Global longitudinal strain predicts outcome in chronic heart failure across American Heart Association stages: results from the MyoVasc study

Abstract Background Global longitudinal strain (GLS) demonstrated a superior prognostic value over left ventricular ejection fraction (LVEF) in acute heart failure (HF). Its prognostic value across American Heart Association (AHA) stages of HF – especially under considering of conventional echocardiographic measures of systolic and diastolic function – has not yet been comprehensively evaluated. Purpose To evaluate the prognostic value of GLS for HF-specific outcome across AHA HF stages A to D. Methods Data from the MyoVasc-Study (n=3,289) were analysed. Comprehensive clinical phenotyping was performed during a five-hour investigation in a dedicated study centre. GLS was measured offline utilizing QLab 9.0.1 (PHILIPS, Germany) in participants presenting with sinus rhythm during echocardiography. Worsening of HF (comprising transition from asymptomatic to symptomatic HF, HF hospitalization, and cardiac death) was assessed during a structured follow-up with subsequent validation and adjudication of endpoints. AHA stages were defined according to current guidelines. Results Complete information on GLS was available in 2,400 participants of whom 2,186 categorized to AHA stage A to D were available for analysis. Overall, 434 individuals were classified as AHA stage A, 629 as stage B and 1,123 as stage C/D. Mean GLS increased across AHA stages of HF: it was lowest in stage A (−19.44±3.15%), −18.01±3.46% in stage B and highest in AHA stage C/D (−15.52±4.64%, P for trend <0.0001). During a follow-up period of 3.0 [1.3/4.0] years, GLS denoted an increased risk for worsening of HF after adjustment for age and sex (hazard ratio, HRGLS [per standard deviation (SD)] 1.97 [95% confidence interval 1.73/2.23], P<0.0001) in multivariable Cox regression analysis. After additional adjustment for cardiovascular risk factors, clinical profile, LVEF and E/E' ratio, GLS was the strongest echocardiographic predictor of worsening of HF (HRGLS [per SD] 1.47 [1.20/1.80], P=0.0002) in comparison to LVEF (HRLVEF [per SD] 1.23 [1.02/1.48], P=0.031) and E/E' ratio (HRE/E' [per SD] 1.12 [0.99/1.26], P=0.083). Interestingly, when stratifying for AHA stages, GLS denoted a similar increased risk for worsening of HF in individuals classified as AHA stage A/B (HRGLS [per SD] 1.63 [1.02/2.61], P=0.039) and in those classified as AHA stage C/D (HRGLS [per SD] 1.95 [1.65/2.29], P<0.0001) after adjustment for age and sex. For further evaluation, Cox regression models with interaction analysis indicated no significant interaction for (i) AHA stage A/B vs C/D (P=0.83) and (ii) NYHA functional class <II vs ≥II in individuals classified as AHA stage C/D (P=0.12). Conclusions GLS demonstrated a higher predictive value for worsening of HF than conventional echocardiographic measures of systolic and diastolic function. Interestingly, GLS indicated an increased risk for worsening of HF across AHA stages highlighting its potential value to advance risk prediction in chronic HF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK), Center for Translational Vascular Biology (CTVB) of the University Medical Center of the Johannes Gutenberg-University Mainz

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End-of-Therapy Echocardiography May Not Be Needed in All in Patients With Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa069 ◽

2020 ◽

Vol 7 (3) ◽

Author(s):

Abinash Virk ◽

Kirsten M Schutte ◽

James M Steckelberg ◽

Walter R Wilson ◽

Lawrence J Sinak ◽

...

Keyword(s):

Infective Endocarditis ◽

Confidence Interval ◽

Transthoracic Echocardiography ◽

Medical Records ◽

American Heart Association ◽

Cardiovascular Surgery ◽

American Heart ◽

Heart Association ◽

Increased Risk

Abstract Background The American Heart Association (AHA) guidelines for infective endocarditis (IE) management recommend end-of-therapy (EOT) echocardiography (ETE) to “establish a new baseline” and based on “expert opinion.” Methods Medical records of IE patients treated between January 2005 and December 2011 were reviewed. Utilization of ETE and cumulative incidence of re-treatment with antimicrobials or cardiovascular surgery (re-Rx/CVS) within 1 year after EOT were evaluated. Results A total of 243 patients completed clinical follow-up at EOT and 170 at 1 year after EOT. One hundred seventy-seven of 243 (72.8%) underwent ETE, the majority (51.4%) transthoracic echocardiography. One hundred thirty-three of 177 (75.1%) were without new/worsened signs or symptoms (new/w-SSx). One hundred forty-one of 177 (79.7%) overall and 117/133 (87.9%) patients without new/w-SSx had no new ETE findings as compared with initial echocardiography. Among 36/177 (20.3%) with new ETE findings, 20/36 (55.6%) had new/w-SSx; ETE findings were more likely in patients with new/w-SSx (39.2% vs 8.3%; P < 0.001) at EOT. Patients were at increased risk of re-Rx/CVS with either new ETE findings (hazard ratio [HR], 25.86; 95% confidence interval [CI], 7.64–87.56; P < .001) or new/w-SSx (HR, 5.35; 95% CI, 2.87–9.95; P < .001). The highest risk of re-Rx/CVS was in patients with both new/w-SSx and new ETE findings (HR, 45.94; 95% CI, 19.07–110.71). Conversely, only 7/187 (3.4%) patients without new/w-SSx who had an ETE required re-Rx/CVS. Conclusions The majority of patients without new/w-SSx at EOT will not have new ETE findings or need re-Rx/CVS within 1 year after EOT. EOT new/w-SSx is associated with new ETE findings and predicts the need for re-Rx/CVS. Further study is needed to determine whether patients without new/w-SSx need ETE.

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A longitudinal analysis of the progression from normal blood pressure to stage 2 hypertension: A 12-year Korean cohort

BMC Public Health ◽

10.1186/s12889-020-10115-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eun Sun Yu ◽

Kwan Hong ◽

Byung Chul Chun

Keyword(s):

Blood Pressure ◽

Health Insurance ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Normal Blood ◽

Normal Blood Pressure ◽

The Mean ◽

Stage 1

Abstract Background The study aimed to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure. Methods We selected a total of 21,172 normotensive individuals between 2003 and 2004 from the National Health Insurance Service-Health Screening and followed them up until 2015. The criteria for blood pressure were based on the American College of Cardiology/American Heart Association 2017 guideline (normal BP: SBP < 120 and DBP < 80 mmHg, elevated BP: SBP 120–129 and DBP < 80 mmHg, stage 1 hypertension: SBP 130–139 or DBP 80–89 mmHg, stage 2 hypertension: SBP ≥140 or DBP ≥ 90 mmHg). We classified the participants into four courses (Course A: normal BP → elevated BP → stage 1 hypertension→ stage 2 hypertension, Course B: normal BP → elevated BP → stage 2 hypertension, Course C: normal BP → stage 1 hypertension → stage 2 hypertension, Course D: normal BP → stage 2 hypertension) according to their progression from normal blood pressure to stage 2 hypertension. Results During the median 12.23 years of follow-up period, 52.8% (n= 11,168) and 23.6% (n=5004) of the participants had stage 1 and stage 2 hypertension, respectively. In particular, over 60 years old had a 2.8-fold higher incidence of stage 2 hypertension than 40–49 years old. After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). The mean years of progression from normal blood pressure to stage 2 hypertension were 8.7±2.6 years (course A), 6.1±2.9 years (course B), 7.5±2.8 years (course C) and 3.2±2.0 years, respectively. Conclusions This study found that the incidence of hypertension is associated with the progression at each stage. We suggest that the strategies necessary to prevent progression to stage 2 hypertension need to be set differently for each target course.

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New 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

Hypertension ◽

10.1161/hypertensionaha.118.11827 ◽

2019 ◽

Vol 73 (1) ◽

pp. 142-147 ◽

Cited By ~ 6

Author(s):

Armando J. Martínez-Rueda ◽

Antonio Olivas-Martínez ◽

Olynka Vega-Vega ◽

Jorge I. Fonseca-Correa ◽

Ricardo Correa-Rotter

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Mexico City ◽

Pharmacological Treatment ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Nonpharmacological Treatment ◽

City Population

The new American College of Cardiology/American Heart Association 2017 Hypertension Guidelines lower the threshold to define hypertension, thus increasing its prevalence. The impact on populations and health systems is poorly understood. We included data from 990 subjects aged 20 to 64 years from the SALMEX cohort (Salt in Mexico; Mexico City) and determined the prevalence of hypertension and requirement for pharmacological treatment according to both Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure 7 and American College of Cardiology/American Heart Association 2017 guidelines. The data obtained were extrapolated to sex- and age-adjusted Mexico City population, and annual costs of medical follow-up were calculated. The new definition increased the prevalence of hypertension among SALMEX cohort from 16.2% to 37.4% (18%–39.3% after adjusting to Mexico City population). The proportion of subjects that require pharmacological and nonpharmacological treatment increased from 17.7% to 19.0% and from 17.7% to 37.4%, respectively (19.4%–21.8% for pharmacological and 19.4%–39.3% for nonpharmacological treatment, after adjusting to Mexico City population). Annual costs of medical follow-up for subjects with hypertension in Mexico City would increase an estimated $59 278 928. The requirement to initiate pharmacological treatment was similar when assessed by Framingham risk score with lipids or with body mass index compared with the Atherosclerotic Cardiovascular Disease score, with correlation κ indexes of 0.981 and 0.972, respectively. On the basis of these results, Framingham body mass index represents an attractive and potentially cost-effective alternative to assess cardiovascular risk. In conclusion, the adoption of the new guidelines in Mexican population has implications not only on its prevalence but also on medical follow-up costs. A pharmacoeconomic model is required to assess the actual financial impact.

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Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

Journal of Oncology ◽

10.1155/2015/609194 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 15

Author(s):

Anna Calleja ◽

Frédéric Poulin ◽

Ciril Khorolsky ◽

Masoud Shariat ◽

Philippe L. Bedard ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Therapy ◽

Right Ventricular ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Breast Cancer Patients ◽

Lv Dysfunction ◽

Her2 Breast Cancer

Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined.Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity.Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls.Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%,P=0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3%) was seen in 40% (n=12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n=11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant.Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

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The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk

Circulation ◽

10.1161/circulationaha.119.043429 ◽

2020 ◽

Vol 141 (7) ◽

pp. 592-599 ◽

Cited By ~ 9

Author(s):

Anandita Agarwala ◽

Erin D. Michos ◽

Zainab Samad ◽

Christie M. Ballantyne ◽

Salim S. Virani

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Primary Prevention ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

The United States ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Increased Risk

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

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Impact of the new American College of Cardiology/American Heart Association definition of hypertension on atherosclerotic vascular events in systemic lupus erythematosus

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216764 ◽

2020 ◽

Vol 79 (5) ◽

pp. 612-617 ◽

Cited By ~ 2

Author(s):

Konstantinos Tselios ◽

Dafna D Gladman ◽

Jiandong Su ◽

Murray Urowitz

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Cerebrovascular Event ◽

Systemic Lupus ◽

Vascular Events

BackgroundThe 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess the impact of this definition on atherosclerotic vascular events (AVEs) in systemic lupus erythematosus.Patients methodsIndividuals from the Toronto Lupus Clinic with at least 2 years of follow-up and no prior AVE were divided in three groups according to their mean blood pressure (BP) over that period (≥140/90 mm Hg, 130-139/80-89 mm Hg and <130/80 mm Hg). They were followed until the first occurrence of an AVE (fatal or non-fatal coronary artery disease, cerebrovascular event and peripheral vascular disease) or last visit. Groups were compared as per the baseline atherosclerotic risk factors. A multivariable time-dependent analysis was performed to adjust for the presence of other risk factors.ResultsOf 1532 patients satisfying the inclusion criteria, 155 (10.1%) had a BP ≥140/90 mm Hg, 316 (20.6%) 130–139/80–89 mm Hg and 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, 124 AVEs were documented. The incidence rates were 18.9, 11.5 and 4.5 per 1000 patient-years for the three groups, respectively (p=0.0007 between the 130–139/80–89 mm Hg group and the normotensives). A mean BP of 130–139/80–89 mm Hg over the first 2 years was independently associated with the occurrence of AVEs (HR 1.73, 95% CI 1.13 to 2.65, p=0.011).ConclusionPatients with lupus with a sustained mean BP of 130–139/80–89 mm Hg over 2 years had a significantly higher incidence of AVEs compared with normotensive individuals. This BP level should be the target for antihypertensive therapy to minimise their cardiovascular risk.

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Comparison of the JNC7 and 2017 American College of Cardiology/American Heart Association Guidelines for the Management of Hypertension in Koreans: Analysis of Two Independent Nationwide Population-Based Studies

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16245134 ◽

2019 ◽

Vol 16 (24) ◽

pp. 5134 ◽

Cited By ~ 3

Author(s):

Won-Jun Choi ◽

Hye-Sun Lee ◽

Jung Hwa Hong ◽

Hyuk-Jae Chang ◽

Ji-Won Lee

Keyword(s):

Clinical Outcomes ◽

National Health ◽

American Heart Association ◽

American Heart ◽

Cox Regression ◽

Heart Association ◽

Survival Outcomes ◽

National Committee ◽

National Health Insurance System ◽

Discrimination Ability

The optimal blood pressure (BP) guidelines in Asian populations have not been determined. We compared all-cause and cardiovascular mortality based on the Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The National Health Insurance System-National Health Screening Cohort (NHIS-HEALS) and Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. BPs were classified into three groups according to each guideline, and survival rates were analyzed with Kaplan-Meier curves and log-rank tests. Hazard ratios (HRs) were calculated using multivariable cox regression analyses, and the discriminatory ability for clinical outcomes was assessed by Harrell’s C-indexes. The JNC7 guidelines demonstrated a linear association between BP levels and survival outcomes. Adjusted HRs from the JNC7 guidelines differentiated the hypertension group (≥140/90) from the pre (130/80–139/89) and normal (<130 and <80) BP groups in clinical outcomes. In contrast, the 2017 ACC/AHA guidelines showed inconsistent survival outcomes according to BP classification (normal: <120 and <80, elevated: 120–129, and <80, and HTN: ≥130/80). According to Harrell’s C-indexes, the JNC7 guidelines had greater discrimination ability in survival outcomes in the NHIS-HEALS dataset. Our results suggest that the JNC7 guidelines are more appropriate than the 2017 ACC/AHA guidelines in Korean populations.

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Immunoglobulin for Kawasaki disease: a 3-year retrospective audit

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000451 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000451

Author(s):

Beth Pascall ◽

Arjuna Thakker ◽

Ying Foo ◽

Pradip Thakker

Keyword(s):

Kawasaki Disease ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Tertiary Hospital ◽

The Past ◽

Mean Delay ◽

Retrospective Audit ◽

Clear Guideline

AimTo evaluate whether intravenous immunoglobulin (IVIG) use in children with suspected Kawasaki disease (KD) was given according to local trust and the newly revised American Heart Association (AHA) guidelines.MethodsIn our tertiary hospital, any child with suspected KD given IVIG, over the past 3 years, was identified. Their electronic notes were then reviewed.ResultsTen patients were identified. Nine patients had a fever lasting 5 days or more. Four patients had either 5/5 or 4/5 of the diagnostic criteria for KD and were diagnosed with complete KD. The remaining six patients were suspected to have incomplete KD. 7/10 patients received IVIG within 10 days of onset of illness. Patients suspected to have incomplete KD experienced a mean delay in administration of IVIG of 5.3 days compared with those with complete KD. In four patients, an alternative diagnosis was established. Three patients had coronary artery abnormalities on first echocardiogram. From these patients, only one had a follow-up echocardiogram recorded in their notes. No patient had more than one follow-up echocardiogram (at both 2 and 6 weeks).ConclusionIdentifying patients with incomplete KD is more difficult than identifying those with complete KD and any delay in giving IVIG could be due to this reason. This audit suggests that increasing awareness of incomplete KD and a clear guideline will aid prompter diagnosis and administration of IVIG. This audit also suggests that all patients with KD should receive more than one follow-up echocardiogram.

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