51
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Otagaki M, Matsumura K, Kin H, Fujii K, Shibutani H, Matsumoto H, Takahashi H, Park H, Yamamoto Y, Sugiura T, Shiojima I. Effect of Tofogliflozin on Systolic and Diastolic Cardiac Function in Type 2 Diabetic Patients. Cardiovasc Drugs Ther 2019; 33:435-442. [DOI: 10.1007/s10557-019-06892-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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52
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The impact of peripheral artery disease on left ventricular diastolic function. J Cardiol 2019; 73:453-458. [DOI: 10.1016/j.jjcc.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/11/2019] [Accepted: 01/24/2019] [Indexed: 12/24/2022]
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53
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Trenkwalder T, Schunkert H. Risk of atrial fibrillation in big people under the magnifying glass of G. J. Mendel. Eur Heart J 2019; 40:1283-1286. [PMID: 30722015 DOI: 10.1093/eurheartj/ehz037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Lazarettstr. 36, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Lazarettstr. 36, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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54
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Nah EH, Kim SY, Cho S, Kim S, Cho HI. Plasma NT-proBNP levels associated with cardiac structural abnormalities in asymptomatic health examinees with preserved ejection fraction: a retrospective cross-sectional study. BMJ Open 2019; 9:e026030. [PMID: 31005928 PMCID: PMC6500281 DOI: 10.1136/bmjopen-2018-026030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Stage B heart failure (HF) is defined as an asymptomatic abnormality of the heart structure or function. The circulating level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in symptomatic patients with left ventricular (LV) dysfunction caused by a structural or functional abnormality. This study investigated the association of the NT-proBNP level with echocardiography-detected cardiac structural or diastolic abnormalities in asymptomatic subjects with preserved LV systolic function (ejection fraction >50%). METHODS We retrospectively studied 652 health examinees who underwent echocardiography and an NT-proBNP test at a health-promotion centre in Seoul, between January 2016 and September 2018. The left ventricular mass index (LVMI) and the left atrial dimension (LAD) were used as markers for structural abnormalities, and the mean e' velocity and mitral early flow velocity/early diastolic tissue velocity (E/e') ratio were used as markers for diastolic dysfunction. The plasma NT-proBNP level was measured using electrochemiluminescence immunoassay (DPC Immulite 2000 XPi, Siemens Healthcare Diagnostics, Tarrytown, New York, USA). RESULTS Subjects with preclinical structural abnormalities were older and had a higher body mass index (BMI), higher blood pressure, lower high-density lipoprotein cholesterol level, higher NT-proBNP level, and higher E/e' (p<0.05). Multivariate regression analysis indicated that the factors associated with a higher NT-proBNP level were older age, female sex, lower BMI, higher creatinine level, higher LVMI and higher LAD (p<0.01). CONCLUSION Diastolic dysfunction is not associated with higher NT-proBNP levels, whereas preclinical cardiac structural abnormalities, as well as older age, female sex, lower BMI, and higher creatinine level, are associated with higher NT-proBNP levels.
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Affiliation(s)
- Eun-Hee Nah
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Seong Yoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea Association of Health Promotion, Seoul, South Korea
| | - Seon Cho
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Suyoung Kim
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, South Korea
| | - Han-Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, South Korea
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55
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Jakobsson J, Kalman SH, Lindeberg-Lindvet M, Bartha E. Is postspinal hypotension a sign of impaired cardiac performance in the elderly? An observational mechanistic study. Br J Anaesth 2019; 119:1178-1185. [PMID: 29040402 DOI: 10.1093/bja/aex274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background We have previously reported that stroke volume is reduced in a majority of elderly patients undergoing surgical repair of hip fracture before and after intrathecal injection of anaesthetic. We aimed to investigate these observations further in a prospective study of elderly patients undergoing elective hip or knee arthroplasty under spinal anaesthesia. Methods Patients ≥65 yr undergoing elective arthroplasty were monitored with LiDCOplus™ preoperatively (baseline), before and continuously for 45 min after spinal anaesthesia. Postspinal hypotension was defined as systolic blood pressure (bp) < 100 mm Hg or > 30% decrease from baseline. Associations between post-spinal hypotension and haemodynamic changes before (i.e. between baseline and before injection) spinal anaesthesia were analysed by logistic regression analysis. Results Twenty patients with a mean age of 74 (range 66-89) yr were included. Stroke volume index decreased by 14% (95% CI 9.3%-19%) before spinal anaesthesia. When patients were categorised according to post-spinal hypotension (Y/N) the patterns of haemodynamic changes differed. In the hypotensive patients, cardiac index progressively decreased whereas it increased initially in the non-hypotensive patients. Reduction of cardiac index from baseline before spinal anaesthesia was associated with increased risk of hypotension: OR 0.79 (95% CI 0.60, 0.91). The predictive value of reduced cardiac index was good (AUC under ROC curve 0.91). Conclusions A decrease in cardiac output from baseline before spinal anaesthesia and an inability to increase it after induction may be important features of postspinal hypotension in elderly patients.
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Affiliation(s)
- J Jakobsson
- Division of Anaesthesia and Intensive Care, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Perioperative Medicine.,Intensive Care, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
| | - S H Kalman
- Division of Anaesthesia and Intensive Care, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Perioperative Medicine.,Intensive Care, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
| | - M Lindeberg-Lindvet
- Division of Anaesthesia and Intensive Care, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Perioperative Medicine.,Intensive Care, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
| | - E Bartha
- Division of Anaesthesia and Intensive Care, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Perioperative Medicine.,Intensive Care, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
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56
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Chang HC, Cheng HM. P wave peak time: A time window to evaluate left ventricular diastolic function. J Clin Hypertens (Greenwich) 2019; 21:616-617. [PMID: 30950576 DOI: 10.1111/jch.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022]
Abstract
The activation time from electrical signals to chamber conformational change has long been demonstrated to associate with LV performance and ventriculo-arterial coupling with prognostic implications in heart failure patients. P wave peak time (PWPT), an easily obtainable parameter from conventional surface electrocardiography, represents the time taken for excitation spreading from sinoatrial node to the maximal summation of positive deflection from both atria. Increased PWPT denotes prolonged intra- or inter-atrial conduction time and indicates elevated intra-atrial pressure. As shown in a recently published study, PWPT was highly correlated with LV end diastolic pressure (LVEDP) derived from direct measurement during cardiac catheterization. With its objective and easily obtainable nature, clinical application of PWPT to evaluate diastolic function can be expected, if more studies in different populations can confirm its clinical utility.
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Affiliation(s)
- Hao-Chih Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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57
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Baroncini LAV, Borges LJL, Camarozano AC, Carmo DDC, Darwich RZ, Fortunato Junior JA. Echocardiographic Correlation between Right Ventricular Function and Left Atrial Volume. Arq Bras Cardiol 2019; 112:249-257. [PMID: 30916187 PMCID: PMC6424030 DOI: 10.5935/abc.20190042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Few reports exist on the relationship of the left ventricular diastolic
dysfunction (LVDD) with its most important features including enlargement of
the left atrium and left ventricular hypertrophy (LVH), and with the right
ventricular (RV) function. Objective To determine the correlation between the left atrial size and the RV function
and dimensions in patients with and without LVDD and LVH. Methods Fifty patients were included, 25 (40% men) of them with LVDD, aged 67.1
± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9
± 16.3 years (control group). Patients underwent transthoracic
echocardiography with evaluation of the left atrial size and volume (LAV),
LVDD, LVH, and RV function and dimensions. P-values < 0.05 were
considered statistically significant. Results LAV > 34 mL/m2 and left atrial size > 40 mm were associated
with lower absolute values of tricuspid annular plane systolic excursion
(TAPSE) and RV lateral S' (p ≤ 0.001, Pearson's correlation
coefficient -0.4 and -0.38, respectively) in the study group. Patients in
the study group showed higher incidence of LVH (p = 0.02) and greater left
atrial diameter (p = 0.03) compared with the control group. In addition,
greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found
in patients with LVDD grade II compared with LVDD grade I. Conclusions The present study determined, for the first time, the correlation of left
atrial enlargement with progressive RV dysfunction in patients with
LVDD.
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Affiliation(s)
| | - Lucas José Lira Borges
- Hospital da Cruz Vermelha - Cruz Vermelha Brasileira - Filial do Estado do Paraná, Curitiba, PR - Brazil
| | | | - Daniela de Castro Carmo
- Hospital da Cruz Vermelha - Cruz Vermelha Brasileira - Filial do Estado do Paraná, Curitiba, PR - Brazil
| | - Rubens Zenobio Darwich
- Hospital da Cruz Vermelha - Cruz Vermelha Brasileira - Filial do Estado do Paraná, Curitiba, PR - Brazil
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58
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Heiskanen JS, Ruohonen S, Rovio SP, Kytö V, Kähönen M, Lehtimäki T, Viikari JSA, Juonala M, Laitinen T, Tossavainen P, Jokinen E, Hutri-Kähönen N, Raitakari OT. Determinants of left ventricular diastolic function-The Cardiovascular Risk in Young Finns Study. Echocardiography 2019; 36:854-861. [PMID: 30905083 DOI: 10.1111/echo.14321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/29/2022] Open
Abstract
Decreased left ventricular (LV) diastolic function is associated with increased all-cause mortality and risk for a heart failure. The determinants of LV diastolic function have been mainly studied in elderly populations; however, the origin of LV heart failure may relate to the lifestyle factors acquired during the life course. Therefore, we examined biochemical, physiological, and lifestyle determinants of LV diastolic function in 34-49-year-old participants of the Cardiovascular Risk in Young Finns Study (Young Finns Study). In 2011, clinical examination and echocardiography were performed for 1928 participants (880 men and 1048 women; aged 34-49 years). LV diastolic function was primarily defined using E/é-ratio (population mean 4.8, range 2.1-9.0). In a multivariate model, systolic blood pressure (P < 0.005), female sex (P < 0.005), age (P < 0.005), waist circumference (P = 0.024), smoking (P = 0.028), serum alanine aminotransferase (P = 0.032) were directly associated with E/é-ratio, while an inverse association was found for height (P < 0.005). Additionally, a higher E/é-ratio was found in participants with concentric hypertrophy compared to normal cardiac geometry (P < 0.005). Other indicators of the LV diastolic function including E/A-ratio and left atrial volume index showed similarly strong associations with systolic blood pressure and age. In conclusion, we identified systolic blood pressure, waist circumference and smoking as modifiable determinants of the LV diastolic function in the 34-49-year-old participants of the Young Finns Study.
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Affiliation(s)
- Jarkko S Heiskanen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Saku Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Orion Pharma, Turku, Finland
| | - Suvi P Rovio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Ville Kytö
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital, Tyks T-Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Eero Jokinen
- Department of Paediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
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59
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Murtaza G, Virk HUH, Khalid M, Lavie CJ, Ventura H, Mukherjee D, Ramu V, Bhogal S, Kumar G, Shanmugasundaram M, Paul TK. Diabetic cardiomyopathy - A comprehensive updated review. Prog Cardiovasc Dis 2019; 62:315-326. [PMID: 30922976 DOI: 10.1016/j.pcad.2019.03.003] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 01/04/2023]
Abstract
Diabetes causes cardiomyopathy and increases the risk of heart failure independent of hypertension and coronary heart disease. This condition called "Diabetic Cardiomyopathy" (DCM) is becoming a well- known clinical entity. Recently, there has been substantial research exploring its molecular mechanisms, structural and functional changes, and possible development of therapeutic approaches for the prevention and treatment of DCM. This review summarizes the recent advancements to better understand fundamental molecular abnormalities that promote this cardiomyopathy and novel therapies for future research. Additionally, different diagnostic modalities, up to date screening tests to guide clinicians with early diagnosis and available current treatment options has been outlined.
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Affiliation(s)
- Ghulam Murtaza
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | | | - Muhammad Khalid
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Clinic, New Orleans, LA, USA
| | - Hector Ventura
- Department of Cardiology, Ochsner Clinic, New Orleans, LA, USA
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA
| | - Vijay Ramu
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Sukhdeep Bhogal
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Gautam Kumar
- Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Timir K Paul
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA.
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60
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Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr 2019; 32:216-232.e2. [DOI: 10.1016/j.echo.2018.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 12/30/2022]
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61
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Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome. Ir J Med Sci 2019; 188:783-790. [DOI: 10.1007/s11845-018-01959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
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62
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Kim HJ, Kim MA, Kim HL, Shim WJ, Park SM, Kim M, Yoon HJ, Shin MS, Hong KS, Shin GJ, Kim YH, Na JO, Jeong JO. Effects of multiparity on left ventricular diastolic dysfunction in women: cross-sectional study of the KoRean wOmen'S chest pain rEgistry (KoROSE). BMJ Open 2018; 8:e026968. [PMID: 30593559 PMCID: PMC6318513 DOI: 10.1136/bmjopen-2018-026968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the association between left ventricular (LV) diastolic dysfunction and multiparity in patients with suspected coronary artery disease (CAD). DESIGN Cross-sectional study. SETTING Linked secondary and tertiary care records from 29 cardiac centres which participated in KoRean wOmen'S chest pain rEgistry. PARTICIPANTS 960 women with suspected CAD who underwent invasive coronary angiography from February 2011 to May 2017. The patients were classified by parity number, as follows: low-parity, 0 to <3; multiparity, ≥3 pregnancies. MAIN OUTCOME MEASURE Prevalence of LV diastolic dysfunction. RESULTS There were 302 and 658 low-parity and multiparity patients, respectively. The prevalence of LV diastolic dysfunction was significantly higher in the multiparity than in the low-parity group. The multiparity group had significantly lower E and e´ septal velocities and E/A ratio, and had a significantly higher E/e´ ratio and right ventricular systolic pressure, which are parameters of LV diastolic dysfunction, than the low-parity group. The prevalence of CAD was significantly higher in the multiparity than in the low-parity group. Receiver operating characteristic curve analysis identified a parity of 2.5 as the cut-off for predicting LV diastolic dysfunction (area under the curve, 0.66; sensitivity, 74.1%; specificity, 52.0%; 95% CI 0.607 to 0.706; p<0.001). After adjustment for confounding factors, multivariate regression analysis showed that multiparity had a 1.80-fold increased risk for LV diastolic dysfunction (OR 1.80, 95% CI 1.053 to 3.081, p=0.032). CONCLUSIONS The prevalence of LV diastolic dysfunction was higher in multiparity than in low-parity women with suspected CAD. Multiparity was an independent risk factor for LV diastolic dysfunction. LV diastolic dysfunction should be evaluated in multiparous women for the risk of subsequent cardiovascular disease and facilitate the initiation of appropriate treatment.
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Affiliation(s)
- Hyun-Jin Kim
- Chungbuk Regional Cardiovascular Center, Chungbuk National University Hospital, Cheongju, Chungcheongbuk-do, Korea
| | - Myung-A Kim
- Cardiovascular Center, Seoul National University Boramae Medical Hospital, Seoul, Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Medical Hospital, Seoul, Korea
| | - Wan Joo Shim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Seong Mi Park
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Mina Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Mi Seung Shin
- Department of Cardiology, Gachon Medical School Gil Medical Center, Incheon, Korea
| | - Kyung-Soon Hong
- Department of Cardiology, Hanllym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Gil Ja Shin
- Department of Cardiology, Ewha Womans University Hospital, Seoul, Korea
| | - Yong-Hyun Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea
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63
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Fraser AG. A manifesto for cardiovascular imaging: addressing the human factor. Eur Heart J Cardiovasc Imaging 2018; 18:1311-1321. [PMID: 29029029 PMCID: PMC5837338 DOI: 10.1093/ehjci/jex216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022] Open
Abstract
Our use of modern cardiovascular imaging tools has not kept pace with their technological development. Diagnostic errors are common but seldom investigated systematically. Rather than more impressive pictures, our main goal should be more precise tests of function which we select because their appropriate use has therapeutic implications which in turn have a beneficial impact on morbidity or mortality. We should practise analytical thinking, use checklists to avoid diagnostic pitfalls, and apply strategies that will reduce biases and avoid overdiagnosis. We should develop normative databases, so that we can apply diagnostic algorithms that take account of variations with age and risk factors and that allow us to calculate pre-test probability and report the post-test probability of disease. We should report the imprecision of a test, or its confidence limits, so that reference change values can be considered in daily clinical practice. We should develop decision support tools to improve the quality and interpretation of diagnostic imaging, so that we choose the single best test irrespective of modality. New imaging tools should be evaluated rigorously, so that their diagnostic performance is established before they are widely disseminated; this should be a shared responsibility of manufacturers with clinicians, leading to cost-effective implementation. Trials should evaluate diagnostic strategies against independent reference criteria. We should exploit advances in machine learning to analyse digital data sets and identify those features that best predict prognosis or responses to treatment. Addressing these human factors will reap benefit for patients, while technological advances continue unpredictably.
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Affiliation(s)
- Alan G Fraser
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.,Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.,Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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64
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Kim HL, Kim MA, Oh S, Kim M, Yoon HJ, Park SM, Shin MS, Hong KS, Shin GJ, Shim WJ. Sex Differences in Traditional and Nontraditional Risk Factors for Obstructive Coronary Artery Disease in Stable Symptomatic Patients. J Womens Health (Larchmt) 2018; 28:212-219. [PMID: 29958048 DOI: 10.1089/jwh.2017.6834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There have been limited data on sex-specific risk factors for coronary artery disease (CAD) in patients with stable chest pain. This study was performed to investigate whether risk factors for CAD differ by sex in stable symptomatic patients. METHODS Data were obtained from a nation-wide registry, enrolling 1025 patients (age, 62.0 ± 11.0 years, 587 women) with chest pain who underwent elective invasive coronary angiography under the suspicion of CAD. RESULTS A total of 373 patients (36.4%) had obstructive CAD (≥50% stenosis) (men vs. women: 33.8% vs. 38.3%, p = 0.135). In men, univariate analyses showed that age, renal function, total cholesterol, low-density lipoprotein cholesterol, triglyceride, C-reactive protein (CRP), left ventricular (LV) systolic function, and septal annular velocity of LV (e') were significantly associated with the presence of obstructive CAD. Among these factors, a high CRP level (≥0.50 mg/dL) was an independent predictor of CAD in multivariable analysis (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.26-6.82; p = 0.012). In women, univariate analyses showed that age, waist circumference, heart rate, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, LV systolic function, LV mass index, e' velocity, E/e', and left atrial size were significantly associated with the presence of obstructive CAD. Among these factors, lower e' velocity (<6.35 cm/s) was an independent predictor of CAD in multivariable analysis (OR, 2.38; 95% CI, 1.21-4.70; p = 0.012). CONCLUSIONS Among patients with stable chest pain, inflammation and LV diastolic dysfunction are independently associated with obstructive CAD in men and women, respectively.
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Affiliation(s)
- Hack-Lyoung Kim
- 1 Division of Cardiology, SMG-SNU Boramae Medical Center , Seoul, Korea
| | - Myung-A Kim
- 1 Division of Cardiology, SMG-SNU Boramae Medical Center , Seoul, Korea
| | - Sohee Oh
- 2 Department of Biostatistics, SMG-SNU Boramae Medical Center , Seoul, Korea
| | - Mina Kim
- 3 Division of Cardiology, Korea University Anam Hospital , Seoul, Korea
| | - Hyun Ju Yoon
- 4 Division of Cardiology, Chonnam National University Hospital , Gwangju, Korea
| | - Seong Mi Park
- 3 Division of Cardiology, Korea University Anam Hospital , Seoul, Korea
| | - Mi Seung Shin
- 5 Division of Cardiology, Gachon Medical School Gil Medical Center , Incheon, Korea
| | - Kyung-Soon Hong
- 6 Division of Cardiology, Hallym University Medical Center , Chuncheon, Korea
| | - Gil Ja Shin
- 7 Division of Cardiology, Ewha Womans University Hospital , Seoul, Korea
| | - Wan-Joo Shim
- 3 Division of Cardiology, Korea University Anam Hospital , Seoul, Korea
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65
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Metkus TS, Suarez-Pierre A, Crawford TC, Lawton JS, Goeddel L, Dodd-O J, Mukherjee M, Abraham TP, Whitman GJ. Diastolic dysfunction is common and predicts outcome after cardiac surgery. J Cardiothorac Surg 2018; 13:67. [PMID: 29903030 PMCID: PMC6003153 DOI: 10.1186/s13019-018-0744-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/31/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diastolic dysfunction (DD) identified on echocardiography predicts mortality after cardiac surgery, however the most useful diastolic parameters for assessment and the association of DD with prolonged mechanical ventilation, ICU re-admission, and hospital length of stay are not established. Methods We included patients that underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure (CAB-AVR) from 2010 to 2016, and who had preoperative transthoracic echocardiography (TTE) at our institution within 6 months of the operation. Diastolic function was graded using the transmitral E and A waves and the septal tissue Doppler velocity. We performed logistic regression to assess the association of grade of DD with a composite endpoint of death, prolonged mechanical ventilation, ICU readmission during hospitalization, and hospital length of stay longer than 14 days. Results Between 2010 and 2016, 577 patients were eligible for inclusion. DD was common, with 42% of the cohort manifesting grade II or grade III DD. Rates of death and prolonged ventilation increased across grades of DD and across quartiles of increasing LV filling pressure, assessed by the E/e’ ratio. Adjusting for age, sex, procedure, systolic and diastolic function, both systolic (odds ratio 0.68 95% CI 0.55–0.85 per inter-quartile increase in LVEF) and diastolic function (odds ratio 1.31 95% CI 1.04–1.66 per increasing DD grade) both independently predicted outcome. Conclusion Diastolic dysfunction is common among patients undergoing cardiac surgery and is associated with death, prolonged mechanical ventilation, and prolonged hospital and ICU length of stay independent of systolic dysfunction.
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Affiliation(s)
- Thomas S Metkus
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD, 21287, USA.
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd C Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee Goeddel
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Dodd-O
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD, 21287, USA
| | - Theodore P Abraham
- Division of Cardiology, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave., Suite M344 San Francisco, San Francisco, CA, USA
| | - Glenn J Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kang JG, Chang Y, Sung KC, Kim JY, Shin H, Ryu S. Association of isolated minor nonspecific ST-T abnormalities with left ventricular hypertrophy and diastolic dysfunction. Sci Rep 2018; 8:8791. [PMID: 29884788 PMCID: PMC5993779 DOI: 10.1038/s41598-018-27028-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to examine the associations of isolated minor nonspecific ST-T abnormalities (NSSTTA) on 12-lead electrocardiogram (ECG) with left ventricular (LV) diastolic function and LV geometry on echocardiography. A cross-sectional study comprised of 74,976 Koreans who underwent ECG and echocardiography as part of a comprehensive health examination between March 2011 and December 2014. ECG was coded using Minnesota Code criteria. The frequencies of NSSTTA, impaired LV relaxation, and echocardiographic LVH were 1,139 (1.5%), 21,118 (28.2%), and 1,687 (2.3%) patients, respectively. The presence of NSSTTA was positively associated with the prevalence of impaired LV relaxation and LVH on echocardiography. In a multivariable-adjusted model, the odds ratio (95% CIs) comparing patients with NSSTTA to control patients was 1.55 (1.33-1.80) for impaired LV relaxation and 3.15 (2.51-3.96) for echocardiographic LVH. The association between NSSTTA and impaired LV relaxation was stronger in the intermediate to high cardiovascular disease-risk group than in the low-risk group according to Framingham Risk Score stratification (P for interaction = 0.02). NSSTTA were associated with increased prevalence of impaired LV relaxation and LVH, suggesting NSSTTA as an early indicator of subclinical cardiac dysfunction and geometric abnormalities.
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Affiliation(s)
- Jeong Gyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jang-Young Kim
- Departments of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, South Korea
- Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Hocheol Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Matsutani D, Sakamoto M, Kayama Y, Takeda N, Horiuchi R, Utsunomiya K. Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes. Cardiovasc Diabetol 2018; 17:73. [PMID: 29788955 PMCID: PMC5963148 DOI: 10.1186/s12933-018-0717-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) greatly increases the risks of cardiovascular disease and heart failure. In particular, left ventricular diastolic dysfunction that develops from the early stages of T2DM is an important factor in the onset and exacerbation of heart failure. The effect of sodium-glucose cotransporter 2 inhibitors on left ventricular diastolic function has not been elucidated. We have performed the first prospective study on the effects of canagliflozin on left ventricular diastolic function in T2DM. METHODS This study was performed to evaluate the effects of additional treatment with canagliflozin for 3 months on left ventricular diastolic function in patients with T2DM. A total of 38 patients with T2DM were consecutively recruited for this study. Left ventricular diastolic function was assessed by echocardiography. The primary study outcome was a change in the septal E/e' as a parameter of left ventricular diastolic function. RESULTS A total of 37 patients (25 males and 12 females) were included in the analysis. Mean age of participants was 64.2 ± 8.1 years (mean ± SD), mean duration of diabetes was 13.5 ± 8.1 years, and mean HbA1c was 7.9 ± 0.7%. Of the participants, 86.5% had hypertension, 100% had dyslipidemia, and 32.4% had cardiovascular disease. Canagliflozin significantly improved left ventricular diastolic function (septal E/e' ratio 13.7 ± 3.5-12.1 ± 2.8, p = 0.001). Furthermore, among the various parameters that changed through the administration of canagliflozin, only changes in hemoglobin significantly correlated with changes in the septal E/e' ratio (p = 0.002). In multiple regression analysis, changes in hemoglobin were also revealed to be an independent predictive factor for changes in the septal E/e' ratio. CONCLUSIONS This study showed for the first time that canagliflozin could improve left ventricular diastolic function within 3 months in patients with T2DM. The benefit was especially apparent in patients with substantially improved hemoglobin values. Trial registration UMIN Clinical Trials Registry UMIN000028141.
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Affiliation(s)
- Daisuke Matsutani
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yosuke Kayama
- Department of Cardiology, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Ryuzo Horiuchi
- Department of Pathology, Tsuruoka Kyoritsu Hospital, 9-34, Fumizonomachi, Tsuruoka-shi, Yamagata, 997-0816, Japan
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Platt MJ, Huber JS, Romanova N, Brunt KR, Simpson JA. Pathophysiological Mapping of Experimental Heart Failure: Left and Right Ventricular Remodeling in Transverse Aortic Constriction Is Temporally, Kinetically and Structurally Distinct. Front Physiol 2018; 9:472. [PMID: 29867532 PMCID: PMC5962732 DOI: 10.3389/fphys.2018.00472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022] Open
Abstract
A growing proportion of heart failure (HF) patients present with impairments in both ventricles. Experimental pressure-overload (i.e., transverse aortic constriction, TAC) induces left ventricle (LV) hypertrophy and failure, as well as right ventricle (RV) dysfunction. However, little is known about the coordinated progression of biventricular dysfunction that occurs in TAC. Here we investigated the time course of systolic and diastolic function in both the LV and RV concurrently to improve our understanding of the chronology of events in TAC. Hemodynamic, histological, and morphometric assessments were obtained from the LV and RV at 2, 4, 9, and 18 weeks post-surgery. Results: Systolic pressures peaked in both ventricles at 4 weeks, thereafter steadily declining in the LV, while remaining elevated in the RV. The LV and RV followed different structural and functional timelines, suggesting the patterns in one ventricle are independent from the opposing ventricle. RV hypertrophy/fibrosis and pulmonary arterial remodeling confirmed a progressive right-sided pathology. We further identified both compensation and decompensation in the LV with persistent concentric hypertrophy in both phases. Finally, diastolic impairments in both ventricles manifested as an intricate progression of multiple parameters that were not in agreement until overt systolic failure was evident. Conclusion: We establish pulmonary hypertension was secondary to LV dysfunction, confirming TAC is a model of type II pulmonary hypertension. This study also challenges some common assumptions in experimental HF (e.g., the relationship between fibrosis and filling pressure) while addressing a knowledge gap with respect to temporality of RV remodeling in pressure-overload.
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Affiliation(s)
- Mathew J. Platt
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Jason S. Huber
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Nadya Romanova
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
| | - Keith R. Brunt
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Jeremy A. Simpson
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- IMPART Team Canada Investigator Network, Saint John, NB, Canada
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Predictors of diastolic dysfunction in ethnic groups: observations from the Hypertensive Cohort of The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). J Hum Hypertens 2018; 32:477-486. [PMID: 29713052 PMCID: PMC6061936 DOI: 10.1038/s41371-018-0064-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/23/2017] [Accepted: 04/06/2018] [Indexed: 12/18/2022]
Abstract
The study aimed to establish a relationship of ethnicity to diastolic dysfunction in subjects of African-Caribbean and South Asian origins and the impact of diastolic dysfunction and ethnicity on all-cause and cardiovascular mortality. Hypertensive subjects with ejection fraction ≥55% and no history of ischemic heart disease/valve pathology (n=1546, 830 South Asians and 716 African-Caribbeans) were identified from the Ethnic - Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. African-Caribbean ethnicity was associated with lower prevalence of having diastolic dysfunction (odds ratio 0.67, 95% confidence interval 0.51-0.87, p=0.003) and increased left ventricular filling pressure (odds ratio 0.48, 95% confidence interval 0.34-0.69, p<0.001) as well as lower left atrial index (p<0.001). This was the case despite the fact that African-Caribbean ethnicity was independently associated with higher left ventricular mass index (p<0.001). Ninety-two deaths (6%) occurred during 68±21 months follow up. On Cox regression analysis, South Asian ethnicity (p=0.024) was predictive of all-cause death before adjustment for parameters of diastolic dysfunction, but it was no longer predictive of death after accounting for these variables. South Asian ethnicity is independently associated with worse parameters of diastolic function in hypertension, despite African-Caribbeans having more prominent hypertrophy.
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Obesity and metabolic features associated with long-term developing diastolic dysfunction in an initially healthy population-based cohort. Clin Res Cardiol 2018; 107:887-896. [PMID: 29680861 DOI: 10.1007/s00392-018-1259-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diastolic dysfunction (DD) is increasingly common. However, its metabolic determinants are poorly known. This study aims to determine which metabolic and inflammatory features predict DD in initially healthy adults. METHODS We prospectively analyzed the association between metabolic features and DD in 728 initially healthy adults aged 30-60 from Eastern France enrolled in the STANISLAS population-based cohort. Clinical and biological cardiovascular features were collected at baseline (1994-1995). DD was assessed twenty years later (2011-2016) by echocardiography using current international guidelines. For replication purposes, 1463 subjects from the Malmö Preventive Project cohort were analyzed. RESULTS In the STANISLAS cohort, 191 subjects (26.2%) developed DD. In age-sex-adjusted logistic models, significant predictors of DD were body mass index (BMI, odds ratio for 1-standard-deviation increase (OR) 1.28, 95% CI 1.08-1.52), waist circumference (WC, OR 1.48, 95% CI 1.18-1.84), waist-hip ratio (OR 1.53, 95% CI 1.16-2.02), systolic blood pressure (OR 1.19, 95% CI 1.00-1.43) and triglycerides (TG, OR 1.18, 95% CI 1.00-1.40). Subjects with elevated WC (> 80th percentile) and TG (> 50th percentile) had a twofold higher DD risk (age-sex-adjusted odds ratio 2.00, 95% CI 1.20-3.31, P = 0.008), whereas no such interplay was observed for BMI. In the Malmö cohort, BMI was similarly associated with DD; participants with both elevated BMI and TG were at higher DD risk (age-sex-adjusted odds ratio 1.61, 95% CI 1.18-2.20, P = 0.002). CONCLUSIONS Subjects with elevated WC and TG may have a higher long-term DD risk. Prevention targeting visceral obesity may help reduce the incidence of DD.
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Butler J, Kalogeropoulos AP, Anstrom KJ, Hsue PY, Kim RJ, Scherzer R, Shah SJ, Shah SH, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Braunwald E. Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study. J Card Fail 2018; 24:255-265. [PMID: 29482027 PMCID: PMC5880702 DOI: 10.1016/j.cardfail.2018.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/28/2022]
Abstract
Antiretroviral therapy (ART) has been associated with a shift in the epidemiology of human immunodeficiency virus (HIV)-associated cardiomyopathy from a phenotype of primarily left ventricular (LV) systolic dysfunction to LV diastolic dysfunction (DD). Patients with HIV receiving ART have higher rates of DD compared with age-matched control subjects and develop DD at a younger age. However, little is known about the natural history and pathogenesis of DD in virally suppressed HIV-infected patients. Current evidence suggests that immune processes modulate the risk for cardiac involvement in HIV-infected persons. Ongoing inflammation appears to have myocardial effects, and accelerated myocardial fibrosis appears to be a key mediator of HIV-induced DD. The Characterizing Heart Function on Antiretroviral Therapy (CHART) study aims to systematically investigate determinants, mechanisms, and consequences of DD in HIV-infected patients. We will compare ART-treated virally suppressed HIV-infected individuals with and without DD and HIV- individuals with DD regarding (1) systemic inflammation, myocardial stress, and subclinical myocardial necrosis as indicated by circulating biomarkers; (2) immune system activation as indicated by cell surface receptors; (3) myocardial fibrosis according to cardiac magnetic resonance examination; (4) markers of fibrosis and remodeling, oxidative stress, and hypercoagulability; (5) left atrial function according to echocardiographic examination; (6) myocardial stress and subclinical necrosis as indicated by circulating biomarkers; (7) proteomic and metabolic profiles; and (8) phenotype signatures derived from clinical, biomarker, and imaging data.
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Affiliation(s)
- Javed Butler
- Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York.
| | | | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Priscilla Y Hsue
- Cardiology Division, Department of Medicine, University of California, San Francisco, California
| | - Raymond J Kim
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Rebecca Scherzer
- UCSF Department of Medicine and San Francisco Department of Veterans Administration, San Francisco, California
| | - Sanjiv J Shah
- Cardiology Division, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Svati H Shah
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Adrian F Hernandez
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National, Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eugene Braunwald
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Shecterle LM, Terry KR, St Cyr JA. Potential Clinical Benefits of D-ribose in Ischemic Cardiovascular Disease. Cureus 2018; 10:e2291. [PMID: 29750132 PMCID: PMC5943027 DOI: 10.7759/cureus.2291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cardiovascular disease still remains the leading cause of deaths worldwide. Atherosclerosis, the most common type of cardiovascular disease, has continued to progress due to many factors, genetics, and lifestyles. All cells require adequate adenosine triphosphate (ATP) levels to maintain their integrity and function. Myocardial ischemia commonly found in atherosclerosis can produce lower levels of ATP, which affects not only cellular energy, but also alters normal function. D-ribose, a naturally occurring pentose carbohydrate, has been shown to increase cellular energy levels and improve function following ischemia in pre-clinical studies and have demonstrated potential benefits in clinical evaluations. This review paper presents an overview of ischemic cardiovascular disease and the potential role that D-ribose could play in improving myocardial energy levels and function in the area of ischemic cardiovascular diseases.
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Dong Y, Yang D, Han Y, Cheng W, Sun J, Wan K, Liu H, Greiser A, Zhou X, Chen Y. Age and Gender Impact the Measurement of Myocardial Interstitial Fibrosis in a Healthy Adult Chinese Population: A Cardiac Magnetic Resonance Study. Front Physiol 2018; 9:140. [PMID: 29559916 PMCID: PMC5845542 DOI: 10.3389/fphys.2018.00140] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 02/12/2018] [Indexed: 02/05/2023] Open
Abstract
Background: Diffuse myocardial fibrosis is a common pathological process in many cardiovascular diseases. In order to determine disease, we must have standard normal imaging values. We investigated myocardial interstitial fibrosis of the left ventricle (LV) in a healthy population of Chinese adults and explored the impact of gender, age, and other physiological factors using a T1 mapping technique of cardiac magnetic resonance imaging (CMR). Materials and Methods: We recruited 69 healthy adult Chinese subjects (35 males; age 18–76). LV function and global strain were obtained from functional imaging. T1 mapping was performed using a modified look-locker sequence. Global and segmental native T1 and extracellular volume (ECV) were calculated using dedicated software. Gender, age, and segmental variation of both native myocardial T1 and ECV of the LV were analyzed. Results: The global myocardial native T1 and ECV of the LV in this Chinese adult healthy population was 1,202 ± 45 ms and 27 ± 3% at 3T field strength, respectively. Females had a higher myocardial native T1 and ECV of the LV compared to males [1,210 (1,188–1,264) ms vs. 1,182 (1,150–1,211) ms, P < 0.001; 28 ± 3 vs. 26 ± 3%, P = 0.027, respectively]. ECV in older group was higher than younger group [27 (26–29)% vs. 25 (24–29), P = 0.019]. The multi-variate linear regression analysis showed that only gender (Beta = −0.512, P < 0.001) was independently related with global native T1 of LV while gender (Beta = −0.278, P = 0.017) and age (Beta = 0.303, P = 0.010) were independently related with global ECV of LV. From the base to apex of the LV, myocardial native T1 (P = 0.020) and ECV (P < 0.001) significantly increased. Within the same slice of the LV, there were significant segmental variations of both myocardial native T1 (P < 0.001) and ECV (P < 0.001) values. Conclusion: Gender and age have significant impacts on the imaging markers of myocardial interstitial fibrosis in healthy adult Chinese volunteers. Segmental variation of myocardial interstitial fibrosis was also observed.
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Affiliation(s)
- Yang Dong
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Yang
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Wei Cheng
- Radiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Radiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wan
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Liu
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
| | | | - Xiaoyue Zhou
- Northeast Asia MR Collaboration, Siemens Healthcare, Beijing, China
| | - Yucheng Chen
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
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Almeida JG, Fontes-Carvalho R, Sampaio F, Ribeiro J, Bettencourt P, Flachskampf FA, Leite-Moreira A, Azevedo A. Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population. Eur Heart J Cardiovasc Imaging 2017; 19:380-386. [DOI: 10.1093/ehjci/jex252] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/04/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- João G Almeida
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - Paulo Bettencourt
- Department of Medicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Frank A Flachskampf
- Institutionen för Medicinska Vetenskaper, Uppsala Universitet, Sjukhusvägen 7, 753 09 Uppsala, Sweden
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Center, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Ana Azevedo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Portugal
- Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto (ISPUP), Rua das Taipas n°135 Porto 4050-600, Portugal
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Roque MCDF, Sampaio-Barros PD, Arruda AL, Barros-Gomes S, Becker D, Andrade JLD, Rodrigues ACT. Evaluation of Left Ventricular Diastolic Function by Echocardiography with Tissue Doppler in Systemic Sclerosis. Arq Bras Cardiol 2017; 109:410-415. [PMID: 28977055 PMCID: PMC5729776 DOI: 10.5935/abc.20170145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Systemic sclerosis (SS) is a connective tissue abnormality characterized by
fibrosis of the skin and internal organs. Cardiac involvement with
consequent myocardial dysfunction in SS is associated with increased
morbidity and mortality. Objective To investigate the left ventricular (LV) diastolic function in patients with
SS and preserved systolic function. Methods Patients with SS were evaluated with two-dimensional echocardiography with
tissue Doppler for analysis of chamber diameters, LV mass index (LVMI),
indexed left atrial volume (iLAV), systolic function of both ventricles, and
presence and degree of diastolic dysfunction (DD). Results We evaluated 50 patients, divided according to the presence of DD into Group
1 (n = 25; normal diastolic function, E/A ratio ≥ 0.8, deceleration
time [DT] > 150 ms and < 200 ms, and septal e’ > 8 cm/s) and Group
2 (n = 25; with DD, subdivided into type I DD [E/A < 0.8, DT > 200
ms], type II [E/A ≥ 0.8, septal e’ < 8 cm/s, iLAV > 34
mL/m2], and type III [E/A > 2, DT < 150 ms, septal e’
< 8 cm/s]). Type I DD was the most frequent (34%), followed by type II DD
(16%). LVMI and iLAV were similar in both groups, but septal and lateral e’
were reduced only in Group 2. In Group 2, we observed that patients with
moderate DD had longer disease duration (p = 0.02). Conclusion The prevalence of type I DD was elevated in SS and associated with aging.
Disease duration emerged as an important factor in moderate DD.
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Affiliation(s)
| | | | - Ana Lucia Arruda
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Derly Becker
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Abstract
Pulmonary hypertension is a pathologic hemodynamic condition defined by a mean pulmonary arterial pressure of 25 mm Hg or greater at rest. Because of age-associated stiffening of the heart and the pulmonary vasculature and the higher prevalence in the elderly of comorbidities associated with the development of pulmonary hypertension, it is an increasingly common finding in this patient population. A right heart catheterization is necessary for the diagnosis and characterization of pulmonary hypertension. The general management is to treat the underlying conditions responsible for the development of the disorder. Pulmonary vasodilators are indicated in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Hooman Poor
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA.
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77
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Sayegh ALC, Degani-Costa LH. Effects of exercise training on endothelial and diastolic age-related dysfunctions: a new view of an old problem. J Physiol 2017; 595:4591-4592. [PMID: 28466473 DOI: 10.1113/jp274531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ana Luiza Carrari Sayegh
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Paulista School of Medicine, Federal University of São Paulo (UNIFESP-EPM), São Paulo, Brazil
| | - Luiza Helena Degani-Costa
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Paulista School of Medicine, Federal University of São Paulo (UNIFESP-EPM), São Paulo, Brazil
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78
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Screever EM, Meijers WC, van Veldhuisen DJ, de Boer RA. New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations. Expert Opin Pharmacother 2017; 18:645-655. [PMID: 28375036 DOI: 10.1080/14656566.2017.1316377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Heart failure (HF) remains a major public health problem worldwide, affecting approximately 23 million patients, and is predominantly a disease of the elderly population. Elderly patients mostly suffer from HF with preserved ejection fraction (HFpEF), which often presents with multiple co-morbidities and they require multiple medical treatments. This, together with the heterogeneous phenotype of HFpEF, makes it a difficult syndrome to diagnose and treat. Areas covered: Although HF is most abundant in the elderly, this group is still underrepresented in clinical trials, which results in the lack of evidence-based medical regimens. The current review has focused on new potential therapies for this poorly studied population. The focus will be on several classes of drugs currently recommended or might be expected soon. These will include sacubitril/valsartan (former LCZ696), Omecamtiv mecarbil, Vericiguat, Ivabradine, mineralocorticoid receptor antagonists (MRAs) and potassium binders. Expert opinion: We discuss promising new treatments and hypothesize that personalized approaches will be needed to treat elderly patients optimally. Medical doctors should not only focus on HF therapy, but comorbidities and polypharmacy should also influence therapeutic decision making. Furthermore, the importance of quality of life as a management endpoint should not be underestimated in the frail elderly.
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Affiliation(s)
- Elles M Screever
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Wouter C Meijers
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Dirk J van Veldhuisen
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Rudolf A de Boer
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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79
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Pellicori P, Salekin D, Pan D, Clark AL. This patient is not breathing properly: is this COPD, heart failure, or neither? Expert Rev Cardiovasc Ther 2017; 15:389-396. [DOI: 10.1080/14779072.2017.1317592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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80
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Nazário Leão R, Marques da Silva P. Diastolic dysfunction in hypertension. HIPERTENSION Y RIESGO VASCULAR 2017; 34:128-139. [PMID: 28268171 DOI: 10.1016/j.hipert.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 12/21/2022]
Abstract
Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction.
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Affiliation(s)
- R Nazário Leão
- Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - P Marques da Silva
- Nova Medical School, Lisboa, Portugal; Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal
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81
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Clinical significance of right ventricular activity on treadmill thallium-201 myocardial single-photon emission computerized tomography using cadmium-zinc-telluride cameras. Nucl Med Commun 2017; 37:650-7. [PMID: 27110956 DOI: 10.1097/mnm.0000000000000494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Identification of right ventricular (RV) abnormalities is important in patients with suspected coronary artery disease (CAD). RV activity can be better visualized on myocardial single-photon emission computerized tomography (SPECT) using a higher sensitivity cadmium-zinc-telluride (CZT) detector. The aim of this study was to investigate the clinical significance of RV/left ventricular (LV) uptake ratios during exercise thallium-201 SPECT using CZT detectors. PATIENTS AND METHODS A total of 102 patients underwent treadmill ECG-gated SPECT, coronary angiography, and echocardiography. SPECT myocardial perfusion was interpreted using a 17-segment model and a 0-4-point scale. RV/LV uptake ratios were calculated on the basis of maximum counts per pixel within the entire RV and LV walls. The relationships between RV/LV uptake ratio and gated SPECT, presence of CAD (≥50% stenosis in the left main or ≥70% in the main branches), demographics, and echocardiographic parameters were analyzed. RESULTS Stress RV/LV ratios correlated positively with the presence of left main or multivessel disease, and tricuspid regurgitation maximum pressure gradient. After multivariate regression, stress/rest RV/LV ratios correlated positively with mitral flow deceleration time, age, female sex, and use of β-blockers. CONCLUSION RV/LV uptake ratios on the basis of exercise myocardial perfusion SPECT imaging using CZT cameras are useful for the detection of severe CAD and could serve as an indicator of pulmonary hypertension and LV diastolic dysfunction.
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82
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Venkatesh S, O'Neal WT, Broughton ST, Shah AJ, Soliman EZ. The clinical utility of normal findings on noninvasive cardiac assessment in the prediction of atrial fibrillation. Clin Cardiol 2017; 40:200-204. [PMID: 28191912 DOI: 10.1002/clc.22644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The absence of abnormalities on noninvasive cardiac assessment possibly confers a reduced risk of atrial fibrillation (AF) despite the presence of traditional risk factors. HYPOTHESIS Normal findings on noninvasive cardiac assessment are associated with a lower risk of AF development. METHODS We examined the clinical utility of normal findings on routine noninvasive cardiac assessment in 5331 participants (85% white; 57% women) from the Cardiovascular Health Study who were free of baseline AF. The combination of a normal electrocardiogram (ECG) + normal echocardiogram was assessed for the development of AF events. A normal ECG was defined as the absence of major or minor Minnesota code abnormalities. A normal echocardiogram was defined as the absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10-year risk of developing AF. RESULTS During the 10-year study period, a total of 951 (18%) AF events were detected. A normal ECG (multivariable hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.69-0.92) and normal echocardiogram (multivariable HR: 0.75, 95% CI: 0.65-0.87) were associated with a reduced risk of AF in isolation. This association improved in those with normal ECG + normal echocardiogram (multivariable HR: 0.66, 95% CI: 0.55-0.79) compared with participants who had abnormal ECG + abnormal echocardiogram (referent). CONCLUSIONS Normal findings on routine noninvasive cardiac assessment identify persons in whom the risk of AF is low. Further studies are needed to explore the utility of this profile regarding the decision to implement certain risk factor modification strategies in older adults to reduce AF burden.
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Affiliation(s)
- Sanjay Venkatesh
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen T Broughton
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amit J Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Cardiology, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Elsayed Z Soliman
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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83
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De Jong KA, Czeczor JK, Sithara S, McEwen K, Lopaschuk GD, Appelbe A, Cukier K, Kotowicz M, McGee SL. Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study. Cardiovasc Diabetol 2017; 16:21. [PMID: 28178970 PMCID: PMC5299776 DOI: 10.1186/s12933-017-0504-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/03/2017] [Indexed: 01/19/2023] Open
Abstract
Background It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required. Methods This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction. Results Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients. Conclusions These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status. Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0504-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirstie A De Jong
- Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.
| | - Juliane K Czeczor
- Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, c/o Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.,German Center of Diabetes Research, Ingolstädter Landstraße 1, 85764, München-Neuherberg, Germany
| | - Smithamol Sithara
- Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Kevin McEwen
- Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Gary D Lopaschuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2H7, Canada.,Department of Pharmacology, University of Alberta, Edmonton, AB, T6G 2H7, Canada
| | - Alan Appelbe
- Cardiology Department, Barwon Health, University Hospital Geelong, Victoria, Australia
| | - Kimberly Cukier
- Geelong Endocrinology and Diabetes Centre, Geelong, VIC, Australia
| | - Mark Kotowicz
- Endocrinology Department, Barwon Health, University Hospital, Geelong, VIC, Australia.,School of Medicine, Deakin University, Waurn Ponds, VIC, Australia.,Melbourne Medical School-Western Precinct, The University of Melbourne, Victoria, Australia
| | - Sean L McGee
- Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
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84
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Eryonucu B, Güler N, Güntekin U, Tuncer M. Comparison of the Effects of Nitroglycerin and Nitroprusside on Transmitral Doppler Flow Parameters in Patients with Hypertensive Urgency. Ann Pharmacother 2017; 39:997-1001. [PMID: 15886286 DOI: 10.1345/aph.1e562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Sodium nitroprusside (NIP) and nitroglycerin (NIT) are frequently selected agents for acutely reducing blood pressure. However, it is not clear which agent is more efficacious in improving left ventricular filling pressure in hypertensive crises. OBJECTIVE: To compare the acute effects of nitroglycerin (NIT) and nitroprusside (NIP) on transmitral Doppler filling parameters in patients with hypertensive urgency. METHODS: We identified 37 patients from our emergency department with hypertensive urgency and left ventricular filling abnormalities. Hypertensive urgency was defined as a severe blood pressure elevation without evidence of progressive end-organ injury. Patients were randomized to receive an infusion of NIT or NIP. NIT was infused at a starting dose of 10 μg/min; NIP was infused at a starting dose of 0.25 μg/kg/min. The infusion rates were adjusted to decrease mean arterial pressure by 25%, and this reduction was obtained within 2 hours in all patients. Diastolic filling parameters were measured by using echocardiography before and after treatment. Pulsed-wave Doppler transmitral flow velocities were used. Early diastolic flow, atrial contraction signal, early diastolic flow/atrial contraction signal, deceleration time, and isovolumetric relaxation time (IVRT) were measured. RESULTS: There were no differences between groups in baseline demographic and echocardiographic parameters. Blood pressure decreased significantly in both treatment groups. In posttreatment echocardiographic examinations, atrial contraction signal, deceleration time, and IVRT were significantly decreased in both treatment groups. Early diastolic flow was significantly decreased in the NIT group. There were no significant differences between the groups in terms of posttreatment early diastolic flow, atrial contraction signal, deceleration time, and IVRT values. CONCLUSIONS: In hypertensive urgency with left ventricular filling abnormalities, reduction of blood pressure associated with NIT or NIP treatment may improve transmitral Doppler filling parameters. There were no differences demonstrated between the 2 agents.
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Affiliation(s)
- Beyhan Eryonucu
- Medical Faculty, Department of Cardiology, Yüzüncü Yil University, Van, Turkey.
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85
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The impact of diabetes on left ventricular diastolic function in patients with arterial hypertension. North Clin Istanb 2017; 2:177-181. [PMID: 28058364 PMCID: PMC5175103 DOI: 10.14744/nci.2015.55477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/18/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE: The aim of this study is to analyse the impact of diabetes mellitus on the left ventricular diastolic function in patients with arterial hypertension. METHODS: Between July 2007 and July 2008, we enrolled patients aged ≥40 years who had hypertension with or without type 2 diabetes mellitus and unknown history of coronary artery disease who applied to 7.–8. internal medicine polyclinics of Goztepe Education and Training Hospital. Transthoracic echocardiography was used to assess the diastolic function. If patients with positive treadmill exercise test and/or EF ≤%50 in transthoracic echocardiography were excluded from the study. A total of 110 patients (males, n=42 38.2%, and females, n=68; 61.8%) with a mean age of 60.78 (±10.627) years were included in the study. For statistical analysis, SPSS 12.0 program and for the comparison of data chi-square test was used. RESULTS: Diastolic dysfunction was significantly more prevalent in diabetes (81.25%) than those without diabetes group (62.9%) (p<0.05). In men, 35.9% in the DM(+) group and 41.1% in the DM(-) group had diastolic dysfunction. In women, 64.1% in the DM(+) group and 58.29% in the DM(-) group had diastolic dysfunction. In the evaluation based on gender, the difference male and female patients was not significant (p>0.05). CONCLUSION: Diabetes in association with hypertension has a negative effect on left ventricular diastolic function. This effect appears similar in men and women.
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86
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Rogers FJ, Gundala T, Ramos JE, Serajian A. Heart Failure With Preserved Ejection Fraction. J Osteopath Med 2016; 115:432-42. [PMID: 26111131 DOI: 10.7556/jaoa.2015.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition. Initially called diastolic heart failure, it soon became clear that this condition is more than the opposite side of systolic heart failure. It is increasingly prevalent and lethal. Currently, HFpEF represents more than 50% of heart failure cases and shares a 90-day mortality and readmission rate similar to heart failure with reduced ejection fraction. Heart failure with preserved ejection fraction is best considered to be a systemic disease. From a cardiovascular standpoint, it is not just a stiff ventricle. A stiff ventricle combined with a stiff arterial and venous system account for the clinical manifestations of flash pulmonary edema and the marked changes in renal function or systemic blood pressure with minor changes in fluid volume status. No effective pharmacologic treatments are available for patients with HFpEF, but an approach to the musculoskeletal system has merit: the functional limitations and exercise intolerance that patients experience are largely due to abnormalities of peripheral vascular function and skeletal muscle dysfunction. Regular exercise training has strong objective evidence to support its use to improve quality of life and functional capacity for patients with HFpEF. This clinical review summarizes the current evidence on the pathophysiologic aspects, diagnosis, and management of HFpEF.
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87
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Characteristics and Course of Heart Failure Stages A–B and Determinants of Progression – design and rationale of the STAAB cohort study. Eur J Prev Cardiol 2016; 24:468-479. [DOI: 10.1177/2047487316680693] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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88
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Abebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM. Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:232. [PMID: 27871223 PMCID: PMC5117494 DOI: 10.1186/s12872-016-0418-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Globally, heart failure (HF) has been recognized as one of the major cardiovascular disorder with high morbidity, mortality and considerable social impact. In Sub Saharan African countries, HF has turned out as a leading form of cardiovascular diseases, and has considerable socioeconomic impact. However, there are differences in clinical characteristics and survival status among patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction. The aim of this study is to outline the clinical characteristics and medication profile, assess the survival status and prognostic factors of Ethiopian HF patients with HFrEF and HFpEF. METHODS A retrospective cohort study was carried out and we employed medical records of patient's, admitted as a result of HF to the University of Gondar Referral Hospital in the period between December 02, 2010 and December 01, 2015 due to HF. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Cox regression was used to analyze independent predictors of mortality in all HF patients. RESULTS Of the 850 patients who were admitted due to HF, 311 patients met the inclusion criteria. Majority of the patients had HFpEF (52.73%) and tend to be women (76.22%). They predominantly had etiologies of valvular and hypertensive heart diseases, and took calcium channel blockers and anticoagulants. Conversely, patients with HFrEF had etiologies of ischemic heart disease and dilated cardiomyopathy and were prescribed angiotensine converting inhibitors (ACEI) and beta blockers. Kaplan Meier curves and Log rank test (p = 0.807) showed that there was no statistically significant difference in the mortality difference among patients with HFpEF and HFrEF. On the other hand, Cox regression analysis showed advanced age, lower sodium level, higher creatinine level and absence of medications like ACEI, spironolactone and statins independently predicted mortality in all HF patients. CONCLUSIONS Different clinical characteristics were found in both groups of HF patients. There was no difference in survival outcome between patients with HFrEF and HFpEF.
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Affiliation(s)
- Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Catena C, Colussi G, Verheyen ND, Novello M, Fagotto V, Soardo G, Sechi LA. Moderate Alcohol Consumption Is Associated With Left Ventricular Diastolic Dysfunction in Nonalcoholic Hypertensive Patients. Hypertension 2016; 68:1208-1216. [DOI: 10.1161/hypertensionaha.116.08145] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/21/2016] [Indexed: 01/19/2023]
Abstract
Ethanol consumption is associated with left ventricular dysfunction in heavy ethanol drinkers. The effect of moderate ethanol intake on left ventricular function in hypertension, however, is unknown. We investigated the relationship between ethanol consumption and cardiac changes in nonalcoholic hypertensive patients. In 335 patients with primary hypertension, we assessed daily ethanol consumption by questionnaires that combined evaluation of recent and lifetime ethanol exposure and examined cardiac structure and function by echocardiography. Patients with abnormal liver tests, previous cardiovascular events, left ventricular ejection fraction <50%, and creatinine clearance <30 mL/min 1.72 m
2
were excluded. Left ventricular hypertrophy was found in 21% of hypertensive patients and diastolic dysfunction was detected in 50% by tissue-Doppler imaging. Ethanol consumption was comparable in hypertensive patients with and without left ventricular hypertrophy, whereas patients with left ventricular diastolic dysfunction had significantly greater consumption than patients with normal ventricular filling. Left atrial diameter, e′ wave velocity, e′/a′ ratio, and E/e′ ratio changed progressively with increasing levels of ethanol consumption, and prevalence of left ventricular diastolic dysfunction increased with a change that became statistically significant in patients consuming 20 g/d of ethanol or more. The e′ wave velocity was inversely correlated with ethanol consumption, and multivariate logistic regression indicated that ethanol consumption predicted diastolic dysfunction independently of age, body mass index, blood pressure, insulin sensitivity, and left ventricular mass index. In conclusion, ethanol consumption is independently associated with left ventricular diastolic dysfunction in nonalcoholic hypertensive patients and might contribute to development of diastolic heart failure.
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Affiliation(s)
- Cristiana Catena
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - GianLuca Colussi
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - Nicolas D. Verheyen
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - Marileda Novello
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - Valentina Fagotto
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - Giorgio Soardo
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
| | - Leonardo A. Sechi
- From the Hypertension Unit (C.C., G.C., M.N., V.F., L.A.S.) and Liver Unit (G.S.), Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy; and Department of Cardiology, Medical University of Graz, Austria (N.D.V.)
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90
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Suner A, Cetin M. Is dipyridamole useful in improving left ventricular systolic and diastolic function in patients with coronary slow flow? Echocardiography 2016; 33:1472-1478. [PMID: 27343175 DOI: 10.1111/echo.13290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Coronary slow flow (CSF) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries without obstructive coronary disease. Previous studies have shown greater impairment of left ventricular (LV) systolic and diastolic function in patients with CSF. We aimed to examine the effect of dipyridamole on these functions. METHODS Our study included 40 patients with CSF and 40 subjects with normal coronary arteries. Conventional echocardiography Doppler imaging (CDI) and tissue Doppler echocardiography imaging (TDI) were used to evaluate LV systolic and diastolic function before and 2 months after treatment with dipyridamole. RESULTS Using CDI, we observed that early diastolic velocity (E) was significantly lower in patients with CSF, while late diastolic velocity (A), E/A ratio, isovolumic relaxation time, and myocardial performance index (MPI) were significantly higher in CSF patients compared with controls. Similarly, while early myocardial velocity (Em) was significantly lower, late myocardial velocity (Am), Em/Am ratio, isovolumic relaxation time (IRT), and MPI were significantly higher in CSF patients according to TDI measurements. Although there was no significant improvement in conventional Doppler parameters, there was significant normalization in tissue Doppler parameters after treatment with dipyridamole. CONCLUSION Left ventricular systolic and diastolic function may be negatively affected by CSF. Dipyridamole may improve these functions, especially at the tissue level.
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Affiliation(s)
- Arif Suner
- Cardiology Department, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Mustafa Cetin
- Cardiology Department, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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91
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Jaroch J, Vriz O, Bociąga Z, Driussi C, Łoboz-Rudnicka M, Rzyczkowska B, Łoboz-Grudzień K. Sex-specific predictors of left ventricular diastolic dysfunction in untreated hypertension. Clin Interv Aging 2016; 11:1495-1504. [PMID: 27822022 PMCID: PMC5089822 DOI: 10.2147/cia.s114337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little is known about the sex-specific differences in left ventricular (LV) diastolic dysfunction (DD) predictors. We hypothesized that arterial stiffness (AS) may play a different role in the etiology of LV DD in hypertensive men and postmenopausal women, acting independently from other established predictors of this condition, such as age, obesity, diabetes mellitus, LV remodeling, and systolic function. OBJECTIVES The aim of the study was to analyze the sex-specific differences in AS and other predictors of LV DD in men and postmenopausal women with untreated hypertension (HTN). PATIENTS AND METHODS The study included 144 patients (63 postmenopausal women and 81 men, mean age 62.7±6.7 years) with previously untreated HTN and no history of cardiovascular diseases. All patients were subjected to detailed echocardiography, vascular ultrasound, and high-resolution echotracking (eTracking) of carotid arteries. RESULTS In the multivariate analysis, concomitant diabetes mellitus turned out to be an independent predictor of LV DD in women (P=0.02). In turn, two independent predictors of LV DD have been identified in men: S'-tissue Doppler-derived peak LV longitudinal systolic shortening velocity (P=0.001) and β, beta stiffness index (P=0.004). CONCLUSION There are sex differences in the predictors of LV DD in untreated HTN. In postmenopausal women, LV DD is mostly determined by diabetes, while in men, it is determined by S', reflecting LV systolic longitudinal function, and β, a parameter of AS.
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Affiliation(s)
- Joanna Jaroch
- Department of Cardiology, T Marciniak Hospital, Wroclaw, Poland
| | - Olga Vriz
- Division of Cardiology, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Caterina Driussi
- Division of Cardiology, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | | | - Krystyna Łoboz-Grudzień
- Department of Cardiology, T Marciniak Hospital, Wroclaw, Poland; Health Science Faculty, Wroclaw Medical University, Wroclaw, Poland
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92
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Cui X, Zhou J, Jin X, Zhou J, Fu M, Hu K, Sun A, Ge J. Prevalence and correlates of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in elderly community residents. Int J Cardiol 2016; 227:820-825. [PMID: 27836303 DOI: 10.1016/j.ijcard.2016.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) is closely related to heart failure with preserved ejection fraction (HFpEF), while the prevalence and correlates of either LVDD or HFpEF in elderly population remain largely unknown. METHODS The study was performed in 1274 community residents (769 women, aged ≥65years) who participated in the Shanghai Heart Health Study. Demographic, laboratory and echocardiographic data were obtained to analyze correlates of LVDD and HFpEF using univariate and multivariate Logistic analysis. RESULTS LVDD was detected in 31.9% (406/1274) residents and it was significantly higher in women than in men (34.2% vs. 28.3%, P=0.027). HFpEF prevalence was 2.8% (35/1274), and increased with aging in the whole cohort. For residents with left ventricular ejection fraction ≥50% and normal-sized ventricular cavity, female sex (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.24-2.29), heart rate (OR 0.76, 95% CI 0.68-0.86), atrial fibrillation (OR 7.37, 95% CI 3.13-17.36), hypertension (OR 1.32, 95% CI 1.00-1.75), N-terminal pro-B type natriuretic peptide (OR 2.33, 95% CI 1.50-3.61) and high-sensitivity troponin T (hs-TnT) (OR 1.90, 95% CI 1.12-3.23) were independent correlates of asymptomatic LVDD. While age (OR 1.44, 95% CI 1.01-2.06), heart rate (OR 0.66, 95% CI 0.47-0.93) and hs-TnT (OR 4.37, 95% CI 1.46-13.12) were independently related to HFpEF. CONCLUSIONS LVDD is common in this community elderly population, and HFpEF is also not rare. Different factors played roles in different stages of HFpEF. Future studies are warranted to explore the predictors of LVDD and HFpEF in the community elderly.
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Affiliation(s)
- Xiaotong Cui
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jingmin Zhou
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xuejuan Jin
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun Zhou
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Kai Hu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Aijun Sun
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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93
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Affiliation(s)
- Gwanpyo Koh
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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94
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Agrawal V, Agrawal A, Dwivedi AN, Tripathi K. Correlation between 2D Echocardiography and Multidetector Row CT for Early Detection of Diastolic Dysfunction in Normotensive Diabetic Patients. J Clin Diagn Res 2016; 10:OC27-30. [PMID: 27656482 DOI: 10.7860/jcdr/2016/20744.8348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/15/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Abnormalities in diastolic function are considered early signs of diabetic cardiomyopathy. Two dimensional echocardiography with Tissue Doppler Imaging (TDI) has been used most commonly to evaluate diastolic left ventricular function. AIM The study was conducted to study the prevalence of diastolic dysfunction with the help of echocardiography and MDCT and their correlation in asymptomatic diabetic people. MATERIALS AND METHODS A total of 15 diabetic, normotensive patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were included. The parameters used for assessment of diastolic dysfunction were early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Subsequently, LV filling pressures (E/Ea) were estimated. RESULTS Of the total 73.3% patients showed presence of diastolic dysfunction by both CT and echocardiography. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.992; p < 0.001), A (r=0.974, p <0.001), E/A (r = 0.979; p < 0.01), Ea (r = 0.977; p < 0.001), and E/Ea (r = 0.994; p < 0.001). CONCLUSION Doppler echocardiography is considered one of the best methods for assessment of LV diastolic dysfunction. In this study of cardiac-asymptomatic diabetic patients, MDCT and echocardiography showed good correlation for assessment of early diastolic dysfunction. Hence, cardiac CT can be an additional tool for assessing LV diastolic function.
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Affiliation(s)
- Vikas Agrawal
- Assistant Professor, Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, Uttar Pradesh, India
| | - Arpit Agrawal
- Resident, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi , Uttar Pradesh, India
| | - Amit Nandan Dwivedi
- Associate Professor, Department of Radiology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, Uttar Pradesh, India
| | - Kamalakar Tripathi
- Professor, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, Uttar Pradesh, India
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95
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Bello NA, Cheng S, Claggett B, Shah AM, Ndumele CE, Roca GQ, Santos ABS, Gupta D, Vardeny O, Aguilar D, Folsom AR, Butler KR, Kitzman DW, Coresh J, Solomon SD. Association of Weight and Body Composition on Cardiac Structure and Function in the ARIC Study (Atherosclerosis Risk in Communities). Circ Heart Fail 2016; 9:e002978. [PMID: 27512104 PMCID: PMC5218510 DOI: 10.1161/circheartfailure.115.002978] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 07/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obesity increases cardiovascular risk. However, the extent to which various measures of body composition are associated with abnormalities in cardiac structure and function, independent of comorbidities commonly affecting obese individuals, is not clear. This study sought to examine the relationship between body mass index, waist circumference, and percent body fat with conventional and advanced measures of cardiac structure and function. METHODS AND RESULTS We studied 4343 participants of the ARIC study (Atherosclerosis Risk in Communities) who were aged 69 to 82 years, free of coronary heart disease and heart failure, and underwent comprehensive echocardiography. Increasing body mass index, waist circumference, and body fat were associated with greater left ventricular (LV) mass and left atrial volume indexed to height(2.7) in both men and women (P<0.001). In women, all 3 measures were associated with abnormal LV geometry, and increasing waist circumference and body fat were associated with worse global longitudinal strain, a measure of LV systolic function. In both sexes, increasing body mass index was associated with greater right ventricular end-diastolic area and worse right ventricular fractional area change (P≤0.001). We observed similar associations for both waist circumference and percent body fat. CONCLUSIONS In a large, biracial cohort of older adults free of clinically overt coronary heart disease or heart failure, obesity was associated with subclinical abnormalities in cardiac structure in both men and women and with adverse LV remodeling and impaired LV systolic function in women. These data highlight the association of obesity and subclinical abnormalities of cardiac structure and function, particularly in women.
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MESH Headings
- Adiposity/ethnology
- Black or African American
- Aged
- Aged, 80 and over
- Atherosclerosis/diagnosis
- Atherosclerosis/ethnology
- Atherosclerosis/physiopathology
- Body Mass Index
- Body Weight/ethnology
- Cross-Sectional Studies
- Echocardiography, Doppler
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/ethnology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Obesity/diagnosis
- Obesity/ethnology
- Obesity/physiopathology
- Prospective Studies
- Risk Factors
- United States/epidemiology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/ethnology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/ethnology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
- Waist Circumference
- White People
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Affiliation(s)
- Natalie A Bello
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Susan Cheng
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Brian Claggett
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Amil M Shah
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Chiadi E Ndumele
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Gabriela Querejeta Roca
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Angela B S Santos
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Deepak Gupta
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Orly Vardeny
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David Aguilar
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Aaron R Folsom
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Kenneth R Butler
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Dalane W Kitzman
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Josef Coresh
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Scott D Solomon
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C., B.C., A.M.S., G.Q.R., A.B.S.S., S.D.S.); Department of Medicine, Johns Hopkins University, Baltimore, MD (C.E.N., J.C.); Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.G.); Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison (O.V.); Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (D.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Medicine, University of Mississippi Medical Center, Jackson (K.R.B.); and Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
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96
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The effect of trimetazidine on ventricular repolarization indexes and left ventricular diastolic function in patients with coronary slow flow. Coron Artery Dis 2016; 27:398-404. [PMID: 27140844 DOI: 10.1097/mca.0000000000000373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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97
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Magnusson M, Holm H, Bachus E, Nilsson P, Leosdottir M, Melander O, Jujic A, Fedorowski A. Orthostatic Hypotension and Cardiac Changes After Long-Term Follow-Up. Am J Hypertens 2016; 29:847-52. [PMID: 26643688 DOI: 10.1093/ajh/hpv187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) increases the risk of incident cardiovascular disease (CVD) and all-cause mortality in population-based cohort studies. Whether OH is associated with development of cardiac anomalies has not been sufficiently explored. METHODS In the prospective population-based Malmö Preventive Project (MPP), a subset of 974 non-diabetic individuals (mean age: 67 years; 29% women) were examined with echocardiography after a mean follow-up period of 23±4 years from baseline. The association of increased left ventricular mass (LVM), pathological cardiac chamber volumes, echocardiographic parameters of systolic and diastolic dysfunction in relation to the presence of OH at baseline, defined as decrease in systolic ≥20mm Hg and/or diastolic blood pressure (BP) ≥10mm Hg upon standing, was studied. RESULTS Among reexamined MPP participants, 40 (4.1%) met OH criteria during baseline screening. In the multivariable-adjusted Cox proportional hazard models, taking demographics, BP, and antihypertensive treatment (AHT) into account, OH predicted left ventricular hypertrophy (LVH) (hazard ratio (HR): 1.97, 1.01-3.84; P = 0.047), decreased right chamber volume (HR: 1.74, 1.19-2.57; P = 0.005), and reduced early diastolic tissue velocity in septal wall (HR: 1.47, 1.01-2.14; P = 0.045). No significant associations were seen between OH and atrial chamber volumes, LV volume, and LV systolic function. CONCLUSIONS The presence of OH among middle-aged adults is associated with the development of structural cardiac changes such as LVH and declining right chamber volume, as well as with the development of diastolic dysfunction, independently of traditional risk factors. These findings may contribute to the understanding of how prevalent OH impacts the risk of CVD.
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Affiliation(s)
- Martin Magnusson
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Medicine, Ystad Hospital, Ystad, Sweden
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden;
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98
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Park HK, Kim BJ, Yoon CH, Yang MH, Han MK, Bae HJ. Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes. J Stroke 2016; 18:195-202. [PMID: 27283279 PMCID: PMC4901948 DOI: 10.5853/jos.2015.01697] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. Methods In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e’) was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e’ as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. Results Among included patients, E/e’ was 10.6±6.4: E/e’ <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e’ ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. Conclusions LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
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Affiliation(s)
- Hong-Kyun Park
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Hwa Yang
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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99
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Spartano NL, Lyass A, Larson MG, Lewis GD, Vasan RS. Submaximal Exercise Systolic Blood Pressure and Heart Rate at 20 Years of Follow-up: Correlates in the Framingham Heart Study. J Am Heart Assoc 2016; 5:e002821. [PMID: 27233297 PMCID: PMC4937245 DOI: 10.1161/jaha.115.002821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beyond their resting values, exercise responses in blood pressure (BP) and heart rate (HR) may add prognostic information for cardiovascular disease (CVD). In cross-sectional studies, exercise BP and HR responses correlate with CVD risk factors; however, it is unclear which factors influence longitudinal changes in exercise responses over time, which is important for our understanding of the development of CVD. METHODS AND RESULTS We assessed BP and HR responses to low-level exercise tests (6-minute Bruce protocol) in 1231 Framingham Offspring participants (55% women) who underwent a routine treadmill test in 1979-1983 (baseline; mean age 39±8 years) that was repeated in 1998-2001 (follow-up; mean age 58±8 years). Adjusting for baseline exercise responses, we related the follow-up exercise responses to baseline CVD risk factors and to their changes between examinations. Compared with men, women had greater rise in exercise systolic (S)BP and HR at 20-year follow-up (both P<0.005). Baseline blood lipid levels, resting SBP and HR, and smoking status were associated with greater exercise SBP at follow-up (all P<0.05). Weight gain across examinations was associated with higher exercise SBP and HR at follow-up (both P<0.0001). Smoking cessation was associated with a 53% reduced risk of attaining the highest quartile of exercise SBP (≥180 mm Hg) at follow-up (P<0.05). CONCLUSION An adverse CVD risk factor profile in young adults and its worsening over time were associated with higher SBP and HR responses to low-level exercise in midlife. Maintaining or adopting a healthy risk factor profile may favorably impact the exercise responses over time.
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Affiliation(s)
- Nicole L Spartano
- Sections of Preventative Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Asya Lyass
- Framingham Heart Study, Framingham, MA Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Martin G Larson
- Framingham Heart Study, Framingham, MA Department of Mathematics and Statistics, Boston University, Boston, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ramachandran S Vasan
- Sections of Preventative Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA Framingham Heart Study, Framingham, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA
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100
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Ofstad AP. Myocardial dysfunction and cardiovascular disease in type 2 diabetes. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:271-81. [PMID: 27071642 DOI: 10.3109/00365513.2016.1155230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is strongly associated with increased risk of myocardial dysfunction and cardiovascular disease (CVD), two separate conditions which often co-exist and influence each other's course. The prevalence of myocardial dysfunction may be as high as 75% in T2DM populations but is often overlooked due to the initial asymptomatic nature of the disease, complicating co-morbidities such as coronary artery disease (CAD) and obesity, and the lack of consensus on diagnostic criteria. More sensitive echocardiographic applications are furthermore needed to improve detection of early subclinical changes in myocardial function which do not affect conventional echocardiographic parameters. The pathophysiology of the diabetic myocardial dysfunction is not fully elucidated, but involves hyperglycemia and high levels of free fatty acids. It evolves over several years and increases the risk of developing overt HF, and is suggested to at least in part account for the worse outcome seen in T2DM individuals after cardiac events. CAD and stroke are the most frequent CV manifestations among T2DM patients and relate to a large degree to the accelerated atherosclerosis driven by inflammation. Diagnosing CAD is challenging due to the lower sensitivity inherent in the diagnostic tests and there is thus a need for new biomarkers to improve prediction and detection of CAD. It seems that a multi-factorial approach (i.e. targeting several CV risk factors simultaneously) is superior to a strict glucose lowering strategy in reducing risk for macrovascular events, and recent research may even support an effect also on HF outcomes.
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Affiliation(s)
- Anne Pernille Ofstad
- a Department of Medical Research , Bærum Hospital, Vestre Viken Hospital Trust , Drammen , Norway
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