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Abiodun OO, Anya T, Adekanmbi VT, Ojji D. Family History of Hypertension and Echocardiographic Left Ventricular Hypertrophy in Hypertensive Nigerians. Glob Health Epidemiol Genom 2024; 2024:7858899. [PMID: 39345991 PMCID: PMC11438504 DOI: 10.1155/2024/7858899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 09/02/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Studies on the relationship between a family history of hypertension and left ventricular hypertrophy are sparse. We evaluated this relationship in patients with essential hypertension. Methods A total of 1668 patients with essential hypertension were consecutively enrolled in the prospective Federal Medical Centre Abuja Hypertension Registry. First-degree family history was defined by the presence of a known history of hypertension in any or both parents, siblings, and children. Echocardiographic left ventricular hypertrophy was diagnosed using the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Results The prevalence of a family history of hypertension, echocardiographic, and electrocardiographic left ventricular hypertrophy were 61.7%, 46.8%, and 30.8%, respectively. After multivariable adjustment, paternal history of hypertension [OR: 1.56, CI: 1.20-2.05, p=0.001] was associated with an increased risk of echocardiographic left ventricular hypertrophy, while maternal history of hypertension [OR: 0.72, CI 0.58-0.91, p=0.006] was associated with a reduced risk. Age ≥50 years (p=0.026), duration of hypertension ≥1 year (p=0.047), and heart failure (p < 0.001) were associated with an increased risk of left ventricular hypertrophy, while male sex (p < 0.001) was associated with a reduced risk. Conclusion Our study showed that a paternal history of hypertension is associated with an increased left ventricular hypertrophy risk among patients with essential hypertension, while maternal history is protective.
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Affiliation(s)
| | - Tina Anya
- Department of Internal MedicineFederal Medical Centre, Abuja, Nigeria
| | - Victor Tunde Adekanmbi
- Department of Obstetrics and GynecologyUniversity of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Dike Ojji
- Department of Internal MedicineUniversity of AbujaUniversity of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
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Yagi R, Mori Y, Goto S, Iwami T, Inoue K. Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adults. JAMA Intern Med 2024; 184:1035-1044. [PMID: 38949831 PMCID: PMC11217891 DOI: 10.1001/jamainternmed.2024.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 07/02/2024]
Abstract
Importance The resting electrocardiogram (ECG) is commonly performed for cardiovascular disease (CVD) screening purposes in Japan. However, evidence is limited regarding the prognostic significance of ECG in clinical practice settings. Objective To investigate the association between ECG abnormalities and CVD outcomes in a working-age population. Design, Setting, and Participants This nationwide cohort study included individuals aged 35 to 65 years from the Japan Health Insurance Association database, which covers approximately 40% (30 million) of the working-age population in Japan. Data from April 1, 2015, to March 31, 2022, were included, and analysis was conducted from October 1, 2022, to April 11, 2024. Exposures Baseline ECG status (normal, 1 minor abnormality, ≥2 minor abnormalities, or major abnormality). Main Outcomes and Measures The primary outcome was a composite of overall death and CVD hospital admission due to myocardial infarction, stroke, or heart failure. The secondary outcome was developing a new major ECG abnormality over the years of screening. Results Of 3 698 429 individuals enrolled in the nationwide annual health check program (mean [SD] age, 47.1 [8.5] years; 66.6% male), 623 073 (16.8%) had 1 minor ECG abnormality, 144 535 (3.9%) had 2 or more minor ECG abnormalities, and 56 921 (1.5%) had a major ECG abnormality. During a median follow-up of 5.5 (IQR, 3.4-5.7) years, baseline ECG abnormality was independently associated with an increased incidence of the composite end points of overall death and CVD admission compared with normal ECG (incidence rates per 10 000 person-years: 92.7 [95% CI, 92.2-93.2] for normal ECG, 128.5 [95% CI, 127.2-129.9] for 1 minor ECG abnormality, 159.7 [95% CI, 156.6-162.9] for ≥2 minor ECG abnormalities, and 266.3 [95% CI, 259.9-272.3] for a major ECG abnormality; adjusted hazard ratios: 1.19 [95% CI, 1.18-1.20] for 1 minor ECG abnormality, 1.37 [95% CI, 1.34-1.39] for ≥2 minor ECG abnormalities, and 1.96 [95% CI, 1.92-2.02] for a major ECG abnormality). Furthermore, the presence and number of minor ECG abnormalities were associated with an increased incidence of developing new major ECG abnormalities (incidence rates per 10 000 person-years: 85.1 [95% CI, 84.5-85.5] for normal ECG, 217.2 [95% CI, 215.5-219.0] for 1 minor ECG abnormality, and 306.4 [95% CI, 302.1-310.7] for ≥2 minor ECG abnormalities; and adjusted hazard ratios: 2.52 [95% CI, 2.49-2.55] for 1 minor ECG abnormality and 3.61 [95% CI, 3.55-3.67] for ≥2 minor ECG abnormalities). Associations were noted regardless of baseline CVD risk. Conclusions and Relevance The findings of this study suggest that the potential role of routine ECG screening for early prevention of CVD events, along with the optimal follow-up strategy, should be examined in future studies.
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Affiliation(s)
- Ryuichiro Yagi
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yuichiro Mori
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Goto
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of General Internal Medicine & Family Medicine, Department of General and Acute Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
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Takenaka T, Ohno Y, Eguchi K, Miyashita H, Suzuki H, Shimada K. Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients. Blood Press 2022; 31:64-70. [PMID: 35438015 DOI: 10.1080/08037051.2022.2062295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSES Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. METHODS The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. RESULTS Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. CONCLUSIONS The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
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Affiliation(s)
- Tsuneo Takenaka
- Kokusai Iryo Fukushi Daigaku, Nephrology, Minato-ku, Tokyo, Japan
| | - Yoichi Ohno
- Saitama Ika Daigaku, Nephrology, Iruma-gun, Saitama, Japan
| | - Kazuo Eguchi
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | - Hiroshi Miyashita
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | | | - Kazuyuki Shimada
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
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Lee JW, Choi BW. Aortic Unfolding Measurement Using Non-Contrast Cardiac CT: Normal Range of Low-Risk Subjects. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:360-371. [PMID: 36237929 PMCID: PMC9514443 DOI: 10.3348/jksr.2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Karaca Özer P, Ayduk Gövdeli E, Engin B, Atıcı A, Baykız D, Orta H, Demirtakan ZG, Emet S, Elitok A, Tayyareci Y, Umman B, Bilge AK, Buğra Z. Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality. Anatol J Cardiol 2021; 25:863-871. [PMID: 34866580 DOI: 10.5152/anatoljcardiol.2021.21940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis. METHODS This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below -12.5% was defined as severely reduced strain, -12.5% to -17.9% as mildly reduced strain, and above -18% as normal strain. RESULTS The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: -11.4±2.2%; HHD: -13.6±2.6%; and athletes: -15.5±2.1%; p<0.001 among groups). LV-GLS below -12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699-0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was -11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537-0.974, p=0.033). Patients with GLS below -12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above -12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of -12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012). CONCLUSION The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.
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Affiliation(s)
- Pelin Karaca Özer
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Elif Ayduk Gövdeli
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Berat Engin
- Department of Cardiology, Manavgat State Hospital; Antalya-Turkey
| | - Adem Atıcı
- Department of Cardiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital; İstanbul-Turkey
| | - Derya Baykız
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Hüseyin Orta
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | | | - Samim Emet
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ali Elitok
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Yelda Tayyareci
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Berrin Umman
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Zehra Buğra
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
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Zhou N, Chen X, Xi J, Ma B, Leimena C, Stoll S, Qin G, Wang C, Qiu H. Genomic characterization reveals novel mechanisms underlying the valosin-containing protein-mediated cardiac protection against heart failure. Redox Biol 2020; 36:101662. [PMID: 32795937 PMCID: PMC7426568 DOI: 10.1016/j.redox.2020.101662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic hypertension is a key risk factor for heart failure. However, the underlying molecular mechanisms are not fully understood. Our previous studies found that the valosin-containing protein (VCP), an ATPase-associated protein, was significantly decreased in the hypertensive heart tissues. In this study, we tested the hypothesis that restoration of VCP protected the heart against pressure overload-induced heart failure. With a cardiac-specific transgenic (TG) mouse model, we showed that a moderate increase of VCP was able to attenuate chronic pressure overload-induced maladaptive cardiac hypertrophy and dysfunction. RNA sequencing and a comprehensive bioinformatic analysis further demonstrated that overexpression of VCP in the heart normalized the pressure overload-stimulated hypertrophic signals and repressed the stress-induced inflammatory response. In addition, VCP overexpression promoted cell survival by enhancing the mitochondria resistance to the oxidative stress via activating the Rictor-mediated-gene networks. VCP was also found to be involved in the regulation of the alternative splicing and differential isoform expression for some genes that are related to ATP production and protein synthesis by interacting with long no-coding RNAs and histone deacetylases, indicating a novel epigenetic regulation of VCP in integrating coding and noncoding genomic network in the stressed heart. In summary, our study demonstrated that the rescuing of a deficient VCP in the heart could prevent pressure overload-induced heart failure by rectifying cardiac hypertrophic and inflammatory signaling and enhancing the cardiac resistance to oxidative stress, which brought in novel insights into the understanding of the mechanism of VCP in protecting patients from hypertensive heart failure.
Deficiency of VCP contributes to the pathogenesis of hypertensive heart failure. Rescue of VCP prevents stress-induced cardiac remodeling and cell death. VCP attenuates stress-induced inflammatory and hypertrophic signaling. VCP promotes cardiac resistance to oxidative stress. VCP mediates a novel epigenetic integrating regulation in the stressed heart.
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Affiliation(s)
- Ning Zhou
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA; Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xin Chen
- Center for Genomics & Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Jing Xi
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Ben Ma
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA; Center of Molecular and Translational Medicine, Institution of Biomedical Science, Georgia State University, Atlanta, GA, 30303, USA
| | - Christiana Leimena
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Shaunrick Stoll
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Gangjian Qin
- Department of Biomedical Engineering, School of Medicine and School of Engineering, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Charles Wang
- Center for Genomics & Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.
| | - Hongyu Qiu
- Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA; Center of Molecular and Translational Medicine, Institution of Biomedical Science, Georgia State University, Atlanta, GA, 30303, USA.
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Braunstein ED, Croft LB, Halperin JL, Liao SL. Improved scoring system for the electrocardiographic diagnosis of left ventricular hypertrophy. World J Cardiol 2019; 11:94-102. [PMID: 31040932 PMCID: PMC6475698 DOI: 10.4330/wjc.v11.i3.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/12/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic (ECG) diagnosis have limited accuracy.
AIM To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.
METHODS A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography (TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.
RESULTS Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333 (6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P’ in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were 67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts, respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.
CONCLUSIONS This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.
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Affiliation(s)
- Eric D Braunstein
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10467, United States
| | - Lori B Croft
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States
| | - Jonathan L Halperin
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States
| | - Steve L Liao
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States
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Dominguez RF, da Costa-Hong VA, Ferretti L, Fernandes F, Bortolotto LA, Consolim-Colombo FM, Egan BM, Lopes HF. Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival. SAGE Open Med 2019; 7:2050312118823582. [PMID: 30671246 PMCID: PMC6327325 DOI: 10.1177/2050312118823582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%-47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values <0.01). Left ventricular ejection fraction increased in 69% of patients. Patients who did not have improved left ventricular ejection fraction had nearly six-fold higher mortality than those that improved (relative risk; 5.7, 95% confidence interval: 1.3-25, p = 0.022). Conclusion Carvedilol reduced cardiac dimensions and improved left ventricular ejection fraction and cardiac remodeling in patients with hypertensive heart disease. These treatment-related changes had a favorable effect on survival.
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Affiliation(s)
| | - Valeria A da Costa-Hong
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Luan Ferretti
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil
| | - Fabio Fernandes
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Luiz A Bortolotto
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fernanda M Consolim-Colombo
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil.,Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Brent M Egan
- Care Coordination Institute, Greenville, SC, USA.,Department of Medicine, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Heno F Lopes
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil.,Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Norby FL, Chen LY, Soliman EZ, Gottesman RF, Mosley TH, Alonso A. Association of left ventricular hypertrophy with cognitive decline and dementia risk over 20 years: The Atherosclerosis Risk In Communities-Neurocognitive Study (ARIC-NCS). Am Heart J 2018; 204:58-67. [PMID: 30077834 PMCID: PMC6214738 DOI: 10.1016/j.ahj.2018.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/08/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an indicator of organ damage largely due to hypertension. We assessed whether LVH was associated with dementia and cognitive function in the Atherosclerosis Risk in Communities study. METHODS Our analysis included 12,665 individuals (23% black race, 56% female, mean age 57) who attended visit 2 in 1990-1992. Cornell voltage (SV3 + RaVL) was derived from 12-lead electrocardiograms and dichotomized as LVH using sex-specific criteria (>28 mm men; >22 mm women). Incident dementia was defined by expert review using a predetermined algorithm, and cognitive function was measured longitudinally using 3 tests. A Cox model was used to evaluate the association between time-dependent LVH and dementia adjusted for time-varying covariates from 1990 to 2013. Linear regression models fit with generalized estimating equations were used to evaluate LVH with cognitive function. RESULTS During a mean follow-up of 18 years, we identified 544 participants with LVH and 1,195 dementia cases. LVH was associated with a higher risk of dementia: multivariable hazard ratio = 1.90; 95% CI: 1.47-2.44. Those with LVH had lower cognitive scores at baseline; however, there was no difference in the rate of cognitive decline over 20 years in those with LVH versus those without LVH. CONCLUSIONS In this population-based study, LVH measured during midlife was associated with an increased risk of incident dementia; however, LVH was not associated with additional cognitive decline. These results underscore the need for hypertension control to prevent subclinical brain injury.
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Affiliation(s)
- Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Lin Y Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Elsayed Z Soliman
- Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi, Jackson, MS
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Li T, Bai B, Tian C, Wang H, Jiang D, Ma F, Shan M. High sucrose/fat diet and isosorbide mononitrate increase insulin resistance, nitric oxide production and myocardial apoptosis in a hypertensive rat model. Mol Med Rep 2018; 17:6789-6795. [PMID: 29488615 DOI: 10.3892/mmr.2018.8651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/07/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to investigate the association between insulin resistance (IR), nitric oxide (NO) production and myocardial apoptosis in a background of coexisting hypertension in a rodent animal model. A hypertensive rat model was established by feeding Wistar and spontaneously hypertensive rats (SHR) with a high sucrose/fat (HSF) diet for 12 weeks, in conjunction with isosorbide mononitrate (ISMN). Increased IR, NO content, apoptotic gene and protein expression, and morphological alterations within rat myocardium were evaluated. Following a total of 12 weeks of feeding with HSF and ISMN resulted in increased IR and NO content within the myocardial tissue of Wistar and SHR rats. HSF and ISMN activated myocardial apoptosis by downregulating the gene transcription and protein expression levels of the anti‑apoptotic B‑cell lymphoma 2 (Bcl‑2), and increasing the pro‑apoptotic Bcl‑2 associated X protein. Apoptosis was demonstrated by DNA fragmentation in terminal deoxynucleotidyl‑transferase‑mediated dUTP nick end labelling assay. In all experiments, the combination of HSF and ISMN was associated with more pronounced effects, indicating the possible synergistic effects. In addition, the correlation analysis in the Wistar rats fed with HSF only, revealed a positive association between NO production and IR. The results of the present study indicated that HSF and ISMN simultaneously increased IR, NO production and myocardial apoptosis in the hypertensive rat model, and may therefore contribute to investigations into the long‑term clinical use of ISMN in hypertensive patients.
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Affiliation(s)
- Ting Li
- Department of Endocrinology and Metabolic Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Bing Bai
- Department of Endocrinology and Metabolic Diseases, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Chenguang Tian
- Department of Endocrinology and Metabolic Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Huihui Wang
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo, Henan 454000, P.R. China
| | - Deyue Jiang
- Department of Endocrinology and Metabolic Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Fangfei Ma
- Department of Endocrinology and Metabolic Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Mengting Shan
- Department of Endocrinology and Metabolic Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
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Takenaka T, Suzuki H, Eguchi K, Miyashita H, Shimada K. Elevated pulse amplification in hypertensive patients with advanced kidney disease. Hypertens Res 2018; 41:299-307. [DOI: 10.1038/s41440-017-0010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 01/30/2023]
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Sahin H, Stark P. Diagnostic Utility of Chest Radiography in Predicting Long-Standing Systemic Arterial Hypertension. AORTA (STAMFORD, CONN.) 2017; 5:168-172. [PMID: 29766008 PMCID: PMC5942550 DOI: 10.12945/j.aorta.2017.17.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/17/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE To investigate the association between aortic arch width on frontal chest radiography and systemic hypertension. METHODS A total of 200 consecutive patients were included. Relationships between aortic arch width measurement on chest radiography and blood pressure measurement were investigated using Student's t -tests and Fisher's exact tests. RESULTS Twenty-five patients were normotensive (< 130/90 mmHg), and 175 were hypertensive. Using cut-off values, 136 patients had an aortic arch width ≥ 3.5 cm, and 65 had an aortic arch width ≥ 4 cm. We found a significant relationship between aortic arch width and hypertension (p < 0.001) as well between aortic arch width cut-off values of 3.5 cm and 4 cm and hypertension (p < 0.001 and p < 0.005, respectively). An aortic arch width ≥ 3.5 cm was associated with a positive likelihood ratio (LR) of 2.3, negative LR of 0.39, sensitivity of 73, specificity of 68, positive predictive value of 94, negative predictive value of 26.6, pretest odds of 7, posttest odds of 16, and posttest probability of 94%. An aortic arch width ≥ 4 cm was associated with a positive LR of 4.50, negative LR of 0.70, sensitivity of 36, specificity of 92, positive predictive value of 97, negative predictive value of 17, pretest odds of 7, posttest odds of 31.5, and posttest probability of 97%. CONCLUSIONS Aortic arch width measurement on chest radiography can be used to predict the presence of long-standing systemic arterial hypertension.
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Affiliation(s)
- Hakan Sahin
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul Stark
- Department of Radiology Service, San Diego VA Healthcare System, San Diego, California, USA
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13
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Yin C, Gu W, Gao Y, Li Z, Chen X, Li Z, Wen S. Association of the -344T/C polymorphism in aldosterone synthase gene promoter with left ventricular structure in Chinese Han: A meta-analysis. Clin Exp Hypertens 2017; 39:562-569. [PMID: 28692307 DOI: 10.1080/10641963.2017.1291660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
No consensus view has been published on the relationship between the aldosterone synthase gene (CYP11B2) -344C/T polymorphism and left ventricular hypertrophy (LVH) in Chinese Han. We undertook a meta-analysis to investigate the potential association of this polymorphism and left ventricular structure-related phenotypes, including left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end systolic diameter (LVESD), left ventricular end diastolic dimension (LVEDD), left ventricular posterior wall thickness (LVPWT), and interventricular septal wall thickness (IVS). Studies in English and Chinese were found based on a systematic search of Medline, Embase, CNKI, and Wanfang databases. The dominant model (TT vs. TC+CC) and homozygote model (TT vs. CC) were selected to examine the association between the -344C/T polymorphism and LVH. The random-effects model was used to pool data. From a total of 3104 participants, despite the investigation of six echocardiographic indicators, we found no significant association between the -344C/T variant and LVH in the whole group and the subgroup analyses by blood pressure. However, in the subgroup of northern Han Chinese, TT genotype had higher LVPWT than CC genotype and TC genotype (pheterogeneity = 0.4, pvalue = 0.04, 95% CI 0.09 (0.00, 0.18)). In addition, no evidence of publication bias was observed. In conclusion, our meta-analysis indicated that subjects with TT genotype might have higher risk of developing LVH in northern Han Chinese.
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Affiliation(s)
- Chengqian Yin
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Wei Gu
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Yun Gao
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Zhao Li
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Xuanzu Chen
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Zhizhong Li
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
| | - Shaojun Wen
- b Department of Hypertension Research , Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing , China
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Altara R, Harmancey R, Didion SP, Booz GW, Zouein FA. Cardiac STAT3 Deficiency Impairs Contractility and Metabolic Homeostasis in Hypertension. Front Pharmacol 2016; 7:436. [PMID: 27899891 PMCID: PMC5110511 DOI: 10.3389/fphar.2016.00436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022] Open
Abstract
Signal transducer and activator of transcription 3 (STAT3) protects the heart from acute ischemic stress. However, the importance of STAT3 to the heart in chronic stress, such as hypertension, is not known. To study this, we used cardiomyocyte-targeted STAT3 knockout (KO) mice and Angiotensin II (ANG II) infusion by osmotic minipumps. After 4 weeks, ANG II induced similar cardiac hypertrophy in wild type (WT) and cardiac Cre-expressing control (CTRL) mice with no impairment of cardiac function. In contrast, STAT3 KO mice exhibited reduced contractile function but similar hypertrophy to CTRL mice. Ejection fraction and fractional shortening decreased by 22.5 and 27.3%, respectively. Since STAT3 has direct protective effects on mitochondrial function, we examined rates of glucose and oleate oxidation by isolated perfused hearts using a Langendorff system. Hearts of ANG II-treated STAT3 KO and CTRL mice had similar rates of oleate oxidation as saline-infused WT mice. Rates of glucose oxidation were similar between hearts of WT plus saline and CTRL plus ANG II mice; however, glucose oxidation was increased by 66% in hearts of ANG II-treated STAT3 KO mice. The ratio of maximal ATP yield from glucose to fatty acid oxidation was 21.1 ± 3.1 in hearts of ANG II-treated STAT3 KO mice vs. 12.6 ± 2.2 in hearts of ANG II-treated CTRL mice. Lactate production was also elevated in hearts of ANG II-treated STAT3 KO mice by 162% compared to ANG II-treated CTRL mice. Our findings indicate that STAT3 is important for maintaining contractile function and metabolic homeostasis in the hypertensive heart, and STAT3 deficiency promotes a switch toward glucose utilization.
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Affiliation(s)
- Raffaele Altara
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson MS, USA
| | - Romain Harmancey
- Department of Physiology and Biophysics, School of Medicine, University of Mississippi Medical Center, Jackson MS, USA
| | - Sean P Didion
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson MS, USA
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson MS, USA
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
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The CXCL10/CXCR3 Axis and Cardiac Inflammation: Implications for Immunotherapy to Treat Infectious and Noninfectious Diseases of the Heart. J Immunol Res 2016; 2016:4396368. [PMID: 27795961 PMCID: PMC5066021 DOI: 10.1155/2016/4396368] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 12/13/2022] Open
Abstract
Accumulating evidence reveals involvement of T lymphocytes and adaptive immunity in the chronic inflammation associated with infectious and noninfectious diseases of the heart, including coronary artery disease, Kawasaki disease, myocarditis, dilated cardiomyopathies, Chagas, hypertensive left ventricular (LV) hypertrophy, and nonischemic heart failure. Chemokine CXCL10 is elevated in cardiovascular diseases, along with increased cardiac infiltration of proinflammatory Th1 and cytotoxic T cells. CXCL10 is a chemoattractant for these T cells and polarizing factor for the proinflammatory phenotype. Thus, targeting the CXCL10 receptor CXCR3 is a promising therapeutic approach to treating cardiac inflammation. Due to biased signaling CXCR3 also couples to anti-inflammatory signaling and immunosuppressive regulatory T cell formation when activated by CXCL11. Numbers and functionality of regulatory T cells are reduced in patients with cardiac inflammation, supporting the utility of biased agonists or biologicals to simultaneously block the pro-inflammatory and activate the anti-inflammatory actions of CXCR3. Other immunotherapy strategies to boost regulatory T cell actions include intravenous immunoglobulin (IVIG) therapy, adoptive transfer, immunoadsorption, and low-dose interleukin-2/interleukin-2 antibody complexes. Pharmacological approaches include sphingosine 1-phosphate receptor 1 agonists and vitamin D supplementation. A combined strategy of switching CXCR3 signaling from pro- to anti-inflammatory and improving Treg functionality is predicted to synergistically lessen adverse cardiac remodeling.
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16
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Does the ADMA/DDAH/NO pathway modulate early regression of left ventricular hypertrophy with esmolol? Med Hypotheses 2015; 87:44-7. [PMID: 26826640 DOI: 10.1016/j.mehy.2015.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/08/2015] [Accepted: 12/15/2015] [Indexed: 11/21/2022]
Abstract
Hypertensive left ventricular hypertrophy (LVH) is a maladaptive response to chronic pressure overload and a strong independent risk factor for cardiovascular disease. Regression of LVH is associated with improved prognosis. Regression of LVH with antihypertensive therapy (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and diuretics) has been reported, although only after long-term treatment. Asymmetrical dimethylarginine (ADMA), the most potent endogenous NO synthase inhibitor, is emerging as an important cardiovascular risk factor in patients with arterial hypertension and LVH, and dimethylarginine dimethylaminohydrolase (DDAH) is the mechanism that most frequently leads to accumulation of ADMA (plasma ADMA is cleared in small part by renal excretion, although the bulk of ADMA is degraded by DDAH). Left ventricular mass is strongly modulated by the NO system. As an important inhibitor of the bioavailability of NO, ADMA is an underlying mechanism of LVH. Beta-blockers can induce regression of LVH and reduced plasma ADMA levels. Oxidative stress is increased in patients with LVH, and this in turn increases generation of ADMA. In a previous preclinical study of spontaneously hypertensive rats, we found that short-term treatment (48 h) with esmolol reverses early LVH, increases the bioavailability of NO, and improves antioxidant status in plasma. Therefore, we propose that the ADMA/DDAH/NO pathway could modulate early regression of LVH with esmolol.
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Faganello G, Fisicaro M, Russo G, Iorio A, Mazzone C, Grande E, Humar F, Cherubini A, Pandullo C, Barbati G, Tarantini L, Benettoni A, Pozzi M, Di Lenarda A, Cioffi G. Insights from Cardiac Mechanics after Three Decades from Successfully Repaired Aortic Coarctation. CONGENIT HEART DIS 2015; 11:254-61. [PMID: 26554640 DOI: 10.1111/chd.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Patients who underwent a successful repair of the aortic coarctation show chronic hyperdynamic state and normal left ventricular (LV) geometry; however, there are few data regarding the LV systolic function in the long term. Accordingly, we assessed LV systolic mechanics and factors associated with LV systolic dysfunction (LVSD) in patients with repaired CoA. METHODS Clinical and echocardiographic data from 19 repaired CoA were analyzed 28 ± 13 years after surgery. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were analyzed as indexes of LV circumferential and longitudinal systolic function, respectively. Echocardiographic data of CoA patients were compared with 19 patients matched for age and hypertension and 38 healthy controls. Sc-MS was considered impaired if <89%, S' if <8.5 cm/s (10th percentiles of healthy controls, respectively). RESULTS There were no statistical differences between study groups in LV volumes, mass and geometry. LV ejection fraction and Sc-MS were similar in all groups, however, CoA group had a significantly lower peak S' in comparison with matched and healthy controls (7.1 ± 1.3, 10.3 ± 1.9, and 11.1 ± 1.5, respectively; all P < 0.001). Prevalence of longitudinal LVSD defined as low S' was 84% in CoA, 13% in matched, and 5% in healthy control group (all P<0.05). Multivariate logistic regression analysis revealed that low peak S' was independently related to higher E/E' ratio and the presence of CoA. CONCLUSIONS Patients who underwent a successful repair of CoA commonly show asymptomatic longitudinal LVSD associated with worse LV diastolic function in the long-term follow-up.
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Affiliation(s)
| | | | - Giulia Russo
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | - Anita Iorio
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | - Carmine Mazzone
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | - Eliana Grande
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | - Franco Humar
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | | | | | - Giulia Barbati
- Cardiovascular Center, Health Authority n° 1, Trieste, Italy
| | - Luigi Tarantini
- Department of Cardiology, St. Martin Hospital, Belluno, Italy
| | | | - Marco Pozzi
- Pediatric and Congenital Cardiac Surgery and Cardiology, United Hospital, Ancona, Italy
| | | | - Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital, Trento, Italy
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Fabule J, Adebajo A. Comparative evaluation of cardiovascular outcomes in patients with osteoarthritis and rheumatoid arthritis on recommended doses of nonsteroidal anti-inflammatory drugs. Ther Adv Musculoskelet Dis 2014; 6:111-30. [PMID: 25342992 DOI: 10.1177/1759720x14541668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIMS AND OBJECTIVES We conducted an analysis to explore whether the cardiovascular outcomes associated with nonsteroidal anti-inflammatory drugs (NSAIDs), when used in licensed doses by patients with osteoarthritis or rheumatoid arthritis, was class or compound dependent. METHODS Using the Ovid technology search engine, we conducted a search of the literature for relevant studies published between 1995 and 2011. We also retrieved further studies following manual searches. The primary endpoint was major vascular events and the secondary endpoints were stroke, hypertension and congestive heart failure. A total of 19 studies were analysed. Studies conducted in the osteoarthritis and rheumatoid arthritis patients' population that reported on cardiovascular events were included in the analysis. The analysis was conducted using the software Review Manager 5.1 and Cochrane methodology. RESULTS Using the primary endpoint of major vascular events (MVE) and a prespecified cutoff point of 1.30, diclofenac (versus 1 comparator) and rofecoxib (versus 2 comparators) had increased risk for MVE [odds ratio (OR) >1.30]. Using the same criteria, diclofenac (versus 1 comparator) had an increased risk of myocardial infarction (MI). Although celecoxib had a slightly increased risk for MI (OR 1.33, versus 1 comparator), the confidence interval included 1 and was not significant. For the secondary endpoints, etoricoxib and rofecoxib were significantly worse off for HT (versus 1 comparator each) and naproxen was significantly worse off for stroke (versus 1 comparator). Although ibuprofen was worse off for HT (versus 1 comparator) the increased risk was not significant. CONCLUSION From the analysis conducted, it appears that the risk for cardiovascular events in arthritis patients on licensed doses of NSAIDs varies considerably and is likely to depend on the individual compound.
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Affiliation(s)
- John Fabule
- Astrazeneca - Global Medical Affairs, 2 Kingdom Street, London W2 6BD, UK
| | - Ade Adebajo
- Academic Rheumatology Group, Faculty of Medicine, University of Sheffield and Barnsley Hospital NHS Foundation Trust, Barnsley, UK
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19
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Kurdi M, Booz GW. Carvedilol protects the infarcted heart by upregulating miR-133: first evidence that disease state affects β-adrenergic arrestin-biased signaling? J Mol Cell Cardiol 2014; 76:12-4. [PMID: 25128784 DOI: 10.1016/j.yjmcc.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Mazen Kurdi
- Department of Chemistry and Biochemistry, Faculty of Sciences, Lebanese University, Rafic Hariri Educational Campus, Hadath, Lebanon; Department of Pharmacology and Toxicology, School of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA; The Mississippi Center for Heart Research, The University of Mississippi Medical Center, Jackson, MS, USA; The Cardiovascular-Renal Research Center, The University of Mississippi Medical Center, Jackson, MS, USA
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA; The Mississippi Center for Heart Research, The University of Mississippi Medical Center, Jackson, MS, USA; The Cardiovascular-Renal Research Center, The University of Mississippi Medical Center, Jackson, MS, USA.
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20
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Assessment of voltage criteria for left ventricular hypertrophy in adult hypertensives in south-western Nigeria. J Cardiovasc Dis Res 2013; 4:44-6. [PMID: 24023472 DOI: 10.1016/j.jcdr.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 07/04/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a common pathophysiological consequence of hypertension. Various voltage (ECG) criteria exist for evaluation of LVH. This study assessed the performance of 4 commonly used ECG criteria in south-western Nigeria. MATERIALS AND METHODS A cross-sectional descriptive study of adult hypertensive subjects. Participants were assessed for LVH using 4 ECG criteria: Sokolow-Lyon, Araoye code system, Cornell voltage, and Gubner-Ungerleider criteria. Echocardiography was used to determine the left ventricular mass index for the participants, and a value greater than 125 g/m(2) was used as the cut-off point for LVH. The sensitivity, specificity, accuracy, positive and negative predictive values were determined for each of the ECG criteria. RESULTS 90 subjects (45 males, 45 females) participated in the study. The prevalence of LVH by echocardiography was 32.2%. The prevalence of LVH by voltage criteria were: 45.6%, 42.2%, 34.4%, 13.3% by Sokolow-Lyon, Araoye code system, Cornell, and Gubner-Ungerleider criteria, respectively. The sensitivity and specificity respectively of the ECG criteria were 58.62% and 60.66% (Sokolow-Lyon), 48.28% and 60.65% (Araoye code system), 51.72% and 73.77% (Cornell), and 13.79% and 86.89% (Gubner-Ungerleider). CONCLUSION Out of the 4 ECG criteria, Araoye code system, Cornell and Sokolow-Lyon criteria compared favorably well with echocardiography and may be used in the initial assessment of LVH in adult hypertensive subjects. However, a combination of any of the 3 criteria with Gubner-Ungerleider criterion will be more clinically useful.
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Mansourian AR. A review of literature on the adverse effects of hyperthyroidism on the heart functional behavior. Pak J Biol Sci 2012; 15:164-76. [PMID: 22816174 DOI: 10.3923/pjbs.2012.164.176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thyroid hormones play an important role on the physiological chemistry of heart and vascular systems in healthy subjects. Any thyroid disorders accompanied with alteration of effective concentration of thyroid hormones cause heart dysfunctions. Thyrotoxicosis is a term given for the clinical manifestation of hyperthyroidism which can invoke heart and vascular abnormalities through the mechanism at heart muscle cells nuclear level. Thyrotoxicosis can play positive roles for heart disorders including atrial fibrillation, left ventricular hypertrophy and right ventricular systolic dysfunction, which are considered as major risk factors for heart abnormalities. Miscalculation of heart dysfunctions related thyrotoxicosis in cardiovascular patients might be avoided through careful laboratory measurements of T4 and T3 to exclude any possible thyroid hormone-related heart diseases.
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Affiliation(s)
- Azad Reza Mansourian
- Biochemistry and Metabolic Disorder Research Center, Gorgan Medical School, Golestan University of Medical Sciences, Gorgan, Iran
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Reffelmann T, Ittermann T, Dörr M, Völzke H, Reinthaler M, Petersmann A, Felix SB. Low serum magnesium concentrations predict cardiovascular and all-cause mortality. Atherosclerosis 2011; 219:280-4. [PMID: 21703623 DOI: 10.1016/j.atherosclerosis.2011.05.038] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/30/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low serum magnesium (Mg(++)) levels are associated with future development of left ventricular hypertrophy independently of common cardiovascular risk factors, as recently demonstrated in the five-year follow-up of the population-based Study of Health in Pomerania (SHIP). As left ventricular hypertrophy has significant prognostic implications, we hypothesized that serum Mg(++) levels are associated with cardiovascular mortality. METHOD AND RESULTS All-cause mortality and cardiovascular mortality were analyzed in relationship to serum Mg(++) concentrations at baseline by Cox proportional hazard model in SHIP (n=4203, exclusion of subjects with Mg(++) supplementation). The median duration of mortality follow-up was 10.1 years (25th percentile: 9.4 years, 75th percentile: 10.8 years; 38,075 person-years). During the follow-up, 417 deaths occurred. Mortality in subjects with Mg(++)≤0.73 mmol/l was significantly higher for all-cause deaths (10.95 death per 1000 person years), and cardiovascular deaths (3.44 deaths per 1000 person years) in comparison to higher Mg(++) concentrations (1.45 deaths from all-cause per 1000 person years, 1.53 deaths from cardiovascular cause per 1000 person years). This association remained statistically significant after adjustment for multiple cardiovascular risk factors, including arterial hypertension, and antihypertensive therapy including diuretics (log-rank-test p=0.0001 for all-cause mortality, and p=0.0174 for cardiovascular mortality). CONCLUSIONS Low serum Mg(++) levels are associated with higher all-cause mortality and cardiovascular mortality. This corresponds well with recent findings that hypomagnesemia is associated with the increase of left ventricular mass over the following years.
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Affiliation(s)
- Thorsten Reffelmann
- Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler Str. 23 a, 17487 Greifswald, Germany.
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Bilim O, Shishido T, Toyama S, Suzuki S, Sasaki T, Kitahara T, Sadahiro M, Takeishi Y, Kubota I. Differential regulation of diacylglycerol kinase isoform in human failing hearts. J Cardiothorac Surg 2011; 6:65. [PMID: 21548979 PMCID: PMC3108920 DOI: 10.1186/1749-8090-6-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 05/08/2011] [Indexed: 11/13/2022] Open
Abstract
Evidence from several studies indicates the importance of Gαq protein-coupled receptor (GPCR) signaling pathway, which includes diacylglycerol (DAG), and protein kinase C, in the development of heart failure. DAG kinase (DGK) acts as an endogenous regulator of GPCR signaling pathway by catalyzing and regulating DAG. Expressions of DGK isoforms α, ε, and ζ in rodent hearts have been detected; however, the expression and alteration of DGK isoforms in a failing human heart has not yet been examined. In this study, we detected mRNA expressions of DGK isoforms γ, η, ε, and ζ in failing human heart samples obtained from patients undergoing cardiovascular surgery with cardiopulmonary bypass. Furthermore, we investigated modulation of DGK isoform expression in these hearts. We found that expressions of DGKη and DGKζ were increased and decreased, respectively, whereas those of DGKγ and DGKε remained unchanged. This is the first report that describes the differential regulation of DGK isoforms in normal and failing human hearts.
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Affiliation(s)
- Olga Bilim
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Dörr M, Ittermann T, Aumann N, Obst A, Reffelmann T, Nauck M, Wallaschofski H, Felix SB, Völzke H. Subclinical hyperthyroidism is not associated with progression of cardiac mass and development of left ventricular hypertrophy in middle-aged and older subjects: results from a 5-year follow-up. Clin Endocrinol (Oxf) 2010; 73:821-6. [PMID: 20874773 DOI: 10.1111/j.1365-2265.2010.03882.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decreased serum TSH levels are associated with increased cardiovascular mortality in elderly, and subclinical hyperthyroidism (SCH) was associated with left ventricular hypertrophy (LVH) as a predictor of cardiovascular mortality in some cross-sectional and case-control studies. The aim was to assess whether SCH independently impacts development of LVH over time. METHODS Of 3300 participants of the population-based Study of Health in Pomerania those with overt hyperthyroidism, hypothyroidism, possible thyroid disease or missing echocardiographic baseline data or follow-up were excluded, resulting in a study population of 1112 individuals (556 women) aged 45-81 years. Echocardiographic left ventricular mass divided by height(2·7) (LVMI(ht)), and LVH(ht) (LVMI(ht) > 44 g/m(2·7) in women and > 48 g/m(2·7) in men) was measured at baseline and after 5-year follow-up (median 5·00; range 4·92; 5·08). Comparison of subjects with (n = 107) and without (n = 1005) SCH were made by linear and logistic regression models adjusted for age, gender, smoking status, hypertension, and waist circumference. RESULTS At follow-up, LVMI(ht) did not differ between subjects with and without SCH (50·2 g/m(2·7), interquartile range (IQR) 41·2; 59·5 vs 47·8 g/m(2·7), IQR 39·3; 56·9; P = 0·29). LVH(ht) was present in 66 (61·7%) subjects with and 543 (54·0%) persons without SCH (P = 0·13). Analyses revealed no association between SCH and progression of LVMI(ht) (β = -0·18; 95%-confidence interval (CI) -2·34; -1·99; P = 0·873), and development of LVH(ht) (relative risk 0·86, 95%-CI 0·60; 1·26; P = 0·462), respectively. CONCLUSIONS In this population-based sample, SCH had no impact on progression of LVMI and development of LVH during 5-year follow-up in subjects aged 45 years or older.
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Affiliation(s)
- Marcus Dörr
- Department of Internal Medicine B, Ernst Moritz Arndt University, Greifswald, Germany.
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Zheng XZ, Du LF, Wang HP. Evaluation of left ventricular hypertrophy in hypertensive patients with echocardiographic myocardial videodensitometry normalized by displacement. Bosn J Basic Med Sci 2010; 10:292-96. [PMID: 21108608 DOI: 10.17305/bjbms.2010.2674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Left ventricular hypertrophy (LVH) is an important predictor of cardiovascular morbidity and mortality. To investigate the feasibility of the myocardial grayscale intensity (GI) normalized by displacement (d) to discriminate between healthy and hypertrophic myocardium in hypertensive patients, sixty hypertensive patients and sixty age and sex-matched healthy volunteers were involved in this study. The peak d and the maximal GI [GI(max)] and minimal GI [GI(min)] for the middle interventricular septal (IVS) and the middle posterior wall (PW) at the level of papillary muscle were obtained from the standard parasternal long axis views using tissue tracking (TT) and videodensitometric analysis, respectively. The GI and the cyclic variation of GI (CVGI) normalized by d were calculated. The results showed that the d both for IVS and PW, the amplitude of CVGI for IVS in hypertensive patients with LVH were smaller than the ones without LVH and the normal subjects. But, the CVGI/d both for IVS and PW in hypertensive patients with LVH were all greater than the ones without LVH and the normal subjects. Moreover, the parameter, CVGI/d correlated positively with left ventricular mass index (LVMI). So, the method employed in this study, videodensitometric analysis in combination with TT allow objective and accurate determination of LVH and CVGI/d is a sensitive indicator for hypertensive patients with LVH.
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Affiliation(s)
- Xiao-Zhi Zheng
- Department of Ultrasound, The Fourth Affiliated Hospital of Nantong University, Yancheng, Jiangsu Province, PR China.
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Reffelmann T, Dörr M, Ittermann T, Schwahn C, Völzke H, Ruppert J, Robinson D, Felix SB. Low serum magnesium concentrations predict increase in left ventricular mass over 5 years independently of common cardiovascular risk factors. Atherosclerosis 2010; 213:563-9. [PMID: 20864108 DOI: 10.1016/j.atherosclerosis.2010.08.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 08/24/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Left ventricular hypertrophy (LVH) is a significant predictor of adverse cardiovascular events. Experimental studies suggest a pathophysiological role of magnesium (Mg(2+)) in the development of arterial hypertension and LVH. METHODS In subjects with complete echocardiographic data from the population-based longitudinal "Study of Health in Pomerania" (n=1 348), the difference in left ventricular mass (LVM) over 5 years (echocardiography) was analyzed in relationship to serum Mg(2+) at baseline. RESULTS Mg(2+) at baseline (0.790 ± 0.003 mmol/l, mean ± SEM) inversely correlated with the difference in LVM over 5 years (p<0.0001, females: p<0.002, males: p<0.024). In the lowest Mg(2+)-quintile (Mg(2+)<=0.73 mmol/l), LVM (187.4 ± 3.1 g at baseline) increased by 14.9 ± 1.2 g, while in the highest Mg(2+)-quintile (Mg(2+)>=0.85 mmol/l) LVM (186.7 ± 3.4 g at baseline) decreased by -0.5 ± 2.8 g (p<0.0001 between quintiles). By multivariable analysis including several cardiovascular risk factors and antihypertensive treatment, serum Mg(2+) was associated with the increase in LVM at a statistically high significant level (p<0.0001). LVM after 5 years was significantly higher in subjects within the lower Mg(2+)-quintiles. This association remained highly significant after adjustment for several cardiovascular risk factors including arterial hypertension and diabetes mellitus. CONCLUSIONS Hypomagnesemia is one of the strongest predictors of gain in LVM over the following 5 years.
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Affiliation(s)
- Thorsten Reffelmann
- Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler Str. 23 a, 17487 Greifswald, Germany.
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Walsh JA, Prineas R, Daviglus ML, Ning H, Liu K, Lewis CE, Sidney S, Schreiner PJ, Iribarren C, Lloyd-Jones DM. Prevalence of electrocardiographic abnormalities in a middle-aged, biracial population: Coronary Artery Risk Development in Young Adults study. J Electrocardiol 2010; 43:385.e1-9. [PMID: 20374967 PMCID: PMC3569004 DOI: 10.1016/j.jelectrocard.2010.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few studies to date have described the prevalence of electrocardiographic (ECG) abnormalities in a biracial middle-aged cohort. METHODS AND RESULTS Participants underwent measurement of traditional risk factors and 12-lead ECGs coded using both Minnesota Code and Novacode criteria. Among 2585 participants, of whom 57% were women and 44% were black (mean age 45 years), the prevalence of major and minor abnormalities was significantly higher (all P < .001) among black men and women compared to whites. These differences were primarily due to higher QRS voltage and ST/T-wave abnormalities among blacks. There was also a higher prevalence of Q waves (Minnesota Code 1-1, 1-2, 1-3) than described by previous studies. These racial differences remained after multivariate adjustment for traditional cardiovascular (CV) risk factors. CONCLUSIONS Black men and women have a significantly higher prevalence of ECG abnormalities, independent of traditional cardiovascular risk factors, than whites in a contemporary cohort of middle-aged participants.
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Affiliation(s)
- Joseph A Walsh
- Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ronald Prineas
- Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Martha L. Daviglus
- Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hongyan Ning
- Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kiang Liu
- Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama-Birmingham, Birmingham, AL
| | - Steven Sidney
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Donald M. Lloyd-Jones
- Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Ruiz-Hurtado G, Delgado C. Nitric oxide pathway in hypertrophied heart: new therapeutic uses of nitric oxide donors. J Hypertens 2010; 28 Suppl 1:S56-61. [PMID: 20823718 DOI: 10.1097/01.hjh.0000388496.66330.b8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left ventricular hypertrophy (LVH) is regarded as a complication common to a number of cardiovascular diseases, including hypertension, myocardial infarction and ischaemia associated with coronary artery disease. Initially LVH is a compensatory mechanism, but in the long term cardiac hypertrophy predisposes individuals to heart failure, myocardial infarction and sudden death. Alteration of the nitric oxide (NO) pathway is believed to play an important role in the haemodynamically overloaded heart and pathological cardiac remodelling. Although re-establishment of the physiological NO pathway could be considered an important therapeutic target, the use of conventional nitrates is limited in the clinical setting by the development of tissue resistance and tolerance and by the shortage of large-scale clinical trials unequivocally confirming the beneficial impact of NO donors on cardiovascular morbidity and mortality. The aim of this review is to present current therapeutic options for dealing with changes in the L-arginine-NO pathway. The most promising therapeutic approach is represented by a new neutral sugar organic nitrate, LA-419, the thiol group of which seems to protect NO from degradation, thereby increasing its bioavailability. In a model of aortic stenosis-induced pressure overload, LA-419 has been found to restore the complete NO signalling cascade and reduce left ventricular remodelling, but without restoring the original pressure gradient, indicating a possible direct antiproliferative effect. Future studies are needed to confirm this therapeutic benefit in other animal models of hypertension and in the clinical setting.
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Affiliation(s)
- Gema Ruiz-Hurtado
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Reffelmann T, Dörr M, Völzke H, Friedrich N, Krebs A, Ittermann T, Felix SB. Urinary albumin excretion, even within the normal range, predicts an increase in left ventricular mass over the following 5 years. Kidney Int 2010; 77:1115-22. [DOI: 10.1038/ki.2010.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lack of association between insulin-like growth factor-1 or insulin-like growth factor-binding protein-3 and left ventricular hypertrophy: results of the Study of Health in Pomerania. J Hypertens 2010; 28:856-64. [DOI: 10.1097/hjh.0b013e328336274a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009; 54:e13-e118. [PMID: 19926002 DOI: 10.1016/j.jacc.2009.07.010] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Circulation 2009; 120:e169-276. [PMID: 19884473 DOI: 10.1161/circulationaha.109.192690] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Nadour W, Biederman RWW. Is left ventricular hypertrophy regression important? Does the tool used to detect it matter? J Clin Hypertens (Greenwich) 2009; 11:441-7. [PMID: 19695032 PMCID: PMC8673408 DOI: 10.1111/j.1751-7176.2009.00137.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 04/30/2009] [Accepted: 04/30/2009] [Indexed: 11/27/2022]
Abstract
Left ventricular hypertrophy (LVH) has been demonstrated to define an adverse cardiovascular prognosis. However, due to poor noninvasive tools in which to accurately define LVH, the clinical manifestations dictate an inexact manner in which to either initiate therapy or to gauge the success of LVH regression. Herein, the authors define the current state of imaging modalities available to interrogate LVH and its regression, but concentrating chiefly on the "gold standard" of cardiovascular magnetic resonance imaging (CMR). The authors review the data demonstrating the importance of LVH regression. Additionally, they highlight the strengths and weaknesses of CMR via several pinnacle studies that demonstrate the ease, efficiency, and accuracy of this new noninvasive reproducible and available tool to relatively inexpensively delineate LVH. Finally, upon pharmacologic administration of an antihypertensive regimen, the authors, for the first time, define a goal of left ventricular mass reduction (in grams) for echocardiography and CMR based in part on Framingham data aiming at improving cardiovascular risk.
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Affiliation(s)
- Wadih Nadour
- Division of Internal Medicine and Cardiology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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Irzmański R, Banach M, Piechota M, Kowalski J, Barylski M, Cierniewski C, Pawlicki L. Atrial and Brain Natriuretic Peptide and Endothelin-1 Concentration in Patients with Idiopathic Arterial Hypertension: The Dependence on the Selected Morphological Parameters. Clin Exp Hypertens 2009; 29:149-64. [PMID: 17497342 DOI: 10.1080/10641960701361593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH). METHODS Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2 - control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis. RESULTS A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH. CONCLUSIONS Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important - especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.
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Affiliation(s)
- Robert Irzmański
- Department of Internal Diseases and Cardiological Rehabilitation, University Hospital, Medical University of Lodz, Lodz, Poland.
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Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am 2009; 93:733-51. [PMID: 19427502 DOI: 10.1016/j.mcna.2009.02.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The increasing prevalence of obesity in the industrialized world is causing an alarming epidemic. Almost 70% of American adults are overweight or obese. The link between increasing body weight and hypertension is well established. Obesity hypertension through metabolic, endocrinic, and systemic hemodynamic alteration causes structural vascular and cardiac adaptations that trigger concentric, eccentric left ventricular hypertrophy and electrophysiological changes, which may increase the risk for congestive heart failure and sudden cardiac death as a result of arrhythmias. The increased renal blood flow in conjunction with a decreased renal vascular resistance causes renal hyperperfusion and hyperfiltration. Such changes lead to glomerulomegaly, focal segmental glomerulosclerosis, tubulointerstitial inflammation, and fibrosis that characterize the renal damage in obese hypertensive subjects. We propose that weight reduction, with the addition of other nonpharmacological approaches that included exercise and reduction in alcohol intake, should be the first choice to treat obesity hypertension. Salt restriction may be helpful only in salt-sensitive patients. The benefits of diet in obese patients include improvement of insulin sensitivity, reduction in sympathetic nervous and renin angiotensin system activities, and restoration of leptin sensitivity. As a consequence of these and other metabolic changes, the previously described systemic and renal hemodynamic alterations improved and the cardiovascular and renal morphological changes induced by obesity were lessened. After reviewing the medications available, we believe that owing to the cardiovascular and renal morbidity and mortality that characterized obesity hypertension, the ACEI or ARBs offer the best cardio-renal protection and should be the pharmacologic treatment of choice. If these alone do not control BP adequately, then a low-dose diuretic should be added as a second approach. Although we strongly believe in our proposal, more multicenter long-term clinical pharmacological trials are needed to evaluate the efficacy and safety of the antihypertensive approaches in the treatment of obesity hypertension.
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Affiliation(s)
- Efrain Reisin
- Section of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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37
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Combination of electrocardiographic and echocardiographic information identifies individuals prone to a progressive increase in left ventricular mass over 5 years. J Hypertens 2009; 27:861-8. [DOI: 10.1097/hjh.0b013e328324f8e8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Validity of electrocardiographic classification of left ventricular hypertrophy across adult ethnic groups with echocardiography as a standard. J Electrocardiol 2008; 41:404-12. [DOI: 10.1016/j.jelectrocard.2008.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Indexed: 11/22/2022]
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Berry JM, Cao DJ, Rothermel BA, Hill JA. Histone deacetylase inhibition in the treatment of heart disease. Expert Opin Drug Saf 2008; 7:53-67. [PMID: 18171314 DOI: 10.1517/14740338.7.1.53] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent work has demonstrated the importance of chromatin remodeling, especially histone acetylation, in the control of gene expression in the heart. Studies in preclinical models suggest that inhibition of histone deacetylase (HDAC) activity - using compounds that show promise in ongoing oncology trials - blunts pathologic growth of cardiac myocytes. Indeed, small-molecule inhibitors of HDACs are members of an evolving class of pharmacologic agents in development for the treatment of several diseases. If proved effective in the treatment of heart disease, HDAC inhibitors could have a significant impact on public health, as cardiovascular disease remains the leading cause of death in the US. This paper reviews understanding of the mechanisms of action of HDAC inhibitors in the heart and summarizes emerging data regarding their effects on disease-related cardiac remodeling and function.
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Affiliation(s)
- Jeff M Berry
- University of Texas Southwestern Medical Center, Donald W Reynolds Cardiovascular Clinical Research Center, Dallas, Texas, USA
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41
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Löndahl M, Katzman P, Fredholm O, Nilsson A, Apelqvist J. Is chronic diabetic foot ulcer an indicator of cardiac disease? J Wound Care 2008; 17:12-6. [PMID: 18210951 DOI: 10.12968/jowc.2008.17.1.27915] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate presence and severity of cardiac disease in individuals with chronic diabetic foot ulcers using echocardiography. METHOD Eighty consecutive patients with chronic foot ulcers attending the multidisciplinary diabetes foot clinic at Helsingborg Hospital underwent clinical examination, toe blood pressure measurement and a standard echocardiographic examination. RESULTS Sixty-nine percent of the patients had a history of myocardial infarction and/or hypertension and/or heart failure; 78% had signs of left ventricular dysfunction and/or left ventricular hypertrophy and/or diastolic dysfunction; 76% of the patients without a history of cardiovascular disease had signs of cardiac dysfunction on echocardiography. CONCLUSION Cardiac dysfunction is a common occurrence present in patients with chronic diabetic foot ulcers, even in those without known cardiac disease or hypertension. Echocardiography may be recommended as a screening procedure in the management of diabetic patients with chronic foot ulcers. The present study supports the view that diabetic chronic foot ulcers ought to be seen as a sign of cardiac disease, although further research is needed to elucidate this issue.
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Affiliation(s)
- M Löndahl
- Department of Endocrinology, Lund University Hospital, Sweden.
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Association between wasted pressure effort and left ventricular hypertrophy in hypertension: influence of arterial wave reflection. Am J Hypertens 2008; 21:329-33. [PMID: 18202668 DOI: 10.1038/ajh.2007.49] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Wave reflection during the systole increases left ventricular (LV) pressure, tension-time index (TTI) and myocardial oxygen requirement. The purpose of this study was to extract that component of extra myocardial oxygen requirement that is due to early systolic wave reflection, define it as wasted effort (DeltaE(w)), and examine its relationship to LV hypertrophy (LVH). METHODS Radial artery pressure waveforms were recorded using applanation tonometry and central aortic waveforms generated in 98 patients with untreated hypertension. Aortic augmentation index (AI(a)), wave reflection amplitude (i.e., aortic augmented pressure (AG)) and systolic duration (ED-Tr), ejection duration (ED) and round-trip travel time of the pressure wave (Tr) were calculated from the aortic waveform, and DeltaE(w) estimated as 2.09 AG (ED-Tr). Carotid-femoral pulse wave velocity (PWV(e)) was also measured and LV mass index (LVMI) determined by echocardiography. RESULTS DeltaE(w) was significantly correlated with age, body height, and LVMI. Women had greater DeltaE(w) than men. The correlation between DeltaE(w) and LVMI was independent of age, gender and body height (P = 0.003). Patients with LVH (LVH (+) group) showed greater DeltaE(w) than patients without LVH (LVH (-) group) (P = 0.003), and this difference remained significant when adjusted for confounding factors. Also, AI(a) and AG were higher in the LVH (+) than in the LVH (-) group (both P < 0.01). In contrast, PWV(e) was not different between the groups, and Tr showed only a marginal difference (P = 0.07). CONCLUSIONS DeltaE(w) appears to be directly and positively associated with LVH in untreated hypertensive patients. The amplitude and duration of the reflected wave, rather than its travel time, are probably responsible for this association.
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 2007; 50:e159-241. [PMID: 17950159 DOI: 10.1016/j.jacc.2007.09.003] [Citation(s) in RCA: 257] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Circulation 2007; 116:e418-99. [PMID: 17901357 DOI: 10.1161/circulationaha.107.185699] [Citation(s) in RCA: 378] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Aktoz M, Erdogan O, Altun A. Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension. Int J Cardiol 2007; 120:344-50. [PMID: 17169449 DOI: 10.1016/j.ijcard.2006.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 08/17/2006] [Accepted: 10/14/2006] [Indexed: 12/25/2022]
Abstract
BACKGROUND The present study sought to determine the diagnostic value of electrocardiographic voltage criteria in predicting geometry patterns in patients with essential hypertension. METHODS Patients with essential hypertension (n=125) according to left ventricular mass index and relative wall thickness as determined by echocardiography were assigned in the following groups: normal geometry (N, n=50), concentric remodeling (CR, n=12), concentric hypertrophy (CH, n=28) and eccentric hypertrophy (EH, n=35). Each patient underwent 12-lead ECG followed by determination of conventional voltage criteria as well as peak to peak QRS lengths in each lead. RESULTS Voltage criteria such as Sokolow-Lyon, Cornell, Cornell product >2440, D1R+D3S >25 mm, and AVL R >11 mm could not significantly predict and discriminate geometric patterns of LVH. However, they all were very specific (range 97-100%) and showed very high positive predictive values (range 94-100%) for detecting abnormal geometry. DI peak >12 mm had a sensitivity 61%, specificity 67%, accuracy 63%, positive predictive value 81%, and negative predictive value 42% in predicting to differentiate CH from CR. Sum of the calculated values from the peak of the R to the nadir of the S wave in all limb leads >60 mm had sensitivity 68%, specificity 75%, accuracy 70%, positive predictive value 86% and negative predictive value 50% in predicting to differentiate CH from CR. CONCLUSIONS Conventional ECG voltage criteria could not significantly discriminate specific geometry patterns observed in patients with essential hypertension.
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Affiliation(s)
- Meryem Aktoz
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
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Cooper CJ, Murphy TP. Is renal artery stenting the correct treatment of renal artery stenosis? The case for renal artery stenting for treatment of renal artery stenosis. Circulation 2007; 115:263-9; discussion 270. [PMID: 17228012 DOI: 10.1161/circulationaha.106.619015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher J Cooper
- Department of Medicine, University of Toledo, 3000 Arlington Ave, Hospital Room No. 1192, Toledo, OH 43614-2598, USA.
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Abstract
Endogenous subclinical hyperthyroidism, defined by normal circulating levels of free T4 and T3 and low levels of TSH, is a common clinical entity and is typically caused by the same conditions that account for the majority of cases of overt hyperthyroidism: Graves' disease, toxic multinodular goiter, and solitary autonomously functioning thyroid nodules. Subclinical hyperthyroidism has been associated with an increased risk of atrial fibrillation and mortality, decreased bone mineral density in postmenopausal women, and mild hyperthyroid symptoms. Treatment of subclinical hyperthyroidism remains controversial, given the lack of prospective randomized controlled trials showing clinical benefit with restoration of the euthyroid state. Nevertheless, it seems reasonable to treat older individuals whose serum TSH levels are less than 0.1 mU/liter and certain high-risk patients, even when the serum TSH is between 0.1 and the lower limit of the normal range.
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Affiliation(s)
- David S Cooper
- Division of Endocrinology, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Hoffberger Building, Suite 56, Baltimore, Maryland 21215, USA.
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48
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Gulliver GA, Sweitzer NK. Risk Factor Management and Lifestyle Modification in Heart Failure. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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49
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Perlini S. Electrocardiographic ‘strain’ pattern in left ventricular hypertrophy: electrical waves or mechanical function? J Hypertens 2006; 24:1925-6. [PMID: 16957549 DOI: 10.1097/01.hjh.0000244938.04052.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Machado DB, Crow RS, Boland LL, Hannan PJ, Taylor HA, Folsom AR. Electrocardiographic findings and incident coronary heart disease among participants in the Atherosclerosis Risk in Communities (ARIC) study. Am J Cardiol 2006; 97:1176-1181. [PMID: 16616022 DOI: 10.1016/j.amjcard.2005.11.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 11/01/2005] [Accepted: 11/01/2005] [Indexed: 10/24/2022]
Abstract
The associations of many electrocardiographic (ECG) abnormalities at rest with incident coronary heart disease (CHD) are not completely established, and whether individual ECG abnormalities convey similar risk across gender and race is uncertain. We studied the independent association of several ECG findings with incident CHD, testing for effect modification by gender and race, in a large, population-based, prospective cohort study. Findings from the baseline 12-lead electrocardiograms in 1987 to 1989 were classified according to the Minnesota Code in 12,987 black and white men and women, aged 45 to 64 years, who were initially free of CHD and the use of specific cardiac medications. The incidence of CHD was ascertained through 2000. After adjustment for multiple cardiovascular risk factors, the ECG findings that had the highest hazard rate ratios (HRRs) for incident CHD, when considered singly, were left ventricular hypertrophy with ST-T strain pattern in white men (HRR 6.50) and in black women (HRR 2.31) and, in the whole cohort, major (HRR 2.27) and minor (HRR 2.47) ST depression and major T-wave abnormalities (HRR 2.12). Statistically significant associations were also found in the whole cohort for minor Q waves and left ventricular hypertrophy by the Cornell definition, but not for a prolonged QTc interval, major ventricular conduction defects, or ST elevation. In conclusion, several 12-lead ECG findings were independently associated with incident CHD in middle-aged adults. With only a few exceptions, the associations were similar for blacks and whites.
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Affiliation(s)
- Daniella B Machado
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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