scholarly journals Left ventricular myocardial crypts: morphological patterns and prognostic implications

2020 ◽  
Vol 22 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Per E Sigvardsen ◽  
Michael H C Pham ◽  
Jørgen T Kühl ◽  
Andreas Fuchs ◽  
Shoaib Afzal ◽  
...  
Keyword(s):  
General Population ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Cardiac Computed Tomography ◽  
Left Ventricular ◽  
Specific Pattern ◽  
Hazard Ratio ◽  
Major Adverse Cardiovascular Events ◽  
General Population Study ◽  
Myocardial Crypts

Abstract Aims  Left ventricular (LV) myocardial crypts are considered a subtle marker of hypertrophic cardiomyopathy. However, crypts have also been observed in seemingly healthy individuals and it is unknown whether myocardial crypts are associated with adverse outcome. Methods and results  Myocardial crypts were defined as invaginations traversing >50% of the myocardial wall and assessed using contrast-enhanced cardiac computed tomography in 10 097 individuals from the Copenhagen General Population Study. Number of crypts, location, shape, penetrance, and volume were assessed. The endpoint was a composite of major adverse cardiovascular events and defined as death, myocardial infarction, heart failure, or stroke. Cox regression models were adjusted for clinical variables, medical history, electrocardiographic parameters, and cardiac chamber sizes. A total of 1199 LV myocardial crypts were identified in 915 (9.1%) individuals. Seven hundred (6.9%) had one crypt and 215 (2.1%) had multiple crypts. During a median follow-up of 4.0 years (interquartile range 1.5–6.7), major adverse cardiovascular events occurred in 619 individuals. Individuals with one or multiple crypts had a hazard ratio for major adverse cardiovascular events of 1.00 [95% confidence interval (CI): 0.72–1.40; P = 0.98] and 0.90 (95% CI: 0.47–1.75; P = 0.76), respectively, compared with those with no crypts. No specific pattern of crypt location, shape, penetrance, or volume was associated to an increased hazard ratio for major adverse cardiovascular events. Conclusion  LV myocardial crypts are frequent in the general population and are not associated with intermediate-term major adverse cardiovascular events.

Left ventricular trabeculation and major adverse cardiovascular events: the Copenhagen General Population Study

2020 ◽  
Vol 22 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Per E Sigvardsen ◽  
Andreas Fuchs ◽  
Jørgen T Kühl ◽  
Shoaib Afzal ◽  
Lars Køber ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
General Population ◽  
Population Study ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
General Population Study

Abstract Aims  Prominent left ventricular trabeculations is a phenotypic trait observed in cardiovascular diseases. In the general population, the extent of left ventricular trabeculations is highly variable, yet it is unknown whether increased trabeculation is associated with adverse outcome. Methods and results  Left ventricular trabeculated mass (g/m2) was measured with contrast-enhanced cardiac computed tomography in 10 097 individuals from the Copenhagen General Population Study. The primary endpoint was a composite of major adverse cardiovascular events and defined as death, heart failure, myocardial infarction, or stroke. The secondary endpoints were the individual components of the primary endpoint. Cox regression models were adjusted for clinical parameters, medical history, electrocardiographic parameters, and cardiac chamber sizes. The mean trabeculated mass was 19.1 g/m2 (standard deviation 4.9 g/m2). During a median follow-up of 4.0 years (interquartile range 1.5–6.7), 710 major adverse cardiovascular events occurred in 619 individuals. Individuals with a left ventricular trabeculated mass in the highest quartile had a hazard ratio for major adverse cardiovascular events of 1.64 [95% confidence interval (CI) 1.30–2.08; P < 0.001] compared to those in the lowest quartile. Corresponding hazard ratios were 2.08 (95% CI 1.38–3.14; P < 0.001) for death, 2.63 (95% CI 1.61–4.31; P < 0.001) for heart failure, 1.08 (95% CI 0.56–2.08; P = 0.82) for myocardial infarction, and 1.07 (95% CI 0.72–1.57; P = 0.74) for stroke. Conclusion  Increased left ventricular trabeculation is independently associated with an increased rate of major adverse cardiovascular events in the general population.

P2441The prognostic value of left atrial dyssynchrony in the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Hoeegholm Karsum ◽  
D M Andersen ◽  
D Modin ◽  
S R Biering-Soerensen ◽  
R Moegelvang ◽  
...  
Keyword(s):  
General Population ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Health Examination ◽  
General Population Study ◽  
Long Term Outcome ◽  
Cardiovascular Morbidity And Mortality ◽  
All Cause Mortality

Abstract Introduction Parameters derived from left atrial (LA) speckle tracking such as LA peak reservoir strain and LA dyssynchrony are potent predictors of cardiovascular morbidity and mortality in various patient populations. However, whether LA dyssynchrony as evaluated by speckle tracking is associated with long-term outcome in the general population is currently unknown. Methods In a cohort study with participants from the general population 385 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had a health examination and an echocardiogram, including LA speckle tracking, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional atrial reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). Results Median LA dyssynchrony was 42 ms (IQR: 22–58 ms), 60% percent of included participants were women, mean age was 55 years (SD 16 years), 34% had hypertension and 7% had diabetes mellitus. During a median follow up of 16.1 years (IQR 15.0–16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. Increasing LA dyssynchrony was associated with increasing age, lower estimated glomerular filtration rate, lower E/A ratio, lower e' and higher E/e'. In a univariable Cox regression, LA dyssynchrony was a significant predictor of all-cause mortality (HR 1.07, 95% CI 1.02–1.11, p=0.001, per 10 ms increase) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, 95% CI 1.00–1.10, p=0.064, per 10 ms increase) nor MACE (HR 1.04, 95% CI 0.98–1.12, p=0.22, per 10 ms increase). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p=0.28), the combined endpoint of AF and IS (HR 1.01, p=0.83), or MACE (HR 0.99, p=0.88,). Similarly, after further adjustment for age, sex, smoking status, systolic blood pressure and cholesterol, LA dyssynchrony did not predict any of the study outcomes (All-cause mortality: HR 1.01, p=0.72) (AF and IS: HR 0.98, p=0.88) (MACE: HR 1.00, p=0.93). Conclusion In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.

scholarly journals Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Seraphim ◽  
K Knott ◽  
K Menacho ◽  
J Augusto ◽  
R Davies ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Transit Time ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Time Estimation ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Pulmonary Transit Time ◽  
Perfusion Cmr ◽  
Center Study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship Background Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale. Objectives To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort. Methods A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing). Results 985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p < 0.001). Stress PTT also correlated with LVEF (r=-0.37), stress MBF (r=-0.31), LVEDVi (r = 0.24), LA area index (r = 0.32) (p < 0.001 for all). Over a median follow-up period of 28.6 (IQR, 22.6 35,7) months, MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both rest and stress PTT, independently predicted MACE, but not all-cause mortality. For every 1xSD (2.39s) increase in rest PTT the adjusted hazard ratio (HR) for MACE was 1.43 (95% CI 1.10-1.85, p = 0.007). The hazard ratio for one standard deviation (2.64s) increase in stress PTT was 1.34 (95% CI 1.048-1.723; p = 0.020) after adjusting for age, LVEF, hypertension, diabetes, sex and presence of LGE Conclusions In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest. Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p < 0.05

Abstract 14614: The Automatically Assessed P-wave Notch Predicts Cardiovascular Events in Patients With Cardiovascular Risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuomi Kario
Keyword(s):  
Left Atrial ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
P Wave ◽  
Control Group ◽  
Atrial Remodeling ◽  
Wave Group ◽  
Left Atrial Diameter ◽  
Wave Characteristics

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and long-term cardiovascular events remains unclear. Hypothesis: We hypothesized that the notched P-wave would be associated with cardiovascular events. Methods: We enrolled 810 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). We compared two definitions: P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥20 msec or ≥40 msec in lead II. The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography. Results: The mean follow-up period was 101±34 months, and 85 cardiovascular events occurred. When we defined a notched P wave as ≥20msec in the M shape (n=92), a notched P wave was a significant predictor of cardiovascular events after adjustment for age, gender, and comorbidity (hazard ratio 1.80, 95%CI: 1.06-3.05). When we defined a notched P wave as ≥40msec in the M shape (n=25), the hazard ratio of cardiovascular events in the notched P-wave group was significantly borderline after adjustment for covariates (hazard ratio 2.23, 95%CI: 0.90-5.56). The left atrial diameter and LVMI in the patients in the notched P-wave group (≥20 msec in the M shape) were significantly higher than those in the control group (left atrial dia. 38.8±5.9 vs. 36.8±5.0 mm, p=0.001; LVMI 103.9±27.7 vs. 96.3±25.7 g/m 2 , p=0.010). Conclusion: The automatically assessed notched P wave was associated with cardiovascular events, left atrial enlargement and left ventricular hypertrophy.

scholarly journals Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

2020 ◽  
Vol 9 (6) ◽  
pp. 1997 ◽  
Author(s):  
Bianca Olivia Cojan-Minzat ◽  
Alexandru Zlibut ◽  
Ioana Danuta Muresan ◽  
Carmen Cionca ◽  
Dalma Horvat ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Replacement Fibrosis ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Cox Analysis ◽  
A Prospective Study

To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

P2609H2FPEF score as a prognostic value in HFpEF patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Sueta ◽  
T Nishihara ◽  
E Yamamoto ◽  
K Tsujita
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Rank Test ◽  
Characteristic Analysis ◽  
Simple Method ◽  
Log Rank Test ◽  
Cerebrovascular Events

Abstract Background The H2FPEF score is recognized as a simple method to diagnose heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). Purpose We investigated the value of the H2FPEF score in predicting subsequent cardiovascular events in HFpEF patients. Methods This study was a retrospective, single-center, observational study. We calculated the H2FPEF scores for 404 consecutive HFpEF patients. Subjects were subdivided into low- (0–3), intermediate- (4–6), and high-score (7–9) groups and followed for 50-months. The primary and secondary endpoints were composite cardiovascular/ cerebrovascular events (cardiovascular death, non-fatal myocardial infarction, unstable angina pectoris, hospitalization for HF decompensation and non-fatal stroke) occurrence and HF-related events (hospitalization for HF decompensation) occurrence at 50-months, respectively. Results Kaplan–Meier analyses demonstrated a significantly higher incidence of cardiovascular/cerebrovascular events in proportion to a higher H2FPEF score (log-rank test, P=0.005). The HF-related event rate was higher in proportion to the H2FPEF score (log-rank test, P<0.001). Multivariate Cox hazard analyses identified the H2FPEF score (per 1 point) as an independent predictor of cardiovascular and HF-related events (Table, hazard ratio, 1.179; 95% confidence interval, 1.066–1.305; P=0.001 and hazard ratio, 1.288; 95% confidence interval, 1.134–1.463; P=0.001, respectively). Receiver operating characteristic analysis showed that the H2FPEF significantly predicted cardiovascular events (Figure A, AUC 0.626, 95% CI 0.557–0.693; P<0.001) and HF-related events (Figure B, AUC 0.680, 95% CI 0.600–0.759; P<0.001). The cutoff H2FPEF score was 5.5 for the identification of cardiovascular and HF-related events. Conclusion The H2FPEF score is a potentially useful marker for the prediction of cardiovascular and HF-related events in HFpEF patients.

scholarly journals Amiodarone-Induced Thyrotoxicosis Is a Predictor of Adverse Cardiovascular Outcome

2009 ◽  
Vol 94 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Kai-Hang Yiu ◽  
Man-Hong Jim ◽  
Chung-Wah Siu ◽  
Chi-Ho Lee ◽  
Michele Yuen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Ventricular Arrhythmias ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Amiodarone Therapy ◽  
Ventricular Ejection Fraction ◽  
Increased Risk

Abstract Background: Amiodarone-induced thyrotoxicosis (AIT) is a clinical condition that is notoriously difficult to manage; the relative risk of adverse cardiovascular events in these patients compared with euthyroid patients is largely unknown. Objective: We compared the clinical characteristics and major adverse cardiovascular events (MACE) in AIT and euthyroid patients. Method: Patients at a tertiary referral center who had been prescribed amiodarone for at least 3 months were retrospectively analyzed. Baseline clinical characteristics, laboratory parameters, and outcome events were evaluated. MACE was defined as cardiovascular mortality, myocardial infarction, stroke and heart failure, or ventricular arrhythmias that required hospitalization. Results: A total of 354 patients (61.8 ± 14.1 yr; 64.7% male) with a mean follow-up of 48.6 ± 26.7 months were studied. AIT, euthyroid status, and amiodarone-induced hypothyroidism were identified in 57 (16.1%), 224 (63.3%), and 73 (20.6%) patients, respectively. No differences in baseline clinical characteristics were observed between AIT and euthyroid patients. Nonetheless AIT patients demonstrated a higher MACE rate (31.6 vs. 10.7%, P &lt; 0.01), mostly driven by a higher rate of ventricular arrhythmias that required admission (7.0 vs. 1.3%, P = 0.03). Cox-regression multivariate analysis revealed that AIT (hazard ratio 2.68; confidence interval 1.53–4.68; P &lt; 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43–4.42; P &lt; 0.01) were independent predictors of MACE. Conclusion: In patients prescribed long-term amiodarone therapy, occurrence of AIT is associated with a 2.7-fold increased risk of MACE. Regular and close biochemical surveillance is thus advisable to identify and treat this high-risk group of patients.

scholarly journals Occupational exposures and exacerbations of asthma and COPD—A general population study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243826
Author(s):  
Stinna Skaaby ◽  
Esben Meulengracht Flachs ◽  
Peter Lange ◽  
Vivi Schlünssen ◽  
Jacob Louis Marott ◽  
...  
Keyword(s):  
Molecular Weight ◽  
General Population ◽  
Confidence Interval ◽  
Population Study ◽  
Cox Regression ◽  
Occupational Exposures ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
General Population Study

Purpose Recent studies suggest that occupational inhalant exposures trigger exacerbations of asthma and chronic obstructive pulmonary disease, but findings are conflicting. Methods We included 7,768 individuals with self-reported asthma (n = 3,215) and/or spirometric airflow limitation (forced expiratory volume in 1 second (FEV1)/ forced expiratory volume (FVC) <0.70) (n = 5,275) who participated in The Copenhagen City Heart Study or The Copenhagen General Population Study from 2001–2016. Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission. Associations between occupational inhalant exposure each year of follow-up and exacerbation were assessed by Cox regression with time varying exposure and age as the underlying time scale. Results Participants were followed for a median of 4.6 years (interquartile range, IQR 5.4), during which 870 exacerbations occurred. Exacerbations were not associated with any of the selected exposures (high molecular weight sensitizers, low molecular weight sensitizers, irritants or low and high levels of mineral dust, biological dust, gases & fumes or the composite variable vapours, gases, dusts or fumes). Hazards ratios ranged from 0.8 (95% confidence interval: 0.7;1.0) to 1.2 (95% confidence interval: 0.9;1.7). Conclusion Exacerbations of obstructive airway disease were not associated with occupational inhalant exposures assigned by a job exposure matrix. Further studies with alternative exposure assessment are warranted.

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