Background : Early identification of atherosclerosis in older adults is paramount due to high cardiovascular morbidity and mortality. Our aim was to investigate CAC in a population of adults ≥55 years without previous history of cardiovascular heart disease (CHD) and its association with cardiovascular risk factors. Methods : This was a retrospective analysis of 6,573 individuals with a mean age of 61.8 years (range 55-85; 68.2% males) who underwent Electron Beam Computed Tomography for CAC score (CACS) assessment. Results : CAC was present in 70.5% of the overall cohort (78.8% of males and 52.7% of females). Twenty six per cent (26%) of those with CAC did not have any CHD risk factors. CACS ranged from 0 to 7,908 (mean 223.3±512.9); males presented a higher mean CACS (284.57 ± 571.1), compared to females (mean CACS 92.2 ± 324.8), p <0.0001. The mean CACS in males increased from 154.2 for ages 55-59 years to 760.2 in those aged 80 to 84 whilst in females mean CACS increased from 39.5 to 224.4, for corresponding age groups. The mean CACS appears to increase with age irrespective of gender. In each gender, age and hypercholesterolemia were associated with higher CACS. Furthermore, in males family history and DM were positively associated with CACS while in females, smoking status and hypertension were positively associated with CACS. Conclusion : A broad distribution of CACS was seen in older subjects. Assessment of CACS may place patients into a higher risk group for future events, and lead to more aggressive treatment with preventative therapies.
Although several studies have demonstrated the association between coronary artery calcification (CAC) and coronary artery disease events, the underlying mechanism has not been fully elucidated. Furthermore, extensive CAC still remains a poorly understood phenomenon. The objective of this study is to determine the clinical characteristics and differences between 831 asymptomatic individuals with very high CAC scores (CACS ≥1000) and 497 asymptomatic individuals with CAC scores of 400 to 999. Individuals with CACS ≥1000 were more likely to have hypertension ([HTN]; P = .0004), hypercholesterolemia ( P = .0001), diabetes mellitus ([DM] P = .005), and high body mass index ([BMI]; P = .03) compared with individuals with CACS = 400-999. On multivariable analysis, age ( P < .0001) and BMI ( P = .01) were found to be significant risk factors for the presence of very high CAC. While for males, age ( P < .0001), hypercholesterolemia ( P = .001), DM ( P = .002), and obesity ( P = .003) were independent risk factors; in females only HTN ( P = .04) was independent risk factor.
Clinical Cardiology. 2019;42:235–240. DOI: 10.1002/clc.23132 Michael Y. Henein's name was incorrectly listed in the article as Henein Y. Michael. The authors apologize for the error.
Trastuzumab reduces the risk of relapse and improves prognosis for breast cancer patients with expression of human epidermal growth factor receptor 2 (HER-2). However, it has proven to be associated with cardiotoxicity, manifest as an asymptomatic decrease in Left Ventricular Ejection Fraction (LVEF) and less often as clinical heart failure (HF). Published studies have tried to identify risk factors predisposing to cardiotoxicity but the results are not uniform. The aim of this meta-analysis is to identify the association of conventional cardiovascular risk factors with the development of Trastuzumab-induced cardiotoxicity (TIC).
Methods
A literature search of PubMed was conducted to identify studies examining the association between cardiovascular risk factors and TIC as defined by clinical HF or deterioration in LVEF [Figure 1]. Data were extracted and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to examine the odds of developing TIC for each of the risk factors.
Results
A total of 35 studies met our criteria and were included in the analysis. Age ≥ 60 years old (OR: 2.03; 95% CI: 1.38–3.00; p = 0.0004), hypertension (OR: 2.01; 95% CI: 1.30–3.09; p = 0.002), smoking (OR: 1.33; 95% CI: 1.07–1.65; p = 0.01), diabetes mellitus (OR: 1.49; 95% CI: 1.22–1.81; p <0.0001), known history of coronary artery disease (CAD) (OR: 3.72; 95% CI: 2.11–6.57; p = 0.0005) and family history of CAD (OR: 5.51; 95% CI: 1.76–17.25; p <0.00001) were significantly associated with the development of TIC. However, obesity (OR: 2.47; 95% CI: 0.93–6.55; p = 0.07) and hyperlipidaemia (OR: 1.32, 95% CI: 0.71–2.46; p = 0.38) did not meet statistical significance for association with development of TIC.
Conclusion
Identifying women at risk for TIC has several important potential applications. Clinicians may decide to assess LVEF more frequently for patients at highest risk for TIC in order to detect LV systolic dysfunction earlier. Additionally, identifying high-risk patients may play a role for recognition which individuals would obtain the most benefit from prophylactic therapy currently under investigation for preventing TIC. Finally, these risk factors could in the future form the basis of a risk prediction model for TIC.
Right Ventricular Failure (RVF) after LVAD implantation is associated with increased morbidity and mortality. We analyse right (RH) mechanics by 2D echo, strain and haemodynamic indices in an effort to define patters which may predispose to RVF during LVAD support.
Methods
70 LV failure patients (47 ± 12 yrs, 59 male, ischaemic: 21%, LV EF: 23%±10) received continuous-flow LVAD as bridge to transplantation within 18 months. Patients were divided into those who developed RVF during LVAD therapy (RVF group) and those who did not (non-RVF). We compared haemodynamic, echo and strain data between the groups.
Results
21 patients (30%) developed post-LVAD implantation RVF resulting in lower survival duration (RVF: 372 days ± 345 vs 650 ± 369, p = 0.03), while 14 patients of the RVF group required subsequent right VAD support. There were no significant differences in age, sex, HR or rhythm, LVEF, cardiac index or in RV stroke work index, mean or systolic pulmonary artery pressure, pulmonary vascular resistance index, TAPSE, RV fractional change area, tricuspid regurgitation grade or TDI systolic and diastolic parameters (p > 0.2). However, RVF group had higher RV end-diastolic pressure (RVEDP, 25 ± 7 mmHg vs 15 ± 6, p = 0.02) and higher mean RA pressure (mRAP, 25 ± 6 mmHg vs 15 ± 7, p = 0.03). Additionaly, there was lower RA peak strain (RAPS: 11 ± 1 vs 33 ± 8%, p = 0.01), lower and later-occurring RV global peak strain (RVGS: 8 ± 2.8% vs 9.2 ± 2.5, p = 0.03, time to RVGS: 57% ±10 vs 47 ± 17, p = 0.03), lower and later-occurring RV free wall peak strain (RVFWS: 8.6 ± 2.7% vs 14.8 ± 2.9, p = 0.01, time to RVFWS: 56% ±19 vs 45 ± 17, p = 0.04), lowerRVFW peak systolic strain rate (RVFWSR: 0.94 ± 0.47s-1 vs 1.1 ± 0.3, p = 0.05) occurring earlier in systole (17% ± 10 vs 0.29 ± 0.13, p = 0.04) and higher late RVFW diastolic strain rate (0.43 ± 0,2s-1 vs 0.28 ± 0.21, p = 0.01). RV contraction after PV closure was more frequently seen in the RVF group (30% vs 20%, p = 0.03). There was also greater time delay between RVFW and septal peak strain (RVD, 147 ± 52 ms vs 53 ± 38, p = 0.03) and between RVFWS and LVFWS (136 ± 55 vs 78 ± 40 ms, p = 0.03). LV strain indices were similar for both groups. Independent predictors of RVF were higher mRAP (OR: 6, 95% CI:0.686–0.976, p = 0.03), lower RAPS (OR: 1.2, CI:1.083–1.716, p = 0.003), lower RVFWS (OR: 1.4, CI: 1.012–2.347, p = 0.04) and greater RVD (OR: 1.028, CI:1.008–1.034, p = 0.01). Higher predictive value was shown for RVD (AUC:0.84), mRAP (AUC: 0.82) and RAPS (AUC: 0.795)
Conclusion
LVAD recipients, who developed post-operative RVF, exhibited lower RAPS and RVFWS and greater RVD, indicating decreased RH compliance and dyssynchronous RV function. RH strain analysis may add incremental value to 2D echo assessment of LVAD candidates and improve decision making before VAD implantation.
Background Electromechanical (EM) coupling heterogeneity is significant in long QT syndrome (LQTS), particularly in symptomatic patients; EM window (EMW) has been proposed as an indicator of interaction and a better predictor of arrhythmia than QTc. Hypothesis To investigate the dynamic response of EMW to exercise in LQTS and its predictive value of arrhythmia. Methods Forty‐seven LQTS carriers (45 ± 15 years, 20 with arrhythmic events), and 35 controls underwent exercise echocardiogram. EMW was measured as the time difference between aortic valve closure on Doppler and the end of QT interval on the superimposed electrocardiogram (ECG). Measurements were obtained at rest, peak exercise (PE) and 4 minutes into recovery. Results Patients did not differ in age, gender, heart rate, or left ventricular ejection fraction but had a negative resting EMW compared with controls (−42 ± 22 vs 17 ± 5 ms, P < 0.0001). EMW became more negative at PE (−89 ± 43 vs 16 ± 7 ms, P = 0.0001) and recovery (−65 ± 39 vs 16 ± 6 ms, P = 0.001) in patients, particularly the symptomatic, but remained unchanged in controls. PE EMW was a stronger predictor of arrhythmic events than QTc (AUC:0.765 vs 0.569, P < 0.001). B‐blockers did not affect EMW at rest but was less negative at PE (BB: −66 ± 21 vs no‐BB: −113 ± 25 ms, P < 0.001). LQT1 patients had worse PE EMW negativity than LQT2. Conclusion LQTS patients have significantly negative EMW, which worsens with exercise. These changes are more pronounced in patients with documented arrhythmic events and decrease with B‐blocker therapy. Thus, EMW assessment during exercise may help improve risk stratification and management of LQTS patients.
ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Koulaouzidis G, Charisopoulou D, Kukla M, et al. Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(3):196-206. doi:10.5114/pg.2021.109063. APA Koulaouzidis, G., Charisopoulou, D., Kukla, M., Marlicz, W., Rydzewska, G., & Koulaouzidis, A. et al. (2021). Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(3), 196-206. https://doi.org/10.5114/pg.2021.109063 Chicago Koulaouzidis, George, Dafni Charisopoulou, Michał Kukla, Wojciech Marlicz, Grażyna Rydzewska, Anastasios Koulaouzidis, and Karolina Skonieczna-Żydecka. 2021. "Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis". Gastroenterology Review/Przegląd Gastroenterologiczny 16 (3): 196-206. doi:10.5114/pg.2021.109063. Harvard Koulaouzidis, G., Charisopoulou, D., Kukla, M., Marlicz, W., Rydzewska, G., Koulaouzidis, A., and Skonieczna-Żydecka, K. (2021). Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(3), pp.196-206. https://doi.org/10.5114/pg.2021.109063 MLA Koulaouzidis, George et al. "Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 16, no. 3, 2021, pp. 196-206. doi:10.5114/pg.2021.109063. Vancouver Koulaouzidis G, Charisopoulou D, Kukla M, Marlicz W, Rydzewska G, Koulaouzidis A et al. Association of non-alcoholic fatty liver disease with coronary artery calcification progression: a systematic review and meta-analysis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(3):196-206. doi:10.5114/pg.2021.109063.
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