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Györfi AH, Filla T, Polzin A, Tascilar K, Buch M, Tröbs M, Matei AE, Airo P, Balbir-Gurman A, Kuwert F, Mihai C, Kabala A, Graßhoff H, Callaghan J, Isomura Y, Mansour J, Spierings J, Tennoe AH, Selvi E, Riccieri V, Hoffmann-Vold AM, Bergmann C, Schett G, Hunzelmann N, van Laar JM, Saketkoo LA, Kuwana M, Siegert E, Riemekasten G, Distler O, du Four T, Smith V, Truchetet ME, Distler JHW. Evaluation of Systemic Sclerosis Primary Heart Involvement and Chronic Heart Failure in the European Scleroderma Trials and Research Cohort. J Am Heart Assoc 2025; 14:e036730. [PMID: 40008525 DOI: 10.1161/jaha.124.036730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 12/05/2024] [Indexed: 02/27/2025]
Abstract
BACKGROUND Systemic sclerosis (SSc) primary heart involvement (SSc-pHI) is one of the leading causes of mortality in SSc. We aimed to evaluate risk factors for SSc-pHI and its progression and the outcomes in the EUSTAR (European Scleroderma Trials and Research) cohort. METHODS SSc-pHI was defined according to the World Scleroderma Foundation/Heart Failure Association definition. Data from 5741 patients with SSc in the EUSTAR cohort were analyzed. Additional cardiovascular data were collected from a subcohort of 838 patients with SSc. Lasso regression was used for risk factor analyses. Kaplan-Meier estimator was used for survival analyses. Progression of SSc-pHI was evaluated by a study definition developed by rheumatology and cardiology experts. RESULTS Risk factors for the presence of SSc-pHI comprised skeletal muscle atrophy (odds ratio [OR], 2.00 [95% CI, 1.00-2.68]), age (OR, 1.91 [95% CI, 1.73-2.03]), male sex (OR, 1.77 [95% CI, 1.42-2.05]), swollen joints (OR, 1.70 [95% CI, 1.47-1.98]), skeletal muscle weakness (OR, 1.38 [95% CI, 1.00-1.85]), and tendon friction rubs (OR, 1.46 [95% CI, 1.00-1.77]) (n=3276). Telangiectasia (OR, 2.10 [95% CI, 1.38-2.72]), intestinal symptoms (OR, 1.70 [95% CI, 1.04-2.42]), age (OR, 1.47 [95% CI, 1.21-1.62]), and antitopoisomerase I antibodies (OR, 1.37 [95% CI, 1.00-1.77]) were associated with an increased risk for new onset of SSc-pHI (n=1000). Survival rate was significantly lower in patients with SSc-pHI than in those without (P value <0.0001, n=3768). Patients with SSc-pHI had a lower survival rate than patients with interstitial lung disease (n=3365). Swollen joints were associated with an increased risk of progressive SSc-pHI (OR, 2.49 [95% CI, 1.79-3.52]) (n=595). Tendon friction rubs (OR, 1.21 [95% CI, 0.94-1.90]) increased the risk of heart failure with preserved ejection fraction in patients with SSc-pHI. CONCLUSIONS We defined progressive SSc-pHI and identified risk factors for new onset and progression of SSc-pHI and for SSc-pHI-associated heart failure with preserved ejection fraction in the largest cohort with SSc. These findings may guide patient stratification for diagnostic workup and therapy.
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Affiliation(s)
- Andrea-Hermina Györfi
- Department of Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
- Hiller Research Center University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
| | - Tim Filla
- Department of Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
- Hiller Research Center University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
| | - Amin Polzin
- Department of Cardiology, Pneumology, and Angiology University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
- Deutsches Zentrum Immuntherapie (DZI) Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
| | - Maya Buch
- Department of Rheumatology University of Manchester Manchester UK
| | - Monique Tröbs
- Department of Medicine 2-Cardiology and Angiology Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen Germany
| | - Alexandru-Emil Matei
- Department of Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
- Hiller Research Center University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
| | - Paolo Airo
- Scleroderma Unit, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili Brescia Italy
| | - Alexandra Balbir-Gurman
- Rheumatology Institute, Rambam Health Care Campus, The Rappaport Faculty of Medicine Technion Haifa Israel
| | - Frederic Kuwert
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
- Deutsches Zentrum Immuntherapie (DZI) Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
| | - Carina Mihai
- Department of Rheumatology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Anna Kabala
- Rheumatology Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin Bordeaux France
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology Universitätsklinikum Schleswig-Holstein Lübeck Germany
| | - Julia Callaghan
- Department of Rheumatology and Clinical Immunology Charité-Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health Berlin Germany
| | - Yohei Isomura
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine Tokyo Japan
| | - Jennifer Mansour
- Scleroderma and Sarcoidosis Patient Care and Research Center University Medical Center Comprehensive Pulmonary Hypertension Center, Tulane University School of Medicine New Orleans LA
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology University Medical Center Utrecht Utrecht the Netherlands
| | | | - Enrico Selvi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences University of Siena Siena Italy
| | | | | | - Christina Bergmann
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
- Deutsches Zentrum Immuntherapie (DZI) Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
- Deutsches Zentrum Immuntherapie (DZI) Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen Erlangen Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology University Hospital Cologne Cologne Germany
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Lesley Ann Saketkoo
- Scleroderma and Sarcoidosis Patient Care and Research Center University Medical Center Comprehensive Pulmonary Hypertension Center, Tulane University School of Medicine New Orleans LA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine Tokyo Japan
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology Charité-Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health Berlin Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology Universitätsklinikum Schleswig-Holstein Lübeck Germany
| | - Oliver Distler
- Department of Rheumatology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Tessa du Four
- Department of Internal Medicine and Department of Rheumatology Ghent University Hospital Ghent Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre Ghent Belgium
| | - Vanessa Smith
- Department of Internal Medicine and Department of Rheumatology Ghent University Hospital Ghent Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre Ghent Belgium
| | - Marie-Elise Truchetet
- Rheumatology Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin Bordeaux France
| | - Jörg H W Distler
- Department of Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
- Hiller Research Center University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University Düsseldorf Germany
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Manzi MV, Mancusi C, Lembo M, Esposito G, Rao MAE, de Simone G, Morisco C, Trimarco V, Izzo R, Trimarco B. Low mechano-energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives. ESC Heart Fail 2022; 9:2291-2300. [PMID: 35481670 PMCID: PMC9288798 DOI: 10.1002/ehf2.13908] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 01/19/2023] Open
Abstract
Aims In a hypertensive population with optimal blood pressure control with a long‐term follow‐up, we aimed at analysing possible predictors of left ventricular (LV) ejection fraction (LVEF) reduction, including indexed mechano‐energetic efficiency (MEEi), a well‐recognized echo‐derived parameter of LV performance. Methods and results The study population included 5673 hypertensive patients from the Campania Salute Network with a long‐term follow‐up, normal baseline LVEF (≥50%), and no prevalent cardiovascular (CV) disease. Patients developing LVEF impairment (LVEF < 50% or a reduction of at least 10 percentage points compared with baseline) were compared with patients with persistently normal LVEF. Optimal blood pressure control was achieved in about 80% of patients. Patients who experienced LVEF reduction were 2.41% during a long‐term follow‐up (mean duration 5.6 ± 3.9 years). At baseline, they were older (59.46 ± 11.58 vs. 53.40 ± 11.41, P < 0.0001) and showed higher LV mass index (53.3 ± 12.83 vs. 47.56 ± 9.58, P < 0.0001), left atrial (LA) volume index (14.4 ± 4.2 vs. 13.1 ± 2.8, P < 0.0001) and carotid intima–media thickness (1.99 ± 0.86 vs. 1.61 ± 0.73, P < 0.0001), lower MEEi (0.32 ± 0.08 vs. 0.34 ± 0.07, P = 0.037), and higher prevalence of CV events during follow‐up (13.9% vs. 3%, P < 0.0001) compared with patients with persistently normal LVEF. A logistic regression analysis, performed after running univariate analyses and selecting parameters significantly associated with LVEF reduction, showed that having a CV event [odds ratio (OR) 7.57, P < 0.0001], being in the lowest MEEi quartile (OR 2.43, P = 0.003), and having a larger LA volume index (OR 1.08, P = 0.028) were all parameters independently associated with the development of LV systolic dysfunction. A further logistic regression model, performed by excluding patients experiencing CV events, demonstrated that the lowest MEEi quartile was independently associated with the evolution towards LVEF reduction (OR 2.35, P = 0.004), despite significant impact of LA volume index (OR 1.08, P = 0.023) and antiplatelet therapy (OR 1.89, P < 0.01). Receiver operating characteristic curves showed that the model including MEEi had higher accuracy than the model without MEEi in predicting LVEF reduction (areas under the curve 0.68 vs. 0.63, P = 0.046). Conclusions Lower values of MEEi at baseline identify hypertensive patients more liable to develop LVEF reduction. In hypertensive setting, MEEi evaluation improves risk stratification for development of LV systolic dysfunction during long‐term follow‐up.
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Affiliation(s)
- Maria V Manzi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Maria Lembo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Giovanni Esposito
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | | | - Giovanni de Simone
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Carmine Morisco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Valentina Trimarco
- Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
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Ventricular-Arterial Uncoupling and Hypertension Mediated Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:361-366. [PMID: 35460512 DOI: 10.1007/s40292-022-00521-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The increase in the pulsatile component of left ventricle afterload is suspected to cause a mismatch between the left ventricle (LV) and the vascular tree. AIM To demonstrate that ventricular-arterial uncoupling is frequently present in the development of LV hypertrophy (H) and diastolic dysfunction (DD) in hypertension (HBP). METHODS Observational study, HBP patients with ejection fraction > 54%. Conventional 2D echocardiography and tissue Doppler performed following imaging guidelines. LV end systolic elastance (Ees), the effective arterial elastance (Ea), and ventricular-arterial coupling (VAC) measured by Chen single beat method. RESULTS 288 patients, mean age 56.3 ± 12.5 years and 168 patients (58.3%) males. Mean LV mass index was 87.2 ± 20.4 grs/m2 and frequency of LVH 20.1% (58 patients). The mean VAC was 0.54 ± 9.23. LV Stroke volume, stroke work and systolic stress were 46.2 ± 10.3 cc/m2, 91.4 ± 22.2 g-min/m2, and 57 ± 14.6 dynes/cm2 in quartile 1, and 33.5 ± 6.6 cc/m2, 65.5 ± 15.2 g-min/m2, and 77.8 ± 17.1 dynes/cm2, in quartile 4, respectively (p < 0.001). Peripheral resistance index was 3349 ± 1072 and 4410 ± 1143 dynes*s/cm-5/m2 quartiles 1 vs. 4 (p < 0.005). The frequency of LVH was 31.9% in quartile 1 and 11.3% in quartile 4 (p < 0.005) and LVH or DD was 37.5% and 12.7%, respectively (p < 0.001). CONCLUSIONS Stroke volume and stroke work were significantly increased while systolic stress and peripheral resistance index were significantly reduced in patients with worst VAC. Ventricular-arterial uncoupling is mostly caused by an increase in Ees rather than by an elevation of Ea. LVH or DD are more frequent in the worst cases of ventricular-arterial uncoupling.
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Chinali M, Aurigemma GP, Gerdts E, Wachtell K, Okin PM, Muthiah A, Kjeldsen SE, Julius S, de Simone G, Devereux RB. Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion.
Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF < 50%.
Results: During a mean follow-up of 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all P < 0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001).
Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Marcello Chinali
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; Division of Cardiology, Bambino Gesù Children’s Hospital–IRCSS, 001655 Rome, Italy; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Anujan Muthiah
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Giovanni de Simone
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Huggins GS, Kinnamon DD, Haas GJ, Jordan E, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Ni H, Burke W, Hershberger RE. Prevalence and Cumulative Risk of Familial Idiopathic Dilated Cardiomyopathy. JAMA 2022; 327:454-463. [PMID: 35103767 PMCID: PMC8808323 DOI: 10.1001/jama.2021.24674] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022]
Abstract
Importance Idiopathic dilated cardiomyopathy (DCM) aggregates in families, and early detection in at-risk family members can provide opportunity to initiate treatment prior to late-phase disease. Most studies have included only White patients, yet Black patients with DCM have higher risk of heart failure-related hospitalization and death. Objective To estimate the prevalence of familial DCM among DCM probands and the age-specific cumulative risk of DCM in first-degree relatives across race and ethnicity groups. Design, Setting, and Participants A family-based, cross-sectional study conducted by a multisite consortium of 25 US heart failure programs. Participants included patients with DCM (probands), defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes, and their first-degree relatives. Enrollment commenced June 7, 2016; proband and family member enrollment concluded March 15, 2020, and April 1, 2021, respectively. Exposures The presence of DCM in a proband. Main Outcomes and Measures Familial DCM defined by DCM in at least 1 first-degree relative; expanded familial DCM defined by the presence of DCM or either left ventricular enlargement or left ventricular systolic dysfunction without known cause in at least 1 first-degree relative. Results The study enrolled 1220 probands (median age, 52.8 years [IQR, 42.4-61.8]; 43.8% female; 43.1% Black and 8.3% Hispanic) and screened 1693 first-degree relatives for DCM. A median of 28% (IQR, 0%-60%) of living first-degree relatives were screened per family. The crude prevalence of familial DCM among probands was 11.6% overall. The model-based estimate of the prevalence of familial DCM among probands at a typical US advanced heart failure program if all living first-degree relatives were screened was 29.7% (95% CI, 23.5% to 36.0%) overall. The estimated prevalence of familial DCM was higher in Black probands than in White probands (difference, 11.3% [95% CI, 1.9% to 20.8%]) but did not differ significantly between Hispanic probands and non-Hispanic probands (difference, -1.4% [95% CI, -15.9% to 13.1%]). The estimated prevalence of expanded familial DCM was 56.9% (95% CI, 50.8% to 63.0%) overall. Based on age-specific disease status at enrollment, estimated cumulative risks in first-degree relatives at a typical US advanced heart failure program reached 19% (95% CI, 13% to 24%) by age 80 years for DCM and 33% (95% CI, 27% to 40%) for expanded DCM inclusive of partial phenotypes. The DCM hazard was higher in first-degree relatives of non-Hispanic Black probands than non-Hispanic White probands (hazard ratio, 1.89 [95% CI, 1.26 to 2.83]). Conclusions and Relevance In a US cross-sectional study, there was substantial estimated prevalence of familial DCM among probands and modeled cumulative risk of DCM among their first-degree relatives. Trial Registration ClinicalTrials.gov Identifier: NCT03037632.
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Affiliation(s)
- Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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Brainin P, Lindberg S, Olsen FJ, Pedersen S, Iversen A, Galatius S, Fritz-Hansen T, Gislason G, Søgaard P, Møgelvang R, Biering-Sørensen T. Early systolic lengthening by speckle tracking echocardiography predicts outcome after coronary artery bypass surgery. IJC HEART & VASCULATURE 2021; 34:100799. [PMID: 34124339 PMCID: PMC8175274 DOI: 10.1016/j.ijcha.2021.100799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. METHODS We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II. RESULTS During median follow-up of 3.8 years [IQR 2.7-4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09-1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08-1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02-1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01--1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. CONCLUSIONS Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.
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Key Words
- A, late transmitral inflow velocity
- CABG, coronary artery bypass graft
- CK-MB, creatine kinase myocardial band
- Deformation
- E, early transmitral inflow velocity
- ESL, early systolic lengthening
- GLS, global longitudinal strain
- HR, hazard ratio
- IDI, integrated discrimination improvement
- IQR, interquartile range
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NRI, net reclassification index
- Prognosis
- Revascularization
- Systolic lengthening
- e’, early diastolic tissue velocity
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Federal University of Acre, Acre, Brazil
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Flemming J. Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health and Medical Sciences, Svendborg, University of Southern Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
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7
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Masjoan Juncos JX, Shakil S, Bradley WE, Wei CC, Zafar I, Powell P, Mariappan N, Louch WE, Ford DA, Ahmad A, Dell'Italia LJ, Ahmad S. Chronic cardiac structural damage, diastolic and systolic dysfunction following acute myocardial injury due to bromine exposure in rats. Arch Toxicol 2021; 95:179-193. [PMID: 32979061 PMCID: PMC7855670 DOI: 10.1007/s00204-020-02919-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
Accidental bromine spills are common and its large industrial stores risk potential terrorist attacks. The mechanisms of bromine toxicity and effective therapeutic strategies are unknown. Our studies demonstrate that inhaled bromine causes deleterious cardiac manifestations. In this manuscript we describe mechanisms of delayed cardiac effects in the survivors of a single bromine exposure. Rats were exposed to bromine (600 ppm for 45 min) and the survivors were sacrificed at 14 or 28 days. Echocardiography, hemodynamic analysis, histology, transmission electron microscopy (TEM) and biochemical analysis of cardiac tissue were performed to assess functional, structural and molecular effects. Increases in right ventricular (RV) and left ventricular (LV) end-diastolic pressure and LV end-diastolic wall stress with increased LV fibrosis were observed. TEM images demonstrated myofibrillar loss, cytoskeletal breakdown and mitochondrial damage at both time points. Increases in cardiac troponin I (cTnI) and N-terminal pro brain natriuretic peptide (NT-proBNP) reflected myofibrillar damage and increased LV wall stress. LV shortening decreased as a function of increasing LV end-systolic wall stress and was accompanied by increased sarcoendoplasmic reticulum calcium ATPase (SERCA) inactivation and a striking dephosphorylation of phospholamban. NADPH oxidase 2 and protein phosphatase 1 were also increased. Increased circulating eosinophils and myocardial 4-hydroxynonenal content suggested increased oxidative stress as a key contributing factor to these effects. Thus, a continuous oxidative stress-induced chronic myocardial damage along with phospholamban dephosphorylation are critical for bromine-induced chronic cardiac dysfunction. These findings in our preclinical model will educate clinicians and public health personnel and provide important endpoints to evaluate therapies.
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MESH Headings
- Animals
- Bromine
- Calcium-Binding Proteins/metabolism
- Cardiomegaly/chemically induced
- Cardiomegaly/metabolism
- Cardiomegaly/pathology
- Cardiomegaly/physiopathology
- Cardiotoxicity
- Diastole
- Disease Models, Animal
- Fibrosis
- Male
- Mitochondria, Heart/metabolism
- Mitochondria, Heart/ultrastructure
- Myocardium/metabolism
- Myocardium/ultrastructure
- NADPH Oxidase 2/metabolism
- Natriuretic Peptide, Brain/metabolism
- Oxidative Stress/drug effects
- Peptide Fragments/metabolism
- Phosphorylation
- Protein Phosphatase 1/metabolism
- Rats, Sprague-Dawley
- Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism
- Systole
- Time Factors
- Troponin I/metabolism
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/chemically induced
- Ventricular Dysfunction, Right/metabolism
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
- Rats
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Affiliation(s)
- Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Shazia Shakil
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Wayne E Bradley
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Chih-Chang Wei
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Pamela Powell
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Center for Heart Failure Research, KG Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - David A Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University, St. Louis, MO, USA
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA.
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8
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Sabbatini AR, Kararigas G. Estrogen-related mechanisms in sex differences of hypertension and target organ damage. Biol Sex Differ 2020; 11:31. [PMID: 32487164 PMCID: PMC7268741 DOI: 10.1186/s13293-020-00306-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022] Open
Abstract
Hypertension (HTN) is a primary risk factor for cardiovascular (CV) events, target organ damage (TOD), premature death and disability worldwide. The pathophysiology of HTN is complex and influenced by many factors including biological sex. Studies show that the prevalence of HTN is higher among adults aged 60 and over, highlighting the increase of HTN after menopause in women. Estrogen (E2) plays an important role in the development of systemic HTN and TOD, exerting several modulatory effects. The influence of E2 leads to alterations in mechanisms regulating the sympathetic nervous system, renin-angiotensin-aldosterone system, body mass, oxidative stress, endothelial function and salt sensitivity; all associated with a crucial inflammatory state and influenced by genetic factors, ultimately resulting in cardiac, vascular and renal damage in HTN. In the present article, we discuss the role of E2 in mechanisms accounting for the development of HTN and TOD in a sex-specific manner. The identification of targets with therapeutic potential would contribute to the development of more efficient treatments according to individual needs.
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Affiliation(s)
| | - Georgios Kararigas
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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9
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Stokar J, Leibowitz D, Durst R, Shaham D, Zwas DR. Echocardiography overestimates LV mass in the elderly as compared to cardiac CT. PLoS One 2019; 14:e0224104. [PMID: 31648248 PMCID: PMC6812823 DOI: 10.1371/journal.pone.0224104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/05/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Echocardiographic studies have shown an increase in LV mass with advanced age. However, autopsy and MRI studies demonstrate that with aging, LV mass is unchanged or slightly decreased, with a decrease in LV volume and an increase in wall thickness consistent with concentric remodeling. LV structural remodeling with aging may lead to an overestimation of LV mass in older adults when using standard echocardiography measurements and calculations. This study compared CT and echocardiographic LV mass calculation in younger and older patients and parameters associated with age-related LV remodeling. METHODS Same subject modality comparison of echocardiographic and cardiac CT LV measurement with derivation of LV mass was performed retrospectively. Echocardiographic measurements were performed by a single observer in accordance with European Association of Cardiovascular Imaging (EACI)/American Society of Echocardiography (ASE) guidelines. CT measurements were performed in end-diastole on multiplanar reformatted image planes corresponding to those typically used in echocardiography. Calculated CT measurements were based on automatic segmentation of heart chambers via edge-tracing algorithms. RESULTS 129 patients were identified. In patients age 65 and older, LV mass was significantly higher when calculated using echocardiographic measurements compared to CT. Patients 65 years of age and older were found to have increased average wall thickness measurements with echocardiography but not with CT. The discrepancy between calculated echo and CT LV mass was reduced when using the mid-septal instead of proximal wall width for the EACI convention. CONCLUSION In the elderly, increased echo-derived LV mass may reflect remodeling rather than a true increase in LV mass.
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Affiliation(s)
- Joshua Stokar
- Division of Endocrinology, Hadassah University Medical Center, Jerusalem, Israel
| | - David Leibowitz
- Division of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ronen Durst
- Division of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Dorith Shaham
- Division of Radiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Donna R. Zwas
- Division of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
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10
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Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, Sengeløv M, Jørgensen PG, Mogelvang R, Shah AM, Jensen JS. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005521. [PMID: 28264868 DOI: 10.1161/circimaging.116.005521] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/20/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. METHODS AND RESULTS A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; P<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension, E/e', and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11; P=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06-1.24; P=0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92-1.07; P=0.81, respectively; P for interaction =0.032). CONCLUSIONS In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.
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Affiliation(s)
- Tor Biering-Sørensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.).
| | - Sofie Reumert Biering-Sørensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Flemming Javier Olsen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Morten Sengeløv
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Peter Godsk Jørgensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Rasmus Mogelvang
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Amil M Shah
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Jan Skov Jensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
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11
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Ojji DB, Lecour S, Atherton JJ, Blauwet LA, Alfa J, Sliwa K. Right Ventricular Systolic Dysfunction Is Common in Hypertensive Heart Failure: A Prospective Study in Sub-Saharan Africa. PLoS One 2016; 11:e0153479. [PMID: 27073856 PMCID: PMC4830610 DOI: 10.1371/journal.pone.0153479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/30/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Right ventricular (RV) systolic dysfunction is now recognized widely as a strong and independent predictor of adverse outcomes in patients with heart failure (HF). Reduction of RV systolic function more closely predicts impaired exercise tolerance and poor survival than does left ventricular (LV) systolic function. In spite of this, there is a dearth of data on RV function in hypertensive HF which is the commonest form of HF in sub-Saharan Africa. We therefore conducted a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, Nigeria over an 8 year period. METHODS Each subject had transthoracic echocardiography performed on them according to the guidelines of American Society of Echocardiography. RV systolic function was defined as a tricuspid annular plane systolic excursion (TAPSE) <15 mm using M-mode echocardiography. RESULTS RV systolic dysfunction was identified in 272 (44.5%) of the 611 subjects that were studied. Subjects with TAPSE less than 15 mm had worse prognosis compared to those with TAPSE ≥15 mm.There was a significant correlation between TAPSE and other adverse prognostic markers including left and right atrial area, LV size, LV mass, LV ejection fraction, restrictive mitral inflow and RV systolic pressure (RVSP). However, LV ejection fraction and right atrial area were the only independent determinants of RV systolic dysfunction. CONCLUSIONS Hypertensive HF is a major cause of RV systolic dysfunction even in a population with a low prevalence of coronary artery disease, and RV systolic dysfunction is associated with poor prognosis in hypertensive HF. Detailed assessment of RV function should therefore be part of the echocardiography evaluation of patients with hypertensive HF.
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Affiliation(s)
- Dike B. Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John J. Atherton
- Department of Cardiology, Royal Brisbane and Women Hospital, and University of Queensland School of Medicine, Brisbane, Australia
| | - Lori A. Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jacob Alfa
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Lumens J, Prinzen FW, Delhaas T. Longitudinal Strain. JACC Cardiovasc Imaging 2015; 8:1360-1363. [DOI: 10.1016/j.jcmg.2015.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
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13
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Ojji D, Atherton J, Sliwa K, Alfa J, Ngabea M, Opie L. Left Ventricular Systolic Dysfunction in Asymptomatic Black Hypertensive Subjects. Am J Hypertens 2015; 28:924-9. [PMID: 25618515 DOI: 10.1093/ajh/hpu247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 11/14/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertension has been established as one of the commonest causes of heart failure especially in sub-Saharan Africa. We have previously observed a high prevalence of left ventricular (LV) systolic dysfunction in hypertensive heart failure patients in Nigeria despite a low prevalence of ischemic heart disease. The present study was, therefore, undertaken to assess the prevalence of asymptomatic LV systolic dysfunction in hypertensive black African subjects with no history of heart failure. METHODS One thousand nine hundred forty-seven hypertensive subjects without heart failure presenting to the Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Nigeria, from April 2006 to August 2013 had clinical and echocardiographic evaluation. RESULTS Nine hundred fifty-three (48.9%) were males and 994 (51.1%) were females. One thousand eight hundred seventeen (93.3%) had normal LV systolic function (LV ejection fraction (LVEF) ≥ 54%), 68 (3.5%) had mild LV systolic dysfunction (LVEF 45-54%), 43 (2.3%) had moderate LV systolic dysfunction (LVEF 30-44%), and 16 (0.9%) had severe LV systolic dysfunction (LVEF < 30%). Male subjects had worse LV systolic function compared to women (mean LVEF 73.2% vs. 75.6%, P value < 0.0001) and diabetic subjects had worse LV systolic function compared to nondiabetic subjects (LVEF 72.3% vs. 75.7%, P = 0.02). In multivariate regression analysis, lower LVEF as a continuous variable was associated with older age, male sex, diabetes mellitus, LV mass indexed for body surface area, diastolic blood pressure, posterior wall thickness in diastole, left atrial diameter, and LV internal diameter in diastole. CONCLUSIONS In a cohort of asymptomatic Black hypertensive subjects, 6.7% had LV systolic dysfunction, which was associated with male gender, diabetes mellitus, and larger LV mass.
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Affiliation(s)
- Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria;
| | - John Atherton
- Department of Cardiology, Royal Brisbane and Women Hospital, University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Karen Sliwa
- Faculty of Medicine, Hatter Institute of Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Jacob Alfa
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Murtala Ngabea
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Lionel Opie
- Faculty of Medicine, Hatter Institute of Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
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Kuroda K, Kato TS, Amano A. Hypertensive cardiomyopathy: A clinical approach and literature review. World J Hypertens 2015; 5:41-52. [DOI: 10.5494/wjh.v5.i2.41] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertensive cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric left ventricular hypertrophy (LVH) associated with diastolic or systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Persistent systemic hypertension leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, so patients are usually asymptomatic during resting conditions. However, their stiff left ventricles become incapable of handling increased blood volume and cannot produce appropriate cardiac output with the slight change of circulating volume that may occur during exercise. Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity. Therefore, early detection of LVH development in patients with hypertension (referred to as HTN-CM) is critical for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM. Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review article presents an overview of the multidimensional impact of myocardial disorder in patients with hypertension. Relevant literature is highlighted and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed, including possible therapeutic options.
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15
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Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, Di Tullio MR. Race-ethnic differences in subclinical left ventricular systolic dysfunction by global longitudinal strain: A community-based cohort study. Am Heart J 2015; 169:721-6. [PMID: 25965720 DOI: 10.1016/j.ahj.2015.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/01/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Race-ethnic differences exist in the epidemiology of heart failure, with blacks experiencing higher incidence and worse prognosis. Left ventricular (LV) systolic dysfunction (LVSD) detected by speckle-tracking global longitudinal strain (GLS) is a predictor of cardiovascular events including heart failure. It is not known whether race-ethnic differences in GLS-LVSD exist in subjects without overt LV dysfunction. METHODS Participants from a triethnic community-based study underwent 2-dimensional echocardiography with assessment of LV ejection fraction (LVEF) and GLS by speckle-tracking. Participants with LVEF <50% were excluded. Left ventricular systolic dysfunction by GLS was defined as GLS >95% percentile in a healthy sample (-14.7%). RESULTS Of the 678 study participants (mean age 71 ± 9 years, 61% women), 114 were blacks; 464, Hispanics; and 100, whites. Global longitudinal strain was significantly lower in blacks (-16.5% ± 3.5%) than in whites (-17.5% ± 3.0%) and Hispanics (-17.3% ± 2.9%) in both univariate (P = .015) and multivariate analyses (P = .011), whereas LVEF was not significantly different between the 3 groups (64.3% ± 4.6%, 63.4% ± 4.9%, 64.7% ± 4.9%, respectively, univariate P = .064, multivariate P = .291). Left ventricular systolic dysfunction by GLS was more frequent in blacks (27.2%) than in whites (19.0%) and Hispanics (14.9%, P = .008). In multivariate analysis adjusted for confounders and cardiovascular risk factors, blacks were significantly more likely to have GLS-LVSD (adjusted odds ratio 2.6, 95% CIs 1.4-4.7, P = .002) compared to the other groups. CONCLUSIONS Among participants from a triethnic community cohort, black race was associated with greater degree of subclinical LVSD by GLS than other race-ethnic groups. This difference was independent of confounders and cardiovascular risk factors.
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Surgit O, Erturk M, Buturak A, Akgul O, Pusuroglu H, Cakmak HA, Yazan S, Gul M, Akkaya E, Eksik A. The assessment of relationship between left ventricular geometry and microvolt T-wave alternans in sustained hypertension. Blood Press 2014; 23:349-355. [PMID: 24919782 DOI: 10.3109/08037051.2014.923252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Left ventricular (LV) hypertrophy (LVH) predicts increased mortality in part due to an elevated incidence of sudden cardiac death in hypertension. The aim of the present study was to investigate the relation of microvolt T-wave alternans (MTWA) with different LV geometric patterns in patient with sustained hypertension. METHODS This study consisted of 311 consecutive patients with sustained hypertension who were divided into four groups according to LV geometrical patterns. 90 patients were in the normal geometry group (NGG) [mean age 49.6 ± 7.8 years; 60 males (66.7%)], 99 patients were in the concentric remodeling group (CRG) [mean age 50.9 ± 6.6 years; 50 males (50.6%)], 63 patients were in the concentric hypertrophy group (CHG) [mean age 51.6 ± 7.3 years; 32 males (50.7%)] and 58 patients were in the eccentric hypertrophy group (EHG) [mean age 51.6 ± 9.0 years; 30 males (51.7%)]. Physical examination, laboratory work-up, office blood pressure measurement, transthoracic echocardiography and MTWA measurements were performed on all participants. RESULTS MTWA positivity was significantly higher in EHG and CHG as compared to CRG and NGG (p < 0.001). Left ventricle mass index (LVMI), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum diameter (IVSd), posterior wall diameter (PWd) and office systolic blood pressure (SBP) were found to be significantly positively correlated with MTWA (all p-values < 0.05). CONCLUSION We demonstrated that increased LVMI is associated with an elevated MTWA positivity in sustained hypertensives. Moreover, clinically significant LV geometric patterns including both concentric and eccentric hypertrophy are related with a raised MTWA positivity, which may lead to particular predilection to life-threatening ventricular arrhythmias and sudden cardiac death in sustained hypertension.
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Affiliation(s)
- Ozgur Surgit
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology , Istanbul , Turkey
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Russo C, Jin Z, Elkind MSV, Rundek T, Homma S, Sacco RL, Di Tullio MR. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail 2014; 16:1301-9. [PMID: 25211239 DOI: 10.1002/ejhf.154] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 01/19/2023] Open
Abstract
AIMS Global longitudinal strain (GLS) assessed by speckle-tracking echocardiography has been proposed as a parameter able to reflect early changes in left ventricular systolic function at a stage when left ventricular ejection fraction (LVEF) is still normal. This study aimed at assessing prevalence and prognostic value of left ventricular systolic dysfunction (LVSD) assessed by echocardiographic speckle-tracking GLS in a community-based cohort. METHODS AND RESULTS Participants from the community-based prospective Northern Manhattan Study underwent two-dimensional transthoracic echocardiography as part of the Cardiovascular Abnormalities and Brain Lesions study. Left ventricular systolic function was assessed by LVEF and speckle-tracking GLS. Subjects were followed annually (mean = 4.8 ± 1.5 years) and incident vascular events (ischaemic stroke, myocardial infarction, and vascular death) were reviewed and adjudicated. Of the 708 study participants, 114 (16.1%) had abnormal GLS but normal LVEF (GLS-LVSD), 30 (4.2%) had abnormal LVEF (LVEF-LVSD), and 564 (79.7%) had normal GLS and LVEF (no-LVSD). In multivariate analysis, risk of events was significantly greater in GLS-LVSD [adjusted hazard ratio (HR) = 2.39, 95% confidence interval (CI) = 1.20-4.77] and in LVEF-LVSD (adjusted HR = 3.51, 95% CI = 1.25-9.88) compared with no-LVSD. Among participants with normal LVEF, lower GLS was significantly associated with events (adjusted HR/unit decrease = 1.15, 95% CI = 1.03-1.28) whereas LVEF was not (adjusted HR/unit decrease = 1.01, 95% CI = 0.94-1.07). The GLS prognostic value was incremental to risk factors and LVEF both in the overall population (chi-square change = 7.406, P = 0.006) and in participants with normal LVEF (chi-square change = 6.357, P = 0.012). CONCLUSION In a community-based cohort, GLS-LVSD was four times more frequent than LVEF-LVSD. GLS-LVSD was a powerful and independent predictor of cardiovascular events. Left ventricular function assessment by GLS may improve cardiovascular risk stratification in subjects with normal LVEF.
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Affiliation(s)
- Cesare Russo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
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Khangura KK, Eirin A, Kane GC, Misra S, Textor SC, Lerman A, Lerman LO. Cardiac function in renovascular hypertensive patients with and without renal dysfunction. Am J Hypertens 2014; 27:445-53. [PMID: 24162729 DOI: 10.1093/ajh/hpt203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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MESH Headings
- Aged
- Biomarkers/blood
- Chi-Square Distribution
- Creatinine/blood
- Diastole
- Female
- Glomerular Filtration Rate
- Humans
- Hypertension/complications
- Hypertension/diagnosis
- Hypertension/mortality
- Hypertension/physiopathology
- Hypertension, Renovascular/complications
- Hypertension, Renovascular/diagnosis
- Hypertension, Renovascular/mortality
- Hypertension, Renovascular/physiopathology
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/mortality
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Right Ventricular/diagnostic imaging
- Hypertrophy, Right Ventricular/etiology
- Hypertrophy, Right Ventricular/mortality
- Hypertrophy, Right Ventricular/physiopathology
- Kaplan-Meier Estimate
- Kidney/physiopathology
- Male
- Middle Aged
- Minnesota/epidemiology
- Multivariate Analysis
- Prevalence
- Retrospective Studies
- Risk Factors
- Stroke Volume
- Systole
- Time Factors
- Ultrasonography
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
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Subramaniam V, Lip GYH. Hypertension to heart failure: a pathophysiological spectrum relating blood pressure, drug treatments and stroke. Expert Rev Cardiovasc Ther 2014; 7:703-13. [DOI: 10.1586/erc.09.43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Adebayo RA, Bamikole OJ, Balogun MO, Akintomide AO, Adeyeye VO, Bisiriyu LA, Mene-Afejuku TO, Ajayi EA, Abiodun OO. Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2013; 7:161-7. [PMID: 24250236 PMCID: PMC3825656 DOI: 10.4137/cmc.s12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.
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Affiliation(s)
- Rasaaq A Adebayo
- Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria
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Coller J, Campbell D, Krum H, Prior D. Early Identification of Asymptomatic Subjects at Increased Risk of Heart Failure and Cardiovascular Events: Progress and Future Directions. Heart Lung Circ 2013; 22:171-8. [DOI: 10.1016/j.hlc.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 11/25/2022]
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de Simone G, Arnett DK, Chinali M, De Marco M, Rao DC, Kraja AT, Hunt SC, Devereux RB. Partial normalization of components of metabolic syndrome does not influence prevalent echocardiographic abnormalities: the HyperGEN study. Nutr Metab Cardiovasc Dis 2013; 23:38-45. [PMID: 21570269 PMCID: PMC3158296 DOI: 10.1016/j.numecd.2011.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 12/21/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) is a complex condition characterized by different phenotypes, according to the combinations of risk factors and is associated with cardiovascular abnormalities. Whether control of MetS components by treatment produces improvement in the associated cardiovascular abnormalities is unknown. We investigated whether partial control of components of MetS was associated with less echocardiographic abnormalities than the complete presentation of MetS based on measured components. METHODS AND RESULTS We evaluated markers of echocardiographic preclinical cardiovascular disease in MetS (ATP III) defined by measured components or by history of treatment, in 1421 African-American and 1195 Caucasian non-diabetic HyperGEN participants, without prevalent cardiovascular disease or serum creatinine >2 mg/dL. Of 2616 subjects, 512 subjects had MetS by measured components and 328 by history. Hypertension was found in 16% of participants without MetS, 6% of those with MetS by history and 42% of those with MetS by measured components. Obesity and central fat distribution had similar prevalence in both MetS groups (both p < 0.0001 vs. No-MetS). Blood pressure was similar in MetS by history and No-MetS, and lower than in MetS by measured components (p < 0.0001). LV mass and midwall shortening, left atrial (LA) dimension and LA systolic force were similarly abnormal in both MetS groups (all p < 0.0001 vs. No-MetS) without difference between them. CONCLUSIONS There is a little impact of control by treatment of single components of MetS (namely hypertension) on echocardiographic abnormalities. Lower blood pressure in participants with MetS by history was not associated with substantially reduced alterations in cardiac geometry and function.
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Affiliation(s)
- G de Simone
- Weill-Cornell Medical College, New York, NY, USA.
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23
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Yeboah J, Rodriguez CJ, Stacey B, Lima JA, Liu S, Carr JJ, Hundley WG, Herrington DM. Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the multi-ethnic study of atherosclerosis (MESA). Circulation 2012; 126:2713-9. [PMID: 23124035 DOI: 10.1161/circulationaha.112.112201] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). METHODS AND RESULTS Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). CONCLUSIONS ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.
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Affiliation(s)
- Joseph Yeboah
- Department of Internal Medicine/Cardiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Park DG, Kim SE, Lee JH, Han KR, Oh DJ. Echocardiographic serial changes of hypertensive cardiomyopathy with severely reduced ejection fraction: comparison with idiopathic dilated cardiomyopathy. Clin Cardiol 2012; 35:554-8. [PMID: 22707118 DOI: 10.1002/clc.22012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 04/18/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertensive cardiomyopathy with reduced ejection fraction (HTCMREF) is known as an important cause of reversible cardiomyopathy, but its serial changes on echocardiography is yet to be elucidated. HYPOTHESIS HTCMREF on serial echocardiography has distinctive points as compared to idiopathic dilated cardiomyopathy (idDCM). METHODS We retrospectively studied 18 hypertensive patients (mean age, 63 ± 13 years, 56% women) admitted with severe left ventricular (LV) systolic dysfunction and heart failure. We compared clinical characteristics and echocardiographic parameters at admission and follow-up between the patients with HTCMREF and 18 age-matched patients with idDCM. Left ventricular mass (LVM) and left atrial volume (LAV) were calculated by a formula using echocardiographic measurement. RESULTS In HTCMREF, left ventricular ejection fraction improved to 52.3 ± 8.8% during a mean follow-up of 574 days. In HTCMREF, initial left atrial diameter was greater than in idDCM (43.6 ± 5.8 mm vs 38.9 ± 6.3, p = 0.027). At follow-up, LAV index decreased in HTCMREF (from 31.9 ± 8.3 mL/m(2) to 21.0 ± 8.9, P < 0.001), as opposed to a significant increase in idDCM (from 28.5 ± 10.9 mL/m(2) to 31.9 ± 8.3, P < 0.001). There was no significant difference in initial LVM index between the 2 groups, but only in HTCMREF did LVM index decrease significantly (151.4 ± 42.1 g/m(2) from 192.2 ± 43.7, P < 0.01) at follow-up. In HTCMREF, LV wall on M-mode was thicker than in idDCM. CONCLUSIONS Hypertensive cardiomyopathy with severe LV systolic dysfunction might be characterized by eccentric left ventricular hypertrophy and enlarged left atrium in comparison with idDCM.
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Affiliation(s)
- Dae-Gyun Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea.
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Cipollini F, Arcangeli E, Greco E, Franconi F, Pettinà G, Seghieri G. Gender difference in the relation blood pressure-left ventricular mass and geometry in newly diagnosed arterial hypertension. Blood Press 2012; 21:255-64. [PMID: 22545829 DOI: 10.3109/08037051.2012.676752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Much evidence suggests sexual dimorphism in the relationship linking blood pressure (BP) to both left ventricular mass (LVM) and geometry in hypertension. To better evaluate gender-associated characteristics in the relation BP-LVM among newly diagnosed hypertension (24-h average ambulatory BP monitoring, ABPM, > 125/80 mmHg), we measured indexed LVM and relative wall thickness (RWT) by standardized echographic methods in 209 Caucasian drug-naïve subjects, of whom 162 (100M/62F) were recognized to be hypertensive. Mean office systolic (SBP)/diastolic (DBP), 24-h average and night-time BP values were similar between sexes and significantly related to indexed LVM in both genders. Daytime SBP was significantly related to indexed LVM only in females (r =0.41; p =0.0008 in women; r =0.11; p = NS in males), while LVM was more sensitive to day-to-night SBP change in females. RWT was, on the contrary, significantly related to ABPM values only in males. All these findings were confirmed after adjusting for possible confounders. Percentage of LVM variance explained by 24-h average, daytime or night-time SBP values were higher in females than in males (17% vs 3%; 11% vs 1%; and 17% vs 8%). In conclusion, in early hypertension, LVM was significantly associated with daytime BP and more sensitive to reduced percentage of night BP fall in females. LVM variance explained by ABPM SBP was much higher in females than in males. RWT, expressing concentric LVM remodelling was, conversely, more related to BP increase in males.
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Affiliation(s)
- Franco Cipollini
- Department of Internal Medicine, Spedali Riuniti, Viale Matteotti 9/D, 51100 Pistoia, Italy
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Ogah OS, Akinyemi RO, Adegbite GD, Udofia OI, Udoh SB, Adesina JO, Ojo OS, Alabi AA, Majekodunmi T, Osinfade JK, Ogundipe RF, Falase AO. Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects. Cardiovasc J Afr 2011; 22:297-302. [PMID: 22159315 PMCID: PMC3721806 DOI: 10.5830/cvja-2010-063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 08/16/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria. METHODS Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period. RESULTS Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD. CONCLUSION Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.
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Affiliation(s)
- O S Ogah
- Department of Medicine, Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State, Nigeria
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Meijs MFL, Bots ML, Vonken EJA, Cramer MJM, Melman PG, Velthuis BK, van der Graaf Y, Mali WPTM, Doevendans PA. Rationale and design of the SMART Heart study: A prediction model for left ventricular hypertrophy in hypertension. Neth Heart J 2011; 15:295-8. [PMID: 18030317 DOI: 10.1007/bf03086003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Left ventricular hypertrophy (LVH) is an independent risk factor for the development of heart failure, coronary heart disease and stroke. LVH develops in response to haemodynamic overload, e.g. hypertension. LVH was originally thought to start as an adaptive and beneficial response required to normalise wall stress. However, this concept has been challenged by recent animal experiments suggesting that any degree of LVH is detrimental for the preservation of cardiac function and survival. If confirmed in humans, these findings imply that an increase in LV mass should be prevented, e.g. by lifestyle or pharmacological interventions. To facilitate and optimise interventions, the SMART Heart study was recently set up to develop a prediction model, also involving single nucleotide polymorphism data, for the identification of subjects at high risk of developing LVH in hypertension. For this purpose 1000 subjects with chronic hypertension will undergo cardiac MR imaging. In addition, this study allows the extrapolation of animal experimental genetic research into the human situation. (Neth Heart J 2007;15:295-8.).
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Affiliation(s)
- M F L Meijs
- Departments of Cardiology and Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects. Eur Heart J 2009; 31:588-94. [DOI: 10.1093/eurheartj/ehp490] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Abstract
Echocardiography serves an extremely important role in the diagnosis and management of patients with heart failure. The various stages of structural and functional changes that constitute progressive left ventricle remodeling have all been characterized by two-dimensional echocardiography. In addition, echocardiography has defined the transition from compensated hypertrophy to left ventricle dilatation and progression to end-stage heart failure. Echocardiography has also played an important role in clinical heart failure trials of beta-adrenergic blocking agents and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and demonstrated their efficacy in heart failure.
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Markham DW, Dries DL, King LP, Leonard D, Yancy CW, Peshock RM, Willett D, Cooper RS, Drazner MH. Blacks and whites have a similar prevalence of reduced left ventricular ejection fraction in the general population: the Dallas Heart Study (DHS). Am Heart J 2008; 155:876-82. [PMID: 18440335 DOI: 10.1016/j.ahj.2007.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/29/2007] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective of the study was to evaluate racial differences in the prevalence of left ventricular (LV) dysfunction. Few data compare the relative frequency of reduced LV ejection fraction (EF) (LVEF) in blacks and whites. Because of the higher prevalence of risk factors for heart failure in blacks, including hypertension, obesity, and LV hypertrophy, we hypothesized that LV dysfunction would also be more common in this ethnic group. METHODS In the DHS, a probability-based sample of Dallas County, we performed cardiac magnetic resonance imaging on 1335 black and 858 white participants aged 30 to 67 years to measure LVEF and volumes. We compared the prevalence of reduced LV EF and distribution of ventricular volumes in the 2 ethnic groups. RESULTS The prevalence of a reduced LVEF, whether defined as < 50%, < 55%, or < 60%, did not appear to be different between black versus white women (P > or = .7 for each) or men (P > or = .4 for each). Similar findings were seen using a recently defined sex-specific threshold (men < 55% and women < 61%) for low EF (P = .1). Mean LV end-diastolic and end-systolic volumes indexed to body surface area were also comparable in black and white men (P > or = .3) and women (P > or = .1). CONCLUSIONS Despite having a higher prevalence of risk factors for heart failure, blacks as compared with whites did not have a higher prevalence of reduced LVEF in the general population.
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Affiliation(s)
- David W Markham
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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Affiliation(s)
- Joseph A Hill
- Donald W. Reynolds Cardiovascular Clinical Research Center , University of Texas Southwestern Medical Center, Dallas, TX 75390-8573, USA.
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Ballo P, Motto A, Mondillo S, Faraguti SA. Impact of obesity on left ventricular mass and function in subjects with chronic volume overload. Obesity (Silver Spring) 2007; 15:2019-26. [PMID: 17712120 DOI: 10.1038/oby.2007.241] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Previous studies evaluated the effect of obesity on left ventricular (LV) mass and systolic function in healthy subjects and in patients with coexistent chronic LV pressure overload due to hypertension, but no data exist regarding subjects with underlying volume overload. This study assessed the impact of overweight-obesity on LV mass and systolic function in patients with coexistent chronic LV volume overload. RESEARCH METHODS AND PROCEDURES In 885 subjects with degenerative aortic regurgitation, a common cause of LV volume overload, LV mass, ejection fraction, and myocardial contractility were determined by echocardiography. RESULTS LV mass was greater in overweight (193.5 +/- 54.2 g) and further increased in obese subjects (208.4 +/- 63.6 g) in comparison with normal-weight patients (177.7 +/- 54.9 g) (p < 0.0001), and these differences were still evident after adjustment for LV workload, gender, and body size. Despite no differences in ejection fraction, LV myocardial contractility was lower in overweight (92.6 +/- 14.8%) and obese subjects (91.7 +/- 14.4%) than normal-weight individuals (95.6 +/- 16.0%) (p = 0.0058). The magnitudes of these effects were not different from those found in age-, gender-, and body size-matched controls, suggesting additive interaction, rather than synergistic, between overweight-obesity and the underlying condition of volume overload. Multivariate analysis showed that BMI independently predicted LV mass and that the negative effect on LV myocardial contractility was mediated by LV hypertrophy. DISCUSSION Overweight and obesity are associated with LV hypertrophy and contractile impairment in patients with underlying chronic LV volume overload.
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Affiliation(s)
- Piercarlo Ballo
- Cardiology Operative Unit, S. Andrea Hospital, La Spezia, Italy.
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Arnold JMO, Howlett JG, Dorian P, Ducharme A, Giannetti N, Haddad H, Heckman GA, Ignaszewski A, Isaac D, Jong P, Liu P, Mann E, McKelvie RS, Moe GW, Parker JD, Svendsen AM, Tsuyuki RT, O'Halloran K, Ross HJ, Rao V, Sequeira EJ, White M. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol 2007; 23:21-45. [PMID: 17245481 PMCID: PMC2649170 DOI: 10.1016/s0828-282x(07)70211-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.
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Ward RP, Goonewardena SN, Lammertin G, Lang RM. Comparison of the frequency of abnormal cardiac findings by echocardiography in patients with and without peripheral arterial disease. Am J Cardiol 2007; 99:499-503. [PMID: 17293193 DOI: 10.1016/j.amjcard.2006.09.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 09/13/2006] [Accepted: 09/13/2006] [Indexed: 02/02/2023]
Abstract
Peripheral arterial disease (PAD) diagnosed by ankle-brachial index (ABI) evaluation is associated with a high cardiovascular mortality rate. Transthoracic echocardiography (TTE) allows identification of left ventricular (LV) dysfunction and other cardiac findings associated with an increased cardiovascular mortality rate, for which treatments to alter prognosis are available. We sought to determine the prevalence of important TTE abnormalities in outpatients with symptomatic PAD by performing screening TEE. Outpatients without previous echocardiography who had been referred for ABI evaluation for suspected PAD underwent prospective screening TTE. The primary end points were LV dysfunction (LV ejection fraction <or=54%) and the composite of any clinically important echocardiographic finding. Patients confirmed to have PAD (ABI <or=0.9, n = 120) were found to have a high prevalence of LV dysfunction (26.7%), marked LV dysfunction (LV ejection fraction <45%) (14.2%), aortic stenosis (5.0%), and composite of any clinically important finding (36.7%). Patients with PAD had significantly more LV dysfunction and composite clinically important findings than patients without PAD (ABI >0.9, n = 84), and PAD was found to be an independent predictor of LV dysfunction (odds ratio 2.8, 95% confidence interval 1.2 to 6.4) and composite clinically important echocardiographic findings (3.2 95% confidence interval 1.5 to 7.1, p <0.01). In conclusion, outpatients with symptomatic PAD have a high prevalence of clinically important TTE abnormalities, including LV dysfunction, and PAD is an independent predictor of an abnormal echocardiogram.
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Affiliation(s)
- R Parker Ward
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
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Kamath S, Markham D, Drazner MH. Increased prevalence of concentric left ventricular hypertrophy in African-Americans: will an epidemic of heart failure follow? Heart Fail Rev 2006; 11:271-7. [PMID: 17131073 DOI: 10.1007/s10741-006-0228-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left ventricular hypertrophy (LVH), used in this review to denote abnormally increased left ventricular (LV) mass, is an important cardiac trait because of its association with numerous adverse cardiovascular outcomes including myocardial infarction and heart failure. LV mass is typically assessed by noninvasive cardiac imaging (echocardiography or MRI); electrocardiography is an insensitive measure. There are two predominant types of hypertrophy: concentric, where LV wall thickness is increased relative to cavity dimensions, and eccentric, where LV wall thickness is not increased relative to cavity dimensions. Several large studies indicate that the prevalence of concentric LVH is higher in African-Americans versus whites. Although there are data to suggest that concentric LVH results in systolic heart failure in animal models, such data are lacking in humans. How concentric LVH affects the prevalence of systolic and diastolic heart failure in African-Americans needs further study. Given the large burden of LVH among African-Americans, such data are needed to estimate the expected burden and type of heart failure which will occur in the future in this population.
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Affiliation(s)
- Sandeep Kamath
- Donald W. Reynolds Cardiovascular Clinical Research Center and Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MSJ, Stewart WJ. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2006; 18:1440-63. [PMID: 16376782 DOI: 10.1016/j.echo.2005.10.005] [Citation(s) in RCA: 8775] [Impact Index Per Article: 461.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dorbala S, Crugnale S, Yang D, Di Carli MF. Effect of body mass index on left ventricular cavity size and ejection fraction. Am J Cardiol 2006; 97:725-9. [PMID: 16490446 DOI: 10.1016/j.amjcard.2005.09.122] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Revised: 09/16/2005] [Accepted: 09/16/2005] [Indexed: 10/25/2022]
Abstract
Extreme obesity is known to be associated with left ventricular (LV) systolic dysfunction. The relation of lesser degrees of obesity and LV systolic function is controversial. This study assessed the relation between body mass index (BMI; weight in kilograms divided by height in meters squared) and the LV ejection fraction (EF) and volumes in 1,806 subjects with normal technetium-99m sestamibi myocardial perfusion imaging results. BMI was evaluated as a continuous and a categorical variable (normal >18.5 and <25, overweight > or =25 and <30, obese > or =30 and <35, and severely obese > or =35 kg/m(2)). The prevalence of an EF < or =50% was similar in normal, overweight, obese, and severely obese subjects. On univariate analysis, only severely obese women had mildly reduced LVEFs. LV end-diastolic and end-systolic volumes increased linearly from normal to obese men and women, respectively (each p <0.01). On multiple linear regression analysis (R = 0.5, p <0.001), BMI (p = 0.03) and diabetes (p <0.001) influenced the EF adversely, whereas age and female gender were protective (p <0.001). However, on gender-stratified analysis, diabetes, not BMI, independently predicted the EF in men and women. BMI remained an independent predictor of greater end-diastolic volumes in men and women (p <0.01) even after accounting for co-morbidities. In conclusion, mild obesity was associated with LV dilatation, but the LVEF was preserved even with severe obesity. Weight control may be recommended to reduce the incidence of obesity-related co-morbidities and their impact on adverse LV remodeling.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Body Mass Index
- Body Weight
- Case-Control Studies
- Exercise Test
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/physiopathology
- Linear Models
- Male
- Middle Aged
- Myocardial Reperfusion
- Obesity, Morbid/diagnosis
- Obesity, Morbid/epidemiology
- Obesity, Morbid/physiopathology
- Predictive Value of Tests
- Prevalence
- Prospective Studies
- Radiopharmaceuticals
- Sex Factors
- Stroke Volume
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Berenji K, Drazner MH, Rothermel BA, Hill JA. Does load-induced ventricular hypertrophy progress to systolic heart failure? Am J Physiol Heart Circ Physiol 2005; 289:H8-H16. [PMID: 15961379 DOI: 10.1152/ajpheart.01303.2004] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ventricular hypertrophy develops in response to numerous forms of cardiac stress, including pressure or volume overload, loss of contractile mass from prior infarction, neuroendocrine activation, and mutations in genes encoding sarcomeric proteins. Hypertrophic growth is believed to have a compensatory role that diminishes wall stress and oxygen consumption, but Framingham and other studies established ventricular hypertrophy as a marker for increased risk of developing chronic heart failure, suggesting that hypertrophy may have maladaptive features. However, the relative contribution of comorbid disease to hypertrophy-associated systolic failure is unknown. For instance, coronary artery disease is induced by many of the same risk factors that cause hypertrophy and can itself lead to systolic dysfunction. It is uncertain, therefore, whether ventricular hypertrophy commonly progresses to systolic dysfunction without the contribution of intervening ischemia or infarction. In this review, we summarize findings from epidemiologic studies, preclinical experiments in animals, and clinical trials to lay out what is known—and not known—about this important question.
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Affiliation(s)
- Kambeez Berenji
- Div. of Cardiology, Dept. of Internal Medicine, Univ. of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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de Simone G, Devereux RB, Kizer JR, Chinali M, Bella JN, Oberman A, Kitzman DW, Hopkins PN, Rao DC, Arnett DK. Body composition and fat distribution influence systemic hemodynamics in the absence of obesity: the HyperGEN Study. Am J Clin Nutr 2005; 81:757-61. [PMID: 15817849 DOI: 10.1093/ajcn/81.4.757] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We have shown that increased cardiac output is related to both fat-free mass and fat mass in obesity. OBJECTIVE We studied the association of body fat distribution and body composition with flow-resistance relations in overweight. DESIGN We studied 521 overweight, nonobese participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study-a component of the National Heart, Lung, and Blood Institute Family Blood Pressure Program, designed to assess the genetic basis of hypertension. Participants had normal ventricular function and no cardiovascular disease: 261 with central fat distribution (CFD) (waist girth >88 cm in women and >102 cm in men) and 260 with peripheral fat distribution (PFD). Fat-free mass (FFM) and fat mass (FM) were measured by bioelectric impedance. Body composition was estimated as FM/FFM. Echocardiographic stroke volume (SV) and cardiac output (CO) were measured. RESULTS Hypertension was present in 73% of the subjects with PFD and in 78% with CFD. Overweight with CFD was associated with greater FM/FFM in both normotensive and hypertensive participants. After FFM, age, sex, and race were controlled for, SV and CO were higher in subjects overweight with CFD than in those with PFD, whereas peripheral resistance was not significantly different. Differences in CO between CFD and PFD were reduced after further adjustment for FM. After the covariates were controlled for, hypertensive subjects had higher peripheral resistance and lower arterial compliance than did normotensive participants, but cardiac output was not significantly different. CONCLUSION CFD is associated with more severe abnormalities in body composition and with higher CO independently of FFM in overweight, nonobese subjects.
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Affiliation(s)
- Giovanni de Simone
- Department of Medicine, The New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
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Abstract
Left ventricular hypertrophy (LVH) represents not only an adaptation to increased load, but also a risk factor and a marker of risk of cardiovascular diseases. It may be detected early in the development of the disease by electrocardiography or echocardiography. LVH is often associated to abnormalities of systolic and diastolic function, and its presence clearly predisposes not only to cardiac ischemia and to congestive heart failure, but also to a higher incidence of stroke. A large number of clinical and experimental studies have shown that long-term antihypertensive treatment may be associated with regression of LVH. Long-term antihypertensive treatment is associated with a progressive decrease of LV mass. Differences on reduction of LV mass using different classes of antihypertensive drugs for the same decrease of blood pressure are usually mild, although the effect on cardiac structure and tissue composition are probably not the same. In fact, not only the quantity of left ventricular mass, but also its quality (i.e., collagen content, contractile machinery) should be evaluated and improved by treatment. The incidence of cardiovascular events in hypertensive patients is clearly related to the value of LV mass achieved during treatment; in fact, a reduction in LVH by antihypertensive treatment is associated with improvement in outcome and with decrease of the risk of cardiovascular morbidity and mortality, even independently from changes of other risk factors, including blood pressure. In patients with LVH at baseline, the decrease of LV mass is associated with a number of pathophysiological changes such as 1) improved systolic performance at the midwall, 2) possible improvement of diastolic filling, 3) autonomic nervous system changes toward normalization, 4) possible reduction or ventricular arrhythmias and 5) coronary reserve improvement. All these changes might explain an improvement of clinical prognosis in hypertensive patients. Ongoing studies will more precisely assess the quantitative relation between development or regression of LV mass, improvement of systolic and diastolic function and incidence of cardiovascular events. At present time detection, prevention and reversal of LVH represent a major goal in the management of hypertensive patients.
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Palmieri V, Wachtell K, Bella JN, Gerdts E, Papademetriou V, Nieminen MS, Dahlöf B, Roman MJ, Devereux RB. Usefulness of the assessment of the appropriateness of left ventricular mass to detect left ventricular systolic and diastolic abnormalities in absence of echocardiographic left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:423-30. [PMID: 15002006 DOI: 10.1038/sj.jhh.1001719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Conventional definitions of left ventricular (LV) hypertrophy do not account for interindividual differences in loading conditions. We may define LV mass as inappropriately high when exceeding 128% of theoretical values predicted by gender, height(2.7), and stroke work, which explain up to 82% of the variability of LV mass in normal reference subjects. In 652 participants in the Losartan Intervention For Endpoint reduction in hypertension study without clinically overt cardiovascular disease or diabetes, we investigated whether inappropriately high LV mass is associated with relevant LV abnormalities independent of traditional definition of LV hypertrophy (ie, LV mass index >116 g/m(2) in men and >104 g/m(2) in women). The study sample was divided into three groups: patients with inappropriately high LV mass but without LV hypertrophy were compared to patients with LV hypertrophy and to patients with appropriate LV mass and without LV hypertrophy. Patients with inappropriately high but nonhypertrophic LV mass had higher body mass index and relative wall thickness, and lower LV myocardial systolic function, than patients with appropriate LV mass or patients with LV hypertrophy. In multivariate analyses, inappropriately high LV mass was independently associated with lower myocardial systolic function independent of LV hypertrophy and other covariates. Inappropriately high LV mass was also associated with prolonged isovolumic relaxation time and lower mitral E/A ratio independent of covariates. In conclusion, inappropriately high LV mass was associated with relevant, often preclinical, manifestations of cardiac disease in the absence of traditionally defined echocardiographic LV hypertrophy and concentric geometry.
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Affiliation(s)
- V Palmieri
- Weill Medical College of Cornell University, New York, NY 10021, USA.
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Kirkpatrick JN, Davis A, Decara JM, Hong AE, Kurtz PL, Balasia B, Spencer KT. Hand-carried cardiac ultrasound as a tool to screen for important cardiovascular disease in an underserved minority health care clinic. J Am Soc Echocardiogr 2004; 17:399-403. [PMID: 15122177 DOI: 10.1016/j.echo.2004.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The disparity in cardiovascular outcomes among racial and social strata may be, in part, because of delayed detection of cardiovascular disease in minority patients. The low cost and portability of hand-carried cardiac ultrasound devices may make screening of underserved patients for cardiac disease feasible. A general internist evaluated 153 patients at a clinic serving an underserved population with a hand-carried cardiac ultrasound device. A total of 27 cases of significant valvular heart disease or ventricular dysfunction were detected in 19 patients (12.4%). Detection of a major cardiac abnormality could not be predicted by cardiac risk factors, age, or chief symptom, whereas patients presenting for new or acute clinic visits were more likely to have an abnormality. The low cost and portability of hand-carried cardiac ultrasound devices may make them important tools for the early detection of cardiovascular disease in minority and underserved populations and, thereby, help to reduce disparities in cardiovascular outcomes.
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Affiliation(s)
- James N Kirkpatrick
- Section of Cardiology and General Internal Medicine, Department of Medicine, University of Chicago, IL 60637, USA
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de Simone G, Devereux RB, Palmieri V, Bella JN, Oberman A, Kitzman DW, Hopkins PN, Rao DC, Arnett DK. Influence of fat-free mass on detection of appropriateness of left ventricular mass: the HyperGEN Study. J Hypertens 2003; 21:1747-52. [PMID: 12923408 DOI: 10.1097/00004872-200309000-00025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the differences between using height(2.7) or fat-free mass for assessment of the appropriateness of left ventricular mass (LVM) in relation to hemodynamic load, and to evaluate the performance of Doppler as compared with M-mode-derived stroke volume for computation of predicted values of LVM. DESIGN Cross-sectional. SETTING Population-based. PARTICIPANTS We studied 2299 participants from the Hypertension Genetic Epidemiology Network Study (prevalent cardiovascular disease in 342). OUTCOME MEASURES Individual predicted values of LVM were generated by equations using sex, stroke work (systolic blood pressure x stroke volume by either Doppler or M-mode) and either height(2.7) or fat-free mass, as measures of body build, in 228 normotensive, non-obese, non-diabetic participants. Observed LVM was divided by the predicted value and evaluated as 'excess of LVM'. RESULTS Among 1957 participants without prevalent cardiovascular disease, obese individuals (n = 1008) were slightly younger than non-obese individuals, whereas diabetic participants (n = 294) were slightly older. Excess of LVM was positively related to body mass index (BMI), independently of echocardiographic method and measure of body build, especially when height(2.7) and m-mode stroke work were used, and was greatest in the presence of concentric left ventricular hypertrophy (P < 0.0001). Excess LVM by height(2.7) was progressively greater than that by fat-free mass, as BMI increased (P < 0.0001). In analyses of covariance of association of prevalent cardiovascular disease with age, sex, race, BMI, and excess of LVM (by each method), methods using height(2.7) were more associated with prevalent cardiovascular disease than were methods using fat-free mass (P < 0.02). CONCLUSIONS Deviation of LVM from values that compensate hemodynamic load can be similarly identified using different measures of body build and methods to generate stroke work. However, the use of height(2.7) to compute LVM as a percentage of that predicted appears to identify deviations from compensatory values that are independently related to prevalent cardiovascular disease more effectively than does the use of fat-free mass.
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Affiliation(s)
- Giovanni de Simone
- Department of Medicine, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA.
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Devereux RB, Roman MJ, Palmieri V, Liu JE, Lee ET, Best LG, Fabsitz RR, Rodeheffer RJ, Howard BV. Prognostic implications of ejection fraction from linear echocardiographic dimensions: the Strong Heart Study. Am Heart J 2003; 146:527-34. [PMID: 12947374 DOI: 10.1016/s0002-8703(03)00229-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although echocardiography is commonly used to assess left ventricular (LV) systolic function, few data are available concerning the prognostic significance of LV ejection fraction (EF) calculated from linear echocardiographic measurements or 2-dimensional (2-D) wall motion scores in population-based samples. METHODS Echocardiography was used in the second Strong Heart Study (SHS) examination to calculate LV EF in 2948 American Indians without prevalent coronary heart disease; 2923 had 2-D wall motion scores. RESULTS Mildly and severely reduced LV EF occurred in 10% and 2% of participants, was associated with older age, male sex, higher systolic pressure, heart rate and markers of renal disease and inflammation. During 37 +/- 9 months follow-up, cardiovascular death occurred in 2%, 5% and 12% of participants with normal, mildly reduced and severely reduced EF; all cause mortality rates were 6%, 10% and 32% (both P <.001). In Cox proportional hazards analyses, adjusting for covariates, cardiovascular death was higher with mildly reduced EF (risk ratio [RR] 2.9, 95% CI 1.6-5.4, P =.0007) and especially with severely reduced EF (RR 6.9, 95% CI 3.0-15.9, P <.0001); all-cause mortality was increased with severe LV dysfunction (RR 4.8, 95% CI 2.8-8.1, P <.001) and marginally with mildly reduced EF (odds ratio 1.4, 95% CI 0.95-2.15, P =.08). Segmental LV dysfunction and mildly and severely reduced EF from 2-D wall motion scores were associated with 3.3-fold (95% CI 1.1-9.4, P =.02), 3.5-fold (95% CI 2.1-5.8) and 3.8-fold (95% CI 1.9-7.6) (all P <.001) increased rates of cardiovascular death. CONCLUSIONS LV EF from linear echocardiographic measurements as well as segmental LV dysfunction and EF from 2-D wall motion scores strongly and independently predict cardiovascular mortality. Reduced EF by simple echocardiographic method has estimated population-attributable risks of about 35% for cardiovascular death and 12% for all-cause mortality in a population-based sample of middle-aged to elderly adults.
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Celentano A, Palmieri V, Arezzi E, Mureddu GF, Sabatella M, Di Minno G, De Simone G. Gender differences in left ventricular chamber and midwall systolic function in normotensive and hypertensive adults. J Hypertens 2003; 21:1415-23. [PMID: 12817192 DOI: 10.1097/00004872-200307000-00033] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Whether left ventricular (LV) systolic function differs between healthy men and women independent of afterload, LV geometry, age, heart rate and body size is disputed. METHODS We studied 517 clinically healthy adults without history of cardiovascular or endocrinal disease (age range 20-70, 274 with essential arterial hypertension). Echocardiography was used to assess LV geometry and systolic function both at endocardial and midwall levels. RESULTS Normotensive and hypertensive women had higher LV systolic function at endocardial and midwall levels independent of afterload. After adjustment for age, body surface area, heart rate and LV geometry, LV systolic function remained higher in women than in men in hypertensive and normotensive subjects. In a second set of multivariate analyses adjusting for age, body mass index, LV geometry and heart rate, women had significantly higher LV systolic function than men, both among normotensive and hypertensive subjects. In a reference group of 95 subjects with optimal blood pressure and normal body mass index (mean age 34 +/- 10; 32 men) extracted from the study sample, lower limits (5th percentile) of parameters of LV systolic function were higher in women than in men. Use of gender-specific partition values revealed that subnormal LV chamber function was uncommon in overweight, normotensive subjects as well as in hypertensive subjects; vice versa, stress-corrected midwall dysfunction was frequently subnormal in both normotensive, overweight (14%, mostly women) and in hypertensive subjects (18%, mostly men). At the opposite end of the spectrum, gender-specific supranormal, stress-corrected LV systolic chamber function (> 95th percentile of the distribution in the reference group) was relatively frequent in both overweight, normotensive (14%) and in hypertensive subjects (27%). CONCLUSIONS Clinically healthy hypertensive and normotensive women have higher LV chamber and midwall systolic function than men, independent of left ventricular geometry, body size, age and heart rate. Use of gender-specific partition values to define subnormal and supranormal LV systolic function revealed that, both in hypertensive and overweight normotensive subjects, subnormal LV chamber function was uncommon, whereas stress-corrected LV chamber systolic function was frequently supranormal. Vice versa, myocardial contractility was subnormal in approximately one-sixth of asymptomatic, normotensive overweight and of hypertensive subjects, with potentially unfavorable prognostic impact.
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Affiliation(s)
- Aldo Celentano
- Department of Clinical and Experimental Medicine, 'Federico II' University Hospital, Naples, Italy.
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Devereux RB, Roman MJ, Paranicas M, Lee ET, Welty TK, Fabsitz RR, Robbins D, Rhoades ER, Rodeheffer RJ, Cowan LD, Howard BV. A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: the Strong Heart Study. Am Heart J 2001; 141:439-46. [PMID: 11231443 DOI: 10.1067/mhj.2001.113223] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although clinical congestive heart failure (CHF) is increasingly common, few data document the prevalence and correlates of underlying left ventricular (LV) systolic dysfunction (D) in population-based samples. METHODS Echocardiography was used in the second Strong Heart Study (SHS) examination to identify mild and severe LVD (LV ejection fraction [EF] 40%-54% and <40%, respectively) in 3184 American Indians. RESULTS Mild and severe LVD were more common in men than women (17.4% vs 7.2% and 4.7% vs 1.8%) and in diabetic than nondiabetic participants (12.7% vs 9.1% and 3.5% vs 1.6%). Stepwise increases were observed from participants with normal EF to those with mild and severe LVD in age (mean 60 vs 61 and 63 years, P <.001), prevalence of overt CHF (2% vs 6% and 28%) and definite coronary heart disease (3% vs 11% and 32%), systolic pressure (129 vs 135 and 136 mm Hg), serum creatinine level (0.98 vs 1.34 and 2.16 mg/dL), and log urinary albumin/creatinine level (3.2 vs 3.7 and 4.7); a negative relation was seen with body mass index (31.1 vs 31.0 and 28.4 kg/m(2)) (all P <.001). In multivariate analyses lower LVEFs were independently associated with clinical CHF and coronary heart disease, lower myocardial contractility, male sex, hypertension, overweight, arterial stiffening (higher pulse pressure/stroke volume) and renal dysfunction (higher serum creatinine level), higher LV mass, and lower relative wall thickness. CONCLUSIONS LVD, present in approximately 14% of middle-aged to elderly adults, is independently associated with overt heart failure and coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal target organ damage and, less consistently, with older age and diabetes.
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Affiliation(s)
- R B Devereux
- Department of Medicine, Cornell Medical Center, New York, NY, USA
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