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Perera S, Aslam A, Burgess S, Castles AV, Segan L, Mukherjee S, Beale AL, Gutman SJ, Biswas S, Leet A, Zaman S. Gender Differences in Medical Student Perceptions of a Career in Cardiology. Heart Lung Circ 2023; 32:1250-1256. [PMID: 37414678 DOI: 10.1016/j.hlc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Worldwide, the cardiology profession has an under-representation of women. We assessed medical students' perceptions of cardiology as a career choice with the aim of identifying barriers to gender diversity. METHOD An anonymous survey was distributed to medical students studying at three Australian medical universities. Questions pertained to demographics, year and stage of medical training, desire to pursue cardiology, and perceived barriers to a cardiology career. Results were analysed according to identified gender and desire to pursue or not pursue a cardiology career. Multivariable logistic regression evaluated for independent associations. The primary outcome were barriers identified to pursuing a career in cardiology. RESULTS From 127 medical student respondents (86.6% female, mean age 25.9±4.8 years), 37.0% stated they wanted to pursue a career in cardiology (39.1% of women versus 23.5% of men, p=0.54). The top four perceived barriers to a cardiology career included: poor work-life balance (92/127, 72.4%), physician training process (63/127, 49.6%), on-call requirements (50/127, 39.4%) and lack of flexibility (49/127, 38.6%), with no gender differences. Women were more likely to report gender-related barriers (37.3% versus 5.9%, p=0.01) and less likely to identify procedural aspects as a barrier (5.5% women versus 29.4% men, p=0.001). Students in their pre-clinical years were more likely to want a career in cardiology (odds ratio 3.0, 95% confidence interval 1.2-7.7, p=0.02). CONCLUSIONS A high proportion of female and male medical students want to pursue a career in cardiology with both genders identifying major barriers of poor work-life balance, lack of flexibility, on-call requirements and the training process.
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Affiliation(s)
| | - Anum Aslam
- Monash Health, Melbourne, Vic, Australia; Western Health, Melbourne, Vic, Australia
| | - Sonya Burgess
- Department of Medicine, The University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Nepean Hospital, Sydney, NSW, Australia
| | - Anastasia Vlachadis Castles
- Department of Cardiology, The Northern Hospital, Melbourne, Vic, Australia; Austin Clinical School, Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
| | - Louise Segan
- Department of Cardiology, Barwon Health, Melbourne, Vic, Australia; Clinical Research, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Swati Mukherjee
- Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia
| | - Anna L Beale
- Monash Health, Melbourne, Vic, Australia; Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Sarah J Gutman
- Monash Health, Melbourne, Vic, Australia; Clinical Research, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Sinjini Biswas
- Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Angeline Leet
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Sarah Zaman
- School of Clinical Sciences Monash Health, Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
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2
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Marschner S, Mukherjee S, Watts M, Min H, Beale AL, O'Brien J, Juneja A, Tremmel JA, Zaman S. Prevention of Cardiovascular Disease in Women With Pregnancy-Related Risk Factors: A Prospective Women's Heart Clinic Study. J Am Heart Assoc 2023; 12:e030015. [PMID: 37642017 PMCID: PMC10547318 DOI: 10.1161/jaha.123.030015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P=0.004), with no significant change in lipid targets (80.6% to 83.7%, P=0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], P<0.001), body mass index (-0.6 kg/m2 [95% CI, -0.8 to -0.3], P<0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], P=0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] P=0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P=0.012), decreased fast food consumption (33.8% to 11.0%, P<0.001), and increased physical activity (84.0% to 92.9%, P=0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Swati Mukherjee
- Department of CardiologyCabrini HealthMelbourneAustralia
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneAustralia
| | - Monique Watts
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medical EducationUniversity of MelbourneMelbourneAustralia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Anna L. Beale
- Department of CardiologyAlfred HospitalMelbourneAustralia
| | | | - Aashima Juneja
- Department of MedicineThe Northern HospitalMelbourneAustralia
| | - Jennifer A. Tremmel
- Department of Medicine (Cardiovascular)Stanford University School of MedicineStanfordCA
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
- Department of CardiologyWestmead HospitalSydneyAustralia
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3
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Gard EK, Beale AL, Telles F, Silvestry FE, Hanff T, Hummel SL, Litwin SE, Petrie MC, Shah SJ, Borlaug BA, Burkhoff D, Komtebedde J, Kaye DM, Nanayakkara S. Left atrial enlargement is associated with pulmonary vascular disease in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:806-814. [PMID: 36847073 PMCID: PMC10625803 DOI: 10.1002/ejhf.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF. METHODS AND RESULTS Data from 85 patients (aged 69 ± 8 years) who underwent exercise right heart catheterization and echocardiography were retrospectively analysed. All had symptoms of heart failure, left ventricular ejection fraction ≥50% and haemodynamic features of HFpEF. Patients were divided into LA volume index-based tertiles (≤34 ml/m2 , >34 to ≤45 ml/m2 , >45 ml/m2 ). A subgroup analysis was performed in patients with recorded LA global reservoir strain (n = 60), with reduced strain defined as ≤24%. Age, sex, body surface area and left ventricular ejection fraction were similar between volume groups. LA volume was associated with blunted increases in cardiac output with exercise (padjusted <0.001), higher resting mean pulmonary artery pressure (padjusted = 0.003), with similar wedge pressure (padjusted = 1). Pulmonary vascular resistance (PVR) increased with increasing LA volume (padjusted <0.001). Larger LA volumes featured reduced LA strain (padjusted <0.001), with reduced strain associated with reduced PVR-compliance time (0.34 [0.28-0.40] vs. 0.38 [0.33-0.43], p = 0.03). CONCLUSION Increasing LA volume may be associated with more advanced pulmonary vascular disease in HFpEF, featuring higher PVR and pulmonary pressures. Reduced LA function, worse at increasing LA volumes, is associated with a disrupted PVR-compliance relationship, further augmenting impaired pulmonary haemodynamics.
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Affiliation(s)
| | | | - Fernando Telles
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Thomas Hanff
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott L. Hummel
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Dan Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - David M. Kaye
- Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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4
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Senarath S, Nanayakkara P, Beale AL, Watts M, Kaye DM, Nanayakkara S. Diagnosis and management of arrhythmias in pregnancy. Europace 2021; 24:1041-1051. [PMID: 34904149 DOI: 10.1093/europace/euab297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Arrhythmias are the most common cardiac complications occurring in pregnancy. Although the majority of palpitations in pregnancy may be explained by atrial or ventricular premature complexes, the full spectrum of arrhythmias can occur. In this article, we establish a systematic approach to the evaluation and management of arrhythmias in pregnancy. Haemodynamically unstable arrhythmias warrant urgent cardioversion. For mild cases of benign arrhythmia, treatment is usually not needed. Symptomatic but haemodynamically stable arrhythmic patients should first undergo a thorough evaluation to establish the type of arrhythmia and the presence or absence of structural heart disease. This will ultimately determine the necessity for treatment given the potential risks of anti-arrhythmic pharmacotherapy in pregnancy. We will discuss the main catalogue of anti-arrhythmic medications, which have some established evidence of safety in pregnancy. Based on our appraisal, we provide a treatment algorithm for the tachyarrhythmic pregnant patient.
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Affiliation(s)
- Sachintha Senarath
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Pavitra Nanayakkara
- Department of Obstetrics and Gynaecology, The Epworth Hospital, Richmond, Victoria, Australia
| | - Anna L Beale
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Monique Watts
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - David M Kaye
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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5
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Beale AL, O'Donnell JA, Nakai ME, Nanayakkara S, Vizi D, Carter K, Dean E, Ribeiro RV, Yiallourou S, Carrington MJ, Marques FZ, Kaye DM. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e020654. [PMID: 34212778 PMCID: PMC8403331 DOI: 10.1161/jaha.120.020654] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Risk factors for heart failure with preserved ejection fraction (HFpEF) include hypertension, age, sex, and obesity. Emerging evidence suggests that the gut microbiota independently contributes to each one of these risk factors, potentially mediated via gut microbial‐derived metabolites such as short‐chain fatty acids. In this study, we determined whether the gut microbiota were associated with HFpEF and its risk factors. Methods and Results We recruited 26 patients with HFpEF and 67 control participants from 2 independent communities. Patients with HFpEF were diagnosed by exercise right heart catheterization. We assessed the gut microbiome by bacterial 16S rRNA sequencing and food intake by the food frequency questionnaire. There was a significant difference in α‐diversity (eg, number of microbes) and β‐diversity (eg, type and abundance of microbes) between both cohorts of controls and patients with HFpEF (P=0.001). We did not find an association between β‐diversity and specific demographic or hemodynamic parameters or risk factors for HFpEF. The Firmicutes to Bacteroidetes ratio, a commonly used marker of gut dysbiosis, was lower, but not significantly so (P=0.093), in the patients with HFpEF. Compared with controls, the gut microbiome of patients with HFpEF was depleted of bacteria that are short‐chain fatty acid producers. Consistent with this, participants with HFpEF consumed less dietary fiber (17.6±7.7 versus 23.2±8.8 g/day; P=0.016). Conclusions We demonstrate key changes in the gut microbiota in patients with HFpEF, including the depletion of bacteria that generate metabolites known to be important for cardiovascular homeostasis. Further studies are required to validate the role of these gut microbiota and metabolites in the pathophysiology of HFpEF.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Joanne A O'Donnell
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Michael E Nakai
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Shane Nanayakkara
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia
| | - Donna Vizi
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Kaye Carter
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Eliza Dean
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Rosilene V Ribeiro
- School of Life and Environmental Sciences, Charles Perkins Centre University of Sydney Australia
| | - Stephanie Yiallourou
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Francine Z Marques
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - David M Kaye
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
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6
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Vlachadis Castles A, Burgess S, Robledo K, Beale AL, Biswas S, Segan L, Gutman S, Mukherjee S, Leet A, Zaman S. Work-life balance: a comparison of women in cardiology and other specialties. Open Heart 2021; 8:e001678. [PMID: 34290044 PMCID: PMC8296777 DOI: 10.1136/openhrt-2021-001678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Significant gender disparities exist in some medical specialties, particularly cardiology. We assessed work, personal life and work-life balance in women in cardiology in Australia and New Zealand (NZ), compared with other specialties, to determine factors that may contribute to the lack of women in the specialty. METHODS This study is a prospective survey-based cohort study comparing cardiology and non-cardiology specialties. An online survey was completed by female doctors in Australia and NZ, recruited via email lists and relevant social media groups. The survey included demographics, specialty, stage of training, work hours/setting, children and relationships, career satisfaction, income and perceptions of specialty. RESULTS 452 participants completed the survey (median age 36 years), of which 57 (13%) worked in cardiology. Of all respondents, 84% were partnered and 75% had children, with no difference between cardiology and non-cardiology specialties. Compared with non-cardiology specialties, women in cardiology worked more hours per week (median 50 hours vs 40 hours, p<0.001), were more likely to be on call more than once per week (33% vs 12%, p<0.001) and were more likely to earn an annual income >$3 00 000 (35% vs 10%, p<0.001). Women in cardiology were less likely to agree that they led a balanced life (33% vs 51%, p=0.03) or that their specialty was female friendly (19% vs 75%, p<0.001) or family friendly (20% vs 63%, p<0.001). CONCLUSIONS Compared with other specialties, women in cardiology reported poorer work-life balance, greater hours worked and on-call commitments and were less likely to perceive their specialty as female friendly or family friendly. Addressing work-life balance may attract and retain more women in cardiology.
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Affiliation(s)
- Anastasia Vlachadis Castles
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Sonya Burgess
- Department of Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kristy Robledo
- Biostatistics, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Anna L Beale
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Louise Segan
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
| | - Sarah Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Swati Mukherjee
- Department of Cardiology, Cabrini Health, Malvern, Victoria, Australia
| | - Angeline Leet
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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7
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Kuang RJ, Beale AL, Bloom JE, Clements W. Paradoxical Cerebral Embolism Secondary to Superior Vena Cava Occlusion and Development of a Systemic Right-to-Left Shunt. Journal of Clinical Interventional Radiology ISVIR 2021. [DOI: 10.1055/s-0041-1730104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractParadoxical cerebral embolism, although rare, can be secondary to acquired causes such as superior vena cava (SVC) occlusion and development of a mediastinal right-to-left shunt. Such shunts allow undisturbed passage of thromboemboli to bypass the pulmonary circulation and enter the systemic circulation. This report presents a case of paradoxical cerebral embolism due to a right-to-left shunt originating from occlusion of the SVC. The etiology of the SVC occlusion stems from a prior central venous access line used for treatment of lymphoma. The patient underwent endovascular treatment with successful coil embolization of the mediastinal shunt.
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Affiliation(s)
- Ronny J.D. Kuang
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anna L Beale
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
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8
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Beale AL, Cosentino C, Segan L, Mariani JA, Vizi D, Evans S, Nanayakkara S, Kaye DM. The effect of parity on exercise physiology in women with heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:213-222. [PMID: 31960599 PMCID: PMC7083419 DOI: 10.1002/ehf2.12557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/01/2019] [Accepted: 10/25/2019] [Indexed: 01/08/2023] Open
Abstract
Aims Women are overrepresented amongst patients with heart failure with preserved ejection fraction (HFpEF); however, the underpinning mechanism for this asymmetric distribution is unclear. Pregnancy represents a potential gender‐specific risk factor for HFpEF. It leads to significant physiological adaption, and increasing parity has been associated with some cardiovascular risk. We sought to examine the relationship between prior parity with the rest and exercise haemodynamic and echocardiographic profile of women with HFpEF. Methods and results Patients referred for assessment of exertional dyspnoea and confirmed to have a haemodynamic and clinical profile consistent with HFpEF were included. Detailed evaluation consisted of rest and exercise right heart catheterization and echocardiography. A socio‐economic and obstetric history was also documented. Fifty‐eight women were assessed and categorized as having either 0–2 births or ≥3 births, dividing the cohort equally. Women with ≥3 births achieved a lower symptom‐limited workload than those with 0–2 births [38 (24–51) vs. 46 (31–68) W, P = 0.04]. Women with ≥3 births had a greater rise in pulmonary capillary wedge pressure indexed to workload with exercise [0.5 (0.3–0.8) vs. 0.3 (0.2–0.5) mmHg/W, P = 0.03], paralleled by a greater rise in right atrial pressure [10 (8–12) vs. 7 (3–11), P = 0.01]. Pulmonary vascular resistance was also higher in women with ≥3 births [1.9 (1.6–2.4) vs. 1.6 (1.4–1.9) mmHg/L/min rest, P = 0.046, and 1.9 (2.4–2.4) vs. 1.4 (1–1.8) mmHg/L/min exercise, P = 0.024]. Left ventricular ejection fraction was lower at rest [60 (57–61) vs. 63 (60–66), P = 0.008] and during exercise [65 (62–67) vs. 68 (66–70), P = 0.038] in women with higher parity. Conclusions Higher parity is associated with greater impairments in multiple physiologic parameters of HFpEF severity in women, including diastolic reserve, pulmonary vascular resistance, and systolic dysfunction.
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Affiliation(s)
- Anna L Beale
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Carmela Cosentino
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Louise Segan
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Justin A Mariani
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Donna Vizi
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Shona Evans
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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9
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Lam CSP, Arnott C, Beale AL, Chandramouli C, Hilfiker-Kleiner D, Kaye DM, Ky B, Santema BT, Sliwa K, Voors AA. Sex differences in heart failure. Eur Heart J 2019; 40:3859-3868c. [DOI: 10.1093/eurheartj/ehz835] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [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] [Received: 06/09/2019] [Revised: 08/08/2019] [Accepted: 11/28/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
The overall lifetime risk of heart failure (HF) is similar between men and women, however, there are marked sex differences in the landscape of this condition that are both important and under-recognized. Men are predisposed to HF with reduced ejection fraction (HFrEF), whereas women predominate in HF with preserved ejection fraction (HFpEF). Sex differences are also notable in the penetrance of genetic cardiomyopathies, risk factors, e.g. breast cancer which may be associated with cancer treatment-induced cardiomyopathy, as well as sex-specific conditions such as peripartum cardiomyopathy (PPCM). This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address important differences in the prognosis of HF. A central hypothesis is that the higher risk of HFrEF in men compared to women may be attributable to their predisposition to macrovascular coronary artery disease and myocardial infarction, whereas coronary microvascular dysfunction/endothelial inflammation has been postulated to play a key role in HFpEF and maybe the common link among HF syndromes that women are predisposed to Takotsubo cardiomyopathy, PPCM, and breast cancer radiotherapy-induced cardiomyopathy. Under-pinning current sex disparities in HF, there is a paucity of women recruited to HF clinical trials (20–25% of cohorts) and thus treatment guidelines are predominantly based on male-derived data. Large gaps in knowledge exist in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
- Duke-National University of Singapore, 8 College Rd, Singapore, Singapore
- University Medical Centre Groningen, Hanzeplein 1, GZ Groningen, The Netherlands
- The George Institute, Level 5/1 King St, Newtown NSW, Sydney, Australia
| | - Clare Arnott
- The George Institute, Level 5/1 King St, Newtown NSW, Sydney, Australia
| | - Anna L Beale
- Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne VIC, Australia
| | | | | | - David M Kaye
- Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne VIC, Australia
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Bernadet T Santema
- University Medical Centre Groningen, Hanzeplein 1, GZ Groningen, The Netherlands
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Private Bag X3 7935 Observatory, Cape Town, South Africa
| | - Adriaan A Voors
- University Medical Centre Groningen, Hanzeplein 1, GZ Groningen, The Netherlands
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10
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Nanayakkara S, Telles F, Beale AL, Evans S, Vizi D, Marwick TH, Kaye DM. Relationship of Degree of Systolic Dysfunction to Variations in Exercise Capacity and Hemodynamic Status in HFpEF. JACC Cardiovasc Imaging 2019; 13:528-530. [PMID: 31734204 DOI: 10.1016/j.jcmg.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022]
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11
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Beale AL, Cosentino C, Segan L, Mariani J, Vizi D, Evans S, Nanayakkara S, Kaye DM. 130The effect of parity on exercise physiology in women with heart failure with preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Women are overrepresented amongst patients with HFpEF, however the underpinning mechanism for this asymmetric distribution is unclear. Pregnancy has been demonstrated to contribute to cardiovascular risk, and represents a potential gender specific risk factor for HFpEF.
Purpose
To investigate the relationship between parity and severity of HFpEF on invasive haemodynamic and echocardiographic studies.
Methods
Patients referred for investigation of dyspnoea with exercise right heart catheterisation from 2008–19 were included and classified as HFpEF with an ejection fraction (EF) ≥50% and a resting PCWP ≥15mmHg or exercise PCWP ≥25mmHg. All patients underwent detailed haemodynamic and echocardiographic assessment, and an obstetric history including socioeconomic data were obtained using a questionnaire.
Results
58 women were included, and categorised as having either 0–2 births, or ≥3 births, dividing the cohort equally. Women with ≥3 births achieved a lower peak exercise workload than those with 0–2 births (46 [31–68] vs. 38 [24–51] W, p=0.04). Women with ≥3 births had a greater rise in pulmonary capillary wedge pressure indexed to workload with exercise (0.5 [0.3–0.8] vs. 0.3 [0.2–0.5] mmHg/W, p=0.03), paralleled by a greater rise in right atrial pressure (10 [8–12] vs. 7 [3–11] mmHg, p=0.01), pictured. Pulmonary vascular resistance was also higher in women with ≥3 births (1.9 [1.6–2.4] vs. 1.6 [1.4–1.9] mmHg/L/min rest, p=0.046, and 1.9 [2.4–2.4] vs. 1.4 [1–1.8] mmHg/L/min exercise, p=0.024). Left ventricular ejection fraction was lower at rest (60 [57–61] vs. 63 [60–66] %, p=0.008) and during exercise (65 [62–67] vs. 68 [66–70] %, p=0.038) in women with higher parity. Otherwise, echocardiographic parameters did not differ according to parity. There were no significant differences between parity groups in baseline characteristics, including age, body mass index, systemic blood pressure, natriuretic peptides or dyspnea class. Similarly, comorbidities and socioeconomic status did not differ.
Conclusion(s)
Higher parity is associated with impairments in multiple physiologic parameters of HFpEF severity in women, including diastolic reserve, pulmonary vascular resistance, and systolic function. This may indicate a role for pregnancy in the development of HFpEF, and suggests that multiparous women should be targeted for intensification of preventative measures for HFpEF.
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Affiliation(s)
- A L Beale
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - L Segan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J Mariani
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - D Vizi
- The Alfred Hospital, Melbourne, Australia
| | - S Evans
- The Alfred Hospital, Melbourne, Australia
| | - S Nanayakkara
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - D M Kaye
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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12
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Beale AL, Meyer P, Marwick TH, Lam CSP, Kaye DM. Sex Differences in Cardiovascular Pathophysiology: Why Women Are Overrepresented in Heart Failure With Preserved Ejection Fraction. Circulation 2019; 138:198-205. [PMID: 29986961 DOI: 10.1161/circulationaha.118.034271] [Citation(s) in RCA: 265] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Consistent epidemiological data demonstrate that patients with heart failure with preserved ejection fraction (HFpEF) are more likely to be women than men. Exploring mechanisms behind this sex difference in heart failure epidemiology may enrich the understanding of underlying HFpEF pathophysiology and phenotypes, with the ultimate goal of identifying therapeutic approaches for the broader HFpEF population. In this review we evaluate the influence of sex on the key domains of cardiac structure and function, the systemic and pulmonary circulation, as well as extracardiac factors and comorbidities that may explain the predisposition of women to HFpEF. We highlight the potential role of factors exclusive to or more prevalent in women such as pregnancy, preeclampsia, and iron deficiency. Finally, we discuss existing controversies and gaps in knowledge, as well as the clinical importance of known sex differences in the context of the potential need for sex-specific diagnostic criteria, improved risk stratification models, and targeted therapies.
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Affiliation(s)
- Anna L Beale
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia (A.L.B., D.M.K.)
| | - Philippe Meyer
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia (A.L.B., D.M.K.)
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.).,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre Groningen, The Netherlands (C.S.P.L.)
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.). .,Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (A.L.B., T.H.M., D.M.K.)
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13
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Cieslik LK, Patel HC, Steele SJ, Beale AL, Tan CN, Mariani JA, Nanayakkara S, Kaye DM. Non-invasive blood pressure monitoring underestimates hypertensive response to exercise in suspected heart failure with preserved ejection fraction. Eur J Prev Cardiol 2019; 27:2180-2182. [PMID: 31480876 DOI: 10.1177/2047487319873452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Hitesh C Patel
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia
| | | | - Anna L Beale
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | | | - Justin A Mariani
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
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Beale AL, Nanayakkara S, Kaye DM. Impact of Sex on Ventricular-Vascular Stiffness and Long-Term Outcomes in Heart Failure With Preserved Ejection Fraction: TOPCAT Trial Substudy. J Am Heart Assoc 2019; 8:e012190. [PMID: 31230508 PMCID: PMC6662372 DOI: 10.1161/jaha.119.012190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Women have higher vascular stiffness with aging. The aim of this study was to characterize sex differences in vascular and ventricular structure and function, and to investigate the impact on the primary outcome in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). Methods and Results Data from the Americas cohort of the TOPCAT trial were analyzed. Patients with echocardiography (n=654) were compared according to sex, and achievement of the primary end point (a composite of death from cardiovascular causes and heart failure hospitalization) assessed. Echocardiography revealed higher arterial, systolic, and diastolic ventricular elastance and worse ventricular‐vascular coupling in women. Women had better overall survival and heart failure hospitalization outcomes (hazard ratio 0.74, 95% CI 0.57–0.98, P=0.034), however, determinants of achievement of the primary outcome differed between the sexes. Pulse pressure was a key determinant of outcome in women (hazard ratio 1.04, 95% CI 1–1.09, P=0.034) whereas in men heart rate (hazard ratio 1.61, 95% CI 1.02–2.52 per 10 mm Hg increase, P=0.04) and B‐type natriuretic peptide (hazard ratio 1.01, 95% CI 1–1.02 per 10 ng/mL increase P=0.02) were associated with poorer outcome. Conclusions Outcomes in patients with heart failure with preserved ejection fraction appear to be differentially influenced by key physiological factors that vary according to sex. In women, ventricular‐vascular stiffening was the most significant determinant of outcome, whereas in men overall survival was influenced by heart rate and B‐type natriuretic peptide; this highlights key sex differences in the pathophysiology and outcomes of heart failure with preserved ejection fraction and warrants further exploration. Clinical Trial Registration URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Anna L Beale
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
| | - Shane Nanayakkara
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
| | - David M Kaye
- 1 Department of Cardiology Alfred Hospital Melbourne Australia.,2 Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,3 Department of Medicine Monash University Melbourne Australia
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15
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Beale AL, Nanayakkara S, Kaye DM. Reply: The Importance of Baseline Physical Activity Level in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2019; 7:535-536. [PMID: 31146881 DOI: 10.1016/j.jchf.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022]
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Abstract
There has been intense interest in the role of the gut microbiome in human health and a broad range of diseases in recent years. In the context of cardiovascular disease, gut dysbiosis (defined as a change in the gut microbiome and the gut-epithelial barrier) has been linked to disturbances in blood pressure (BP) regulation. These findings build upon our understanding of the complex pathophysiology of essential hypertension. There are clear sex differences in the epidemiology of hypertension, with distinct trends in BP across the life-course in men and women. To date, a role for the gut microbiome in contributing to the sex differences in BP is yet to be clearly established. The purpose of this review is to summarise the current literature regarding how the gut microbiome differs between men and women and to investigate whether sex-determined differences in the gut microbiome influence the response to factors such as diet, obesity and inflammation. Finally, we will explore evidence for the possible interaction between sex-specific factors, including sex hormones and pregnancy, with the gut in the context of hypertension pathophysiology.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Francine Z Marques
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia. .,School of Biological Sciences, Faculty of Science, Monash University, Melbourne, Australia.
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17
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Beale AL, Warren JL, Roberts N, Meyer P, Townsend NP, Kaye D. Iron deficiency in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Open Heart 2019; 6:e001012. [PMID: 31168385 PMCID: PMC6519409 DOI: 10.1136/openhrt-2019-001012] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 12/30/2022] Open
Abstract
Objective Iron deficiency (ID) has an established impact on outcomes in patients with heart failure with reduced ejection fraction; however, there is a lack of conclusive evidence in patients with heart failure with preserved ejection fraction (HFpEF). We sought to clarify the prevalence and impact of ID in patients with HFpEF. Methods A systematic search of Cohcrane, MEDLINE, EMBASE, Web of Science and CINAHL electronic databases was performed to identify relevant studies. Included studies defined HFpEF as heart failure with an ejection fraction ≥50%. We used a random-effects meta-analysis to determine the composite prevalence of ID in patients with HFpEF across the included studies. Other outcomes were assessed with qualitative analysis due to a paucity of studies with comparable outcome measures. Results The prevalence of ID in the included studies was 59% (95% CI 52% to 65%). ID was associated with lower VO2 max in three of four studies reporting VO2 max as an outcome measure, lower functional status as determined by dyspnoea class or 6 min walk test in two of three studies, and worse health-related quality of life in both studies reporting on this outcome. Conversely, ID had no impact on death or hospitalisation in three of the four studies investigating this. Conclusions ID is highly prevalent in patients with HFpEF and is associated with worse exercise capacity and functional outcomes, but not hospitalisation or mortality. Our study establishes that ID may play an important a role in HFpEF.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | | | - Nia Roberts
- Knowledge Centre, University of Oxford Health Care Libraries, Oxford, UK
| | - Philippe Meyer
- Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - David Kaye
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Cardiology, Alfred Health, Melbourne, Victoria, Australia
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18
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Nanayakkara S, Beale AL, Evans S, Vizi D, Kaye D. LOW BRAIN NATRIURETIC PEPTIDE IN HEMODYNAMICALLY PROVEN HEART FAILURE PRESERVED EJECTION FRACTION: AN INVASIVE-ECHOCARDIOGRAPHIC CHARACTERIZATION STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31360-9] [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: 10/27/2022]
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19
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Beale AL, Nanayakkara S, Segan L, Mariani JA, Maeder MT, van Empel V, Vizi D, Evans S, Lam CS, Kaye DM. Sex Differences in Heart Failure With Preserved Ejection Fraction Pathophysiology. JACC: Heart Failure 2019; 7:239-249. [DOI: 10.1016/j.jchf.2019.01.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
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20
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Beale AL, Julliard MV, Maziarski P, Ziltener JL, Burri H, Meyer P. Electrocardiographic findings in elite professional cyclists: The 2017 international recommendations in practice. J Sci Med Sport 2018; 22:380-384. [PMID: 30001949 DOI: 10.1016/j.jsams.2018.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/25/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To categorize ECG findings into normal, borderline or abnormal in a team of professional elite cyclists according to the 2017 international recommendations. DESIGN A cross-sectional study was performed. METHODS Twelve-lead ECGs collected between 2012 and 2015 as part of an annual routine examination for a team of professional elite cyclists were analysed, and findings classified as normal, borderline or abnormal according to the 2017 recommendations. Information on exercise capacity testing was also collected. RESULTS A total of 43 professional cyclists, all Caucasian males ranging between 21 and 38years of age, were included. Given most were followed up for multiple years, a total of 103 ECGs were collected. Normal variations were found in 43 (100%) athletes; borderline findings in 4 (9.3%), and 2 (4.7%) athletes had abnormal findings. No pathology was identified on further investigation of the four cyclists with two concurrent borderline or any abnormal ECG findings, reflecting a false positive rate of 9.3%. CONCLUSIONS In this team of professional cyclists, the prevalence of abnormal ECG findings requiring further investigation, and the false positive rate were low, despite a very high prevalence of normal variations expected in athletes. This may be as a result of heightened specificity of the new international recommendations for ECG interpretation in athletes.
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Affiliation(s)
- Anna L Beale
- Cardiology Service, Geneva University Hospitals, Switzerland; Monash University Central Clinical School, Australia.
| | | | | | - Jean-Luc Ziltener
- Centre for Sports Medicine and Exercise, Clinique la Colline, Switzerland
| | - Haran Burri
- Cardiology Service, Geneva University Hospitals, Switzerland
| | - Philippe Meyer
- Cardiology Service, Geneva University Hospitals, Switzerland
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21
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Fang L, Ellims AH, Beale AL, Taylor AJ, Murphy A, Dart AM. Systemic inflammation is associated with myocardial fibrosis, diastolic dysfunction, and cardiac hypertrophy in patients with hypertrophic cardiomyopathy. Am J Transl Res 2017; 9:5063-5073. [PMID: 29218105 PMCID: PMC5714791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Regional or diffuse fibrosis is an early feature of hypertrophic cardiomyopathy (HCM) and is related to poor prognosis. Previous studies have documented low-grade inflammation in HCM. The aim of this study was to examine the relationships between circulating inflammatory markers and myocardial fibrosis, systolic and diastolic dysfunction, and the degree of cardiac hypertrophy in HCM patients. METHODS AND RESULTS Fifty HCM patients were recruited while 20 healthy subjects served as the control group. Seventeen inflammatory cytokines/chemokines were measured in plasma. Cardiac magnetic resonance imaging and echocardiography were used to assess cardiac phenotypes. Tumour necrosis factor (TNF)-α, interleukin (IL)-6 and serum amyloid P (SAP) were significantly increased in HCM patients compared to controls. IL-6, IL-4, and monocyte chemotactic protein (MCP)-1 were correlated with regional fibrosis while stromal cell-derived factor-1 and MCP-1 were correlated with diffuse fibrosis. Fractalkine and interferon-γ were associated with left ventricular wall thickness. The above associations remained significant in a linear regression model including age, gender, body mass index and family history. TNF-α, IL-6, SAP, MCP-1 and IL-10 were associated with parameters of diastolic dysfunction. White blood cells were also increased in HCM patients and correlated with diffuse fibrosis and diastolic dysfunction. However the associations between parameters of systemic inflammation and diastolic dysfunction were weakened in the linear regression analysis. CONCLUSIONS Systemic inflammation is associated with parameters of the disease severity of HCM patients, particularly regional and diffuse fibrosis. Modifying inflammation may reduce myocardial fibrosis in HCM patients.
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Affiliation(s)
- Lu Fang
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | - Andris H Ellims
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
- Department of Cardiovascular Medicine, Alfred Heart Centre, The Alfred HospitalMelbourne, Australia
| | - Anna L Beale
- Department of Cardiovascular Medicine, Alfred Heart Centre, The Alfred HospitalMelbourne, Australia
| | - Andrew J Taylor
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
- Department of Cardiovascular Medicine, Alfred Heart Centre, The Alfred HospitalMelbourne, Australia
| | - Andrew Murphy
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | - Anthony M Dart
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
- Department of Cardiovascular Medicine, Alfred Heart Centre, The Alfred HospitalMelbourne, Australia
- Monash UniversityMelbourne, Australia
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22
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Beale AL, Demaio AR. Non-communicable disease risk factors: a call for primary care clinicians to act and to refer. Brief intervention, not silent abdication. Br J Sports Med 2017; 53:322-323. [DOI: 10.1136/bjsports-2017-098475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 11/03/2022]
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Abstract
OBJECTIVES To examine prospectively the prevalence of iron deficiency among new patients presenting with colorectal cancer and to compare transferrin saturation and serum ferritin as markers of iron deficiency in this group of patients. PATIENTS AND METHODS Data were gathered on all patients presenting with a new diagnosis of colorectal cancer over a 12-month period. Iron status was estimated and, when possible, confirmed by measurement of serum ferritin concentration and transferrin saturation. Iron status was further examined in relation to tumour site and Dukes' stage. RESULTS During the study 157 patients presented with a new colorectal cancer. Of these, 130 could be evaluated and 78[60%] had evidence of iron deficiency. Transferrin saturation was below the reference range in 55 patients, but serum ferritin was below in only 18 patients. Among the 49 patients with right-sided cancers, 39[80%] were iron deficient. Iron deficiency was significantly more likely in patients with right sided cancers compared with those with cancers at or distal to the splenic flexure (chi2 = 13, P < 0.001). CONCLUSION The majority of patients with a new diagnosis of colorectal cancer are iron deficient at presentation. In such patients transferrin saturation measurement is a more sensitive marker of iron deficiency than serum ferritin. The potential role of measuring serum transferrin saturation as an adjunct to faecal occult blood screening should be explored further.
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Affiliation(s)
- A L Beale
- Royal Gwent Hospital, Newport, South Wales, UK
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