Abstract 19277: Late Systolic Central Hypertension as a Predictor of Incident Heart Failure: the Multi-Ethnic Study of Atherosclerosis

Background: Experimental studies demonstrate that high aortic pressure in late systole relative to early systole, causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. Methods: We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last 1/3 of systole) to early (first 2/3 of systole) pressure-time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded non-invasively from 6,124 adults. The late/early systolic PTI ratio (L/ESPTI) was assessed as a predictor of incident heart failure (HF) during median 8.5 years of follow-up. Results: The L/ESPTI was predictive of incident HF (hazard ratio per 1% increase=1.22; 95%CI=1.15-1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95%CI=1.14-1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/ESPTI was the modifiable factor associated with the greatest improvements in model performance. A high L/ESPTI was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95%CI=0.86-2.23; P=0.18) whereas the HR associated with a high L/E was 2.31 (95%CI=1.52-3.49; P<0.0001). Cumulative hazard curves for HF among participants stratified according to the presence or absence of hypertension (prevalence=45%) or a high L/ESPTI (set empirically to an identical prevalence of 45% based on E/LSPTI) are shown in the figure. Conclusions: Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population.

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Wave reflection augments central systolic and pulse pressures during facial cooling

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01369.2007 ◽

2008 ◽

Vol 294 (6) ◽

pp. H2535-H2539 ◽

Cited By ~ 21

Author(s):

David G. Edwards ◽

Matthew S. Roy ◽

Raju Y. Prasad

Keyword(s):

Cardiovascular Events ◽

Wave Reflection ◽

Augmentation Index ◽

Systolic Pressure ◽

Aortic Pressure ◽

Applanation Tonometry ◽

Pressure Waveform ◽

Central Aortic Pressure ◽

Facial Cooling ◽

Change In Mean

Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.

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Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽

10.1136/heartjnl-2021-319129 ◽

2021 ◽

pp. heartjnl-2021-319129

Author(s):

Marios Rossides ◽

Susanna Kullberg ◽

Johan Grunewald ◽

Anders Eklund ◽

Daniela Di Giuseppe ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

General Population ◽

Strong Predictor ◽

Strong Association ◽

International Classification Of Diseases ◽

Population Based ◽

Clinical Predictors ◽

Cox Models ◽

Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

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Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

Clinical Research in Cardiology ◽

10.1007/s00392-021-01907-x ◽

2021 ◽

Author(s):

Jan-Per Wenzel ◽

Ramona Bei der Kellen ◽

Christina Magnussen ◽

Stefan Blankenberg ◽

Benedikt Schrage ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

General Population ◽

Diastolic Dysfunction ◽

Cardiovascular Risk Factors ◽

Population Based ◽

Left Ventricular ◽

Health Study ◽

Common Finding

Abstract Aim Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. Methods and results From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. Conclusion The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

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Correction: Risk factors for incident heart failure with preserved or reduced ejection fraction, and valvular heart failure, in a community-based cohort

Open Heart ◽

10.1136/openhrt-2018-000782corr1 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000782corr1

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ejection Fraction ◽

Community Based ◽

Reduced Ejection Fraction ◽

Incident Heart Failure

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Assessment of Conventional Cardiovascular Risk Factors and Multiple Biomarkers for the Prediction of Incident Heart Failure and Atrial Fibrillation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2010.05.049 ◽

2010 ◽

Vol 56 (21) ◽

pp. 1712-1719 ◽

Cited By ~ 182

Author(s):

J. Gustav Smith ◽

Christopher Newton-Cheh ◽

Peter Almgren ◽

Joachim Struck ◽

Nils G. Morgenthaler ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Multiple Biomarkers ◽

Incident Heart Failure

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Abstract 2432: Effect of Left Ventricular Systolic Dysfunction on Wasted Left Ventricular Energy and Tension-Time Index

Circulation ◽

10.1161/circ.118.suppl_18.s_725-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Scott J Denardo ◽

Wilmer W Nichols

Keyword(s):

Heart Failure ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Aortic Pressure ◽

Left Ventricular ◽

Systemic Hypertension ◽

Pressure Waveform ◽

Ventricular Systolic Dysfunction ◽

Time Index ◽

Tension Time

Information obtained from the aortic pressure waveform is affected by age, physical condition, systemic hypertension, diabetes mellitus and coronary artery disease. However, alterations in the aortic pressure waveform in patients (pts) with heart failure and left ventricular systolic dysfunction (LVSD) have not been fully described, including a description of the effect on wasted LV pressure energy and tension-time index. Non-invasive high-fidelity radial artery tonometry was used for data acquisition, and a mathematical transfer function used to generate aortic pressure waveforms (see figure ). Pulse wave analysis (PWA) of the aortic pressure waveform was used to obtain information associated with LV/vascular coupling in 23 pts age 55±9.5 yrs with LVSD (mean LV ejection fraction, 22±6%) and compared to data collected from 23 normal subjects matched for age, gender, height, weight and heart rate. Measurements obtained using PWA in heart failure pts with LVSD demonstrate decreased wasted LV energy and tension time index, consistent with poor LV mechanical performance, in addition to decreased unaugmented pressure, pulse pressure, ejection duration and augmentation index. Further standardization of these aortic pressure waveform findings in heart failure pts may allow for the clinical use of arterial PWA to non-invasively estimate LVSD.

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