1
|
Zierath R, Claggett B, Arthur V, Yang Y, Skali H, Matsushita K, Kitzman D, Konety S, Mosley T, Shah AM. Changes in Pulmonary Artery Pressure Late in Life: The Atherosclerosis Risk in Communities (ARIC) Study. J Am Coll Cardiol 2023; 82:2179-2192. [PMID: 38030347 DOI: 10.1016/j.jacc.2023.09.821] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Although the prognostic implications of higher pulmonary artery systolic pressure (PASP) are well established, few data exist regarding longitudinal change in pulmonary pressure in late life. OBJECTIVES The aim of this study was to quantify changes in PASP over 6 years and determine the relative contributions of cardiac and pulmonary dysfunction. METHODS Among 1,420 participants in the ARIC (Atherosclerosis Risk in Communities) study with echocardiographic measures of PASP at both the fifth (2011-2013) and seventh (2018-2019) visits, longitudinal changes in PASP over about 6.5 years were quantified. Multivariable regression was used to determine the extent to which cardiac and pulmonary dysfunction were associated with changes in PASP and to define the relationship of changes in PASP with dyspnea development. RESULTS The mean age was 75 ± 5 years at visit 5 and 81 ± 5 years at visit 7, 24% of subjects were Black adults, and 68% were women. Over the 6.5 years, PASP increased by 5 ± 8 mm Hg, from 28 ± 5 to 33 ± 8 mm Hg. PASP increased more in older participants. Predictors of greater increases in PASP included worse left ventricular (LV) systolic and diastolic function, pulmonary function, and renal function. Increases in PASP were associated with concomitant increases in measures of LV filling pressure, including E/e' ratio and left atrial volume index. Each 5 mm Hg increase was associated with 16% higher odds of developing dyspnea (OR: 1.16; 95% CI: 1.07-1.27; P < 0.001). CONCLUSIONS Pulmonary pressure increased over 6.5 years in late life, was associated with concomitant increases in LV filling pressure, and predicted the development of dyspnea. Interventions targeting LV diastolic function may be effective at mitigating age-related increases in PASP.
Collapse
Affiliation(s)
- Rani Zierath
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Claggett
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Yimin Yang
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hicham Skali
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Suma Konety
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas Mosley
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Amil M Shah
- Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
2
|
Zhao L, Zierath R, Claggett B, Dorbala P, Matsushita K, Kitzman D, Folsom AR, Konety S, Mosley T, Skali H, Shah AM. Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The ARIC Study. JACC Cardiovasc Imaging 2023; 16:1133-1145. [PMID: 37178075 DOI: 10.1016/j.jcmg.2023.02.022] [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: 09/30/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND There is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for heart failure (HF). OBJECTIVES This study aims to quantify intraindividual longitudinal changes of diastolic function over 6 years in late life. METHODS The authors studied 2,524 older adult participants in the prospective community-based ARIC (Atherosclerosis Risk In Communities) study who underwent protocol-based echocardiography at study visits 5 (2011-2013) and 7 (2018-2019). The primary diastolic measures were tissue Doppler e', E/e' ratio, and left atrial volume index (LAVI). RESULTS Mean age was 74 ± 4 years at visit 5 and 80 ± 4 at visit 7, 59% were women, and 24% were Black. At visit 5, mean e'septal was 5.8 ± 1.4 cm/s, E/e'septal 11.7 ± 3.5, and LAVI 24.3 ± 6.7 mL/m2. Over a mean of 6.6 ± 0.8 years, e'septal decreased by 0.6 ± 1.4 cm/s, E/e'septal increased by 3.1 ± 4.4, and LAVI increased by 2.3 ± 6.4 mL/m2. The proportion with 2 or more abnormal diastolic measures increased from 17% to 42% (P < 0.001). Compared with participants free of cardiovascular (CV) risk factors or diseases at visit 5 (n = 234), those with prevalent CV risk factors or diseases but without prevalent or incident HF (n = 2,150) demonstrated greater increases in E/e'septal and LAVI. Increases of E/e'septal and LAVI were both associated with the development of dyspnea between visits in analyses adjusted for CV risk factors. CONCLUSIONS Diastolic function generally deteriorates over 6.6 years in late life, particularly among persons with CV risk factors, and is associated with development of dyspnea. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.
Collapse
Affiliation(s)
- Li Zhao
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Sixth Medical Center, PLA General Hospital, Beijing, China
| | - Rani Zierath
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pranav Dorbala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Aaron R Folsom
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Suma Konety
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas Mosley
- Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| |
Collapse
|
3
|
Kuno T, Vasquez N, April-Sanders AK, Swett K, Kizer JR, Thyagarajan B, Talavera GA, Ponce SG, Shook-Sa BE, Penedo FJ, Daviglus ML, Kansal MM, Cai J, Kitzman D, Rodriguez CJ. Pre-Heart Failure Longitudinal Change in a Hispanic/Latino Population-Based Study: Insights From the Echocardiographic Study of Latinos. JACC Heart Fail 2023; 11:946-957. [PMID: 37204366 DOI: 10.1016/j.jchf.2023.04.008] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pre-heart failure (pre-HF) is an entity known to progress to symptomatic heart failure (HF). OBJECTIVES This study aimed to characterize pre-HF prevalence and incidence among Hispanics/Latinos. METHODS The Echo-SOL (Echocardiographic Study of Latinos) assessed cardiac parameters on 1,643 Hispanics/Latinos at baseline and 4.3 years later. Prevalent pre-HF was defined as the presence of any abnormal cardiac parameter (left ventricular [LV] ejection fraction <50%; absolute global longitudinal strain <15%; grade 1 or more diastolic dysfunction; LV mass index >115 g/m2 for men, >95 g/m2 for women; or relative wall thickness >0.42). Incident pre-HF was defined among those without pre-HF at baseline. Sampling weights and survey statistics were used. RESULTS Among this study population (mean age: 56.4 years; 56% female), HF risk factors, including prevalence of hypertension and diabetes, worsened during follow-up. Significant worsening of all cardiac parameters (except LV ejection fraction) was evidenced from baseline to follow-up (all P < 0.01). Overall, the prevalence of pre-HF was 66.7% at baseline and the incidence of pre-HF during follow-up was 66.3%. Prevalent and incident pre-HF were seen more with increasing baseline HF risk factor burden as well as with older age. In addition, increasing the number of HF risk factors increased the risk of prevalence of pre-HF and incidence of pre-HF (adjusted OR: 1.36 [95% CI: 1.16-1.58], and adjusted OR: 1.29 [95% CI: 1.00-1.68], respectively). Prevalent pre-HF was associated with incident clinical HF (HR: 10.9 [95% CI: 2.1-56.3]). CONCLUSIONS Hispanics/Latinos exhibited significant worsening of pre-HF characteristics over time. Prevalence and incidence of pre-HF are high and are associated with increasing HF risk factor burden and with incidence of cardiac events.
Collapse
Affiliation(s)
- Toshiki Kuno
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Nestor Vasquez
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ayana K April-Sanders
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Katrina Swett
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA; Department of Medicine, University of California San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory A Talavera
- Department of Psychology, College of Sciences, San Diego State University, San Diego, California, USA
| | - Sonia G Ponce
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mayank M Kansal
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dalane Kitzman
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carlos J Rodriguez
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
4
|
Ramonfaur D, Skali H, Claggett B, Windham BG, Palta P, Kitzman D, Ndumele C, Konety S, Shah AM. Bidirectional Association Between Frailty and Cardiac Structure and Function: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2023; 12:e029458. [PMID: 37522168 PMCID: PMC10492980 DOI: 10.1161/jaha.122.029458] [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: 01/30/2023] [Accepted: 03/30/2023] [Indexed: 08/01/2023]
Abstract
Background Frailty and heart failure frequently coexist in late life. Limited data exist regarding the longitudinal associations of frailty and subclinical cardiac dysfunction. We aim to quantify the association of frailty with longitudinal changes in cardiac function and of cardiac function with progression in frailty status in older adults. Methods and Results Participants in the Atherosclerosis Risk in Communities cohort underwent frailty assessments at Visit 5 (V5; 2011-2013), V6 (2016-2017), and V7 (2018-2019), and echocardiographic assessments at V5 and V7. We assessed the association between frailty status at V5 and changes in frailty status from V5 to V7 and changes in cardiac function over 6 years. We then evaluated the association of cardiac function measured at Visit 5 with progression in frailty status over 4 years. Multivariable regression models adjusted for demographics and comorbidities. Among 2574 participants free of heart failure at V5 and V7 (age 74±4 years at V5 and 81±4 years at V7), 3% (n=83) were frail. Frailty at V5 was associated with greater left atrial volume index and E/e' ratio at V5 and 7. Participants who transitioned from robust at V5 to frail at V7 demonstrated greater increases in left ventricular mass index, left atrial volume index, and E/e' over the same period. Among 1648 robust participants at Visit 5, greater left ventricular mass index and mean wall thickness, lower tissue Doppler imaging e', and higher E/e' ratio at Visit 5 were associated with progression in frailty status. Conclusions Among robust, older adults free of heart failure, progression in frailty and subclinical left ventricular remodeling and diastolic dysfunction are interrelated.
Collapse
Affiliation(s)
- Diego Ramonfaur
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - Hicham Skali
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - Brian Claggett
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| | - B. Gwen Windham
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMS
| | - Priya Palta
- Division of General Medicine, Departments of Medicine and EpidemiologyColumbia University Irving Medical CenterNew YorkNY
| | - Dalane Kitzman
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Chiadi Ndumele
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | | | - Amil M. Shah
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women’s HospitalBostonMA
| |
Collapse
|
5
|
Baim-Lance A, Ferreira KB, Cohen HJ, Ellenberg SS, Kuchel GA, Ritchie C, Sachs GA, Kitzman D, Morrison RS, Siu A. Improving the Approach to Defining, Classifying, Reporting and Monitoring Adverse Events in Seriously Ill Older Adults: Recommendations from a Multi-stakeholder Convening. J Gen Intern Med 2023; 38:399-405. [PMID: 35581446 PMCID: PMC9905384 DOI: 10.1007/s11606-022-07646-7] [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: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinical trials are needed to study topics relevant to older adults with serious illness. Investigators conducting clinical trials with this population are challenged by how to appropriately define, classify, report, and monitor serious and non-serious adverse events (SAEs/AEs), given that some traditionally reported AEs (pressure ulcers, delirium) and SAEs (death, hospitalization) are common in persons with serious illness, and may be consistent with their goals of care. OBJECTIVES A multi-stakeholder group convened to establish greater clarity on and new approaches to address this critical issue. PARTICIPANTS Thirty-two study investigators, members of regulatory and sponsor agencies, and patient stakeholders took part. APPROACH The group met virtually four times and, using a collaborative approach, conducted a survey, select interviews, and reviewed regulatory guidance to collectively define the problem and identify a new approach. RESULTS SAE/AE challenges fell into two areas: (1) definitions and classifications, including (a) implausible relationships, (b) misalignment with patient-centered care goals, and (c) well-known associations, and (2) reporting and monitoring, including (a) limited guidance, (b) inconsistent standards across regulators, and (c) Data Safety Monitoring Board (DSMB) member knowledge gaps. Problems largely reflected practice norms rather than regulatory requirements that already support context-specific and aggregate reporting. Approaches can be improved by adopting principles that better align strategies for addressing adverse events with the type of intervention being tested, favoring routine and aggregate over expedited reporting, and prioritizing how SAE/AEs relate to patient-centered care goals. Reporting plans and decisions should follow an algorithm underpinned by these principles. CONCLUSIONS Adoption of the proposed approach-and supporting it with education and better alignment with regulatory guidance and procedures-could improve the quality and efficiency of clinical trials' safety involving older adults with serious illness and other vulnerable populations.
Collapse
Affiliation(s)
- Abigail Baim-Lance
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1070, New York, NY, 10029, USA.
- Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, Bronx, NY, USA.
| | - Katelyn B Ferreira
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1070, New York, NY, 10029, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Susan S Ellenberg
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut, Farmington, CT, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine and the Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Greg A Sachs
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dalane Kitzman
- Department of Internal Medicine: Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1070, New York, NY, 10029, USA
- Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, Bronx, NY, USA
| | - Albert Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1070, New York, NY, 10029, USA
- Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, Bronx, NY, USA
| |
Collapse
|
6
|
Pandey A, Khan MS, Garcia K, Simpson F, Bahnson J, Patel KV, Singh S, Vaduganathan M, Bertoni A, Kitzman D, Johnson K, Lewis CE, Espeland MA. Association of Baseline and Longitudinal Changes in Frailty Burden and Risk of Heart Failure in Type 2 Diabetes-Findings from the Look AHEAD Trial. J Gerontol A Biol Sci Med Sci 2022; 77:2489-2497. [PMID: 35453142 PMCID: PMC9799190 DOI: 10.1093/gerona/glac094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Individuals with diabetes have a high frailty burden and increased risk of heart failure (HF). In this study, we evaluated the association of baseline and longitudinal changes in frailty with risk of HF and its subtypes: HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). METHODS Participants (age: 45-76 years) of the Look AHEAD trial without prevalent HF were included. The frailty index (FI) was used to assess frailty burden using a 35-variable deficit model. The association between baseline and longitudinal changes (1- and 4-year follow-up) in FI with risk of overall HF, HFpEF (ejection fraction [EF] ≥ 50%), and HFrEF (EF < 50%) independent of other risk factors and cardiorespiratory fitness was assessed using adjusted Cox models. RESULTS The study included 5 100 participants with type 2 diabetes mellitus, of which 257 developed HF. In adjusted analysis, higher frailty burden was significantly associated with a greater risk of overall HF. Among HF subtypes, higher baseline FI was significantly associated with risk of HFpEF (hazard ratio [HR] [95% CI] per 1-SD higher FI: 1.37 [1.15-1.63]) but not HFrEF (HR [95% CI]: 1.19 [0.96-1.46]) after adjustment for potential confounders, including traditional HF risk factors. Among participants with repeat measures of FI at 1- and 4-year follow-up, an increase in frailty burden was associated with a higher risk of HFpEF (HR [95% CI] per 1-SD increase in FI at 4 years: 1.78 [1.35-2.34]) but not HFrEF after adjustment for other confounders. CONCLUSIONS Among individuals with type 2 diabetes mellitus, higher baseline frailty and worsening frailty burden over time were independently associated with higher risk of HF, particularly HFpEF after adjustment for other confounders.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katelyn Garcia
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston–Salem, North Carolina, USA
| | - Felicia Simpson
- Department of Mathematics, Winston–Salem State University, Winston–Salem, North Carolina, USA
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston–Salem, North Carolina, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sumitabh Singh
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston–Salem, North Carolina, USA
| | - Dalane Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston–Salem, North Carolina, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Karen Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston–Salem, North Carolina, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
7
|
Pandey A, Segar MW, Singh S, Reeves G, O'Connor C, Pina I, Whellan D, Kraus W, Mentz R, Kitzman D. Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial. Circulation 2022; 146:80-90. [PMID: 35616018 DOI: 10.1161/circulationaha.122.059983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Supervised aerobic exercise training (ET) is recommended for stable outpatients with heart failure (HF) with reduced ejection fraction (HFrEF). Frailty, a syndrome characterized by increased vulnerability and decreased physiologic reserve, is common in patients with HFrEF and associated with a higher risk of adverse outcomes. The effect modification of baseline frailty on the efficacy of aerobic ET in HFrEF is not known. METHODS Stable outpatients with HFrEF randomized to aerobic ET versus usual care in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were included. Baseline frailty was estimated using the Rockwood frailty index (FI), a deficit accumulation-based model of frailty assessment; participants with FI scores >0.21 were identified as frail. Multivariable Cox proportional hazard models with multiplicative interaction terms (frailty treatment arm) were constructed to evaluate whether frailty modified the treatment effect of aerobic ET on the primary composite end point (all-cause hospitalization and mortality), secondary end points (composite of cardiovascular death or cardiovascular hospitalization, and cardiovascular death or HF hospitalization), and Kansas City Cardiomyopathy Questionnaire score. Separate models were constructed for continuous (FI) and categorical (frail versus not frail) measures of frailty. RESULTS Among 2130 study participants (age, 59±13 years; 28% women), 1266 (59%) were characterized as frail (FI>0.21). Baseline frailty burden significantly modified the treatment effect of aerobic ET (P interaction: FI × treatment arm=0.02; frail status [frail versus nonfrail] × treatment arm=0.04) with a lower risk of primary end point in frail (hazard ratio [HR], 0.83 [95% CI, 0.72-0.95]) but not nonfrail (HR, 1.04 [95% CI, 0.87-1.25]) participants. The favorable effect of aerobic ET among frail participants was driven by a significant reduction in the risk of all-cause hospitalization (HR, 0.84 [95% CI, 0.72-0.99]). The treatment effect of aerobic ET on all-cause mortality and other secondary endpoints was not different between frail and nonfrail patients (P interaction>0.1 for each). Aerobic ET was associated with a nominally greater improvement in Kansas City Cardiomyopathy Questionnaire scores at 3 months among frail versus nonfrail participants without a significant treatment interaction by frailty status (P interaction>0.2). CONCLUSION Among patients with chronic stable HFrEF, baseline frailty modified the treatment effect of aerobic ET with a greater reduction in the risk of all-cause hospitalization but not mortality.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston (M.W.S.)
| | - Sumitabh Singh
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Gordon Reeves
- Cardiovascular Disease, Heart Failure and Transplant, Novant Health, Charlotte, NC (G.R.)
| | - Christopher O'Connor
- Inova Heart and Vascular Institute, Falls Church, VA (C.O.).,Duke University Medical Center, Durham, NC. (C.O.).,Duke Clinical Research Institute, Durham, NC. (C.O., R.M.)
| | | | - David Whellan
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (D.W.)
| | - William Kraus
- Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Robert Mentz
- Duke Clinical Research Institute, Durham, NC. (C.O., R.M.).,Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Dalane Kitzman
- Cardiovascular Medicine and Geriatrics Sections, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| |
Collapse
|
8
|
Aparna F, Pajewski N, Kitzman D, Upadhya B, Killeen A, Rajagopalan S, Wright J, Rahman M, Dobre M. MO094: Intensive Blood Pressure Lowering and Myocardial Fibrosis Biomarkers in Individuals With and Without CKD: Results From the Systolic Blood Pressure Intervention Trial (Sprint). Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac133.015] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Circulating cardiac biomarkers implicated in the pathogenesis of heart disease may provide a non-invasive, more precise assessment of cardiovascular risk. In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure lowering was associated with a 25% reduction in cardiovascular events and a 27% reduction in all-cause mortality. We sought to assess whether the beneficial effect of lowering systolic blood pressure on clinical outcomes was accompanied by a reduction in serum biomarkers of myocardial fibrosis.
METHOD
SPRINT, a multicenter randomized controlled trial conducted in the United States, enrolled participants aged ≥ 50 years, at increased risk for cardiovascular disease and randomized them to intensive systolic blood pressure lowering (target < 120 mmHg) or standard blood pressure lowering (target < 140 mmHg). In a randomly selected subgroup of SPRINT participants, myocardial fibrosis was assessed by two collagen-derived serum peptides, C-terminal propeptide of procollagen type I (CICP) and N-terminal propeptide of procollagen type 3 (P3NP) and Galectin 3 measured at study baseline and at 24 months follow-up. Chronic kidney disease was defined as eGFR < 60 mL/min/1.73 m2. Analyses were based on linear mixed models including clinic site as a random effect, with adjustments for treatment group and baseline level of each respective biomarker.
RESULTS
A total of 742 SPRINT participants with and without CKD with available measurements of myocardial fibrosis biomarkers at study baseline and 24 months were included in the study. The median (IQR) Galectin 3, CICP and P3NP levels at study baseline and 24 months follow-up in the intensive versus standard group are presented in the Table 1. Intensive blood pressure lowering was not associated with longitudinal changes in CICP or P3NP (Table 1 and Figure 1). Intensive blood pressure lowering was associated with a statistically significant increase in Galectin 3 level [between group mean difference 0.47 (IQR: 0.03–0.92) ng/mL, P = 0.04]. All of the findings were generally consistent across participants with and without CKD (Table 1).
CONCLUSION
In a random sample of SPRINT participants, intensive versus standard blood pressure lowering was not associated with a reduction in circulating myocardial fibrosis biomarkers overtime in hypertensive individuals with and without CKD.
Collapse
Affiliation(s)
- Fnu Aparna
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Nephrology and Hypertension, Cleveland, OH, USA
| | - Nicholas Pajewski
- Wake Forest School of Medicine, Biostatistics and Data Science, Winston-Salem, NC, USA
| | - Dalane Kitzman
- Wake Forest School of Medicine, Cardiology, Winston-Salem, NC, USA
| | - Bharathi Upadhya
- Wake Forest School of Medicine, Cardiology, Winston-Salem, NC, USA
| | - Anthony Killeen
- University of Minnesota Medical School, Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | - Sanjay Rajagopalan
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cardiovascular Research Institute, Cleveland, OH, USA
| | - Jackson Wright
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Nephrology and Hypertension, Cleveland, OH, USA
| | - Mahboob Rahman
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Nephrology and Hypertension, Cleveland, OH, USA
| | - Mirela Dobre
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Nephrology and Hypertension, Cleveland, OH, USA
| |
Collapse
|
9
|
Inciardi RM, Claggett B, Minamisawa M, Shin SH, Selvaraj S, Gonçalves A, Wang W, Kitzman D, Matsushita K, Prasad NG, Su J, Skali H, Shah AM, Chen LY, Solomon SD. Association of Left Atrial Structure and Function With Heart Failure in Older Adults. J Am Coll Cardiol 2022; 79:1549-1561. [PMID: 35450571 DOI: 10.1016/j.jacc.2022.01.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 12/07/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited data exist to characterize novel measures of left atrial (LA) structure and function in older adults without prevalent heart failure (HF). OBJECTIVES The aim was to assess reference range of LA measures, their associations with N-terminal pro-B-type natriuretic-peptide (NT-proBNP) and the related risk for incident HF or death. METHODS We analyzed LA structure (LA maximal [LAViMax] and minimal volume indexed by body surface area) and function (LA emptying fraction, LA reservoir, conduit, and contraction strain) in 4,901 participants from the ARIC (Atherosclerosis Risk In Communities) study (mean age 75 ± 5 years, 40% male, and 19% Black) without prevalent HF. We assessed sex-specific 10th and 90th percentile ARIC-based reference limits in 301 participants free of prevalent cardiovascular disease, and related LA measures to NT-proBNP and incident HF or death (median follow-up of 5.5 years) in the whole ARIC cohort. RESULTS Approximately 20% of the overall population had LA abnormalities according to the ARIC-based reference limit. Each LA measure was associated with NT-proBNP and, except for LAViMax, with incident HF or death after multivariable adjustment (including left ventricular function and NT-proBNP). Results were consistent in participants with normal LAViMax (P for interaction > 0.05). LA measures were prognostic for both incident HF with preserved ejection fraction or death and incident HF with reduced ejection fraction or death. When added to HF risk factors and NT-proBNP (baseline C-statistics = 0.74) all LA measures, except for LAViMax, significantly enhanced the prognostic accuracy. CONCLUSIONS Novel measures of LA structure and function, but not standard assessment by LAViMax, are associated with increased risk of incident HF or death regardless of measures of left ventricular function and NT-proBNP.
Collapse
Affiliation(s)
- Riccardo M Inciardi
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health. University of Brescia, Brescia, Italy
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Masatoshi Minamisawa
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Sung-Hee Shin
- Cardiovascular Division, Inha University and Inha University Hospital, Incheon, South Korea
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexandra Gonçalves
- Philips Healthcare, Andover, Massachusetts, USA; University of Porto Medical School, Porto, Portugal
| | - Wendy Wang
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dalane Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Narayana G Prasad
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jimmy Su
- Philips Healthcare, Andover, Massachusetts, USA
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lin Yee Chen
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
10
|
Wang S, Wang B, Mishra S, Jain S, Ding J, Krtichevsky S, Kitzman D, Yadav H. A novel probiotics therapy for aging-related leaky gut and inflammation. Innov Aging 2021. [PMCID: PMC8680846 DOI: 10.1093/geroni/igab046.2521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Inflammaging characterized with increased low grade inflammation in older adults is common determinant of unhealthy aging; and is a major risk factor of morbidity and mortality in older adults. The precise origin of inflammation in older adults is not known, however, emerging evidence indicate that increased intestinal epithelial permeability (leaky gut) and abnormal (dysbiotic) gut microbiota could be one of the key source. However, no preventive and treatment therapies are available to reverse the leaky gut and microbiome dysbiosis in older adults. Here, we presented the evidence that a human-origin probiotics cocktail containing 5 Lactobacillus and 5 Enterococcus strains isolated from healthy human infant gut can ameliorate aging-related metabolic, physical and cognitive dysfunctions in older mice. We show that the Feeding this probiotic cocktail prevented high-fat diet–induced (HFD-induced) abnormalities in glycose metabolism and physical functions in older mice and reduced microbiota dysbiosis, leaky gut, inflammation. Probiotic-modulated gut microbiota reduced leaky gut by increasing tight junctions on intestinal epithelia, which in turn reduced inflammation. Mechanistically, probiotics increased bile salt hydrolase activity in older microbiota, which in turn increased taurine deconjugation from bile acids to increase free taurine abundance in the gut. We further show that taurine stimulated tight junctions and suppressed gut leakiness. Further, taurine increased life span, reduced adiposity and leaky gut, and enhanced physical function in Caenorhabditis elegans. Whether this novel human origin probiotic therapy could prevent or treat aging-related leaky gut and inflammation in the elderly by reversing microbiome dysbiosis requires evaluation.
Collapse
Affiliation(s)
- Shaohua Wang
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Bo Wang
- NC A&T State University, Greensboro, North Carolina, United States
| | - Sidharth Mishra
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Shalini Jain
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Jingzhong Ding
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Krtichevsky
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Hariom Yadav
- Wake Forest Medical Center, Winston-Salem, North Carolina, United States
| |
Collapse
|
11
|
Justice J, Espeland M, Houston D, Kritchevsky S, Nicklas B, Pajewski N, Kitzman D. The First Evaluation of a Geroscience Biomarker Index (TAME-BI) in a Trial of Caloric Restriction and Exercise. Innov Aging 2021. [PMCID: PMC8680521 DOI: 10.1093/geroni/igab046.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We leveraged the WF OAIC biorepository to measure a consensus-derived panel of blood-based biomarkers of aging and constructed a geroscience-guided biomarker index (TAME-BI), testing it for the first time in a clinical trial. We measured IL-6, TNF-α-receptor-I, growth differentiating factor-15, cystatin C, and N-terminal pro-B-type natriuretic peptide in a 20-week randomized trial of caloric restriction (CR), aerobic exercise (EX), CR+EX, or attention-control in 88 patients (67±5years) with heart failure with preserved ejection fraction (HFpEF). We calculated TAME-BI (analyte levels ranked, binned by quintile, and summed) and found a time×treatment interaction for improved TAME-BI with intervention (p≤0.05) and detected associations between change in TAME-BI and change in six-minute walk distance (r= -0.24), usual walk speed (r= -0.23), and left ventricular relative wall thickness (r= 0.31). In sum, CR+EX intervention improved TAME-BI and changes in TAME-BI were associated with changes in key functional measures in older HFpEF patients.
Collapse
Affiliation(s)
- Jamie Justice
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
| | - Mark Espeland
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Denise Houston
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Barbara Nicklas
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Nicholas Pajewski
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
12
|
Chew DS, Li Y, Zeitouni M, Whellan DJ, Kitzman D, Mentz RJ, Duncan P, Pastva AM, Reeves GR, Nelson MB, Chen H, Reed SD. Economic Outcomes of Rehabilitation Therapy in Older Patients With Acute Heart Failure in the REHAB-HF Trial: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2021; 7:140-148. [PMID: 34817542 DOI: 10.1001/jamacardio.2021.4836] [Citation(s) in RCA: 3] [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] [Indexed: 11/14/2022]
Abstract
Importance In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a novel 12-week rehabilitation intervention demonstrated significant improvements in validated measures of physical function, quality of life, and depression, but no significant reductions in rehospitalizations or mortality compared with a control condition during the 6-month follow up. The economic implications of these results are important given the increasing pressures for cost containment in health care. Objective To report the economic outcomes of the REHAB-HF trial and estimate the potential cost-effectiveness of the intervention. Design, Setting, Participants The multicenter REHAB-HF trial randomized 349 patients 60 years or older who were hospitalized for acute decompensated heart failure to rehabilitation intervention or a control group; patients were enrolled from September 17, 2014, through September 19, 2019. For this preplanned secondary analysis of the economic outcomes, data on medical resource use and quality of life (via the 5-level EuroQol 5-Dimension scores converted to health utilities) were collected. Medical resource use and medication costs were estimated using 2019 US Medicare payments and the Federal Supply Schedule, respectively. Cost-effectiveness was estimated using the validated Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, which uses an individual-patient simulation model informed by the prospectively collected trial data. Data were analyzed from March 24, 2019, to December 1, 2020. Interventions Rehabilitation intervention or control. Main Outcomes and Measures Costs, quality-adjusted life-years (QALYs), and the lifetime estimated cost per QALY gained (incremental cost-effectiveness ratio). Results Among the 349 patients included in the analysis (183 women [52.4%]; mean [SD] age, 72.7 [8.1] years; 176 non-White [50.4%] and 173 White [49.6%]), mean (SD) cumulative costs per patient were $26 421 ($38 955) in the intervention group (excluding intervention costs) and $27 650 ($30 712) in the control group (difference, -$1229; 95% CI, -$8159 to $6394; P = .80). The mean (SD) cost of the intervention was $4204 ($2059). Quality of life gains were significantly greater in the intervention vs control group during 6 months (mean utility difference, 0.074; P = .001) and sustained beyond the 12-week intervention. Incremental cost-effectiveness ratios were estimated at $58 409 and $35 600 per QALY gained for the full cohort and in patients with preserved ejection fraction, respectively. Conclusions and Relevance These analyses suggest that longer-term benefits of this novel rehabilitation intervention, particularly in the subgroup of patients with preserved ejection fraction, may yield good value to the health care system. However, long-term cost-effectiveness is currently uncertain and dependent on the assumption that benefits are sustained beyond study follow-up, which needs to be corroborated in future trials in this patient population.
Collapse
Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michel Zeitouni
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dalane Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy M Pastva
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Gordon R Reeves
- Novant Health Heart and Vascular Institute, Charlotte, North Carolina
| | - M Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
13
|
Pandey A, Shah SJ, Butler J, Kellogg DL, Lewis GD, Forman DE, Mentz RJ, Borlaug BA, Simon MA, Chirinos JA, Fielding RA, Volpi E, Molina AJA, Haykowsky MJ, Sam F, Goodpaster BH, Bertoni AG, Justice JN, White JP, Ding J, Hummel SL, LeBrasseur NK, Taffet GE, Pipinos II, Kitzman D. Exercise Intolerance in Older Adults With Heart Failure With Preserved Ejection Fraction: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1166-1187. [PMID: 34503685 PMCID: PMC8525886 DOI: 10.1016/j.jacc.2021.07.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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: 09/15/2020] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
Exercise intolerance (EI) is the primary manifestation of chronic heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure among older individuals. The recent recognition that HFpEF is likely a systemic, multiorgan disorder that shares characteristics with other common, difficult-to-treat, aging-related disorders suggests that novel insights may be gained from combining knowledge and concepts from aging and cardiovascular disease disciplines. This state-of-the-art review is based on the outcomes of a National Institute of Aging-sponsored working group meeting on aging and EI in HFpEF. We discuss aging-related and extracardiac contributors to EI in HFpEF and provide the rationale for a transdisciplinary, "gero-centric" approach to advance our understanding of EI in HFpEF and identify promising new therapeutic targets. We also provide a framework for prioritizing future research, including developing a uniform, comprehensive approach to phenotypic characterization of HFpEF, elucidating key geroscience targets for treatment, and conducting proof-of-concept trials to modify these targets.
Collapse
Affiliation(s)
- Ambarish Pandey
- University of Texas Southwestern Medical Center, Dallas, Texas, USA. https://twitter.com/ambarish4786
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dean L Kellogg
- University of Texas Health Science Center and GRECC, South Texas Veterans Affairs Health System, San Antonio, Texas, USA
| | | | - Daniel E Forman
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Robert J Mentz
- Duke Clinical Research Center, Durham, North Carolina, USA
| | | | - Marc A Simon
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | | | | | - Elena Volpi
- University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | | | - Flora Sam
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bret H Goodpaster
- Advent Health Translational Research Institute, Orlando, Florida, USA
| | - Alain G Bertoni
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jamie N Justice
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jingzhone Ding
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Scott L Hummel
- University of Michigan and the VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | | | | | | | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| |
Collapse
|
14
|
Handing EP, Rapp SR, Chen SH, Rejeski WJ, Wiberg M, Bandeen-Roche K, Craft S, Kitzman D, Ip EH. Heterogeneity in Association Between Cognitive Function and Gait Speed Among Older Adults: An Integrative Data Analysis Study. J Gerontol A Biol Sci Med Sci 2021; 76:710-715. [PMID: 32841312 PMCID: PMC8011698 DOI: 10.1093/gerona/glaa211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing evidence shows that cognition and gait speed are associated and are important measures of health among older adults. However, previous studies have used different methods to assess these 2 outcomes and lack sufficient sample size to examine heterogeneity among subgroups. This study examined how the relationship between global cognitive function and gait speed are influenced by age, gender, and race utilizing an integrated data analysis approach. METHOD Data on cognition (Montreal Cognitive Assessment [MoCA], Mini-Mental Status Examination [MMSE], and Modified Mini-Mental State Examination [3MSE]) and gait speed (range: 4-400 m) were acquired and harmonized from 25 research studies (n = 2802) of adults aged 50+ from the Wake Forest Older American Independence Center. Multilevel regression models examined the relationship between predicted values of global cognitive function (MoCA) and gait speed (4-m walk), including heterogeneity by age, race, and gender. RESULTS Global cognitive function and gait speed exhibited a consistent positive relationship among whites with increasing age, while this was less consistent for African Americans. That is, there was a low correlation between global cognitive function and gait speed among African Americans aged 50-59, a positive correlation in their 60s and 70s, then a negative correlation thereafter. CONCLUSION Global cognition and gait speed exhibited a curvilinear U-shaped relationship among whites; however, the association becomes inverse in African Americans. More research is needed to understand this racial divergence and could aid in identifying interventions to maintain cognitive and gait abilities across subgroups.
Collapse
Affiliation(s)
- Elizabeth P Handing
- Department of Internal Medicine, Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Marie Wiberg
- Department of Statistics, USBE, Umeå University, Sweden
| | | | - Suzanne Craft
- Department of Internal Medicine, Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane Kitzman
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
15
|
Ip EH, Pierce J, Chen S, Lovato J, Hughes TM, Hayden KM, Hugenschmidt CE, Craft S, Kitzman D, Rapp S. Conversion between the Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE). Alzheimers Dement (Amst) 2021; 13:e12161. [PMID: 33816754 PMCID: PMC8010479 DOI: 10.1002/dad2.12161] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE) are two commonly used instruments for assessing cognitive function. Although conversion between 3MSE and MMSE is useful in applications such as integrative data analysis, there are limited published reports on the topic. Our objective is to provide a dual tool: (1) an item-level conversion tool to score responses for deriving both 3MSE and MMSE measures, and (2) cross-walk tables to facilitate quick conversion between 3MSE and MMSE. METHODS An SAS program tool allows scoring of 3MSE item-level responses into MMSE score. Using integrated data sets (n = 8346), actual 3MSE and MMSE scores obtained from the same individuals were linked to form cross-walk tables. RESULTS An SAS conversion program was made available. Cross-walk tables were derived. Validation sample shows bias is -0.11 (standard deviation = 1.02) in 3MSE→MMSE; the converse had substantially large bias. DISCUSSION The 3MSE→MMSE conversion table can be used in clinical practice and legacy system data.
Collapse
Affiliation(s)
- Edward H. Ip
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - June Pierce
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Shyh‐Huei Chen
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James Lovato
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christina E. Hugenschmidt
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Suzanne Craft
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Dalane Kitzman
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Internal MedicineSection on Cardiovascular MedicineWinston‐SalemNorth CarolinaUSA
| | - Steve Rapp
- Department of Psychiatry & Behavioral MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| |
Collapse
|
16
|
Liu Y, Shao Q, Cheng HJ, Li T, Zhang X, Callahan MF, Herrington D, Kitzman D, Zhao D, Cheng CP. Chronic Ca 2+/Calmodulin-Dependent Protein Kinase II Inhibition Rescues Advanced Heart Failure. J Pharmacol Exp Ther 2021; 377:316-325. [PMID: 33722881 DOI: 10.1124/jpet.120.000361] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/11/2021] [Indexed: 11/22/2022] Open
Abstract
Ca2+/calmodulin-dependent protein kinase II (CaMKII) is upregulated in congestive heart failure (CHF), contributing to electrical, structural, and functional remodeling. CaMKII inhibition is known to improve CHF, but its direct cardiac effects in CHF remain unclear. We hypothesized that CaMKII inhibition improves cardiomyocyte function, [Ca2+]i regulation, and β-adrenergic reserve, thus improving advanced CHF. In a 16-week study, we compared plasma neurohormonal levels and left ventricular (LV)- and myocyte-functional and calcium transient ([Ca2+]iT) responses in male Sprague-Dawley rats (10/group) with CHF induced by isoproterenol (170 mg/kg sq for 2 days). In rats with CHF, we studied the effects of the CaMKII inhibitor KN-93 or its inactive analog KN-92 (n = 4) (70 µg/kg per day, mini-pump) for 4 weeks. Compared with controls, isoproterenol-treated rats had severe CHF with 5-fold-increased plasma norepinephrine and about 50% decreases in ejection fraction (EF) and LV contractility [slope of LV end-systolic pressure-LV end-systolic volume relation (EES)] but increased time constant of LV relaxation (τ). They also showed significantly reduced myocyte contraction [maximum rate of myocyte shortening (dL/dtmax)], relaxation (dL/dtmax), and [Ca2+]iT Isoproterenol superfusion caused significantly fewer increases in dL/dtmax and [Ca2+]iT KN-93 treatment prevented plasma norepinephrine elevation, with increased basal and acute isoproterenol-stimulated increases in EF and EES and decreased τ in CHF. KN-93 treatment preserved normal myocyte contraction, relaxation, [Ca2+]iT, and β-adrenergic reserve, whereas KN-92 treatment failed to improve LV and myocyte function, and plasma norepinephrine remained high in CHF. Thus, chronic CaMKII inhibition prevented CHF-induced activation of the sympathetic nervous system, restoring normal LV and cardiomyocyte basal and β-adrenergic-stimulated contraction, relaxation, and [Ca2+]iT, thereby playing a rescue role in advanced CHF. SIGNIFICANCE STATEMENT: We investigated the therapeutic efficacy of late initiation of chronic Ca2+/calmodulin-dependent protein kinase II (CaMKII) inhibition on progression of advanced congestive heart failure (CHF). Chronic CaMKII inhibition prevented CHF-induced activation of the sympathetic nervous system and restored normal intrinsic cardiomyocyte basal and β-adrenergic receptor-stimulated relaxation, contraction, and [Ca2+]i regulation, leading to reversal of CHF progression. These data provide new evidence that CaMKII inhibition is able and sufficient to rescue a failing heart, and thus cardiac CaMKII inhibition is a promising target for improving CHF treatment.
Collapse
Affiliation(s)
- Yixi Liu
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Qun Shao
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Heng-Jie Cheng
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Tiankai Li
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Xiaowei Zhang
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Michael F Callahan
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - David Herrington
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Dalane Kitzman
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - David Zhao
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| | - Che-Ping Cheng
- Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, China (Y.L.); Department of Cardiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S.); Department of Internal Medicine, Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (Y.L., Q.S., H.-J.C., T.L., X.Z., M.F.C., D.H., D.K., D.Z., C.-P.C.); Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L.); and Department of Cardiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (X.Z.)
| |
Collapse
|
17
|
Yadav H, Ahmadi S, Wang B, Justice J, Ding J, Kitzman D, McClain D, Kritchevsky S. Metformin Improves Cognition by Reducing Leaky Gut and Benefiting Gut Microbiome–Goblet Cell–Mucin Axis. Innov Aging 2020. [PMCID: PMC7740291 DOI: 10.1093/geroni/igaa057.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Older adults are suffering from several aging-related illnesses including cognitive decline and effective strategies to prevent and/or treat them are lacking, because of a poor understanding of therapeutic targets. Low-grade inflammation is a key risk factor of aging-related morbidities and mortalities, and it is often higher in older adults. Although, precise reasons for increased inflammation remain unknown, however, emerging evidence indicates that abnormal (dysbiotic) gut microbiome and dysfunctional gut permeability (leaky gut) are linked with increased inflammation in older adults. However, no drugs are available to treat aging-related microbiome dysbiosis and leaky gut, and little is known about the cellular and molecular processes that can be targeted to reduce leaky gut in older adults. Here, we demonstrated that metformin, a safe FDA approved antidiabetic drug, decreased leaky gut and inflammation in older obese mice, by beneficially modulating the gut microbiota. In addition, metformin increased goblet cell mass and mucin production in the older gut, thereby decreasing leaky gut and inflammation. Mechanistically, metformin increased the goblet cell differentiation markers by suppressing Wnt signaling. Our results suggest that metformin can prevent and treat aging-related leaky gut and inflammation, by beneficially modulating gut microbiome/goblet cell/mucin biology.
Collapse
Affiliation(s)
- Hariom Yadav
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Shokouh Ahmadi
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Bo Wang
- North Carolina A&T State University, North Carolina, United States
| | - Jamie Justice
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Jingzhong Ding
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Donald McClain
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
18
|
Pandey A, Kitzman D, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, Nelson MB, Upadhya B, Chen H, Reeves GR. Frailty Among Older Decompensated Heart Failure Patients: Prevalence, Association With Patient-Centered Outcomes, and Efficient Detection Methods. JACC Heart Fail 2020; 7:1079-1088. [PMID: 31779931 DOI: 10.1016/j.jchf.2019.10.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF). BACKGROUND In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF. METHODS Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined. RESULTS A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85). CONCLUSIONS Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dalane Kitzman
- Department of Internal Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David J Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert J Mentz
- Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina
| | - Amy M Pastva
- Department of Medicine and Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - M Benjamin Nelson
- Department of Internal Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bharathi Upadhya
- Department of Internal Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gordon R Reeves
- Heart and Vascular Institute, Novant Health, Charlotte, North Carolina.
| |
Collapse
|
19
|
Hugenschmidt CE, Hughes TM, Jung Y, Lockhart SN, Whitlow CT, Yang M, Williams BJ, Cleveland M, Bateman JR, Baker LD, Sachs BC, Craft S, Kitzman D. Heart failure with preserved ejection fraction (HFpEF) is associated with cognitive impairment and reduced brain volume. Alzheimers Dement 2020. [DOI: 10.1002/alz.046641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Mia Yang
- Wake Forest School of Medicine Winston‐Salem NC USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Teramoto K, Santos M, Claggett B, John JE, Solomon SD, Kitzman D, Folsom AR, Cushman M, Matsushita K, Skali H, Shah AM. Pulmonary vascular dysfunction among people aged over 65 years in the community in the Atherosclerosis Risk In Communities (ARIC) Study: A cross-sectional analysis. PLoS Med 2020; 17:e1003361. [PMID: 33057391 PMCID: PMC7561082 DOI: 10.1371/journal.pmed.1003361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/31/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure (HF) risk is highest in late life, and impaired pulmonary vascular function is a risk factor for HF development. However, data regarding the contributors to and prognostic importance of pulmonary vascular dysfunction among HF-free elders in the community are limited and largely restricted to pulmonary hypertension. Our objective was to define the prevalence and correlates of abnormal pulmonary pressure, resistance, and compliance and their association with incident HF and HF phenotype (left ventricular [LV] ejection fraction [LVEF] ≥ or < 50%) independent of LV structure and function. METHODS AND FINDINGS We performed cross-sectional and time-to-event analyses in a prospective epidemiologic cohort study, the Atherosclerosis Risk in Communities study. This is an ongoing, observational study that recruited 15,792 persons aged 45-64 years between 1987 and 1989 (visit 1) from four representative communities in the United States: Minneapolis, Minnesota; Jackson, Mississippi; Hagerstown, Maryland; and Forsyth County, North Carolina. The current analysis included 2,810 individuals aged 66-90 years, free of HF, who underwent echocardiography at the fifth study visit (June 8, 2011, to August 28, 2013) and had measurable tricuspid regurgitation by spectral Doppler. Echocardiography-derived pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), and pulmonary arterial compliance (PAC) were measured. The main outcome was incident HF after visit 5, and key secondary end points were incident HF with preserved LVEF (HFpEF) and incident HF with reduced LVEF (HFrEF). The mean ± SD age was 76 ± 5 years, 66% were female, and 21% were black. Mean values of PASP, PVR, and PAC were 28 ± 5 mm Hg, 1.7 ± 0.4 Wood unit, and 3.4 ± 1.0 mL/mm Hg, respectively, and were abnormal in 18%, 12%, and 14%, respectively, using limits defined from the 10th and 90th percentile limits in 253 low-risk participants free of cardiovascular disease or risk factors. Left heart dysfunction was associated with abnormal PASP and PAC, whereas a restrictive ventilatory deficit was associated with abnormalities of PASP, PVR, and PAC. PASP, PVR, and PAC were each predictive of incident HF or death (hazard ratio per SD 1.3 [95% CI 1.1-1.4], p < 0.001; 1.1 [1.0-1.2], p = 0.04; 1.2 [1.1-1.4], p = 0.001, respectively) independent of LV measures. Elevated pulmonary pressure was predictive of incident HFpEF (HFpEF: 2.4 [1.4-4.0, p = 0.001]) but not HFrEF (1.4 [0.8-2.5, p = 0.31]). Abnormal PAC predicted HFrEF (HFpEF: 2.0 [1.0-4.0, p = 0.05], HFrEF: 2.8 [1.4-5.5, p = 0.003]), whereas abnormal PVR was not predictive of either (HFpEF: 0.9 [0.4-2.0, p = 0.85], HFrEF: 0.7 [0.3-1.4, p = 0.30],). A greater number of abnormal pulmonary vascular measures was associated with greater risk of incident HF. Major limitations include the use of echo Doppler to estimate pulmonary hemodynamic measures, which may lead to misclassification; inclusions bias related to detectable tricuspid regurgitation, which may limit generalizability of our findings; and survivor bias related to the cohort age, which may result in underestimation of the described associations. CONCLUSIONS In this study, we observed abnormalities of PASP, PVR, and PAC in 12%-18% of elders in the community. Higher PASP and lower PAC were independently predictive of incident HF. Abnormally high PASP predicted incident HFpEF but not HFrEF. These findings suggest that impairments in pulmonary vascular function may precede clinical HF and that a comprehensive pulmonary hemodynamic evaluation may identify pulmonary vascular phenotypes that differentially predict HF phenotypes.
Collapse
Affiliation(s)
- Kanako Teramoto
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Mário Santos
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal
- Department of Cardiology, Hospital Santo António, Porto Hospital Center, Porto, Portugal
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Jenine E. John
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, Vermont, United States of America
- Department of Pathology, University of Vermont, Burlington, Vermont, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
21
|
Schultz H, Brubaker P, Roberts T, Christensen B, Kitzman D. Examining Energy Expenditure During Aerobic And Resistance Exercise In Overweight Patients With HFpEF. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683976.25060.94] [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: 11/21/2022]
|
22
|
Ahmadi S, Razazan A, Nagpal R, Jain S, Wang B, Mishra SP, Wang S, Justice J, Ding J, McClain DA, Kritchevsky SB, Kitzman D, Yadav H. Metformin Reduces Aging-Related Leaky Gut and Improves Cognitive Function by Beneficially Modulating Gut Microbiome/Goblet Cell/Mucin Axis. J Gerontol A Biol Sci Med Sci 2020; 75:e9-e21. [PMID: 32129462 PMCID: PMC7302182 DOI: 10.1093/gerona/glaa056] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Aging-related illnesses are increasing and effective strategies to prevent and/or treat them are lacking. This is because of a poor understanding of therapeutic targets. Low-grade inflammation is often higher in older adults and remains a key risk factor of aging-related morbidities and mortalities. Emerging evidence indicates that abnormal (dysbiotic) gut microbiome and dysfunctional gut permeability (leaky gut) are linked with increased inflammation in older adults. However, currently available drugs do not treat aging-related microbiome dysbiosis and leaky gut, and little is known about the cellular and molecular processes that can be targeted to reduce leaky gut in older adults. Here, we demonstrated that metformin, a safe Food and Drug Administration-approved antidiabetic drug, decreased leaky gut and inflammation in high-fat diet-fed older obese mice, by beneficially modulating the gut microbiota. In addition, metformin increased goblet cell mass and mucin production in the obese older gut, thereby decreasing leaky gut and inflammation. Mechanistically, metformin increased the goblet cell differentiation markers by suppressing Wnt signaling. Our results suggest that metformin can be used as a regimen to prevent and treat aging-related leaky gut and inflammation, especially in obese individuals and people with western-style high-fat dietary lifestyle, by beneficially modulating gut microbiome/goblet cell/mucin biology.
Collapse
Affiliation(s)
- Shokouh Ahmadi
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Atefeh Razazan
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ravinder Nagpal
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shalini Jain
- Department of Endocrinology and Metabolism, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Mouse Metabolic Phenotyping Core, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bo Wang
- Department of Chemistry, North Carolina A&T State University, Greensboro
| | - Sidharth P Mishra
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shaohua Wang
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jamie Justice
- Department of Internal Medicine – Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jingzhong Ding
- Department of Internal Medicine – Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald A McClain
- Department of Endocrinology and Metabolism, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Mouse Metabolic Phenotyping Core, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Kritchevsky
- Department of Internal Medicine – Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane Kitzman
- Department of Internal Medicine – Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hariom Yadav
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
23
|
Dent SF, Reding K, Lesser GJ, Klepin HD, Wagner LI, Kitzman D, Brubaker PH, Mihalko S, Avis NE, Winkfield KM, Ky B, Crotts T, Kikuchi R, Calhoun T, Hundley WG. Understanding and predicting fatigue, cardiovascular (CV) decline & events after breast cancer treatment (UPBEAT): A prospective multi-center wake forest NCORP research-base study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps602] [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: 11/20/2022] Open
Abstract
TPS602 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients, treated with modern anticancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and the future development of CV events. The comprehensive assessment includes: ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, expanded short physical performance battery), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2 peak via cardiopulmonary exercise test), and fatigue (via FACT-F). Eligibility criteria: age > 18 years; ECOG 0-2, able to walk without symptoms; receiving chemotherapy +/- HER2 targeted agent(s). To date, 244 participants are enrolled through 12 NCORP or ECOG-ACRIN sites. An additional 7 sites are onboarding and will be enrolling later in the year. Participants will be followed for 9 years with active surveillance of CV events (i.e., heart failure, myocardial infarction, stroke, all-cause and CV death). EA NCORP Grant: 2 UG1 CA189828 06; Research Base Grant: 2UG1 CA189824; R01: 1R01CA199167. Clinical trial information: NCT02791581 .
Collapse
Affiliation(s)
| | | | | | - Heidi D. Klepin
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC
| | | | | | | | | | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | |
Collapse
|
24
|
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Dalane Kitzman
- Sections on Cardiovascular Medicine and Geriatrics Department of Internal Medicine Wake Forest School of Medicine Winston Salem NC
| |
Collapse
|
25
|
Pandey A, Patel KV, Bahnson JL, Gaussoin SA, Martin CK, Balasubramanyam A, Johnson KC, McGuire DK, Bertoni AG, Kitzman D, Berry JD. Association of Intensive Lifestyle Intervention, Fitness, and Body Mass Index With Risk of Heart Failure in Overweight or Obese Adults With Type 2 Diabetes Mellitus: An Analysis From the Look AHEAD Trial. Circulation 2020; 141:1295-1306. [PMID: 32134326 PMCID: PMC9976290 DOI: 10.1161/circulationaha.119.044865] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 12/26/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established. METHODS Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models. RESULTS Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75-1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44-0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24-0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82-0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69-0.94]). CONCLUSIONS Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kershaw V. Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Judy L. Bahnson
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Sarah A. Gaussoin
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Ashok Balasubramanyam
- Section of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Darren K. McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Dalane Kitzman
- Department of Internal Medicine, Wake Forest University, Winston-Salem, NC
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | |
Collapse
|
26
|
Jordan JH, D’Agostino RB, Avis NE, Mihalko SL, Brubaker PH, Kitzman D, Winkfield KM, Suerkin CK, Reding KW, Klepin HD, Lesser GJ, Hundley WG. Fatigue, Cardiovascular Decline, and Events after Breast Cancer Treatment: Rationale and Design of UPBEAT Study. JACC CardioOncol 2020; 2:114-118. [PMID: 34396215 PMCID: PMC8352177 DOI: 10.1016/j.jaccao.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - W. Gregory Hundley
- Virginia Commonwealth University, 1200 East Broad Street, P.O. Box 980335, Richmond, Virginia 23298 @VCUHealthHeart@JenJordanPhD
| |
Collapse
|
27
|
Lewis CE, Bantle JP, Bertoni AG, Blackburn G, Brancati FL, Bray GA, Cheskin LJ, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gibbs BB, Glasser S, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Kitzman D, Knowler WC, Lipkin E, Michaels S, Montez MG, Nathan DM, Nyenwe E, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Ryan DH, Wadden TA, Wagenknecht LE, Wyatt H, Wing RR, Yanovski SZ. History of Cardiovascular Disease, Intensive Lifestyle Intervention, and Cardiovascular Outcomes in the Look AHEAD Trial. Obesity (Silver Spring) 2020; 28:247-258. [PMID: 31898874 PMCID: PMC6980987 DOI: 10.1002/oby.22676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/19/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P ≤ 0.001) in the ILI group. CONCLUSIONS Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey M. Curtis
- Southwestern American Indian Center, Phoenix, AZ; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ; St. Joseph’s Hospital and Medical Center, Phoenix
| | - Caitlin Egan
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | | | | | - Helen P. Hazuda
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | - James O. Hill
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | | | - Van S. Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | - Steven E. Kahn
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | | | - William C. Knowler
- Southwestern American Indian Center, Phoenix; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Edward Lipkin
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | - Maria G. Montez
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | | | - Jennifer Patricio
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | - Anne Peters
- University of Southern California; Los Angeles, CA
| | - Xavier Pi-Sunyer
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | | | | | - Donna H. Ryan
- Pennington Biomedical Research Center; Baton Rouge, LA
| | | | | | - Holly Wyatt
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | - Rena R. Wing
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| |
Collapse
|
28
|
Pandey A, Kitzman D, Reeves G. Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management. JACC Heart Fail 2019; 7:1001-1011. [PMID: 31779921 PMCID: PMC7098068 DOI: 10.1016/j.jchf.2019.10.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Frailty, a syndrome characterized by an exaggerated decline in function and reserve of multiple physiological systems, is common in older patients with heart failure (HF) and is associated with worse clinical and patient-reported outcomes. Although several detailed assessment tools have been developed and validated in the geriatric population, they are cumbersome, not validated in patients with HF, and not commonly used in routine management of patients with HF. More recently, there has been an increasing interest in developing simple frailty screening tools that could efficiently and quickly identify frail patients with HF in routine clinical settings. As the burden and recognition of frailty in older patients with HF increase, a more comprehensive approach to management is needed that targets deficits across multiple domains, including physical function and medical, cognitive, and social domains. Such a multidomain approach is critical to address the unique, multidimensional challenges to the care of these high-risk patients and to improve their functional status, quality of life, and long-term clinical outcomes. This review discusses the burden of frailty, the conceptual underpinnings of frailty in older patients with HF, and potential strategies for the assessment, screening, and management of frailty in this vulnerable patient population.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Dalane Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Gordon Reeves
- Novant Health Heart & Vascular Institute, Charlotte, North Carolina.
| |
Collapse
|
29
|
Wang S, Ahmadi S, Nagpal R, Jain S, Mishra S, Kritchevsky S, Kitzman D, Yadav H. HEAT KILLED LB. PARACASEI OR CELL WALL LIPOTEICHOIC ACID AMELIORATES AGE-RELATED LEAKY GUT AND INFLAMMATION. Innov Aging 2019. [PMCID: PMC6845130 DOI: 10.1093/geroni/igz038.3363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Increased inflammation associated with leaky gut is a major risk factor for morbidity and mortality in older adults; however, successful preventive and therapeutic strategies are not available to ameliorate these conditions. In this study, we demonstrate that a human-origin Lactobacillus paracasei D3-5 strain (D3-5), even when dead, extended life span of C. elegans. In addition, feeding D3-5 to older mice (>79 weeks) prevented high fat diet (HFD)-induced metabolic dysfunction and decreased leaky gut and inflammation, which were associated with improved physical and cognitive function. D3-5 feeding significantly increased mucin production and proportionately, the abundance of mucin-degrading bacteria Akkermansia muciniphila was also increased. Mechanistically, we show that the cell wall of D3-5 contains lipoteichoic acid (LTA), which enhanced mucin (Muc2) expression via TLR-2/p38-MAPK pathway, which in turn reduced age-related leaky gut and inflammation. This study indicates that the D3-5 and its LTA can prevent/treat age-related leaky gut and inflammation.
Collapse
Affiliation(s)
- Shaohua Wang
- Wake Forest School of Medicine, Winston-Salem, United States
| | - Shokouh Ahmadi
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Ravinder Nagpal
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Shalini Jain
- Wake Forest Medical Center, Winston-Salem, North Carolina, United States
| | - Sidharth Mishra
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Hariom Yadav
- Wake Forest Medical Center, Winston-Salem, North Carolina, United States
| |
Collapse
|
30
|
Beavers K, Neiberg R, Beavers DP, Dewey E, Kitzman D, Messier S, Rejeski J, Kritchevsky S. DOES PHYSICAL FUNCTION RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS VARY BY SEX-GENDER? Innov Aging 2019. [PMCID: PMC6846594 DOI: 10.1093/geroni/igz038.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to explore whether the effect of intentional weight loss on physical function in older adults varies by sex/gender. Individual level data from 1369 older, (67.7±5.4 years), obese (BMI: 33.9±4.4 kg/m2), adults (30% male, 21% African American) who participated in eight randomized controlled trials of weight loss were pooled. All studies were 5-6 months in duration and collected baseline demographic and pre/post gait speed (n=1296), short physical performance battery (SPPB; n=866), and grip strength (n=401) data. Treatment effects were generated by weight loss assignment [weight loss (WL; n=764) versus non-weight loss (NWL; n=605)], as well as categorical amount of weight change (high loss: >-7%, moderate loss: -7 to -3%, and weight gain/stability: <-3%). Analyses were adjusted for age, race/ethnicity, study, education, baseline BMI, and baseline value of the outcome measure of interest. Sex/gender stratified results were presented if the interaction term was p≤0.10. A sex/gender*weight loss assignment interaction was observed for SPPB (p=0.07), with women experiencing greater weight loss-associated improvement in SPPB score (WL: 0.42±0.08 versus NWL: 0.10±0.09; p=0.02) compared to men (WL: 0.30±0.11 versus NWL: 0.30±0.13). A sex/gender*weight loss amount interaction was observed for grip strength (p=0.05), with no difference observed across categories in women; however, greatest grip strength improvement was seen in men experiencing moderate weight loss compared to high loss and weight gain/stability categories. Weight loss-associated improvement in SPPB score is greater in women than men; grip strength gains in men are greatest among those achieving moderate weight loss.
Collapse
Affiliation(s)
- Kristen Beavers
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Rebecca Neiberg
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Daniel P Beavers
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Eliza Dewey
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Messier
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Jack Rejeski
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
31
|
Beavers DP, Neiberg R, Beavers K, Kitzman D, Nicklas BM, Messier S, Rejeski J, Kritchevsky S. DOES PHYSICAL FUNCTION RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS VARY BY RACE-ETHNICITY? Innov Aging 2019. [PMCID: PMC6841005 DOI: 10.1093/geroni/igz038.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The purpose of this study is to explore whether the effect of weight loss on physical function in older adults varies by race/ethnicity. Individual level data from 1369 older, (67.7±5.4 years), obese (BMI: 33.9±4.4 kg/m2), adults (30% male, 21% African American) who participated in eight randomized controlled trials of weight loss were pooled. Studies were 5-6 months in duration and collected baseline demographic and pre/post gait speed (n=1296), short physical performance battery (SPPB; n=866), and grip strength (n=401) data. Treatment effects were generated by weight loss assignment [weight loss (WL; n=764) versus non-weight loss (NWL; n=605)], as well as categorical amount of weight change (high loss: >-7%, moderate loss: -7 to -3%, and weight gain/stability: <-3%). Analyses were adjusted for age, sex/gender, study, education, baseline BMI, and baseline value of the outcome measure of interest. Race/ethnicity stratified results were presented if the interaction term was p≤0.10. A race/ethnicity*weight loss assignment interaction was observed for gait speed (p=0.07), with African Americans experiencing greater weight loss-associated improvement (WL: 0.07±0.01 m/s versus NWL: 0.02±0.01 m/s; p=0.03) compared to Whites (WL: 0.08±0.01 m/s versus NWL: 0.07±0.01 m/s). A race/ethnicity*weight loss amount interaction was also observed for gait speed (p<0.01), with greater weight loss associated with greater improvement in both African Americans and Whites; although, gains were most apparent in African Americans experiencing high loss (0.12±0.02 m/s) compared to gain/stability (0.01±0.01 m/s). The beneficial effects of weight loss on gait speed appear greater in African Americans and are augmented with greater weight loss.
Collapse
Affiliation(s)
- Daniel P Beavers
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Rebecca Neiberg
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Kristen Beavers
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Barbara M Nicklas
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Messier
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Jack Rejeski
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
32
|
Nochioka K, Querejeta Roca G, Claggett B, Biering-Sørensen T, Matsushita K, Hung CL, Solomon SD, Kitzman D, Shah AM. Right Ventricular Function, Right Ventricular-Pulmonary Artery Coupling, and Heart Failure Risk in 4 US Communities: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA Cardiol 2019; 3:939-948. [PMID: 30140848 DOI: 10.1001/jamacardio.2018.2454] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 01/02/2023]
Abstract
Importance Limited data exist on the prevalence and prognostic importance of right ventricular (RV) dysfunction for heart failure (HF) in the general population. Objective To assess the prevalence of RV dysfunction and its association with HF and mortality in a community-based elderly cohort. Design, Setting, and Participants Cross-sectional and time-to-event analysis of participants in the Atherosclerosis Risks in the Community (ARIC), a multicenter, population-based cohort study at the fifth study visit from 2011 to 2013, with a median follow-up of 4.1 years. This study included 1004 elderly participants in the ARIC study attending the fifth study visit who underwent both 3-dimensional and 2-dimensional RV echocardiography. Three-dimensional echocardiography data were analyzed between September 15, 2015, and July 24, 2016. Exposures Right ventricular ejection fraction (RVEF), RV-pulmonary artery (PA) coupling defined by the RVEF/PA systolic pressure (PASP) ratio, and RV longitudinal strain by 3-dimensional echocardiography. Main Outcomes and Measures For cross-sectional analysis, the prevalence of RV dysfunction across ACCF/AHA HF stages (0; A, at elevated risk for HF but without structural heart disease or clinical HF; B, structural heart disease but without clinical HF; and C, prevalent HF). For time-to-event analysis, a composite of incident HF hospitalization or all-cause death among participants free of HF at visit 5. Results Of the 1004 participants, mean (SD) age was 76 (5) years, 385 were men (38%), and 121 were black (12%). Mean (SD) RVEF was 53% (8%). Right ventricular EF, RVEF/PASP, and RV longitudinal strain were each progressively lower across advancing HF stages. Using reference limits from stage 0 participants, RVEF was abnormal in 103 asymptomatic persons with stage A HF (15%) and 27 with stage B HF (24%). Among participants free of HF at baseline, lower RVEF and worse RV-PA coupling (ie, lower RVEF/PASP ratio) both were associated with incident HF or death independent of LVEF and N-terminal pro b-type natriuretic peptide (hazard ratio, 1.20; 95% CI, 1.02-1.42 per 5% decrease in RVEF; P = .03; hazard ratio, 1.65, 95% CI, 1.15-2.37 per 0.5 unit decrease in RVEF/PASP ratio; P = .007). Conclusions and Relevance Right ventricular function and RV-PA coupling declined progressively across American College of Cardiology Foundation/American Heart Association HF stages. Among persons free of HF, lower RVEF was associated with incident HF or death independent of LVEF or N-terminal pro b-type natriuretic peptide.
Collapse
Affiliation(s)
- Kotaro Nochioka
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chung-Lieh Hung
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, MacKay Medical College, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
33
|
Ahmadi S, Wang S, Nagpal R, Mainali R, Soleimanian-Zad S, Kitzman D, Yadav H. An In Vitro Batch-culture Model to Estimate the Effects of Interventional Regimens on Human Fecal Microbiota. J Vis Exp 2019. [PMID: 31424444 DOI: 10.3791/59524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The emerging role of the gut microbiome in several human diseases demands a breakthrough of new tools, techniques and technologies. Such improvements are needed to decipher the utilization of microbiome modulators for human health benefits. However, the large-scale screening and optimization of modulators to validate microbiome modulation and predict related health benefits may be practically difficult due to the need for large number of animals and/or human subjects. To this end, in vitro or ex vivo models can facilitate preliminary screening of microbiome modulators. Herein, it is optimized and demonstrated an ex vivo fecal microbiota culture system that can be used for examining the effects of various interventions of gut microbiome modulators including probiotics, prebiotics and other food ingredients, aside from nutraceuticals and drugs, on the diversity and composition of the human gut microbiota. Inulin, one of the most widely studied prebiotic compounds and microbiome modulators, is used as an example here to examine its effect on the healthy fecal microbiota composition and its metabolic activities, such as fecal pH and the fecal levels of organic acids including lactate and short-chain fatty acids (SCFAs). The protocol may be useful for studies aimed at estimating the effects of different interventions of modulators on fecal microbiota profiles and at predicting their health impacts.
Collapse
Affiliation(s)
- Shokouh Ahmadi
- Department of Internal Medicine- Molecular Medicine, Wake Forest School of Medicine; Department of Microbiology and Immunology, Wake Forest School of Medicine; Department of Food Science and Technology, Isfahan University of Technology
| | - Shaohua Wang
- Department of Internal Medicine- Molecular Medicine, Wake Forest School of Medicine; Department of Microbiology and Immunology, Wake Forest School of Medicine
| | - Ravinder Nagpal
- Department of Internal Medicine- Molecular Medicine, Wake Forest School of Medicine; Department of Microbiology and Immunology, Wake Forest School of Medicine
| | - Rabina Mainali
- Department of Internal Medicine- Molecular Medicine, Wake Forest School of Medicine; Department of Microbiology and Immunology, Wake Forest School of Medicine
| | - Sabihe Soleimanian-Zad
- Department of Food Science and Technology, Isfahan University of Technology; Research Institute for Biotechnology and Bioengineering, College of Agriculture, Isfahan University of Technology
| | - Dalane Kitzman
- Department of Geriatrics and Gerontology, Wake Forest School of Medicine
| | - Hariom Yadav
- Department of Internal Medicine- Molecular Medicine, Wake Forest School of Medicine; Department of Microbiology and Immunology, Wake Forest School of Medicine;
| |
Collapse
|
34
|
Christensen BL, Brubaker PH, Tiarks G, Becton JT, Kitzman D. Examining the Impact of Obesity on Ventilatory Responses During Acute Exercise in Patients with HFpEF. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561841.40584.91] [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: 11/21/2022]
|
35
|
Reding K, D'Agostino R, Lesser GJ, Klepin HD, Wagner LI, Kitzman D, Brubaker PH, Mihalko S, Jordan J, Avis NE, Winkfield KM, Ky B, Dent SF, Crotts T, Calhoun T, Lane K, Hundley WG. Understanding and predicting fatigue, cardiovascular (CV) decline, and events after breast cancer treatment (UPBEAT): A prospective cardio-oncology study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps11634] [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: 11/20/2022] Open
Abstract
TPS11634 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients,treated with modern cancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and future development of CV events. The comprehensive assessment of factors includes ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, Expanded SPPB), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points, include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2peak via cardiopulmonary exercise test), fatigue (via FACT-F). Eligibility criteria are: age >18 years; ECOG 0-2, able to walk without symptoms; and for BC patients, treatment with chemotherapy. 143 participants are accrued and currently enrolling through ECOG and NCORP sites. Participants will be followed for 9 years with active surveillance of CV events, i.e., heart failure, myocardial infarction, stroke, all-cause and CV death. Clinical trial information: NCT02791581.
Collapse
Affiliation(s)
- Kerryn Reding
- Fred Hutchinson Cancer Research Center & University of Washington, School of Nursing, Seattle, WA
| | | | | | - Heidi D. Klepin
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC
| | - Lynne I. Wagner
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | |
Collapse
|
36
|
Nagpal R, Mishra SP, Wang S, Tallant A, Varagic J, Kitzman D, Yadav H. A human‐origin probiotics cocktail exhibit cardio‐protective effects independent of GLP‐1 receptor signaling. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.720.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ravinder Nagpal
- Internal Medicine‐ Molecular MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Sidharth P Mishra
- Internal Medicine‐ Molecular MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Shaohua Wang
- Internal Medicine‐ Molecular MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Ann Tallant
- The Hypertension and Vascular Research CenterWake Forest School of MedicineWinston‐SalemNC
| | - Jasmina Varagic
- The Hypertension and Vascular Research CenterWake Forest School of MedicineWinston‐SalemNC
| | - Dalane Kitzman
- Internal Medicine‐ CardiologyWake Forest School of MedicineWinston‐SalemNC
| | - Hariom Yadav
- Internal Medicine‐ Molecular MedicineWake Forest School of MedicineWinston‐SalemNC
| |
Collapse
|
37
|
Reding K, Brubaker P, Dagostino R, Kitzman D, Hundley WW, Nicklas B, Jordan JH, Langford DJ, Grodesky M, Hundley W. THE ROLE OF INTERMUSCULAR FAT IN REDUCED EXERCISE CAPACITY IN CANCER SURVIVORS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32094-7] [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: 11/26/2022]
|
38
|
Byrum GV, Malaver D, Yeboah J, Kitzman D, Jao G. QUANTITATIVE ASSESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION BY TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION MEASURED FROM THE RIGHT VENTRICULAR INFLOW VIEW DURING TRANSTHORACIC ECHOCARDIOGRAPHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32107-2] [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]
|
39
|
Supiano MA, Lovato L, Ambrosius WT, Bates J, Beddhu S, Drawz P, Dwyer JP, Hamburg NM, Kitzman D, Lash J, Lustigova E, Miracle CM, Oparil S, Raj DS, Weiner DE, Taylor A, Vita JA, Yunis R, Chertow GM, Chonchol M. Pulse wave velocity and central aortic pressure in systolic blood pressure intervention trial participants. PLoS One 2018; 13:e0203305. [PMID: 30256784 PMCID: PMC6157848 DOI: 10.1371/journal.pone.0203305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Arterial stiffness, typically assessed as the aortic pulse wave velocity (PWV), and central blood pressure levels may be indicators of cardiovascular disease (CVD) risk. This ancillary study to the Systolic Blood Pressure Intervention Trial (SPRINT) obtained baseline assessments (at randomization) of PWV and central systolic blood pressure (C-SBP) to: 1) characterize these vascular measurements in the SPRINT cohort, and 2) test the hypotheses that PWV and C-SBP are associated with glucose homeostasis and markers of chronic kidney disease (CKD). The SphygmoCor® CPV device was used to assess carotid-femoral PWV and its pulse wave analysis study protocol was used to obtain C-SBP. Valid results were obtained from 652 participants. Mean (±SD) PWV and C-SBP for the SPRINT cohort were 10.7 ± 2.7 m/s and 132.0 ± 17.9 mm Hg respectively. Linear regression analyses for PWV and C-SBP results adjusted for age, sex, and race/ethnicity in relation to several markers of glucose homeostasis and CKD did not identify any significant associations with the exception of a marginally statistically significant and modest association between PWV and urine albumin-to-creatinine ratio (linear regression estimate ± SE, 0.001 ± 0.0006; P-value 0.046). In a subset of SPRINT participants, PWV was significantly higher than in prior studies of normotensive persons, as expected. For older age groups in the SPRINT cohort (age > 60 years), PWV was compared with a reference population of hypertensive individuals. There were no compelling associations noted between PWV or C-SBP and markers of glucose homeostasis or CKD. Clinical Trial Registration: NCT01206062.
Collapse
Affiliation(s)
- Mark A. Supiano
- Geriatrics Division University of Utah School of Medicine and VA Salt Lake City Geriatric Research, Education and Clinical Center, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Laura Lovato
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Walter T. Ambrosius
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Jeffrey Bates
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, United States of America
| | - Srinivasan Beddhu
- Nephrology Division University of Utah and Salt Lake City VA Medical Center, Salt Lake City, Utah, United States of America
| | - Paul Drawz
- Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jamie P. Dwyer
- Division of Nephrology/Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Naomi M. Hamburg
- Section of Vascular Biology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Dalane Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - James Lash
- Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Eva Lustigova
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Cynthia M. Miracle
- Division of Nephrology and Hypertension, University of California San Diego and VA San Diego Healthcare System, San Diego, California, United States of America
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Dominic S. Raj
- Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC, United States of America
| | - Daniel E. Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Addison Taylor
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, United States of America
| | - Joseph A. Vita
- Section of Vascular Biology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Reem Yunis
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Denver, Colorado, United States of America
| |
Collapse
|
40
|
Rangel MO, Kaplan R, Daviglus M, Schneiderman N, Hurwitz BE, Cai J, Gonzalez F, Kitzman D, Kansal M, Rodriguez CJ. Estimation of Incident Heart Failure Risk among US Hispanics/Latinos Using a Validated Echocardiographic Risk-Stratification Index: the Echocardiographic Study of Latinos. J Card Fail 2018; 24:622-624. [PMID: 30223030 DOI: 10.1016/j.cardfail.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Jianwen Cai
- University of North Carolina; Chapel Hill, North Carolina
| | | | - Dalane Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mayank Kansal
- University of Illinois at Chicago, Chicago, Illinois
| | | |
Collapse
|
41
|
Sink KM, Evans GW, Shorr RI, Bates JT, Berlowitz D, Conroy MB, Felton DM, Gure T, Johnson KC, Kitzman D, Lyles MF, Servilla K, Supiano MA, Whittle J, Wiggers A, Fine LJ. Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the Randomized Clinical Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc 2018; 66:679-686. [PMID: 29601076 DOI: 10.1111/jgs.15236] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine predictors of serious adverse events (SAEs) involving syncope, hypotension, and falls, with particular attention to age, in the Systolic Blood Pressure Intervention Trial. DESIGN Randomized clinical trial. SETTING Academic and private practices across the United States (N = 102). PARTICIPANTS Adults aged 50 and older with a systolic blood pressure (SBP) of 130 to 180 mmHg at high risk of cardiovascular disease events, but without diabetes, history of stroke, symptomatic heart failure or ejection fraction less than 35%, dementia, or standing SBP less than 110 mmHg (N = 9,361). INTERVENTION Treatment of SBP to a goal of less than 120 mmHg or 140 mmHg. MEASUREMENTS Outcomes were SAEs involving syncope, hypotension, and falls. Predictors were treatment assignment, demographic characteristics, comorbidities, baseline measurements, and baseline use of cardiovascular medications. RESULTS One hundred seventy-two (1.8%) participants had SAEs involving syncope, 155 (1.6%) hypotension, and 203 (2.2%) falls. Randomization to intensive SBP control was associated with greater risk of an SAE involving hypotension (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.21-2.32, P = .002), and possibly syncope (HR = 1.32, 95% CI = 0.98-1.79, P = .07), but not falls (HR = 0.98, 95% CI = 0.75-1.29, P = .90). Risk of all three outcomes was higher for participants with chronic kidney disease or frailty. Older age was also associated with greater risk of syncope, hypotension, and falls, but there was no age-by-treatment interaction for any of the SAE outcomes. CONCLUSIONS Participants randomized to intensive SBP control had greater risk of hypotension and possibly syncope, but not falls. The greater risk of developing these events associated with intensive treatment did not vary according to age.
Collapse
Affiliation(s)
- Kaycee M Sink
- Department of Medicine, Section on Department of Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Gregory W Evans
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Ronald I Shorr
- Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.,Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Dan Berlowitz
- Bedford Veterans Affairs Hospital, Bedford, Massachusetts.,School of Medicine, Boston University, Boston, Massachusetts.,School of Public Health, Boston University, Boston, Massachusetts
| | - Molly B Conroy
- Division of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah M Felton
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Tanya Gure
- Division of General Internal Medicine and Geriatrics, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Dalane Kitzman
- Department of Cardiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Mary F Lyles
- Department of Medicine, Section on Department of Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Karen Servilla
- Renal Section, New Mexico VA Health Care System, Albuquerque, New Mexico
| | - Mark A Supiano
- Division of Geriatrics, School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Veterans, Geriatric Research, Education and Clinical Center, Salt Lake City, Utah
| | - Jeff Whittle
- Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alan Wiggers
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University Cleveland Campus, Cleveland, Ohio
| | - Lawrence J Fine
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
42
|
Warraich H, Kitzman D, Whellan D, Pamela D, Mentz R, Pastva A, Nelson B, Reeves G. PHYSICAL FUNCTION, QUALITY OF LIFE, AND DEPRESSION IN ELDERLY, HOSPITALIZED PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE WITH PRESERVED VERSUS REDUCED EJECTION FRACTION: ANALYSIS FROM THE REHAB-HF TRIAL. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32418-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
43
|
Beddhu S, Chertow GM, Cheung AK, Cushman WC, Rahman M, Greene T, Wei G, Campbell RC, Conroy M, Freedman BI, Haley W, Horwitz E, Kitzman D, Lash J, Papademetriou V, Pisoni R, Riessen E, Rosendorff C, Watnick SG, Whittle J, Whelton PK. Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control. Circulation 2017; 137:134-143. [PMID: 29021322 DOI: 10.1161/circulationaha.117.030848] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [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: 07/31/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear. METHODS SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target <120 mm Hg) and standard (target <140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP. RESULTS Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level (P for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction P value of 0.78. Results were similar for all-cause death and kidney events. CONCLUSIONS Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.
Collapse
Affiliation(s)
- Srinivasan Beddhu
- Medical Service, Veterans Affairs Salt Lake City Health Care System, UT (S.B., A.K.C.) .,Division of Nephrology and Hypertension (S.B., A.K.C., G.W.)
| | - Glenn M Chertow
- University of Utah School of Medicine, Salt Lake City. Stanford University, Palo Alto, CA (G.M.C.)
| | - Alfred K Cheung
- Medical Service, Veterans Affairs Salt Lake City Health Care System, UT (S.B., A.K.C.).,Division of Nephrology and Hypertension (S.B., A.K.C., G.W.)
| | | | - Mahboob Rahman
- Case Western Reserve University, Cleveland, OH (M.R., E.H.)
| | | | - Guo Wei
- Division of Nephrology and Hypertension (S.B., A.K.C., G.W.)
| | - Ruth C Campbell
- Medical University of South Carolina, Charleston (R.C.C., R.P.)
| | | | | | - William Haley
- Wake Forest School of Medicine, Winston-Salem, NC. Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL (W.H.)
| | - Edward Horwitz
- Case Western Reserve University, Cleveland, OH (M.R., E.H.).,Metrohealth Medical Center, Cleveland, OH (E.H.)
| | | | - James Lash
- University of Illinois at Chicago, IL (J.L.)
| | | | - Roberto Pisoni
- Medical University of South Carolina, Charleston (R.C.C., R.P.).,Ralph H. Johnson VA Medical Center, Charleston, SC (R.P.)
| | | | | | | | - Jeffrey Whittle
- Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.)
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.)
| | | |
Collapse
|
44
|
Nadruz W, Kitzman D, Windham BG, Kucharska-Newton A, Butler K, Palta P, Griswold ME, Wagenknecht LE, Heiss G, Solomon SD, Skali H, Shah AM. Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study. J Gerontol A Biol Sci Med Sci 2017; 72:958-964. [PMID: 27733425 DOI: 10.1093/gerona/glw199] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/18/2016] [Indexed: 01/30/2023] Open
Abstract
Background The contribution of cardiovascular dysfunction to frailty in older adults is uncertain. This study aimed to define the relationship between frailty and cardiovascular structure and function, and determine whether these associations are independent of coexisting abnormalities in other organ systems. Methods We studied 3,991 older adults (mean age 75.6±5.0 years; 59% female) from the Atherosclerosis Risk in Communities (ARIC) Study in whom the following six organ systems were uniformly assessed: cardiac (by echocardiography), vascular (by ankle-brachial-index and pulse-wave-velocity), pulmonary (by spirometry), renal (by estimated glomerular filtration rate), hematologic (by hemoglobin), and adipose (by body mass index and bioimpedance). Frailty was defined by the presence of ≥3 of the following: low strength, low energy, slowed motor performance, low physical activity, or unintentional weight loss. Results Two hundred eleven (5.3%) participants were frail. In multivariable analyses adjusted for demographics, diabetes, hypertension, and measures of other organ system function, frailty was independently and additively associated with left ventricular hypertrophy (odds ratio [OR] = 1.72; 95% confidence interval [CI] = 1.30-2.40), reduced global longitudinal strain (reflecting systolic function; OR = 1.68; 95% CI = 1.16-2.44), and greater left atrial volume index (reflecting diastolic function; OR = 1.60; 95% CI = 1.13-2.27), which together demonstrated the greatest association with frailty (OR = 2.10; 95% CI = 1.57-2.82) of the systems studied. Lower magnitude associations were observed for vascular and pulmonary abnormalities, anemia, and impaired renal function. Cardiovascular abnormalities remained associated with frailty after excluding participants with prevalent cardiovascular disease. Conclusions Abnormalities of cardiac structure and function are independently associated with frailty, and together show the greatest association with frailty among the organ systems studied.
Collapse
Affiliation(s)
- Wilson Nadruz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Dalane Kitzman
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Beverly Gwen Windham
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | | | - Kenneth Butler
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | - Priya Palta
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Michael E Griswold
- Department of Medicine, Geriatrics University of Mississippi Medical Center, Jackson
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
45
|
Feldman T, Komtebedde J, Burkhoff D, Massaro J, Maurer MS, Leon MB, Kaye D, Silvestry FE, Cleland JGF, Kitzman D, Kubo SH, Van Veldhuisen DJ, Kleber F, Trochu JN, Auricchio A, Gustafsson F, Hasenfuβ G, Ponikowski P, Filippatos G, Mauri L, Shah SJ. Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure: Rationale and Design of the Randomized Trial to REDUCE Elevated Left Atrial Pressure in Heart Failure (REDUCE LAP-HF I). Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.116.003025. [PMID: 27330010 DOI: 10.1161/circheartfailure.116.003025] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Heart failure with preserved ejection fraction (HFpEF), a major public health problem with high morbidity and mortality rates, remains difficult to manage because of a lack of effective treatment options. Although HFpEF is a heterogeneous clinical syndrome, elevated left atrial pressure-either at rest or with exertion-is a common factor among all forms of HFpEF and one of the primary reasons for dyspnea and exercise intolerance in these patients. On the basis of clinical experience with congenital interatrial shunts in mitral stenosis, it has been hypothesized that the creation of a left-to-right interatrial shunt to decompress the left atrium (without compromising left ventricular filling or forward cardiac output) is a rational, nonpharmacological strategy for alleviating symptoms in patients with HFpEF. A novel transcatheter interatrial shunt device has been developed and evaluated in patients with HFpEF in single-arm, nonblinded clinical trials. These studies have demonstrated the safety and potential efficacy of the device. However, a randomized, placebo-controlled evaluation of the device is required to further evaluate its safety and efficacy in patients with HFpEF. In this article, we give the rationale for a therapeutic transcatheter interatrial shunt device in HFpEF, and we describe the design of REDUCE Elevated Left Atrial Pressure in Heart Failure (REDUCE LAP-HF I), the first randomized controlled trial of a device-based therapy to reduce left atrial pressure in HFpEF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02600234.
Collapse
Affiliation(s)
- Ted Feldman
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
| | - Jan Komtebedde
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Daniel Burkhoff
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Joseph Massaro
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Mathew S Maurer
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Martin B Leon
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - David Kaye
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Frank E Silvestry
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - John G F Cleland
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Dalane Kitzman
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Spencer H Kubo
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Dirk J Van Veldhuisen
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Franz Kleber
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Jean-Noël Trochu
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Angelo Auricchio
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Finn Gustafsson
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Gerd Hasenfuβ
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Piotr Ponikowski
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Gerasimos Filippatos
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Laura Mauri
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Sanjiv J Shah
- From the NorthShore University Health System, Evanston Hospital, IL (T.F.); Corvia Medical Incorporated, Tewksbury, MA (J.K.); Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY (D.B., M.S.M., M.B.L.); Harvard Clinical Research Institute, Boston University School of Public Health, MA (J.M.); Alfred Hospital and Baker IDI Heart and Diabetes Institute Melbourne, Australia (D.K.); Hospital of the University of Pennsylvania, Philadelphia (F.E.S.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London (J.G.F.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); University of Minnesota, Minneapolis (S.H.K.); University Medical Center Groningen, University of Groningen, The Netherlands (D.J.V.V.); Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine Berlin, Germany (F.K.); Université de Nantes, Institut du thorax, Centre Hospitalier Universitaire Nantes, France (J.-N.T.); Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.); August Universität, Gottingen, Germany (G.H.); Department of Cardiac Diseases, Military Hospital, Medical University, Wroclaw, Poland (P.P.); National and Kapodistian University of Athens, School of Medicine, Attikon University Hospital, Greece (G.F.); Division of Cardiology, Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| |
Collapse
|
46
|
Upadhya B, Williamson J, Kitzman D. IMPACT OF INTENSIVE BLOOD PRESSURE CONTROL ON INCIDENCE AND TYPE OF HEART FAILURE IN THE ELDERLY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B. Upadhya
- Wake Forest University, Winston-Salem, North Carolina
| | | | - D. Kitzman
- Wake Forest University, Advance, North Carolina,
| |
Collapse
|
47
|
O'Neal WT, Mazur M, Bertoni AG, Bluemke DA, Al-Mallah MH, Lima JAC, Kitzman D, Soliman EZ. Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.117.006023. [PMID: 28546456 PMCID: PMC5669197 DOI: 10.1161/jaha.117.006023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Several markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF). Methods and Results We analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093). Conclusions Markers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.
Collapse
Affiliation(s)
- Wesley T O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Matylda Mazur
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alain G Bertoni
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.,King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, King Saud bin Abdul Aziz University for Health Sciences Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD.,Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Dalane Kitzman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elsayed Z Soliman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC .,Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
48
|
Hung CL, Gonçalves A, Shah AM, Cheng S, Kitzman D, Solomon SD. Age- and Sex-Related Influences on Left Ventricular Mechanics in Elderly Individuals Free of Prevalent Heart Failure: The ARIC Study (Atherosclerosis Risk in Communities). Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.004510. [PMID: 28093411 DOI: 10.1161/circimaging.116.004510] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 04/13/2016] [Accepted: 10/18/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Advanced age is related to left ventricular (LV) remodeling. We sought to investigate the relationships between aging, elevated hemodynamic load, cardiac mechanics, and LV remodeling in an elderly community-based population. METHODS AND RESULTS We studied 1105 subjects (76±5 years, 61% women) without prevalent heart failure, who attended the visit 5 of the ARIC study (Atherosclerosis Risk in Communities). LV global longitudinal strain, global circumferential strain, and torsion indices were analyzed using 3-dimensional echocardiography. Advanced age was associated with greater LV concentricity, lower myocardial diastolic relaxation, reduced global longitudinal strain (adjusted estimate, 0.39±0.19% (SE)/decade; P=0.038), borderline greater global circumferential strain (adjusted estimate, -0.59±0.36% (SE)/decade; P=0.08), and higher torsion indices (adjusted estimate for torsion, 0.33±0.04° (SE)/decade; P<0.001). In addition, greater concentricity was associated with decreased global longitudinal strain and greater torsion in multivariable models (all P<0.001). Women showed smaller LV cavity size, greater concentricity, lower myocardial relaxation velocity E', though demonstrated greater global longitudinal strain, global circumferential strain, and torsion than men (all P<0.05). Overall, subjects with hypertension and increasing age were more likely to have higher torsion, though the association between advanced age and greater torsion was more pronounced in women than in men (both interaction P<0.05). CONCLUSIONS In an asymptomatic, senescent community-dwelling population, we observed a distinct, sex-specific pattern of cardiac remodeling. Although we observed worse diastolic and longitudinal function with advanced age or elevated load in both sexes, a significant increase of torsion was more pronounced in women.
Collapse
Affiliation(s)
- Chung-Lieh Hung
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| | - Alexandra Gonçalves
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| | - Amil M Shah
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| | - Susan Cheng
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| | - Dalane Kitzman
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
| | - Scott D Solomon
- From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
| |
Collapse
|
49
|
Shah AM, Claggett B, Kitzman D, Biering-Sørensen T, Jensen JS, Cheng S, Matsushita K, Konety S, Folsom AR, Mosley TH, Wright JD, Heiss G, Solomon SD. Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults: The Atherosclerosis Risk in Communities Study. Circulation 2016; 135:426-439. [PMID: 27927714 DOI: 10.1161/circulationaha.116.024825] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although age-associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values for incident heart failure (HF), as well as their associations with circulating biomarkers of HF risk. METHODS Among 5801 elderly participants in the ARIC study (Atherosclerosis Risk in Communities; age range, 67-90 years; mean age, 76±5 years; 42% male; 21% black), we determined the continuous association of diastolic measures (tissue Doppler imaging [TDI] e', E/e', and left atrial size) with concomitant N-terminal pro-brain natriuretic peptide and subsequent HF hospitalization or death. We also determined sex-specific 10th and 90th percentile limits for these measures using quantile regression in 401 participants free of prevalent cardiovascular disease and risk factors. RESULTS Each measure of diastolic function was robustly associated with N-terminal pro-brain natriuretic peptide and incident HF or death. ARIC-based reference limits for TDI e' (4.6 and 5.2 cm/s for septal and lateral TDI e', respectively) were substantially lower than guideline cut points (7 and 10 cm/s, respectively), whereas E/e' and left atrial size demonstrated good agreement with guideline cut points. TDI e' was nonlinearly associated with incident HF or death, with inflection points for risk supportive of ARIC-based limits. ARIC-based limits for diastolic function improved risk discrimination over guideline-based cut points based on the integrated discrimination improvement (P<0.001) and continuous net reclassification improvement (P<0.001), reclassifying 42% of the study population as having normal diastolic function. We replicate these findings in the Copenhagen City Heart Study. With these limits, 46% had normal diastolic function and were at low risk of HF hospitalization or death (1%/y over a mean 1.7-year follow-up), 49% had 1 or 2 abnormal measures and were at intermediate risk (2.4%/y), and all 3 diastolic measures were abnormal in 5% who were at high risk (7.5%/y). CONCLUSIONS Our findings suggest that left ventricular longitudinal relaxation velocity declines as a part of healthy aging and is largely prognostically benign. The use of age-based normative values when considering an elderly population improves the risk discrimination of diastolic measures for incident HF or death.
Collapse
Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.).
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Dalane Kitzman
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Tor Biering-Sørensen
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Jan Skov Jensen
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Susan Cheng
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Kunihiro Matsushita
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Suma Konety
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Aaron R Folsom
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Thomas H Mosley
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Jacqueline D Wright
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Gerardo Heiss
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., T.B.-S., S.C., S.D.S.); Wake Forest University School of Medicine, Winston-Salem, NC (D.K.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark (T.B.-S., J.S.J.); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M.); Cardiovascular Division, (S.K.) and Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.D.W.); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (G.H.)
| |
Collapse
|
50
|
Shah AM, Claggett B, Loehr LR, Chang PP, Matsushita K, Kitzman D, Konety S, Kucharska-Newton A, Sueta CA, Mosley TH, Wright JD, Coresh J, Heiss G, Folsom AR, Solomon SD. Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study. Circulation 2016; 135:224-240. [PMID: 27881564 DOI: 10.1161/circulationaha.116.023361] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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: 05/10/2016] [Accepted: 11/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although heart failure (HF) disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association HF stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain and diastolic dysfunction in defining HF stages is unclear. METHODS HF stages were classified in 6118 participants in the Atherosclerosis Risk in Communities study (67-91 years of age) at the fifth study visit as follows: A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with earlier hospitalization). RESULTS Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. Left ventricular (LV) ejection fraction was preserved in 77% and 65% in Stages C1 and C2, respectively. Incorporation of longitudinal strain and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (P=0.028) and integrated discrimination index (P=0.016). Abnormal LV structure, systolic function (based on LV ejection fraction and longitudinal strain), and diastolic function (based on e', E/e', and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants. CONCLUSIONS The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared with previous reports in younger community-based samples. LV ejection fraction is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HF with preserved LV ejection fraction in the elderly. LV diastolic function and longitudinal strain provide incremental prognostic value beyond conventional measures of LV structure and LV ejection fraction in identifying persons at risk for HF hospitalization or death.
Collapse
Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Laura R Loehr
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Patricia P Chang
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Kunihiro Matsushita
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Dalane Kitzman
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Suma Konety
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Anna Kucharska-Newton
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Carla A Sueta
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Thomas H Mosley
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Jacqueline D Wright
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Joseph Coresh
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Gerardo Heiss
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Aaron R Folsom
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., S.D.S.); Gillings School of Global Public Health (L.L., A.K.N., G.H.) and School of Medicine (P.C., C.S.), University of North Carolina, Chapel Hill; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., J.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.K.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (S.K., A.R.F.); Divisions of Geriatrics and Neurology, University of Mississippi Medical Center, Jackson (T.H.M.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC (J.W.)
| |
Collapse
|