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Pihlman J, Nuotio J, Rovio S, Pahkala K, Ruohonen S, Jokinen E, Laitinen TP, Burgner DP, Hutri-Kähönen N, Tossavainen P, Taittonen L, Kähönen M, Viikari JSA, Raitakari OT, Magnussen CG, Juonala M. Exposure to parental smoking and cardiac structure and function in adulthood: the Cardiovascular Risk in Young Finns Study. Scand J Public Health 2024; 52:15-23. [PMID: 36071613 DOI: 10.1177/14034948221119611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The relationship between childhood tobacco smoke exposure and cardiac structure and function in midlife is unclear. We investigated the association between parental smoking with cardiac structure and function in adulthood. METHODS 1250 participants (56.5% female) from the Cardiovascular Risk in Young Finns Study who had data on parental smoking and/or serum cotinine, a biomarker of exposure to tobacco smoke, at baseline 1980 (age 3-18 years) and echocardiography performed in 2011. Parental smoking hygiene (i.e., smoking in the vicinity of children) was categorized by parental smoking and serum cotinine levels in offspring. Dimensions of the left ventricle, diastolic and systolic function, and cardiac remodeling were used as outcomes. Analyses were adjusted for sex, age, and covariates (blood pressure (BP), serum lipids, body mass index, socioeconomic status, smoking (only in adulthood)) in childhood and adulthood. RESULTS Parental smoking was not associated with systolic or diastolic function in adulthood. Participants exposed to parental smoking (odds ratio (OR) 1.90, 95%CI 1.23-2.92), hygienic parental smoking (OR 1.74, 95%CI 1.12-2.71), and non-hygienic parental smoking (OR 1.88, 95%CI 1.02-3.45) had higher odds of concentric remodeling (relative wall thickness >85th sex-specific percentile without left ventricular hypertrophy). These associations were attenuated after adjustment for child and adult covariates in the non-hygienic parental smoking group. CONCLUSIONS Exposure to parental smoking in childhood was associated with a higher likelihood of concentric remodeling and thicker left ventricular and interventricular septal walls in midlife, which was not improved by parents who smoked hygienically. Parental smoking was not related to systolic or diastolic function in this relatively young population.
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Affiliation(s)
- Jukka Pihlman
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Saku Ruohonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Eero Jokinen
- Department of Paediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Finland
| | - David P Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Australia
- Department of Paediatrics, University of Melbourne, Australia
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Finland
| | - Leena Taittonen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Finland
- Vaasa Central Hospital, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
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Lundin M, Heiberg E, Nordlund D, Gyllenhammar T, Steding-Ehrenborg K, Engblom H, Carlsson M, Atar D, van der Pals J, Erlinge D, Borgquist R, Khoshnood A, Ekelund U, Nickander J, Themudo R, Nordin S, Kozor R, Bhuva AN, Moon JC, Maret E, Caidahl K, Sigfridsson A, Sörensson P, Schelbert EB, Arheden H, Ugander M. Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Sci Rep 2023; 13:22806. [PMID: 38129418 PMCID: PMC10740032 DOI: 10.1038/s41598-023-48173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12-1.20], p < 0.001), followed by GTI (HR 1.14[1.09-1.19], p < 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35-1.94], p < 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p < 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).
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Affiliation(s)
- Magnus Lundin
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - David Nordlund
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tom Gyllenhammar
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dan Atar
- Department of Cardiology, and Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Jesper van der Pals
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital, and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ardavan Khoshnood
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences, Emergency and Internal Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Raquel Themudo
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Institute of Medicine, University of Gothenburg and Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Peder Sörensson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Royal North Shore Hospital, University of Sydney, Kolling Building, Level 12, Room 612017, St Leonards, NSW, 2065, Australia.
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Fung ASY, Soundappan D, Loewenstein DE, Playford D, Strange G, Kozor R, Otton J, Ugander M. Prognostic association supports indexing size measures in echocardiography by body surface area. Sci Rep 2023; 13:19390. [PMID: 37938592 PMCID: PMC10632399 DOI: 10.1038/s41598-023-46183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
Body surface area (BSA) is the most commonly used metric for body size indexation of echocardiographic measures, but its use in patients who are underweight or obese is questioned (body mass index (BMI) < 18.5 kg/m2 or ≥ 30 kg/m2, respectively). We aim to use survival analysis to identify an optimal body size indexation metric for echocardiographic measures that would be a better predictor of survival than BSA regardless of BMI. Adult patients with no prior valve replacement were selected from the National Echocardiography Database Australia. Survival analysis was performed for echocardiographic measures both unindexed and indexed to different body size metrics, with 5-year cardiovascular mortality as the primary endpoint. Indexation of echocardiographic measures (left ventricular end-diastolic diameter [n = 230,109] and mass [n = 224,244], left atrial volume [n = 150,540], aortic sinus diameter [n = 90,805], right atrial area [n = 59,516]) by BSA had better prognostic performance vs unindexed measures (underweight: C-statistic 0.655 vs 0.647; normal weight/overweight: average C-statistic 0.666 vs 0.625; obese: C-statistic 0.627 vs 0.613). Indexation by other body size metrics (lean body mass, height, and/or weight raised to different powers) did not improve prognostic performance versus BSA by a clinically relevant magnitude (average C-statistic increase ≤ 0.02), with smaller differences in other BMI subgroups. Indexing measures of cardiac and aortic size by BSA improves prognostic performance regardless of BMI, and no other body size metric has a clinically meaningful better performance.
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Affiliation(s)
- Angus S Y Fung
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Dhnanjay Soundappan
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Daniel E Loewenstein
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Geoffrey Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
| | - James Otton
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia.
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
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4
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Berman AN, Ginder C, Wang XS, Borden L, Hidrue MK, Searl Como JM, Daly D, Sun YP, Curry WT, Del Carmen M, Morrow DA, Scirica B, Choudhry NK, Januzzi JL, Wasfy JH. A pragmatic clinical trial assessing the effect of a targeted notification and clinical support pathway on the diagnostic evaluation and treatment of individuals with left ventricular hypertrophy (NOTIFY-LVH). Am Heart J 2023; 265:40-49. [PMID: 37454754 DOI: 10.1016/j.ahj.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Electronic health records contain vast amounts of cardiovascular data, including potential clues suggesting unrecognized conditions. One important example is the identification of left ventricular hypertrophy (LVH) on echocardiography. If the underlying causes are untreated, individuals are at increased risk of developing clinically significant pathology. As the most common cause of LVH, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor. Contemporary healthcare systems have suboptimal mechanisms for detecting and effectively implementing hypertension treatment before downstream consequences develop. Thus, there is an urgent need to validate alternative intervention strategies for individuals with preexisting-but potentially unrecognized-LVH. METHODS Through a randomized pragmatic trial within a large integrated healthcare system, we will study the impact of a centralized clinical support pathway on the diagnosis and treatment of hypertension and other LVH-associated diseases in individuals with echocardiographic evidence of concentric LVH. Approximately 600 individuals who are not treated for hypertension and who do not have a known cardiomyopathy will be randomized. The intervention will be directed by population health coordinators who will notify longitudinal clinicians and offer to assist with the diagnostic evaluation of LVH. Our hypothesis is that an intervention that alerts clinicians to the presence of LVH will increase the detection and treatment of hypertension and the diagnosis of alternative causes of thickened myocardium. The primary outcome is the initiation of an antihypertensive medication. Secondary outcomes include new hypertension diagnoses and new cardiomyopathy diagnoses. The trial began in March 2023 and outcomes will be assessed 12 months from the start of follow-up. CONCLUSION The NOTIFY-LVH trial will assess the efficacy of a centralized intervention to improve the detection and treatment of hypertension and LVH-associated diseases. Additionally, it will serve as a proof-of-concept for how to effectively utilize previously collected electronic health data to improve the recognition and management of a broad range of chronic cardiovascular conditions. TRIAL REGISTRATION NCT05713916.
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Affiliation(s)
- Adam N Berman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Massachusetts General Physicians Organization, Boston, MA
| | - Curtis Ginder
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Xianghong S Wang
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | - Linnea Borden
- Massachusetts General Physicians Organization, Boston, MA
| | - Michael K Hidrue
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | | | - Danielle Daly
- Massachusetts General Physicians Organization, Boston, MA
| | - Yee-Ping Sun
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William T Curry
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcela Del Carmen
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin Scirica
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Niteesh K Choudhry
- Department of Medicine, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA
| | - Jason H Wasfy
- Massachusetts General Physicians Organization, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Antza C, Tziomalos G, Kostopoulos G, Trakatelli C, Kotsis V. The Importance of Out-of-Office Blood Pressure Measurement, as Highlighted by the Correlation with Left Ventricular Hypertrophy in an Untreated Hypertensive Population. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1636. [PMID: 37763755 PMCID: PMC10537443 DOI: 10.3390/medicina59091636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Hypertensive heart disease, especially left ventricular hypertrophy (LVH), is considered to be one of the main types hypertension-mediated organ damage. Hence, the purpose of this study was to examine which method of measuring BP (office BP measurement (OBPM), 24 h ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM)), can be better correlated with echocardiographic LVH in the untreated hypertensive population. Materials and Methods: This study's population consisted of 202 patients 58 ± 15 years old (40.8% males). All patients reported elevated home BP measurements for at least 3 months, but they had never been treated before for hypertension. Office and out-of-office BP measurements, including ABPM on a usual working day and seven-day HBPM, as well as 2D echocardiography, were performed. Results: In the univariate analysis, LVH was associated (p < 0.05) with a mean 24 h systolic BP (OR: 1.93, CI: 1.29-2.91), a mean 24 h diastolic BP (OR: 1.30, CI: 1.16-1.80), ambulatory daytime systolic (OR: 1.11, CI:1.01-1.82) and diastolic BP (OR: 1.13, CI:1.09-1.17), ambulatory nighttime systolic BP (OR: 2.11, CI: 1.04-4.31), and mean home systolic BP (OR: 1.05, CI:1.01-1.12). Pearson's correlation analysis showed a significant correlation between the LV mass index and the mean 24 h systolic BP (r = 0.58, p < 0.05), daytime systolic BP (r = 0.59, p < 0.05), and nighttime systolic BP (r = 0.57, p < 0.05). Most of the population with confirmed LVH presented confirmed hypertension (based on ABPM, 48.1% or HBPM, 40%). The second most dominant phenotype was masked hypertension (ABPM, 32.7% and HBPM, 23.7%). The majority (59.3%) had non-dipping status, 20.4% had a reverse dipping pattern, 13% had a dipping pattern, and only 7.3% had extreme dipping BP. Conclusions: Out-of-office BP measurement devices seemed to be superior compared to in-office. This advantage is highlighted by better correlations in the identification of LVH as well as the diagnosis of masked hypertension, a condition also highly correlated with LVH.
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Affiliation(s)
- Christina Antza
- 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Georgios Tziomalos
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Kostopoulos
- 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, 56429 Thessaloniki, Greece
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Ismail ASM, Aouf MA, Diab RH, Baghdady YK. Relation of the left ventricular geometric patten to coronary artery disease in hypertensive patients using a 320-detector-row CT scanner. Egypt Heart J 2023; 75:34. [PMID: 37186223 PMCID: PMC10130248 DOI: 10.1186/s43044-023-00360-7] [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: 08/10/2022] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND It was estimated that about 1.3 billion people were diagnosed to be hypertensive in 2015. All countries consistently show this high prevalence. Ischemic heart disease stands as the most common cause of systolic blood pressure-related deaths per year. Left ventricular hypertrophy determined by echocardiography can predict cardiovascular morbidity and mortality. The question of whether the LV geometric pattern has an additional prognostic value is still not clearly answered. Currently, coronary computed tomography is widely used in clinical practice with a great capability of simultaneous evaluation of the LV mass and the coronary arterial tree. Our study aims to examine the relationship between LV mass and geometry and coronary artery disease using an ECG-gated 320-detector- row CT scanner. RESULTS Two hundred ninety-eight hypertensive Egyptian individuals were enrolled in our study, the mean age was 57.5 ± 10.5, and males comprised 76.5% of the study population. The mean LV mass and LV mass index were 193 ± 60 gm and 95.2 ± 27.5 g/m2 respectively. One-fifth of the patient had CAD luminal stenosis ≥ 50%. Normal LV geometric pattern was observed in about 37% of the study population. About one-third of the patients showed concentric remodeling. Patients with increased LV mass index represented one-third of the study population with a greater percentage of the concentric hypertrophy pattern than the eccentric hypertrophy pattern. Patients with high CAD-RADS showed statistically significant higher LV mass, LV mass index, and septal wall thickness. Patients with high CAD-RADS showed a greater percentage of concentric and eccentric hypertrophy. The LV geometric pattern was the only independent predictor of the high CAD-RADS. The LV geometric patterns associated with high RADS ordered from the highest to the lowest, were concentric LVH, Eccentric LV, and concentric remodeling. CONCLUSIONS LV geometric pattern is the only independent predictor of high CAD-RADS after adjustment for LV mass index and septal wall thickness. Among abnormal LV geometric patterns, concentric hypertrophy stands as the most important predictor of high CAD-RADS.
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Dhore-Patil A, Thannoun T, Samson R, Le Jemtel TH. Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction: Role of Obesity. Front Physiol 2022; 12:785879. [PMID: 35242044 PMCID: PMC8886215 DOI: 10.3389/fphys.2021.785879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022] Open
Abstract
Heart failure with preserved ejection fraction is a growing epidemic and accounts for half of all patients with heart failure. Increasing prevalence, morbidity, and clinical inertia have spurred a rethinking of the pathophysiology of heart failure with preserved ejection fraction. Unlike heart failure with reduced ejection fraction, heart failure with preserved ejection fraction has distinct clinical phenotypes. The obese-diabetic phenotype is the most often encountered phenotype in clinical practice and shares the greatest burden of morbidity and mortality. Left ventricular remodeling plays a major role in its pathophysiology. Understanding the interplay of obesity, diabetes mellitus, and inflammation in the pathophysiology of left ventricular remodeling may help in the discovery of new therapeutic targets to improve clinical outcomes in heart failure with preserved ejection fraction. Anti-diabetic agents like glucagon-like-peptide 1 analogs and sodium-glucose co-transporter 2 are promising therapeutic modalities for the obese-diabetic phenotype of heart failure with preserved ejection fraction and aggressive weight loss via lifestyle or bariatric surgery is still key to reverse adverse left ventricular remodeling. This review focuses on the obese-diabetic phenotype of heart failure with preserved ejection fraction highlighting the interaction between obesity, diabetes, and coronary microvascular dysfunction in the development and progression of left ventricular remodeling. Recent therapeutic advances are reviewed.
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Affiliation(s)
- Aneesh Dhore-Patil
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.,Tulane University Heart and Vascular Institute, New Orleans, LA, United States
| | - Tariq Thannoun
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.,Tulane University Heart and Vascular Institute, New Orleans, LA, United States
| | - Rohan Samson
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.,Tulane University Heart and Vascular Institute, New Orleans, LA, United States
| | - Thierry H Le Jemtel
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.,Tulane University Heart and Vascular Institute, New Orleans, LA, United States
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8
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Oh JK, Park JH. Role of strain echocardiography in patients with hypertension. Clin Hypertens 2022; 28:6. [PMID: 35164856 PMCID: PMC8845306 DOI: 10.1186/s40885-021-00186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023] Open
Abstract
AbstractHypertension is a well-recognized risk factor for the development of cardiovascular disease, and the early detection of cardiac changes from hypertension can allow reversing these. Hypertensive heart diseases (HHD) refer to the complex and diverse change of the cardiac structure and function secondary to hypertension. Although conventional echocardiography is the most common imaging modality in detecting HHD, it cannot detect subtle changes of cardiac structure in subclinical states. Because strain echocardiography is another echocardiographic modality can detect subclinical myocardial dysfunction by measuring intrinsic myocardial deformation, it became more and more popular in clinical and research fields. In this review article, we described the basic concept of strain echocardiography and summarized several clinical studies showing its clinical utilities in the detection of HHD.
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Karaca Özer P, Ayduk Gövdeli E, Engin B, Atıcı A, Baykız D, Orta H, Demirtakan ZG, Emet S, Elitok A, Tayyareci Y, Umman B, Bilge AK, Buğra Z. Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality. Anatol J Cardiol 2021; 25:863-871. [PMID: 34866580 DOI: 10.5152/anatoljcardiol.2021.21940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis. METHODS This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below -12.5% was defined as severely reduced strain, -12.5% to -17.9% as mildly reduced strain, and above -18% as normal strain. RESULTS The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: -11.4±2.2%; HHD: -13.6±2.6%; and athletes: -15.5±2.1%; p<0.001 among groups). LV-GLS below -12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699-0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was -11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537-0.974, p=0.033). Patients with GLS below -12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above -12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of -12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012). CONCLUSION The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.
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Affiliation(s)
- Pelin Karaca Özer
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Elif Ayduk Gövdeli
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Berat Engin
- Department of Cardiology, Manavgat State Hospital; Antalya-Turkey
| | - Adem Atıcı
- Department of Cardiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital; İstanbul-Turkey
| | - Derya Baykız
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Hüseyin Orta
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | | | - Samim Emet
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ali Elitok
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Yelda Tayyareci
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Berrin Umman
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Zehra Buğra
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
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10
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Bello H, Norton GR, Peterson VR, Libhaber CD, Mmopi KN, Mthembu N, Masiu M, Da Silva Fernandes D, Bamaiyi AJ, Peters F, Sareli P, Woodiwiss AJ. Hemodynamic and Functional Correlates of Concentric vs. Eccentric LVH in a Community-Based Sample With Prevalent Volume-Dependent Hypertension. Am J Hypertens 2021; 34:1300-1310. [PMID: 34379750 DOI: 10.1093/ajh/hpab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (P < 0.0001) and eccentric (P < 0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial, or 24-hour blood pressures (BP), but neither increases in SVR or Zc nor decreases in TAC. LV RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall shortening and s') (P < 0.05 to <0.005) and decreases in LV systolic function were noted in concentric (P < 0.05), but not eccentric LVH. CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH.
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Affiliation(s)
- Hamza Bello
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vernice R Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe N Mmopi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonhlanhla Mthembu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohlabani Masiu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Da Silva Fernandes
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adamu J Bamaiyi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Okamoto C, Tsukamoto O, Hasegawa T, Hitsumoto T, Matsuoka K, Takashima S, Amaki M, Kanzaki H, Izumi C, Ito S, Kitakaze M. Lower B-type natriuretic peptide levels predict left ventricular concentric remodelling and insulin resistance. ESC Heart Fail 2021; 9:636-647. [PMID: 34786876 PMCID: PMC8787986 DOI: 10.1002/ehf2.13700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 01/19/2023] Open
Abstract
Aims Natriuretic peptides have reportedly been associated with cardiac hypertrophy and insulin resistance; however, it has not been established if B‐type natriuretic peptide (BNP) is associated with either insulin resistance or cardiac remodelling in a population with normal plasma BNP levels. We investigated the relationship among plasma BNP levels, insulin resistance, and left ventricular (LV) remodelling in a population with normal physiological plasma BNP levels. Methods and results Among 1632 individuals who participated in annual health checks between 2005 and 2008 in Arita‐cho, Saga, Japan, 675 individuals [median (interquartile range) for age 62 (51–69) years; 227 men (34%)] with LV ejection fraction 50% and BNP level <35 pg/mL were enrolled in this study. Insulin resistance was assessed using homeostatic model assessment of insulin resistance (HOMA‐IR). LV geometry, including LV concentric remodelling, was classified based on relative wall thickness (RWT) and LV mass index values derived from echocardiographic findings. Factors associated with insulin resistance and LV geometry were investigated using multiple logistic regression analysis. Tertiles of BNP were inversely associated with HOMA‐IR [1st tertile, 1.33 (0.76–1.74); 2nd tertile, 1.05 (0.72–1.59); 3rd tertile, 0.95 (0.66–1.58), P = 0.005]. Lower BNP was associated with the prevalence of insulin resistance, defined as HOMA‐IR ≥1.37, even after full multivariate adjustment [1 SD increment in BNP = adjusted odds ratio (aOR) 0.740; 95% confidence interval (CI) 0.601–0.912; P = 0.005]. LV concentric remodelling (RWT >0.42; LV mass index ≤115 g/m2 in men and ≤95 g/m2 in women) was observed in 107 (16%) participants, while normal LV geometry (RWT ≤0.42; LV mass index ≤115 g/m2 in men and ≤95 g/m2 in women) was seen in 423 (63%), and LV hypertrophy (LV mass index >115 g/m2 in men and >95 g/m2 in women) in 145 (21%). Both low BNP level and higher insulin resistance were independently linked to LV concentric remodelling after multivariate adjustment (1 SD increment in BNP = aOR 0.714, 95% CI 0.544–0.938, P = 0.015; HOMA‐IR ≥ 1.37 vs. <1.37: aOR 1.694, 95% CI 1.004–2.857, P = 0.048, respectively). Conclusions Lower BNP levels are linked to either insulin resistance or LV concentric remodelling in a population with normal plasma BNP levels, suggesting that participants with lower natriuretic peptide level might be vulnerable to the development of metabolic disorders and LV morphological abnormalities.
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Affiliation(s)
- Chisato Okamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Osamu Tsukamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, Garacia Hospital, Mino, Osaka, Japan
| | - Tatsuro Hitsumoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ken Matsuoka
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiji Takashima
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shin Ito
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Kitakaze
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan.,Hanwa Daini Senboku Hospital, Sakai, Osaka, 599-8271, Japan
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12
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Jefferies JL, Mazur WM, Howell CR, Plana JC, Ness KK, Li Z, Joshi VM, Green DM, Mulrooney DA, Towbin JA, Martinez HR, Goldberg JF, Howell RM, Srivastava DK, Robison LL, Hudson MM, Armstrong GT. Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Cancer 2021; 127:4646-4655. [PMID: 34411296 DOI: 10.1002/cncr.33860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy. METHODS Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed. RESULTS Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P < .001), and all were greater than the proportions in noncancer controls (18%; all P < .05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak <85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68). CONCLUSIONS Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance.
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Affiliation(s)
- John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Juan C Plana
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Vijaya M Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey A Towbin
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hugo R Martinez
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jason F Goldberg
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deo Kumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
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13
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Guzik BM, McCallum L, Zmudka K, Guzik TJ, Dominiczak AF, Padmanabhan S. Echocardiography Predictors of Survival in Hypertensive Patients With Left Ventricular Hypertrophy. Am J Hypertens 2021; 34:636-644. [PMID: 33950188 DOI: 10.1093/ajh/hpaa194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/07/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a well-known target organ damage. Concentric hypertrophy is the strongest predictor of increased risk of cardiovascular events, but the predictive value of individual echocardiographic parameters remains unclear.The aim of this study was to search for echocardiographic and hemodynamic variables associated with concentric and eccentric remodeling and their association with long-term cardiovascular outcomes. METHODS Patients with echocardiography performed within 1 year prior to the initial clinic visit were included into the study. Logistic regression and multivariable Cox-proportional hazards were calculated according to several risk factors and variables. Additionally, cubic spline interpolation was used. RESULTS We observed 690 patients for 10 years. There was a total of 177 major adverse cardiac and cerebrovascular events (MACCE) and 90 deaths over a 10-year period. Left ventricular concentric hypertrophy is associated with worse outcomes than eccentric hypertrophy in hypertensive subjects. Interestingly, different echocardiographic parameters contributed to risk depending on type of hypertrophy. In concentric hypertrophy, relative wall thickness provides linear prediction of risk for all-cause mortality (ACM) and composite endpoint. Systolic blood pressure is a significant predictor of MACCE. Blood pressure variability also showed significant predictive value for MACCE and ACM. CONCLUSIONS These data indicate risk stratification based on LVH need to consider different measures based on the type of remodeling.
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Affiliation(s)
- Bartlomiej M Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Krzysztof Zmudka
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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14
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Jain S, Obeid MJ, Yenigalla S, Paravathaneni M, Gadela NV, Singh G, Kulkarni V, Kondaveety S, Gade KC, Lee J, Kulick-Soper CM, Sanchez N, Satija V, Hashmath Z, Zamani P, Akers S, Chirinos JA. Impact of Chronic Obstructive Pulmonary Disease in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2021; 149:47-56. [PMID: 33757785 DOI: 10.1016/j.amjcard.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
COPD often coexists with HFpEF, but its impact on cardiovascular structure and function in HFpEF is incompletely understood. We aimed to compare cardiovascular phenotypes in patients with Chronic Obstructive Pulmonary Disease (COPD), Heart Failure with Preserved Ejection Fraction (HFpEF), or both. We studied 159 subjects with COPD alone (n = 48), HFpEF alone (n = 79) and HFpEF + COPD (n = 32). We used MRI and arterial tonometry to assess cardiac structure and function, thoracic aortic stiffness, and measures of body composition. Relative to participants with COPD only, those with HFpEF with or without COPD exhibited a greater prevalence of female sex and obesity, whereas those with HFpEF + COPD were more often African-American. Compared to the other groups, participants with HFpEF and COPD demonstrated a more concentric LV geometry (LV wall-cavity ratio 1.2, 95%CI: 1.1-1.3; p = 0.003), a greater LV mass (67.4, 95%CI: 60.7-74.2; p = 0.03, and LV extracellular volume (49.4, 95%CI: 40.9-57.9; p = 0.002). Patients with comorbid HFpEF + COPD also exhibited greater thoracic aortic stiffness assessed by pulse-wave velocity (11.3, 95% CI: 8.7-14.0 m/s; p = 0.004) and pulsatile load imposed by the ascending aorta as measured by aortic characteristic impedance (139 dsc; 95%CI=111-166; p = 0.005). Participants with HFpEF, with or without COPD, exhibited greater abdominal and pericardial fat, without difference in thoracic skeletal muscle size. In conclusion, individuals with co-morbid HFpEF and COPD have a greater degree of systemic large artery stiffening, LV remodeling, and LV fibrosis than those with either condition alone.
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15
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Sahiti F, Morbach C, Cejka V, Albert J, Eichner FA, Gelbrich G, Heuschmann PU, Störk S. Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study. Front Cardiovasc Med 2021; 8:669335. [PMID: 34179134 PMCID: PMC8232934 DOI: 10.3389/fcvm.2021.669335] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure. Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of Würzburg, Germany, aged 30–79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg% per mL/m2, p < 0.001) and lower global work efficiency (GWE) (−0.02% per mL/m2, p < 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg% per g/m2, p < 0.001) and global constructive work (GCW) (+2.05 mmHg% per g/m2, p < 0.01) and lower GWE (−0.015% per g/m2, p < 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension. Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease.
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Affiliation(s)
- Floran Sahiti
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
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16
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Barbieri A, Albini A, Maisano A, De Mitri G, Camaioni G, Bonini N, Mantovani F, Boriani G. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8:667984. [PMID: 33987213 PMCID: PMC8110723 DOI: 10.3389/fcvm.2021.667984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maisano
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gerardo De Mitri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Camaioni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Olsen FJ, Solomon SD, Biering-Sørensen T. Piecing together the puzzle of sex-specific differences in left ventricular ejection fraction. Eur J Heart Fail 2021; 23:417-419. [PMID: 33590612 DOI: 10.1002/ejhf.2127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Flemming J Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Zeb H, Cavallazzi R. A 52-Year-Old Man With Sudden Dyspnea, Chest Pain, and Seizure. Chest 2021; 159:e173-e179. [PMID: 33678288 DOI: 10.1016/j.chest.2020.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/01/2020] [Accepted: 03/04/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hassan Zeb
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
| | - Rodrigo Cavallazzi
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, KY
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19
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Tp-Te interval prolongs in hypertension independent of the left ventricular geometry. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.754891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Saasita PK, Senoga S, Muhongya K, Agaba DC, Migisha R. High prevalence of uncontrolled hypertension among patients with type 2 diabetes mellitus: a hospital-based cross-sectional study in Southwestern Uganda. Pan Afr Med J 2021; 39:142. [PMID: 34527158 PMCID: PMC8418183 DOI: 10.11604/pamj.2021.39.142.28620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/06/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION most patients with diabetes mellitus are prone to uncontrolled blood pressures despite effective medical therapies; only about 30% of hypertensive patients have their blood pressures controlled. Poor control of hypertension is associated with increased risk for cardiovascular mortality and morbidity. We aimed to determine the prevalence and associated factors of uncontrolled hypertension among patients with type 2 diabetes mellitus (T2DM) attending ambulatory care at Mbarara Regional Referral Hospital, Southwestern Uganda. METHODS we conducted a cross-sectional study from January to April 2019, among hypertensive T2DM patients. We used a structured questionnaire to obtain data on socio-demographic and clinical characteristics. We defined uncontrolled hypertension in participants with blood pressure ≥140/90mmHg and performed binary logistic regression to determine factors associated with uncontrolled hypertension. RESULTS we analyzed data of 206 hypertensive participants with concomitant T2DM, with a median age of 54 (IQR, 49-60) years, and median duration of diabetes of 4 (IQR, 3-8) years; 71% were female. The prevalence of uncontrolled hypertension was 82.5% (170/206). Isolated systolic hypertension (aOR=7.58; 95%CI: 2.18-26.36, P=0.001) and left ventricular hypertrophy (LVH) (aOR=5.38; 95%CI: 1.11-26.10, P=0.037) were significantly associated with uncontrolled hypertension. CONCLUSION this study revealed a high prevalence of uncontrolled hypertension among T2DM patients in Southwestern Uganda. Isolated systolic hypertension and LVH were the key factors associated with uncontrolled hypertension. We recommend optimization therapy to reduce the burden of uncontrolled hypertension among patients with T2DM especially in those with isolated systolic hypertension, and left ventricular hypertrophy, who are at higher cardiovascular risk.
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Affiliation(s)
- Patrick Kambale Saasita
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Siraj Senoga
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kakule Muhongya
- Department of Accident and Emergency, Kampala International University Western campus, Ishaka, Bushenyi, Uganda
| | - David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
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21
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Yeo JL, Brady EM, McCann GP, Gulsin GS. Sex and ethnic differences in the cardiovascular complications of type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211034297. [PMID: 34408835 PMCID: PMC8365016 DOI: 10.1177/20420188211034297] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus represents a global health concern affecting 463 million adults and is projected to rapidly rise to 700 million people by 2045. Amongst those with type 2 diabetes (T2D), there are recognised differences in the impact of the disease on different sex and ethnic groups. The relative risk of cardiovascular complications between individuals with and without T2D is higher in females than males. People of South Asian heritage are two to four times more likely to develop T2D than white people, but conversely not more likely to experience cardiovascular complications. Differences in the pathophysiological responses in these groups may identify potential areas for intervention beyond glycaemic control. In this review, we highlight key differences of diabetes-associated cardiovascular complications by sex and ethnic background, with a particular emphasis on South Asians. Evidence assessing therapeutic efficacy of new glucose lowering drugs in minority groups is limited and many major cardiovascular outcomes trials do not report ethnic specific data. Conversely, lifestyle intervention and bariatric surgery appear to have similar benefits regardless of sex and ethnic groups. We encourage future studies with better representation of women and ethnic minorities that will provide valuable data to allow better risk stratification and tailored prevention and management strategies to improve cardiovascular outcomes in T2D.
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Affiliation(s)
- Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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22
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Masjoan Juncos JX, Shakil S, Bradley WE, Wei CC, Zafar I, Powell P, Mariappan N, Louch WE, Ford DA, Ahmad A, Dell'Italia LJ, Ahmad S. Chronic cardiac structural damage, diastolic and systolic dysfunction following acute myocardial injury due to bromine exposure in rats. Arch Toxicol 2021; 95:179-193. [PMID: 32979061 PMCID: PMC7855670 DOI: 10.1007/s00204-020-02919-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
Accidental bromine spills are common and its large industrial stores risk potential terrorist attacks. The mechanisms of bromine toxicity and effective therapeutic strategies are unknown. Our studies demonstrate that inhaled bromine causes deleterious cardiac manifestations. In this manuscript we describe mechanisms of delayed cardiac effects in the survivors of a single bromine exposure. Rats were exposed to bromine (600 ppm for 45 min) and the survivors were sacrificed at 14 or 28 days. Echocardiography, hemodynamic analysis, histology, transmission electron microscopy (TEM) and biochemical analysis of cardiac tissue were performed to assess functional, structural and molecular effects. Increases in right ventricular (RV) and left ventricular (LV) end-diastolic pressure and LV end-diastolic wall stress with increased LV fibrosis were observed. TEM images demonstrated myofibrillar loss, cytoskeletal breakdown and mitochondrial damage at both time points. Increases in cardiac troponin I (cTnI) and N-terminal pro brain natriuretic peptide (NT-proBNP) reflected myofibrillar damage and increased LV wall stress. LV shortening decreased as a function of increasing LV end-systolic wall stress and was accompanied by increased sarcoendoplasmic reticulum calcium ATPase (SERCA) inactivation and a striking dephosphorylation of phospholamban. NADPH oxidase 2 and protein phosphatase 1 were also increased. Increased circulating eosinophils and myocardial 4-hydroxynonenal content suggested increased oxidative stress as a key contributing factor to these effects. Thus, a continuous oxidative stress-induced chronic myocardial damage along with phospholamban dephosphorylation are critical for bromine-induced chronic cardiac dysfunction. These findings in our preclinical model will educate clinicians and public health personnel and provide important endpoints to evaluate therapies.
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MESH Headings
- Animals
- Bromine
- Calcium-Binding Proteins/metabolism
- Cardiomegaly/chemically induced
- Cardiomegaly/metabolism
- Cardiomegaly/pathology
- Cardiomegaly/physiopathology
- Cardiotoxicity
- Diastole
- Disease Models, Animal
- Fibrosis
- Male
- Mitochondria, Heart/metabolism
- Mitochondria, Heart/ultrastructure
- Myocardium/metabolism
- Myocardium/ultrastructure
- NADPH Oxidase 2/metabolism
- Natriuretic Peptide, Brain/metabolism
- Oxidative Stress/drug effects
- Peptide Fragments/metabolism
- Phosphorylation
- Protein Phosphatase 1/metabolism
- Rats, Sprague-Dawley
- Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism
- Systole
- Time Factors
- Troponin I/metabolism
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/chemically induced
- Ventricular Dysfunction, Right/metabolism
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
- Rats
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Affiliation(s)
- Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Shazia Shakil
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Wayne E Bradley
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Chih-Chang Wei
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Pamela Powell
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Center for Heart Failure Research, KG Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - David A Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University, St. Louis, MO, USA
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA.
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Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study. J Hypertens 2020; 39:952-960. [PMID: 33323911 DOI: 10.1097/hjh.0000000000002746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography. RESULTS During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (-8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91-0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83-0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95-0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93-0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry. CONCLUSION The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.
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Zhu P, Dai Y, Qiu J, Xu H, Liu J, Zhao Q. Prognostic implications of left ventricular geometry in coronary artery bypass grafting patients. Quant Imaging Med Surg 2020; 10:2274-2284. [PMID: 33269226 DOI: 10.21037/qims-19-926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The prognostic implications of left ventricular (LV) mass and geometry have been confirmed in populations with different cardiac diseases. However, the prognostic value of LV geometry in coronary artery bypass grafting (CABG) patients is unclear. Methods A total of 2,517 patients undergoing CABG between January 2012 and September 2016 in our cardiac surgery unit were included. Patients were divided into the following 4 groups according to left ventricular mass index (LVMi) and relative wall thickness (RWT): normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Results The median follow-up period was 47.0 months (interquartile range was 32.5-61.3 months). Compared to the normal geometry group, the concentric remodeling group [hazard ratio (HR): 3.023; 95% confidence interval (CI): 1.134-8.060], the eccentric hypertrophy group (HR: 3.422; 95% CI: 1.395-8.398), and the concentric hypertrophy group (HR: 5.399; 95% CI: 2.289-12.735) have higher main adverse cardiovascular and cerebrovascular event (MACCE) risk. Moreover, increased MACCE risk was associated with higher LVMi (HR: 1.015 per 1 g/m2 increase in LVMi; 95% CI: 1.005-1.026) and RWT (HR: 1.991 per 0.1-U increase in RWT; 95% CI: 1.343-2.952). We observed similar results concerning mortality. Adding LV geometry to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II significantly improved the area under the curve (AUC) for MACCE (from 0.621 to 0.703; P=0.042). The addition of LV geometry showed significant integrated discrimination improvement (IDI) and net reclassification improvement (NRI) for MACCE (IDI: 0.043, P<0.001; NRI: 0.200, P<0.001) and death (IDI: 0.018, P=0.020; NRI: 0.308, P=0.002), as was the addition of LVMi and RWT. Conclusions LV geometry is an independent and incremental prognostic factor for MACCE and death in CABG patients.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Dai
- School of Management, Fudan University, Shanghai, China
| | - Jiapei Qiu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Xu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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25
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Breetveld NM, Alers R, Geerts L, van Kuijk SMJ, van Dijk AP, van der Vlugt MJ, Heidema WM, van Neer J, van Empel VPM, Brunner‐La Rocca H, Scholten RR, Ghossein‐Doha C, Spaanderman MEA. Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study. J Am Heart Assoc 2020; 9:e015043. [PMID: 32924785 PMCID: PMC7792392 DOI: 10.1161/jaha.119.015043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Abstract
Background During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. Methods and Results In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m2. We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06-17.40; and adjusted OR, 4.67; 95% CI, 1.02-21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99-1.35]; OR, 1.24 [95% CI, 0.98-1.58]; and OR, 1.20 [95% CI, 0.98-1.47], respectively). Conclusions In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.
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Affiliation(s)
- Nicolette M. Breetveld
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Robert‐Jan Alers
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Lauren Geerts
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Arie P. van Dijk
- Department of CardiologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Wieteke M. Heidema
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Jolijn van Neer
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | | | | | - Ralph R. Scholten
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Chahinda Ghossein‐Doha
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Marc E. A. Spaanderman
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
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Impact of left ventricular mass/end-diastolic volume ratio by three-dimensional echocardiography on two-dimensional global longitudinal strain and diastolic function in native hypertensive patients. J Hypertens 2020; 37:2041-2047. [PMID: 31157744 DOI: 10.1097/hjh.0000000000002147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In hypertensive patients, high left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) is related to LV dysfunction and myocardial fibrosis. PURPOSE We examined the ability of 3D-echo-derived LVM/EDV ratio in identifying early systolic and diastolic dysfunction in relation with LV concentric geometry in native hypertensive patients. METHODS One-hundred and forty-four newly diagnosed, never treated hypertensive patients underwent 2D-echo, including computation of 2D-derived global longitudinal strain (GLS), and 3D-echo. The study population was divided into two groups: elevated 3D-LVM/EDV (≥1.23 in women and ≥1.22 in men), corresponding to LV concentric geometry (n = 50), and normal ratio (<1.23 in women and <1.22 in men) corresponding to LV normal or eccentric geometry (n = 94). RESULTS The two groups were comparable for sex, heart rate, BMI, and blood pressure (BP). Patients with elevated 3D-LVM/EDV ratio were older and had lower GLS (P < 0.001) than patients with normal LVM/EDV ratio. Transmitral E/A ratio (P < 0.0001) and e' velocity (P < 0.0001) were lower, and E/e' ratio (P < 0.0001) higher in patients with elevated LVM/EDV ratio. In the pooled population, LVM/EDV ratio was positively correlated to E/e' (r = 0.39, P < 0.0001) and negatively to GLS (r = -0.29, P < 0.001). By separate multilinear regression analyses, after adjusting for sex, age, heart rate, mean BP and BMI, LVM/EDV ratio - but not 2D-relative wall thickness - was independently associated with E/e' (β = 0.304, P = 0.003) and GLS (β = -0.501, P < 0.0001). CONCLUSION Three-dimensional echocardiographic assessment of LV concentric geometry allows identifying an early diastolic and longitudinal systolic dysfunction in native hypertensive patients. In particular, 3D-LVM/EDV ratio is independently associated with both E/e' ratio and GLS.
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Lipid profile and left ventricular geometry pattern in obese children. Lipids Health Dis 2020; 19:109. [PMID: 32456629 PMCID: PMC7251900 DOI: 10.1186/s12944-020-01285-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/12/2020] [Indexed: 01/19/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular and all-cause mortality. Previous studies reported conflicting results concerning the relationship between serum lipid levels and left ventricular geometry pattern. We sought to explore the relationship between standard serum lipid profile measures with left ventricular geometry pattern in obese children. Patients and methods In this cross-sectional study, a total of 70 obese children were examined. Fasting blood samples were taken to measure total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TGs), glucose, and insulin. Based on these values TG/HDL ratio, BMI and HOMA index were calculated. We also measured the average 24-h ambulatory systolic blood pressure (SBP) and two-dimensional (2/D) transthoracic echocardiography was performed to determine left ventricular mass index (LVMI) and relative wall thickness (RWT). Multiple regression analyses were conducted to explore relationships between study variables and the LVMI or RWT as outcome variables. The final model with LVMI included TG/HDL ratio, BMI, 24 h-average SBP, age and sex, while for the RWT we included BMI, insulin, age and sex. Results Our study included 70 children (65.71% boys and 34.29% girls) median age (14 years, IQR = 12–16)." We demonstrated independent and positive association of TG/HDL ratio, BMI and 24 h-average SBP with LVMI (effect = 3.65, SE = 1.32, p < 0.01; effect = 34.90, SE = 6.84, p < 0.01; effect = 0.32, SE = 0.12, p < 0.01, respectively). On the other hand, in model with RWT as outcome variable, only BMI and insulin were significantly linked (BMI: effect = 13.07, SE = 5.02, p = 0.01 Insulin: effect = 2.80, SE = 0.97). Conclusion Increased TG/HDL ratio in obese children is associated with the development of eccentric left ventricular hypertrophy while increased BMI and insulin were associated with concentric left ventricular hypertophy.
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Walpot J, Inácio JR, Massalha S, Hossain A, Small GR, Crean AM, Yam Y, Rybicki F, Dwivedi G, Chow BJW. Determining Early Remodeling Patterns in Diabetes and Hypertension Using Cardiac Computed Tomography: The Feasibility of Assessing Early LV Geometric Changes. Am J Hypertens 2020; 33:496-504. [PMID: 31903488 DOI: 10.1093/ajh/hpaa002] [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: 11/20/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is conflicting data on early left ventricle (LV) remodeling in diabetes mellitus (DM) and hypertension (HTN). This study examines the feasibility of cardiac computed tomography angiography (CCTA) to detect early LV geometric changes in patients with DM and HTN. METHODS Consecutive patients (n = 5,992) who underwent prospective electrocardiography (ECG)-triggered (mid-diastolic) CCTA were screened. Patients with known structural heart disease or known LV dysfunction were excluded. Left ventricular mass (LVM), left ventricular mid-diastolic volume (LVMDV), and LV concentricity (LVM/LVMDV) were measured and indexed to body surface area. RESULTS A total of 4,283 patients were analyzed (mean age 57 ± 10.69 years, female 46.7%). DM, HTN, and HTN + DM were present in 4.1%, 35.8% and 10.6% of patients, respectively. Compared to normal patients, HTN and HTN + DM patients had increased LVM indexed to body surface area (LVMi) (56.87 ± 17.24, 59.26 ± 13.62, and 58.56 ± 13.09, respectively; P < 0.05). There was no difference in LVMi between normal subjects and patients with DM (56.39 ± 11.50, P = 0.617).Concentricity indices were higher in patient with HTN (1.0456 ± 0.417; P < 0.001), DM (1.109 ± 0.638; P = 0.004), and HTN + DM (1.083 ± 0.311, P < 0.001) than normal individuals (0.9671 ± 0.361). There was no overlap of the 95% confidence intervals in the composite of concentricity indices and LVMi between the different groups. CONCLUSIONS CCTA measures of LVM and concentricity index may discriminate patients with HTN and DM before overt structural heart disease.
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Affiliation(s)
- Jeroen Walpot
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Joao R Inácio
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samia Massalha
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Alomgir Hossain
- University of Ottawa Heart Institute, Cardiovascular Research Methods Centre, Ottawa, ON, Canada
| | - Gary R Small
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Andrew M Crean
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Yeung Yam
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Frank Rybicki
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, University of Western Australia, Perth, Australia
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Benjamin J W Chow
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Bjelakovic B, Stefanutti C, Bonic D, Vukovic V, Kavaric N, Saranac L, Kocic G, Klisic A, Jevtović Stojmenov T, Lukic S, Jovic M, Bjelakovic M. Serum uric acid and left ventricular geometry pattern in obese children. ATHEROSCLEROSIS SUPP 2019; 40:88-93. [DOI: 10.1016/j.atherosclerosissup.2019.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Protein Carbonyl Content Is a Predictive Biomarker of Eccentric Left Ventricular Hypertrophy in Hemodialysis Patients. Diagnostics (Basel) 2019; 9:diagnostics9040202. [PMID: 31775390 PMCID: PMC6963343 DOI: 10.3390/diagnostics9040202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
High prevalence of left ventricular hypertrophy (LVH) and elevated oxidative stress are associated with poor outcomes in chronic hemodialysis patients. Abnormal left ventriculаr geomеtry and different geometric patterns play an important role as well. Our study analyzed the role of oxidative stress on myocardial remodeling in these patients. Plasma malondialdehyde (MDA), protein carbonyl (PC) content, and total antioxidative capacity (TAC) were investigated in 104 hemodialysis patients together with transthoracic echocardiography. Compared to patients with normal ventricular geometry, patients with LVH had increased MDA and PC plasma concentration. Multivariate analysis demonstrated that protein carbonyls, as biomarkers of oxidative protein modification, were an independent predictor of eccentric hypertrophy (eLVH), including higher LV end-diastolic diameter and LV end-diastolic volume, (β = 0.32 and β = 0.28, p < 0.001 for both). The incidence of eLVH increased progressively from the lowest to the highest baseline PC tertile (p < 0.001 for the trend) and the subjects in the former group showed a 76% greater risk of developing eLVH compared to their counterparts. After further adjustment for the potential mediators, PCs carried eLVH odds (95% confidence interval (CI)) of 1.256 (0.998-1.514), per standard deviation increase. High plasma protein carbonyls levels are a significant independent predictor of eccentric LVH in chronic hemodialysis patients.
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Walpot J, Inácio JR, Massalha S, El mais H, Hossain A, Shiau J, Small GR, Crean AM, Yam Y, Rybicki F, Chow BJ. Early LV remodelling patterns in overweight and obesity: Feasibility of cardiac CT to detect early geometric left ventricular changes. Obes Res Clin Pract 2019; 13:478-485. [DOI: 10.1016/j.orcp.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/21/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023]
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Abstract
BACKGROUND This study evaluated cardiac function using tissue Doppler echocardiography and assessed electrocardiographic findings in children diagnosed with Wilson's disease. METHOD Asymptomatic patients with a diagnosis of Wilson's disease (n = 43) were compared to healthy controls (n = 37) that were age and gender matched. RESULTS The standard electrocardiographic and conventional echocardiographic examinations were similar in both groups. The left ventricular ejection fraction, shortening fraction, and diastolic function were not significantly different between the two groups. The Tei index for mitral lateral, mitral septal, tricuspid lateral, tricuspid septal, and inter-ventricular septum on tissue Doppler echocardiography was higher in the patient group, yet it did not reach statistical significance. Mitral lateral and septal systolic annular velocity values were significantly lower in the patient group when compared to the control group (p = 0.02 and 0.04, respectively). Also, mitral lateral and septal isovolumetric contraction time values were higher in the patient group (p = 0.04). Although the left ventricular values were not significantly different, relative left ventricular wall thickness was higher in the patient group when compared to the control group, and concentric remodelling in the left ventricle was found in 7 (16%) of 42 patients. QT interval (p = 0.02) and P-wave dispersion values (p = 0.04) were significantly higher in the patient group compared to the control group, and these tend to predict arrhythmias. CONCLUSION Our study based on the tissue Doppler echocardiography assessment indicated a subclinical systolic, rather than diastolic, dysfunction in the myocardium with increased QT interval and P-wave dispersion, despite the young age of the patients and short disease duration.
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Park SM, Wei J, Cook-Wiens G, Nelson MD, Thomson L, Berman D, Handberg E, Petersen J, Anderson D, Pepine CJ, Merz CNB. Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study. Eur Heart J Cardiovasc Imaging 2019; 20:875-882. [PMID: 30904924 DOI: 10.1093/ehjci/jez044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/28/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. METHODS AND RESULTS Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = -0.296, P = 0.001). CONCLUSIONS In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.
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Affiliation(s)
- Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3206, Los Angeles, CA 90048, USA
| | - Galen Cook-Wiens
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Michael D Nelson
- Department of Bioengineering, University of Texas, Arlington, Arlington, TX 76019, USA
| | - Louise Thomson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3206, Los Angeles, CA 90048, USA
| | - Daniel Berman
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3206, Los Angeles, CA 90048, USA
| | - Eileen Handberg
- University of Florida, Gainesville, Gainesville, FL 32611, USA
| | - John Petersen
- University of Florida, Gainesville, Gainesville, FL 32611, USA
| | - David Anderson
- University of Florida, Gainesville, Gainesville, FL 32611, USA
| | - Carl J Pepine
- University of Florida, Gainesville, Gainesville, FL 32611, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3206, Los Angeles, CA 90048, USA
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Shilly S, Merchant K, Singer P, Frank R, Gurusinghe S, Infante L, Sethna CB. Left ventricular cardiac geometry and ambulatory blood pressure in children. J Clin Hypertens (Greenwich) 2019; 21:566-571. [PMID: 30980607 PMCID: PMC8030399 DOI: 10.1111/jch.13540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 01/19/2023]
Abstract
Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D-echocardiography were retrospectively reviewed in children and adolescents <21 years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z-score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001-1.14, P = 0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00-1.09, P = 0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000-1.04, P = 0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001-1.04, P = 0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.
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Affiliation(s)
- Steffi Shilly
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Kumail Merchant
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Pamela Singer
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Rachel Frank
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Shari Gurusinghe
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Lulette Infante
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Christine B. Sethna
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
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Differential impact of local and regional aortic stiffness on left ventricular remodeling: a cardiovascular magnetic resonance study. J Hypertens 2019; 36:552-559. [PMID: 29334490 DOI: 10.1097/hjh.0000000000001597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular (LV) remodeling and aortic stiffness have independent predictive value for all causes and cardiovascular mortality. Because elastic properties of the arterial wall vary along the aortic pathway, we hypothesized that local and regional aortic stiffness could differently impact on LV remodeling. METHODS AND RESULTS Regional aortic stiffness was determined from carotid-femoral pulse wave velocity (cfPWV) measured by aplanation tonometry. Aortic arch pulse wave velocity was measured by phase contrast cardiovascular magnetic resonance (CMR). Local stiffness was calculated in the ascending aorta pulse wave velocity (aaPWV) and descending aorta pulse wave velocity using central pulse pressure measurement, cine CMR acquisition, and surface change estimation. CMR LV remodeling was expressed as LV mass to end-diastolic volume ratio.We evaluated 146 study participants (41 ± 15 years) free of overt cardiovascular disease. In stepwise multivariate regression analysis, cfPWV and aaPWV were significantly and independently correlated to mass to end-diastolic volume ratio (partial R = 0.07 and R = 0.10, respectively, all P < 0.005) after adjustment for age, sex, BMI, brachial mean blood pressure, and central pulse pressure. Descending aorta pulse wave velocity was correlated with mass to end-diastolic volume ratio to a lower extent (R = 0.04, P = 0.0115) and aortic arch pulse wave velocity was not independently associated with mass to end-diastolic volume ratio. CfPWV and aaPWV were both independently associated with mass to end-diastolic volume ratio, explaining 5 and 8% of mass to end-diastolic volume ratio variance, respectively. CONCLUSION In study participants free of overt cardiovascular disease, stiffness of the ascending aorta representing the local proximal aortic function face to the LV and of the downstream aortic pathway assessed by cfPWV reflecting more advanced alterations of material properties involving the entire aorta, are independent determinants of LV remodeling after adjustment to age, BMI, mean blood pressure, and sex.
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Ejiofor L, Di Nora C, Cervesato E, Cosei I, Ravasel A, Popescu BA, Antonini-Canterin F. Differences in left ventricular geometry in hypertensive African-Europeans and Caucasian patients. Eur J Intern Med 2019; 62:43-47. [PMID: 30686661 DOI: 10.1016/j.ejim.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There are data showing race-related differences regarding left ventricular (LV) geometry in hypertensive patients. Several authors reported that concentric remodeling is the most common remodeling pattern in hypertensive African-Americans, and this pattern may be related to prognosis. There is little information about the LV remodeling patterns in hypertensive Africans that migrated to Europe, which might have different distributions from those seen in African-Americans. The aim our study was to describe the prevalence of LV remodeling patterns in hypertensive African-Europeans and to compare it with that of hypertensive Caucasians. METHODS This is a descriptive study that included 135 consecutive treated hypertensive African-Europeans and 128 hypertensive Caucasians. Patients were examined by transthoracic echocardiography and categorized into the four classic geometric patterns according to LV mass index (LVMi) and relative wall thickness (RWT). RESULTS The mean age and gender distribution were similar in the 2 groups. Caucasians had significantly higher body mass index, LV diastolic and systolic diameters, while African-Europeans had higher RWT and interventricular septum thickness. No differences in LVMi was found. In the African-European group, the prevalence of normal pattern, concentric remodeling, concentric hypertrophy and eccentric hypertrophy were 13%, 36%, 45% and 6% respectively, while in Caucasians they were 21%, 33%, 34% and 12%, respectively. African-Europeans had a higher prevalence of concentric remodeling and hypertrophy compared to Caucasians (81% vs. 67%, p = .005). CONCLUSIONS This study shows important differences in LV geometry between treated African-European and Caucasian hypertensive patients. Also, African-Europeans may have slightly different characteristics compared to African-Americans.
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Affiliation(s)
| | - Concetta Di Nora
- Cardiology Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy.
| | | | - Iulian Cosei
- Emergency Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Andreea Ravasel
- Emergency Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bogdan A Popescu
- Emergency Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
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Norton GR, Peterson VR, Robinson C, Norman G, Libhaber CD, Libhaber E, Gomes M, Sareli P, Woodiwiss AJ. Independent of left ventricular mass, circulating inflammatory markers rather than pressure load are associated with concentric left ventricular remodelling. Int J Cardiol 2019; 274:342-347. [DOI: 10.1016/j.ijcard.2018.09.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/09/2023]
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Boulestreau R, Cremer A, Delarche N, Gosse P. [Alteration of left ventricular longitudinal systolic function in 2D-strain in primary aldosteronism: A new target organ damage marker]. Ann Cardiol Angeiol (Paris) 2018; 67:315-320. [PMID: 30327134 DOI: 10.1016/j.ancard.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Primary hyperaldosteronism is the leading cause of secondary hypertension, and leads to frequent cardiovascular complications. Many studies have studied left ventricular geometry and function in this population, but longitudinal systolic function is still poorly described. METHODS We studied 35 hypertensive patients with primary aldosteronism, and 35 with essential hypertension matched for age, sex, body mass index, and 24h blood pressure. Patients benefited from an echocardiography to measure the mass and the geometry of the left ventricle, left ventricle ejection fraction, systolic longitudinal, circumferential, and radial strain, and diastolic function. RESULTS Compared to essential hypertensive patients, patients with primary aldosteronism presented a significantly higher left ventricular mass index and relative wall thickness (60.3±16.1g/m2 vs 47.3±18.6, P=0.003, and 0.44±0.08 vs 0.36±0.06, P=0.00005, respectively), as well as a significantly reduced longitudinal systolic strain (-17.8±3,4 vs -20.3±3,6%, P=0.004). There were no significant differences in the other parameters. CONCLUSIONS Primary aldosteronism is associated with a deterioration of longitudinal systolic function of the left ventricle compared with essential hypertensive patients. This marker of cardiac damage, reproducible and easily available in routine could help for the screening of these patients.
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Affiliation(s)
- R Boulestreau
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | - A Cremer
- Centre d'excellence en hypertension artérielle, hôpital St-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - N Delarche
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France
| | - P Gosse
- Centre d'excellence en hypertension artérielle, hôpital St-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
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Elboudwarej O, Wei J, Darouian N, Cook-Wiens G, Li Q, Thomson LE, Petersen JW, Anderson RD, Mehta P, Shufelt C, Berman D, Azarbal B, Samuels B, Handberg E, Sopko G, Pepine CJ, Bairey Merz CN. Maladaptive left ventricular remodeling in women: An analysis from the Women's Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction study. Int J Cardiol 2018; 268:230-235. [DOI: 10.1016/j.ijcard.2018.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/23/2018] [Accepted: 03/30/2018] [Indexed: 10/28/2022]
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40
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Cameli M, Mandoli GE, Ambrosio G, Cerbai E, Coiro S, Emdin M, Marcucci R, Morrone D, Palazzuoli A, Savino K, Padeletti L, Mondillo S, Pedrinelli R. Arterial hypertension and atrial fibrillation: standard and advanced echocardiography from diagnosis to prognostication. J Cardiovasc Med (Hagerstown) 2018; 19:51-61. [PMID: 29251696 DOI: 10.2459/jcm.0000000000000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Structural changes in left and right cardiac chambers that occur in arterial hypertension (AH) may lead to an increased risk of atrial fibrillation. Considering that AH is currently the most common cardiovascular disease in the general population, it represents a major risk factor for atrial fibrillation development. This review explores the complex relationship between atrial fibrillation and AH, starting from its pathophysiological basis. It focuses on the role of echocardiography in the management of hypertensive and atrial fibrillation patients, with emphasis on what should be evaluated about left ventricular remodeling, diastolic and systolic function, left atrial (LA) size and function and right ventricular deformation in patients with AH.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giulia E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Florence
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Michele Emdin
- Scuola Superiore Sant'Anna.,Fondazione Toscana G. Monasterio, Pisa
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Doralisa Morrone
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Siena
| | - Ketty Savino
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Luigi Padeletti
- Institute of Internal Medicine and Cardiology, Careggi Hospital, University of Florence, Florence.,IRCCS Multimedica, Milan, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
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Fitzpatrick JK, Cohen BE, Rosenblatt A, Shaw RE, Schiller NB. Usefulness of Epicardial Area in the Short Axis to Identify Elevated Left Ventricular Mass in Men. Am J Cardiol 2018; 121:1639-1644. [PMID: 29628127 DOI: 10.1016/j.amjcard.2018.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
Abstract
Left ventricular (LV) hypertrophy is strongly associated with increased cardiovascular morbidity and mortality. The 2-dimensional LV mass algorithms suffer from measurement variability that can lead to misclassification of patients with LV hypertrophy as normal, or vice versa. Among the 4 echocardiographic measurements required by the 2-dimensional LV mass algorithms, epicardial and endocardial area have the lowest interobserver variation and could be used to corroborate LV mass calculations. We sought cut-off values that are able to discriminate between elevated and normal LV mass based on endocardial or epicardial area alone. Using data from 664 men enrolled in the Mind Your Heart Study, we calculated the correlation of LV mass index with epicardial area and endocardial area. We then used receiver operator characteristic curves to identify epicardial and endocardial area cut-points that could discriminate subjects with normal LV mass and LV hypertrophy. LV mass index was more strongly correlated with epicardial area compared with endocardial area, r = 0.70 versus r = 0.27, respectively. Epicardial area had a significantly higher area under the receiver operator characteristic curve (p <0.001) compared with endocardial area, 0.90 (95% confidence interval 0.86 to 0.93) versus 0.63 (95% confidence interval 0.57 to 0.71). An epicardial area cut-point of ≥38.0 cm2 corresponded to a sensitivity of 95.0% and specificity of 54.4% for detecting LV hypertrophy. In conclusion, epicardial area showed promise as a method of rapid screening for LV hypertrophy and could be used to validate formal LV mass calculations.
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Barbieri A, Rossi A, Gaibazzi N, Erlicher A, Mureddu GF, Frattini S, Faden G, Manicardi M, Beraldi M, Agostini F, Lazzarini V, Moreo A, Temporelli PL, Faggiano P. Refined 4-group classification of left ventricular hypertrophy based on ventricular concentricity and volume dilatation outlines distinct noninvasive hemodynamic profiles in a large contemporary echocardiographic population. Echocardiography 2018; 35:1258-1265. [PMID: 29797430 DOI: 10.1111/echo.14031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) may reflect a wide variety of physiologic and pathologic conditions. Thus, it can be misleading to consider all LVH to be homogenous or similar. Refined 4-group classification of LVH based on ventricular concentricity and dilatation may be identified. To determine whether the 4-group classification of LVH identified distinct phenotypes, we compared their association with various noninvasive markers of cardiac stress. METHODS Cohort of unselected adult outpatients referred to a seven tertiary care echocardiographic laboratory for any indication in a 2-week period. We evaluated the LV geometric patterns using validated echocardiographic indexation methods and partition values. RESULTS Standard echocardiography was performed in 1137 consecutive subjects, and LVH was found in 42%. The newly proposed 4-group classification of LVH was applicable in 88% of patients. The most common pattern resulted in concentric LVH (19%). The worst functional and hemodynamic profile was associated with eccentric LVH and those with mixed LVH had a higher prevalence of reduced EF than those with concentric LVH (P < .001 for all). CONCLUSIONS The new 4-group classification of LVH system showed distinct differences in cardiac function and noninvasive hemodynamics allowing clinicians to distinguish different LV hemodynamic stress adaptations in patients with LVH.
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Affiliation(s)
- Andrea Barbieri
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Gaibazzi
- Cardiology Division, Parma University Hospital, Parma, Italy
| | | | | | | | - Giacomo Faden
- Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
| | - Marcella Manicardi
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Monica Beraldi
- Cardiological Department, "Carlo Poma" Hospital Mantova, Mantova, Italy
| | | | | | | | | | - Pompilio Faggiano
- Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
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Bertoluci C, Foppa M, Santos ABS, Branchi TV, Fuchs SC, Fuchs FD. Echocardiographic Left Ventricular Reverse Remodeling After 18 Months of Antihypertensive Treatment in Stage I Hypertension. Results From the Prever-Treatment Study. Am J Hypertens 2018; 31:321-328. [PMID: 29036504 DOI: 10.1093/ajh/hpx171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Antihypertensive treatment improves echocardiographic parameters of hypertensive target organ damage in stage II hypertension, but less is known about the effects in stage I hypertension. METHODS In a cohort study nested in the randomized double-blind trial PREVER-treatment, 2-dimensional echocardiograms were performed in 110 individuals, aged 54.8 ± 7.9 years-old, with stage I hypertension at baseline and after 18 months of treatment with chlorthalidone/amiloride or losartan. RESULTS At baseline, 66 (60%) participants had concentric remodeling. After antihypertensive treatment, systolic (SBP) and diastolic blood pressure (BP) were reduced from 141/90 to 130/83 mm Hg (P = 0.009). There was a significant reduction in left ventricular (LV) mass (LVM) index (82.7 ± 17.1 to 79.2 ± 17.5 g/m2; P = 0.005) and relative wall thickness (0.45 ± 0.06 to 0.42 ± 0.05; P < 0.001), increasing the proportion of participants with normal LV geometry (31% to 49%, P = 0.006). Left atrial (LA) volume index reduced (26.8 ± 7.3 to 24.9 ± 6.5 ml/m2; P = 0.001), and mitral E-wave deceleration time increased (230 ± 46 to 247 ± 67 ms; P = 0.005), but there was no change in other parameters of diastolic function. LVM reduction was significantly higher in the 2 higher tertiles of SBP reduction compared to the lower tertile. CONCLUSIONS Treatment of patients with stage I hypertension for 18 months promotes favorable effects in the LA and LV remodeling. This improvement in cardiac end-organ damage might be associated with reduction of long term clinical consequences of hypertensive cardiomyopathy, particularly heart failure with preserved ejection fraction.
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Discerning the relationship between left ventricular geometry, high-sensitivity troponin T, and nondipper hypertension. Blood Press Monit 2018; 23:12-18. [PMID: 29278556 DOI: 10.1097/mbp.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ojji DB, Libhaber E, Alfa J, Murtala N, Abdullahi B, Nwankwo A, Nnamonu A, Karen S. Left ventricular mass estimation by different partition values in a large population of black hypertensive subjects. Health Sci Rep 2018; 1:e25. [PMID: 30623057 PMCID: PMC6266419 DOI: 10.1002/hsr2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/19/2023] Open
Abstract
AIMS Our aim is to compare the impact of the 2 most widely used methods of indexing left ventricular mass (LVM) on the distribution of abnormal left ventricular (LV) geometric patterns, in a large sample of untreated asymptomatic black hypertensive subjects. METHODS AND RESULTS All patients with hypertension referred to the Cardiology unit of University of Abuja Teaching Hospital, Abuja, Nigeria from 2006 to 2013, who gave informed consent, and underwent physical examination and echocardiography. LVM indexation was classified into 4 geometric patterns after echocardiography: normal geometry, concentric hypertrophy, concentric remodeling, and eccentric hypertrophy. Concentric hypertrophy was the commonest geometric pattern and was detected in 33.6% to 39.5% of the patients. LVM/height2.7 was a better method to detect abnormal geometric pattern than LVM/BSA (P < 0.0001). CONCLUSION In a large cohort of hypertensive subjects with no clinical evidence of cardiovascular disease, abnormal LV geometry was found in greater than four-fifths of the population. In addition, LVM indexed for height 2.7 was found to be a better method for detecting LVH than LVM indexed for BSA, as the highest prevalence of abnormal geometry was diagnosed when LVM was indexed for height2.7.
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Affiliation(s)
- Dike B. Ojji
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Elena Libhaber
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Jacob Alfa
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ngabea Murtala
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Bolaji Abdullahi
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ada Nwankwo
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Anita Nnamonu
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Sliwa Karen
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownSouth Africa
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Affiliation(s)
- Calvin Woon-Loong Chin
- a Department of Cardiology , National Heart Centre Singapore , Singapore.,b Duke-NUS Medical School , Singapore
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Goh VJ, Le TT, Bryant J, Wong JI, Su B, Lee CH, Pua CJ, Sim CPY, Ang B, Aw TC, Cook SA, Chin CWL. Novel Index of Maladaptive Myocardial Remodeling in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006840. [PMID: 28847911 PMCID: PMC5617557 DOI: 10.1161/circimaging.117.006840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients. METHODS AND RESULTS The RI was derived using LaPlace's Law (), and normal RI ranges were established in 180 healthy volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive patients and 10 patients with heart failure with preserved ejection fraction. Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure accounted for only 20% of the variance observed in LV mass. Although there was no association between blood pressure and myocardial fibrosis, LV mass was independently associated with fibrosis. Compared with hypertensive patients without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%), patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified myocardial response: elevated indexed LV masses (83±24 g/m2), more fibrosis (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for all). RI was similar in HTN-LVH/low RI and heart failure with preserved ejection fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). CONCLUSIONS We suggest that RI provides an approach for stratifying hypertensive patients and is suitable for testing in other disease cohorts to assess its clinical utility. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02670031.
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Affiliation(s)
- Vera J Goh
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Thu-Thao Le
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jennifer Bryant
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jia Ing Wong
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Boyang Su
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chi-Hang Lee
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chee Jian Pua
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chloe P Y Sim
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Briana Ang
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Tar Choon Aw
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Stuart A Cook
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Calvin W L Chin
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.).
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Prevalence and correlates of new-onset left ventricular geometric abnormalities in a general population: the PAMELA study. J Hypertens 2017; 34:1423-31. [PMID: 27136313 DOI: 10.1097/hjh.0000000000000956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM We sought to evaluate new-onset abnormal LV (left ventricle) patterns and their correlates over a 10-year period in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. METHODS The study included 817 patients with normal LV geometry at baseline evaluation having a readable echocardiogram at the end of follow-up. Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the Pressioni Arteriose Monitorate e Loro Associazioni population. RESULTS Over a 10-year period 39% of participants progressed to abnormal LV geometric patterns as follows: LV concentric remodelling (15.2%), eccentric dilated left ventricular hypertrophy (LVH) (8.4%), concentric LVH (7.9%), eccentric nondilated LVH (6.8%), and concentric dilated LVH (0.7%). Age [odds ratio (OR): 1.039; 95% confidence interval (CI) 1.023-1.056, P < 0.0001], LV mass index (OR: 1.039; 95% CI 1.026-1.052, P < 0.0001), night-time SBP (OR: 1.024; 95% CI 1.005-1.043, P = 0.01), office SBP changes during follow-up (OR: 1.017 95% CI 1.007-1028, P = 0.001), and BMI (OR: 1.067; 95% CI 1.017-1.120, P = 0.009) emerged as key correlates of new-onset abnormal LV geometry. Age and LV mass index turned out to be strong determinants of all sub-types of LVH; whereas blood pressure, BMI, and sex exhibited a different predictive value across the various LV geometric patterns. CONCLUSIONS Our study provides the first evidence that long-term changes from normal cardiac morphology toward abnormal LV geometry represent a clinically relevant phenomenon at the community level. From a practical perspective this finding reinforces the concept that life-style changes and pharmacologic treatment aimed to reduce over-weight/obesity and optimize blood pressure are of paramount importance for prevention of subclinical cardiac damage.
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Imanishi J, Kaihotsu K, Yoshikawa S, Nishimori M, Sone N, Honjo T, Iwahashi M. Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry. Int J Cardiovasc Imaging 2017; 34:185-192. [PMID: 28770454 DOI: 10.1007/s10554-017-1218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
Abstract
Although acute pulmonary edema (APE) is common in patients with heart failure (HF) with preserved ejection fraction (EF), its pathogenesis in patients with HF with reduced EF (HFrEF) is not completely understood. The purpose of our study was to explore the contributions of left ventricular (LV) geometry to understand the difference between HFrEF patients with or without APE. We studied 122 consecutive acute decompensated HF patients with HFrEF (≤40%). APE was defined as acute-onset dyspnea and radiographic alveolar edema requiring immediate airway intervention. LV geometry was determined from a combination of the LV mass index and relative wall thickness (RWT). Long-term unfavorable outcome events were tracked during a follow-up of a median of 21 months (interquartile range, 10-28 months), during which APE was observed in 29 patients (24%). Compared to those without APE, hospitalized patients with APE had a higher systolic blood pressure, RWT, and LVEF and lower end-diastolic dimension. Among echocardiographic variables, a multivariate logistic regression analysis identified RWT as the only independent determinant of APE (hazard ratio: 2.46, p < 0.001). Those with concentric geometry (n = 25; RWT > 0.42) had a higher incidence of APE relative to those with non-concentric geometry. Furthermore, among patients with APE, mortality was significantly higher among those with concentric geometry (log-rank, p = 0.008). Compared with non-concentric geometry, concentric geometry (increased RWT, not LV mass) was strongly associated with APE onset and a poorer outcome among APE patients. An easily obtained echocardiographic RWT index may facilitate the risk stratification of patients.
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Affiliation(s)
- Junichi Imanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan.
| | - Kenji Kaihotsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
| | - Sachiko Yoshikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
| | - Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
| | - Naohiko Sone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
| | - Tomoyuki Honjo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
| | - Masanori Iwahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shinko Hospital, 1-4-47, Wakihama-cho, Chuo-ku, Kobe, 650-0072, Japan
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Aronow WS. Hypertension and left ventricular hypertrophy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:310. [PMID: 28856150 DOI: 10.21037/atm.2017.06.14] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College Valhalla, NY, USA
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