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Strange GA, Maron BA, Zeder K, Chan YK, Chen A, Playford D, Humbert M, Mocumbi AO, Stewart S. Global distribution of prognostically significant pulmonary pressure indicative of pulmonary hypertension. J Glob Health 2025; 15:04098. [PMID: 40114580 PMCID: PMC11926580 DOI: 10.7189/jogh.15.04098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025] Open
Abstract
Background There remains a paucity of data to describe how many people worldwide are affected by pulmonary hypertension (PH), an insidious condition associated with adverse vascular remodelling, progressive heart failure, and death without proactive diagnosis and management. Methods We combined data on the population rate of echocardiographic investigations with tricuspid regurgitant velocity (TRV) levels observed within a clinical cohort of >500 000 people, to conservatively estimate the number of adults with mild (TRV 2.5-2.8 m/s), moderate (TRV 2.9-3.4 m/s) and severe (>3.4 m/s) PH in Australia. We then applied the estimated number of PH cases (age- and sex-specific) to World Bank population estimates for 2021. Results We conservatively estimate that 16.01 (95% confidence interval (CI) = 15.31-16.71) million men and 15.53 (95% CI = 14.79-16.27) million women, representing 0.616% (95% CI = 0.589-0.643%) and 0.589% (95% CI = 0.561-0.617%) of those aged 20-79 years worldwide, are affected by mild to severe forms of PH. The highest to lowest proportion of cases occur in Southern/Western Europe ( ~ 0.84% men and ~ 0.76% women) and sub-Saharan Africa ( ~ 0.40% both sexes), respectively. In absolute terms, the greatest number of PH cases reside in Eastern ( ~ 9.0 million) and Southern ( ~ 6.5 million) Asia. PH associated with left heart disease is predominant globally, with an estimated 8.7 (0.33%) and 7.5 (0.28%) million male and female cases worldwide. However, in sub-Saharan Africa, those aged <45 years and without left heart disease account for 11.7% of all PH cases compared to <4.0% of cases in Europe/North America. Conclusions For the first-time, we provide conservative estimates of the global pattern of PH (affecting ~ 31.5 million people). These findings provide a rationale for more definitive burden-of-disease studies focusing on likely regional differences in causality and how PH might be successfully prevented/treated.
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Affiliation(s)
- Geoff A Strange
- Heart Research Institute, University of Sydney, Sydney, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Bradley A Maron
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, University of Maryland, Bethesda, Maryland, USA
| | - Katarina Zeder
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, University of Maryland, Bethesda, Maryland, USA
- Division of Pulmonology, Medical University of Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research Australian Catholic University, Melbourne, Australia
| | | | - David Playford
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Marc Humbert
- Université Paris-Saclay, Inserm UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Universidade Eduardo Mondlane, Maputo, Mozambique
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Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Bansal N, Beaton AZ, Commodore-Mensah Y, Currie ME, Elkind MSV, Fan W, Generoso G, Gibbs BB, Heard DG, Hiremath S, Johansen MC, Kazi DS, Ko D, Leppert MH, Magnani JW, Michos ED, Mussolino ME, Parikh NI, Perman SM, Rezk-Hanna M, Roth GA, Shah NS, Springer MV, St-Onge MP, Thacker EL, Urbut SM, Van Spall HGC, Voeks JH, Whelton SP, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2025; 151:e41-e660. [PMID: 39866113 DOI: 10.1161/cir.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Strom JB, Playford D, Stewart S, Strange G. An Artificial Intelligence Algorithm for Detection of Severe Aortic Stenosis: A Clinical Cohort Study. JACC. ADVANCES 2024; 3:101176. [PMID: 39372458 PMCID: PMC11450902 DOI: 10.1016/j.jacadv.2024.101176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 06/18/2024] [Indexed: 10/08/2024]
Abstract
Background Identifying individuals with severe aortic stenosis (AS) at high risk of mortality remains challenging using current clinical imaging methods. Objectives The purpose of this study was to evaluate an artificial intelligence decision support algorithm (AI-DSA) to augment the detection of severe AS within a well-resourced health care setting. Methods Agnostic to clinical information, an AI-DSA trained to identify echocardiographic phenotype associated with an aortic valve area (AVA)<1 cm2 using minimal input data (excluding left ventricular outflow tract measures) was applied to routine transthoracic echocardiograms (TTE) reports from 31,141 U.S. Medicare beneficiaries at an academic medical center (2003-2017). Results Performance of AI-DSA to detect the phenotype associated with an AVA<1 cm2 was excellent (sensitivity 82.2%, specificity 98.1%, negative predictive value 9.2%, c-statistic = 0.986). In addition to identifying clinical severe AS cases, AI-DSA identified an additional 1,034 (3.3%) individuals with guideline-defined moderate AS but with a similar clinical and TTE phenotype to those with severe AS with low rates of aortic valve replacement (6.6%). Five-year mortality was 75.9% in those with known severe AS, 73.5% in those with a similar phenotype to severe AS, and 44.6% in those without severe AS. The AI-DSA continued to perform well to identify severe AS among those with a depressed left ventricular ejection fraction. Overall rates of aortic valve replacement remained low, even in those with an AVA<1 cm2 (21.9%). Conclusions Without relying on left ventricular outflow tract measurements, an AI-DSA used echocardiographic reports to reliably identify the phenotype of severe AS. These results suggest possible utility for this AI-DSA to enhance detection of severe AS individuals at risk for adverse outcomes.
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Affiliation(s)
- Jordan B. Strom
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Playford
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Simon Stewart
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland
| | - Geoff Strange
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Heart Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Moore MK, Jones GT, Whalley G, Prendergast B, Williams MJA, Coffey S. Outcomes of patients with early calcific aortic valve disease detected by clinically indicated echocardiography. Eur Heart J Cardiovasc Imaging 2024; 25:356-364. [PMID: 37847155 PMCID: PMC10883728 DOI: 10.1093/ehjci/jead259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
AIMS Previous studies have demonstrated relatively slow rates of progression of early calcific aortic valve disease (CAVD), which encompasses aortic sclerosis (ASc) and mild aortic stenosis (AS). The potential evolution to clinically significant AS is unclear, and we therefore examined the long-term outcomes of patients with ASc and mild AS detected at the time of clinically indicated echocardiography. METHODS AND RESULTS Data from initial clinically indicated echocardiograms performed between 2010 and 2018 in patients aged ≥18 years were extracted and linked to nationally collected outcome data. Those with impaired right or left systolic ventricular function or other significant left-sided valve disease were excluded. A time to first event analysis was performed with a composite primary outcome of cardiovascular death and aortic valve intervention (AVI). Of the 13 313 patients, 8973 had no CAVD, 3436 had ASc, and 455 had mild AS. The remainder had moderate or worse stenosis. Over a median follow-up period of 4.2 (interquartile range 1.8-6.7) years (and after adjustment for age and sex), those with ASc were at greater risk of the primary outcome [hazard ratio (HR) 2.9, 95% confidence interval (CI) 2.1-4.0] and need for AVI (HR 26.8, 95% CI 9.1-79.1) compared with those with no CAVD. Clinical event rates accelerated after ∼5 years in those with mild AS. CONCLUSION Patients with ASc are >25 times more likely to require AVI than those with no CAVD, and follow-up echocardiography should be considered within 3-4 years in those with mild AS.
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Affiliation(s)
- Matthew K Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, PO Box 9056, Dunedin 9054, New Zealand
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian Whalley
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, PO Box 9056, Dunedin 9054, New Zealand
| | | | - Michael J A Williams
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, PO Box 9056, Dunedin 9054, New Zealand
- Department of Cardiology, Dunedin Hospital, Te Whatu Ora Southern, 201 Great King Street, Dunedin 9016, New Zealand
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, PO Box 9056, Dunedin 9054, New Zealand
- Department of Cardiology, Dunedin Hospital, Te Whatu Ora Southern, 201 Great King Street, Dunedin 9016, New Zealand
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 PMCID: PMC12146881 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 845] [Impact Index Per Article: 845.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Pellikka PA. Looking to the Future for the Journal of the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1-2. [PMID: 36604018 DOI: 10.1016/j.echo.2022.11.002] [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: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 01/04/2023]
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