scholarly journals EXPRESS: Partitioning risk factors for embolic stroke of undetermined source (ESUS) using exploratory factor analysis

2021 ◽  
pp. 174749302110098
Author(s):  
Jon Davis Perkins ◽  
Naveed Akhtar ◽  
Rajvir Singh ◽  
Assad Kamran ◽  
Saadat Ilyas
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Aortic Arch ◽  
Exploratory Factor Analysis ◽  
Heart Function ◽  
Left Ventricular ◽  
Embolic Stroke ◽  
Volume Index ◽  
Left Heart ◽  
Latent Factors

Background Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear. Methods and Results ESUS patients were pair matched for age, sex and ethnicity with a group of all other strokes (both n=331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart related variables such as left ventricular wall motion abnormalities, reduced ejection fraction and increased left atrial volume index, as well as, aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors. Conclusions Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.

scholarly journals Analysis of Risk Factors for Changes in The Doppler Echocardiographic Indexes of Patients With Gout

2021 ◽  
Author(s):  
Wantai Dang ◽  
Danling Luo ◽  
Hui Luo ◽  
Jing Hu ◽  
Xiaohui Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Wall Thickening ◽  
Course Of Disease ◽  
Left Ventricular Structure ◽  
Ventricular Structure ◽  
Mitral Annulus Velocity

Abstract Objective: The analysis of risk factors for changes in the Doppler echocardiographic indexes of patients with gout with different serum uric acid (SUA) levels were explored to provide clinical evidence for the early diagnosis and treatment of abnormal heart function in this patients.Methods: We obtained information of 227 patients with primary gout (intermittent period), the left ventricular structure and functional index were measured using echocardiography and multivariate logistics regression was used to analyze the risk factors related to changes in heart function in patients with gout.Results: Logistic regression analysis showed that the course of disease and cystatin C (Cys-C) were risk factors for the increase of left atrial volume index (LAVI) (OR=1.14, 105.47; 95% CI, 1.01-1.28, 1.18-9468.03). Age, body mass index (BMI), course of disease, and diabetes were risk factors for the increase of the ratio of diastolic peak early transmission flow velocity to peak early diastolic mitral annulus velocity (E/Em) (OR=1.04, 1.17, 1.14, 4.82; 95% CI, 1.01-1.08, 1.03-1.33, 1.02-1.27, 1.07-21.71). However, the percentage of neutrophils percentage (NE%) and lymphocytes percentage (LY%) might reduce the risk of left ventricular wall thickening, whereas HGB might reduce the risk of increasing E/Em (OR=0.80, 0.75, 0.94; 95% CI, 0.66-0.96, 0.60-0.93, 0.89-1.00).Conclusion: Our findings suggest that BMI, course of disease, diabetes, and Cys-C are risk factors for decreased left ventricular function. Furthermore, HGB, NE%, and LY% appear to have a weak protective effect for the remodeling of left ventricular structure and function.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Güzin Özden ◽  
Ayşe Esin Kibar Gül ◽  
Eda Mengen ◽  
Ahmet Ucaktürk ◽  
Hazım Alper Gürsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Ventricular ◽  
Atherogenic Index ◽  
Volume Index ◽  
Common Component

Abstract Objectives The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity. Methods A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated. Results The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m2) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index. Conclusions LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

scholarly journals The Importance of Service Attributes between Low-cost and Full-service Carrier Customers: A case of Airline Type Hybridisation

2021 ◽  
Vol 10 (10(6)) ◽  
pp. 1741-1757
Author(s):  
Nkululeko Funyane
Keyword(s):  
Factor Analysis ◽  
Maximum Likelihood ◽  
Exploratory Factor Analysis ◽  
Low Cost ◽  
Latent Factors ◽  
Significant Difference ◽  
The Difference

This study sought to assess if the importance attached by customers to the airline service attributes differed across low-cost and full-service airline models. A Mann-Whitney U Test was used to assess the difference between the two models. However, before subjecting the data to differential tests, an exploratory factor analysis (maximum likelihood) was performed on the fifty-five items of service attributes, reducing them into forty-two items retained into ten latent factors (airline service attributes). The results of the revealed a significant difference in the importance attached to staff competence, courtesy and responsiveness only. Such findings suggest that the positioning of airlines into binary (FSC - LCC) models could be a waste of effort and resources since airlines seem to be converging.

P14893D strain echocardiography in assessing left ventricular diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H T Ozer ◽  
O Ozer ◽  
C Coteli ◽  
A Kivrak ◽  
M L Sahiner ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Catheterization ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
2D Strain

Abstract Background Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult. Purpose In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization. Methods Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin. Results The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively. Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance. Measurement of longitudinal strain Conclusion In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms. Acknowledgement/Funding None

Subclinical Hypothyroidism as an Independent Determinant of Left Atrial Dysfunction in the General Population

2020 ◽  
Author(s):  
Koki Nakanishi ◽  
Masao Daimon ◽  
Yuriko Yoshida ◽  
Naoko Sawada ◽  
Kazutoshi Hirose ◽  
...  
Keyword(s):  
General Population ◽  
Subclinical Hypothyroidism ◽  
Left Atrial ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Left Heart ◽  
Ventricular Ejection Fraction ◽  
Significant Difference

Abstract Purpose Although subclinical hypothyroidism (SCH) is a common clinical entity and carries independent risk for incident heart failure (HF), its possible association with subclinical cardiac dysfunction is unclear. Left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic strain can unmask subclinical left heart abnormalities and are excellent predictors for HF. This study aimed to investigate the association between the presence of SCH and subclinical left heart dysfunction in a sample of the general population without overt cardiac disease. Methods We examined 1078 participants who voluntarily underwent extensive cardiovascular health check-ups, including laboratory tests and 2-dimensional speckle-tracking echocardiography to assess LVGLS and LA reservoir, conduit, and pump strain. SCH was defined as an elevated serum thyroid-stimulating hormone level with normal concentration of free thyroxine. Results Mean age was 62 ± 12 years, and 56% were men. Seventy-eight (7.2%) participants exhibited SCH. Individuals with SCH had significantly reduced LA reservoir (37.1 ± 6.6% vs 39.1 ± 6.6%; P = 0.011) and conduit strain (17.3 ± 6.3% vs 19.3 ± 6.6%; P = 0.012) compared with those with euthyroidism, whereas there was no significant difference in left ventricular ejection fraction, LA volume index, LVGLS, and LA pump strain between the 2 groups. In multivariable analyses, SCH remained associated with impaired LA reservoir strain, independent of age, traditional cardiovascular risk factors, and pertinent laboratory and echocardiographic parameters. including LVGLS (standardized β −0.054; P = 0.032). Conclusions In an unselected community-based cohort, individuals with SCH had significantly impaired LA phasic function. This association may be involved in the higher incidence of HF in subjects with SCH.

scholarly journals Left heart hypoplasia and neonatal aortic arch obstruction: Is the rhodes left ventricular adequacy score applicable?

1999 ◽  
Vol 118 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Lloyd Y. Tani ◽  
L.LuAnn Minich ◽  
Luciana T. Pagotto ◽  
Robert E. Shaddy ◽  
Edwin C. McGough ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Left Ventricular ◽  
Left Heart ◽  
Arch Obstruction

scholarly journals Effects of patient characteristics and comorbidities on temporal trends of low-flow, low-gradient aortic stenosis phenotypes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sen ◽  
T Manning ◽  
K Innes-Jones ◽  
C Neil ◽  
T.H Marwick
Keyword(s):  
Risk Factors ◽  
Aortic Stenosis ◽  
Temporal Trends ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Over Time

Abstract Background Aortic stenosis (AS) is a common primary heart valve disease in the elderly. Low-flow, low-gradient (LFLG) AS is an increasingly important phenotype. Purpose To evaluate the temporal changes in incidence of severe AS phenotypes: paradoxical LFLG, classical LFLG and non-LFLG and explore risk factors that contribute to temporal trends. Methods We analyzed 25,507 consecutive transthoracic echocardiograms over 6½ years between 2013 and 2019 divided into deciles. LFLG-AS was defined as mean transvalvular pressure gradient &lt;40 mmHg and stroke volume index (SVi) &lt;35 mL/m2, aortic valve area (AVA) &lt;1 cm2 or indexed AVA &lt;0.6 cm2/m2, with either normal (paradoxical LFLG) or decreased (&lt;40%; classical LFLG) left ventricular ejection fraction. Trends and associations with patients characteristics and comorbidities were assessed over time in deciles. Results Of 891 cases that fulfilled severe AS criteria, there were 536 cases of LFLG-AS (85 classical and 451 paradoxical LFLG-AS). There was a statistically significant increase in incidence of paradoxical LFLG-AS between each time interval (p&lt;0.0001), while significant reduction in incidence of non-LFLG-AS (p=0.009) that was not seen with classical LFLG-AS (p=0.7) (Figure). More comprehensive echocardiographic assessment of relevant parameters over time assisted with identification of LFLG-AS cases. Intrinsic patient factors such as age and E/e' contributed towards the increasing trend of paradoxical LFLG-AS. There was a rising population aged over 70 years (p=0.01). Multivariate logistic regression analysis showed that age, sex, E/e', obesity, atrial fibrillation and heart rate were potential risk factors responsible for temporal trend towards rising paradoxical LFLG-AS incidence. There was also a gradual increase in number of patients with low transvalvular flow rate (&lt;200mL/s) over time (p=0.04). Conclusion The incidence of paradoxical LFLG-AS is rising in a hospital echocardiogram service. The parallel increase in LV filling pressure and age in AS patients suggests the increment in LFLG-AS is related to changes to the LV myocardium. Subtypes of aortic stenosis over time Funding Acknowledgement Type of funding source: None

Abstract P150: Association Of Leisure Time Physical Activity (LTPA) With Left Atrial Function In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Romil Parikh ◽  
Riccardo M Inciardi ◽  
Wendy Wang ◽  
Sheila M Hegde ◽  
Faye L Norby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Diastolic Function ◽  
Left Atrial ◽  
Contractile Function ◽  
Left Ventricular ◽  
Volume Index ◽  
Aric Study ◽  
Lv Diastolic Function ◽  
Conduit Function

Introduction: Prior research indicates that higher LTPA is associated with better left ventricular (LV) diastolic function, but not with left atrial volume index (LAVI). Left atrial (LA) strain is a more sensitive marker of LA pathology. Hence, we evaluated association of LTPA with LA strain in the ARIC study, a community-based cohort study. Hypothesis: Higher LTPA is associated with better LA reservoir, conduit and contractile function. Methods: We included 4005 participants (mean age 75 years, 63% female, 21% black) with 2D echocardiographic (2DE) LA % strain data, LTPA data, and without prevalent coronary heart disease, valvular heart disease, heart failure, atrial fibrillation, and stroke at Visit 5 (V5, 2011-13). We estimated LTPA as metabolic equivalent-minutes per week from validated Baecke questionnaire and categorized it as poor, intermediate, or ideal as per AHA recommendation. We categorized change in LTPA from V3 (1993-95) to V5 as persistently poor (referent), decreasing, increasing, or persistently active. LA reservoir, conduit, and contractile % strain were measured from speckle-tracking 2DE. Linear regression was used to evaluate association of LTPA with LA function. We modeled LTPA (1) cross-sectionally at V5 as a continuous variable and (2) change from V3 to V5, as continuous and categorical variables (referent- persistently poor). Results: Higher LTPA at V5 (Table) and persistently high (vs poor) LTPA from V3 to 5 (β estimate -0.89, 95% CI -1.40, -0.38) were significantly associated with better LA conduit function after adjusting for CV risk factors, LV function, and LAVI. The same associations with LA reservoir function were no longer significant after adjusting for CV risk factors. LTPA was not associated with LA contractile function (Table). Conclusions: Consistent with LTPA’s salutary effect on LV diastolic function, higher LTPA is associated with better LA conduit function. Maintaining high LTPA from midlife to late-life may be beneficial in mitigating age-related changes in cardiac function.

Sign in / Sign up

Export Citation Format

Share Document