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Patel ZJ, Rahman N, Vadhar S, Desai RV. A SHORT STORY: CARDIAC AL AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Desai RV, Chen X, Martin B, Chaturvedi S, Hwang DW, Li W, Yu C, Ding S, Thomson M, Singer RH, Coleman RA, Hansen MMK, Weinberger LS. A DNA repair pathway can regulate transcriptional noise to promote cell fate transitions. Science 2021; 373:science.abc6506. [PMID: 34301855 DOI: 10.1126/science.abc6506] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/08/2021] [Indexed: 12/13/2022]
Abstract
Stochastic fluctuations in gene expression ("noise") are often considered detrimental, but fluctuations can also be exploited for benefit (e.g., dither). We show here that DNA base excision repair amplifies transcriptional noise to facilitate cellular reprogramming. Specifically, the DNA repair protein Apex1, which recognizes both naturally occurring and unnatural base modifications, amplifies expression noise while homeostatically maintaining mean expression levels. This amplified expression noise originates from shorter-duration, higher-intensity transcriptional bursts generated by Apex1-mediated DNA supercoiling. The remodeling of DNA topology first impedes and then accelerates transcription to maintain mean levels. This mechanism, which we refer to as "discordant transcription through repair" ("DiThR," which is pronounced "dither"), potentiates cellular reprogramming and differentiation. Our study reveals a potential functional role for transcriptional fluctuations mediated by DNA base modifications in embryonic development and disease.
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Affiliation(s)
- Ravi V Desai
- Gladstone/UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA.,Medical Scientist Training Program and Tetrad Graduate Program, University of California, San Francisco, CA 94158, USA
| | - Xinyue Chen
- Gladstone/UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Benjamin Martin
- Gladstone/UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA.,Institute for Molecules and Materials, Radboud University, 6525 AJ Nijmegen, the Netherlands
| | - Sonali Chaturvedi
- Gladstone/UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Dong Woo Hwang
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Weihan Li
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Chen Yu
- Gladstone Institute of Cardiovascular Disease, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Sheng Ding
- Gladstone Institute of Cardiovascular Disease, Gladstone Institutes, San Francisco, CA 94158, USA.,School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China
| | - Matt Thomson
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Robert H Singer
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Robert A Coleman
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Maike M K Hansen
- Institute for Molecules and Materials, Radboud University, 6525 AJ Nijmegen, the Netherlands
| | - Leor S Weinberger
- Gladstone/UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA. .,Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94158, USA.,Department of Biochemistry and Biophysics, University of California, San Francisco, CA 94158, USA
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Dunn TS, Patel P, Abazid B, Nagaraj HM, Desai RV, Gupta H, Lloyd SG. Quantification of pulmonary/systemic shunt ratio by single-acquisition phase-contrast cardiovascular magnetic resonance. Echocardiography 2019; 36:1181-1190. [PMID: 31087463 DOI: 10.1111/echo.14358] [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: 03/04/2019] [Accepted: 04/14/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Phase-contrast cardiovascular magnetic resonance (PC-CMR) quantification of intracardiac shunt (measuring the pulmonary to systemic flow ratio, Qp/Qs) is typically determined by measuring flow through planes perpendicular the pulmonary trunk (PA) and ascending aorta (Ao). This method is subject to error from presence of background velocity offsets and requires two scan acquisitions. We evaluated an alternate PC-CMR technique for quantifying Qp/Qs using a single modified plane that encompasses both the PA and Ao. MATERIAL AND METHODS In 53 patients evaluated for intracardiac shunting, PC-CMR measurement in the individual Ao and PA planes and also in a single-acquisition plane was obtained and Qp/Qs calculated by each method. Bland-Altman analysis was performed to evaluate the agreement between the two methods. RESULTS The 95% confidence limits of agreement ranged from -0.52 to +0.34 indicating good agreement between the two methods. There was excellent agreement on the clinically relevant threshold value of Qp/Qs ratio of 1.5 (representing criteria for surgical correction of shunt). CONCLUSIONS Qp/Qs determined from the single-acquisition approach agrees well with that of the individual PA and Ao method and offers potential improved accuracy (due to background velocity offset).
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Affiliation(s)
- Terence Sean Dunn
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pratik Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bassem Abazid
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hosakote M Nagaraj
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ravi V Desai
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Himanshu Gupta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
| | - Steven G Lloyd
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
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Hansen MMK, Desai RV, Simpson ML, Weinberger LS. Cytoplasmic Amplification of Transcriptional Noise Generates Substantial Cell-to-Cell Variability. Cell Syst 2018; 7:384-397.e6. [PMID: 30243562 PMCID: PMC6202163 DOI: 10.1016/j.cels.2018.08.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/14/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
Abstract
Transcription is an episodic process characterized by probabilistic bursts, but how the transcriptional noise from these bursts is modulated by cellular physiology remains unclear. Using simulations and single-molecule RNA counting, we examined how cellular processes influence cell-to-cell variability (noise). The results show that RNA noise is higher in the cytoplasm than the nucleus in ∼85% of genes across diverse promoters, genomic loci, and cell types (human and mouse). Measurements show further amplification of RNA noise in the cytoplasm, fitting a model of biphasic mRNA conversion between translation- and degradation-competent states. This multi-state translation-degradation of mRNA also causes substantial noise amplification in protein levels, ultimately accounting for ∼74% of intrinsic protein variability in cell populations. Overall, the results demonstrate how noise from transcriptional bursts is intrinsically amplified by mRNA processing, leading to a large super-Poissonian variability in protein levels.
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Affiliation(s)
- Maike M K Hansen
- Gladstone|UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Ravi V Desai
- Gladstone|UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA
| | - Michael L Simpson
- Center for Nanophase Materials Science, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Leor S Weinberger
- Gladstone|UCSF Center for Cell Circuitry, Gladstone Institutes, San Francisco, CA 94158, USA; Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA.
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Ahmed AA, Patel K, Nyaku MA, Kheirbek RE, Bittner V, Fonarow GC, Filippatos GS, Morgan CJ, Aban IB, Mujib M, Desai RV, Allman RM, White M, Deedwania P, Howard G, Bonow RO, Fletcher RD, Aronow WS, Ahmed A. Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking. Circ Heart Fail 2015; 8:694-701. [PMID: 26038535 DOI: 10.1161/circheartfailure.114.001885] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 10/26/2014] [Accepted: 04/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND According to the 2004 Surgeon General's Report on Health Consequences of Smoking, after >15 years of abstinence, the cardiovascular risk of former smokers becomes similar to that of never-smokers. Whether this health benefit of smoking cessation varies by amount and duration of prior smoking remains unclear. METHODS AND RESULTS Of the 4482 adults ≥65 years without prevalent heart failure (HF) in the Cardiovascular Health Study, 2556 were never-smokers, 629 current smokers, and 1297 former smokers with >15 years of cessation, of whom 312 were heavy smokers (highest quartile; ≥32 pack-years). Age-sex-race-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for centrally adjudicated incident HF and mortality during 13 years of follow-up were estimated using Cox regression models. Compared with never-smokers, former smokers as a group had similar risk for incident HF (aHR, 0.99; 95% CI, 0.85-1.16) and all-cause mortality (aHR, 1.08; 95% CI, 0.96-1.20), but former heavy smokers had higher risk for both HF (aHR, 1.45; 95% CI, 1.15-1.83) and mortality (aHR, 1.38; 95% CI, 1.17-1.64). However, when compared with current smokers, former heavy smokers had lower risk of death (aHR, 0.64; 95% CI, 0.53-0.77), but not of HF (aHR, 0.97; 95% CI, 0.74-1.28). CONCLUSIONS After >15 years of smoking cessation, the risk of HF and death for most former smokers becomes similar to that of never-smokers. Although this benefit of smoking cessation is not extended to those with ≥32 pack-years of prior smoking, they have lower risk of death relative to current smokers.
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Affiliation(s)
- Amiya A Ahmed
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Kanan Patel
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Margaret A Nyaku
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Raya E Kheirbek
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Vera Bittner
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Gregg C Fonarow
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Gerasimos S Filippatos
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Charity J Morgan
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Inmaculada B Aban
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Marjan Mujib
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Ravi V Desai
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Richard M Allman
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Michel White
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Prakash Deedwania
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - George Howard
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Robert O Bonow
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Ross D Fletcher
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Wilbert S Aronow
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.)
| | - Ali Ahmed
- From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
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6
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Schiros CG, Desai RV, Venkatesh BA, Gaddam KK, Agarwal S, Lloyd SG, Calhoun DA, Denney TS, Dell’italia LJ, Gupta H. Left ventricular torsion shear angle volume analysis in patients with hypertension: a global approach for LV diastolic function. J Cardiovasc Magn Reson 2014; 16:70. [PMID: 25316384 PMCID: PMC4177166 DOI: 10.1186/s12968-014-0070-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 08/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Torsion shear angle φ is an important measure of left ventricular (LV) systolic and diastolic functions. Here we provide a novel index utilizing LV normalized torsion shear angle φ ^ volume V ^ loop to assess LV diastolic functional properties. We defined the area within φ ^ V ^ loop as torsion hysteresis area, and hypothesized that it may be an important global parameter of diastolic function. We evaluated the φ ^ changes to increased V ^ during early diastole - d φ ^ / d V ^ as a potential measure of LV suction. METHODS Sixty resistant hypertension patients (HTN), forty control volunteers were studied using cardiovascular magnetic resonance with tissue tagging. Volumetric and torsional parameters were evaluated. RESULTS HTN demonstrated concentric remodeling with preserved ejection fraction. HTN had significantly decreased normalized early filling rate, early diastolic mitral annulus velocity and E/A (1.33 ± 1.13 vs. 2.19 ± 1.07, P < 0.0001) vs. control. Torsion hysteresis area was greater (0.11 ± 0.07 vs. 0.079 ± 0.045, P < 0.001) and peak - d φ ^ / d V ^ at early diastole was higher (10.46 ± 8.51 vs. 6.29 ± 3.85, P = 0.002) than control. Torsion hysteresis area was significantly correlated with E/A (r = -0.23, P = 0.025). Thirteen HTN patients had both E/A ratio < 1.12 (Control mean E/A-1SD) and torsion hysteresis area > 0.12 (Control mean torsion hysteresis area + 1SD). CONCLUSIONS Torsion hysteresis area and peak early diastolic - d φ ^ / d V ^ were significantly increased in hypertensive concentric remodeling. The φ ^ V ^ loop takes into account the active and passive recoil processes of LV diastolic and systolic phases, therefore provides a new global description of LV diastolic function.
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Affiliation(s)
- Chun G Schiros
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Ravi V Desai
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | | | - Krishna K Gaddam
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Shilpi Agarwal
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Steven G Lloyd
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
| | - David A Calhoun
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Thomas S Denney
- />Department of Electrical and Computer Engineering, Auburn University, Auburn, AL USA
| | - Louis J Dell’italia
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
| | - Himanshu Gupta
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
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Shariff N, Desai RV, Patel K, Ahmed MI, Fonarow GC, Rich MW, Aban IB, Banach M, Love TE, White M, Aronow WS, Epstein AE, Ahmed A. Rate-control versus rhythm-control strategies and outcomes in septuagenarians with atrial fibrillation. Am J Med 2013; 126:887-93. [PMID: 24054956 PMCID: PMC3818786 DOI: 10.1016/j.amjmed.2013.04.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 01/19/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of atrial fibrillation substantially increases after 70 years of age. However, the effect of rate-control versus rhythm-control strategies on outcomes in these patients remains unclear. METHODS In the randomized Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 4060 patients (mean age 70 years, range 49-80 years) with paroxysmal and persistent atrial fibrillation were randomized to rate-control versus rhythm-control strategies. Of these, 2248 were 70-80 years, of whom 1118 were in the rate-control group. Propensity scores for rate-control strategy were estimated for each of the 2248 patients and were used to assemble a cohort of 937 pairs of patients receiving rate-control versus rhythm-control strategies, balanced on 45 baseline characteristics. RESULTS Matched patients had a mean age of 75 years; 45% were women, 7% were nonwhite, and 47% had prior hospitalizations due to arrhythmias. During 3.4 years of mean follow-up, all-cause mortality occurred in 18% and 23% of matched patients in the rate-control and rhythm-control groups, respectively (hazard ratio [HR] associated with rate control, 0.77; 95% confidence interval [CI], 0.63-0.94; P = .010). HRs (95% CIs) for cardiovascular and noncardiovascular mortality associated with rate control were 0.88 (0.65-1.18) and 0.62 (0.46-0.84), respectively. All-cause hospitalization occurred in 61% and 68% of rate-control and rhythm-control patients, respectively (HR 0.76; 95% CI, 0.68-0.86). HRs (95% CIs) for cardiovascular and noncardiovascular hospitalization were 0.66 (0.56-0.77) and 1.07 (0.91-1.27), respectively. CONCLUSION In septuagenarian patients with atrial fibrillation, compared with rhythm-control, a rate-control strategy was associated with significantly lower mortality and hospitalization.
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Alagiakrishnan K, Patel K, Desai RV, Ahmed MB, Fonarow GC, Forman DE, White M, Aban IB, Love TE, Aronow WS, Allman RM, Anker SD, Ahmed A. Orthostatic hypotension and incident heart failure in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2013; 69:223-30. [PMID: 23846416 DOI: 10.1093/gerona/glt086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the association of orthostatic hypotension with incident heart failure (HF) in older adults. METHODS Of the 5,273 community-dwelling adults aged 65 years and older free of baseline prevalent HF in the Cardiovascular Health Study, 937 (18%) had orthostatic hypotension, defined as ≥20 mmHg drop in systolic or ≥10 mmHg drop in diastolic blood pressure from supine to standing position at 3 minutes. Of the 937, 184 (20%) had symptoms of dizziness upon standing and were considered to have symptomatic orthostatic hypotension. Propensity scores for orthostatic hypotension were estimated for each of the 5,273 participants and were used to assemble a cohort of 3,510 participants (883 participants with and 2,627 participants without orthostatic hypotension) who were balanced on 40 baseline characteristics. Cox regression models were used to estimate the association of orthostatic hypotension with centrally adjudicated incident HF and other outcomes during 13 years of follow-up. RESULTS Participants (n = 3,510) had a mean (±standard deviation) age of 74 (±6) years, 58% were women, and 15% nonwhite. Incident HF occurred in 25% and 21% of matched participants with and without orthostatic hypotension, respectively (hazard ratio, 1.24; 95% confidence interval, 1.06-1.45; p = .007). Among matched participants, hazard ratios for incident HF associated with symptomatic (n = 173) and asymptomatic (n = 710) orthostatic hypotension were 1.57 (95% confidence interval, 1.16-2.11; p = .003) and 1.17 (95% confidence interval, 0.99-1.39; p = .069), respectively. CONCLUSIONS Community-dwelling older adults with orthostatic hypotension have higher independent risk of developing new-onset HF, which appeared to be more pronounced in those with symptomatic orthostatic hypotension.
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Affiliation(s)
- Kannayiram Alagiakrishnan
- University of Alabama at Birmingham, 1720 2nd Avenue South, CH-19, Suite 219, Birmingham, AL 35294-2041, USA.
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Deedwania P, Patel K, Fonarow GC, Desai RV, Zhang Y, Feller MA, Ovalle F, Love TE, Aban IB, Mujib M, Ahmed MI, Anker SD, Ahmed A. Prediabetes is not an independent risk factor for incident heart failure, other cardiovascular events or mortality in older adults: findings from a population-based cohort study. Int J Cardiol 2013; 168:3616-22. [PMID: 23731526 DOI: 10.1016/j.ijcard.2013.05.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 09/04/2011] [Revised: 04/24/2013] [Accepted: 05/04/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether prediabetes is an independent risk factor for incident heart failure (HF) in non-diabetic older adults remains unclear. METHODS Of the 4602 Cardiovascular Health Study participants, age≥65 years, without baseline HF and diabetes, 2157 had prediabetes, defined as fasting plasma glucose (FPG) 100-125 mg/dL. Propensity scores for prediabetes, estimated for each of the 4602 participants, were used to assemble a cohort of 1421 pairs of individuals with and without prediabetes, balanced on 44 baseline characteristics. RESULTS Participants had a mean age of 73 years, 57% were women, and 13% African American. Incident HF occurred in 18% and 20% of matched participants with and without prediabetes, respectively (hazard ratio {HR} associated with prediabetes, 0.90; 95% confidence interval {CI}, 0.76-1.07; p=0.239). Unadjusted and multivariable-adjusted HRs (95% CIs) for incident HF associated with prediabetes among 4602 pre-match participants were 1.22 (95% CI, 1.07-1.40; p=0.003) and 0.98 (95% CI, 0.85-1.14; p=0.826), respectively. Among matched individuals, prediabetes had no independent association with incident acute myocardial infarction (HR, 1.02; 95% CI, 0.81-1.28; p=0.875), angina pectoris (HR, 0.93; 95% CI, 0.77-1.12; p=0.451), stroke (HR, 0.86; 95% CI, 0.70-1.06; p=0.151) or all-cause mortality (HR, 0.99; 95% CI, 0.88-1.11; p=0.840). CONCLUSIONS We found no evidence that prediabetes is an independent risk factor for incident HF, other cardiovascular events or mortality in community-dwelling older adults. These findings question the wisdom of routine screening for prediabetes in older adults and targeted interventions to prevent adverse outcomes in older adults with prediabetes.
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Schiros C, Desai RV, Venkatesh BA, Ahmed M, Agarwal S, Lloyd S, Calhoun D, McGiffin D, Denney TS, Dell'Italia LJ, Gupta H. Left ventricular torsional hysteresis in patients with hypertension: a global parameter for diastolic function. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559450 DOI: 10.1186/1532-429x-15-s1-o28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mujib M, Desai RV, Ahmed MI, Guichard JL, Feller MA, Ekundayo OJ, Deedwania P, Ali M, Aban IB, Love TE, White M, Aronow WS, Rahimtoola SH, Bonow RO, Ahmed A. Rheumatic heart disease and risk of incident heart failure among community-dwelling older adults: a prospective cohort study. Ann Med 2012; 44:253-61. [PMID: 21254894 PMCID: PMC3116996 DOI: 10.3109/07853890.2010.530685] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Little is known about the association of rheumatic heart disease (RHD) with incident heart failure (HF) among older adults. DESIGN Cardiovascular Health Study, a prospective cohort study. METHODS Of the 4,751 community-dwelling adults ≥ 65 years, free of prevalent HF at baseline, 140 had RHD, defined as self-reported physician-diagnosed RHD along with echocardiographic evidence of left-sided valvular disease. Propensity scores for RHD, estimated for each of the 4,751 participants, were used to assemble a cohort of 720, in which 124 and 596 participants with and without RHD, respectively, were balanced on 62 baseline characteristics. RESULTS Incident HF developed in 33% and 22% of matched participants with and without RHD, respectively, during 13 years of follow-up (hazard ratio when RHD was compared to no-RHD 1.60; 95% confidence interval 1.13-2.28; P = 0.008). Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for RHD-associated incident heart failure were 2.04 (1.54-2.71; P < 0.001), 1.32 (1.02-1.70; P = 0.034), and 1.55 (1.14-2.11; P = 0.005), respectively. RHD was not associated with all-cause mortality (HR 1.09; 95% CI 0.82-1.45; P = 0.568). CONCLUSION RHD is an independent risk factor for incident HF among community-dwelling older adults free of HF, but has no association with mortality.
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Shariff N, Aleem A, Levin V, Desai RV, Nanda S, Martinez MW, Smith SJ, Freudenberger R. Venous thromboembolism in patients with heart failure: in-hospital and chronic use of anti-coagulants for prevention. Recent Pat Cardiovasc Drug Discov 2012; 7:53-58. [PMID: 22250920 DOI: 10.2174/157489012799362395] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 12/31/2011] [Accepted: 12/23/2011] [Indexed: 05/31/2023]
Abstract
Heart failure (HF) is a common clinical syndrome characterized by high morbidity and frequent hospitalizations. HF is an independent and major risk factor for venous thromboembolism (VTE) and VTE occurring in patients with HF carries a worse prognosis. The present review will focus on short and long term role of anti-coagulants in prevention of venous thrombosis in HF patients. We will also be discussing the recently investigated and patented anti-coagulants which could have a role in this specific population.
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Affiliation(s)
- Nasir Shariff
- Dept of Cardiovascular Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania 18103, USA.
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Roy B, Desai RV, Mujib M, Epstein AE, Zhang Y, Guichard J, Jones LG, Feller MA, Ahmed MI, Aban IB, Love TE, Levesque R, White M, Aronow WS, Fonarow GC, Ahmed A. Effect of warfarin on outcomes in septuagenarian patients with atrial fibrillation. Am J Cardiol 2012; 109:370-7. [PMID: 22118824 DOI: 10.1016/j.amjcard.2011.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 11/18/2022]
Abstract
Anticoagulation has been shown to decrease ischemic stroke in atrial fibrillation (AF). However, concerns remain regarding their safety and efficacy in those ≥70 years of age who constitute most patients with AF. Of the 4,060 patients (mean age 65 years, range 49 to 80) in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 2,248 (55% of 4,060) were 70 to 80 years of age, 1,901 of whom were receiving warfarin. Propensity score for warfarin use, estimated for each of the 2,248 patients, was used to match 227 of the 347 patients not on warfarin (in 1:1, 1:2, or 1:3 sets) to 616 patients on warfarin who were balanced in 45 baseline characteristics. All-cause mortality occurred in 18% and 33% of matched patients receiving and not receiving warfarin, respectively, during up to 6 years (mean 3.4) of follow-up (hazard ratio [HR] when warfarin use was compared to its nonuse 0.58, 95% confidence interval [CI] 0.43 to 0.77, p <0.001). All-cause hospitalization occurred in 64% and 67% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.93, 95% CI 0.77 to 1.12, p = 0.423). Ischemic stroke occurred in 4% and 8% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.57, 95% CI 0.31 to 1.04, p = 0.068). Major bleeding occurred in 7% and 10% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.73, 95% CI 0.44 to 1.22, p = 0.229). In conclusion, warfarin use was associated with decreased mortality in septuagenarian patients with AF but had no association with hospitalization or major bleeding.
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Affiliation(s)
- Brita Roy
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Roy B, Pawar PP, Desai RV, Fonarow GC, Mujib M, Zhang Y, Feller MA, Ovalle F, Aban IB, Love TE, Iskandrian AE, Deedwania P, Ahmed A. A propensity-matched study of the association of diabetes mellitus with incident heart failure and mortality among community-dwelling older adults. Am J Cardiol 2011; 108:1747-53. [PMID: 21943936 DOI: 10.1016/j.amjcard.2011.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
Abstract
Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ≥65 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ≥126 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31% and 26% of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95% confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95% CI 1.94 to 2.55, p <0.001) and 1.52 (95% CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57% and 47% of matched participants with and without DM, respectively (hazard ratio 1.35, 95% CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95% CI 1.45 to 4.32, p = 0.001), 1.37 (95% CI 0.97 to 1.93, p = 0.072), and 1.11 (95% CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.
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Zhang Y, Kilgore ML, Arora T, Mujib M, Ekundayo OJ, Aban IB, Feller MA, Desai RV, Love TE, Allman RM, Fonarow GC, Ahmed A. Design and rationale of studies of neurohormonal blockade and outcomes in diastolic heart failure using OPTIMIZE-HF registry linked to Medicare data. Int J Cardiol 2011; 166:230-5. [PMID: 22119116 DOI: 10.1016/j.ijcard.2011.10.089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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] [Received: 08/11/2011] [Revised: 10/04/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization for Medicare beneficiaries. Nearly half of all HF patients have diastolic HF or HF with preserved ejection fraction (HF-PEF). Because these patients were excluded from major randomized clinical trials of neurohormonal blockade in HF there is little evidence about their role in HF-PEF. METHODS The aims of the American Recovery & Reinvestment Act-funded National Heart, Lung, and Blood Institute-sponsored "Neurohormonal Blockade and Outcomes in Diastolic Heart Failure" are to study the long-term effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists in four separate propensity-matched populations of HF-PEF patients in the OPTIMIZE-HF (Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients with Heart Failure) registry. Of the 48,612 OPTIMIZE-HF hospitalizations occurring during 2003-2004 in 259 U.S. hospitals, 20,839 were due to HF-PEF (EF ≥40%). For mortality and hospitalization we used Medicare national claims data through December 31, 2008. RESULTS Using a two-step (hospital-level and hospitalization-level) probabilistic linking approach, we assembled a cohort of 11,997 HF-PEF patients from 238 OPTIMIZE-HF hospitals. These patients had a mean age of 75 years, mean EF of 55%, were 62% women, 15% African American, and were comparable with community-based HF-PEF cohorts in key baseline characteristics. CONCLUSIONS The assembled Medicare-linked OPTIMIZE-HF cohort of Medicare beneficiaries with HF-PEF with long-term outcomes data will provide unique opportunities to study clinical effectivenss of various neurohormonal antagonists with outcomes in HF-PEF using propensity-matched designs that allow outcome-blinded assembly of balanced cohorts, a key feature of randomized clinical trials.
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Affiliation(s)
- Yan Zhang
- University of Alabama at Birmingham, Birmingham, AL 35294–2041, USA
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Sims RV, Mujib M, McGwin G, Zhang Y, Ahmed MI, Desai RV, Aban IB, Sawyer P, Anker SD, Ahmed A. Heart failure is a risk factor for incident driving cessation among community-dwelling older adults: findings from a prospective population study. J Card Fail 2011; 17:1035-40. [PMID: 22123368 DOI: 10.1016/j.cardfail.2011.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) patients often depend on driving for access to specialty care. We analyzed a public-use copy of the Cardiovascular Health Study (CHS) data to determine if HF is a risk factor for driving cessation and to identify other risk factors for driving cessation among those with HF. METHODS AND RESULTS Of the 5,383 community-dwelling drivers aged ≥65 years (mean age 73 years, 55% women, 13% African American), 839 had HF: 246 had baseline prevalent HF and 593 developed incident HF before driving cessation during 9 years of follow-up. Incident driving cessation occurred at rates of 3,980 and 3,709 per 10,000 person-years of follow-up for those with and without HF, respectively (unadjusted hazard ratio [HR] associated with HF as a time-varying variable: 2.13, 95% confidence interval [CI] 1.83-2.47; P < .001). This association remained unchanged after multivariable risk adjustment (HR 1.43, 95% CI 1.21-1.68; P < .001). Among the 839 older drivers with HF, independent predictors for incident driving cessation were age ≥75 years (HR 1.99, 95% CI 1.44-2.73; P < .001), female gender (HR 1.93, 95% CI 1.37-2.74; P < .001), difficulty walking half a mile (HR 1.47 (1.04-2.08); P = .028), vision problems (HR 1.47, 95% CI 1.07-2.02; P = .018), and stroke as a time-varying covariate (HR 1.96, 95% CI 1.38-2.79; P < .001). CONCLUSIONS HF is an independent risk factor for incident driving cessation among community-dwelling older drivers. Several patient characteristics predicted driving cessation in older HF patients, which may be targets for interventions to prevent driving cessation among these patients.
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Affiliation(s)
- Richard V Sims
- Veterans Affairs Medical Center, Birmingham, Alabama, USA
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White M, Desai RV, Guichard JL, Mujib M, Aban IB, Ahmed MI, Feller MA, de Denus S, Ahmed A. Bucindolol, systolic blood pressure, and outcomes in systolic heart failure: a prespecified post hoc analysis of BEST. Can J Cardiol 2011; 28:354-9. [PMID: 21982425 DOI: 10.1016/j.cjca.2011.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the Beta-Blocker Evaluation of Survival Trial (BEST), systolic blood pressure (SBP) ≤ 120 mm Hg was an independent predictor of poor prognosis in ambulatory patients with chronic systolic heart failure (HF). Because SBP is an important predictor of response to β-blocker therapy, the BEST protocol prespecified a post hoc analysis to determine whether the effect of bucindolol varied by baseline SBP. METHODS In the BEST, 2706 patients with chronic systolic (left ventricular ejection fraction < 35%) HF and New York Heart Association class III (92%) or IV (8%) symptoms and receiving standard background therapy were randomized to receive either bucindolol (n = 1354) or placebo (n = 1354). Of these, 1751 had SBP ≤ 120 mm Hg, and 955 had SBP > 120 mm Hg at baseline. RESULTS Among patients with SBP > 120 mm Hg, all-cause mortality occurred in 28% and 22% of patients receiving placebo and bucindolol, respectively (hazard ratio when bucindolol was compared with placebo, 0.77; 95% confidence interval [CI], 0.59-0.99; P = 0.039). In contrast, among those with SBP ≤ 120 mm Hg, 36% and 35% of patients in the placebo and bucindolol groups died, respectively (hazard ratio, 0.95; 95% CI, 0.81-1.12; P = 0.541). Hazard ratios (95% CIs; P values) for HF hospitalization associated with bucindolol use were 0.70 (0.56-0.89; P = 0.003) and 0.82 (0.71-0.95; P = 0.008) for patients with SBP > 120 and ≤ 120 mm Hg, respectively. CONCLUSION Bucindolol, a nonselective β-blocker with weak α(2)-blocking properties, significantly reduced HF hospitalization in systolic HF patients regardless of baseline SBP. However, bucindolol reduced mortality only in those with SBP > 120 mm Hg.
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Affiliation(s)
- Michel White
- Montreal Heart Institute, Montreal, Québec, Canada.
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Guichard JL, Desai RV, Ahmed MI, Mujib M, Fonarow GC, Feller MA, Ekundayo OJ, Bittner V, Aban IB, White M, Aronow WS, Love TE, Bakris GL, Zieman SJ, Ahmed A. Isolated diastolic hypotension and incident heart failure in older adults. Hypertension 2011; 58:895-901. [PMID: 21947466 DOI: 10.1161/hypertensionaha.111.178178] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Aging is often associated with increased systolic blood pressure and decreased diastolic blood pressure. Isolated systolic hypertension or an elevated systolic blood pressure without an elevated diastolic blood pressure is a known risk factor for incident heart failure in older adults. In the current study, we examined whether isolated diastolic hypotension, defined as a diastolic blood pressure <60 mm Hg and a systolic blood pressure ≥100 mm Hg, is associated with incident heart failure. Of the 5795 Medicare-eligible community-dwelling adults age ≥65 years in the Cardiovascular Health Study, 5521 were free of prevalent heart failure at baseline. After excluding 145 individuals with baseline systolic blood pressure <100 mm Hg, the final sample included 5376 participants, of whom 751 (14%) had isolated diastolic hypotension. Propensity scores for isolated diastolic hypotension were calculated for each of the 5376 participants and used to match 545 and 2348 participants with and without isolated diastolic hypotension, respectively, who were balanced on 58 baseline characteristics. During >12 years of median follow-up, centrally adjudicated incident heart failure developed in 25% and 20% of matched participants with and without isolated diastolic hypotension, respectively (hazard ratio associated with isolated diastolic hypotension: 1.33 [95% CI: 1.10-1.61]; P=0.004). Among the 5376 prematch individuals, multivariable-adjusted hazard ratio for incident heart failure associated with isolated diastolic hypotension was 1.29 (95% CI: 1.09-1.53; P=0.003). As in isolated systolic hypertension, among community-dwelling older adults without prevalent heart failure, isolated diastolic hypotension is also a significant independent risk factor for incident heart failure.
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Affiliation(s)
- Jason L Guichard
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA
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Perry GJ, Ahmed MI, Desai RV, Mujib M, Zile M, Sui X, Aban IB, Zhang Y, Tallaj J, Allman RM, Aronow WS, Fleg JL, Ahmed A. Left ventricular diastolic function and exercise capacity in community-dwelling adults ≥65 years of age without heart failure. Am J Cardiol 2011; 108:735-40. [PMID: 21704282 DOI: 10.1016/j.amjcard.2011.04.025] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/21/2011] [Accepted: 04/21/2011] [Indexed: 01/19/2023]
Abstract
Left ventricular diastolic dysfunction (LVDD) has been reported to have strong correlation with exercise capacity. However, this relationship has not been studied extensively in community-dwelling older adults. Data on pulse and tissue Doppler echocardiographic estimates of resting early (E) and atrial (A) transmitral peak inflow and early (Em) mitral annular velocities, and six-minute walk test were obtained from 89 community-dwelling older adults (mean age, 74; range, 65-93 years; 54% women), without a history of heart failure. Overall, 47% had cardiovascular morbidity and 60% had normal diastolic function (E/A 0.75-1.5 and E:Em <10). Among the 36 individuals with LVDD, 83%, 14% and 3% had grade I (E/A <0.75, regardless of E/E(m)), II (E/A 0.75-1.5 and E/E(m) ≥10) and III (E/A>1.5 and E/E(m) ≥10) LVDD, respectively. Those with LVDD were older (77 versus 73 years; p = 0.001) and had a trend for higher prevalence of cardiovascular morbidity (58% versus 40%; p = 0.083). LVDD negatively correlated with six-minute walk distance (1013 versus 1128 feet; R = -0.25; p = 0.017). This association remained significant despite adjustment for cardiovascular morbidity (R = -0.35; p = 0.048), but lost significance when adjusted for age (R = -0.32; p = 0.105), age and cardiovascular morbidity (R = -0.38; p = 0.161), and additional adjustment for sex, race, body mass index, and systolic blood pressure (R = -0.44; p = 0.365). In conclusion, most community-dwelling older adults without heart failure had normal left ventricular diastolic function or grade-I LVDD. Although LVDD was associated with decreased performance on a six-minute walk test, that association was no longer evident after adjustment for age, body mass index and cardiovascular morbidity.
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Filippatos GS, Desai RV, Ahmed MI, Fonarow GC, Love TE, Aban IB, Iskandrian AE, Konstam MA, Ahmed A. Hypoalbuminaemia and incident heart failure in older adults. Eur J Heart Fail 2011; 13:1078-86. [PMID: 21807662 DOI: 10.1093/eurjhf/hfr088] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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: 01/02/2023] Open
Abstract
AIMS To test the hypothesis that baseline hypoalbuminaemia is associated with incident heart failure (HF) in community-dwelling older adults. METHODS AND RESULTS Of the 5795 community-dwelling adults aged ≥65 years in the Cardiovascular Health Study, 5450 were free of centrally adjudicated prevalent HF at baseline, and also had data on baseline serum albumin. Of these, 599 (11%) had hypoalbuminaemia, defined as baseline serum albumin levels ≤3.5 mg/dL. Propensity scores for hypoalbuminaemia were calculated for each patient and used to assemble a matched cohort of 582 pairs of participants with and without hypoalbuminaemia, who were well balanced on 58 baseline characteristics. Using Cox regression models, we estimated the association of hypoalbuminaemia with centrally adjudicated incident HF during 9.6 years of median follow-up. Matched participants had a mean (±SD) age of 74 (±6) years, 62% were women, and 16% were African Americans. Incident HF occurred in 25 and 20% of matched participants with and without hypoalbuminaemia, respectively [hazard ratio when hypoalbuminaemia was compared with normoalbuminaemia, 1.40; 95% confidence interval, 1.05-1.85; P = 0.020]. Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for incident HF associated with hypoalbuminaemia were 1.33 (1.12-1.58; P = 0.001), 1.33 (1.11-1.60; P = 0.002), and 1.25 (1.04-1.50; P= 0.016), respectively. The combined endpoint of incident HF or all-cause mortality occurred in 59 and 50% of matched participants with and without hypoalbuminaemia, respectively (hazard ratio, 1.33; 95% confidence interval, 1.11-1.61; P= 0.002). CONCLUSIONS Among community-dwelling older adults without HF, baseline hypoalbuminaemia was associated with increased risk of incident HF during 10 years of follow-up.
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Meyer P, Desai RV, Mujib M, Feller MA, Adamopoulos C, Banach M, Lainscak M, Aban I, White M, Aronow WS, Deedwania P, Iskandrian AE, Ahmed A. Right ventricular ejection fraction <20% is an independent predictor of mortality but not of hospitalization in older systolic heart failure patients. Int J Cardiol 2011; 155:120-5. [PMID: 21664707 DOI: 10.1016/j.ijcard.2011.05.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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] [Received: 01/29/2011] [Revised: 04/24/2011] [Accepted: 05/13/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reduced right ventricular ejection fraction (RVEF) is associated with poor outcomes in patients with chronic systolic heart failure (HF). Although most HF patients are older adults, little is known about the relationship between low RVEF and outcomes in older adults with systolic HF. METHODS Of the 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with systolic HF (left ventricular ejection fraction ≤ 35%) 822 were ≥ 65 years and had data on baseline RVEF estimated by gated-equilibrium radionuclide ventriculography. Using RVEF ≥ 40% (n = 308) as reference, we examined association of RVEF 30-39% (n = 214), 20-29% (n = 206) and <20% (n = 94) with outcomes using Cox regression models. RESULTS All-cause mortality occurred in 36%, 40%, 39% and 56% of patients with RVEF ≥ 40%, 30-39%, 20-29% and <20% respectively. Compared with RVEF ≥ 40%, unadjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality associated with RVEF 30-39%, 20-29% and <20% were 1.19 (0.90-1.57; P = 0.220), 1.13 (0.84-1.51; P = 0.423) and 1.97 (1.43-2.73; P<0.001) respectively. Respective multivariable-adjusted HR's (95% CI's) for all-cause mortality were 1.19 (0.88-1.60; P = 0.261), 1.00 (0.73-1.39; P = 0.982) and 1.70 (1.14-2.53; P = 0.009). Adjusted HR's (95% CI's) associated with RVEF <20% (versus ≥ 40%) for cardiovascular mortality and HF mortality were 1.79 (1.17-2.76; P = 0.008) and 1.97 (1.02-3.83; P = 0.045) respectively. RVEF had no independent association with sudden cardiac death, all-cause or HF hospitalization. CONCLUSIONS Abnormally low RVEF is a significant independent predictor of mortality, but not of HF hospitalization, in older adults with systolic HF.
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Banach M, Bhatia V, Feller MA, Mujib M, Desai RV, Ahmed MI, Guichard JL, Aban I, Love TE, Aronow WS, White M, Deedwania P, Fonarow G, Ahmed A. Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure. Am J Cardiol 2011; 107:1208-14. [PMID: 21296319 DOI: 10.1016/j.amjcard.2010.12.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
We studied the impact of baseline systolic blood pressure (SBP) on outcomes in patients with mild to moderate chronic systolic and diastolic heart failure (HF) in the Digitalis Investigation Group trial using a propensity-matched design. Of 7,788 patients, 7,785 had baseline SBP data and 3,538 had SBP ≤ 120 mm Hg. Propensity scores for SBP ≤ 120 mm Hg, calculated for each of the 7,785 patients, were used to assemble a matched cohort of 3,738 patients with SBP ≤ 120 and >120 mm Hg who were well-balanced in 32 baseline characteristics. All-cause mortality occurred in 35% and 32% of matched patients with SBPs ≤ 120 and >120 mm Hg respectively, during 5 years of follow-up (hazard ratio [HR] when SBP ≤ 120 was compared to >120 mm Hg 1.10, 95% confidence interval [CI] 0.99 to 1.23, p = 0.088). HRs for cardiovascular and HF mortalities associated with SBP ≤ 120 mm Hg were 1.15 (95% CI 1.01 to 1.30, p = 0.031) and 1.30 (95% CI 1.08 to 1.57, p = 0.006). Cardiovascular hospitalization occurred in 53% and 49% of matched patients with SBPs ≤ 120 and > 120 mm Hg, respectively (HR 1.13, 95% CI 1.03 to 1.24, p = 0.008). HRs for all-cause and HF hospitalizations associated with SBP ≤ 120 mm Hg were 1.10 (95% CI 1.02 to 1.194, p = 0.017) and 1.21 (95% CI 1.07 to 1.36, p = 0.002). In conclusion, in patients with mild to moderate long-term systolic and diastolic HF, baseline SBP ≤ 120 mm Hg was associated with increased cardiovascular and HF mortalities and all-cause, cardiovascular, and HF hospitalizations that was independent of other baseline characteristics.
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Mujib M, Rahman AAZ, Desai RV, Ahmed MI, Feller MA, Aban I, Love TE, White M, Deedwania P, Aronow WS, Fonarow G, Ahmed A. Warfarin use and outcomes in patients with advanced chronic systolic heart failure without atrial fibrillation, prior thromboembolic events, or prosthetic valves. Am J Cardiol 2011; 107:552-7. [PMID: 21185004 DOI: 10.1016/j.amjcard.2010.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 10/05/2010] [Accepted: 10/05/2010] [Indexed: 11/29/2022]
Abstract
Warfarin is often used in patients with systolic heart failure (HF) to prevent adverse outcomes. However, its long-term effect remains controversial. The objective of this study was to determine the association of warfarin use and outcomes in patients with advanced chronic systolic HF without atrial fibrillation (AF), previous thromboembolic events, or prosthetic valves. Of the 2,708 BEST patients, 1,642 were free of AF without a history of thromboembolic events and without prosthetic valves at baseline. Of these, 471 patients (29%) were receiving warfarin. Propensity scores for warfarin use were estimated for each patient and were used to assemble a matched cohort of 354 pairs of patients with and without warfarin use who were balanced on 62 baseline characteristics. Kaplan-Meier and Cox regression analyses were used to estimate the association between warfarin use and outcomes during 4.5 years of follow-up. Matched participants had a mean age ± SD of 57 ± 13 years with 24% women and 24% African-Americans. All-cause mortality occurred in 30% of matched patients in the 2 groups receiving and not receiving warfarin (hazard ratio 0.86, 95% confidence interval 0.62 to 1.19, p = 0.361). Warfarin use was not associated with cardiovascular mortality (hazard ratio 0.97, 95% confidence interval 0.68 to 1.38, p = 0.855), or HF hospitalization (hazard ratio 1.09, 95% confidence interval 0.82 to 1.44, p = 0.568). In conclusion, in patients with chronic advanced systolic HF without AF or other recommended indications for anticoagulation, prevalence of warfarin use was high. However, despite a therapeutic international normalized ratio in those receiving warfarin, its use had no significant intrinsic association with mortality and hospitalization.
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Desai RV, Ahmed MI, Mujib M, Aban IB, Zile MR, Ahmed A. Natural history of concentric left ventricular geometry in community-dwelling older adults without heart failure during seven years of follow-up. Am J Cardiol 2011; 107:321-4. [PMID: 21129719 DOI: 10.1016/j.amjcard.2010.09.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 01/01/2023]
Abstract
Presence of concentric left ventricular (LV) geometry has important pathophysiologic and prognostic implications. However, little is known about its natural history in older adults. Of the 5,795 community-dwelling adults ≥65 years of age in the Cardiovascular Health Study, 1,871 without baseline heart failure had data on baseline and 7-year echocardiograms. Of these 343 (18%) had baseline concentric LV geometry (concentric remodeling 83%, concentric LV hypertrophy [LVH] 17%) and are the focus of the present study. LV geometry at year 7 was categorized into 4 groups based on LVH (LV mass indexed for height >51 g/m²·⁷) and relative wall thickness (RWT): eccentric hypertrophy (RWT ≤0.42 with LVH), concentric hypertrophy (RWT >0.42 with LVH), concentric remodeling (RWT >0.42 without LVH), and normal (RWT ≤0.42 without LVH). At year 7, LV geometry normalized in 57%, remained unchanged in 35%, and transitioned to eccentric hypertrophy in 7% of participants. Incident eccentric hypertrophy occurred in 4% and 25% of those with baseline concentric remodeling and concentric hypertrophy, respectively, and was associated with increased LV end-diastolic volume and decreased LV ejection fraction at year 7. Previous myocardial infarction and baseline above-median LV mass (>39 g/m²·⁷) and RWT (>0.46) had significant unadjusted associations with incident eccentric LVH; however, only LV mass >39 g/m²·⁷ (odds ratio 17.52, 95% confidence interval 3.91 to 78.47, p <0.001) and previous myocardial infarction (odds ratio 4.73, 95% confidence interval 1.16 to 19.32, p = 0.031) had significant independent associations. In conclusion, in community-dwelling older adults with concentric LV geometry, transition to eccentric hypertrophy was uncommon but structurally maladaptive.
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Abstract
A 37-year-old woman was diagnosed to have a small ventricular septal defect (VSD) with high velocity tricuspid regurgitation (TR) that was attributed to atrio-VSD (Gerbode). Cardiac MR revealed a small subaortic VSD in the membranous portion of the interventricular septum. The atrioventricular portion was intact. Cardiac MR clearly showed flow jet through the VSD, impinging on the anterior tricuspid leaflet during systole, and bouncing back into the right atrium as TR. This ricochet mechanism of TR in VSD may be misinterpreted as Gerbode defect or as evidence of pulmonary hypertension.
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Affiliation(s)
- Ravi V Desai
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Desai RV, Meyer P, Ahmed MI, Mujib M, Adamopoulos C, White M, Aban IB, Iskandrian AE, Ahmed A. Relationship between left and right ventricular ejection fractions in chronic advanced systolic heart failure: insights from the BEST trial. Eur J Heart Fail 2010; 13:392-7. [PMID: 21097899 DOI: 10.1093/eurjhf/hfq206] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Abnormally low right ventricular ejection fraction (RVEF) is a predictor of poor outcomes in chronic heart failure (HF) patients with low left ventricular ejection fraction (LVEF). However, little is known about the relationship between LVEF and RVEF in these patients. METHODS AND RESULTS Of the 2707 Beta-blocker Evaluation of Survival Trial (BEST) participants with ambulatory chronic HF, New York Heart Association class III-IV symptoms, and LVEF ≤ 35%, 2008 patients had gated-equilibrium radionuclide angiographic data on baseline LVEF and RVEF. Patients were categorized into quartiles by LVEF ≥ 29% (n = 507), 23-28% (n = 513), 17-22% (n = 538), and < 17% (n = 450). Logistic regression models were used to determine the association of LVEF quartiles (reference, ≥ 29%) with abnormally low RVEF (<20%). The prevalence of RVEF < 20% for patients with LVEF quartiles ≥ 29, 23-28, 17-22, and < 17% were 3, 6, 15, and 32%, respectively. Unadjusted odds ratios [95% confidence intervals (CIs)] for RVEF < 20% (vs. ≥ 20%) associated with LVEF quartiles 23-28, 17-22, and < 17% (reference, ≥ 29%) were 2.18 (1.14-4.17; P = 0.018), 6.32 (3.54-11.30; P < 0.001), and 16.67 (9.46-29.39; P < 0.001), respectively. Respective multivariable-adjusted odds ratios (95% CIs) were 1.82 (0.94-3.54; P = 0.076), 4.55 (2.48-8.35; P < 0.001), and 10.53 (5.70-19.44; P< 0.001), respectively. Heart failure symptoms and signs had unadjusted associations with low RVEF, but lacked intrinsic associations. CONCLUSION In patients with advanced systolic HF, LVEF has a strong dose-dependent relationship with RVEF which is independent of other characteristics, and low LVEF is useful as a surrogate marker of abnormally low RVEF in these patients.
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Affiliation(s)
- Ravi V Desai
- University of Alabama at Birmingham, 1530 3rd Ave South, CH19, Ste-219, Birmingham, AL 35294-2041, USA
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Desai RV, Ahmed MI, Fonarow GC, Filippatos GS, White M, Aban IB, Aronow WS, Ahmed A. Effect of serum insulin on the association between hyperuricemia and incident heart failure. Am J Cardiol 2010; 106:1134-8. [PMID: 20920653 DOI: 10.1016/j.amjcard.2010.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
Increased serum uric acid (UA) is associated with incident heart failure (HF). However, whether it is a direct effect of UA or an effect of increased xanthine oxidase (XO) is unknown. Because hyperuricemia in hyperinsulinemia is primarily due to impaired renal UA excretion, its association with incident HF would suggest a direct UA effect. In contrast, hyperuricemia in normoinsulinemia is likely due to increased UA production and thus its association with incident HF would suggest an XO effect. To clarify this, we examined the association of hyperuricemia with centrally adjudicated incident HF in Cardiovascular Health Study participants with and without hyperinsulinemia. Of the 5,411 participants ≥ 65 years of age without baseline HF, 1,491 (28%) had hyperuricemia (serum UA ≥ 6 mg/dl for women and ≥ 7 mg/dl for men). Propensity scores for hyperuricemia were estimated using 63 baseline characteristics. Mean serum UA levels were 6.0 and 5.3 mg/dl in those with (n = 2,731) and those without (n = 2,680) hyperinsulinemia (median serum insulin ≥ 13 mU/L), respectively (p < 0.001). Propensity-adjusted hazard ratios (95% confidence intervals) for hyperuricemia-associated incident HF during 8 years of median follow-up were 0.99 (0.83 to 1.18, p = 0.886) and 1.32 (1.04 to 1.67, p = 0.021) for those with and without hyperinsulinemia respectively (p for interaction = 0.014). In conclusion, the absence of an association of hyperuricemia with incident HF in those with hyperinsulinemia (despite a significantly higher mean serum UA) and a significant association in normoinsulinemia suggest that UA has no intrinsic association with incident HF and that it may predict incident HF when it is a marker of increased of XO activity.
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Adamopoulos C, Meyer P, Desai RV, Karatzidou K, Ovalle F, White M, Aban I, Love TE, Deedwania P, Anker SD, Ahmed A. Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: a propensity-matched study. Eur J Heart Fail 2010; 13:200-6. [PMID: 20930001 DOI: 10.1093/eurjhf/hfq159] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [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: 11/13/2022] Open
Abstract
AIMS Obesity is paradoxically associated with survival benefit in patients with chronic heart failure (HF). However, obesity complicates the management of diabetes mellitus (DM), which is common in HF. Yet, little is known about the impact of obesity in HF patients with DM. Therefore, we examined the association between obesity and outcomes in propensity-matched cohorts of HF patient with and without DM. METHODS AND RESULTS Of the 7788 participants with chronic mild to moderate HF in the Digitalis Investigation Group trial, 7379 were non-cachectic [body mass index (BMI) ≥ 20 kg/m²] at baseline. Of these, 2153 (29%) had DM, of whom 798 (37%) were obese (BMI ≥ 30 kg/m²). Of the 5226 patients without DM, 1162 (22%) were obese. Propensity scores for obesity were used to separately assemble 636 pairs of obese and non-obese patients with DM and 770 pairs of obese and non-obese patients without DM, who were balanced on 32 baseline characteristics. Among matched patients with DM, all-cause mortality occurred in 38 and 39% of obese and non-obese patients, respectively [hazard ratio (HR) when obesity was compared with no obesity 0.99; 95% confidence interval (CI) 0.80-1.22; P = 0.915]. Among matched patients without DM, all-cause mortality occurred in 23 and 27% obese and non-obese patients, respectively (HR associated with obesity 0.77; 95% CI 0.61-0.97; P = 0.025). CONCLUSION In patients with chronic mild to moderate HF and DM, obesity confers no paradoxical survival benefit. Whether intentional weight loss may improve outcomes in these patients needs to be investigated in future prospective studies.
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Kim EM, Desai RV, Doppalapudi H, Lloyd SG. Boomerang-shaped heart in isolated dextroversion. Eur Heart J 2010; 32:247. [PMID: 20861139 DOI: 10.1093/eurheartj/ehq363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eddie M Kim
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Cardiovascular MRI, 1808 7th Avenue South, Birmingham, AL 35294, USA
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White M, Desai RV, Mujib M, Ahmed MI, Aban I, Fonarow G, Deedwania P, Aronow WS, Waagstein F, Ahmed A. Does the Effect of Beta-Blockers on Outcomes in Patients with Advanced Chronic Systolic Heart Failure Vary by Baseline Systolic Blood Pressure? Insights from the BEST Trial. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Desai RV, Banach M, Ahmed MI, Mujib M, Aban I, Love TE, White M, Fonarow G, Deedwania P, Aronow WS, Ahmed A. Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial). Am J Cardiol 2010; 106:221-7. [PMID: 20599007 DOI: 10.1016/j.amjcard.2010.02.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
The impact of baseline systolic blood pressure (SBP) on outcomes in patients with advanced chronic systolic heart failure (HF) has not been studied using a propensity-matched design. Of the 2,706 participants in the Beta-Blocker Evaluation of Survival Trial (BEST) with chronic HF, New York Heart Association class III to IV symptoms and left ventricular ejection fraction < or =35%, 1,751 had SBP < or =120 mm Hg (median 108, range 70 to 120) and 955 had SBP >120 mm Hg (median 134, range 121 to 192). Propensity scores for SBP >120 mm Hg, calculated for each patient, were used to assemble a matched cohort of 545 pairs of patients with SBPs < or =120 and >120 mm Hg who were balanced in 65 baseline characteristics. Matched Cox regression models were used to estimate associations between SBP < or =120 mm Hg and outcomes over 4 years of follow-up. Matched participants had a mean age +/- SD of 62 +/- 12 years, 24% were women, and 24% were African-American. HF hospitalization occurred in 38% and 32% of patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.33 SBP < or =120 was compared to >120 mm Hg, 95% confidence interval 1.04 to 1.69, p = 0.023). All-cause mortality occurred in 28% and 30% of matched patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.13 SBP < or =120 compared to >120 mm Hg, 95% confidence interval 0.86 to 1.49, p = 0.369). In conclusion, in patients with advanced chronic systolic HF, baseline SBP < or =120 mm Hg is associated with increased risk of HF hospitalization, but had no association with all-cause mortality.
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Gheorghiade M, Flaherty JD, Fonarow GC, Desai RV, Lee R, McGiffin D, Love TE, Aban I, Eichhorn EJ, Bonow RO, Ahmed A. Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure. Int J Cardiol 2010; 151:69-75. [PMID: 20554334 DOI: 10.1016/j.ijcard.2010.04.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 04/20/2010] [Accepted: 04/28/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs. METHODS Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics. RESULTS All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015). CONCLUSIONS In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.
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Desai RV, Gupta R, Litovsky SH, Nath H, Gupta H, Singh SP, Evanochko WT, Knobloch JE, Lloyd SG. X-ray angiography and magnetic resonance imaging to distinguish interarterial from septal courses of anomalous left coronary artery: an ex vivo heart model. J Invasive Cardiol 2009; 21:648-652. [PMID: 19966369] [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: 05/28/2023]
Abstract
OBJECTIVE We sought to demonstrate the distinguishing features between interarterial and intraseptal courses of an anomalous left coronary artery from the right sinus of Valsalva (RSV) on X-ray angiography, using an ex vivo model. BACKGROUND An anomalous left main coronary artery (LMCA) arising from the RSV can take prepulmonary, retro-aortic, interarterial (IA) or intraseptal (IS) courses, of which only the IA course is associated with sudden death. Anomalous LMCA is usually identified during catheter angiography. On Xray angiography, IA and IS courses have common characteristics that makes their distinction challenging. We hypothesized that the cranialcaudal orientation of the vessel on X-ray angiography allows these pathways to be distinguished, and tested this hypothesis using an ex vivo heart model. METHODS Plastic tubing was inserted along the IA and IS courses in an ex vivo normal pig heart. X-ray imaging in standard views and MRI on a 3-T scanner were performed. RESULTS In a normally formed heart, an anomalous LMCA with IA path must take a cephalad course, superior to the pulmonary valve. Conversely, an IS vessel will pass caudally, at or below the level of the infundibular septum. These findings were demonstrated in the X-ray angiograms and confirmed by magnetic resonance imaging. CONCLUSIONS X-ray angiography can differentiate IA and IS courses of an anomalous LMCA in the normally formed heart. This may obviate the need for further cross-sectional imaging in many cases.
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Affiliation(s)
- Ravi V Desai
- Department of Medicine, University of Alabama at Birmingham, 35294, USA
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Krishnamurthy M, Desai RV, Patel H. A man with drowsiness and abdominal pain. Postgrad Med J 2004; 80:555, 557. [PMID: 15356361 PMCID: PMC1743089 DOI: 10.1136/pgmj.2003.014746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Krishnamurthy
- Department of internal medicine, yckoff heights medical Center, Brooklyn, NY, USA
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Desai RV, Bansilal S. Looking beyond haemodynamics in chronic heart failure. Postgrad Med J 2004; 80:247. [PMID: 15082860 PMCID: PMC1742973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Jain V, Singhi S, Desai RV. Infectious mononucleosis presenting as upper airway obstruction. Indian J Chest Dis Allied Sci 2003; 45:135-7. [PMID: 12715938] [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: 03/02/2023]
Abstract
Upper airway obstruction though a common complication of infectious mononucleosis is rarely considered in differential diagnosis of stridor. We report a three-year-old child who had upper airway obstruction due to infectious mononucleosis, managed conservatively with oxygen, intravenous fluids and steroids.
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Affiliation(s)
- Vivek Jain
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Desai RV, Jain V, Singh P, Singhi S, Radotra BD. Radiculomyelitic rabies: can MR imaging help? AJNR Am J Neuroradiol 2002; 23:632-4. [PMID: 11950657 PMCID: PMC7975101] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Radiculomyelitic (silent) rabies and acute disseminated encephalomyelitis have similar clinical presentations but distinct management and prognostic implications. It is thus important to differentiate between the two antemortem. Because of their distinct pathologic abnormalities, MR imaging may be helpful in distinguishing between the two entities. We report a case in which MR imaging helped us to diagnose silent rabies antemortem, which was subsequently confirmed at autopsy.
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Affiliation(s)
- Ravi V Desai
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Desai RV, Jain V, Katariya S. Codman's triangle in tubercular osteomyelitis. J Postgrad Med 2002; 48:157-8. [PMID: 12215708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Shah HS, Mehta RV, Desai RV. Estimation of particle size distribution parameters with forward-scattering techniques. Appl Opt 1979; 18:4173-4177. [PMID: 20216775 DOI: 10.1364/ao.18.004173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A polydisperse sample can be statistically represented by a log-normal distribution having two parameters, viz., geometrical standard deviation sigma(g) and modal size parameter X(m). In an earlier paper a method to determine sigma(g) from the shift in the angular position of the maximum in Itheta(2) vs theta plot was discussed. The present paper describes a method of determining the other parameter X(m) from the polarization measurement in the forward direction. This can be achieved by comparing the angular position of maxima in P (degree of polarization) vs theta with that of the similar curve of a single particle. Certain experimental results are also discussed. This method is expected to be useful in routine particle size analysis.
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