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Whalley GA, Gamble GD, Harrington A, Dugo C, Morgan A, Ikenasio B, Deo A, Crengle S, Christiansen J. Measuring Linear Left Ventricular Mass - Do M-mode and 2-dimensional Linear Measurements Produce the Same Results in Healthy Volunteers? J Am Soc Echocardiogr 2024:S0894-7317(24)00171-8. [PMID: 38614436 DOI: 10.1016/j.echo.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Gillian A Whalley
- Department of Medicine and HeartOtago, Otago School of Medicine, The University of Otago, Dunedin, New Zealand; Unitec Institute of Technology, Auckland, New Zealand.
| | - Greg D Gamble
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Allanah Harrington
- Unitec Institute of Technology, Auckland, New Zealand; Te Whatu Ora, Auckland, New Zealand
| | | | - Angela Morgan
- Unitec Institute of Technology, Auckland, New Zealand
| | | | - Arun Deo
- Unitec Institute of Technology, Auckland, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, Otago School of Medicine, The University of Otago, Dunedin, New Zealand
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2
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Francis JR, Fairhurst H, Yan J, Fernandes Monteiro A, Lee AM, Maurays J, Kaethner A, Whalley GA, Hardefeldt H, Williamson J, Marangou J, Reeves B, Wheaton G, Robertson T, Horton A, Cush J, Wade V, Monteiro A, Draper ADK, Morris PS, Ralph AP, Remenyi B. Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study. J Am Soc Echocardiogr 2023; 36:733-745. [PMID: 36806665 DOI: 10.1016/j.echo.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Early detection of rheumatic heart disease (RHD) through echocardiographic screening can facilitate early access to effective treatment, which reduces the risk for progression. Accurate, feasible approaches to echocardiographic screening that can be incorporated into routine health services are needed. The authors hypothesized that offsite expert review could improve the diagnostic accuracy of nonexpert-obtained echocardiographic images. METHODS This prospective cross-sectional study was performed to evaluate the diagnostic accuracy of health worker-conducted single parasternal long-axis view with a sweep of the heart using hand-carried ultrasound for the detection of RHD in high-risk populations in Timor-Leste and Australia. In the primary analysis, the presence of any mitral or aortic regurgitation met the criteria for a positive screening result. Sensitivity and specificity were calculated for a screen-and-refer approach based on nonexpert practitioner assessment (approach 1) and for an approach using offsite expert review of nonexpert practitioner-obtained images to decide onward referral (approach 2). Each participant had a reference test performed by an expert echocardiographer on the same day as the index test. Diagnosis of RHD was determined by a panel of three experts, using 2012 World Heart Federation criteria. RESULTS The prevalence of borderline or definite RHD among 3,329 participants was 4.0% (95% CI, 3.4%-4.7%). The sensitivity of approach 1 for borderline or definite RHD was 86.5% (95% CI, 79.5%-91.8%), and the specificity was 61.4% (95% CI, 59.7%-63.1%). Approach 2 achieved similar sensitivity (88.4%; 95% CI, 81.5%-93.3%) and improved specificity (77.1%; 95% CI, 75.6%-78.6%). CONCLUSION Nonexpert practitioner-obtained single parasternal long-axis view with a sweep of the heart images, reviewed by an offsite expert, can detect borderline and definite RHD on screening with reasonable sensitivity and specificity. Brief training of nonexpert practitioners with ongoing support could be used as an effective strategy for scaling up echocardiographic screening for RHD in high-risk settings.
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Affiliation(s)
- Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
| | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Anferida Fernandes Monteiro
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | | | - Alex Kaethner
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia
| | - Gillian A Whalley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jacqui Williamson
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Benjamin Reeves
- Department of Paediatric Cardiology, Cairns Hospital, Cairns, Australia
| | - Gavin Wheaton
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | - Ari Horton
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia; Paediatric Cardiology, Monash Heart and Monash Children's Hospital, Melbourne, Australia
| | - James Cush
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Vicki Wade
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Andre Monteiro
- Department of Cardiology, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Peter S Morris
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia
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Sengupta SP, Coffey S, Whalley GA. Survey of echocardiography practice across five continents. Echocardiography 2023; 40:335-342. [PMID: 36914948 DOI: 10.1111/echo.15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND AND AIM The term echocardiography refers to a diverse range of cardiovascular ultrasound imaging methods, both inside and outside specialist cardiology practice. While guidelines exist, we hypothesized that there are significant worldwide differences in the way echocardiography is practiced. We surveyed echocardiography practitioners around the world to characterize the workforce and their practice. METHOD Social media and word of mouth were used in an explosive sampling approach to recruit echo users, who then completed an online survey that included personal demographics and questions about their practice, their resources, and daily use of echocardiography. RESULTS In total, 594 participants completed the survey: 54.9% sonographers; 30% cardiologists, with the remainder other physicians or trainees. Significant variation in the number of echoes performed and the time allocated to scanning was observed. There were also differences in the gathering of adjunct measures such as blood pressure and body size. CONCLUSION There is wide variation in echocardiography practices across the world. Differences are likely to be both clinician- and healthcare system-driven. Guidelines for practice developed in well-resourced western countries and intended for use in cardiology-based echocardiography laboratories may not be applicable to other countries or indeed to new echo users.
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Affiliation(s)
- Shantanu P Sengupta
- Department of Cardiology, Sengupta Hospital and Research Institute, Ravinagar, Nagpur, India
| | - Sean Coffey
- Department of Medicine and HeartOtago, Otago School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine and HeartOtago, Otago School of Medicine, The University of Otago, Dunedin, New Zealand
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Fordyce AM, Whalley GA, Coffey S, Wilson LC. Adjunct Methods for the Detection of Patent Foramen Ovale: The Contribution of Transcranial Doppler and the Valsalva Manoeuvre. Heart Lung Circ 2022; 31:1471-1481. [PMID: 36038470 DOI: 10.1016/j.hlc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
A patent foramen ovale (PFO) is present in 25% of the population. In some patients, especially those without traditional stroke risk factors and with no immediately apparent cause, a cryptogenic stroke may be caused by an embolus passing through the PFO to the systemic circulation. The identification, or indeed exclusion, of a PFO is sought in these patients, most commonly using contrast-enhanced transthoracic or transoesophageal echocardiography. Another method for detecting a PFO is transcranial Doppler, which allows the detection of PFO possibly without the need for an echo laboratory, and with arguably improved sensitivity. This review will focus on transcranial Doppler detection of PFO, with a brief summary of echocardiographic techniques and the use of ultrasound contrast agents, and the role of provocations to increase diagnostic accuracy, specifically the Valsalva manoeuvre. We discuss the phases alongside the direct and indirect signs of an adequate Valsalva manoeuvre.
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Affiliation(s)
- Andrew M Fordyce
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/AFordyceOtago
| | - Gillian A Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/GWhalleyPhD
| | - Sean Coffey
- Department of Medicine, University of Otago, Dunedin, New Zealand; Southern District Health Board, New Zealand. http://www.twitter.com/DrSeanCoffey
| | - Luke C Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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Whalley GA, Harrington A, Christiansen J, Ikenasio B, Deo A, Gamble GD, Crengle S. New Echocardiography Reference Ranges for Aotearoa (NewERA) Study: the application of international echocardiographic reference values to linear measurements of the hearts of healthy, young Māori and Pacific adults may not detect cardiac enlargement. N Z Med J 2022; 135:19-34. [PMID: 35834830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS To develop ethnic-specific echocardiography reference ranges for Aotearoa, and to investigate the impact of indexation to body surface area (BSA). Current reference international ranges are derived from people of mostly NZ European ethnicity and may not be appropriate for Māori and New Zealanders of Pacific ethnicity, who both experience high rates of cardiovascular disease. METHODS Echocardiography was performed in a cross-sectional study of 263 healthy adults (18-50 years): Māori (N=71, 43 female), Pacific (N=53, 28 female), European (N=139, 74 female). Linear measurements of the left heart are reported and indexed to BSA. The upper/lower limit of normal (ULN/LLN) by ethnicity and sex were derived (quantile regression). Ethnic- and sex-specific differences were examined using ANOVA. RESULTS The ULN was higher for all un-indexed dimensions in men compared to women, and for most indices the ULN was smallest in NZ Europeans and largest in Māori and Pacific peoples. Indexation reversed these relationships: NZ Europeans had higher ULN for many measurements. CONCLUSIONS Indexing to BSA introduced bias that preferences the NZ European ethnicity by creating an upper limit reference threshold that far exceeds this sample's upper range. As a result, this may lead to under-recognition of cardiac enlargement in Māori and Pacific patients, and in particular for women. Unique reference ranges for all ethnic groups and sexes are required to optimally detect and manage cardiovascular diseases (CVD) in Aotearoa.
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Affiliation(s)
- Gillian A Whalley
- Department of Medicine and HeartOtago, Otago School of Medicine, The University of Otago, Dunedin, New Zealand; Unitec Institute of Technology, Auckland, New Zealand
| | - Allanah Harrington
- Unitec Institute of Technology, Auckland, New Zealand; Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | | | | | - Arun Deo
- Unitec Institute of Technology, Auckland, New Zealand
| | - Greg D Gamble
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, Otago School of Medicine, The University of Otago, Dunedin, New Zealand
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Aitken-Buck HM, Moore M, Whalley GA, Lohner L, Ondruschka B, Coffey S, Tse RD, Lamberts RR. Estimating heart mass from heart volume as measured from post-mortem computed tomography. Forensic Sci Med Pathol 2022; 18:333-342. [PMID: 35478080 PMCID: PMC9587075 DOI: 10.1007/s12024-022-00478-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
Heart mass can be predicted from heart volume as measured from post-mortem computed tomography (PMCT), but with limited accuracy. Although related to heart mass, age, sex, and body dimensions have not been included in previous studies using heart volume to estimate heart mass. This study aimed to determine whether heart mass estimation can be improved when age, sex, and body dimensions are used as well as heart volume. Eighty-seven (24 female) adult post-mortem cases were investigated. Univariable predictors of heart mass were determined by Spearman correlation and simple linear regression. Stepwise linear regression was used to generate heart mass prediction equations. Heart mass estimate performance was tested using median mass comparison, linear regression, and Bland-Altman plots. Median heart mass (P = 0.0008) and heart volume (P = 0.008) were significantly greater in male relative to female cases. Alongside female sex and body surface area (BSA), heart mass was univariably associated with heart volume in all cases (R2 = 0.72) and in male (R2 = 0.70) and female cases (R2 = 0.64) when segregated. In multivariable regression, heart mass was independently associated with age and BSA (R2 adjusted = 0.46-0.54). Addition of heart volume improved multivariable heart mass prediction in the total cohort (R2 adjusted = 0.78), and in male (R2 adjusted = 0.74) and female (R2 adjusted = 0.74) cases. Heart mass estimated from multivariable models incorporating heart volume, age, sex, and BSA was more predictive of actual heart mass (R2 = 0.75-0.79) than models incorporating either age, sex, and BSA only (R2 = 0.48-0.57) or heart volume only (R2 = 0.64-0.73). Heart mass can be more accurately predicted from heart volume measured from PMCT when combined with the classical predictors, age, sex, and BSA.
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Affiliation(s)
- Hamish M Aitken-Buck
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, 9054, New Zealand.
| | - Matthew Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rexson D Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Regis R Lamberts
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, 9054, New Zealand
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Van der Giessen H, Wilson LC, Coffey S, Whalley GA. Review: Detection of patient foramen ovale using transcranial Doppler or standard echocardiography. Australas J Ultrasound Med 2021; 23:210-219. [PMID: 34765407 DOI: 10.1002/ajum.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/07/2022] Open
Abstract
A patent foramen ovale (PFO) is a common remnant of fetal circulation present in up to 25% of the worldwide adult population. Paradoxical embolism occurs when venous blood crosses the PFO into the arterial system, bypassing the pulmonary circulation. This allows for the direct passage of microemboli into cerebral blood vessels, increasing the risk of cryptogenic stroke. This review investigates the current diagnostic procedures used to detect and grade a PFO, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and transcranial Doppler (TCD). Only a few studies have directly compared the use of TTE with TCD for PFO detection but several have compared TTE and TCD independently against the clinical gold standard TOE. Known pitfalls of TTE and TCD are also discussed, including the difficulty of differentiating between intracardiac shunts and intrapulmonary shunts. This review also discusses methods to optimise imaging, such as performing an adequate Valsalva manoeuvre, the role of abdominal compression and the choice of the injection site for the contrast agent and how these may increase the diagnostic success of detecting a right-to-left shunt when prompted by a clinician.
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Affiliation(s)
- Hanna Van der Giessen
- The Department of Medicine, Otago Medical School The University of Otago Dunedin New Zealand
| | - Luke C Wilson
- The Department of Medicine, Otago Medical School The University of Otago Dunedin New Zealand
| | - Sean Coffey
- The Department of Medicine, Otago Medical School The University of Otago Dunedin New Zealand
| | - Gillian A Whalley
- The Department of Medicine, Otago Medical School The University of Otago Dunedin New Zealand
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Whalley GA. Forging an evidence-based path forward. Australas J Ultrasound Med 2021; 24:69. [PMID: 34765412 DOI: 10.1002/ajum.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Gillian A Whalley
- Department of Medicine Otago School of Medicine University of Otago Dunedin New Zealand
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9
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Whalley GA. Collaboration in the time of COVID. Australas J Ultrasound Med 2021; 24:185-186. [PMID: 34888128 PMCID: PMC8591272 DOI: 10.1002/ajum.12287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gillian A. Whalley
- Department of MedicineOtago School of MedicineUniversity of OtagoDunedinNew Zealand
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10
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Francis JR, Whalley GA, Kaethner A, Fairhurst H, Hardefeldt H, Reeves B, Auld B, Marangou J, Horton A, Wheaton G, Robertson T, Ryan C, Brown S, Smith G, Dos Santos J, Flavio R, Embaum K, da Graca Noronha M, Lopes Belo S, Madeira Santos C, Georginha Dos Santos M, Cabral J, do Rosario I, Harries J, Francis LA, Draper ADK, James CL, Davis K, Yan J, Mitchell A, da Silva Almeida I, Engelman D, Roberts KV, Ralph AP, Remenyi B. Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Circ Cardiovasc Imaging 2021; 14:e011790. [PMID: 34384239 PMCID: PMC8373443 DOI: 10.1161/circimaging.120.011790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10–15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70–6.47); proportion with definite RHD was 3.23% (95% CI, 2.61–3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2–77.8), specificity was 78.1% (95% CI, 76.4–79.8). Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.
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Affiliation(s)
- Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Maluk Timor, Timor-Leste (J.R.F., J.D.S., R.F., K.E.)
| | - Gillian A Whalley
- Dunedin School of Medicine, University of Otago, New Zealand (G.A.W.)
| | | | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.)
| | - Hilary Hardefeldt
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Benjamin Auld
- Department of Cardiology, Queensland Children's Hospital, Australia (B.A.)
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.)
| | - Ari Horton
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Gavin Wheaton
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Chelsea Ryan
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Shannon Brown
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Greg Smith
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | | | | | | | - Mario da Graca Noronha
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Sonia Lopes Belo
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Carla Madeira Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Maria Georginha Dos Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Jose Cabral
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Ivonia do Rosario
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | | | - Laura A Francis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Anthony D K Draper
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Christian L James
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Kimberly Davis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Ines da Silva Almeida
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Australia (D.E.)
| | - Kathryn V Roberts
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Division of Medicine, Royal Darwin Hospital, Australia (A.P.R.)
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.).,Department of Pediatrics, Cairns Base Hospital, Australia (B.R.)
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11
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Whalley GA. Sonography - anyone, anytime, anywhere? Australas J Ultrasound Med 2021; 24:119. [PMID: 34765421 PMCID: PMC8409449 DOI: 10.1002/ajum.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gillian A Whalley
- Department of MedicineOtago School of MedicineUniversity of OtagoDunedinNew Zealand
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12
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Affiliation(s)
- Anthony Forshaw
- Hearts 1(st), Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - John F Younger
- Cardiology Department, Royal Brisbane and Womens' Hospital, Brisbane, and University of Queensland, Brisbane, Qld, Australia
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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13
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Martin J, Coffey S, Whalley GA. Sex Disparity in Cardiovascular Disease Outcomes: Do Our Current Echocardiographic Reference Ranges Measure Up? Heart Lung Circ 2020; 30:e1-e5. [PMID: 33176982 DOI: 10.1016/j.hlc.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
Reducing inequity in access to health care and disparity in health outcomes remain key objectives in cardiovascular medicine. Echocardiography is often the primary diagnostic tool used to detect cardiovascular disease (CVD), and relies on comparison with published reference ranges to appropriately detect pathology. Our understanding of the contribution of age, sex and ethnicity to quantification of cardiac size is improving, but cardiovascular disease management guidelines have yet to evolve. While recently, sex, age and ethnicity-specific reference values have been produced, treatment thresholds in many clinical guidelines do not differentiate between sexes. As a result, in order to reach management thresholds, women are often required to have more severe pathology. In order to reduce potential disadvantage to women, future research efforts should be directed to develop more personalised treatment approaches by identification of sex-appropriate management thresholds.
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Affiliation(s)
- Josh Martin
- Department of Cardiology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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14
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Moharram MA, Aitken-Buck HM, Reijers R, Hout IV, Williams MJ, Jones PP, Whalley GA, Lamberts RR, Coffey S. Correlation between epicardial adipose tissue and body mass index in New Zealand ethnic populations. N Z Med J 2020; 133:22-32. [PMID: 32525859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM We aimed to investigate the correlation between epicardial adipose tissue (EAT) and body mass index (BMI) in different ethnic groups in New Zealand. METHODS The study included 205 individuals undergoing open heart surgery. Māori and Pacific groups were combined to increase statistical power. EAT was measured using 2D echocardiography. RESULTS There were 164 New Zealand Europeans (NZE) and 41 Māori/Pacific participants. The mean (SD) age of the study group was 67.9 (10.1) years, 69.1 (9.5) for NZE and 63.5 (11.4) for Māori/Pacific. BMI was 29.6 (5.5) kg/m2 for NZE and 31.8 (6.2) for Māori/Pacific. EAT thickness was 6.2 (2.2) mm and 6.0 (1.8) mm for NZE and Māori/Pacific, respectively. Using univariate linear regression, BMI showed moderate correlation with EAT in NZE (R2=0.26, p<0.001); however, there was no significant correlation between BMI and EAT in Māori/Pacific patients (R2=0.05, p=0.17). Using multivariate analysis, BMI remained a significant predictor of EAT thickness in NZE (R2 =0.27, p<0.001). CONCLUSIONS BMI was associated with EAT thickness in NZE patients, but not in Māori/Pacific patients. The same level of BMI can carry different connotations of risk in different ethnic groups, with BMI likely being an inconsistent measure of obesity in in Māori/Pacific patients.
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Affiliation(s)
- Mohammed A Moharram
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin
| | - Hamish M Aitken-Buck
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin
| | - Robin Reijers
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin
| | - Isabelle van Hout
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin
| | - Michael Ja Williams
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin
| | - Peter P Jones
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin
| | - Gillian A Whalley
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin
| | - Regis R Lamberts
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, Dunedin
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15
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Brown L, Swan A, Whalley GA. The 21st Century Echocardiography Laboratory in Australia and New Zealand: Rapid Evolution of Training and Workforce, Practice and Technology. Heart Lung Circ 2019; 28:1421-1426. [PMID: 31010637 DOI: 10.1016/j.hlc.2019.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/08/2019] [Accepted: 03/21/2019] [Indexed: 01/09/2023]
Abstract
Echocardiography is a common and increasingly used noninvasive imaging tool in medicine. In this paper, we imagine the echocardiography laboratory of the future and consider the challenges we face currently, and may face in the future, and how these might be overcome; challenges such as training enough sonographers to meet the increasing demands of the ageing population living with chronic cardiovascular disease and the need for surveillance in other clinical scenarios. We consider the changing qualification framework and the requirements for accreditation and registration in Australia and New Zealand and the potential for migrant sonographers to meet some of the increasing demand. Advanced scopes of practice are likely to be a feature of the future workforce and we consider some of the ways these may evolve. Lastly, we consider how the evolving clinical landscape and technology may change the way echocardiography is delivered.
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Affiliation(s)
- Lynn Brown
- Cardiology Department, Flinders Medical Centre, Adelaide, SA, Australia
| | - Amy Swan
- Cardiology Department, Flinders Medical Centre, Adelaide, SA, Australia
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16
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Prasad SB, Lin AK, Guppy-Coles KB, Stanton T, Krishnasamy R, Whalley GA, Thomas L, Atherton JJ. Diastolic Dysfunction Assessed Using Contemporary Guidelines and Prognosis Following Myocardial Infarction. J Am Soc Echocardiogr 2018; 31:1127-1136. [DOI: 10.1016/j.echo.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/17/2022]
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17
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Marks ECA, Wilkinson TM, Frampton CM, Skelton L, Pilbrow AP, Yandle TG, Pemberton CJ, Doughty RN, Whalley GA, Ellis CJ, Troughton RW, Owen MC, Pattinson NR, Cameron VA, Richards AM, Gieseg SP, Palmer BR. Plasma levels of soluble VEGF receptor isoforms, circulating pterins and VEGF system SNPs as prognostic biomarkers in patients with acute coronary syndromes. BMC Cardiovasc Disord 2018; 18:169. [PMID: 30111293 PMCID: PMC6094571 DOI: 10.1186/s12872-018-0894-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 07/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background Development of collateral circulation in coronary artery disease is cardio-protective. A key process in forming new blood vessels is attraction to occluded arteries of monocytes with their subsequent activation as macrophages. In patients from a prospectively recruited post-acute coronary syndromes cohort we investigated the prognostic performance of three products of activated macrophages, soluble vascular endothelial growth factor (VEGF) receptors (sFlt-1 and sKDR) and pterins, alongside genetic variants in VEGF receptor genes, VEGFR-1 and VEGFR-2. Methods Baseline levels of sFlt-1 (VEGFR1), sKDR (VEGFR2) and pterins were measured in plasma samples from subgroups (n = 513; 211; 144, respectively) of the Coronary Disease Cohort Study (CDCS, n = 2067). DNA samples from the cohort were genotyped for polymorphisms from the VEGFR-1 gene SNPs (rs748252 n = 2027, rs9513070 n = 2048) and VEGFR-2 gene SNPs (rs2071559 n = 2050, rs2305948 n = 2066, rs1870377 n = 2042). Results At baseline, levels of sFlt-1 were significantly correlated with age, alcohol consumption, NTproBNP, BNP and other covariates relevant to cardiovascular pathophysiology. Total neopterin levels were associated with alcohol consumption at baseline. 7,8 dihydroneopterin was associated with BMI. The A allele of VEGFR-2 variant rs1870377 was associated with higher plasma sFlt-1 and lower levels of sKDR at baseline. Baseline plasma sFlt-1 was univariately associated with all cause mortality with (p < 0.001) and in a Cox’s proportional hazards regression model sFlt-1 and pterins were both associated with mortality independent of established predictors (p < 0.027). Conclusions sFlt-1 and pterins may have potential as prognostic biomarkers in acute coronary syndromes patients. Genetic markers from VEGF system genes warrant further investigation as markers of levels of VEGF system components in these patients. Trial registration Australian New Zealand Clinical Trials Registry. ACTRN12605000431628. 16 September 2005, Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12872-018-0894-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward C A Marks
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.,School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
| | - Tom M Wilkinson
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Chris M Frampton
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Lorraine Skelton
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Anna P Pilbrow
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Tim G Yandle
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Chris J Pemberton
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Robert N Doughty
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Medicine, Dunedin School of Medicine, University of Otago, Auckland, New Zealand
| | - Chris J Ellis
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard W Troughton
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Maurice C Owen
- Canterbury Scientific Ltd, 71 Whiteleigh Ave, Christchurch, New Zealand
| | - Neil R Pattinson
- Canterbury Scientific Ltd, 71 Whiteleigh Ave, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Steven P Gieseg
- School of Biological Sciences, University of Canterbury, Christchurch, New Zealand
| | - Barry R Palmer
- Christchurch Heart institute, Department of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand. .,School of Health Sciences, College of Health, Massey University Wellington, Wellington, New Zealand.
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18
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Yan MR, Parsons A, Whalley GA, Kelleher J, Rush EC. Snack bar compositions and their acute glycaemic and satiety effects. Asia Pac J Clin Nutr 2017; 26:624-629. [PMID: 28582811 DOI: 10.6133/apjcn.072016.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Maintaining blood glucose within homeostatic limits and eating foods that sup-press hunger and promote satiety have beneficial impacts for health. This study investigated the glycaemic re-sponse and satiety effects of a serving size of a healthier snack bar, branded Nothing Else, that met the required nutrient profiling score criteria for a health claim, in comparison to two top-selling commercial snack bars. METHODS AND STUDY DESIGN In an experimental study, 24 participants aged >=50 years were recruited. On three different days blood glucose concentration was measured twice at baseline and 15, 30, 45, 60, 90 and 120 minutes after consumption of a serving size of each bar. Satiety effects were self-reported hunger, fullness, desire to eat, and amount could eat ratings on visual analogue scales. RESULTS The incremental area under the blood glucose response curve (iAUC) over two hours for the Nothing Else bar was 30% lower than commercial Bar 2 (p<0.001). At 45 minutes after eating, the Nothing Else bar induced the highest fullness rating and lowest hunger rating among the three snack bars. At two hours, fullness induced by the Nothing Else bar was twice that of Bar 2 (p=0.019), but not different to Bar 1 (p=0.212). CONCLUSIONS The Nothing Else snack bar developed using the nutrient profiling scheme as a guideline, with its high protein and dietary fibre contents, had a lower glycaemic impact and induced a higher subjective satiety than the two commercial snack bars of equal weight.
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Affiliation(s)
- Mary R Yan
- AUT Food Network, Auckland University of Technology, Auckland, New Zealand.,Faculty of Social and Health Sciences, Unitec Institute of Technology, Auckland, New Zealand
| | - Andrew Parsons
- AUT Food Network, Auckland University of Technology, Auckland, New Zealand
| | - Gillian A Whalley
- Institute of Diagnostic Imaging, Australasian Sonographers Association, Victoria, Australia
| | - John Kelleher
- AUT Food Network, Auckland University of Technology, Auckland, New Zealand
| | - Elaine C Rush
- AUT Food Network, Auckland University of Technology, Auckland, New Zealand. ;
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19
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Prickett TCR, Doughty RN, Troughton RW, Frampton CM, Whalley GA, Ellis CJ, Espiner EA, Richards AM. C-Type Natriuretic Peptides in Coronary Disease. Clin Chem 2016; 63:316-324. [PMID: 28062626 DOI: 10.1373/clinchem.2016.257816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
AIMS C-type natriuretic peptide (CNP) is a paracrine growth factor expressed in the vascular endothelium. Although upregulated in atheromatous arteries, the predictive value of plasma CNP products for outcome in coronary disease is unknown. This study aimed to compare the prognostic value of plasma CNP products with those of other natriuretic peptides in individuals with coronary artery disease, and investigate their associations with cardiac and renal function. METHODS AND RESULTS Plasma concentrations of CNP and amino-terminal proCNP (NT-proCNP) were measured at baseline in 2129 individuals after an index acute coronary syndrome admission and related to cardiac and renal function, other natriuretic peptides [atrial NP (ANP) and B-type NP (BNP)] and prognosis (primary end point, mortality; secondary end point, cardiac readmission). Median follow-up was 4 years. At baseline, and in contrast to CNP, ANP, and BNP, plasma NT-proCNP was higher in males and weakly related to cardiac function but strongly correlated to plasma creatinine. All NPs were univariately associated with mortality. Resampling at 4 and 12 months in survivors showed stable concentrations of NT-proCNP whereas all other peptides declined. When studied by diagnosis (myocardial infarction, unstable angina) at index admission using a multivariate model, NT-proBNP predicted mortality and readmission in myocardial infarction. In unstable angina, only NT-proCNP predicted both mortality and cardiac readmission. CONCLUSIONS In contrast to the close association of NT-proBNP with cardiac function, and predictive value for outcome after myocardial infarction, plasma NT-proCNP is highly correlated with renal function and is an independent predictor of mortality and cardiac readmission in individuals with unstable angina.
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Affiliation(s)
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Chris M Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Chris J Ellis
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Eric A Espiner
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Department of Medicine, University of Otago, Christchurch, New Zealand
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20
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Badve SV, Palmer SC, Strippoli GFM, Roberts MA, Teixeira-Pinto A, Boudville N, Cass A, Hawley CM, Hiremath SS, Pascoe EM, Perkovic V, Whalley GA, Craig JC, Johnson DW. The Validity of Left Ventricular Mass as a Surrogate End Point for All-Cause and Cardiovascular Mortality Outcomes in People With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:554-563. [PMID: 27138469 DOI: 10.1053/j.ajkd.2016.03.418] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/13/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Left ventricular mass (LVM) is a widely used surrogate end point in randomized trials involving people with chronic kidney disease (CKD) because treatment-induced LVM reductions are assumed to lower cardiovascular risk. The aim of this study was to assess the validity of LVM as a surrogate end point for all-cause and cardiovascular mortality in CKD. STUDY DESIGN Systematic review and meta-analysis. SETTING & POPULATION Participants with any stages of CKD. SELECTION CRITERIA FOR STUDIES Randomized controlled trials with 3 or more months' follow-up that reported LVM data. INTERVENTION Any pharmacologic or nonpharmacologic intervention. OUTCOMES The surrogate outcome of interest was LVM change from baseline to last measurement, and clinical outcomes of interest were all-cause and cardiovascular mortality. Standardized mean differences (SMDs) of LVM change and relative risk for mortality were estimated using pairwise random-effects meta-analysis. Correlations between surrogate and clinical outcomes were summarized across all interventions combined using bivariate random-effects Bayesian models, and 95% credible intervals were computed. RESULTS 73 trials (6,732 participants) covering 25 intervention classes were included in the meta-analysis. Overall, risk of bias was uncertain or high. Only 3 interventions reduced LVM: erythropoiesis-stimulating agents (9 trials; SMD, -0.13; 95% CI, -0.23 to -0.03), renin-angiotensin-aldosterone system inhibitors (13 trials; SMD, -0.28; 95% CI, -0.45 to -0.12), and isosorbide mononitrate (2 trials; SMD, -0.43; 95% CI, -0.72 to -0.14). All interventions had uncertain effects on all-cause and cardiovascular mortality. There were weak and imprecise associations between the effects of interventions on LVM change and all-cause (32 trials; 5,044 participants; correlation coefficient, 0.28; 95% credible interval, -0.13 to 0.59) and cardiovascular mortality (13 trials; 2,327 participants; correlation coefficient, 0.30; 95% credible interval, -0.54 to 0.76). LIMITATIONS Limited long-term data, suboptimal quality of included studies. CONCLUSIONS There was no clear and consistent association between intervention-induced LVM change and mortality. Evidence for LVM as a valid surrogate end point in CKD is currently lacking.
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Affiliation(s)
- Sunil V Badve
- Australasian Kidney Trials Network, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; Department of Nephrology, St. George Hospital, Sydney, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia.
| | - Suetonia C Palmer
- Australasian Kidney Trials Network, Brisbane, Australia; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Giovanni F M Strippoli
- School of Public Health, University of Sydney, Sydney, Australia; Diaverum Scientific Office and Diaverum Academy, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Matthew A Roberts
- Australasian Kidney Trials Network, Brisbane, Australia; Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Neil Boudville
- Australasian Kidney Trials Network, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, Brisbane, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Swapnil S Hiremath
- Division of Nephrology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Vlado Perkovic
- Australasian Kidney Trials Network, Brisbane, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia
| | | | - Jonathan C Craig
- Australasian Kidney Trials Network, Brisbane, Australia; School of Public Health, University of Sydney, Sydney, Australia; Cochrane Kidney and Transplant Group, Sydney, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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21
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Rigolli M, Anandabaskaran S, Christiansen JP, Whalley GA. Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis. Open Heart 2016; 3:e000388. [PMID: 27158524 PMCID: PMC4854151 DOI: 10.1136/openhrt-2015-000388] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose Cardiac MR (CMR) is the gold standard for left ventricular (LV) quantification. However, two-dimensional echocardiography (2DE) is the most common approach, and both three-dimensional echocardiography (3DE) and multidetector CT (MDCT) are increasingly available. The clinical significance and interchangeability of these modalities remains under-investigated. Therefore, we undertook a systemic review to evaluate the accuracy and absolute bias in LV quantification of all the commonly available non-invasive imaging modalities (2DE, CE-2DE, 3DE, MDCT) compared to cardiac MR (CMR). Methods Studies were included that reported LV echocardiographic (2DE, CE-2DE, 3DE) and/or MDCT measurements compared to CMR. Only modern CMR (SSFP sequences) was considered. Studies involving small sample size (<10 patients) and unusual cardiac geometry (ie, congenital heart diseases) were excluded. We evaluated LV end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF). Results 1604 articles were initially considered: 65 studies were included (total of 4032 scans (echo, CT, MRI) performed in 2888 patients). Compared to CMR, significant biased underestimation of LV volumes with 2DE was seen (LVEDV—33.30 mL, LVESV −16.20 mL, p<0.0001). This difference was reduced but remained significant with CE-2DE (LVEDV −18.05, p<0.0001) and 3DE (LVEDV −14.41, p<0.001), while MDCT values were similar to CMR (LVEDV −1.20, p=0.43; LVESV −0.13, p=0.91). However, excellent agreement for echocardiographic LVEF evaluation (2DE LVEF 0.78–1.01%, p=0.37) was observed, especially with 3DE (LVEF 0.14%, p=0.88). Conclusions Comparing imaging modalities to CMR as reference standard, 3DE had the highest accuracy in LVEF estimation: 2DE and 3DE-derived LV volumes were significantly underestimated. Newer generation CT showed excellent accuracy for LV volumes.
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Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | | | | | - Gillian A Whalley
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Institute of Diagnostic Ultrasound, Australasian Sonographers Association, Melbourne, Victoria, Australia
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22
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Poppe KK, Doughty RN, Whalley GA, Triggs CM. A new approach to assessment of the left ventricle. MethodsX 2016; 3:274-8. [PMID: 27104150 PMCID: PMC4826587 DOI: 10.1016/j.mex.2016.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cardiac motion is a continuous process; however most measurements to assess cardiac function are taken at brief moments in the cardiac cycle. Using functional data analysis, repeated measurements of left ventricular volume recorded at each frame of a continuous image measured with cardiac ultrasound (echocardiography) were turned into a function of volume over time. The first derivative of the displacement of volume with respect to time is velocity; the second derivative is acceleration. Plotting volume, velocity, and acceleration against each other in a 3-dimensional plot results in a closed loop. The area within the loop is defined by the kinematics of volume change and so may represent ventricular function. We have developed an approach to analyzing images of the left ventricle that incorporates information from throughout the cardiac cycle.
Comparing systolic and diastolic areas within a loop defined by volume, velocity, and acceleration of left ventricular volume highlights imbalances in the kinematics of the two phases, potentially indicating early sub-clinical disease. Substantially more information about left ventricular function may be derived from a non-invasive clinically available tool such as echocardiography.
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Affiliation(s)
- Katrina K. Poppe
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Department of Statistics, University of Auckland, Auckland, New Zealand
- Corresponding author at: Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Rob N. Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
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23
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Pinkham MI, Whalley GA, Guild SJ, Malpas SC, Barrett CJ. Arterial baroreceptor reflex control of renal sympathetic nerve activity following chronic myocardial infarction in male, female, and ovariectomized female rats. Am J Physiol Regul Integr Comp Physiol 2015; 309:R169-78. [PMID: 25994953 DOI: 10.1152/ajpregu.00026.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is controversy regarding whether the arterial baroreflex control of renal sympathetic nerve activity (SNA) in heart failure is altered. We investigated the impact of sex and ovarian hormones on changes in the arterial baroreflex control of renal SNA following a chronic myocardial infarction (MI). Renal SNA and arterial pressure were recorded in chloralose-urethane anesthetized male, female, and ovariectomized female (OVX) Wistar rats 6-7 wk postsham or MI surgery. Animals were grouped according to MI size (sham, small and large MI). Ovary-intact females had a lower mortality rate post-MI (24%) compared with both males (38%) and OVX (50%) (P < 0.05). Males and OVX with large MI, but not small MI, displayed an impaired ability of the arterial baroreflex to inhibit renal SNA. As a result, the male large MI group (49 ± 6 vs. 84 ± 5% in male sham group) and OVX large MI group (37 ± 3 vs. 75 ± 5% in OVX sham group) displayed significantly reduced arterial baroreflex range of control of normalized renal SNA (P < 0.05). In ovary-intact females, arterial baroreflex control of normalized renal SNA was unchanged regardless of MI size. In males and OVX there was a significant, positive correlation between left ventricle (LV) ejection fraction and arterial baroreflex range of control of normalized renal SNA, but not absolute renal SNA, that was not evident in ovary-intact females. The current findings demonstrate that the arterial baroreflex control of renal SNA post-MI is preserved in ovary-intact females, and the state of left ventricular dysfunction significantly impacts on the changes in the arterial baroreflex post-MI.
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Simpson J, Castagno D, Doughty RN, Poppe KK, Earle N, Squire I, Richards M, Andersson B, Ezekowitz JA, Komajda M, Petrie MC, McAlister FA, Gamble GD, Whalley GA, McMurray JJV. Is heart rate a risk marker in patients with chronic heart failure and concomitant atrial fibrillation? Results from the MAGGIC meta-analysis. Eur J Heart Fail 2015; 17:1182-91. [PMID: 26358762 DOI: 10.1002/ejhf.346] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/15/2015] [Accepted: 07/19/2015] [Indexed: 01/08/2023] Open
Abstract
AIM To investigate the relationship between heart rate and survival in patients with heart failure (HF) and coexisting atrial fibrillation (AF). METHODS AND RESULTS Patients with AF included in the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) meta-analysis were the main focus of this analysis (3259 patients from 17 studies). The outcome was all-cause mortality at 3 years. Heart rate was analysed as a categorical (tertiles; T1 ≤77 b.p.m., T2 78-98 b.p.m., T3 ≥98 b.p.m.) and continuous variable. Cox proportional hazard models were used to compare the risk of all-cause death between tertiles of baseline heart rate. Patients in the highest tertile were more often female, less likely to have an ischaemic aetiology or diabetes, had a lower ejection fraction but higher blood pressure and New York Heart Association (NYHA) class. Higher heart rate was associated with higher mortality in patients with sinus rhythm (SR) but not in those in AF. In patients with heart failure and reduced ejection fraction (HF-REF) and AF, death rates per 100 patient years were lowest in the highest heart rate tertile (T1 18.9 vs. T3 15.9) but this difference was not statistically significant (P = 0.10). In patients with heart failure and preserved ejection fraction (HF-PEF), death rates per 100 patient years were highest in the highest heart rate tertile (T1 14.6 vs. T3 16.0, P = 0.014). However, after adjustment for other important prognostic variables, higher heart rate was no longer associated with higher mortality in HF-PEF (or HF-REF). CONCLUSIONS In this meta-analysis of patients with HF, heart rate does not have the same prognostic significance in patients in AF as it does in those in SR, irrespective of ejection fraction or treatment with beta-blocker.
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Affiliation(s)
- Joanne Simpson
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Rob N Doughty
- Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Katrina K Poppe
- Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Nikki Earle
- Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Iain Squire
- University of Leicester, Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Mark Richards
- University of Otago, Christchurch, Department of Medicine, Christchurch, New Zealand
| | - Bert Andersson
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Justin A Ezekowitz
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Michel Komajda
- Université Paris 6, Pitié Salpetrière Hospital, Paris, France
| | - Mark C Petrie
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, UK
| | - Finlay A McAlister
- The Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Greg D Gamble
- Department of Medicine and National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
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Earle NJ, Poppe KK, Pilbrow AP, Cameron VA, Troughton RW, Skinner JR, Love DR, Shelling AN, Whalley GA, Ellis CJ, Richards AM, Doughty RN. Genetic markers of repolarization and arrhythmic events after acute coronary syndromes. Am Heart J 2015; 169:579-86.e3. [PMID: 25819866 DOI: 10.1016/j.ahj.2014.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/21/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a genetic contribution to the risk of ventricular arrhythmias in survivors of acute coronary syndromes (ACS). We wished to explore the role of 33 candidate single nucleotide polymorphisms (SNPs) in prolonged repolarization and sudden death in patients surviving ACS. METHODS A total of 2,139 patients (1680 white ethnicity) surviving an admission for ACS were enrolled in the prospective Coronary Disease Cohort Study. Extensive clinical, echocardiographic, and neurohormonal data were collected for 12 months, and clinical events were recorded for a median of 5 years. Each SNP was assessed for association with sudden cardiac death (SCD)/cardiac arrest (CA) and prolonged repolarization at 3 time-points: index admission, 1 month, and 12 months postdischarge. RESULTS One hundred six SCD/CA events occurred during follow-up (6.3%). Three SNPs from 3 genes (rs17779747 [KCNJ2], rs876188 [C14orf64], rs3864180 [GPC5]) were significantly associated with SCD/CA in multivariable models (after correction for multiple testing); the minor allele of rs17779747 with a decreased risk (hazard ratio [HR] 0.68 per copy of the minor allele, 95% CI 0.50-0.92, P = .012), and rs876188 and rs386418 with an increased risk (HR 1.52 [95% CI 1.10-2.09, P = .011] and HR 1.34 [95% CI 1.04-1.82, P = .023], respectively). At 12 months postdischarge, rs10494366 and rs12143842 (NOS1AP) were significant predictors of prolonged repolarization (HR 1.32 [95% CI 1.04-1.67, P = .022] and HR 1.30 [95% CI 1.01-1.66, P = .038], respectively), but not at earlier time-points. CONCLUSION Three SNPs were associated with SCD/CA. Repolarization time was associated with variation in the NOS1AP gene. This study demonstrates a possible role for SNPs in risk stratification for arrhythmic events after ACS.
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Affiliation(s)
- N J Earle
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - K K Poppe
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - A P Pilbrow
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - V A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - R W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - J R Skinner
- Greenlane Pediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
| | - D R Love
- Diagnostic Genetics, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - A N Shelling
- Department of Obstetrics and Gynecology, University of Auckland, Auckland, New Zealand
| | - G A Whalley
- Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand
| | - C J Ellis
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - A M Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - R N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Poppe KK, Whalley GA, Doughty RN, Woodward M, Patel A, Chow CK, Hirakawa Y, Chalmers J, Hillis GS, Triggs CM. The development and feasibility of a composite score of echocardiographic indices that may stratify outcome in patients with diabetes mellitus. Int J Cardiol 2015; 182:244-9. [PMID: 25577772 DOI: 10.1016/j.ijcard.2014.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/21/2014] [Accepted: 12/25/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early detection of changes in cardiac structure and function associated with type 2 diabetes (T2DM) is important. However when multiple abnormalities are present, combining individual measurements can be subjective. This study sought to create a simple echo score that summarises measurements that may detect early and prognostically important changes in cardiac function. METHODS Standard echocardiography was performed on 849 people with T2DM (median age 65years, 40% female, median duration of diabetes 5.5years). Principal components analysis was performed on measurements of LV mass, LA volume, E:e', and s', to create an objective summary score. The score was included in two Cox proportional hazard models adjusted for CV risk factors: one estimated the development of heart failure (HF) and the second estimated any CV event. RESULTS The first two principal components represented 75% of the variation between the four echo measurements. A continuous score that represents the residual difference between these two components was derived that only requires measurement of medial E:e' and s'. The score was significantly associated with the development of HF within four years (hazard ratio 1.34; 95% CI 1.15, 1.56). CONCLUSIONS We have developed a simple, objective score that enhances the use of echocardiography in the detection of sub-clinical cardiac disease in people with T2DM. Initial findings suggest that it may help identify those at increased risk of developing HF within four years.
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Affiliation(s)
- Katrina K Poppe
- Department of Medicine and National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland New Zealand; Department of Statistics, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Gillian A Whalley
- Faculty of Social and Health Sciences, Unitec Institute of Technology, Private Bag 92025, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine and National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland New Zealand
| | - Mark Woodward
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia
| | - Anushka Patel
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia
| | - Clara K Chow
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia; Westmead Hospital, University of Sydney, NSW 2006, Australia
| | - Yoichiro Hirakawa
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia
| | - John Chalmers
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia
| | - Graham S Hillis
- The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia
| | - Christopher M Triggs
- Department of Statistics, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Whalley GA, Pitama S, Troughton RW, Doughty RN, Gamble GD, Gillies T, Wells JE, Faatoese A, Huria T, Richards M, Cameron VA. Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora Manawa/Community Heart Study. Aust N Z J Public Health 2015; 39:26-31. [PMID: 25558958 DOI: 10.1111/1753-6405.12300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/01/2014] [Accepted: 08/01/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is the leading cause of mortality in New Zealand with a disproportionate burden of disease in the Māori population. The Hauora Manawa Project investigated the prevalence of cardiovascular risk factors and CVD in randomly selected Māori and non-Māori participants. This paper reports the prevalence of structural changes in the heart. METHODS A total of 252 rural Māori, 243 urban Māori; and 256 urban non-Māori underwent echocardiography to assess cardiac structure and function. Multivariable logistic regression was used to determine variables associated with heart size. RESULTS Left ventricular (LV) mass measurements were largest in the rural Māori cohort (183.5,sd 61.4), intermediate in the urban Māori cohort (169.7,sd 57.1) and smallest in the non-Māori cohort (152.6,sd 46.7; p<0.001). Similar patterns were observed for other measurements and indexation had no impact. One-third (32.3%) met the gender-based ASE criteria for LV hypertrophy (LVH) with higher prevalence in both Maori cohorts (highest in the rural cohort). There were three significant predictors of LVH: rural Māori (p=0.0001); age (p<0.0001); and gender (p=0.0048). CONCLUSION Structural and functional heart abnormalities are more prevalent in Māori compared to non-Māori, and especially rural Māori. Early identification should lead to better management, ultimately improving life expectancy and quality of life.
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Rigolli M, Rossi A, Quintana M, Klein AL, Yu CM, Ghio S, Dini FL, Prior D, Troughton RW, Temporelli PL, Poppe KK, Doughty RN, Whalley GA. The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival? Int J Cardiol 2014; 181:362-8. [PMID: 25555281 DOI: 10.1016/j.ijcard.2014.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/13/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
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Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; University of Verona, Verona, Italy
| | | | | | | | - Cheuk-Man Yu
- Chinese University of Hong Kong, Hong Kong, China
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Frank L Dini
- Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | | | - Richard W Troughton
- Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Katrina K Poppe
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Unitec Institute of Technology, Auckland, New Zealand.
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29
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Pilbrow AP, Cordeddu L, Cameron VA, Frampton CM, Troughton RW, Doughty RN, Whalley GA, Ellis CJ, Yandle TG, Richards AM, Foo RSY. Circulating miR-323-3p and miR-652: candidate markers for the presence and progression of acute coronary syndromes. Int J Cardiol 2014; 176:375-85. [PMID: 25124998 DOI: 10.1016/j.ijcard.2014.07.068] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/29/2014] [Accepted: 07/15/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prognostic utility of circulating plasma microRNA in patients with acute coronary syndromes (ACS) has been proposed but not yet demonstrated. We set out to investigate circulating microRNA levels in patients incurring recent ACS and examined associations with neurohormones, cardiac structure and function, and survival over 5 years of follow-up. METHODS An initial screen of 375 microRNAs was performed in 35 ACS patients and 16 healthy controls. Candidates identified from the initial screen (miR-323-3p, miR-652, miR-27b, miR-103 and miR-208a) were validated in a further cohort of 200 patients at baseline (~ 30 days post-ACS) and at 4 and 12 months post-ACS, and compared with 100 controls. RESULTS In the validation cohort, significantly higher levels in patients were replicated for miR-323-3p, miR-652 and miR-27b (10-fold, 2.3-fold and 2.3-fold, respectively, adjusted p<0.05). Lower levels of miR-103 were not replicated and miR-208a was undetectable. From baseline to 4 months post-admission, miR-323-3p and miR-652 remained elevated in patients compared to controls (adjusted p<0.01), with no further change in levels between 4 and 12 months; whereas miR-27b fell to control levels by 4 months. Baseline levels of miR-652 in the lowest tertile were significantly associated with readmission for heart failure (log-rank p<0.001). In combination with NT-proBNP and LVEF, miR-652 significantly improved risk stratification (p<0.001). CONCLUSIONS Our study identifies miR-652 as a novel candidate biomarker for post-ACS prognosis beyond existing biomarkers of LVEF and NT-proBNP. Moreover circulating miR-323-3p was markedly elevated in patients for at least a year post-ACS and may be a stable biomarker for ACS.
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Affiliation(s)
- Anna P Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand.
| | - Lina Cordeddu
- Division of Cardiovascular Medicine, ACCI Building, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Vicky A Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand
| | - Chris M Frampton
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand
| | - Robert N Doughty
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Gillian A Whalley
- Faculty of Social and Health Sciences, Unitec, Private Bag 92025, Auckland 1142, New Zealand
| | - Chris J Ellis
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Timothy G Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8011, New Zealand; Cardiovascular Research Institute, National University Health Systems, Centre for Translational Medicine, Medical Drive, 117599, Singapore
| | - Roger S-Y Foo
- Division of Cardiovascular Medicine, ACCI Building, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK; Cardiovascular Research Institute, National University Health Systems, Centre for Translational Medicine, Medical Drive, 117599, Singapore
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Rigolli M, Whalley GA. Heart failure with preserved ejection fraction. J Geriatr Cardiol 2014; 10:369-76. [PMID: 24454331 PMCID: PMC3888920 DOI: 10.3969/j.issn.1671-5411.2013.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/02/2013] [Accepted: 09/11/2013] [Indexed: 01/16/2023]
Abstract
Progressive aging of the population and prolongation of life expectancy have led to the rising prevalence of heart failure (HF). Despite the improvements in medical therapy, the mortality rate of this condition has remained unacceptably high, becoming the primary cause of death in the elderly population. Almost half of patients with signs and symptoms of HF are found to have a nearly normal ejection fraction, which delineates a distinct clinical syndrome, known as HF with preserved ejection fraction (HF-PEF). While early research focused on the importance of diastolic dysfunction, more recent studies reported the pathophysiological complexity of the disease with multiple cardiovascular abnormalities contributing to its development and progression. HF-PEF is a challenging major health problem with yet no solution as there is no evidence-based treatment which improves clinical outcomes. This review summarizes the state of current knowledge on diagnosis, prognosis and treatment of HF-PEF, with particular insights on the pathological characteristics in the elderly population.
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Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitakere Hospital, Waitemata District Health Board, Private Bag 93-503, Auckland, New Zealand ; Division of Cardiology, University of Verona, Ospedale Maggiore, Ple Stefani 1, 37126 Verona, Italy
| | - Gillian A Whalley
- Awhina Health Campus, Waitakere Hospital, Waitemata District Health Board, Private Bag 93-503, Auckland, New Zealand ; Faculty of Social and Health Sciences, Unitec Institute of Technology, Private Bag 92025, Auckland, New Zealand
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Wong CM, Hawkins NM, Petrie MC, Jhund PS, Gardner RS, Ariti CA, Poppe KK, Earle N, Whalley GA, Squire IB, Doughty RN, McMurray JJV. Heart failure in younger patients: the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). Eur Heart J 2014; 35:2714-21. [PMID: 24944329 DOI: 10.1093/eurheartj/ehu216] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIM Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients. METHODS AND RESULTS Patients were stratified into six age categories: <40 (n = 876), 40-49 (n = 2638), 50-59 (n = 6894), 60-69 (n = 12 071), 70-79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40-49, and 50-59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively. CONCLUSION Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.
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Affiliation(s)
- Chih M Wong
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Mark C Petrie
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Roy S Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Cono A Ariti
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Katrina K Poppe
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Nikki Earle
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Robert N Doughty
- Department of Medicine, The University of Auckland, Auckland, New Zealand National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Hee L, Brennan X, Chen J, Allman C, Whalley GA, French JK, Juergens CP, Thomas L. Long-term outcomes in patients with restrictive filling following ST-segment elevation myocardial infarction. Intern Med J 2014; 44:291-4. [PMID: 24621285 DOI: 10.1111/imj.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/25/2013] [Indexed: 12/01/2022]
Abstract
This study evaluated the effect of restrictive filling pattern (RFP) on 5-year outcomes in patients following ST-segment elevation myocardial infarction (STEMI). A hundred STEMI patients treated either by rescue or primary percutaneous coronary intervention with an echocardiogram performed within 6 weeks of STEMI comprised the study group. Creatinine kinase (CK) and left ventricular ejection fraction were independent determinants of RFP, and RFP was an independent predictor of cardiac and all-cause mortality at median follow up of 5 years.
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Affiliation(s)
- L Hee
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, New South Wales, Australia
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Palmer BR, Slow S, Ellis KL, Pilbrow AP, Skelton L, Frampton CM, Palmer SC, Troughton RW, Yandle TG, Doughty RN, Whalley GA, Lever M, George PM, Chambers ST, Ellis C, Richards AM, Cameron VA. Genetic polymorphism rs6922269 in the MTHFD1L gene is associated with survival and baseline active vitamin B12 levels in post-acute coronary syndromes patients. PLoS One 2014; 9:e89029. [PMID: 24618918 PMCID: PMC3949666 DOI: 10.1371/journal.pone.0089029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Aims The methylene-tetrahydrofolate dehydrogenase (NADP+ dependent) 1-like (MTHFD1L) gene is involved in mitochondrial tetrahydrofolate metabolism. Polymorphisms in MTHFD1L, including rs6922269, have been implicated in risk for coronary artery disease (CAD). We investigated the association between rs6922269 and known metabolic risk factors and survival in two independent cohorts of coronary heart disease patients. Methods and Results DNA and plasma from 1940 patients with acute coronary syndromes were collected a median of 32 days after index hospital admission (Coronary Disease Cohort Study, CDCS). Samples from a validation cohort of 842 patients post-myocardial infarction (PMI) were taken 24–96 hours after hospitalization. DNA samples were genotyped for rs6922269, using a TaqMan assay. Homocysteine and active vitamin B12 were measured by immunoassay in baseline CDCS plasma samples, but not PMI plasma. All cause mortality was documented over follow-up of 4.1 (CDCS) and 8.8 (PMI) years, respectively. rs6922269 genotype frequencies were AA n = 135, 7.0%; GA n = 785, 40.5% and GG n = 1020, 52.5% in the CDCS and similar in the PMI cohort. CDCS patients with AA genotype for rs6922269 had lower levels of co-variate adjusted baseline plasma active vitamin B12 (p = 0.017) and poorer survival than patients with GG or GA genotype (mortality: AA 19.6%, GA 12.0%, GG 11.6%; p = 0.007). In multivariate analysis, rs6922269 genotype predicted survival, independent of established covariate predictors (p = 0.03). However the association between genotype and survival was not validated in the PMI cohort. Conclusion MTHFD1L rs6922269 genotype is associated with active vitamin B12 levels at baseline and may be a marker of prognostic risk in patients with established coronary heart disease.
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Affiliation(s)
- Barry R. Palmer
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
- Genetics Otago, University of Otago, Christchurch, New Zealand
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
- * E-mail:
| | - Sandy Slow
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katrina L. Ellis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Anna P. Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Lorraine Skelton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chris M. Frampton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Suetonia C. Palmer
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard W. Troughton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim G. Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Rob N. Doughty
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian A. Whalley
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand
| | - Michael Lever
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Peter M. George
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Stephen T. Chambers
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Chris Ellis
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Vicky A. Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
- Genetics Otago, University of Otago, Christchurch, New Zealand
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Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C, McMurray JJ, Swedberg K, Køber L, Berry C, Squire I. Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis†. Eur J Heart Fail 2014; 14:473-9. [DOI: 10.1093/eurjhf/hfs026] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department; Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 16, 28007 and Universidad Europea de Madrid; Spain
| | - Robert N. Doughty
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | - Katrina Poppe
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | | | - Nikki Earle
- Department of Medicine; The University of Auckland; Auckland New Zealand
| | | | - John J.V. McMurray
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre; Glasgow UK
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Lars Køber
- Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Colin Berry
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre; Glasgow UK
| | - Iain Squire
- University of Leicester and NIHR Biomedical Research Unit, Glenfield Hospital; Leicester UK
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Abstract
Echocardiography is an excellent noninvasive tool for the assessment of ventricular size and both systolic and diastolic function, and it is routinely used in patients with heart failure. This review will discuss the role of echocardiography in heart failure diagnosis, prognostic assessment and in the management of heart failure patients.
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Affiliation(s)
- Gillian A Whalley
- University of Auckland, Department of Medicine, Private Bag 92019, Auckland, New Zealand.
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36
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Somaratne JB, Whalley GA, Bagg W, Doughty RN. Early detection and significance of structural cardiovascular abnormalities in patients with Type 2 diabetes mellitus. Expert Rev Cardiovasc Ther 2014; 6:109-25. [DOI: 10.1586/14779072.6.1.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hongning Y, Stewart RA, Whalley GA. The impact of beta-blockade on right ventricular function in mitral regurgitation. Heart Lung Circ 2013; 23:378-80. [PMID: 24268977 DOI: 10.1016/j.hlc.2013.10.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 10/11/2013] [Accepted: 10/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although mitral regurgitation (MR) results in left ventricular (LV) volume overload, right ventricular (RV) function may also be impaired. We investigated the influence of short-term beta-blockade on RV function in patients with moderate-severe MR. METHODS Twenty-six patients were randomised in a cross-over design to receive two weeks of beta-blockade or placebo. Echocardiography was performed at baseline and at the end of the treatment periods. Measurements included: RV ejection fraction (RVEF) tricuspid annular motion and Tei index. RESULTS No differences in mean RVEF (64.0 ± 6.0 v 67.0 ± 8.0%, p=0.3), tricuspid annular motion (13.5 ± 3.0 v 14.7 ± 2.9 cm/s, p=0.5), or median Tei index (0.61 (0.54, 0.88) v 0.59 (0.54, 0.74), p=0.8) were observed between placebo and metoprolol, despite significantly longer cardiac time intervals. Tei index under both conditions was significantly reduced. CONCLUSIONS Short-term treatment with a beta-blocker did not influence RV function in these patients. Interestingly, the RV Tei index was high suggesting significant RV dysfunction despite normal RVEF.
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Affiliation(s)
- Yin Hongning
- The 2nd Hospital of Hebei Medical University, Shijiazhuang, China
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38
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Poppe KK, Squire IB, Whalley GA, Køber L, McAlister FA, McMurray JJV, Pocock S, Earle NJ, Berry C, Doughty RN. Known and missing left ventricular ejection fraction and survival in patients with heart failure: a MAGGIC meta-analysis report. Eur J Heart Fail 2013; 15:1220-7. [PMID: 23803952 DOI: 10.1093/eurjhf/hft101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Treatment of patients with heart failure (HF) relies on measurement of LVEF. However, the extent to which EF is recorded varies markedly. We sought to characterize the patient group that is missing a measure of EF, and to explore the association between missing EF and outcome. METHODS AND RESULTS Individual data on 30 445 patients from 28 observational studies in the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) project were used to compare the prevalence of co-morbidities and outcome across three groups of HF patients: those with missing EF (HF-mEF), reduced EF (HF-REF), and preserved EF (HF-PEF). A total of 29% had HF-mEF, 52% HF-REF, and 19% HF-PEF. Compared with patients in whom EF was known, patients with HF-mEF were older, had a greater prevalence of COPD and previous stroke, and were smokers. Patients with HF-mEF were less likely to receive evidence-based treatment than those with HF-REF. Adjusted mortality in HF-mEF was similar to that in HF-REF and greater than that in HF-PEF at 3 years [HF-REF, hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.95-1.12); HF-PEF, HR 0.78, 95% CI 0.71-0.86]. CONCLUSION Missing EF is common. The short- and long-term outcome of patients with HF-mEF is poor and they exhibit different co-morbidity profiles and treatment patterns compared with patients with known EF. HF patients with missing EF represent a high risk group.
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Affiliation(s)
- Katrina K Poppe
- Department of Medicine, The University of Auckland, New Zealand
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Whalley GA, Marwick TH, Doughty RN, Cooper BA, Johnson DW, Pilmore A, Harris DCH, Pollock CA, Collins JF. Effect of early initiation of dialysis on cardiac structure and function: results from the echo substudy of the IDEAL trial. Am J Kidney Dis 2012; 61:262-70. [PMID: 23157937 DOI: 10.1053/j.ajkd.2012.09.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 09/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormalities of cardiac structure and function are common in patients undergoing dialysis, and cardiovascular disease is the major cause of mortality in this group. Heart failure is a common clinical manifestation of cardiovascular disease and is preceded by left ventricular hypertrophy (LVH). There are variable reports about the impact of dialysis on LVH, both deleterious and beneficial. Our study investigated whether the timing of the initiation of dialysis therapy had an impact on cardiac structure and function. STUDY DESIGN Randomized controlled trial. SETTING & PARTICIPANTS This is a cardiac substudy involving 182 patients with stage 5 chronic kidney disease in the IDEAL (Initiating Dialysis Early and Late) trial. INTERVENTION The IDEAL trial randomly assigned patients on the basis of estimated glomerular filtration rate (eGFR), calculated using the Cockcroft-Gault equation, to start dialysis therapy early (GFR, 10-14 mL/min/1.73 m(2)), with the others starting late (GFR, 5-7 mL/min/1.73 m(2)). OUTCOMES & MEASUREMENTS Echocardiograms were obtained at baseline and 12 months after randomization. Primary outcomes were change in left ventricular mass indexed for height (LVMi) between baseline and 12 months, left ventricular ejection fraction, left ventricular systolic annular velocity, ratio of mitral inflow velocity (E) to mitral annular velocity (Ea) (E/Ea), and left atrial volume indexed for height (LAVi). RESULTS LVMi at baseline was elevated, but similar in both groups, with no significant change within or between groups at 12 months. E/Ea and LAVi were increased at baseline, consistent with significant diastolic dysfunction; there were no differences between groups at 12 months and no changes were observed for left ventricular volumes, left ventricular ejection fraction, stroke volume, and other echocardiographic parameters. LIMITATIONS Small multicenter study using echocardiography. CONCLUSIONS Advanced cardiac disease in these patients with stage 5 chronic kidney disease did not progress during the 12-month study period and planned early initiation of dialysis therapy did not result in differences in any echocardiographic variables of cardiac structure and function.
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Affiliation(s)
- Gillian A Whalley
- Unitec Institute of Technology, and University of Auckland, Auckland, New Zealand.
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40
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Pocock SJ, Ariti CA, McMurray JJV, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 2012; 34:1404-13. [PMID: 23095984 DOI: 10.1093/eurheartj/ehs337] [Citation(s) in RCA: 803] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Using a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF). METHODS AND RESULTS The MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced and preserved left-ventricular ejection fraction (EF), from 30 cohort studies, six of which were clinical trials. 40.2% of patients died during a median follow-up of 2.5 years. Using multivariable piecewise Poisson regression methods with stepwise variable selection, a final model included 13 highly significant independent predictors of mortality in the following order of predictive strength: age, lower EF, NYHA class, serum creatinine, diabetes, not prescribed beta-blocker, lower systolic BP, lower body mass, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and not prescribed ACE-inhibitor or angiotensin-receptor blockers. In preserved EF, age was more predictive and systolic BP was less predictive of mortality than in reduced EF. Conversion into an easy-to-use integer risk score identified a very marked gradient in risk, with 3-year mortality rates of 10 and 70% in the bottom quintile and top decile of risk, respectively. CONCLUSION In patients with HF of both reduced and preserved EF, the influences of readily available predictors of mortality can be quantified in an integer score accessible by an easy-to-use website www.heartfailurerisk.org. The score has the potential for widespread implementation in a clinical setting.
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Affiliation(s)
- Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Teh RO, Kerse NM, Robinson EM, Doughty RN, Whalley GA. Which cardiovascular risk factors are associated with cardiovascular disease and predict future events in advanced age in New Zealand? Australas J Ageing 2012; 33:14-21. [DOI: 10.1111/j.1741-6612.2012.00626.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth O Teh
- Department of General Practice and Primary Health Care; University of Auckland; Auckland New Zealand
| | - Ngaire M Kerse
- Department of General Practice and Primary Health Care; University of Auckland; Auckland New Zealand
| | - Elizabeth M Robinson
- Department of Epidemiology and Biostatistics; University of Auckland; Auckland New Zealand
| | - Robert N Doughty
- Department of Medicine; University of Auckland; Auckland New Zealand
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Rusinaru D, Tribouilloy C, Berry C, Richards AM, Whalley GA, Earle N, Poppe KK, Guazzi M, Macin SM, Komajda M, Doughty RN. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta-analysis(†): Meta-Analysis Global Group in Chronic heart failure (MAGGIC). Eur J Heart Fail 2012; 14:1139-46. [PMID: 22782968 DOI: 10.1093/eurjhf/hfs099] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS Hyponatraemia has been associated with reduced survival in patients with heart failure and reduced ejection fraction (HF-REF). The relationship between serum sodium and outcome is unclear in heart failure with preserved (≥ 50%) ejection fraction (HF-PEF). Therefore, we used a large individual patient data meta-analysis to study the risk of death associated with hyponatraemia in HF-REF and in HF-PEF. METHODS AND RESULTS This analysis included 14 766 patients from 22 studies that recruited patients without ejection fraction inclusion criterion at baseline and reported death from any cause. Cox proportional analysis was undertaken for hyponatraemia (sodium <135 mmol/L), adjusted for variables of clinical relevance, and stratified by study. The endpoint was death from any cause at 3 years. Patients with hyponatraemia (n = 1618) and patients with normal serum sodium had similar characteristics as regards to age, gender, and ischaemic aetiology. However, patients with hyponatraemia had higher New York Heart Association class and lower blood pressure. At follow-up, there were 335 deaths among 1618 patients with hyponatraemia (21%) and 2128 deaths among 13 148 patients with normal serum sodium (16%). The risk of death appeared to increase linearly with serum sodium levels <140 mmol/L. Hyponatraemia was identified in 1199 HF-REF patients (11%) and 419 HF-PEF patients (11%). Hyponatraemia was independently predictive of death in both HF-REF [adjusted hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.50-1.91] and HF-PEF (adjusted HR 1.40, 95% CI 1.10-1.79, P for interaction 0.20). CONCLUSION Hyponatraemia is a powerful determinant of mortality in patients with HF regardless of ejection fraction. Further work is needed to determine if correction of hyponatraemia translates into clinical benefit.
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Affiliation(s)
- Dan Rusinaru
- Department of Cardiovascular Diseases, Amiens University Hospital, 80054 Amiens Cedex 1, France
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Ellis KL, Palmer BR, Frampton CM, Troughton RW, Doughty RN, Whalley GA, Ellis CJ, Pilbrow AP, Skelton L, Yandle TG, Richards AM, Cameron VA. Genetic variation in the renin-angiotensin-aldosterone system is associated with cardiovascular risk factors and early mortality in established coronary heart disease. J Hum Hypertens 2012; 27:237-44. [PMID: 22739771 DOI: 10.1038/jhh.2012.24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined renin-angiotensin-aldosterone (RAAS) system gene variants for associations with cardiovascular risk factors and outcomes in coronary heart disease. Coronary disease patients (n=1186) were genotyped for 21 single-nucleotide polymorphisms (SNPs) within angiotensinogen (AGT), angiotensin-converting enzyme (ACE), angiotensin-II type-1 receptor (AGTR1) and aldosterone synthase (CYP11B2). Associations with all-cause mortality and cardiovascular readmissions were assessed over a median of 3.0 years. The AGT M235T 'T' allele was associated with a younger age of clinical coronary disease onset (P=0.006), and the AGT rs2478545 minor allele was associated with lower circulating natriuretic peptides (P=0.0001-P=0.001) and E/E(1) (P=0.018). Minor alleles of AGT SNPs rs1926723 and rs11122576 were associated with more frequent history of renal disease (P0.04) and type-2 diabetes (P0.02), higher body mass index (P0.02) and greater mortality (P0.007). AGT rs11568054 minor allele carriers had more frequent history of renal disease (P=0.04) and higher plasma creatinine (P=0.033). AGT rs6687360 minor allele carriers exhibited worse survival (P=0.02). ACE rs4267385 was associated with older clinical coronary disease onset (P=0.008) and hypertension (P=0.013) onset, increased plasma creatinine (P=0.01), yet greater mortality (P=0.044). Less history of hypertension was observed with the AGTR1 rs12685977 minor allele (P=0.039). Genetic variation within the RAAS was associated with cardiovascular risk factors and accordingly poorer survival.
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Affiliation(s)
- K L Ellis
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand.
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Ellis KL, Pilbrow AP, Potter HC, Frampton CM, Doughty RN, Whalley GA, Ellis CJ, Palmer BR, Skelton L, Yandle TG, Troughton RW, Richards AM, A Cameron V. Association between endothelin type A receptor haplotypes and mortality in coronary heart disease. Per Med 2012; 9:341-349. [PMID: 29758796 DOI: 10.2217/pme.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS The endothelin type A receptor, encoded by EDNRA, mediates the effects of endothelin-1 to promote vasoconstriction, vascular cell growth, adhesion, fibrosis and thrombosis. We investigated the association between EDNRA haplotype and cardiovascular outcomes in patients with coronary artery disease. METHODS Coronary disease patients (n = 1007) were genotyped for the His323His (rs5333) variant and one tag SNP from each of the major EDNRA haplotype blocks (rs6537484, rs1568136, rs5335 and rs10003447). EDNRA haplotype associations with clinical history, natriuretic peptides cardiac function and cardiovascular outcomes were tested over a median 3.8 years. RESULTS Univariate analysis identified a 'low-risk' EDNRA haplotype associated with later age of Type 2 diabetes onset (p = 0.004) smaller BMI (p = 0.021), and reduced mortality (log rank p = 0.001). Cox proportional hazards analysis including established cardiovascular risk factors revealed an independent association between haplotype and mortality (p < 0.0001). CONCLUSION These data highlight the potential importance of the endothelin system, and in particular EDNRA in coronary disease.
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Affiliation(s)
- Katrina L Ellis
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
| | - Anna P Pilbrow
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Howard C Potter
- Molecular Pathology Laboratory, Canterbury District Health Board, Christchurch, New Zealand
| | - Chris M Frampton
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Rob N Doughty
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand
| | - Chris J Ellis
- Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand
| | - Barry R Palmer
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Lorraine Skelton
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tim G Yandle
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Richard W Troughton
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - A Mark Richards
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Vicky A Cameron
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
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45
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Cameron VA, Faatoese AF, Gillies MW, Robertson PJ, Huria TM, Doughty RN, Whalley GA, Richards MA, Troughton RW, Tikao-Mason KN, Wells EJ, Sheerin IG, Pitama SG. A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand. BMJ Open 2012; 2:bmjopen-2011-000799. [PMID: 22685219 PMCID: PMC3378934 DOI: 10.1136/bmjopen-2011-000799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services. DESIGN Prospective cohort study. SETTING Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand. PARTICIPANTS Screening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20-64 years. MAIN OUTCOME MEASURES The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities. RESULTS Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m(2), p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts. CONCLUSIONS Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.
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Affiliation(s)
- Vicky A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | | | - Matea W Gillies
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Paul J Robertson
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Tania M Huria
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand
| | - Mark A Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Karen N Tikao-Mason
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Elisabeth J Wells
- Department of Public Health, University of Otago, Christchurch, New Zealand
| | - Ian G Sheerin
- Department of Public Health, University of Otago, Christchurch, New Zealand
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
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Ellis KL, Frampton CM, Pilbrow AP, Troughton RW, Doughty RN, Whalley GA, Ellis CJ, Skelton L, Thomson J, Yandle TG, Richards AM, Cameron VA. Genomic Risk Variants at 1p13.3, 1q41, and 3q22.3 Are Associated With Subsequent Cardiovascular Outcomes in Healthy Controls and in Established Coronary Artery Disease. ACTA ACUST UNITED AC 2011; 4:636-46. [DOI: 10.1161/circgenetics.111.960336] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Genome-wide association studies have identified gene variants associated with coronary artery disease risk; however, whether they affect disease progression is largely unknown. This study investigated associations between polymorphisms at 1p13.3 (rs599839), 1q41 (rs17465637), and 3q22.3 (rs9818870) and cardiovascular outcomes in healthy volunteers and in patients with established heart disease.
Methods and Results—
Canterbury Healthy Volunteer study (HV) (n=1649), Coronary Disease Cohort Study (CDCS) (n=1797), and Post-Myocardial Infarction study (PMI) (n=906) participants (New Zealand), were genotyped for rs599839, rs9818870, and rs17465637. Associations between genotype and anthropometric characteristics, neurohormonal analysis, echocardiography, and clinical outcomes over medium-long-term follow-up (median HV, 5.9 years; CDCS, 3.7 years; PMI, 11.3 years) were tested. At 1p13.3, HV and CDCS participants carrying 1 or more rs599839 G allele had a lower prevalence of dyslipidemia (
P
≤0.005) or lower levels of low-density lipoprotein (
P
=0.031) and total (
P
=0.004) cholesterol and/or less history of myocardial infarction (
P
≤0.04) compared with AA participants. Moreover, CDCS and PMI AG/GG participants had better cardiac function as indicated by echocardiography (
P
≤0.026), and fewer CDCS AG/GG participants were readmitted for a non-ST-segment elevation MI (
P
=0.012) during follow-up. The polymorphism at 1q41 (rs17465637) was associated with better cardiovascular outcomes in the HV (
P
=0.028) and PMI (
P
=0.008) cohorts, and 3q22.3 (rs9818870) was a predictor of death/admission in the HV cohort (
P
=0.045).
Conclusions—
These data suggest that coronary artery disease genomic risk variants at 1p13.3 and 1q41 are associated with subsequent clinical outcome in heart patients and confirm rs9818870 at 3q22.3 as a predictor of cardiovascular risk in individuals free of overt heart disease.
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Affiliation(s)
- Katrina L. Ellis
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Chris M. Frampton
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Anna P. Pilbrow
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Richard W. Troughton
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Rob N. Doughty
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Gillian A. Whalley
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Chris J. Ellis
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Lorraine Skelton
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Judith Thomson
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Tim G. Yandle
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - A. Mark Richards
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
| | - Vicky A. Cameron
- From the Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand (K.L.E., C.M.F., A.P.P., R.W.T., L.S., J.T., T.G.Y., A.M.R., V.A.C.); Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand (R.N.D., G.A.W., C.J.E.), and Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand (G.A.W.)
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Faatoese AF, Pitama SG, Gillies TW, Robertson PJ, Huria TM, Tikao-Mason KN, Doughty RN, Whalley GA, Richards AM, Troughton RW, Sheerin IG, Wells JE, Cameron VA. Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort. Aust N Z J Public Health 2011; 35:517-23. [PMID: 22151157 DOI: 10.1111/j.1753-6405.2011.00777.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori. METHODS Participants (aged 20-64 years), of Māori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants' primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice electronic-decision support software used to estimate 5-year CVD risk. RESULTS Mean age of participants (n=252) was 45.7 ± 0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. CONCLUSIONS High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Māori community. IMPLICATIONS There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.
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Palmer BR, Frampton CM, Skelton L, Yandle TG, Doughty RN, Whalley GA, Ellis CJ, Troughton RW, Richards AM, Cameron VA. KCNE5 polymorphism rs697829 is associated with QT interval and survival in acute coronary syndromes patients. J Cardiovasc Electrophysiol 2011; 23:319-24. [PMID: 21985337 DOI: 10.1111/j.1540-8167.2011.02192.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The KCNE family is a group of small transmembrane channel proteins involved in potassium ion (K(+)) conductance. The X-linked KCNE5 gene encodes a regulator of the K(+) current mediated by the potassium channel KCNQ1. Polymorphisms in KCNE5 have been associated with altered cardiac electrophysiological properties in human studies. We investigated associations of the common rs697829 polymorphism from KCNE5 with baseline characteristics, baseline electrocardiographic (ECG) measurements, and patient survival in a cohort of post-acute coronary syndromes (ACS) patients (the Coronary Disease Cohort Study cohort). METHODS AND RESULTS DNA samples (n = 1,740) were genotyped for rs697829 using a TaqMan assay. Baseline ECG data revealed corrected QT (QTc) interval was associated with rs697829 in male, but not female, patients, being extended in the G genotype group (A 416 ± 1.71; G 431 ± 4.25 ms, P = 0.002). Covariate-adjusted survival was poorest in G genotype patients in Cox proportional hazard modeling of mortality data of males (P(overall) = 0.020). Male patients with G genotype had a hazard ratio of 1.44 (1.11-2.33) for death when compared to the A genotype male patients (P = 0.048) after adjustment for age, baseline log-transformed N-terminal pro-B-type natriuretic peptide (NTproBNP), β-blocker and insulin treatment, QTc interval, history of myocardial infarction, and physical activity score. CONCLUSION This study suggests an association between rs697829, a common single nucleotide polymorphism (SNP) from KCNE5, and ECG measurements and survival in postacute ACS patients. Prolonged subclinical QT interval may be a marker of adverse outcome in this group of patients.
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Affiliation(s)
- Barry R Palmer
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
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49
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Somaratne JB, Whalley GA, Poppe KK, ter Bals MM, Wadams G, Pearl A, Bagg W, Doughty RN. Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community. Cardiovasc Diabetol 2011; 10:29. [PMID: 21492425 PMCID: PMC3094210 DOI: 10.1186/1475-2840-10-29] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/14/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular disease and is common among patients with type 2 diabetes. However, no systematic screening for LVH is currently recommended for patients with type 2 diabetes. The purpose of this study was to determine whether NT-proBNP was superior to 12-lead electrocardiography (ECG) for detection of LVH in patients with type 2 diabetes. METHODS Prospective cross-sectional study comparing diagnostic accuracy of ECG and NT-proBNP for the detection of LVH among patients with type 2 diabetes. Inclusion criteria included having been diagnosed for > 5 years and/or on treatment for type 2 diabetes; patients with Stage 3/4 chronic kidney disease and known cardiovascular disease were excluded. ECG LVH was defined as either the Sokolow-Lyon or Cornell voltage criteria. NT-proBNP level was measured using the Roche Diagnostics Elecsys assay. Left ventricular mass was assessed from echocardiography. Receiver operating characteristic curve analysis was carried out and area under the curve (AUC) was calculated. RESULTS 294 patients with type 2 diabetes were recruited, mean age 58 (SD 11) years, BP 134/81 ± 18/11 mmHg, HbA 1c 7.3 ± 1.5%. LVH was present in 164 patients (56%). In a logistic regression model age, gender, BMI and a history of hypertension were important determinants of LVH (p < 0.05). Only 5 patients with LVH were detected by either ECG voltage criteria. The AUC for NT-proBNP in detecting LVH was 0.68. CONCLUSIONS LVH was highly prevalent in asymptomatic patients with type 2 diabetes. ECG was an inadequate test to identify LVH and while NT-proBNP was superior to ECG it remained unsuitable for detecting LVH. Thus, there remains a need for a screening tool to detect LVH in primary care patients with type 2 diabetes to enhance risk stratification and management.
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Affiliation(s)
- Jithendra B Somaratne
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Gillian A Whalley
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Katrina K Poppe
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Mariska M ter Bals
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Gina Wadams
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Ann Pearl
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Warwick Bagg
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Rob N Doughty
- Cardiovascular Research Group, Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
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50
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Poppe KK, Doughty RN, Yu CM, Quintana M, Møller JE, Klein AL, Gamble GD, Dini FL, Whalley GA. Understanding differences in results from literature-based and individual patient meta-analyses: An example from meta-analyses of observational data. Int J Cardiol 2011; 148:209-13. [DOI: 10.1016/j.ijcard.2009.09.566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/23/2009] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
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