Pub Date : 2022-05-31DOI: 10.1101/2022.05.30.22275704
R. Tabassum, S. Ruotsalainen, L. Ottensmann, M. Gerl, C. Klose, T. Tukiainen, M. Pirinen, K. Simons, E. Widén, S. Ripatti
Despite well-recognized difference in the atherosclerotic cardiovascular disease (ASCVD) risk between men and women, sex differences in risk factors and sex specific mechanisms in the pathophysiology of ASCVD remain poorly understood. Lipid metabolism plays a central role in the development of ASCVD. Understanding sex differences in lipids and their genetic determinants could provide mechanistic insights into sex differences in ASCVD and aid in precise risk assessment. Thus, we examined sex differences in plasma levels of 179 lipid species from 7,266 participants and performed sex-stratified genome-wide association studies (GWAS) to evaluate contribution of genetic factors in sex differences. We sought for replication using independent data from 2,045 participants. Significant sex differences in levels of 141 lipid species were observed (P<7.0x10-4). Interestingly, 121 lipid species showed significant age-sex interactions with opposite age-related changes in 39 lipid species. In general, most of the cholesteryl esters, ceramides, lysophospholipids and glycerides were higher in 45-50-year-old men compared with women of same age, but the sex-differences narrowed down or reversed with age. We did not observe any major differences in genetic effect in the sex stratified GWAS which suggests that common genetic variants do not have a major role in sex differences in lipidome. In conclusion, our study provides a comprehensive view of sex differences in circulatory lipids pointing to potential sex differences in lipid metabolism, and highlights need for sex- and age-specific prevention strategies.
{"title":"Lipidome‐ and Genome‐Wide Study to Understand Sex Differences in Circulatory Lipids","authors":"R. Tabassum, S. Ruotsalainen, L. Ottensmann, M. Gerl, C. Klose, T. Tukiainen, M. Pirinen, K. Simons, E. Widén, S. Ripatti","doi":"10.1101/2022.05.30.22275704","DOIUrl":"https://doi.org/10.1101/2022.05.30.22275704","url":null,"abstract":"Despite well-recognized difference in the atherosclerotic cardiovascular disease (ASCVD) risk between men and women, sex differences in risk factors and sex specific mechanisms in the pathophysiology of ASCVD remain poorly understood. Lipid metabolism plays a central role in the development of ASCVD. Understanding sex differences in lipids and their genetic determinants could provide mechanistic insights into sex differences in ASCVD and aid in precise risk assessment. Thus, we examined sex differences in plasma levels of 179 lipid species from 7,266 participants and performed sex-stratified genome-wide association studies (GWAS) to evaluate contribution of genetic factors in sex differences. We sought for replication using independent data from 2,045 participants. Significant sex differences in levels of 141 lipid species were observed (P<7.0x10-4). Interestingly, 121 lipid species showed significant age-sex interactions with opposite age-related changes in 39 lipid species. In general, most of the cholesteryl esters, ceramides, lysophospholipids and glycerides were higher in 45-50-year-old men compared with women of same age, but the sex-differences narrowed down or reversed with age. We did not observe any major differences in genetic effect in the sex stratified GWAS which suggests that common genetic variants do not have a major role in sex differences in lipidome. In conclusion, our study provides a comprehensive view of sex differences in circulatory lipids pointing to potential sex differences in lipid metabolism, and highlights need for sex- and age-specific prevention strategies.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85388967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Burzotta, F. Graziani, C. Trani, C. Aurigemma, P. Bruno, A. Lombardo, G. Liuzzo, M. Nesta, G. Lanza, E. Romagnoli, G. Locorotondo, A. Leone, N. Pavone, Claudio Spalletta, G. Pelargonio, T. Sanna, N. Aspromonte, F. Cavaliere, F. Crea, M. Massetti
Background A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking. Methods and Results At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%). Conclusions Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.
{"title":"Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single‐Center Experience","authors":"F. Burzotta, F. Graziani, C. Trani, C. Aurigemma, P. Bruno, A. Lombardo, G. Liuzzo, M. Nesta, G. Lanza, E. Romagnoli, G. Locorotondo, A. Leone, N. Pavone, Claudio Spalletta, G. Pelargonio, T. Sanna, N. Aspromonte, F. Cavaliere, F. Crea, M. Massetti","doi":"10.1161/JAHA.121.024404","DOIUrl":"https://doi.org/10.1161/JAHA.121.024404","url":null,"abstract":"Background A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking. Methods and Results At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%). Conclusions Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73690372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Hannawi, Dhananjay Vaidya, L. Yanek, Michelle C. Johansen, B. Kral, L. Becker, D. Becker, P. Nyquist
Background The periventricular white matter is more sensitive to the systemic hemodynamic alterations than the deep white matter because of differences in its vascular structure and systemic circulation relationship. We hypothesize that periventricular white matter hyperintensity (PVWMH) volume shows greater association than deep white matter hyperintensity (DWMH) volume with vascular properties (VPs) reflecting arterial stiffness and cardiovascular remodeling, indicators of the systemic circulation. Methods and Results A total of 426 participants (age, 59.0±6.1 years; 57.5% women; and 39.7% Black race) in the Genetic Study of Atherosclerosis Risk who were aged ≥50 years and had brain magnetic resonance imaging were studied. VPs included pulse pressure, hypertensive response to exercise, diastolic brachial artery diameter, diastolic common carotid artery diameter, common carotid artery distensibility coefficient, and left ventricular function. The relative associations of VPs with PVWMH and DWMH as multiple measures within the same individual were determined using multilevel linear models. We also determined if age modified the differences in VPs associations with PVWMH and DWMH. Our findings indicated that, within the same subject, PVWMH volume had greater association than DWMH volume with pulse pressure (P=0.002), hypertensive response to exercise (P=0.04), diastolic brachial artery diameter (P=0.012), and diastolic common carotid artery diameter (P=0.04), independent of age and cardiovascular risk factors. The differences of PVWMH versus DWMH associations with VPs did not differ at any age threshold. Conclusions We show, for the first time, that PVWMH has greater association than DWMH, independent of age, with vascular measurements of arterial stiffness and cardiovascular remodeling suggesting that changes in the systemic circulation affect the PVWMH and DWMH differently.
{"title":"Association of Vascular Properties With the Brain White Matter Hyperintensity in Middle‐Aged Population","authors":"Y. Hannawi, Dhananjay Vaidya, L. Yanek, Michelle C. Johansen, B. Kral, L. Becker, D. Becker, P. Nyquist","doi":"10.1161/JAHA.121.024606","DOIUrl":"https://doi.org/10.1161/JAHA.121.024606","url":null,"abstract":"Background The periventricular white matter is more sensitive to the systemic hemodynamic alterations than the deep white matter because of differences in its vascular structure and systemic circulation relationship. We hypothesize that periventricular white matter hyperintensity (PVWMH) volume shows greater association than deep white matter hyperintensity (DWMH) volume with vascular properties (VPs) reflecting arterial stiffness and cardiovascular remodeling, indicators of the systemic circulation. Methods and Results A total of 426 participants (age, 59.0±6.1 years; 57.5% women; and 39.7% Black race) in the Genetic Study of Atherosclerosis Risk who were aged ≥50 years and had brain magnetic resonance imaging were studied. VPs included pulse pressure, hypertensive response to exercise, diastolic brachial artery diameter, diastolic common carotid artery diameter, common carotid artery distensibility coefficient, and left ventricular function. The relative associations of VPs with PVWMH and DWMH as multiple measures within the same individual were determined using multilevel linear models. We also determined if age modified the differences in VPs associations with PVWMH and DWMH. Our findings indicated that, within the same subject, PVWMH volume had greater association than DWMH volume with pulse pressure (P=0.002), hypertensive response to exercise (P=0.04), diastolic brachial artery diameter (P=0.012), and diastolic common carotid artery diameter (P=0.04), independent of age and cardiovascular risk factors. The differences of PVWMH versus DWMH associations with VPs did not differ at any age threshold. Conclusions We show, for the first time, that PVWMH has greater association than DWMH, independent of age, with vascular measurements of arterial stiffness and cardiovascular remodeling suggesting that changes in the systemic circulation affect the PVWMH and DWMH differently.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"145 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80489883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyoung Youn Lee, Y. Jung, N. Mamadjonov, K. Jeung, Min Chul Kim, K. Lim, Chang‐Yeop Jeon, Youngjeon Lee, Hyung-Joong Kim
Background Postischemic cerebral hypoperfusion has been indicated as an important contributing factor to secondary cerebral injury after cardiac arrest. We evaluated the effects of sodium nitroprusside administered via a subdural intracranial catheter on the microcirculation, oxygenation, and electrocortical activity of the cerebral cortex in the early postresuscitation period using a pig model of cardiac arrest. Methods and Results Twenty‐nine pigs were resuscitated with closed cardiopulmonary resuscitation after 14 minutes of untreated ventricular fibrillation. Thirty minutes after restoration of spontaneous circulation, 24 pigs randomly received either 4 mg of sodium nitroprusside (IT‐SNP group) or saline placebo (IT‐saline group) via subdural intracranial catheters and were observed for 5 hours. The same dose of sodium nitroprusside was administered intravenously in another 5 pigs. Compared with the IT‐saline group, the IT‐SNP group had larger areas under the curve for tissue oxygen tension and percent changes of arteriole diameter and number of perfused microvessels from baseline (all P<0.05) monitored on the cerebral cortex during the 5‐hour period, without severe hemodynamic instability. This group also showed faster recovery of electrocortical activity measured using amplitude‐integrated electroencephalography. Repeated‐measures analysis of variance revealed significant group–time interactions for these parameters. Intravenously administered sodium nitroprusside caused profound hypotension but did not appear to increase the cerebral parameters. Conclusions Sodium nitroprusside administered via a subdural intracranial catheter increased post–restoration of spontaneous circulation cerebral cortical microcirculation and oxygenation and hastened electrocortical activity recovery in a pig model of cardiac arrest. Further studies are required to determine its impact on the long‐term neurologic outcomes.
{"title":"Effects of Sodium Nitroprusside Administered Via a Subdural Intracranial Catheter on the Microcirculation, Oxygenation, and Electrocortical Activity of the Cerebral Cortex in a Pig Cardiac Arrest Model","authors":"Hyoung Youn Lee, Y. Jung, N. Mamadjonov, K. Jeung, Min Chul Kim, K. Lim, Chang‐Yeop Jeon, Youngjeon Lee, Hyung-Joong Kim","doi":"10.1161/JAHA.122.025400","DOIUrl":"https://doi.org/10.1161/JAHA.122.025400","url":null,"abstract":"Background Postischemic cerebral hypoperfusion has been indicated as an important contributing factor to secondary cerebral injury after cardiac arrest. We evaluated the effects of sodium nitroprusside administered via a subdural intracranial catheter on the microcirculation, oxygenation, and electrocortical activity of the cerebral cortex in the early postresuscitation period using a pig model of cardiac arrest. Methods and Results Twenty‐nine pigs were resuscitated with closed cardiopulmonary resuscitation after 14 minutes of untreated ventricular fibrillation. Thirty minutes after restoration of spontaneous circulation, 24 pigs randomly received either 4 mg of sodium nitroprusside (IT‐SNP group) or saline placebo (IT‐saline group) via subdural intracranial catheters and were observed for 5 hours. The same dose of sodium nitroprusside was administered intravenously in another 5 pigs. Compared with the IT‐saline group, the IT‐SNP group had larger areas under the curve for tissue oxygen tension and percent changes of arteriole diameter and number of perfused microvessels from baseline (all P<0.05) monitored on the cerebral cortex during the 5‐hour period, without severe hemodynamic instability. This group also showed faster recovery of electrocortical activity measured using amplitude‐integrated electroencephalography. Repeated‐measures analysis of variance revealed significant group–time interactions for these parameters. Intravenously administered sodium nitroprusside caused profound hypotension but did not appear to increase the cerebral parameters. Conclusions Sodium nitroprusside administered via a subdural intracranial catheter increased post–restoration of spontaneous circulation cerebral cortical microcirculation and oxygenation and hastened electrocortical activity recovery in a pig model of cardiac arrest. Further studies are required to determine its impact on the long‐term neurologic outcomes.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79008212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Corn, Marie Lund, M. Hlatky, J. Wohlfahrt, M. Melbye
Background Change in low‐density lipoprotein cholesterol (LDL‐C) level after statin initiation varies widely among individuals, and in part may be because of factors shared by family members. Methods and Results We used the Danish national registers to identify 89 006 individuals who initiated statins between 2008 and 2018 and had LDL‐C measured immediately before and after the start of treatment. Among these, we identified 5148 first‐degree relatives and 3198 spouses. We decomposed the variation in attained LDL‐C level after statin initiation by applying a mixed‐effect model with 5 variance components (inter‐family and inter‐individual variance in pre‐statin LDL‐C level, inter‐family and inter‐individual variance in statin response, and residual variance). Results were presented as a percentage of the total variance explained by the different variance components. We found that half of the variation in attained LDL‐C level after statin initiation consisted of variance in statin response, approximately one third of variance in pre‐statin LDL‐C level, and the remaining 10% to 15% of residual variance. While the inter‐individual variance in statin response accounted for almost half of the LDL‐C variation in both cohorts, the inter‐family variance in statin response accounted for 3.3% among first‐degree relatives and for 6.0% among spouses. Conclusions Individual factors account for most of the variation in LDL‐C level after statin initiation; factors affecting statin response common within spouses and first‐degree relatives account for a similar share of variation. These results suggest a modest influence of shared genetics and shared familial environment on statin response.
{"title":"Familial Resemblance in Low‐Density Lipoprotein Cholesterol Response to Statins in the Danish Population","authors":"G. Corn, Marie Lund, M. Hlatky, J. Wohlfahrt, M. Melbye","doi":"10.1161/JAHA.121.025465","DOIUrl":"https://doi.org/10.1161/JAHA.121.025465","url":null,"abstract":"Background Change in low‐density lipoprotein cholesterol (LDL‐C) level after statin initiation varies widely among individuals, and in part may be because of factors shared by family members. Methods and Results We used the Danish national registers to identify 89 006 individuals who initiated statins between 2008 and 2018 and had LDL‐C measured immediately before and after the start of treatment. Among these, we identified 5148 first‐degree relatives and 3198 spouses. We decomposed the variation in attained LDL‐C level after statin initiation by applying a mixed‐effect model with 5 variance components (inter‐family and inter‐individual variance in pre‐statin LDL‐C level, inter‐family and inter‐individual variance in statin response, and residual variance). Results were presented as a percentage of the total variance explained by the different variance components. We found that half of the variation in attained LDL‐C level after statin initiation consisted of variance in statin response, approximately one third of variance in pre‐statin LDL‐C level, and the remaining 10% to 15% of residual variance. While the inter‐individual variance in statin response accounted for almost half of the LDL‐C variation in both cohorts, the inter‐family variance in statin response accounted for 3.3% among first‐degree relatives and for 6.0% among spouses. Conclusions Individual factors account for most of the variation in LDL‐C level after statin initiation; factors affecting statin response common within spouses and first‐degree relatives account for a similar share of variation. These results suggest a modest influence of shared genetics and shared familial environment on statin response.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72616783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT. Methods and Results We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P=0.033; OR, 0.581; P=0.035) and favorable outcomes (OR, 0.142; P=0.020; OR, 0.581; P=0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713). Conclusions To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.
尽管血管再通成功，但在接受血管内治疗(EVT)的大血管闭塞引起的急性缺血性卒中患者中，有多达一半的患者不能恢复功能独立。我们的目的是评估脑循环时间(CCT)作为EVT后预后预测因子的作用。方法和结果我们回顾性地招募了连续的急性缺血性卒中大血管闭塞患者进行EVT。研究了基于数字减影血管造影的三种CCT:卒中侧CCT、健康侧CCT，以及卒中侧CCT与健康侧CCT的变化。显著的临床恢复被定义为24小时美国国立卫生研究院卒中量表评分下降≤2或≥8分。3个月时改良Rankin量表评分≤2分被认为是一个有利的结果。采用Logistic回归分析评估CCT对预后的预测。100例患者入组，其中38例(38.0%)临床恢复显著，43例(43.0%)预后良好。Logistic回归分析发现，卒中侧CCT较健康侧和卒中侧CCT变化较短是显著临床恢复的独立阳性预后因素(优势比[OR]， 0.189;P = 0.033;或者,0.581;P=0.035)和良好结局(OR, 0.142;P = 0.020;或者,0.581;P=0.046)，校正了潜在混杂因素。与基线模型相比，包含卒中侧CCT与健康侧CCT变化的模型在临床恢复显著(0.780 vs 0.742)或预后良好(0.759 vs 0.713)的患者曲线下面积值也显著更高。据我们所知，这是首次报道基于数字减影血管造影数据的CCT对EVT后急性缺血性卒中大血管闭塞患者的临床结果具有独立的预测作用。鉴于这种现成的CCT可以在EVT期间提供替代灌注信息，因此有必要进行前瞻性的多中心试验。
{"title":"Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke","authors":"Jia-Qi Wang, Ying-Jia Wang, Jingsong Qiu, Wei Li, Xian-Hui Sun, Yong-Gang Zhao, Xin Liu, Ziai Zhao, Liang Liu, Thanh N. Nguyen, Huisheng Chen","doi":"10.1161/JAHA.122.025853","DOIUrl":"https://doi.org/10.1161/JAHA.122.025853","url":null,"abstract":"Background Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT. Methods and Results We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P=0.033; OR, 0.581; P=0.035) and favorable outcomes (OR, 0.142; P=0.020; OR, 0.581; P=0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713). Conclusions To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73828646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Ann, Hyeji Lee, Kyung Sun Park, Young-jee Jeon, Eun Ji Park, Sangwoo Park, Yong-Giun Kim, Yongjik Lee, Seong Hoon Choi, W. Kwon, Gyung-Min Park
Background Data are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population. Methods and Results This retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all). Conclusions In this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.
{"title":"Marital Status and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals","authors":"S. Ann, Hyeji Lee, Kyung Sun Park, Young-jee Jeon, Eun Ji Park, Sangwoo Park, Yong-Giun Kim, Yongjik Lee, Seong Hoon Choi, W. Kwon, Gyung-Min Park","doi":"10.1161/JAHA.121.024942","DOIUrl":"https://doi.org/10.1161/JAHA.121.024942","url":null,"abstract":"Background Data are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population. Methods and Results This retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all). Conclusions In this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88740363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Daley, E. Buratto, Gregory King, L. Grigg, A. Iyengar, N. Alphonso, A. Bullock, D. Celermajer, J. Ayer, Terry Robertson, Y. D'udekem, I. Konstantinov
Background The long‐term impact of fenestration at the time of Fontan operation remains unclear. We aimed to review the early and long‐term impact of Fontan fenestration in the Australia and New Zealand cohort. Methods and Results We reviewed 1443 patients (621 fenestrated, 822 nonfenestrated) from the Australia and New Zealand Fontan registry. Data were collected on preoperative demographics, operative details, and follow‐up. Propensity‐score matching was performed to account for the various preoperative and operative differences and risk factors. Primary outcomes were survival and freedom from failure. Median follow‐up was 10.6 years. After propensity‐score matching (407 matched pairs), there was no difference in survival (87% versus 90% at 20 years; P=0.16) or freedom from failure (73% versus 80% at 20 years; P=0.10) between patients with and without fenestration, respectively. Although patients with fenestration had longer bypass and cross‐clamp times (P<0.001), there was no difference in hospital length of stay or prolonged pleural effusions (P=0.80 and P=0.46, respectively). Freedom from systemic and Fontan circuit thromboembolism was higher in the nonfenestrated group (89%; 95% CI, 88%–95%) than the fenestrated group (84%; 95% CI, 77%–89%; P=0.03). There was no difference in incidence of plastic bronchitis, protein‐losing enteropathy, New York Heart Association Class III/IV symptoms, or Fontan takedown. Conclusions In the propensity score–matched analysis we have demonstrated no difference in long‐term survival or freedom from Fontan failure in patients with and without fenestration. There was a higher incidence of long‐term thromboembolic events in patients with fenestration. Overall, it appears that fenestration in Fontan circulation does not bring long‐term benefits.
背景Fontan手术时开窗的长期影响尚不清楚。我们的目的是回顾Fontan开窗对澳大利亚和新西兰队列的早期和长期影响。方法和结果我们回顾了来自澳大利亚和新西兰Fontan注册中心的1443例患者(621例开窗，822例非开窗)。收集术前人口统计学、手术细节和随访资料。进行倾向评分匹配，以解释各种术前和手术差异和危险因素。主要结局是生存和免于失败。中位随访时间为10.6年。倾向评分匹配(407对配对)后，20年生存率无差异(87% vs 90%;P=0.16)或免于失败(73%对80%;P=0.10)。虽然开窗患者的搭桥和交叉钳夹时间较长(P<0.001)，但住院时间和延长的胸腔积液没有差异(P分别=0.80和P=0.46)。未开窗组的全身性和丰坦回路血栓栓塞发生率更高(89%;95% CI, 88%-95%)高于开窗组(84%;95% ci, 77%-89%;P = 0.03)。可塑性支气管炎、蛋白质丢失性肠病、纽约心脏协会III/IV级症状或丰坦停用的发生率无差异。结论:在倾向评分匹配分析中，我们已经证明，在开窗和不开窗的患者中，长期生存率和Fontan失效的自由度没有差异。开窗患者的长期血栓栓塞事件发生率较高。总的来说，在方潭循环中开窗似乎没有带来长期的好处。
{"title":"Impact of Fontan Fenestration on Long‐Term Outcomes: A Propensity Score–Matched Analysis","authors":"M. Daley, E. Buratto, Gregory King, L. Grigg, A. Iyengar, N. Alphonso, A. Bullock, D. Celermajer, J. Ayer, Terry Robertson, Y. D'udekem, I. Konstantinov","doi":"10.1161/JAHA.122.026087","DOIUrl":"https://doi.org/10.1161/JAHA.122.026087","url":null,"abstract":"Background The long‐term impact of fenestration at the time of Fontan operation remains unclear. We aimed to review the early and long‐term impact of Fontan fenestration in the Australia and New Zealand cohort. Methods and Results We reviewed 1443 patients (621 fenestrated, 822 nonfenestrated) from the Australia and New Zealand Fontan registry. Data were collected on preoperative demographics, operative details, and follow‐up. Propensity‐score matching was performed to account for the various preoperative and operative differences and risk factors. Primary outcomes were survival and freedom from failure. Median follow‐up was 10.6 years. After propensity‐score matching (407 matched pairs), there was no difference in survival (87% versus 90% at 20 years; P=0.16) or freedom from failure (73% versus 80% at 20 years; P=0.10) between patients with and without fenestration, respectively. Although patients with fenestration had longer bypass and cross‐clamp times (P<0.001), there was no difference in hospital length of stay or prolonged pleural effusions (P=0.80 and P=0.46, respectively). Freedom from systemic and Fontan circuit thromboembolism was higher in the nonfenestrated group (89%; 95% CI, 88%–95%) than the fenestrated group (84%; 95% CI, 77%–89%; P=0.03). There was no difference in incidence of plastic bronchitis, protein‐losing enteropathy, New York Heart Association Class III/IV symptoms, or Fontan takedown. Conclusions In the propensity score–matched analysis we have demonstrated no difference in long‐term survival or freedom from Fontan failure in patients with and without fenestration. There was a higher incidence of long‐term thromboembolic events in patients with fenestration. Overall, it appears that fenestration in Fontan circulation does not bring long‐term benefits.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89271159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin Lidgard, L. Zelnick, A. Go, K. O’Brien, N. Bansal
Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N‐terminal pro–brain‐type natriuretic peptide and high‐sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self‐reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N‐terminal pro–brain‐type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10‐fold cross‐validated Harrell’s C‐indices for each risk score and cardiac biomarker alone and in combination. The C‐index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N‐terminal pro–brain‐type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI −0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI −0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N‐terminal pro–brain‐type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease–specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.
背景当代指南推荐使用动脉粥样硬化性心血管疾病筛查工具指导初级预防。这些评分在中晚期慢性肾病患者中的表现尚不清楚，特别是在与临床可用的心脏生物标志物(包括N端前脑型利钠肽和高敏感性肌钙蛋白T (hsTnT))联合使用时。方法和结果我们研究了1027名来自慢性肾功能不全队列的参与者，他们没有自我报告的动脉粥样硬化性心血管疾病，在入组时没有服用阿司匹林或他汀类药物。在基线时测量Framingham风险评分、合并队列方程、N端脑前型利钠肽和hsTnT。结果包括致死性和非致死性心肌梗死、中风和心源性死亡。我们计算了10倍交叉验证的Harrell’s C指数，用于每个风险评分和单独或联合的心脏生物标志物。鉴别动脉粥样硬化性心血管疾病的C‐指数(95% CI)， Framingham风险评分为0.72(0.67,0.77)，合并队列方程为0.72(0.67,0.76)。HsTnT与各风险评分的鉴别性相当，并改善了各风险评分的鉴别性(Framingham 0.029, 95% CI 0.003, 0.055;合并队列方程变化0.027,95% CI 0.002, 0.052)。N端脑前型利钠肽的辨别能力低于风险评分，并且没有显著改善其辨别能力(Framingham变化0.009,95% CI - 0.001, 0.018;合并队列方程变化0.011,95% CI−0.001,0.024)。结论:Framingham风险评分和合并队列方程显示慢性肾脏疾病患者对动脉粥样硬化性心血管疾病有中度区分。HsTnT，而不是N端脑前型利钠肽，总体上提高了他们的识别能力。在慢性肾脏疾病特异性动脉粥样硬化性心血管疾病风险评分得以开发之前，如何将hsTnT纳入现有的临床风险评分可能值得考虑。
{"title":"Framingham and American College of Cardiology/American Heart Association Pooled Cohort Equations, High‐Sensitivity Troponin T, and N‐Terminal Pro–Brain‐Type Natriuretic Peptide for Predicting Atherosclerotic Cardiovascular Events Across the Spectrum of Kidney Dysfunction","authors":"Benjamin Lidgard, L. Zelnick, A. Go, K. O’Brien, N. Bansal","doi":"10.1161/JAHA.121.024913","DOIUrl":"https://doi.org/10.1161/JAHA.121.024913","url":null,"abstract":"Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N‐terminal pro–brain‐type natriuretic peptide and high‐sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self‐reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N‐terminal pro–brain‐type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10‐fold cross‐validated Harrell’s C‐indices for each risk score and cardiac biomarker alone and in combination. The C‐index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N‐terminal pro–brain‐type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI −0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI −0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N‐terminal pro–brain‐type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease–specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72882571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. S. Rønningen, T. Berge, M. Solberg, S. Enger, M. O. Pervez, E. B. Orstad, B. Kvisvik, E. N. Aagaard, M. Lyngbakken, I. Ariansen, H. Røsjø, K. Steine, A. Tveit
Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.
超声心动图测量左心房容积是心血管事件的有力预测指标，对评估舒张功能障碍很重要。尽管如此，对影响左心房重构的因素了解有限。特别是，40岁出头的人的血压对以后的左心房容量的影响还没有得到充分的阐明。方法和结果我们将1950年出生的40岁人群的数据与ACE(阿克斯舒斯心脏检查)1950年研究相关联。我们将研究人群按40岁出头的收缩压分成四分位数，并评估60岁中期左心房扩大的个体比例。用线性回归分析评估血压和左心房容积之间的关系。在本研究纳入的2591名个体中，1302名(50.3%)为女性，40岁计划的平均年龄为40.1±0.3岁。收缩压为128.1±13.6 mm Hg，舒张压为78.3±9.5 mm Hg, ACE 1950研究的平均年龄为64.0±0.6岁。在收缩压的四分位数中，左心房增大的个体比例增加(P=0.001)。收缩压与左房容积独立相关;收缩压每升高1毫米汞柱，收缩压末容积增加0.09 mL (95% CI, 0.04-0.14 mL)。结论:我们的研究结果表明，40岁出头的人血压升高与以后的左房重构有关。注册网址:https://www.clinicaltrials.gov;唯一标识符:NCT01555411。
{"title":"Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid‐60s: Data From the ACE 1950 Study","authors":"P. S. Rønningen, T. Berge, M. Solberg, S. Enger, M. O. Pervez, E. B. Orstad, B. Kvisvik, E. N. Aagaard, M. Lyngbakken, I. Ariansen, H. Røsjø, K. Steine, A. Tveit","doi":"10.1161/JAHA.121.023738","DOIUrl":"https://doi.org/10.1161/JAHA.121.023738","url":null,"abstract":"Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"188 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79413050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：