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Brinza E, Flint K. Reply to: Comment on: Malnutrition in heart failure with preserved ejection fraction. J Am Geriatr Soc 2024. [PMID: 38739002 DOI: 10.1111/jgs.18954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 05/14/2024]
Abstract
AbstractThis letter comments on the letter by May.
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Affiliation(s)
- Ellen Brinza
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelsey Flint
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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Narendrula A, Brinza E, Horvat Davey C, Longenecker CT, Webel AR. Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001596. [PMID: 38292295 PMCID: PMC10826575 DOI: 10.1136/bmjsem-2023-001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies. Methods We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review. Results Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA. Conclusions PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions. PROSPERO registration number CRD42021226089.
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Affiliation(s)
- Aparna Narendrula
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ellen Brinza
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Horvat Davey
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, Washington, USA
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Davey CH, Longenecker CT, Brinza E, McCabe M, Hileman CO, Vedanthan R, Bosworth HB, Webel A. The impact of COVID-19 on cardiovascular health behaviors in people living with HIV. AIDS Care 2023; 35:1911-1918. [PMID: 36755400 PMCID: PMC10406970 DOI: 10.1080/09540121.2023.2175195] [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] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/13/2022] [Indexed: 02/10/2023]
Abstract
The COVID-19 pandemic's impact on cardiovascular health behaviors including diet, physical activity, medication adherence, and self-care among people living with HIV (PLWH) remains unknown. Using qualitative analyses, we examined the impact of the COVID-19 pandemic on cardiovascular health behaviors among PLWH. Twenty-four PLWH were enrolled in this multisite study from September to October 2020. Individuals participated in semi-structured telephone interviews that were recorded, transcribed, and coded by 4 independent coders. Codes were adjudicated and analyzed for common themes. Participants were, on average, 59.2 years old (+/-9.4), 75% African American (n = 18) and 71% male (n = 17). The pandemic altered cardiovascular disease health behaviors. PLWH changed diet based on stay-at-home orders and food access. Alterations in physical activity included transitioning from gym and group class exercise to home-based exercise. Antiretroviral adherence was maintained, even when other health behaviors wavered, suggesting resilience in PLWH that may be harnessed to maintain other health behaviors.
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Affiliation(s)
| | - Chris T. Longenecker
- Department of Medicine, Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Ellen Brinza
- Lerner College of Medicine, Cleveland Clinic, Cleveland, USA
| | - Madeline McCabe
- College of Medicine, Case Western Reserve University, Cleveland, USA
| | | | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Hayden B. Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, USA
- Duke University School of Nursing, Durham, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, USA
| | - Allison Webel
- School of Nursing, University of Washington, Seattle, USA
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Brinza E, Flint K. Malnutrition in heart failure with preserved ejection fraction: More than meets the eye. J Am Geriatr Soc 2023; 71:3354-3356. [PMID: 37707391 DOI: 10.1111/jgs.18593] [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: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023]
Abstract
This editorial comments on the article by Zainul et al. in this issue.
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Affiliation(s)
- Ellen Brinza
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelsey Flint
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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Narendrula A, Ajani K, Lang J, Brinza E, Longenecker CT. Psychological distress and health perception in patients with a previous myocardial infarction or stroke: a national cross-sectional study. BMC Cardiovasc Disord 2023; 23:430. [PMID: 37649045 PMCID: PMC10468856 DOI: 10.1186/s12872-023-03422-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND While understanding the impact of mental health on health perception improves patient-centered care, this relationship is not well-established in patients with cardiovascular disease (CVD). We examined the relationship between psychological distress and health perception in patients with a previous myocardial infarction (MI) and/or stroke. METHODS We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported. Presence and severity of anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8). Binary analyses of anxiety/depression, multivariable logistic regressions controlling for confounders, and univariable analyses of confounders and anxiety/depression severity were performed. RESULTS Of 31,948 individuals for whom data on MI/stroke was available, 1235 reported a previous MI and 1203 a previous stroke. The odds of positive perceived health status were lower for individuals with anxiety/depression compared to those without anxiety/depression in both post-MI (anxiety OR 0.52, 95% CI = 0.32-0.85, P < 0.001; depression OR 0.45, 95% CI = 0.29-0.7, P < 0.001) and post-stroke groups (anxiety OR 0.61, 95% CI = 0.39-0.97, P < 0.001; depression OR 0.37, 95% CI = 0.25-0.55, P < 0.001) upon multivariable analyses. Increasing severity of anxiety/depression was also associated with worse perception of health status upon univariable analysis. CONCLUSION Among patients with a previous acute CVD event, those with psychological distress have worse perception of their health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care and encourage patient behaviors that may improve both CVD and mental health outcomes.
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Affiliation(s)
- Aparna Narendrula
- New York University Grossman School of Medicine, 550 First Avenue, NBV 16 North 30, 10016, New York, NY, USA.
| | - Kiran Ajani
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jacob Lang
- New York-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
| | - Ellen Brinza
- University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Coy T, Brinza E, DeLozier S, Gornik HL, Webel AR, Longenecker CT, White Solaru KT. Black men's awareness of peripheral artery disease and acceptability of screening in barbershops: a qualitative analysis. BMC Public Health 2023; 23:46. [PMID: 36609297 PMCID: PMC9821364 DOI: 10.1186/s12889-022-14648-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) disproportionately burdens Black Americans, particularly Black men. Despite the significant prevalence and high rate of associated morbidity and mortality, awareness of and treatment initiation for PAD remains low in this demographic group. Given the well-established social cohesion among barbershops frequently attended by Black men, barbershops may be ideal settings for health screening and education to improve awareness, early detection, and treatment initiation of PAD among Black men. METHODS A qualitative study involving 1:1 participant interviews in Cleveland, Ohio assessed perspectives of Black men about barbershop-based screening and education about PAD. Inductive thematic analysis was performed to derive themes directly from the data to reflect perceived PAD awareness and acceptability of screening in a barbershop setting. RESULTS Twenty-eight African American/Black, non-Hispanic men completed a qualitative interview for this analysis. Mean age was 59.3 ± 11.2 years and 93% of participants resided in socioeconomically disadvantaged zip codes. Several themes emerged indicating increased awareness of PAD and acceptability of barbershop-based screenings for PAD, advocacy for systemic changes to improve the health of the community, and a desire among participants to increase knowledge about cardiovascular disease. CONCLUSIONS Participants were overwhelmingly accepting of PAD screenings and reported increased awareness of PAD and propensity to seek healthcare due to engagement in the study. Participants provided insight into barriers and facilitators of health and healthcare-seeking behavior, as well as into the community and the barbershop as an institution. Additional research is needed to explore the perspectives of additional stakeholders and to translate community-based screenings into treatment initiation.
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Affiliation(s)
- Tyler Coy
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Ellen Brinza
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Heather L Gornik
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, WA, USA
| | - Christopher T Longenecker
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- School of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Khendi T White Solaru
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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White Solaru KT, Coy T, DeLozier S, Brinza E, Ravenell J, Longenecker CT, Wright JT, Gornik HL. Findings of a Novel Barbershop-Based Peripheral Artery Disease Screening Program for Black Men. J Am Heart Assoc 2022; 11:e026347. [PMID: 36250671 DOI: 10.1161/jaha.122.026347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Peripheral artery disease (PAD) increases the risk of cardiovascular events and limb events including amputations. PAD is twice as prevalent in Black compared with non-Hispanic White individuals, especially among men. Screening for PAD using the ankle-brachial index in community settings, such as the barbershop, could lead to earlier diagnosis and treatment. Methods and Results A pilot study was conducted at 2 barbershops in Cleveland, OH from June to December 2020 to assess the feasibility of screening for PAD in the barbershop setting and the effect of an educational intervention on PAD awareness. After screening with both automated and Doppler ankle-brachial index, PAD was identified in 5/31 (16.1%) of participants. Baseline systolic blood pressure, low-density lipoprotein cholesterol, and random blood glucose were higher in participants who screened positive for PAD (P<0.001). PAD awareness was low overall. There was a significant improvement in PAD awareness assessment scores obtained at the initial and exit visits (9.93±4.23 to 12.50±4.41, P=0.004). An association was found between PAD awareness at baseline and highest education level achieved: compared with those with some college/associate's degree or higher, non-high school graduates scored lower on PAD awareness (P=0.022), as did those who only had a high school diploma or tests of General Educational Development (P=0.049). Conclusions In a pilot study, barbershop-based screening for PAD among Black men revealed a higher than expected PAD prevalence and low PAD awareness. An educational video was effective at increasing PAD awareness. Ankle-brachial index screening and educational outreach in the barbershop may be a feasible and effective tool to diagnose PAD and reduce PAD disparities among Black men at highest risk.
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Affiliation(s)
- Khendi T White Solaru
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Tyler Coy
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH
| | - Sarah DeLozier
- Clinical Research Center University Hospitals Cleveland OH
| | - Ellen Brinza
- Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Joseph Ravenell
- Langone's Departments of Population Health and Medicine New York University School of Medicine New York NY
| | - Christopher T Longenecker
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Jackson T Wright
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Heather L Gornik
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
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Shivapour DM, Javed O, Wu Y, Brinza E, Hornacek D, Conic J, Gornik HL, Kim ESH. Changes in Carotid Duplex Ultrasound Velocities After Aortic Valve Replacement for Severe Aortic Stenosis. J Ultrasound Med 2020; 39:139-145. [PMID: 31267549 DOI: 10.1002/jum.15087] [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: 12/07/2018] [Revised: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The peak systolic velocity (PSV) and end-diastolic velocity (EDV) obtained by carotid duplex ultrasound (CDU) imaging of the internal carotid arteries (ICAs) are parameters used to determine the severity of ICA stenosis. Severe aortic stenosis (AS) results in a parvus-et-tardus pattern on spectral Doppler waveforms; however, the impact of severe AS on CDU velocities is unclear. The purpose of this study was to assess the impact of severe AS on CDU velocities by evaluating changes in CDU velocities before and after aortic valve replacement (AVR) METHODS: A single-center retrospective review of patients with severe AS who underwent surgical AVR and who had preoperative and postoperative CDU examinations performed within 12 months of each other was conducted. Patients with any carotid intervention between the preoperative and postoperative CDU were excluded. RESULTS We identified 92 patients who satisfied all inclusion criteria. The mean age was 72.2 years; 71.7% were men; the mean preoperative aortic valve area ± SD was 0.8 ± 0.2 cm2 ; and the mean time from preoperative to postoperative AVR CDU was 182.3 ± 98.4 days. The peak aortic valve gradient decreased from 62.5 to 22.0 mm Hg after AVR (P < .001); however, there were no significant changes in the PSV or EDV in either the right or left ICA. CONCLUSIONS Although severe AS may cause characteristic changes in the spectral Doppler waveform on CDU imaging, there is no significant effect on the ICA PSV or EDV. Adjustments in velocity criteria to determine the degree of carotid artery stenosis in patients with substantial AS may not be necessary.
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Affiliation(s)
- Daniel M Shivapour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omair Javed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio, USA
| | - Ellen Brinza
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Hornacek
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juliana Conic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heather L Gornik
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Esther S H Kim
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Joseph MS, Konerman MA, Zhang M, Wei B, Brinza E, Walden P, Jackson EA, Rubenfire M. Long-term outcomes following completion of a structured nutrition and exercise lifestyle intervention program for patients with metabolic syndrome. Diabetes Metab Syndr Obes 2018; 11:753-759. [PMID: 30532575 PMCID: PMC6244588 DOI: 10.2147/dmso.s175858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Metabolic syndrome is associated with an increased risk of cardiovascular disease and multiple other chronic health conditions. Studies have demonstrated the effectiveness of structured diet and exercise programs to improve the components of metabolic syndrome. The durability of these benefits after program completion is unclear. The aim of this study was to evaluate trends in cardiovascular risk factors 12 months post completion of a 12- or 24-week structured lifestyle intervention program. METHODS Individuals with metabolic syndrome were referred to the Metabolic Fitness program, a 12- or 24-week lifestyle intervention program consisting of weekly exercise and nutrition education sessions. Patients were assessed at baseline, 12 weeks, and 24 weeks for those in the 24-week program. Data collection included weight, body mass index, waist circumference, body composition percentage, sBP, dBP, fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Unstructured follow-up data were obtained by retrospective chart review for up to 12 months post program completion. RESULTS Two-hundred twenty-five patients were enrolled in the 12-week program and 121 in the 24-week program. At the conclusion of the 12-week program, patients showed significant improvement in sBP and dBP. At the conclusion of the 24-week program, patients showed significant improvement in body mass index, weight, sBP, dBP, fasting blood glucose, total cholesterol, and triglycerides. However, 12 months after program completion, while the majority of parameters were still improved compared with baseline, only change in low-density lipoprotein cholesterol remained significantly improved compared with the end of 12-week program, and sBP had increased back above baseline in both programs. CONCLUSION Patients with metabolic syndrome participating in a structured lifestyle intervention program show significant improvement in their cardiovascular risk and metabolic profile at program completion. The durability of these improvements appears to wane over time, however, stressing the need for programs that can facilitate maintenance of long-term behavior change.
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Affiliation(s)
- Megan S Joseph
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
| | - Monica A Konerman
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Min Zhang
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
| | - Boxian Wei
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
| | - Ellen Brinza
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
| | - Patrick Walden
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
| | | | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA,
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Nguyen N, Sharma A, West JK, Serhal M, Brinza E, Gornik HL, Kim ES. Presentation, clinical features, and results of intervention in upper extremity fibromuscular dysplasia. J Vasc Surg 2017; 66:554-563. [DOI: 10.1016/j.jvs.2017.02.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
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Khaira KB, Brinza E, Singh GD, Amsterdam EA, Waldo SW, Tong K, Pandya K, Laird JR, Armstrong EJ. Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction. Vasc Med 2017; 22:307-315. [DOI: 10.1177/1358863x17714153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.
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Affiliation(s)
- Kavita B Khaira
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ellen Brinza
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Gagan D Singh
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ezra A Amsterdam
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Stephen W Waldo
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Kathleen Tong
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Kruti Pandya
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - John R Laird
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
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Singh GD, Armstrong EJ, Waldo SW, Alvandi B, Brinza E, Hildebrand J, Amsterdam EA, Humphries MD, Laird JR. Non-compressible ABIs are associated with an increased risk of major amputation and major adverse cardiovascular events in patients with critical limb ischemia. Vasc Med 2017; 22:210-217. [PMID: 28466753 DOI: 10.1177/1358863x16689831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Ankle-brachial indices (ABIs) are important for the assessment of disease burden among patients with peripheral artery disease. Although low values have been associated with adverse clinical outcomes, the association between non-compressible ABI (ncABI) and clinical outcome has not been evaluated among patients with critical limb ischemia (CLI). The present study sought to compare the clinical characteristics, angiographic findings and clinical outcomes of those with compressible (cABI) and ncABI among patients with CLI. Consecutive patients undergoing endovascular evaluation for CLI between 2006 and 2013 were included in a single center cohort. Major adverse cardiovascular events (MACE) were then compared between the two groups. Among 284 patients with CLI, 68 (24%) had ncABIs. These patients were more likely to have coronary artery disease ( p=0.003), diabetes ( p<0.001), end-stage renal disease ( p<0.001) and tissue loss ( p=0.01) when compared to patients with cABI. Rates of infrapopliteal disease were similar between the two groups ( p=0.10), though patients with ncABI had lower rates of iliac ( p=0.004) or femoropopliteal stenosis ( p=0.003). Infrapopliteal vessels had smaller diameters ( p=0.01) with longer lesions ( p=0.05) among patients with ncABIs. After 3 years of follow-up, ncABIs were associated with increased rates of mortality (HR 1.75, 95% CI: 1.12-2.78), MACE (HR 2.04, 95% CI: 1.35-3.03) and major amputation (HR 1.96, 95% CI: 1.11-3.45) when compared to patients with cABIs. In conclusion, ncABIs are associated with higher rates of mortality and adverse events among those undergoing endovascular therapy for CLI.
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Affiliation(s)
- Gagan D Singh
- 1 Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Ehrin J Armstrong
- 2 Division of Cardiology, University of Colorado, Denver, CO, USA.,3 VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Stephen W Waldo
- 2 Division of Cardiology, University of Colorado, Denver, CO, USA.,3 VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Bejan Alvandi
- 1 Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Ellen Brinza
- 2 Division of Cardiology, University of Colorado, Denver, CO, USA.,3 VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Justin Hildebrand
- 1 Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Ezra A Amsterdam
- 1 Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Misty D Humphries
- 4 Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - John R Laird
- 1 Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis School of Medicine, Sacramento, CA, USA
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13
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Serhal M, Mittal A, Khoury M, Brinza E, Fendrikova-Mahlay N, Gornik H, Kim E. FAMILY HISTORY OF ARTERIAL DISORDERS IN PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Brinza E, Grabinski V, Durga S, O’Connor S, Yesenko SL, Kim ESH, Gornik HL. Lower Extremity Fibromuscular Dysplasia: Clinical Manifestations, Diagnostic Testing, and Approach to Management. Angiology 2016; 68:722-727. [DOI: 10.1177/0003319716682121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibromuscular dysplasia (FMD), a disease well described in the renal and cerebrovascular circulations, also manifests in the lower extremity (LE) arteries. This study reports on the clinical presentation, imaging findings, and treatment of patients with LE FMD seen at a single center. Over a 7-year span, 100 of 449 patients with FMD had imaging of the LE arteries, of which 62 were found to have LE FMD (13.8% of the entire FMD cohort including patients with and without LE imaging). The majority of patients were women (96.8%), with an average age of 52 ± 11.3 years at the time of diagnosis. All patients had FMD present in another vascular bed, most commonly in the renal (80.6%) and extracranial carotid arteries (79.0%). Most patients had multifocal FMD (95.2%) and bilateral LE disease (69.4%), with the external (87.1%), common (19.4%), and internal (11.3%) iliac arteries most commonly affected. Presenting symptoms of LE involvement included claudication (22.6%), atypical leg symptoms (14.5%), and dissection (6.5%), but most patients were asymptomatic (71.0%). Nearly all patients were managed conservatively (98.4%) and only 1 patient required intervention.
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Affiliation(s)
- Ellen Brinza
- Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Victoria Grabinski
- Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sridevi Durga
- Department of Cardiovascular Medicine, Borgess Medical Center, Kalamazoo, MI, USA
| | - Sarah O’Connor
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sandra L. Yesenko
- Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Esther S. H. Kim
- Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heather L. Gornik
- Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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15
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O'Connor S, Kim ES, Brinza E, Moran R, Fendrikova-Mahlay N, Wolski K, Gornik HL. Systemic connective tissue features in women with fibromuscular dysplasia. Vasc Med 2015; 20:454-62. [PMID: 26156071 DOI: 10.1177/1358863x15592192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic disease associated with hypertension, headache, dissection, stroke, and aneurysm. The etiology is unknown but hypothesized to involve genetic and environmental components. Previous studies suggest a possible overlap of FMD with other connective tissue diseases that present with dissections and aneurysms. The aim of this study was to investigate the prevalence of connective tissue physical features in FMD. A total of 142 FMD patients were consecutively enrolled at a single referral center (97.9% female, 92.1% of whom had multifocal FMD). Data are reported for 139 female patients. Moderately severe myopia (29.1%), high palate (33.1%), dental crowding (29.7%), and early-onset arthritis (15.6%) were prevalent features. Classic connective features such as hypertelorism, cleft palate, and hypermobility were uncommon. The frequency of systemic connective tissue features was compared between FMD patients with a high vascular risk profile (having had ⩾1 dissection and/or ⩾2 aneurysms) and those with a standard vascular risk profile. A history of spontaneous pneumothorax (5.9% high risk vs 0% standard risk) and atrophic scarring (17.6% high risk vs 6.8% standard risk) were significantly more prevalent in the high risk group, p<0.05. High palate was observed in 43.1% of the high risk group versus 27.3% in the standard risk group, p=0.055. In conclusion, in a cohort of women with FMD, there was a prevalence of moderately severe myopia, high palate, dental crowding, and early-onset osteoarthritis. However, a characteristic phenotype was not discovered. Several connective tissue features such as high palate and pneumothorax were more prominent among FMD patients with a high vascular risk profile.
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Affiliation(s)
- Sarah O'Connor
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Esther Sh Kim
- Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, OH, USA
| | - Ellen Brinza
- Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, OH, USA
| | - Rocio Moran
- Cleveland Clinic Genomic Medicine Institute, Cleveland, OH, USA
| | | | - Kathy Wolski
- Cleveland Clinic Department of C5 Research, Cleveland, OH, USA
| | - Heather L Gornik
- Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, OH, USA
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