AMIL SHAH - Academia.edu (original) (raw)
Papers by AMIL SHAH
JAMA network open, Sep 1, 2022
IMPORTANCE Sparse data exist regarding the contributions of subclinical impairments in cardiovasc... more IMPORTANCE Sparse data exist regarding the contributions of subclinical impairments in cardiovascular and noncardiovascular function to incident heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) among Black US residents, limiting understanding of the etiology of HF subtypes. OBJECTIVES To identify subclinical cardiovascular and noncardiovascular risk factors associated with HFrEF and HFpEF in Black US residents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used cross-sectional and time-to-event analysis with data from the community-based Jackson Heart Study (JHS), a longitudinal cohort study with baseline data collected from 2000 to 2004 (visit 1) and 10-year follow-up for incident HF. Black US residents from the Jackson, Mississippi, metropolitan area enrolled in JHS; those with prevalent HF, with moderate or greater aortic or mitral valve diseases on visit 1, who died before 2005, and who had missing HF status on follow-up were excluded. The analysis included 4361 participants and was performed between June 2020 to August 2021. EXPOSURES Quantitative measures of cardiovascular (left ventricular mass index [LVMI], left ventricular ejection fraction [LVEF], left atrial [LA] diameter, and pulse pressure) and noncardiovascular (percent predicted forced expiration volume in 1 second [FEV 1 (percent predicted)], estimated glomerular filtration rate (eGFR), waist circumference, and hemoglobin A 1c [HbA 1c ] level) organ function. MAIN OUTCOMES AND MEASURES Incident HF, HFrEF, and HFpEF over 10-year follow-up. RESULTS The 4361 participants had a mean (SD) age of 54 (13); 2776 (64%) were women; and there were 163 HFpEF and 146 HFrEF events. In multivariable models incorporating measures reflecting each organ system, factors associated with incident HFpEF included greater LA diameter (hazard
JAMA Network Open
ImportanceFood insecurity disproportionately affects Black individuals in the US. Its association... more ImportanceFood insecurity disproportionately affects Black individuals in the US. Its association with coronary heart disease (CHD), heart failure (HF), and stroke is unclear.ObjectiveTo evaluate the associations of economic food insecurity and proximity with unhealthy food options with risk of incident CHD, HF, and stroke and the role of diet quality and stress.Design, Setting, and ParticipantsThis cohort study was a time-to-event analysis of 3024 Black adult participants in the Jackson Heart Study (JHS) without prevalent cardiovascular disease (CVD) at visit 1 (2000-2004). Data analysis was conducted from September 1, 2020, to November 30, 2021.ExposuresEconomic food insecurity, defined as receiving food stamps or self-reported not enough money for groceries, and high frequency of unfavorable food stores (>2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile).Main Outcomes and MeasuresThe main outcomes were incident CVD including incident CHD, s...
Scientific reports, Jan 2, 2018
Increased activation of the renin-angiotensin system is involved in the onset and progression of ... more Increased activation of the renin-angiotensin system is involved in the onset and progression of cardiometabolic diseases, while natriuretic peptides (NP) may exert protective effects. We have recently demonstrated that sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, which blocks the angiotensin II type-1 receptor and augments natriuretic peptide levels, improved peripheral insulin sensitivity in obese hypertensive patients. Here, we investigated the effects of sacubitril/valsartan (400 mg QD) treatment for 8 weeks on the abdominal subcutaneous adipose tissue (AT) phenotype compared to the metabolically neutral comparator amlodipine (10 mg QD) in 70 obese hypertensive patients. Abdominal subcutaneous AT biopsies were collected before and after intervention to determine the AT transcriptome and expression of proteins involved in lipolysis, NP signaling and mitochondrial oxidative metabolism. Both sacubitril/valsartan and amlodipine treatment...
Circulation. Heart failure, Jan 30, 2014
Background-The mechanism of functional limitation in heart failure with preserved ejection fracti... more Background-The mechanism of functional limitation in heart failure with preserved ejection fraction remains controversial. We examined the contributions of central cardiac and peripheral mechanisms and hypothesized that the pulmonary vascular response to exercise is an important determinant of aerobic capacity among patients with exertional pulmonary venous hypertension (ePVH). Methods and Results-We compared 31 ePVH patients (peak VO 2 <80% of predicted and peak pulmonary arterial wedge pressure≥20 mm Hg) with 31 age-and sex-matched controls (peak VO 2 >80% predicted) who underwent invasive cardiopulmonary exercise testing for unexplained exertional intolerance. ePVH patients had lower peak cardiac output (73±14% versus 103±18% predicted; P<0.001) compared with controls, related both to impaired chronotropic response (peak heart rate 111±25 beats per minute versus 136±24 beats per minute; P<0.001) and to reduced peak stroke volume index (47±10 mL/min per m 2 versus 54±15 mL/min per m 2 ; P=0.03). Peak systemic O 2 extraction was not different between groups (arterial-mixed venous oxygen content difference: 13.0±2.1 mL/dL versus 13.4±2.4 mL/dL; P=0.46). ePVH patients had higher resting (150±74 versus 106±50 dyne/s per cm −5 ; P=0.009), peak (124±74 dyne/s per cm −5 versus 70±41 dyne/s per cm −5 ; P<0.001), and isoflow pulmonary vascular resistance (124±74 dyne/s per cm −5 versus 91±33 dyne/s per cm −5 at cardiac output≈10.6 L/min; P=0.04). Pulmonary vascular resistance decreased with exercise in all control subjects but increased in 36% (n=11) of ePVH patients. Abnormal pulmonary vascular response was not associated with peak VO 2. Conclusions-Reduced cardiac output response, rather than impaired peripheral O 2 extraction, constrains oxygen delivery and aerobic capacity in ePVH. Pulmonary vascular dysfunction is common in patients with ePVH at rest and during exercise.
European heart journal, Jan 19, 2015
Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, t... more Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, the relationship between moderate alcohol consumption and risk for HF, in either men or women, remains unclear. We examined 14 629 participants of the Atherosclerosis Risk in Communities (ARIC) study (54 ± 6 years, 55% women) without prevalent HF at baseline (1987-89) who were followed for 24 ± 1 years. Self-reported alcohol consumption was assessed as the number of drinks/week (1 drink = 14 g of alcohol) at baseline, and updated cumulative average alcohol intake was calculated over 8.9 ± 0.3 years. Using multivariable Cox proportional hazards models, we examined the relation of alcohol intake with incident HF and assessed whether associations were modified by sex. Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting ≥7 to 14 drinks per week, and 3% reporting ≥14-21 and ≥21 drinks per week, respectively. Incide...
The Journal of Clinical Hypertension, 2009
Background Chronic kidney disease is a significant risk factor for end-stage kidney disease, card... more Background Chronic kidney disease is a significant risk factor for end-stage kidney disease, cardiovascular events, and premature death. However, the prognostic value of low estimated glomerular filtration rate (eGFR) in the elderly is debatable. Methods We determined eGFR using the Japanese equation in 132,160 elderly subjects (65-75 years) who attended the special health checkup (Tokutei-Kenshin) in 2008 and investigated the association between baseline eGFR and 5-year all-cause and cardiovascular mortality. Results The median (SD) eGFR was 70.5 ± 15.3 mL/min/ 1.73 m 2. During follow-up, we noted 2045 all-cause deaths including 408 from cardiovascular events. A J-shaped curve was obtained when all-cause and cardiovascular mortality rates were compared with decreases in eGFR, with the highest mortality observed for eGFR \45 mL/ min/1.73 m 2. These trends were statistically significant in the Kaplan-Meier analysis (P \ 0.001). In the Cox proportional hazard analysis, after adjusting for possible confounders, those with eGFR \45 mL/min/1.73 m 2 , but not eGFR 45-59 mL/min/1.73 m 2 showed a higher allcause and cardiovascular mortality than those with eGFR [90 mL/min/1.73 m 2 [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.06-1.91 for all-cause mortality, HR 2.28, 95% CI 1.28-4.03 for cardiovascular mortality]. Sexbased subgroup analyses showed similar results for both men and women. Conclusions We conclude that eGFR \45 mL/min/ 1.73 m 2 is an independent risk factor for all-cause and cardiovascular mortality in the elderly population.
European Journal of Heart Failure, 2010
Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myoca... more Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown. The Valsartan in Acute Myocardial Infarction trial (VALIANT) enrolled 14 703 patients with acute MI complicated by HF, systolic dysfunction, or both. We compared the risk of death, HF hospitalization, and/or recurrent MI among patients with and without diabetes using Cox proportional hazards models. To assess the relationship between diabetes, LVEF and outcomes, we assessed the relative influence of baseline LVEF on outcomes in diabetic and non-diabetic patients. Totally, 11 325 subjects (3095 diabetics) with site-reported LVEF and known diabetes status were included. At any given LVEF, diabetes was associated with a higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.37, 95% CI 1.25-1.51], death or HF hospitalization (adjusted HR 1.42, 95% CI 1.31-1.51), and death or recurrent MI (adjusted HR 1.36, 95% CI 1.24-1.48). Diabetes modified the relationship between LVEF and death or HF hospitalization (P for interaction = 0.0109), such that the association between diabetes and increased risk was greater in magnitude at higher LVEF. No interaction was noted between diabetes and LVEF on risk of all-cause mortality or death or recurrent MI. Diabetes is associated with a higher risk of death or HF hospitalization across the spectrum of LVEF in high-risk post-MI patients. The magnitude of reduction in risk of death or HF hospitalization associated with increasing LVEF is significantly attenuated among patients with diabetes when compared to patients without diabetes.
Circulation. Cardiovascular imaging, 2016
Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outc... more Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outcomes, emerging evidence supports the importance of LA function. We examined LA emptying fraction (LAEF) across the spectrum of cardiovascular disease burden in a large cohort of elderly adults living in the community. We studied 1142 participants in the Atherosclerosis Risk in Communities (ARIC) study who were in sinus rhythm, free of valvular disease, and had acceptable quality 3-dimensional echocardiograms (mean age, 76±5 years; 59% women). We determined the cross-sectional correlates of LAEF and compared LAEF among elderly adults without cardiovascular disease or cardiovascular risk factors (n=201), those with hypertension (n=734), and those with overt heart failure (HF; n=207). In multivariable analysis, lower LAEF was associated with higher LA volumes and worse left ventricular systolic and diastolic functions. Elderly participants free of cardiovascular disease or risk factors had ...
F1000 - Post-publication peer review of the biomedical literature, 2019
Circulation Research, 2019
Response by Jia et al to Letter Regarding Article, “Interleukin-35 Promotes Macrophage Survival a... more Response by Jia et al to Letter Regarding Article, “Interleukin-35 Promotes Macrophage Survival and Improves Wound Healing After Myocardial Infarction in Mice” In Response: We appreciate the comments by Wang et al on our recent publication. In our article, we reveal that IL (interleukin)-35 increases the number of Ly6C macrophages, which is functionally similar to M2-type macrophages. Two highly intriguing articles reported that mouse cardiac macrophage populations could be divided into CCR2 (C-C motif chemokine receptor 2) MHC II (major histocompatibility complex II), CCR2 MHC II, and CCR2 MHC II subsets. We observed that IL-35 could mediate and improve the survival of CCR2 MHC II macrophages, which play crucial roles in various forms of tissue remodeling such as coronary development and postnatal coronary growth. Although we revealed that CD31 was not significantly altered in mice treated with anti–IL-35 antibody compared with its expression in wild-type mice (see Online Figure VII), we cannot completely rule out the possibility that IL-35 contributes to the proliferation of coronary arterial endothelial cells in some way, since CD31 is expressed in both vascular and endocardial endothelial cells. Therefore, future studies are required to explore the mechanisms and the cell-specific effects of IL-35 in coronary arterial endothelial cells using Connexin40-GFP (green fluorescent protein) mice expressing GFP in endothelial cells of coronary arteries, but not veins, capillaries, or endocardium. In addition, more clinical and experimental data are needed to explore the side effects, such us infection incidence, cancer incidence, and mortality post IL-35 treatment and ensure the optimal temporal and spatial treatment option of IL-35 in the setting of myocardial infarction (MI). Immunofluorescence staining of FACS-purified Tregs (see Figure 1) and adoptive transfer of EBI3 (Epstein-Barr virus–induced gene 3) KO and wild-type Tregs (see Figure 4) demonstrate that Tregs-derived IL-35 contributed to the healing process by modulating extracellular matrix deposition and the transition of fibroblasts to myofibroblasts. However, the sources of IL-35 are complex and we are unable to identify the function of certain immune cell population secreting IL-35, as discussed in our article. IL-35–producing inducible regulatory T cells (iTr35 cells) represent unique members of the Treg cell family that were generated by IL-35 and do not express Foxp3 (forkhead box P3). The exact roles of iTr35 cells in MI thus remain elusive and future studies are required to explore the number and function of iTr35 cells after MI. Tregs increased gradually and peaked on day, normalized by 2-week post MI, and subsequently reexpanded in chronic heart failure phase (8 weeks after MI). Tregs change their phenotype in a phasic manner after MI. After acute MI, Treg activation is beneficial and improves cardiac wound healing. However, in chronic ischemic heart failure, Tregs could become dysfunctional and promote adverse left ventricular remodeling. The opposite functions of Tregs in acute and chronic MI period highlighting important differences in immune cell activation and inflammatory profiles. Similarly, the activation of TGF (transforming growth factor)β1 is protective against ischemic myocardial damage during the early phase through improving the replacement of necrotic tissue by a stable collagenous scar and thus preventing left ventricular rupture. However, sustained expression of TGF-β1 is detrimental and could lead to cardiac remodeling and heart failure after MI. In our article, we demonstrate the combination of EBI3 and p35 is increased at day 3, peaked at day 5 and decreased significantly at day 14 post MI, implying that IL-35 promotes TGF-β1 production, contributes to the beneficial effects of Tregs activation and is a central coordinator of wound healing process in the early phase of MI. Future studies are needed to explore the expression and corresponding functional roles of IL-35 in chronic heart failure. Our data indicate that IL-35 reduces cardiac rupture, improves wound healing, and attenuates cardiac remodeling after MI in mice. We agree with the comments by Wang et al that researchers should explore complex mechanisms of IL-35 and the potential benefits and risks of IL-35 treatment in human MI populations. Independent studies and replications from different research laboratories will contribute to the better understanding on the function and therapeutic potentials of IL-35 in MI patients.
The American Journal of Surgery, 2002
Background: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma perit... more Background: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei. This study documented the morbidity of intraperitoneal chemotherapy in a single institution. Methods: A retrospective review of pseudomyxoma peritonei over a 6-year period was undertaken. Treatment, morbidity, and outcome were documented. Results: Eleven patients were identified with an average of 1.9 debulking procedures and 0.8 chemotherapy courses (0.3 complete). Intraperitoneal chemotherapy was not completed in 5 patients because of complications (56%): severe abdominal pain, seizure, neutropenia, and thrombocytopenia (the latter resulted in 1 patient's death). There was no association between incomplete chemotherapy and recurrence. Recurrence was 64% in those without chemotherapy and 44% in those with. Follow-up averaged 26 months and actual 3-year survival was 60%. Conclusions: Intraperitoneal chemotherapeutic morbidity and mortality were 56% and 11%, respectively. Chemotherapy was associated with decreased recurrence. To optimize outcomes, multicenter prospective trials will likely be required to further refine intraperitoneal chemotherapy protocols.
Journal of Cardiac Failure, 2007
International Journal of Cardiology, 2013
Background: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (D... more Background: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (DYS-PAP) obtained by 2D speckle-tracking echocardiography (2D-STE) in the prediction of recurrent ischemic mitral regurgitation (MR) after restrictive annuloplasty. Methods: The study population consisted of 524 consecutive patients who survived coronary artery bypass grafting (CABG) and restrictive annuloplasty, performed between 2001 and 2010 at 3 different Institutions and who met inclusion criteria. The assessment of DYS-PAP was performed preoperatively and at follow-up (median 45.3 months [IQR 26-67]) by 2D-STE in the apical four-chamber view for the anterolateral papillary muscle (ALPM) and apical long-axis view for the posteromedial papillary muscle (PMPM). Results: Recurrence of MR (≥2+ in patients with no/trivial MR at discharge) was found in 112 patients (21.3%) at follow-up. Compared to patients without recurrence of MR, these patients had higher DYS-PAP values at baseline (60.6± 4.4 ms vs. 47.2± 2.9 ms, pb 0.001) which significantly worsened at follow-up (74.4± 5.2 ms, p =0.002 vs. baseline). In contrast, in patients with no MR recurrence, DYS-PAP was significantly reduced (25.3± 4.4 ms, p =0.002 vs. baseline). At logistic regression analysis DYS-PAP (odds ratio [OR]: 4.8, 95% Confidence Interval [CI]: 3.4-8.2, p b 0.001), was the strongest predictor of recurrent MR with a cutoff ≥58 ms (95%CI 51-66 ms). The model showed an area under the Receiver Operating Characteristic (ROC) curve of 0.97 (CI 0.94-0.99 [optimism-corrected 0.94; CI 0.89-0.95]) with 98% sensitivity (CI 96-100% [optimism-corrected 95%; CI 91-96%]) and 90% specificity (CI 85-94% [optimism-corrected 87%; CI 82-90%]). Conclusions: DYS-PAP represents a reliable tool to identify patients with ischemic MR who can benefit from restrictive annuloplasty.
Diabetes, Obesity and Metabolism, 2013
Context-Obese individuals have high aldosterone levels that may contribute to insulin resistance ... more Context-Obese individuals have high aldosterone levels that may contribute to insulin resistance (IR) and endothelial dysfunction leading to obesity induced cardiovascular disease. We conducted a study to evaluate the effect of mineralocorticoid receptor antagonism on IR and endothelial function in obese individuals. Design-This was a placebo-controlled, double blind, randomized, parallel-group study (NCT01406015). Participants and Interventions-Thirty two non-diabetic, obese subjects (BMI 30 to 45 kg/ m 2) with no other medical problems were randomized to six weeks of treatment with spironolactone 50 mg daily or placebo. Insulin sensitivity index (ISI) was assessed by Matsuda method, endothelial function by flow mediated vasodilatation (FMD) of brachial artery and renal plasma perfusion by clearance of para-aminohippurate (PAH). Results-There was no change in weight, BMI or plasma potassium during the study period. Treatment with spironolactone led to increases in serum aldosterone (7.6±6.6 Vs 3.2±1.3 ng/dL; p <0.02, post-treatment Vs baseline) and urine aldosterone (11.0±7. Vs 4.8±2.4 µg/G creatinine; p<0.01) and decreases in systolic blood pressure (116±11 Vs 123±10 mmHg; p<0.001). There were no changes in these variables in the placebo group. Neither spironolactone nor placebo treatment had a significant effect on ISI or other indices of glucose metabolism (HOMA, area under the curve for insulin, area under the curve for glucose), brachial artery reactivity or the renal plasma perfusion values. Changes in these variables were similar in two groups. Conclusions-We conclude that six weeks of treatment with spironolactone does not change insulin sensitivity or endothelial function in normotensive obese individuals with no other comorbidities.
Circulation
BACKGROUND: Limited data exist on American College of Cardiology/American Heart Association valvu... more BACKGROUND: Limited data exist on American College of Cardiology/American Heart Association valvular heart disease (VHD) stage prevalence, progression, and association with incident cardiovascular diseases in late life. METHODS: Participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective community-based cohort study, underwent protocol echocardiography at ARIC visits 5 (2011–2013) and 7 (2018–2019), and their aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation stage were defined according to American College of Cardiology/American Heart Association guidelines. The overall VHD stage prevalence at visit 5 was measured. The associations between VHD stages and incident adjudicated death, heart failure, coronary heart disease, stroke, and atrial fibrillation were assessed with Cox proportional hazard models adjusted for age, sex, race, hypertension, diabetes, prior myocardial infarction, heart failure, body mass index, study center, sy...
Giornale italiano di cardiologia (2006), 2014
Although cardiovascular risk in patients with diabetes progressively increases with higher levels... more Although cardiovascular risk in patients with diabetes progressively increases with higher levels of blood glucose and glycated hemoglobin, none of currently available outcome trials has provided a clear demonstration that the improvement of glycemic control prevents cardiovascular disease. Meta-analyses of trials show that, for a reduction of glycated hemoglobin of 1%, the incidence of major cardiovascular events is reduced by about 10%; conversely, effects on cardiovascular mortality are heterogeneous. Available data suggest that early treatment in patients with lower levels of comorbidity can be more effective than in individuals with established diabetic complications. In addition, hypoglycemia induced by intensified treatment may have a negative impact on cardiovascular mortality. Furthermore, the possibility that individual drugs, or classes of drugs, for diabetes have either beneficial or detrimental effects on cardiovascular risk independent of their glucose-lowering action ...
Cardiology Clinics, 2014
Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is a... more Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is associated with significant morbidity, mortality, and costs. Prompt diagnosis may help decrease mortality, hospital stay, and costs related to treatment. A complete heart failure evaluation comprises a comprehensive history and physical examination, echocardiogram, and diagnostic tools that provide information regarding the etiology of heart failure, related complications, and prognosis in order to prescribe appropriate therapy, monitor response to therapy, and transition expeditiously to advanced therapies when needed. Emerging technologies and biomarkers may provide better risk stratification and more accurate determination of cause and progression.
Journal of Cardiac Failure, 2012
Background: Right atrial pressure, pulmonary vascular resistance (PVR) and right ventricular (RV)... more Background: Right atrial pressure, pulmonary vascular resistance (PVR) and right ventricular (RV) stroke volume index (SVI) are known prognostic parameters in pulmonary arterial hypertension (PAH). Methods: We evaluated the relationship of RV longitudinal strain (LS), a novel noninvasive measure of RV function, with invasive hemodynamics and NT-proBNP in advanced PAH. RV LS was measured by speckle tracking echocardiography in 35 healthy controls and in 74 patients with advanced PAH, decreased exercise capacity, and PVR>800 dynes.sec/cm-5 despite 2 PAH-specific therapies. Right heart catheterization and NT-proBNP assessed in all PAH patients. Results: RV LS, measurable in 59/74 PAH patients and 32/35 controls, was lower in PAH patients vs controls (-14.6±4.5 vs-26.7±4.2, p<0.0001). RV LS correlated with invasive RV SVI (r=-0.45, p=0.0004), Right atrial pressure (r=0.28, p=0.03), PVR (r=0.25, p=0.05), and with NT-proBNP (r=0.45, p=0.0005) by right heart catheterization. Compared to standard echo parameters of RV function (fractional area change, Tei index, TAPSE, tricuspid annular systolic velocity), only RV LS significantly correlated with all 3 invasive parameters and NT-proBNP, remaining significant in bivariate analyses adjusting for associated standard RV parameters. Conclusions: RV LS, decreased in PAH, correlates with prognostic invasive hemodynamic measures and with NT-proBNP. RV LS may represent a novel sensitive noninvasive measure of RV function in PAH.
Diabetes Care, 2013
OBJECTIVE In 2010, the American Heart Association defined seven metrics (smoking, BMI, physical a... more OBJECTIVE In 2010, the American Heart Association defined seven metrics (smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose) for ideal cardiovascular health (ICH). Subsequent studies have shown that the prevalence of achieving these metrics is very low in the general population. Adults with type 1 diabetes are at increased risk of cardiovascular disease (CVD), but no studies to date have been published on the prevalence of ICH in this population. RESEARCH DESIGN AND METHODS Data for this analysis were collected as part of the prospective Coronary Artery Calcification in Type 1 Diabetes study. This analysis involved 546 subjects with type 1 diabetes and 631 subjects without diabetes who had complete information for calculating the ICH metrics. RESULTS Overall, the prevalence of ICH was low in this population, with none meeting the ideal criteria for all seven metrics. The prevalence of ideal physical activity (10.0%) and diet (1.1%) w...
Coronary Artery Disease, 2013
Objectives Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary ... more Objectives Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Epicardial fat thickness (EFT) reflects visceral adiposity and is considered an important cardiometabolic marker. In this study, we aimed to examine the presence of an association between CFR and EFT in MetS patients. Methods Forty-six MetS patients (25 men, mean age 47.3±6.6 years) and 44 age-matched and sex-matched controls (24 men, mean age 46.0±6.1 years) were prospectively studied. Both CFR and EFT were measured by transthoracic echocardiography. Peak diastolic coronary flow velocities were measured in the left anterior descending artery by pulsed wave Doppler at the baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Results The waist circumference, total and low-density lipoprotein-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressures, and high sensitive C-reactive protein were significantly higher in MetS patients. The mean EFT was significantly higher in MetS patients compared with the controls (8.7±0.2 vs. 4.8±0.1 mm, P < 0.001); however, CFR was significantly lower in MetS patients (2.3±0.2 vs. 2.7±0.2, P < 0.001). CFR was correlated significantly with BMI, waist circumference, high-density lipoprotein-cholesterol, triglycerides, fasting glucose, high sensitive C-reactive protein, and EFT. In regression analysis, MetS itself and EFT were found to be independent predictors of impaired CFR. Conclusion CFR is impaired in MetS patients. MetS itself and increased EFT are associated independently with coronary microvascular dysfunction and EFT is a predictor of worse CFR even after accounting for the presence or absence of the MetS.
JAMA network open, Sep 1, 2022
IMPORTANCE Sparse data exist regarding the contributions of subclinical impairments in cardiovasc... more IMPORTANCE Sparse data exist regarding the contributions of subclinical impairments in cardiovascular and noncardiovascular function to incident heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) among Black US residents, limiting understanding of the etiology of HF subtypes. OBJECTIVES To identify subclinical cardiovascular and noncardiovascular risk factors associated with HFrEF and HFpEF in Black US residents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used cross-sectional and time-to-event analysis with data from the community-based Jackson Heart Study (JHS), a longitudinal cohort study with baseline data collected from 2000 to 2004 (visit 1) and 10-year follow-up for incident HF. Black US residents from the Jackson, Mississippi, metropolitan area enrolled in JHS; those with prevalent HF, with moderate or greater aortic or mitral valve diseases on visit 1, who died before 2005, and who had missing HF status on follow-up were excluded. The analysis included 4361 participants and was performed between June 2020 to August 2021. EXPOSURES Quantitative measures of cardiovascular (left ventricular mass index [LVMI], left ventricular ejection fraction [LVEF], left atrial [LA] diameter, and pulse pressure) and noncardiovascular (percent predicted forced expiration volume in 1 second [FEV 1 (percent predicted)], estimated glomerular filtration rate (eGFR), waist circumference, and hemoglobin A 1c [HbA 1c ] level) organ function. MAIN OUTCOMES AND MEASURES Incident HF, HFrEF, and HFpEF over 10-year follow-up. RESULTS The 4361 participants had a mean (SD) age of 54 (13); 2776 (64%) were women; and there were 163 HFpEF and 146 HFrEF events. In multivariable models incorporating measures reflecting each organ system, factors associated with incident HFpEF included greater LA diameter (hazard
JAMA Network Open
ImportanceFood insecurity disproportionately affects Black individuals in the US. Its association... more ImportanceFood insecurity disproportionately affects Black individuals in the US. Its association with coronary heart disease (CHD), heart failure (HF), and stroke is unclear.ObjectiveTo evaluate the associations of economic food insecurity and proximity with unhealthy food options with risk of incident CHD, HF, and stroke and the role of diet quality and stress.Design, Setting, and ParticipantsThis cohort study was a time-to-event analysis of 3024 Black adult participants in the Jackson Heart Study (JHS) without prevalent cardiovascular disease (CVD) at visit 1 (2000-2004). Data analysis was conducted from September 1, 2020, to November 30, 2021.ExposuresEconomic food insecurity, defined as receiving food stamps or self-reported not enough money for groceries, and high frequency of unfavorable food stores (>2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile).Main Outcomes and MeasuresThe main outcomes were incident CVD including incident CHD, s...
Scientific reports, Jan 2, 2018
Increased activation of the renin-angiotensin system is involved in the onset and progression of ... more Increased activation of the renin-angiotensin system is involved in the onset and progression of cardiometabolic diseases, while natriuretic peptides (NP) may exert protective effects. We have recently demonstrated that sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, which blocks the angiotensin II type-1 receptor and augments natriuretic peptide levels, improved peripheral insulin sensitivity in obese hypertensive patients. Here, we investigated the effects of sacubitril/valsartan (400 mg QD) treatment for 8 weeks on the abdominal subcutaneous adipose tissue (AT) phenotype compared to the metabolically neutral comparator amlodipine (10 mg QD) in 70 obese hypertensive patients. Abdominal subcutaneous AT biopsies were collected before and after intervention to determine the AT transcriptome and expression of proteins involved in lipolysis, NP signaling and mitochondrial oxidative metabolism. Both sacubitril/valsartan and amlodipine treatment...
Circulation. Heart failure, Jan 30, 2014
Background-The mechanism of functional limitation in heart failure with preserved ejection fracti... more Background-The mechanism of functional limitation in heart failure with preserved ejection fraction remains controversial. We examined the contributions of central cardiac and peripheral mechanisms and hypothesized that the pulmonary vascular response to exercise is an important determinant of aerobic capacity among patients with exertional pulmonary venous hypertension (ePVH). Methods and Results-We compared 31 ePVH patients (peak VO 2 <80% of predicted and peak pulmonary arterial wedge pressure≥20 mm Hg) with 31 age-and sex-matched controls (peak VO 2 >80% predicted) who underwent invasive cardiopulmonary exercise testing for unexplained exertional intolerance. ePVH patients had lower peak cardiac output (73±14% versus 103±18% predicted; P<0.001) compared with controls, related both to impaired chronotropic response (peak heart rate 111±25 beats per minute versus 136±24 beats per minute; P<0.001) and to reduced peak stroke volume index (47±10 mL/min per m 2 versus 54±15 mL/min per m 2 ; P=0.03). Peak systemic O 2 extraction was not different between groups (arterial-mixed venous oxygen content difference: 13.0±2.1 mL/dL versus 13.4±2.4 mL/dL; P=0.46). ePVH patients had higher resting (150±74 versus 106±50 dyne/s per cm −5 ; P=0.009), peak (124±74 dyne/s per cm −5 versus 70±41 dyne/s per cm −5 ; P<0.001), and isoflow pulmonary vascular resistance (124±74 dyne/s per cm −5 versus 91±33 dyne/s per cm −5 at cardiac output≈10.6 L/min; P=0.04). Pulmonary vascular resistance decreased with exercise in all control subjects but increased in 36% (n=11) of ePVH patients. Abnormal pulmonary vascular response was not associated with peak VO 2. Conclusions-Reduced cardiac output response, rather than impaired peripheral O 2 extraction, constrains oxygen delivery and aerobic capacity in ePVH. Pulmonary vascular dysfunction is common in patients with ePVH at rest and during exercise.
European heart journal, Jan 19, 2015
Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, t... more Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, the relationship between moderate alcohol consumption and risk for HF, in either men or women, remains unclear. We examined 14 629 participants of the Atherosclerosis Risk in Communities (ARIC) study (54 ± 6 years, 55% women) without prevalent HF at baseline (1987-89) who were followed for 24 ± 1 years. Self-reported alcohol consumption was assessed as the number of drinks/week (1 drink = 14 g of alcohol) at baseline, and updated cumulative average alcohol intake was calculated over 8.9 ± 0.3 years. Using multivariable Cox proportional hazards models, we examined the relation of alcohol intake with incident HF and assessed whether associations were modified by sex. Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting ≥7 to 14 drinks per week, and 3% reporting ≥14-21 and ≥21 drinks per week, respectively. Incide...
The Journal of Clinical Hypertension, 2009
Background Chronic kidney disease is a significant risk factor for end-stage kidney disease, card... more Background Chronic kidney disease is a significant risk factor for end-stage kidney disease, cardiovascular events, and premature death. However, the prognostic value of low estimated glomerular filtration rate (eGFR) in the elderly is debatable. Methods We determined eGFR using the Japanese equation in 132,160 elderly subjects (65-75 years) who attended the special health checkup (Tokutei-Kenshin) in 2008 and investigated the association between baseline eGFR and 5-year all-cause and cardiovascular mortality. Results The median (SD) eGFR was 70.5 ± 15.3 mL/min/ 1.73 m 2. During follow-up, we noted 2045 all-cause deaths including 408 from cardiovascular events. A J-shaped curve was obtained when all-cause and cardiovascular mortality rates were compared with decreases in eGFR, with the highest mortality observed for eGFR \45 mL/ min/1.73 m 2. These trends were statistically significant in the Kaplan-Meier analysis (P \ 0.001). In the Cox proportional hazard analysis, after adjusting for possible confounders, those with eGFR \45 mL/min/1.73 m 2 , but not eGFR 45-59 mL/min/1.73 m 2 showed a higher allcause and cardiovascular mortality than those with eGFR [90 mL/min/1.73 m 2 [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.06-1.91 for all-cause mortality, HR 2.28, 95% CI 1.28-4.03 for cardiovascular mortality]. Sexbased subgroup analyses showed similar results for both men and women. Conclusions We conclude that eGFR \45 mL/min/ 1.73 m 2 is an independent risk factor for all-cause and cardiovascular mortality in the elderly population.
European Journal of Heart Failure, 2010
Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myoca... more Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown. The Valsartan in Acute Myocardial Infarction trial (VALIANT) enrolled 14 703 patients with acute MI complicated by HF, systolic dysfunction, or both. We compared the risk of death, HF hospitalization, and/or recurrent MI among patients with and without diabetes using Cox proportional hazards models. To assess the relationship between diabetes, LVEF and outcomes, we assessed the relative influence of baseline LVEF on outcomes in diabetic and non-diabetic patients. Totally, 11 325 subjects (3095 diabetics) with site-reported LVEF and known diabetes status were included. At any given LVEF, diabetes was associated with a higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.37, 95% CI 1.25-1.51], death or HF hospitalization (adjusted HR 1.42, 95% CI 1.31-1.51), and death or recurrent MI (adjusted HR 1.36, 95% CI 1.24-1.48). Diabetes modified the relationship between LVEF and death or HF hospitalization (P for interaction = 0.0109), such that the association between diabetes and increased risk was greater in magnitude at higher LVEF. No interaction was noted between diabetes and LVEF on risk of all-cause mortality or death or recurrent MI. Diabetes is associated with a higher risk of death or HF hospitalization across the spectrum of LVEF in high-risk post-MI patients. The magnitude of reduction in risk of death or HF hospitalization associated with increasing LVEF is significantly attenuated among patients with diabetes when compared to patients without diabetes.
Circulation. Cardiovascular imaging, 2016
Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outc... more Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outcomes, emerging evidence supports the importance of LA function. We examined LA emptying fraction (LAEF) across the spectrum of cardiovascular disease burden in a large cohort of elderly adults living in the community. We studied 1142 participants in the Atherosclerosis Risk in Communities (ARIC) study who were in sinus rhythm, free of valvular disease, and had acceptable quality 3-dimensional echocardiograms (mean age, 76±5 years; 59% women). We determined the cross-sectional correlates of LAEF and compared LAEF among elderly adults without cardiovascular disease or cardiovascular risk factors (n=201), those with hypertension (n=734), and those with overt heart failure (HF; n=207). In multivariable analysis, lower LAEF was associated with higher LA volumes and worse left ventricular systolic and diastolic functions. Elderly participants free of cardiovascular disease or risk factors had ...
F1000 - Post-publication peer review of the biomedical literature, 2019
Circulation Research, 2019
Response by Jia et al to Letter Regarding Article, “Interleukin-35 Promotes Macrophage Survival a... more Response by Jia et al to Letter Regarding Article, “Interleukin-35 Promotes Macrophage Survival and Improves Wound Healing After Myocardial Infarction in Mice” In Response: We appreciate the comments by Wang et al on our recent publication. In our article, we reveal that IL (interleukin)-35 increases the number of Ly6C macrophages, which is functionally similar to M2-type macrophages. Two highly intriguing articles reported that mouse cardiac macrophage populations could be divided into CCR2 (C-C motif chemokine receptor 2) MHC II (major histocompatibility complex II), CCR2 MHC II, and CCR2 MHC II subsets. We observed that IL-35 could mediate and improve the survival of CCR2 MHC II macrophages, which play crucial roles in various forms of tissue remodeling such as coronary development and postnatal coronary growth. Although we revealed that CD31 was not significantly altered in mice treated with anti–IL-35 antibody compared with its expression in wild-type mice (see Online Figure VII), we cannot completely rule out the possibility that IL-35 contributes to the proliferation of coronary arterial endothelial cells in some way, since CD31 is expressed in both vascular and endocardial endothelial cells. Therefore, future studies are required to explore the mechanisms and the cell-specific effects of IL-35 in coronary arterial endothelial cells using Connexin40-GFP (green fluorescent protein) mice expressing GFP in endothelial cells of coronary arteries, but not veins, capillaries, or endocardium. In addition, more clinical and experimental data are needed to explore the side effects, such us infection incidence, cancer incidence, and mortality post IL-35 treatment and ensure the optimal temporal and spatial treatment option of IL-35 in the setting of myocardial infarction (MI). Immunofluorescence staining of FACS-purified Tregs (see Figure 1) and adoptive transfer of EBI3 (Epstein-Barr virus–induced gene 3) KO and wild-type Tregs (see Figure 4) demonstrate that Tregs-derived IL-35 contributed to the healing process by modulating extracellular matrix deposition and the transition of fibroblasts to myofibroblasts. However, the sources of IL-35 are complex and we are unable to identify the function of certain immune cell population secreting IL-35, as discussed in our article. IL-35–producing inducible regulatory T cells (iTr35 cells) represent unique members of the Treg cell family that were generated by IL-35 and do not express Foxp3 (forkhead box P3). The exact roles of iTr35 cells in MI thus remain elusive and future studies are required to explore the number and function of iTr35 cells after MI. Tregs increased gradually and peaked on day, normalized by 2-week post MI, and subsequently reexpanded in chronic heart failure phase (8 weeks after MI). Tregs change their phenotype in a phasic manner after MI. After acute MI, Treg activation is beneficial and improves cardiac wound healing. However, in chronic ischemic heart failure, Tregs could become dysfunctional and promote adverse left ventricular remodeling. The opposite functions of Tregs in acute and chronic MI period highlighting important differences in immune cell activation and inflammatory profiles. Similarly, the activation of TGF (transforming growth factor)β1 is protective against ischemic myocardial damage during the early phase through improving the replacement of necrotic tissue by a stable collagenous scar and thus preventing left ventricular rupture. However, sustained expression of TGF-β1 is detrimental and could lead to cardiac remodeling and heart failure after MI. In our article, we demonstrate the combination of EBI3 and p35 is increased at day 3, peaked at day 5 and decreased significantly at day 14 post MI, implying that IL-35 promotes TGF-β1 production, contributes to the beneficial effects of Tregs activation and is a central coordinator of wound healing process in the early phase of MI. Future studies are needed to explore the expression and corresponding functional roles of IL-35 in chronic heart failure. Our data indicate that IL-35 reduces cardiac rupture, improves wound healing, and attenuates cardiac remodeling after MI in mice. We agree with the comments by Wang et al that researchers should explore complex mechanisms of IL-35 and the potential benefits and risks of IL-35 treatment in human MI populations. Independent studies and replications from different research laboratories will contribute to the better understanding on the function and therapeutic potentials of IL-35 in MI patients.
The American Journal of Surgery, 2002
Background: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma perit... more Background: Many centers include intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei. This study documented the morbidity of intraperitoneal chemotherapy in a single institution. Methods: A retrospective review of pseudomyxoma peritonei over a 6-year period was undertaken. Treatment, morbidity, and outcome were documented. Results: Eleven patients were identified with an average of 1.9 debulking procedures and 0.8 chemotherapy courses (0.3 complete). Intraperitoneal chemotherapy was not completed in 5 patients because of complications (56%): severe abdominal pain, seizure, neutropenia, and thrombocytopenia (the latter resulted in 1 patient's death). There was no association between incomplete chemotherapy and recurrence. Recurrence was 64% in those without chemotherapy and 44% in those with. Follow-up averaged 26 months and actual 3-year survival was 60%. Conclusions: Intraperitoneal chemotherapeutic morbidity and mortality were 56% and 11%, respectively. Chemotherapy was associated with decreased recurrence. To optimize outcomes, multicenter prospective trials will likely be required to further refine intraperitoneal chemotherapy protocols.
Journal of Cardiac Failure, 2007
International Journal of Cardiology, 2013
Background: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (D... more Background: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (DYS-PAP) obtained by 2D speckle-tracking echocardiography (2D-STE) in the prediction of recurrent ischemic mitral regurgitation (MR) after restrictive annuloplasty. Methods: The study population consisted of 524 consecutive patients who survived coronary artery bypass grafting (CABG) and restrictive annuloplasty, performed between 2001 and 2010 at 3 different Institutions and who met inclusion criteria. The assessment of DYS-PAP was performed preoperatively and at follow-up (median 45.3 months [IQR 26-67]) by 2D-STE in the apical four-chamber view for the anterolateral papillary muscle (ALPM) and apical long-axis view for the posteromedial papillary muscle (PMPM). Results: Recurrence of MR (≥2+ in patients with no/trivial MR at discharge) was found in 112 patients (21.3%) at follow-up. Compared to patients without recurrence of MR, these patients had higher DYS-PAP values at baseline (60.6± 4.4 ms vs. 47.2± 2.9 ms, pb 0.001) which significantly worsened at follow-up (74.4± 5.2 ms, p =0.002 vs. baseline). In contrast, in patients with no MR recurrence, DYS-PAP was significantly reduced (25.3± 4.4 ms, p =0.002 vs. baseline). At logistic regression analysis DYS-PAP (odds ratio [OR]: 4.8, 95% Confidence Interval [CI]: 3.4-8.2, p b 0.001), was the strongest predictor of recurrent MR with a cutoff ≥58 ms (95%CI 51-66 ms). The model showed an area under the Receiver Operating Characteristic (ROC) curve of 0.97 (CI 0.94-0.99 [optimism-corrected 0.94; CI 0.89-0.95]) with 98% sensitivity (CI 96-100% [optimism-corrected 95%; CI 91-96%]) and 90% specificity (CI 85-94% [optimism-corrected 87%; CI 82-90%]). Conclusions: DYS-PAP represents a reliable tool to identify patients with ischemic MR who can benefit from restrictive annuloplasty.
Diabetes, Obesity and Metabolism, 2013
Context-Obese individuals have high aldosterone levels that may contribute to insulin resistance ... more Context-Obese individuals have high aldosterone levels that may contribute to insulin resistance (IR) and endothelial dysfunction leading to obesity induced cardiovascular disease. We conducted a study to evaluate the effect of mineralocorticoid receptor antagonism on IR and endothelial function in obese individuals. Design-This was a placebo-controlled, double blind, randomized, parallel-group study (NCT01406015). Participants and Interventions-Thirty two non-diabetic, obese subjects (BMI 30 to 45 kg/ m 2) with no other medical problems were randomized to six weeks of treatment with spironolactone 50 mg daily or placebo. Insulin sensitivity index (ISI) was assessed by Matsuda method, endothelial function by flow mediated vasodilatation (FMD) of brachial artery and renal plasma perfusion by clearance of para-aminohippurate (PAH). Results-There was no change in weight, BMI or plasma potassium during the study period. Treatment with spironolactone led to increases in serum aldosterone (7.6±6.6 Vs 3.2±1.3 ng/dL; p <0.02, post-treatment Vs baseline) and urine aldosterone (11.0±7. Vs 4.8±2.4 µg/G creatinine; p<0.01) and decreases in systolic blood pressure (116±11 Vs 123±10 mmHg; p<0.001). There were no changes in these variables in the placebo group. Neither spironolactone nor placebo treatment had a significant effect on ISI or other indices of glucose metabolism (HOMA, area under the curve for insulin, area under the curve for glucose), brachial artery reactivity or the renal plasma perfusion values. Changes in these variables were similar in two groups. Conclusions-We conclude that six weeks of treatment with spironolactone does not change insulin sensitivity or endothelial function in normotensive obese individuals with no other comorbidities.
Circulation
BACKGROUND: Limited data exist on American College of Cardiology/American Heart Association valvu... more BACKGROUND: Limited data exist on American College of Cardiology/American Heart Association valvular heart disease (VHD) stage prevalence, progression, and association with incident cardiovascular diseases in late life. METHODS: Participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective community-based cohort study, underwent protocol echocardiography at ARIC visits 5 (2011–2013) and 7 (2018–2019), and their aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation stage were defined according to American College of Cardiology/American Heart Association guidelines. The overall VHD stage prevalence at visit 5 was measured. The associations between VHD stages and incident adjudicated death, heart failure, coronary heart disease, stroke, and atrial fibrillation were assessed with Cox proportional hazard models adjusted for age, sex, race, hypertension, diabetes, prior myocardial infarction, heart failure, body mass index, study center, sy...
Giornale italiano di cardiologia (2006), 2014
Although cardiovascular risk in patients with diabetes progressively increases with higher levels... more Although cardiovascular risk in patients with diabetes progressively increases with higher levels of blood glucose and glycated hemoglobin, none of currently available outcome trials has provided a clear demonstration that the improvement of glycemic control prevents cardiovascular disease. Meta-analyses of trials show that, for a reduction of glycated hemoglobin of 1%, the incidence of major cardiovascular events is reduced by about 10%; conversely, effects on cardiovascular mortality are heterogeneous. Available data suggest that early treatment in patients with lower levels of comorbidity can be more effective than in individuals with established diabetic complications. In addition, hypoglycemia induced by intensified treatment may have a negative impact on cardiovascular mortality. Furthermore, the possibility that individual drugs, or classes of drugs, for diabetes have either beneficial or detrimental effects on cardiovascular risk independent of their glucose-lowering action ...
Cardiology Clinics, 2014
Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is a... more Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is associated with significant morbidity, mortality, and costs. Prompt diagnosis may help decrease mortality, hospital stay, and costs related to treatment. A complete heart failure evaluation comprises a comprehensive history and physical examination, echocardiogram, and diagnostic tools that provide information regarding the etiology of heart failure, related complications, and prognosis in order to prescribe appropriate therapy, monitor response to therapy, and transition expeditiously to advanced therapies when needed. Emerging technologies and biomarkers may provide better risk stratification and more accurate determination of cause and progression.
Journal of Cardiac Failure, 2012
Background: Right atrial pressure, pulmonary vascular resistance (PVR) and right ventricular (RV)... more Background: Right atrial pressure, pulmonary vascular resistance (PVR) and right ventricular (RV) stroke volume index (SVI) are known prognostic parameters in pulmonary arterial hypertension (PAH). Methods: We evaluated the relationship of RV longitudinal strain (LS), a novel noninvasive measure of RV function, with invasive hemodynamics and NT-proBNP in advanced PAH. RV LS was measured by speckle tracking echocardiography in 35 healthy controls and in 74 patients with advanced PAH, decreased exercise capacity, and PVR>800 dynes.sec/cm-5 despite 2 PAH-specific therapies. Right heart catheterization and NT-proBNP assessed in all PAH patients. Results: RV LS, measurable in 59/74 PAH patients and 32/35 controls, was lower in PAH patients vs controls (-14.6±4.5 vs-26.7±4.2, p<0.0001). RV LS correlated with invasive RV SVI (r=-0.45, p=0.0004), Right atrial pressure (r=0.28, p=0.03), PVR (r=0.25, p=0.05), and with NT-proBNP (r=0.45, p=0.0005) by right heart catheterization. Compared to standard echo parameters of RV function (fractional area change, Tei index, TAPSE, tricuspid annular systolic velocity), only RV LS significantly correlated with all 3 invasive parameters and NT-proBNP, remaining significant in bivariate analyses adjusting for associated standard RV parameters. Conclusions: RV LS, decreased in PAH, correlates with prognostic invasive hemodynamic measures and with NT-proBNP. RV LS may represent a novel sensitive noninvasive measure of RV function in PAH.
Diabetes Care, 2013
OBJECTIVE In 2010, the American Heart Association defined seven metrics (smoking, BMI, physical a... more OBJECTIVE In 2010, the American Heart Association defined seven metrics (smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose) for ideal cardiovascular health (ICH). Subsequent studies have shown that the prevalence of achieving these metrics is very low in the general population. Adults with type 1 diabetes are at increased risk of cardiovascular disease (CVD), but no studies to date have been published on the prevalence of ICH in this population. RESEARCH DESIGN AND METHODS Data for this analysis were collected as part of the prospective Coronary Artery Calcification in Type 1 Diabetes study. This analysis involved 546 subjects with type 1 diabetes and 631 subjects without diabetes who had complete information for calculating the ICH metrics. RESULTS Overall, the prevalence of ICH was low in this population, with none meeting the ideal criteria for all seven metrics. The prevalence of ideal physical activity (10.0%) and diet (1.1%) w...
Coronary Artery Disease, 2013
Objectives Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary ... more Objectives Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Epicardial fat thickness (EFT) reflects visceral adiposity and is considered an important cardiometabolic marker. In this study, we aimed to examine the presence of an association between CFR and EFT in MetS patients. Methods Forty-six MetS patients (25 men, mean age 47.3±6.6 years) and 44 age-matched and sex-matched controls (24 men, mean age 46.0±6.1 years) were prospectively studied. Both CFR and EFT were measured by transthoracic echocardiography. Peak diastolic coronary flow velocities were measured in the left anterior descending artery by pulsed wave Doppler at the baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Results The waist circumference, total and low-density lipoprotein-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressures, and high sensitive C-reactive protein were significantly higher in MetS patients. The mean EFT was significantly higher in MetS patients compared with the controls (8.7±0.2 vs. 4.8±0.1 mm, P < 0.001); however, CFR was significantly lower in MetS patients (2.3±0.2 vs. 2.7±0.2, P < 0.001). CFR was correlated significantly with BMI, waist circumference, high-density lipoprotein-cholesterol, triglycerides, fasting glucose, high sensitive C-reactive protein, and EFT. In regression analysis, MetS itself and EFT were found to be independent predictors of impaired CFR. Conclusion CFR is impaired in MetS patients. MetS itself and increased EFT are associated independently with coronary microvascular dysfunction and EFT is a predictor of worse CFR even after accounting for the presence or absence of the MetS.