82 (69 %), dyslipidemia in 68 (57 %) and metabolic syndrome in 47 patients (40 %). LVH was present in 35 cases (29 %) and associated with OOB (OR = 4.51; CI95%:1.18-17.17, p < 0.001), in a model corrected for age and SAH diagnosis. When only the metabolic syndrome components were analyzed, in the multiple logistic regression model, the abdominal circumference was the only clinical variable associated with LVH (OR = 17.65; CI95%:3.70-84.17; p < 0.001). SIGNIFICANCE It was observed a high prevalence of ventricular hypertrophy in young women with a history of pre-eclampsia. This condition was associated with the presence of obesity.
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Affiliation(s)
- Ricardo Mattos Ferreira
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | | | | | - José Carlos Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | - Artur Junio Togneri Ferron
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Meliza Goi Roscani
- Department of Medicine, Federal University of Sao Carlos-UFSCar, São Carlos, Brazil
| | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil.
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Tan W, Wang X, Sun Y, Wang X, He J, Zhong L, Jiang X, Sun Y, Tian E, Li Z, He L, Hao Y, Tang B, Hua W, Ma X, Yang J. Roxadustat reduces left ventricular mass index compared to rHuEPO in haemodialysis patients in a randomized controlled trial. J Intern Med 2024; 295:620-633. [PMID: 38343089 DOI: 10.1111/joim.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is highly prevalent in haemodialysis (HD) patients and is associated with an increased risk of death. Roxadustat and recombinant human erythropoietin (rHuEPO, abbreviated as EPO) are the main treatment strategies for renal anaemia in HD patients, but it has not been clear whether there is a difference in their effect on LVH. METHODS In this multi-centre, prospective, randomized trial of 12-month duration, study participants were randomized in a 1:1 ratio to the roxadustat group or the EPO group. The doses of both treatment regimens were adjusted so that the patients had a haemoglobin level of 10.0-12.0 g per dL. The primary study endpoint was the change from baseline to 12 months in the left ventricular mass index (LVMI, g/m2) measured by echocardiography. RESULTS In total, 114 patients were enrolled. The mean age was 50 years, and the median dialysis duration was 33 months. Sixty-one patients were men, and 24 were diabetic. LVMI decreased from 116.18 ± 27.84 to 110.70 ± 25.74 g/m2 in the roxadustat group. However, it increased from 109.35 ± 23.41 to 114.99 ± 28.46 g/m2 in the EPO group, with a significant difference in the change in LVMI between the two groups [-5.48 (-11.60 to 0.65) vs. 5.65 (0.74 to 10.55), p < 0.05]. Changes in left ventricular mass, end-diastolic volume and 6-min walk test seemed superior in the roxadustat group. There were no significant differences in other cardiac geometry, biochemical parameters and major adverse cardiovascular events between the two groups. CONCLUSIONS Compared to EPO, roxadustat is more helpful in the regression of LVH in HD patients.
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Affiliation(s)
- Wei Tan
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Xiang Wang
- Department of Ultrasound, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Yudong Sun
- Department of Nephrology, Armed Police Chongqing Corps Hospital, Chongqing, China
| | - Xiaohui Wang
- Department of Nephrology, Jiulongpo's Traditional Chinese Medicine Hospital of Chongqing, Chongqing, China
| | - Jin He
- Department of Nephrology, Chonggang General Hospital, Chongqing, China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianhong Jiang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Yan Sun
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - En Tian
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Zhuoying Li
- Department of Nephrology, Armed Police Chongqing Corps Hospital, Chongqing, China
| | - Liangping He
- Department of Nephrology, Jiulongpo's Traditional Chinese Medicine Hospital of Chongqing, Chongqing, China
| | - Ying Hao
- Department of Nephrology, Chonggang General Hospital, Chongqing, China
| | - Bin Tang
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Hua
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Vizzuso S, Torto AD, Fiore G, Carugo S, Zuccotti G, Verduci E. Tri-ponderal mass index and left ventricular hypertrophy in a cohort of caucasian children and adolescents with obesity. Ital J Pediatr 2024; 50:75. [PMID: 38637874 PMCID: PMC11027303 DOI: 10.1186/s13052-024-01634-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Pediatric obesity is a global emerging burden for society; among its health-related consequences there are hypertension (HTN) and left ventricular hypertrophy (LVH). Several anthropometric indices have been investigated for the early identification of cardiovascular risk in children. The aim of the present study was to assess whether tri-ponderal mass index (TMI) was associated with LVH in a cohort of Caucasian children and adolescents with obesity. METHODS In this observational study, 63 children and adolescents with obesity aged 7-to-16 years were enrolled. During outpatient visits, adiposity, and cardio-metabolic indices (BMI z-score, WHR, TMI, ABSI) were collected. All subjects underwent a 24-hour ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography. RESULTS Children and adolescents with obesity with LVH had significantly higher BMI z-score (p = 0.009), WHR (p = 0.006) and TMI (p = 0.026) compared to children without LVH. WC and WHR were the only indices significantly associated with left ventricular mass index (LVMI). CONCLUSION Left ventricular remodeling is associated with the cardio-metabolic risk markers WC and WHR, but not with the adiposity index TMI among children with obesity.
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Affiliation(s)
- Sara Vizzuso
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy.
| | | | - Giulia Fiore
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Internal Medicine, Cardiology Unity, University of Milan, Fondazione Ospedale Maggiore IRCCS Policlinico Milano, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
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Wang C, Liang L, Luo S, Wang H, Wang X, Cheng Y, Pan G, Peng J, Han S, Wang X. Nomogram-based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers. J Clin Hypertens (Greenwich) 2024; 26:363-373. [PMID: 38430459 PMCID: PMC11007794 DOI: 10.1111/jch.14786] [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: 11/25/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.
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Affiliation(s)
- Chuang‐chang Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Li‐Keng Liang
- Yunkang school of medicine and healthNanfang CollegeGuangzhouChina
| | - Sheng‐ming Luo
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐Cheng Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xiao‐li Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Ya‐Hui Cheng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Guang‐ming Pan
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jiang‐Yang Peng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Shu‐jie Han
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xia Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
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Forså MI, Smedsrud MK, Haugaa KH, Bjerring AW, Früh A, Sarvari SI, Landgraff HW, Hallén J, Edvardsen T. Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents: a longitudinal observation study. Eur J Prev Cardiol 2024; 31:591-598. [PMID: 37992187 DOI: 10.1093/eurjpc/zwad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
AIMS Echocardiographic characteristics to distinguish physiological left ventricular (LV) hypertrophy from pathology are warranted in early adolescent athletes. This study aimed to explore the phenotype, progression, and potential grey zone of LV hypertrophy during adolescence in athletes and hypertrophic cardiomyopathy (HCM) genotype-positive patients. METHODS AND RESULTS In this longitudinal observation study, we compared seventy-six 12-year-old athletes with 55 age-matched and sex-matched HCM genotype-positive patients. Echocardiographic parameters were evaluated by using paediatric reference values (Z-scores). Hypertrophic cardiomyopathy genotype-positive patients were included if they had no or mild LV hypertrophy [maximum wall thickness <13 mm, Z-score <6 for interventricular septum diameter (ZIVSd), or posterior wall thickness]. We collected clinical data, including data on cardiac events. The mean follow-up-time was 3.2 ± 0.8 years. At baseline, LV hypertrophy was found in 28% of athletes and 21% of HCM genotype-positive patients (P = 0.42). Septum thickness values were similar (ZIVSd 1.4 ± 0.9 vs. 1.0 ± 1.3, P = 0.08) and increased only in HCM genotype-positive patients {ZIVSd progression rate -0.17 [standard error (SE) 0.05], P = 0.002 vs. 0.30 [SE 0.10], P = 0.001}. Left ventricular volume Z-scores (ZLVEDV) were greater in athletes [ZLVEDV 1.0 ± 0.6 vs. -0.1 ± 0.8, P < 0.001; ZLVEDV progression rate -0.05 (SE 0.04), P = 0.21 vs. -0.06 (SE 0.04), P = 0.12]. Cardiac arrest occurred in two HCM genotype-positive patients (ages 13 and 14), with ZIVSd 8.2-11.5. CONCLUSION Left ventricular hypertrophy was found in a similar proportion in early adolescence but progressed only in HCM genotype-positive patients. A potential grey zone of LV hypertrophy ranged from a septum thickness Z-score of 2.0 to 3.3. Left ventricular volumes remained larger in athletes. Evaluating the progression of wall thickness and volume may help clinicians distinguish physiological LV hypertrophy from early HCM.
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Affiliation(s)
- Marianne I Forså
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Marit K Smedsrud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo NO-0424, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Andreas Früh
- Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo NO-0424, Norway
| | - Sebastian I Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Hege W Landgraff
- Department of Physical Performance, Norwegian School of Sport Sciences, PO Box 4012 Ullevål stadion, Oslo NO-0806, Norway
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sport Sciences, PO Box 4012 Ullevål stadion, Oslo NO-0806, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
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Hurley SK, Vizthum D, Ducharme-Smith K, Kamath-Rayne BD, Brady TM. Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity. Clin Pediatr (Phila) 2024; 63:365-374. [PMID: 37326064 DOI: 10.1177/00099228231177286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Children born prematurely have greater lifetime risk for hypertension. We aimed to determine (1) the association between prematurity and cardiovascular disease (CVD) risk factors among 90 children with obesity and elevated blood pressure and (2) if dietary sodium intake modified these associations. Multivariable regression analysis explored for associations between prematurity (<37 weeks gestation; early gestational age) and low birth weight (<2.5 kg) with hypertension, left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Effect modification by dietary sodium intake was also explored. Patients were predominately male (60%), black (78%), adolescents (13.3 years), and with substantial obesity (body mass index: 36.5 kg/m2). Early gestational age/low birth weight was not an independent predictor for hypertension, LVMI, or LVH. There was no effect modification by sodium load. Our results suggest the increased CVD risk conferred by prematurity is less significant at certain cardiometabolic profiles. Promoting heart-healthy lifestyles to prevent pediatric obesity remains of utmost importance to foster cardiovascular health.
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Affiliation(s)
- Sara K Hurley
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Diane Vizthum
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Tammy M Brady
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Pediatrics, Baltimore, MD, USA
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Sebastian SA, Co EL, Kanagala SG, Padda I, Sethi Y, Johal G. Metabolic surgery in improving arterial health in obese individuals. Curr Probl Cardiol 2024; 49:102359. [PMID: 38128633 DOI: 10.1016/j.cpcardiol.2023.102359] [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: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Arterial stiffness has gained recognition as a stand-alone risk factor for cardiovascular disease (CVD). Obesity is intricately linked to elevated arterial stiffness, the development of left ventricular (LV) hypertrophy, and the emergence of diastolic dysfunction, all of which collectively contribute substantially to an unfavorable prognosis. Weight loss has become a standard recommendation for all patients with CVD concurrent with morbid obesity; however, randomized evidence to support this recommendation was limited earlier. The latest scientific studies revealed dynamic changes in aortic stiffness after substantial weight loss by bariatric surgery, also known as metabolic surgery, in patients with obesity. There is also a favorable evolution in LV hypertrophy and a significant impact on arterial hypertension and other promising cardiovascular outcomes in obese people after bariatric surgery. METHODS/RESULTS We aimed to examine the cardiovascular effects of various metabolic surgeries in morbidly obese individuals, especially their role in improving arterial health, the potential impact on surrogate markers of atherosclerotic vascular disease, and consequently reducing the likelihood of cardiovascular events. CONCLUSION In conclusion, metabolic surgery is associated with a significant decrease in the occurrence of major adverse cardiovascular events (MACE) and all-cause mortality among obese individuals, alongside remarkable enhancement of arterial health. These findings underscore the critical importance of implementing strategies to combat obesity and reduce adiposity within the general population.
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Affiliation(s)
| | - Edzel Lorraine Co
- Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Sai Gautham Kanagala
- Department of Internal Medicine, Metropolitan Hospital Center, New York, United States
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, United States
| | - Yashendra Sethi
- Department of Internal Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, India
| | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, United States
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Annaloro A, Invernizzi C, Aguilar F, Alvarez J, Cuspidi C, Grassi G, Lurbe E. Association Between Elevated Body Mass Index and Cardiac Organ Damage in Children and Adolescents: Evidence and Mechanisms. High Blood Press Cardiovasc Prev 2024; 31:167-175. [PMID: 38530573 PMCID: PMC11043137 DOI: 10.1007/s40292-024-00633-5] [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: 01/29/2024] [Accepted: 03/03/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage. AIM The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth. METHODS In 78 subjects aged 5-16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance. RESULTS Subjects mean age (± SD) amounted to 12.03 ± 2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r = 0.38, waist circumference (WC): r = 0.46, P < 0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group. CONCLUSIONS In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes.
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Affiliation(s)
- Alessandra Annaloro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Chiara Invernizzi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francisco Aguilar
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Julio Alvarez
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Empar Lurbe
- Ciber Fsiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
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Hiyamuta H, Yamada S, Nakano T, Taniguchi M, Masutani K, Tsuruya K, Kitazono T. Impact of Electrocardiographic Parameters on Sudden Death in Patients Receiving Maintenance Hemodialysis: Ten-Year Outcomes of the Q-Cohort Study. J Atheroscler Thromb 2024; 31:214-231. [PMID: 37730375 PMCID: PMC10918032 DOI: 10.5551/jat.64255] [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: 03/22/2023] [Accepted: 07/13/2023] [Indexed: 09/22/2023] Open
Abstract
AIM Sudden death is one of the most common causes of death among hemodialysis patients. Electrocardiography (ECG) is a noninvasive and inexpensive test that is regularly performed in hemodialysis clinics. However, the association between abnormal ECG findings and the risk of sudden death in hemodialysis patients is yet to be fully elucidated. Thus, the aim of this study was to determine the ECG parameters linked to sudden death in patients undergoing hemodialysis. METHODS The Q-Cohort Study is a multicenter, longitudinal, observational study of hemodialysis patients. In this study, 1,153 Japanese hemodialysis patients aged ≥ 18 years with ECG data recorded within 1 year of study enrollment were followed up for 10 years. Cox proportional hazards models were used to estimate the multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between ECG parameters and sudden death. RESULTS During the median follow-up period of 9.0 years, 517 patients died, 76 of whom exhibited sudden death. After adjusting for confounding factors, higher heart rate, QT prolongation, and left ventricular hypertrophy as per the Sokolow-Lyon voltage criteria were found to be independently associated with an increased risk of sudden death. The adjusted HRs [95% CIs] for each abnormal ECG parameter were 2.02 [1.05-3.89], 2.10 [1.30-1.77], and 1.91 [1.18-3.09], respectively. CONCLUSIONS Higher heart rate, QT prolongation, and left ventricular hypertrophy on ECG have been determined to be associated with an increased risk of sudden death. Therefore, regular ECG recording could enable medical practitioners to identify hemodialysis patients who require intervention to prevent lethal arrhythmia.
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Affiliation(s)
- Hiroto Hiyamuta
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Higashikuni Y, Liu W, Sata M. Nocturnal blood pressure and left ventricular hypertrophy in patients with diabetes mellitus. Hypertens Res 2024; 47:819-822. [PMID: 38148349 DOI: 10.1038/s41440-023-01562-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Yasutomi Higashikuni
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Wenhao Liu
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
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11
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Hill-Horowitz T, Merchant K, Abdullah M, Castellanos-Reyes L, Singer P, Dukkipati H, Frank R, Sethna CB, Basalely A. Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines. J Pediatr 2024; 266:113895. [PMID: 38154521 DOI: 10.1016/j.jpeds.2023.113895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To describe the epidemiology of reclassification of prehypertensive and unclassified adolescents by 2022 American Heart Association pediatric ambulatory blood pressure monitoring (ABPM) guidelines, and to evaluate the association of the new diagnostic categories with left ventricular hypertrophy (LVH). STUDY DESIGN A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH. RESULTS A majority of prehypertensive adolescents reclassified to hypertension (70%, n = 49/70). More than one-half (57%, n = 28/49) of the hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups. CONCLUSIONS The 2022 ABPM guidelines clearly define blood pressure phenotypes. However, reclassification to hypertension was not associated with an increased odds of LVH. Because most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.
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Affiliation(s)
- Taylor Hill-Horowitz
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY.
| | - Kumail Merchant
- Department of Pediatric Nephrology, NYU Langone Hospital, Long Island, Mineola, NY; NYU Long Island School of Medicine, Mineola, NY
| | - Mahie Abdullah
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Laura Castellanos-Reyes
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Pamela Singer
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Haripriya Dukkipati
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Rachel Frank
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY; Feinstein Institutes for Medical Research, Manhasset, NY; Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY
| | - Abby Basalely
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY; Feinstein Institutes for Medical Research, Manhasset, NY; Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY
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12
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Souffront K, P. Nelson B, Lukas M, Reyes Garay H, Gordon L, Matos T, Hanesworth I, Mantel R, Shubeck C, Bernstein C, T. Loo G, Richardson LD. Stage B Heart Failure Is Ubiquitous in Emergency Patients with Asymptomatic Hypertension. West J Emerg Med 2024; 25:160-165. [PMID: 38596912 PMCID: PMC11000548 DOI: 10.5811/westjem.17990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension. Method This was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York. Adult (≥18 years of age) English- or Spanish-speaking patients who had an initial blood pressure (BP) ≥160/100 millimeters of mercury (mmHg) and second BP ≥140/90 mm Hg, and pending discharge, were invited to participate in the study. We excluded patients with congestive heart failure, renal insufficiency, and atrial fibrillation, or who were pregnant, a prisoner, cognitively unable to provide informed consent, or experiencing symptoms of hypertension. We assessed echocardiographic evidence of subclinical heart disease (left ventricular hypertrophy, and diastolic and systolic dysfunction). Results A total of 53 patients were included in the study; a majority were young (mean 49.5 years old, [SD 14-52]), self-identified as Black or Other (n = 39; 73.5%), and female (n = 30; 56.6%). Mean initial blood pressure was 172/100 mm Hg, and 24 patients (45.3%) self-reported a history of hypertension. Fifty patients completed an echocardiogram. All (100%) had evidence of subclinical heart disease, with 41 (77.4%) displaying left ventricular hypertrophy and 31 (58.5%) diastolic dysfunction. There was a significant relationship between diastolic dysfunction and female gender [x2 (1, n = 53) = 3.98; P = 0.046]; Black or other race [x2 (3, n = 53) = 9.138; P = 0.03] and Hispanic or other ethnicity [x2 (2, n = 53) = 8.03; P = 0.02]. Less than one third of patients demonstrated systolic dysfunction on echocardiogram, and this was more likely to occur in patients with diabetes mellitus [x2 (1, n = 51) = 4.84; P = 0.02]. Conclusion There is a high probability that Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure. Emergency clinicians should provide individualized care that considers their unique health needs, cultural backgrounds, and social determinants of health.
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Affiliation(s)
- Kimberly Souffront
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
| | - Bret P. Nelson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Megan Lukas
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | | | - Lauren Gordon
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Thalia Matos
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Isabella Hanesworth
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Rebecca Mantel
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Claire Shubeck
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Cassidy Bernstein
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
| | - George T. Loo
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Lynne D. Richardson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
- Icahn School of Medicine at Mount Sinai, Department of Artificial Intelligence and Human Health, New York
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13
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Dobre MA, Ahlawat S, Schelling JR. Chronic kidney disease associated cardiomyopathy: recent advances and future perspectives. Curr Opin Nephrol Hypertens 2024; 33:203-211. [PMID: 38193308 PMCID: PMC10872957 DOI: 10.1097/mnh.0000000000000952] [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] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Cardiomyopathy in chronic kidney disease (CKD) is a complex condition with multiple triggers and poor prognosis. This review provides an overview of recent advances in CKD-associated cardiomyopathy, with a focus on pathophysiology, newly discovered biomarkers and potential therapeutic targets. RECENT FINDINGS CKD is associated with a specific pattern of myocardial hypertrophy and fibrosis, resulting in diastolic and systolic dysfunction, and often triggered by nonatherosclerotic processes. Novel biomarkers, including amino-terminal type III procollagen peptide (PIIINP), carboxy-terminal type I procollagen peptide (PICP), FGF23, marinobufagenin, and several miRNAs, show promise for early detection and risk stratification. Treatment options for CKD-associated cardiomyopathy are limited. Sodium glucose cotransporter-2 inhibitors have been shown to reduce left ventricle hypertrophy and improve ejection fraction in individuals with diabetes and mild CKD, and are currently under investigation for more advanced stages of CKD. In hemodialysis patients calcimimetic etelcalcetide resulted in a significant reduction in left ventricular mass. SUMMARY CKD-associated cardiomyopathy is a common and severe complication in CKD. The identification of novel biomarkers may lead to future therapeutic targets. Randomized clinical trials in individuals with more advanced CKD would be well posed to expand treatment options for this debilitating condition.
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Affiliation(s)
- Mirela A Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
- School of Medicine
| | - Shruti Ahlawat
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
| | - Jeffrey R Schelling
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
- School of Medicine
- Department of Physiology & Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
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14
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Frenzel S, Bülow R, Dörr M, Felix SB, Friedrich N, Völzke H, Wittfeld K, Grabe HJ, Bahls M. Left ventricular hypertrophy as a risk factor for accelerated brain aging: Results from the Study of Health in Pomerania. Hum Brain Mapp 2024; 45:e26567. [PMID: 38391110 PMCID: PMC10885183 DOI: 10.1002/hbm.26567] [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: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024] Open
Abstract
Previous studies provided evidence for the importance of cardiac structure abnormalities, in particular greater left ventricular (LV) mass, for brain aging, but longitudinal studies are lacking to date. We included 926 individuals (median age 48 years; 53% women) from the TREND cohort of the Study of Health in Pomerania (SHIP) without reduced ejection fraction or a history of myocardial infarction. LV mass index (LVMI) was determined by echocardiography at baseline. Brain morphometric measurements were derived from magnetic resonance images at baseline and 7-year follow-up. Direct effects of baseline LVMI on brain morphometry at follow-up were estimated using linear regression models with adjustment for baseline brain morphometry. At baseline, median LVMI was 40 g/m2.7 and 241 individuals (26%) met the criterion of LV hypertrophy. After correction for multiple testing, baseline LVMI was directly associated with reduced global cortical thickness and increased cortical brain age at follow-up independent from hypertension and blood pressure. Exposure-outcome relations were nonlinear and significantly stronger in the upper half of the exposure distribution. Specifically, an increase in baseline LVMI from the 50% quantile to the 95% quantile was associated additional 2.7 years (95% confidence interval = [1.5 years, 3.8 years]) of cortical brain age at follow-up. Additional regional analyses yielded bilateral effects on multiple frontal cortical regions. Our findings highlight the role of cardiac structure in brain aging. LVMI constitutes an easily measurable marker that might help to identify persons at risk for cognitive impairment and dementia.
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Affiliation(s)
- Stefan Frenzel
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Robin Bülow
- Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Marcus Dörr
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- Institute of Clinical Chemistry and Laboratory MedicineUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Hans J. Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Martin Bahls
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
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15
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Mba IN, Basil B, Myke-Mbata B, Olayanju OA, Faleye A, Adebisi SA. Kidney Function in Hypertensive Patients with Left Ventricular Hypertrophy. West Afr J Med 2024; 41:30-35. [PMID: 38412104] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Impairment of kidney function is one of the long-term sequelae of hypertension and it contributes to increased morbidity and mortality in hypertensive patients. Left ventricular hypertrophy (LVH) is a common complication of hypertension which can worsen the outcome in affected patients. This study was designed to compare kidney function in hypertensive patients with LVH with that in hypertensive patients without LVH. METHODS The study was conducted among hypertensive patients attending cardiology clinics at two tertiary hospitals in Nigeria. A questionnaire was used to obtain demographic and clinical information from the participants. Kidney function was determined by measuring serum urea and creatinine, urinary creatinine and microalbumin. Echocardiography was performed to detect LVH. Results of kidney function tests were compared between participants who had LVH and those who did not. RESULTS Of the 105 participants recruited, 58 (55.2%) were males. The median age of all participants was 52 (interquartile range (IQR) 40-61) years and LVH was confirmed in 48 (45.7%) of them. Participants with LVH were older (55 vs 49 years; p=0.02) but had lower weight (74 vs 78 kg; p=0.04). Participants without LVH had higher microalbuminuria (5.2 vs 4.05 mg/dl; p=0.03), lower estimated glomerular filtration rate (62 vs 92 ml/min/1.73 m2; p=0.004), and higher stages of CKD. CONCLUSION Hypertensive patients with LVH had lower levels of microalbuminuria, higher estimated GFR, and lower stages of CKD compared to those with no LVH.
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Affiliation(s)
- I N Mba
- Department of Chemical Pathology, Nile University of Nigeria, Abuja, Nigeria
| | - B Basil
- Department of Chemical Pathology, Benue State University, Markurdi, Nigeria
| | - B Myke-Mbata
- Department of Chemical Pathology, Benue State University, Markurdi, Nigeria
| | - O A Olayanju
- Department of Chemical Pathology, Benjamin Carson College of Medical and Health Sciences, Ilisan, Nigeria. E-mail:
- Department of Chemical Pathology Babcock University Teaching Hospital, Ilisan, Nigeria
| | - A Faleye
- Department of Chemical Pathology, Benjamin Carson College of Medical and Health Sciences, Ilisan, Nigeria. E-mail:
- Department of Chemical Pathology Babcock University Teaching Hospital, Ilisan, Nigeria
| | - S A Adebisi
- Department of Chemical Pathology, Benue State University, Markurdi, Nigeria
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16
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Akhan O, Kış M, Güzel T, Zoghi M. Differences Between Two Distinct Hypertrophic Cardiac Conditions: Fabry Disease versus Hypertrophic Cardiomyopathy. Arq Bras Cardiol 2024; 121:e20230229. [PMID: 38324858 DOI: 10.36660/abc.20230229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/25/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and Fabry disease (FD) are genetically inherited diseases with left ventricular hypertrophy (LVH) phenotype characteristics that cause adverse cardiac outcomes. OBJECTIVES To investigate the demographic, clinical, biochemical, electrocardiographic (ECG), and echocardiographic (ECHO) differences between HCM and FD. METHODS 60 HCM and 40 FD patients were analyzed retrospectively as a subanalysis of the 'LVH-TR study' after excluding patients with atrial fibrillation, pace rhythm, bundle branch blocks, and second and third-degree atrioventricular (AV) blocks. The significance level was accepted as <0.05. RESULTS Male gender (p=0.048) and creatinine (p=0.010) are significantly higher in favor of FD; however, ST depression (p=0.028), QT duration (p=0.041), interventricular septum thickness (IVSd) (p=0.003), posterior wall thickness (PWd) (p=0.009), moderate-severe mitral regurgitation (MR) (p=0.013), and LV mass index (LVMI) (p=0.041) are significantly higher in favor of HCM in the univariate analyses. In multivariate analysis, statistical significance only continues in creatinine (p=0.018) and QT duration (0.045). FD was positively correlated with creatinine (rho=0.287, p=0.004) and HCM was positively correlated with PWd (rho=0.306, p=0.002), IVSd (rho=0.395, p<0.001), moderate-severe MR (rho=0.276, p<0.005), LVMI (rho=0.300, p=0.002), relative wall thickness (RWT) (rho=0.271, p=0.006), QT duration (rho=0.213, p=0.034) and ST depression (rho=0.222, p=0.026). CONCLUSION Specific biochemical, ECG, and ECHO characteristics can aid in the differentiation and early diagnosis of HCM and FD.
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Affiliation(s)
- Onur Akhan
- Bilecik Training and Research Hospital - Cardiology, Bilecik - Turquia
| | - Mehmet Kış
- Dokuz Eylul University Faculty of Medicine - Cardiology, Izmir - Turquia
| | - Tuncay Güzel
- Health Science University , Gazi Yasargil Training and Research Hospital - Cardiology, Diyarbakır - Turquia
| | - Mehdi Zoghi
- Ege University Faculty of Medicine - Cardiology, Izmir - Turquia
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17
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Lluch-Requerey C, Montilla-Garrido MA, Morgado-García-Polavieja JI, Gragera-Martínez Á, Gómez-Menchero A. Left ventricular hypertrophy. Is there only hypertrophic cardiomyopathy? Arch Cardiol Mex 2024; 94:123-126. [PMID: 38507316 DOI: 10.24875/acm.22000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/07/2023] [Indexed: 03/22/2024] Open
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18
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Sager P, Rusch A, Weber L, Breuss A, Appert S, Brenner R, Buser M, Ammann P, Rickli H, Maeder MT. ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long-term mortality. Clin Cardiol 2024; 47:e24155. [PMID: 37740622 PMCID: PMC10765998 DOI: 10.1002/clc.24155] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND In aortic stenosis (AS), left ventricular hypertrophy (LVH) is the response to pressure overload and represents the substrate for a maladaptive cascade, the so-called AS-related cardiac damage. We hypothesized that in AS patients electrocardiogram (ECG) LVH not only predicts echocardiography LVH but also other noninvasive and invasive markers of cardiac damage and prognosis after aortic valve replacement (AVR). METHODS In 279 patients with severe AS undergoing ECG, echocardiography, and cardiac catheterization before AVR, the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score were assessed. RESULTS The mean left ventricular mass index was 109 ± 34 g/m2 , and 131 (47%) patients had echocardiography LVH. The areas under the receiver operator characteristics curve (AUC) for the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score for the prediction of echocardiography LVH were 0.59, 0.70, 0.63, and 0.65. The Peguero-Lo Presti score had the numerically greatest AUC for the prediction of left ventricular end-diastolic pressure >15 mmHg, mean pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance >3 Wood units, mean right atrial pressure >14 mmHg, and stroke volume index <31 mL/m2 . After a median follow-up of 1365 (interquartile range: 931-1851) days after AVR only the Peguero-Lo Presti score was significantly associated with all-cause mortality [hazard ratio: 1.24 (95% confidence interval: 1.01-1.54); per 1 mV increase; p = .045]. CONCLUSIONS Among severe AS patients, the Peguero-Lo Presti score is associated with abnormalities in cardiac structure including LVH, invasive measures of cardiac damage, and long-term mortality after AVR.
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Affiliation(s)
- Patrizia Sager
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- University of BaselBaselSwitzerland
| | - Andreas Rusch
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- Department of CardiologyKantonsspital MünsterlingenMünsterlingenSwitzerland
| | - Lukas Weber
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Alexander Breuss
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Sharon Appert
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Roman Brenner
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Marc Buser
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Peter Ammann
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Hans Rickli
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Micha T. Maeder
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- University of BaselBaselSwitzerland
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19
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Hudson ER, Weil BR. Porcine Model of Hypertrophy-Independent Left Ventricular Stiffening via Repetitive Pressure Overload. Methods Mol Biol 2024; 2803:205-217. [PMID: 38676895 DOI: 10.1007/978-1-0716-3846-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Diastolic dysfunction arising from alterations in myocardial structure and/or function is a central component of several cardiovascular disorders, including heart failure with preserved ejection fraction (HFpEF). Basic research aimed at understanding underlying mechanisms contributing to the development of diastolic dysfunction has generally centered upon models of left ventricular (LV) hypertrophy arising from persistent and severe elevations in myocardial afterload (e.g., aortic banding). Mechanisms of hypertrophy-independent diastolic dysfunction, on the other hand, have received less attention, even though overt anatomic LV hypertrophy is absent in many HFpEF patients. Here, we describe the development of a novel porcine model of repetitive pressure overload (RPO) in which chronic, intermittent exposure to transient episodes of hypertension produces an increase in LV stiffness, interstitial fibrosis, cardiomyocyte hypertrophy, and capillary rarefaction without significant changes in LV mass. This model offers important insight into how diastolic dysfunction and HFpEF may develop in the absence of comorbidities, sustained hypertension, or LV hypertrophy, while also providing a useful translational research tool for investigation of novel therapeutic approaches to restore myocardial compliance and improve diastolic function.
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Affiliation(s)
| | - Brian R Weil
- The Department of Physiology & Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
- Clinical Translational Research Center, Buffalo, NY, USA.
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20
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Kiuchi S, Ikeda T. The Prevention of the New Onset of Heart Failure in Hypertensive Patients. Intern Med 2024; 63:11-15. [PMID: 36261381 PMCID: PMC10824648 DOI: 10.2169/internalmedicine.0799-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
In 2014, Japan was estimated to have approximately 27 million patients with hypertension (HT), and the ultimate goal of treatment is to prevent complications of HT, including heart failure (HF). The major structural changes in the heart that cause HF are left ventricular (LV) hypertrophy (LVH) and the resulting LV diastolic dysfunction. However, in patients with HT with well-controlled blood pressure (BP), whether they are in HF stage A (only HT) or B (with organic heart disease) is often unclear. It has been reported that strict BP control suppresses LVH, and the improvement of LVH leads to the suppression of cardiovascular complications. Thus, detecting HF stage B HT and providing appropriate treatment lead to the suppression of HF onset. This review focuses on the detection and treatment of organic heart disease in HT.
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Affiliation(s)
- Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
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Ridder A, O'Driscoll J, Khalil A, Thilaganathan B. Routine first-trimester pre-eclampsia screening and maternal left ventricular geometry. Ultrasound Obstet Gynecol 2024; 63:75-80. [PMID: 37448160 DOI: 10.1002/uog.26306] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a pregnancy complication associated with premature cardiovascular disease morbidity and mortality (i.e. before 60 years of age or in the first year postpartum). PE is associated with adverse left ventricular (LV) remodeling in the peri- and postpartum periods, an independent risk factor for cardiovascular disease. This study aimed to compare LV geometry by LV mass (LVM) and LVM index (LVMI) between participants with a high vs low screening risk for preterm PE in the first trimester. METHODS This was a prospective cohort study of singleton pregnancies between 11 + 0 and 13 + 6 weeks' gestation that underwent screening for preterm PE as part of their routine first-trimester ultrasound assessment at a tertiary center in London, UK, from February 2019 until March 2020. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm. Participants with a screening risk of ≥ 1 in 50 for preterm PE were classified as high risk and those with a screening risk of ≤ 1 in 500 were classified as low risk. All participants underwent two-dimensional and M-mode transthoracic echocardiography. RESULTS A total of 128 participants in the first trimester of pregnancy were included in the analysis, with 57 (44.5%) participants screened as low risk and 71 (55.5%) participants as high risk for PE. The risk groups did not vary in maternal age and gestational age at assessment. Maternal body surface area and body mass index were significantly higher in the high-risk group (all P < 0.05). The high-risk participants were significantly more likely to be Afro-Caribbean, nulliparous and have a family history of hypertensive disease in pregnancy as well as other cardiovascular disease (all P < 0.05). In addition, mean arterial blood pressure (P < 0.001), mean heart rate (P < 0.001), median LVM (130.06 (interquartile range, 113.62-150.50) g vs 97.44 (81.68-114.16) g; P < 0.001) and mean LVMI (72.87 ± 12.2 g/m2 vs 57.54 ± 12.72 g/m2 ; P < 0.001) were significantly higher in the high-risk group. Consequently, those in the high-risk group were more likely to have abnormal LV geometry (37.1% vs 7.0%; P < 0.001). CONCLUSIONS Early echocardiographic assessment in participants at high risk of preterm PE may unmask clinically healthy individuals who are at increased risk for future cardiovascular disease. Adverse cardiac remodeling in the first trimester of pregnancy may be an indicator of decreased cardiovascular reserve and subsequent dysfunctional cardiovascular adaptation in pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Ridder
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Fabi M, Meli M, Leardini D, Andreozzi L, Maltoni G, Bitelli M, Pierantoni L, Zarbo C, Dondi A, Bertulli C, Bernardini L, Pession A, Lanari M. Body Mass Index (BMI) Is the Strongest Predictor of Systemic Hypertension and Cardiac Mass in a Cohort of Children. Nutrients 2023; 15:5079. [PMID: 38140337 PMCID: PMC10745364 DOI: 10.3390/nu15245079] [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: 10/17/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage. AIM The aim of this study is to investigate cardiac damage in HTN, its risk factors (RFs), and evolution. METHODS We conducted a prospective/retrospective study involving children referred to the Childhood Hypertension Outpatient Clinic. This study included clinical and echocardiographic assessments of cardiac morphology and function at three time points: enrollment (T0) and follow-up (T1 and T2). RESULTS Ninety-two patients (mean age 11.4 ± 3 years) were enrolled. Cardiac eccentric and concentric hypertrophy were present in 17.9% and 9%, respectively, with remodeling in 10.5%. Overweight/obese subjects exhibited significantly higher systolic blood pressure (SBP), frequency of HTN, and body mass index (BMI) at T0 compared with patients with chronic kidney disease (CKD). SBP and BMI persisted more during follow-up. Normal-weight vs. overweight/obese patients were significantly more likely to have normal geometry. Positive correlations were found between BMI and left ventricular (LV) mass at T0, BMI and SBP at T0 and T1. Gender, BMI, SBP, and diastolic blood pressure (DBP) significantly predicted LV mass index (LVMI), but only BMI added significance to the prediction. During follow-up, the variation of BMI positively correlated with the variation of SBP, but not with LVMI. CONCLUSIONS In our cohort, body weight is strongly associated with HTN and cardiac mass. Importantly, the variation in body weight has a more significant impact on the consensual variation of cardiac mass than blood pressure (BP) values. A strict intervention on weight control through diet and a healthy lifestyle from early ages might reduce the burden of CV morbidity in later years.
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Affiliation(s)
- Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.A.); (L.P.); (A.D.); (M.L.)
| | - Matteo Meli
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.B.); (C.Z.); (L.B.)
| | - Davide Leardini
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Laura Andreozzi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.A.); (L.P.); (A.D.); (M.L.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (A.P.)
| | - Maria Bitelli
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.B.); (C.Z.); (L.B.)
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.A.); (L.P.); (A.D.); (M.L.)
| | - Chiara Zarbo
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.B.); (C.Z.); (L.B.)
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.A.); (L.P.); (A.D.); (M.L.)
| | - Cristina Bertulli
- Pediatric Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (A.P.)
| | - Luca Bernardini
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (M.B.); (C.Z.); (L.B.)
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (A.P.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (L.A.); (L.P.); (A.D.); (M.L.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
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Mingalimova AR, Nefedova GA, Drapkina OM. Predictors of Atrial Fibrillation Developing in Hospital Stage After Coronary Artery Bypass Surgery. Kardiologiia 2023; 63:21-28. [PMID: 38088109 DOI: 10.18087/cardio.2023.11.n2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023]
Abstract
Aim To identify independent predictors associated with in-hospital atrial fibrillation (AF) following coronary artery bypass grafting (CABG).Material and methods The study included 80 patients (88.75 % men) who had elective CABG surgery at the Sklifosovsky Research Institute of Emergency Medicine. Based on the development of AF during the hospital stage of treatment (up to 10 days after CABG surgery), patients were divided into two groups. The group with AF consisted of 19 patients, and the group without AF consisted of 61 patients. All patients underwent electrocardiography (ECG), transthoracic echocardiography (EchoCG) with calculation of the left ventricular (LV) geometry type, and assessment of operational indexes. During surgery, biopsy of a part of the right atrial (RA) appendage was taken from 61 patients to verify the severity of myocardial fibrosis on a four-score scale where 0 is no interstitial fibrosis, 1 is slight fibrosis, 2 is moderate fibrosis, and 3 is severe fibrosis.Results All included patients had a low risk of developing postoperative complications according to the EuroSCORE II scale. According to EchoCG data, patients with AF had significantly higher ratios of left ventricular myocardial mass to body surface area (LVMM / BSA) (p = 0.0006) and of left atrial volume to body surface area (LA volume / BSA), p = 0.008). The distribution of patients by type of LV geometry was as follows: in the group with AF, 52.63 % (n=10) of patients were diagnosed with concentric LV hypertrophy (LVH) whereas in the group without AF, the majority of patients (83.60 %, n=51) had normal LV geometry and concentric LV remodeling (LVR) (p<0.0001). According to the results of histological study, patients of the AF group more frequently had moderate and severe interstitial fibrosis in the AF appendage (p = 0.003). After multivariate regression and ROC analysis, the predictive value remained for concentric LVH (p=0.002), LVMM / BSA ratio ≥97 g / m2 (p=0.006), LA volume / BSA ratio ≥ 34.4 ml / m2 (p=0.04), and for RA appendage interstitial fibrosis score ≥2 (p=0.004). Based on the identified predictors, a regression model was developed to predict the development of AF at the hospital stage after CABG (p<0.0001). The sensitivity and specificity of the model were 86.67 % and 78.26 %, respectively.Conclusion In patients at low perioperative risk, the LVMM / BSA ratio ≥97 g / m2, the LA volume ratio / BSA ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG operation.Conclusion In patients at low perioperative risk, a LVMM / BSA ratio ≥97 g / m2, a LA volume / BSA ratio ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG.
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Affiliation(s)
- A R Mingalimova
- National Medical Research Center of Therapy and Preventive Medicine
| | - G A Nefedova
- Sklifosovsky Research Institute for Emergency Medicine
| | - O M Drapkina
- National Medical Research Center of Therapy and Preventive Medicine
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Zhong C, Chen YL, Yu XX, Yang Q, Shi YQ, Tan LW, Wang AS, Wu DQ, Zhang GF, Yang HP, Li Q, Wang M. [Analysis of etiology and complications in children with stage 5 chronic kidney disease]. Zhonghua Er Ke Za Zhi 2023; 61:1109-1117. [PMID: 38018048 DOI: 10.3760/cma.j.cn112140-20230728-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Objective: To investigate the etiology, complications, and prognostic factors of stage 5 chronic kidney disease (CKD5) in children. Methods: A case series study was conducted to retrospectively analyze the general situation, clinical manifestations, laboratory tests, genetic testing, and follow-up data (until October 2022) of 174 children with CKD5 who were diagnosed and hospitalized at the Children's Hospital of Chongqing Medical University from April 2012 to April 2021. The characteristics of complications in the children were compared based on age, gender, and etiology. Based on the presence or absence of left ventricular hypertrophy (LVH), patients were divided into LVH group and non LVH group for analyzing the influencing factors of cardiovascular disease. Patients were also divided into death group and survival group, peritoneal dialysis group and hemodialysis group based on the follow-up data for analyzing the prognostic factors. The chi-square test, independent sample t-test, Fisher exact probability test, Mann-Whitney U test and Kruskal Wallis test were used to analyze data among different groups. Multivariate Logistic regression analysis was used to identify the prognostic factors. Results: A total of 174 children with CKD5 were enrolled in the study (96 boys and 78 girls), aged 11.2 (8.2, 13.0) years. Congenital kidney and urinary tract malformations (CAKUT) were the most common causes of the CKD5 (84 cases, 48.3%), followed by glomerular diseases (83 cases, 47.7%), and among which 28 cases (16.1%) were hereditary glomerular diseases. The common complications of CKD5 included anemia (98.2%, 165/168), mineral and bone disorder in chronic kidney disease (CKD-MBD) (97.7%, 170/174), lipid metabolism disorders (87.5%, 63/72), hypertension (81.4%, 127/156) and LVH (57.6%,57/99). The incidences of hypertension in primary glomerular disease were higher than that in CAKUT(93.8%(30/32) vs.73.7%(56/76),χ2=5.59,P<0.05). The incidences of hypertension in secondary glomerular disease were higher than that in CAKUT and that in hereditary kidney disease (100.0%(20/20) vs. 73.7%(56/76), 68.2%(15/22), both P<0.05). The incidence of hypocalcemia in CAKUT, primary glomerular disease, and hereditary kidney disease was higher than that in secondary glomerular disease (82.1%(69/84), 88.2%(30/34), 89.3%(25/28) vs. 47.6%(10/21), χ2=10.21, 10.75, 10.80, all P=0.001); the incidence of secondary hyperparathyroidism in women was higher than that in men (80.0%(64/80) vs. 95.0%(57/60), χ2=6.58, P=0.010). The incidence of LVH in children aged 6-<12 was higher than that in children aged 12-18 (73.5%(25/34) vs. 43.1%(22/51), χ2=7.62, P=0.006). Among 113 follow-up children, the mortality rate was 39.8% (45/113). Compared to the survival group, the children in the death group had lower hemoglobin, higher blood pressure, lower albumin, lower alkaline phosphatase and higher left ventricular mass index ((67±19) vs. (75±20) g/L, 142 (126, 154) vs. 128(113, 145) mmHg(1 mmHg=0.133 kPa), (91±21) vs. (82±22) mmHg, 32 (26, 41) vs. 40 (31, 43) g/L, 151 (82, 214) vs. 215 (129, 37) U/L, 48 (38, 66) vs. 38(32, 50) g/m2.7,t=2.03, Z=2.89, t=2.70, Z=2.49, 2.79, 2.29,all P<0.05), but no independent risk factors were identified (all P>0.05). The peritoneal dialysis group had better alleviation for anemia, low calcium, and high phosphorus than the hemodialysis group ((87±22) vs. (72±16) g/L, (1.9±0.5) vs. (1.7±0.4) mmol/L, (2.2±0.7) vs. (2.8±0.9) mmol/L, t=2.92, 2.29, 2.82, all P<0.05), and the survival rate of the peritoneal dialysis group was significantly higher than that of the hemodialysis group (77.8% (28/36) vs. 48.4% (30/62), χ2=8.14, P=0.004). Conclusions: CAKUT is the most common etiology in children with CKD 5, and anemia is the most common complication. The incidence of complications in children with CKD 5 varies with age, gender and etiology. Anemia, hypertension, hypoalbuminemia, reduced alkaline phosphatase and elevated LVMI may be the prognostic factors in children with CKD5. Peritoneal dialysis may be more beneficial for improving the long-term survival rate.
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Affiliation(s)
- C Zhong
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Y L Chen
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - X X Yu
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Q Yang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Y Q Shi
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - L W Tan
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - A S Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - D Q Wu
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - G F Zhang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - H P Yang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Q Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - M Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Genovesi S, Tassistro E, Giussani M, Antolini L, Lieti G, Orlando A, Montemerlo M, Patti I, Parati G. Association between lifestyle modifications and improvement of early cardiac damage in children and adolescents with excess weight and/or high blood pressure. Pediatr Nephrol 2023; 38:4069-4082. [PMID: 37349569 PMCID: PMC10584714 DOI: 10.1007/s00467-023-06034-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND It is not known whether, in children and adolescents with alterations in weight and/or blood pressure (BP), lifestyle modifications are associated with an improvement of early cardiac damage. METHODS In a pediatric population referred for excess weight, high BP, or both (n = 278, 10.6 (2.3) years), echocardiography was performed at enrollment and after 15 months of follow-up, during which participants received nonpharmacological treatment, based on correcting unhealthy lifestyles and improving dietary habits. Left ventricular mass was indexed for height (g/m2.7, LVMI), and an LVMI value higher than or equal to age- and gender-specific 95th percentile was the criterion for defining left ventricular hypertrophy (LVH). Multiple linear and logistic regression analyses were carried out to determine associations between changes in BMI and BP z-scores and changes of LVMI values and LVH prevalence, from baseline to follow-up. RESULTS At baseline, 33.1% of study participants were hypertensive, 52.9% obese, and 36.3% had LVH. At follow-up, the prevalence of hypertension, obesity, and LVH was 18.7%, 30.2%, and 22.3%, respectively (p < 0.001 for all). A decrease in LVMI from 37.1 to 35.2 g/m2.7 (p < 0.001) was observed. Only delta BMI z-score positively related to an improvement of LVMI. Reductions of BMI (OR = 0.22, 95% CI 0.07-0.64) and diastolic BP (OR = 0.64, 95% CI 0.42-0.93) z-scores from baseline to follow-up and family history of hypertension (OR = 0.36, 95% CI 0.16-0.78) were associated with a lower prevalence of LVH. CONCLUSIONS In a pediatric population at cardiovascular risk, changing incorrect lifestyle and dietary habits is associated with both reduction of BMI and BP values and regression of early cardiac damage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy.
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100, Milan, Italy.
| | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy
| | - Marco Giussani
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100, Milan, Italy
| | - Laura Antolini
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy
| | - Antonina Orlando
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100, Milan, Italy
| | - Massimo Montemerlo
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100, Milan, Italy
| | - Ilenia Patti
- School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, 20100, Milan, Italy
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100, Milan, Italy
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Liu Y, Lin Y, Huang X, Li Y, Liu Y, Shi L. Association of serum transforming growth factor β 1 with left ventricular hypertrophy in children with primary hypertension. Eur J Pediatr 2023; 182:5439-5446. [PMID: 37755472 PMCID: PMC10746758 DOI: 10.1007/s00431-023-05219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/31/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
The current study was designed to assess the association of serum transforming growth factor β1 (TGF-β1) with left ventricular hypertrophy (LVH) in children with primary hypertension. The present single-center prospective trial examined 182 patients diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics, between January 2021 and September 2022. Clinical data were analyzed, and ambulatory blood pressure was assessed for 24 h. LVH, the commonest subclinical cardiac feature of hypertension, was assessed by echocardiography. According to left ventricular geometry, cases were assigned to the LVH (n = 44) and normal geometry (n = 138) groups. Serum TGF-β1 amounts were quantitated by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were established to analyze various variables for their predictive values in LVH. Among 182 children with primary hypertension, the concentrations of serum TGF-β1 were higher in stage 2 hypertension than in stage 1 (47.3 (38.8, 52.5) vs. 46.0 (38.6, 48.2) ng/L, Z = - 2.376; P = 0.018). Additionally, serum TGF-β1 content showed a positive correlation with BP levels (P < 0.05). TGF-β1 amounts were significantly elevated in the LVH group compared with the normal geometry group (51.7 (46.1, 54.9) vs. 46.1 (38.7, 48.1) ng/L, Z = - 4.324; P = 0.0000). Serum TGF-β1 content was positively associated with LVH (r = 0.321, P = 0.0000). Multivariable logistic regression analysis showed BMI (OR = 1.188, 95% CI 1.082-1.305; P = 0.0000) and elevated serum TGF-β1 content (OR = 1.063, 95% CI 1.016-1.113; P = 0.009) independently predicted LVH. A multivariable logistic regression model considering BMI and TGF-β1 content in LVH prediction was 0.771, with sensitivity and specificity of 72.7% and 70.3%, respectively. CONCLUSION These data revealed an association of serum TGF-β1 with BP in children with primary hypertension. Serum TGF-β1 concentration was positively correlated with hypertensive cardiac damage. Serum TGF-β1 might constitute a valuable molecular marker for the prediction of LVH in children with primary hypertension. The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension, which may provide a new reference index for early clinical identification of hypertensive cardiac damage. WHAT IS KNOWN • Experimental and clinical data indicated TGF-β1 is involved in BP elevation. • TGF-β1 is positively correlated with LVMI and hypertrophy in adults. WHAT IS NEW • Our current study reveals an association of serum TGF-β1 with BP in children with primary hypertension. • Elevated serum TGF-β1 level is positively associated with LVH in children with primary hypertension. • The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension.
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Affiliation(s)
- Yang Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaolan Huang
- Central Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Yaqi Li
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yanyan Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Lin Shi
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
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27
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Gould A, Ambrosini I, Masci PG, Mcnally RJ, Chowienczyk PJ, Faconti L. "Resistant hypertension, catecholamine excess, left ventricular hypertrophy and systolic dysfunction: hypertensive cardiomyopathy?". J Hum Hypertens 2023; 37:1129-1130. [PMID: 37568006 DOI: 10.1038/s41371-023-00852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/14/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Allon Gould
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ilaria Ambrosini
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London Guy's and St Thomas NHS Trust Foundation, London, UK
| | - Ryan John Mcnally
- School of Cardiovascular Medicine & Sciences, King's College London Guy's and St Thomas NHS Trust Foundation, London, UK
| | - Philip J Chowienczyk
- School of Cardiovascular Medicine & Sciences, King's College London Guy's and St Thomas NHS Trust Foundation, London, UK
| | - Luca Faconti
- School of Cardiovascular Medicine & Sciences, King's College London Guy's and St Thomas NHS Trust Foundation, London, UK.
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28
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Kusumi K, Raina R, Samuels J, Tibrewal A, Furth S, Mitsnefes M, Devineni S, Warady BA. Evidence of increased vascular stiffness and left ventricular hypertrophy in children with cystic kidney disease. Pediatr Nephrol 2023; 38:4093-4100. [PMID: 37428222 DOI: 10.1007/s00467-023-06081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most common cause of mortality in chronic kidney disease (CKD). Children with early-onset CKD arguably experience the greatest lifetime CVD burden. We utilized data from the Chronic Kidney Disease in Children Cohort Study (CKiD) to evaluate two pediatric CKD cohorts: congenital anomalies of the kidney and urinary tract (CAKUT) and cystic kidney disease for CVD risks and outcomes. METHODS CVD risk factors and outcomes including blood pressures, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and ambulatory arterial stiffness index (AASI) scores were evaluated. RESULTS Forty-one patients in the cystic kidney disease group were compared to 294 patients in the CAKUT group. Cystic kidney disease patients had higher cystatin-C levels, despite similar iGFR. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) indexes were higher in the CAKUT group, but a significantly higher proportion of cystic kidney disease patients was on anti-hypertensive medications. Cystic kidney disease patients had increased AASI scores and a higher incidence of LVH. CONCLUSIONS This study provides a nuanced analysis of CVD risk factors and outcomes including AASI and LVH in two pediatric CKD cohorts. Cystic kidney disease patients had increased AASI scores, higher incidence of LVH, and higher rates of anti-hypertensive medication use which could imply a greater burden of CVD despite similar GFR. Our work suggests that additional mechanisms may contribute to vascular dysfunction in cystic kidney disease, and that these patients may need additional interventions to prevent the development of CVD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Kirsten Kusumi
- Division of Nephrology, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Rupesh Raina
- Division of Nephrology, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA.
- Northeast Ohio Medical University, Rootstown, OH, USA.
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, USA.
| | - Joshua Samuels
- Division of Pediatric Nephrology and Hypertension, University of Texas Medical School at Houston, Houston, TX, USA
| | - Abhishek Tibrewal
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, USA
| | - Susan Furth
- Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | - Mark Mitsnefes
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Bradley A Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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29
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Volpe M, Gallo G. Hypertension, coronary artery disease and myocardial ischemic syndromes. Vascul Pharmacol 2023; 153:107230. [PMID: 37739329 DOI: 10.1016/j.vph.2023.107230] [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: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023]
Abstract
Hypertension represents a major contributor to the development of coronary artery disease. The pathophysiological mechanisms underlying the link between hypertension and CAD are complex and include overactivation of neurohormones, accelerated development of the atherosclerotic plaque, endothelial dysfunction, altered intramyocardial coronary circulation, hypertension-mediated cardiac and vascular damage and the relationship between arterial stiffness and coronary perfusion. Blood pressure (BP) reduction is associated with a significant decrease of the risk of coronary events. Therapeutic interventions targeted to reduce BP and to improve endothelial function and coronary microvascular dysfunction, as well as to prevent left ventricular hypertrophy and dysfunction, contribute to reduce the burden of coronary disease and its acute ischemic manifestations.
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Affiliation(s)
- Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome 00189, Italy; IRCCS San Raffaele, Via della Pisana 235, Rome 00163, Italy.
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome 00189, Italy
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30
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Armstrong MK, Chirinos JA, Kapuku GK, Pierce GL. Aortic pressure-only wave separation analysis in adolescents: accuracy and associations with left ventricular mass index. J Hum Hypertens 2023; 37:1119-1125. [PMID: 36151308 DOI: 10.1038/s41371-022-00757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
Early-life exposure to high blood pressure (BP) is associated with cardiovascular target organ damage but not all BP-related risk is attributable to systolic and diastolic BP alone. In adolescence, aortic wave separation (WS) parameters are associated with increased left ventricular mass index (LVMI) but this approach is limited by the requirement for aortic flow measurements. Several methods for estimating the aortic flow waveform from pressure waveforms have emerged, but their accuracy and associations with LVMI have never been tested in adolescents, which was the aim of our study. Carotid pressure waveforms were acquired by tonometry from 58 adolescents (age 16 ± 1.5 years, 59% female). Measured (aortic) flow and LVMI were acquired via 2D echocardiography. Three pressure-only approximations of aortic flow were synthesized, including triangular, excess, and individualized-physiologic flow. A 4th aortic flow (average flow) was approximated from the average of all 58 measured flow waveforms. Forward (Pf) and backward (Pb) pressure and reflection magnitude (Rm) were derived from WS analysis. The individualized-physiologic flow produced the best approximations of Pf (mean difference ± SD, -0.15 ± 2.38 mmHg), Pb (0.14 ± 0.25 mmHg), and Rm (0.01 ± 0.02 mmHg). Pf derived using measured, individualized-physiologic, and average flow, was similarly associated with LVMI adjusting for age, brachial systolic BP, cardiac output, and BMI (P ≤ 0.03 all). Pb derived using all flow waveforms was associated with LVMI and all associations yielded similar effect estimates. Of the estimated flow waveforms, individualized-physiologic flow yielded the best approximation of WS parameters and may provide important physiological and clinical insight among adolescents.
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Affiliation(s)
- Matthew K Armstrong
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania and Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gaston K Kapuku
- Departments of Pediatrics and Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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31
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Yan X, Gong J, Wang Z, Wang F, Qi C. Association of lipoprotein(a) with left ventricular hypertrophy assessed by electrocardiogram in adults: a large cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1260050. [PMID: 38098866 PMCID: PMC10720892 DOI: 10.3389/fendo.2023.1260050] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Background and aims Increasing evidence supports a causal relationship between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular disease, yet its association with left ventricular hypertrophy (LVH) assessed by electrocardiogram (ECG) remains unknown. The aim of this study was to explore the relationship between Lp(a) and LVH assessed by ECG in general population. Methods and results In this cross-sectional study, we screened 4,052 adults from the participants of the third National Health and Nutrition Examination Survey for analysis. Lp(a) was regarded as an exposure variable. LVH defined by the left ventricular mass index estimated from ECG was considered as an outcome variable. Multivariate logistic regression and restricted cubic spline (RCS) were used to assess the relationship between Lp(a) and LVH. Individuals with LVH had higher Lp(a) compared to individuals without LVH (P< 0.001). In the fully adjusted model, Lp(a) was strongly associated with LVH when as a continuous variable (per 1-unit increment, OR: 1.366, 95% CI: 1.043-1.789, P = 0.024), and higher Lp(a) remained independently associated with a higher risk of LVH when participants were divided into four groups according to quartiles of Lp(a) (Q4 vs Q1, OR: 1.508, 95% CI: 1.185-1.918, P = 0.001). And in subgroup analysis, this association remained significant among participants< 60 years, ≥ 60 years, male, with body mass index< 30 kg/m2, with hypertension and without diabetes (P< 0.05). In addition, we did not observe a nonlinear and threshold effect of Lp(a) with LVH in the RCS analysis (P for nonlinearity = 0.113). Conclusion Lp(a) was closely associated with LVH assessed by ECG in general population.
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Affiliation(s)
- Xuejiao Yan
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jing Gong
- Department of Geriatrics, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenwei Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Wang
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chunjian Qi
- Medical Research Center, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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32
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Vasileiadis K, Antza C, Kotsis V. The Depiction of Hypertension in Heart Imaging Examinations: An Up-to-Date Review of the Evidence. Vasc Health Risk Manag 2023; 19:789-796. [PMID: 38045022 PMCID: PMC10693270 DOI: 10.2147/vhrm.s436133] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
Hypertension is one of the main preventable cardiovascular (CV) risk factors all over the years, closely related to CV morbidity and mortality. One of the most common hypertensive target organ damages is hypertensive heart disease (HHD), including left ventricular hypertrophy, which progresses gradually and leads to systolic or diastolic dysfunction of the left ventricular, and finally to end-stage heart failure. Regarding its prevalence and the need for early diagnosis, assessment of heart imaging examination is of major importance. Echocardiography has been used as the standard imaging technique to evaluate HHD for years, providing an accurate evaluation of the left ventricular geometry, along with the systolic and diastolic function. However, nowadays there is a growing interest in cardiovascular magnetic resonance (CMR). Despite the importance of the use of echocardiography in everyday clinical practice, numerous studies have shown the superiority of CMR as an imaging technique for clinical and research purposes, mainly due to its strength to provide an unlimited area of view, as well as the identification and quantification of the type and extent of myocardial fibrosis. Hence, this review aims to analyze the importance of heart imaging in the hypertensive population, with a special interest in CMR imaging.
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Affiliation(s)
- Konstantinos Vasileiadis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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33
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Liu Y, Shi L, Lin Y, Li YQ, Liu YY, Zhang HW. [Clinical features and risk factors of left ventricular hypertrophy in children with primary hypertension]. Zhonghua Er Ke Za Zhi 2023; 61:1031-1037. [PMID: 37899343 DOI: 10.3760/cma.j.cn112140-20230907-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.
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Affiliation(s)
- Y Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - L Shi
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Lin
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Q Li
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Y Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - H W Zhang
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
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34
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Zhou LN, Dong SS, Zhang SZ, Huang LW, Huang W. Concurrent fabry disease and immunoglobulin a nephropathy: a case report. BMC Nephrol 2023; 24:324. [PMID: 37914990 PMCID: PMC10621085 DOI: 10.1186/s12882-023-03282-3] [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: 11/29/2022] [Accepted: 07/25/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked, hereditary dysfunction of glycosphingolipid storage caused by mutations in the GLA gene encoding alpha-galactosidase A enzyme. In rare cases, FD may coexist with immunoglobulin A nephropathy (IgAN). We describe a case of concurrent FD, IgAN, and dilated cardiomyopathy-causing mutations in the TTN and BAG3 genes, which has not been reported previously. CASE PRESENTATION A 60-year-old female patient was admitted with a one-week history of facial and lower-limb edema, two-year history of left ventricular hypertrophy and sinus bradycardia, and recurring numbness and pain in three lateral digits with bilateral thenar muscle atrophy. Renal biopsy revealed concurrent FD (confirmed via an alpha-galactosidase A enzyme assay, Lyso-GL-3 quantification, and GLA gene sequencing) and IgAN. Heterozygous mutations in the TTN (c.30,484 C > A;p.P10162T) and BAG3 (c.88 A > G;p.I30V) genes were observed. The patient reported that two of her brothers had undergone kidney transplantation; one died suddenly at 60 years of age, and the other required a cardiac pacemaker. The 35-year-old son of the patient was screened for the GLA gene mutation and found to be positive for the same mutation as the patient. The patient was administered oral losartan (50 mg/day). Enzyme replacement therapy was refused due to financial reasons. Her renal and cardiac functions were stable yet worth closely monitoring during follow-up. CONCLUSION The family history of patients with concurrent heart and renal diseases should be assessed in detail. Genetic testing and histological examinations are essential for diagnosing FD with IgAN.
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Affiliation(s)
- Li-Na Zhou
- Department of Nephrology, Wenzhou People's Hospital, The Third Affiliated Hospital of Shanghai University, Wenzhou, 325000, Zhejiang Province, China
| | - Shao-Shao Dong
- Department of Nephrology, Wenzhou People's Hospital, The Third Affiliated Hospital of Shanghai University, Wenzhou, 325000, Zhejiang Province, China
| | - Sheng-Ze Zhang
- Department of Nephrology, Wenzhou People's Hospital, The Third Affiliated Hospital of Shanghai University, Wenzhou, 325000, Zhejiang Province, China
| | - Li-Wa Huang
- Department of Nephrology, Wenzhou People's Hospital, The Third Affiliated Hospital of Shanghai University, Wenzhou, 325000, Zhejiang Province, China
| | - Wen Huang
- Department of Nephrology, The Second Affiliated Hospital of Wenzhou Medical University, No. 108 College Road, Wenzhou, 325000, Zhejiang Province, China.
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Cuspidi C, Faggiano A, Mancia G, Grassi G. Echocardiographic Phenotypes of Subclinical Organ Damage: Clinical and Prognostic Value in the General Population. Findings from the Pamela Study. High Blood Press Cardiovasc Prev 2023; 30:497-511. [PMID: 38032423 DOI: 10.1007/s40292-023-00610-4] [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: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of established adverse prognostic significance such as left ventricular hypertrophy (LVH), alterations of LV geometry, left atrial (LA) enlargement, and aortic root (AR) dilatation. The excess cardiovascular (CV) risk associated with these phenotypes has been consistently demonstrated in different clinical settings such in patients with systemic hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, heart failure and in geneal population samples. The Pressioni Monitorate e Loro Associazioni (PAMELA), a longitudinal population-based study originally designed to assess the normality values, prognostic significance of office, home and 24-hour blood pressure, including among the many clinical and laboratory variables the collection of echocardiographic data, allowed to gather important information on the clinical prognostic significance of subclinical cardiac damage during a long follow-up period. This article summarizes the original findings provided by the PAMELA study on the clinical correlates and prognostic significance of echocardiographic markers of subclinical organa damage namely LVH, left atrial enlargement (LA) and AR dilatation at the community level.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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36
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Leventoğlu E, Büyükkaragöz B, Kavas FÇ, Holoğlu MC, Kavgacı A, Fidan K, Dalgıç A, Bakkaloğlu SA, Tunaoğlu FS, Söylemezoğlu O. Electrocardiographic measurements in children with pre-dialysis chronic kidney disease and undergoing kidney replacement therapy. Eur J Pediatr 2023; 182:4993-5005. [PMID: 37624446 DOI: 10.1007/s00431-023-05154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Cardiovascular diseases are the main causes of morbidity in children with chronic kidney disease (CKD). Electrocardiography (ECG) can provide important information about cardiac functions and parameters associated with sudden cardiac death. This study aims to evaluate the potentially dangerous changes in CKD and kidney replacement therapies by ECG and to determine the value of ECG in predicting cardiovascular outcome compared with echocardiography. 101 patients with CKD were divided into subgroups according to treatment modalities as pre-dialysis CKD, hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KTx). Differences in anthropometric measurements, laboratory results, blood pressures, ECG monitoring were compared within groups as well as with 40 healthy controls. Available echocardiographic findings were noted. In the patients, HD group had highest frequency of hypertension. ECG revealed prolonged QTc as more frequent (16.8% vs 0%, p = 0.006) and higher QTcD (56.7 ± 6.5 vs 39.9 ± 5.1 ms, p = 0.001) in the patients compared to controls, especially in dialysis patients, whereas lowest values were in KTx subgroup. Left ventricular (LV) hypertrophy (LVH) was more frequent (47.1%) in HD compared to other CKD subgroups in ECG (p = 0.052). Echocardiography also showed LV mass index as highest in HD and lowest in KTx (121.4 ± 55.7 vs 63.7 ± 18.3 g/m2, p = 0.000), with numerically highest LVH in HD (58.3%, p = 0.063). Conclusion: ECG can be used to detect cardiovascular problems in patients with CKD, especially in HD. As ECG results were in line with echocardiography, patients with ECG abnormalities suggestive of LVH should be referred for echocardiographic assessment. What is Known: • Cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias and sudden cardiac death are major causes of morbidity and mortality in chronic kidney disease. • Electrocardiography has significant advantages in demonstrating cardiac functions in children because it is readily available, non-invasive and often non-experts can interpret the results. What is New: • The heart rate is higher, QTc is longer and QTcD is higher in dialysis patients and the prolonged QTc is more frequent in patients with underlying glomerular diseases. • Left ventricular hypertrophy is more common in HD patients and those with hypertension, hypercalcemia, anemia or glomerular etiology. The cardiovascular risky conditions are less frequent in the patients with kidney transplantation.
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Affiliation(s)
- Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey.
| | - Bahar Büyükkaragöz
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Furkan Çağrı Kavas
- Faculty of Medicine, Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Mert Can Holoğlu
- Faculty of Medicine, Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Akif Kavgacı
- Faculty of Medicine, Department of Pediatric Cardiology, Gazi University, Ankara, Turkey
| | - Kibriya Fidan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Aydın Dalgıç
- Faculty of Medicine, Department of Transplantation Surgery, Gazi University, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Fatma Sedef Tunaoğlu
- Faculty of Medicine, Department of Pediatric Cardiology, Gazi University, Ankara, Turkey
| | - Oğuz Söylemezoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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Özpak E, Van Heuverswyn F, Timmermans F, De Pooter J. Feasibility and safety of left bundle branch area pacing in patients with septal hypertrophy. J Cardiovasc Electrophysiol 2023; 34:2255-2261. [PMID: 37717221 DOI: 10.1111/jce.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) aims to provide physiological ventricular activation during pacing. Left ventricular septal hypertrophy (LVSH) might be challenging for LBBAP due to the thickness of the interventricular septum and potential presence of septal scar. This study assesses the feasibility, safety, and outcome of LBBAP in patients with LVSH using primarily stylet-driven leads (SDL). METHODS Adult patients with LVSH who underwent LBBAP between March 2019 and November 2022 were enrolled. Baseline patient characteristics, procedural data and postprocedural results were collected. The feasibility of LBBAP in LVSH patients was compared to a cohort of LBBAP patients with normal septal wall thickness (NST). RESULTS Seventeen LVSH and 133 NST patients underwent LBBAP with successful implantation achieved in 15 LVSH patients (88%). Mean implant depth was 17.2 ± 1.9 mm, with 53% proven left bundle branch (LBB) capture. Paced QRS duration (146 ± 14 ms) and V6 R-wave peak time (V6 RWPT; 79 ± 20 ms) were comparable between patients with and without septal hypertrophy, although patients with NST had higher rates of proven LBB capture (71% vs. 53%). In LVSH pacing thresholds (0.6 ± 0.3 V at 0.4 ms) and R-wave amplitude (13.9 ± 5.6 mV) were favorable and remained stable at follow-up. At 12 months, 87% of patients had stable or improved left ventricular ejection fraction. CONCLUSION The results of the study indicate that LBBAP in patients with LVSH is safe and feasible and no lead-related complications were observed despite a mean implant depth exceeding 15 mm. LBBAP using SDL results in favorable pacing and electrocardiographic characteristics in LVSH patients, comparable to patients with NST.
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Affiliation(s)
- Emine Özpak
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Boszko M, Strzelczyk J, Szmigielski C, Kalinowski P, Ziarkiewicz-Wróblewska B, Styczyński G. Left Ventricular Morphology and Function in Normotensive, Metabolically Healthy Obese Individuals without Fatty Liver Disease. Cardiology 2023; 149:23-27. [PMID: 37857258 DOI: 10.1159/000534645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Obesity is one of the major risk factors for the development of heart failure (HF), although the exact underlying mechanism remains unclear. In the clinical setting, assessing the impact of obesity on the cardiovascular system is difficult due to comorbidities. OBJECTIVES The purpose of this study was to evaluate an independent influence of obesity on the left ventricular (LV) morphology and function. To eliminate hemodynamic and metabolic confounders, we performed an echocardiographic evaluation of severely obese but normotensive and metabolically healthy patients without fatty liver disease. METHODS The patients were retrospectively selected from the cohort of 180 consecutive obese patients systematically evaluated with transthoracic echocardiography before bariatric surgery. Finally, 25 obese subjects, predominantly females, were evaluated with transthoracic echocardiography. Inclusion criteria were defined as absence of diabetes, hypertension, and hyperlipidemia, no use of medications and no hepatic steatosis on liver biopsy. They were matched with a control group of healthy subjects with normal body mass index. RESULTS In obese patients, LV hypertrophy (LVH) (expressed as LV mass indexed for height in meters2.7) was significantly more frequent in the obese group (48 vs. 0%, p < 0.001). LV longitudinal systolic function measured by mitral annular systolic velocity was significantly lower in the obese group (S' 8.5 vs. 9.7 cm/s, p = 0.002). All studied indices of the LV diastolic function (E/A, mean E' and E/E' ratio) were impaired in obese subjects, even after adjustment for systolic blood pressure and heart rate (E/A 1.31 vs. 1.64, p < 0.001, E' mean 11 vs. 14.8 cm/s, p < 0.001, E/E' 7.5 vs. 6.4, p = 0.002 for obese vs. controls, respectively). CONCLUSIONS LVH is significantly more common, and LV diastolic and longitudinal systolic function is significantly impaired in young, metabolically healthy, normotensive, severely obese individuals without fatty liver disease when compared to age and sex-matched lean subjects. These abnormalities may represent the independent effect of the obesity on the heart, which may contribute to the development the obesity-related HF in later life.
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Affiliation(s)
- Maria Boszko
- Department of Internal Diseases, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Strzelczyk
- Department of Internal Diseases, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Diseases, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Grzegorz Styczyński
- Department of Internal Diseases, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Meucci MC, Lillo R, Del Franco A, Monda E, Iannaccone G, Baldassarre R, Di Nicola F, Parisi V, Lombardo A, Spinelli L, Biagini E, Pieroni M, Pisani A, Crea F, Iaccarino G, Limongelli G, Olivotto I, Graziani F. Prognostic Implications of the Extent of Cardiac Damage in Patients With Fabry Disease. J Am Coll Cardiol 2023; 82:1524-1534. [PMID: 37793750 DOI: 10.1016/j.jacc.2023.07.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There is limited evidence on the risk stratification of cardiovascular outcomes in patients with Fabry disease (FD). OBJECTIVES This study sought to classify FD patients into disease stages, based on the extent of the cardiac damage evaluated by echocardiography, and to assess their prognostic impact in a multicenter cohort. METHODS Patients with FD from 5 Italian referral centers were categorized into 4 stages: stage 0, no cardiac involvement; stage 1, left ventricular (LV) hypertrophy (LV maximal wall thickness >12 mm); stage 2, left atrium (LA) enlargement (LA volume index >34 mL/m2); stage 3, ventricular impairment (LV ejection fraction <50% or E/e' ≥15 or TAPSE <17 mm). The study endpoint was the composite of all-cause death, hospitalization for heart failure, new-onset atrial fibrillation, major bradyarrhythmias or tachyarrhythmias, and ischemic stroke. RESULTS A total of 314 patients were included. Among them, 174 (56%) were classified as stage 0, 41 (13%) as stage 1, 57 (18%) as stage 2 and 42 (13%) as stage 3. A progressive increase in the composite event rate at 8 years was observed with worsening stages of cardiac damage (log-rank P < 0.001). On multivariable Cox regression analysis, the staging was independently associated with the risk of cardiovascular events (HR: 2.086 per 1-stage increase; 95% CI: 1.487-2.927; P < 0.001). Notably, cardiac staging demonstrated a stronger and additive prognostic value, as compared with the degree of LV hypertrophy. CONCLUSIONS In FD patients, a novel staging classification of cardiac damage, evaluated by echocardiography, is strongly associated with cardiovascular outcomes and may be helpful to refine risk stratification.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Baldassarre
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Di Nicola
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vanda Parisi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Letizia Spinelli
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy
| | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Pisani
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy; Department of Public Health, Nephrology Unit, Federico II University, Naples, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Guido Iaccarino
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy; Meyer Children's Hospital IRCCS, Florence, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Palmeira NGF, Bianco HT, Bombig MTN, Povoa FF, Fonseca FAH, Izar MC, Thalenberg JM, Luna B, Marui F, Fischer SM, Amodeo C, de Souza DDSM, Povoa R. Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients. Arq Bras Cardiol 2023; 120:e20230050. [PMID: 37820172 PMCID: PMC10519347 DOI: 10.36660/abc.20230050] [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: 01/19/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. OBJECTIVE To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. METHODS A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. RESULTS A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. CONCLUSION High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.
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Affiliation(s)
- Natascha Gonçalves Francisco Palmeira
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Henrique Tria Bianco
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | | | - Fernando Focaccia Povoa
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Francisco A. H. Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - José Marcos Thalenberg
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Braulio Luna
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Fabiane Marui
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Simone Matheus Fischer
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Celso Amodeo
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | | | - Rui Povoa
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
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Romano S, Marcon D, Branz L, Tagetti A, Monamì G, Giontella A, Malesani F, Pecoraro L, Minuz P, Brugnara M, Fava C. Subclinical Target Organ Damage in a Sample of Children with Autosomal Dominant Polycystic Kidney Disease: A Pilot Study. Medicina (Kaunas) 2023; 59:1777. [PMID: 37893495 PMCID: PMC10608453 DOI: 10.3390/medicina59101777] [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: 08/23/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Hypertension and vascular damage can begin in adolescents affected by Autosomal Dominant Polycystic Kidney Disease (ADPKD). This study aimed to evaluate markers of vascular damage and left ventricular geometry in a sample of children with ADPKD. Materials and Methods: Several vascular measurements were obtained: ambulatory blood pressure monitoring (ABPM), carotid intima-media thickness (cIMT), carotid distensibility coefficient (cDC), pulse wave velocity (PWV), and echocardiographic measurements (relative wall thickness (RWT) and left ventricular mass index (LVMI)). Results: Eleven ADPKD children were recruited (four females and seven males, mean age 9.5 ± 3.2 years). Four children were hypertensive at the ABPM, five were normotensive, and for two ABPM was not available. RWT was tendentially high (mean 0.47 ± 0.39). Eight patients had concentric cardiac remodeling, while one patient had cardiac hypertrophy. cIMT was above the 95° percentile for sex and height in 80% of the children (0.5 ± 0.005 mm). The average PWV and cDC were between the normal range (5.5 ± 4.6 m/s and 89.6 ± 16.1 × 10-3/KPa, respectively). We observed a positive correlation between the PWV and RWT (r = 0.616; p = 0.044) and a negative correlation between cDC and RWT (r = -0.770; p = 0.015). Cardiovascular damages (cIMT > 95° percentile) were found in normotensive patients. Conclusions: Increased RWT and high cIMT, indicating subclinical organ damage, are already present in ADPKD children. RWT was significantly correlated to that of cDC and PWV, implying that vascular stiffening is associated with cardiac remodeling. None of the children had an alteration in renal function. Subclinical cardiovascular damage preceded the decline in glomerular filtration rate.
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Affiliation(s)
- Simone Romano
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Denise Marcon
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Lorella Branz
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Angela Tagetti
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Giada Monamì
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Alice Giontella
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Francesca Malesani
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Pietro Minuz
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
| | - Milena Brugnara
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Cristiano Fava
- Section of General Medicine and Hypertension, Department of Medicine, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy (D.M.); (L.B.); (A.G.); (P.M.); (C.F.)
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Koga M, Izumo M, Yoneyama K, Akashi YJ, Yashima F, Tada N, Yamawaki M, Shirai S, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation: Insights from the OCEAN-TAVI Registry. Am J Cardiol 2023; 204:130-139. [PMID: 37541149 DOI: 10.1016/j.amjcard.2023.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
Electrocardiogram (ECG) left ventricular hypertrophy (LVH) is associated with the prognosis of patients with aortic stenosis. However, the impact of the presence or absence of ECG-LVH on the clinical outcomes after transcatheter aortic valve implantation (TAVI) is limited. This study aimed to assess the prognostic value of ECG-LVH among patients with aortic stenosis treated by TAVI. A total of 1,667 patients who underwent TAVI were prospectively enrolled into the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation) registry. A total of 1,446 patients (mean age 84 years; 29.9% men) were analyzed. The Sokolow-Lyon index was used to determine the presence of ECG-LVH. LVH was also assessed using transthoracic echocardiography (TTE). We investigated the association between ECG-LVH and all-cause and cardiovascular mortality. This study identified ECG-LVH and TTE-LVH in 743 (51.5%) and 1,242 patients (86.0%), respectively. The Kaplan-Meier analysis revealed that all-cause mortality was significantly higher among patients without ECG-LVH than among those with ECG-LVH (log-rank p <0.001). In the multivariable analysis, the absence of ECG-LVH was independently associated with all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.39 to 2.82, p <0.001), regardless of the presence or absence of TTE-LVH. Furthermore, the presence of TTE-LVH with the absence of ECG-LVH was observed in 575 patients (40%), which was associated with cardiovascular mortality (hazard ratio 2.84, 95% confidence interval 1.56 to 5.17, p <0.001). In conclusion, the absence of ECG-LVH was independently associated with an increased risk of all-cause mortality after TAVI. Risk stratification using both ECG-LVH and TTE-LVH is a useful predictor of adverse clinical outcomes after TAVI.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Monga S, Valkovič L, Myerson SG, Neubauer S, Mahmod M, Rider OJ. Role of Cardiac Energetics in Aortic Stenosis Disease Progression: Identifying the High-risk Metabolic Phenotype. Circ Cardiovasc Imaging 2023; 16:e014863. [PMID: 37847766 PMCID: PMC10581424 DOI: 10.1161/circimaging.122.014863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/01/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Severe aortic stenosis (AS) is associated with left ventricular (LV) hypertrophy and cardiac metabolic alterations with evidence of steatosis and impaired myocardial energetics. Despite this common phenotype, there is an unexplained and wide individual heterogeneity in the degree of hypertrophy and progression to myocardial fibrosis and heart failure. We sought to determine whether the cardiac metabolic state may underpin this variability. METHODS We recruited 74 asymptomatic participants with AS and 13 healthy volunteers. Cardiac energetics were measured using phosphorus spectroscopy to define the myocardial phosphocreatine to adenosine triphosphate ratio. Myocardial lipid content was determined using proton spectroscopy. Cardiac function was assessed by cardiovascular magnetic resonance cine imaging. RESULTS Phosphocreatine/adenosine triphosphate was reduced early and significantly across the LV wall thickness quartiles (Q2, 1.50 [1.21-1.71] versus Q1, 1.64 [1.53-1.94]) with a progressive decline with increasing disease severity (Q4, 1.48 [1.18-1.70]; P=0.02). Myocardial triglyceride content levels were overall higher in all the quartiles with a significant increase seen across the AV pressure gradient quartiles (Q2, 1.36 [0.86-1.98] versus Q1, 1.03 [0.81-1.56]; P=0.034). While all AS groups had evidence of subclinical LV dysfunction with impaired strain parameters, impaired systolic longitudinal strain was related to the degree of energetic impairment (r=0.219; P=0.03). Phosphocreatine/adenosine triphosphate was not only an independent predictor of LV wall thickness (r=-0.20; P=0.04) but also strongly associated with myocardial fibrosis (r=-0.24; P=0.03), suggesting that metabolic changes play a role in disease progression. The metabolic and functional parameters showed comparable results when graded by clinical severity of AS. CONCLUSIONS A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, and these metabolic changes precede irreversible LV remodeling and subclinical dysfunction. As such, cardiac metabolism may play an important and potentially causal role in disease progression.
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Affiliation(s)
- Shveta Monga
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
| | - Ladislav Valkovič
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia (L.V.)
| | - Saul G. Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
| | - Oliver J. Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., L.V., S.G.M., S.N., M.M., O.J.R.)
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Chen Y, Dai S, Ge X, Shang D, Xie Q, Hao C, Zhu T. Plasma fibrinogen: a driver of left ventricular remodeling in patients undergoing peritoneal dialysis and its related risk factors. Ren Fail 2023; 45:2255679. [PMID: 38346031 PMCID: PMC10512895 DOI: 10.1080/0886022x.2023.2255679] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND AIM Plasma fibrinogen has been proven to be significantly associated with cardiovascular mortality in patients undergoing peritoneal dialysis (PD). The study aimed to investigate the role of fibrinogen in left ventricular (LV) remodeling and functions in patients on PD, and explore risk factors related to high fibrinogen level. METHODS From February 2008 to July 2018, adult patients on regular PD for at least 1 month were recruited and followed up for two years. Correlation analysis was performed to explore the fibrinogen level and echocardiography measurements. Pathogenic factors correlated to the left ventricular hypertrophy (LVH) progression were explored by logistic regression models and the role of fibrinogen in it was verified by receiver operating characteristic (ROC) curves. Linear regression models were conducted to identify factors associated with fibrinogen level. RESULTS A total of 278 patients undergoing PD (168 males, 60.4%) were recruited. Patients were trisected according to fibrinogen levels at baseline. Mean wall thickness (MWT), relative wall thickness (RWT), and left ventricular mass index (LVMI) were positively associated with fibrinogen level while E/A ratio was negatively associated with it. Multivariate logistic regression and ROC curve showed that fibrinogen was an independent risk factor for LVH progression. Multivariate linear regression analysis identified age, total cholesterol (CHO), fasting blood glucose (FBG), and high-sensitivity C-reactive protein (hsCRP) were significantly related to plasma fibrinogen level. CONCLUSIONS An elevated fibrinogen level was independently associated with LVH progression in patients undergoing PD. Older age, higher level of FBG, CHO, and hsCRP were risk factors for elevated plasma fibrinogen level.
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Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Da Shang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Edmonston D, Isakova T, Wolf M. Plasma Serotonin and Cardiovascular Outcomes in Chronic Kidney Disease. J Am Heart Assoc 2023; 12:e029785. [PMID: 37609990 PMCID: PMC10547345 DOI: 10.1161/jaha.123.029785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Background Platelet-poor plasma serotonin levels are associated with adverse cardiovascular outcomes. Although plasma serotonin levels increase in chronic kidney disease, the cardiovascular implications remain unknown. Methods and Results In 1114 participants from the prospective CRIC (Chronic Renal Insufficiency Cohort) Study, we evaluated the association between plasma serotonin, categorized as undetectable, intermediate, and high (≥20 ng/mL) levels, and cross-sectional findings on echocardiography, including left ventricular hypertrophy, left ventricular ejection fraction, and pulmonary hypertension. We also analyzed whether serotonin was associated with time-to-event cardiovascular outcomes, including heart failure hospitalization and atherosclerotic cardiovascular disease (ASCVD) events, in addition to mortality. Because selective serotonin reuptake inhibitors decrease plasma serotonin levels, we specifically evaluated the influence of selective serotonin reuptake inhibitor use in the relationship between serotonin and outcomes. Plasma serotonin level inversely correlated with estimated glomerular filtration rate and directly correlated with blood pressure. High plasma serotonin was associated with left ventricular hypertrophy (adjusted odds ratio, 2.74 [95% CI, 1.11-7.41]). In contrast, undetectable plasma serotonin level was associated with the highest risk of heart failure (adjusted hazard ratio [HR], 2.26 [95% CI, 1.40-3.66]) and ASCVD events (adjusted HR, 1.96 [95% CI, 1.15-3.32]). Conclusions In a large chronic kidney disease cohort, plasma serotonin levels correlated with blood pressure, and elevated serotonin levels were associated with left ventricular hypertrophy. In contrast, undetectable plasma serotonin was associated with the highest risk of heart failure and ASCVD events.
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Affiliation(s)
- Daniel Edmonston
- Division of Nephrology, Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Myles Wolf
- Division of Nephrology, Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
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Yang H, Teng H, Luo P, Fu R, Wang X, Qin G, Gao M, Ren J. The role of left ventricular hypertrophy measured by echocardiography in screening patients with ischaemia with non-obstructive coronary arteries: a cross-sectional study. Int J Cardiovasc Imaging 2023; 39:1657-1666. [PMID: 37237153 DOI: 10.1007/s10554-023-02879-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Many patients with ischaemia with non-obstructive coronary arteries (INOCA) have a poor prognosis. This study aims to explore the diagnostic value of left ventricular hypertrophy (LVH)-related ultrasound parameters in INOCA patients. The study group consisted of 258 patients with INOCA in this retrospective cross-sectional study, and these patients were free of obstructive coronary artery disease, previous revascularization, atrial fibrillation, ejection fraction < 50%, major distortions of left ventricular geometry, suspected non-ischaemic causes. Control individuals were matched 1:1 with study group according to age, sex, cardiovascular risk factors, and time of hospital stay. According to left ventricular mass index (LVMI) and relative wall thickness, left ventricular geometry was composed of concentric hypertrophy, eccentric hypertrophy, concentric remodeling and normal geometry. LVH-related parameters, left ventricular geometry, demographic characteristics, laboratory parameters and other echocardiographic indicators were compared between the two groups. Subgroup analysis was performed based on sex. LVMI in the study group was higher than that in the control group (86.86 ± 18.83 g/m2 vs 82.25 ± 14.29 g/m2, P = 0.008). The ratio of LVH was higher in the study group (20.16% vs 10.85%, P = 0.006). After subgroup analysis based on sex, LVMI differences (85.77 ± 18.30 g/m2 vs 81.59 ± 14.64 g/m2, P = 0.014) and the ratio of LVH differences (25.00% vs 14.77%, P = 0.027) still existed in females between the two groups. There was no difference in the constituent ratio of left ventricular geometry between the two groups (P = 0.157). Sex-based subgroup analysis showed no difference in the constituent ratio of left ventricular geometry between the two groups in females (P = 0.242). The degree of LVH in the study group was higher than that in the control group, suggesting that LVH may play an important role in the occurrence and development of INOCA. Moreover, LVH-related ultrasound parameters may be of higher diagnostic value for female INOCA patients than for male INOCA patients.
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Affiliation(s)
- Hao Yang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Hua Teng
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Peng Luo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Ruqian Fu
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Xiaoting Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Guang Qin
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Min Gao
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Jianli Ren
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China.
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Sugianto RI, Grabitz C, Bayazit A, Duzova A, Thurn-Valsassina D, Memaran N, Doyon A, Canpolat N, Kaplan Bulut I, Azukaitis K, Obrycki Ł, Anarat A, Büscher R, Caliskan S, Harambat J, Lugani F, Ozcakar ZB, Paripović D, Ranchin B, Querfeld U, Schaefer F, Schmidt BM, Melk A. Stricter Blood Pressure Control Is Associated With Lower Left Ventricular Mass in Children After Kidney Transplantation: A Longitudinal Analysis of the 4C-T Study. Hypertension 2023; 80:1900-1908. [PMID: 37462031 PMCID: PMC10424823 DOI: 10.1161/hypertensionaha.123.21187] [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: 03/07/2023] [Accepted: 06/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND We assessed the effect of blood pressure (BP) control on left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). METHODS Ninety-six patients (64 males) ≥9 months post-kidney transplantation from the 4C-T (Cardiovascular Comorbidity in Children with Chronic Kidney Disease and Transplantation) study were analyzed longitudinally (mean follow-up, 2.6±1.3 years). Cumulative systolic blood pressure (SBP)/diastolic BP exposure was calculated as a time-averaged area under the curve and categorized: ≤50th, 50th to ≤75th, 75th to ≤90th, and >90th percentile (pct). We performed adjusted linear and logistic mixed models for LVMI and LVH, respectively. RESULTS At baseline, LVMI was 49.7±12.7g/m2.16 with 64% (n=61) kidney transplantation recipients displaying LVH. Compared with patients with cumulative SBP exposure >90th pct, patients with cumulative SBP of 50th to ≤75th showed a significant LVMI reduction of -5.24g/m2.16 (P=0.007). A similar tendency was seen for cumulative SBP≤50th (β=-3.70 g/m2.16; P=0.067), but patients with cumulative SBP of 75th to ≤90th pct showed no reduction. A post hoc analysis in patients with cumulative SBP≤75th revealed that median SBP exposure was at 57.5th pct. For cumulative diastolic BP, a significant LVMI reduction was seen in all 3 categories ≤90th pct compared with patients >90th pct. Patients with cumulative SBP of ≤50th or 50th to ≤75th pct showed 79% or 83% lower odds of developing LVH, respectively. Patients with cumulative diastolic BP ≤50th showed a tendency of 82% lower odds for LVH (95% CI, 0.03-1.07). CONCLUSIONS Stricter BP control led to regression of LVMI and LVH. Our data suggest a BP target below the 60th pct, which needs to be substantiated in a randomized controlled trial.
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Affiliation(s)
- Rizky I. Sugianto
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Aysun Bayazit
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey (A.B., A.A.)
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey (A. Duzova)
| | - Daniela Thurn-Valsassina
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
| | - Anke Doyon
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany (A. Doyon, F.S.)
| | - Nur Canpolat
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Turkey (N.C., S.C.)
| | - Ipek Kaplan Bulut
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey (I.K.B.)
| | - Karolis Azukaitis
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Lithuania (K.A.)
| | - Łukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, the Children’s Memorial Health Institute, Warsaw, Poland (L.O.)
| | - Ali Anarat
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey (A.B., A.A.)
| | | | - Salim Caliskan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Turkey (N.C., S.C.)
| | - Jérôme Harambat
- Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux, France (J.H.)
| | | | - Zeynep B. Ozcakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University Medical School, Turkey (Z.B.O.)
| | - Dušan Paripović
- Department of Nephrology, University Children’s Hospital, School of Medicine, University of Belgrade, Serbia (D.P.)
| | - Bruno Ranchin
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon & Université de Lyon, France (B.R.)
| | - Uwe Querfeld
- Charité Children’s Hospital, Berlin, Germany (U.Q.)
| | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany (A. Doyon, F.S.)
| | - Bernhard M.W. Schmidt
- Department of Nephrology and Hypertension (B.M.W.S.), Hannover Medical School, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases (R.I.S., C.G., D.T.-V., N.M., A.M.), Hannover Medical School, Germany
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Arrieta V, Jover E, Navarro A, Martín-Núñez E, Garaikoetxea M, Matilla L, García-Peña A, Fernández-Celis A, Gainza A, Álvarez V, Sádaba R, López-Andrés N. Soluble ST2 levels are related to replacement myocardial fibrosis in severe aortic stenosis. Rev Esp Cardiol (Engl Ed) 2023; 76:679-689. [PMID: 36565751 DOI: 10.1016/j.rec.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with aortic stenosis (AS) exhibit left ventricular (LV) remodeling and replacement myocardial fibrosis (RMF). Whether sST2 is associated with RMF measured by cardiac magnetic resonance and with sex remains unknown. METHODS We recruited 79 consecutive patients (73.0 [68.0-78.0] years; 61% men) with severe isolated AS underdoing valve replacement. RMF was identified and quantified by late gadolinium enhancement (LGE). Serum sST2 levels were determined. RESULTS RMF was associated with higher circulating sST2 levels, LV hypertrophy and dilation, and lower LV ejection fraction. All patients with LV dysfunction had RMF. Circulating levels of sST2 ≥ 28.8 ng/mL were associated with RMF and greater LV hypertrophy. LGE mass was correlated with LV remodeling and sST2. Of note, sST2 levels were also associated with the RMF pattern, being higher in midwall than in subendocardial fibrosis. Multivariate analyses showed that only LV ejection fraction and sST2 levels were associated with RMF. Moreover, men had higher levels of sST2 and RMF. RMF was associated with higher LV dilation and hypertrophy only in men and was correlated with LGE mass. CONCLUSIONS SST2 was an independent factor for RMF in patients with severe isolated AS. The presence of RMF was predicted by sST2 ≥ 28.2 ng/mL, and was associated with greater LV hypertrophy. sST2 expression and clinical associations may be sex-specific.
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Affiliation(s)
- Vanessa Arrieta
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Eva Jover
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Adela Navarro
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Ernesto Martín-Núñez
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mattie Garaikoetxea
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lara Matilla
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaia García-Peña
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaya Fernández-Celis
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia Gainza
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Virginia Álvarez
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Rafael Sádaba
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
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Xu Z, Gong C, Chen Y. Patient in their 40s with unexplained myocardial hypertrophy. Heart 2023; 109:1280-1340. [PMID: 37567610 DOI: 10.1136/heartjnl-2023-322687] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao Gong
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucheng Chen
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Cuspidi C, Gherbesi E, Sala C, Tadic M. Sex, gender, and subclinical hypertensiveorgan damage-heart. J Hum Hypertens 2023; 37:626-633. [PMID: 36030347 DOI: 10.1038/s41371-022-00750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022]
Abstract
Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. Although the risk of cardiac HMOD is related with the severity of BP elevation, the interaction of numerous non-hemodynamic factors plays a relevant role in this unfavorable dynamic process. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described. The objective of the present review is to provide comprehensive, updated information on sex-related differences in cardiac HMOD, focusing on the most important manifestations of subclinical hypertensive heart disease such as left ventricular hypertrophy (LVH), LV systolic and diastolic dysfunction, left atrial and aortic dilatation. Current evidence, based on cross-sectional and longitudinal observational studies as well as real-world registries and randomized controlled trials, suggests that women are more at risk of developing (and maintaining) LVH, concentric remodeling and subclinical LV dysfunction, namely the morpho-functional features of heart failure with preserved ejection fraction. It should be pointed out, however, that further studies are needed to fill the gap in defining gender-based optimal therapeutic strategies in order to protect women's hearts.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
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