scholarly journals Left Atrial Phasic Function in Patients with Hypertension and Recurrent Atrial Fibrillation: Gender Differences of the Relationship with Diastolic Dysfunction and Central Aortic Pressure

2019 ◽  
Vol 15 (5) ◽  
pp. 622-633
Author(s):  
E. V. Kokhan ◽  
E. M. Ozova ◽  
V. A. Romanova ◽  
G. K. Kiyakbaev ◽  
Zh. D. Kobalava
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Aortic Pressure ◽  
Men And Women ◽  
Central Aortic Pressure ◽  
Recurrent Atrial Fibrillation

Aim. To evaluate gender-related differences of left atrial (LA) phasic function and structural remodeling in conjunction with the parameters of left ventricular (LV) diastolic dysfunction and central aortic pressure in patients with hypertension and recurrent atrial fibrillation (AF).Material and methods. The comparative study included 30 men and 37 women with non-valvular AF, hypertension and LV hypertrophy. Conventional echocardiographic measures were extended with LA measures, including its volume in three phases, LAemptying fraction (LAEF), passive and active ejection fraction. The parameters of central aortic pressure were estimated by applanation tonometry method.Results. No difference was observed between LA and LV structural parameters in men and women. However, in women LAEF (39 [28;50] vs 50 [42;55]%; p=0.02) and E/E’(9.7 [7.8;12] vs 7.1 [5.6;8.6]; p=0.001) were worse than in men. Active LA ejection fraction was higher in women (31 [21;42] vs 24 [19;31]%; p=0.04), whereas passive one – in men (12 [10;14] vs 33 [23;38]%; p<0.001), respectively. Men and women had comparable heart rate (HR), central and peripheral systolic and diastolic pressure, pulse wave velocity (PWV), but women had higher augmentation index (AI) values [33 [28;39] vs 23 [21;28]%; p<0.001], even adjusted by HR (AI 75) (34 [27;39] vs 26 [20;29]%; p<0.001). Only in men PWV weakly correlated with AI 75 (r=0.44; p=0.02 versus r=-0.11; p=0.51, respectively for men and women; intergroup differences: z=2.26; p=0.012). In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and glomerular filtration rate (GFR), whereas in women – with E’ and AI 75.Conclusion. Patients of different genders with recurrent AF and hypertension have comparable LA structuralremodeling. However, women characterized by a more pronounced decrease in LAEF and impaired LV diastolic function than men. In women as distinct from men LV filling is predominantly due to LA systole. In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and GFR, whereas in women – with E’ and AI 75. 

Abstract 12972: Serum-induced Expression of Brain Natriuretic Peptide Contributes to its Increase in Patients With HFpEF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ryuji Okamoto ◽  
Ryotaro Hashizume ◽  
Noboru Suzuki ◽  
Hiroshi Kiyonari ◽  
Kaoru Dohi
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Multivariate Regression ◽  
Female Gender ◽  
Multivariate Regression Analysis ◽  
Induced Expression ◽  
Reduced Ejection Fraction

Introduction: Brain natriuretic peptide (BNP) levels are relatively higher in patients with heart failure with preserved ejection fraction (HFpEF) than heart failure with reduced ejection fraction (HFrEF); however, the mechanism remains unclear. BNP is induced by undetermined stretch-activated receptors including mechanically gated channels, which can be activated by a mechanical stimulus alone, and mechanically modulated channels, which require nonmechanical stimuli such as agonists. Thus it is possible that serum-induced expression of BNP may contribute to the increase of BNP in patients. Purpose: Our purpose is to examine whether serum-induced BNP expression (iBNP) partly contributes to the increase in BNP in patients with HFpEF. Methods: We generated the BNP reporter mice by knocking luciferase cDNA in the initiation site of NPPB . Neonatal cardiomyocytes were isolated and cultured from 2-day-old neonates. These cardiomyocytes were stimulated for 24 hours with 20% serum from patients with HFpEF or HFrEF (n=114 and 82, respectively) and the luciferase activity was examined as iBNP and the ratio of iBNP to BNP was measured. The patients’ characteristics and clinical parameters were compared and multivariate regression analysis was performed using SPSS version 25. Results: The mean ages were 71 yrs in HFpEF and 67 yrs in HFrEF. The female gender was higher in HFpEF (46% vs 32%). The prevalence of atrial fibrillation and hypertension and the use of calcium channel blocker (CCB) were higher in HFpEF than in HFrEF (31 vs 17%, 66 vs 43%, 28 vs 18%). The prevalence of coronary artery disease, chronic kidney disease and diabetes mellitus were lower in HFpEF than HFrEF (21 vs 42%, 44 vs 74%, 25 vs 44%). The ratio of iBNP to BNP was significantly higher in HFpEF than in HFrEF (26.9 vs 16.1, P<0.001). Multivariate regression analysis showed the existence of HFpEF was an independent predictor for the ratio of iBNP to BNP after adjusting all other measurements (β=0.154, P=0.032). Age, hemoglobin, the use of CCB and the deceleration time were also independent predictors (β=0.167, P=0.025; β=0.203, P=0.006; β=0.138, P=0.049; β=0.143, P=0.049, respectively). Conclusions: These results indicate the elevation of BNP in patients with HFpEF is partly due to the iBNP from heart.

Abstract 2457: Atrial Fibrillation is Associated with Severe Sleep Disordered Breathing TIA and Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kensaku Shibazaki ◽  
Kazumi Kimura ◽  
Junichi Uemura ◽  
Kenichiro Sakai ◽  
Shuichi Fuii
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Multivariate Regression ◽  
Sleep Disordered Breathing ◽  
Japanese Patients ◽  
Multivariate Regression Analysis ◽  
Stroke Patients ◽  
Sleep Study ◽  
Factors Associated ◽  
Disordered Breathing

Background and Purpose Sleep disordered breathing (SBD) was reported to be a risk factor for cerebrovascular disease. We investigated the frequency of SDB in Japanese patients with acute transient ischemic attack (TIA) and stroke and the factors associated with severe SDB in Japan. Methods Between May 2010 and April 2011, we prospectively enrolled TIA and stroke patients within 24 hours of onset and performed sleep study up to 7 days after admission. SBD was defined as respiratory disturbance index (RDI: apnea or hypopnea event per hour) ≥5. Patients were divided into 2 groups according to the RDI value as follows: ≥30(severe) and <30(none or non-severe). We demonstrated the frequency of SDB and the factors associated with severe SDB were investigated by multivariate regression analysis. Results A total of 150 patients (92 males; mean age, 72.8 years) were enrolled in this study; 28 had TIA and 122 had stroke. The mean time from admission to sleep study was 4 days. Mean RDI was 22.2±17.6. SDB was observed in 126(84%) patients. Frequencies of SDB were as follows: 21(75%) patients in TIA, 105(86%) in stroke [8/10(80%) in large artery atherosclerosis, 14/14(100%) in small vessel occlusion, 37/41(90%) in cardioembolism, 46/57(81%) in other cause of stroke/undetermined]. Severe SDB was observed in 44 (29%) patients; 21% in TIA and 31% in stroke. Frequencies of male (75% for the severe SDB group vs. 56% for the non-severe SDB group, p=0.027), atrial fibrillation (39% vs. 23%, p=0.045), body mass index (23.8±3.8 vs. 22.3±3.8, p=0.043), and neck circumference (37.8±4.3 vs. 35.8±4.2, p=0.012) were significantly higher in the severe SDB than in the non-severe SDB. Metabolic syndrome (36% vs. 21%, p=0.057) and waist circumference (88.9±9.8 vs. 85.5±9.3, p=0.080) showed a tendency toward higher in the severe SDB group than in the non-severe SDB group. There were no significant differences in age, prior stroke, vascular risk factors, Glasgow Coma Scale, and NIHSS score on admission. On multivariate regression analysis, atrial fibrillation (odds ratio, 2.5; 95% confidence interval, 1.079-5.836, p=0.0326) was found to be independently associated with severe SDB. Conclusions Most Japanese patients with acute TIA and stroke had SDB, and the presence of atrial fibrillation was associated with severe SDB.

scholarly journals 1574. Multivariate Regression Analysis to Determine Independent Predictors of Treatment Outcomes in the RESTORE-IMI 2 Trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S785-S786
Author(s):  
Robert Tipping ◽  
Jiejun Du ◽  
Maria C Losada ◽  
Michelle L Brown ◽  
Katherine Young ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Response ◽  
Treatment Outcomes ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Apache Ii Score ◽  
Double Blind ◽  
Mitt Population ◽  
Study Results ◽  
All Cause Mortality

Abstract Background In the RESTORE-IMI 2 trial, imipenem/cilastatin/relebactam (IMI/REL) was non-inferior to PIP/TAZ for treating hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) in the primary endpoint of Day 28 all-cause mortality (D28 ACM) and the key secondary endpoint of clinical response (CR) at early follow-up (EFU; 7-14 d after end of therapy). We performed a multivariate regression analysis to determine independent predictors of treatment outcomes in this trial. Methods Randomized, controlled, double-blind, phase 3, non-inferiority trial comparing IMI/REL 500 mg/250 mg vs PIP/TAZ 4 g/500 mg, every 6 h for 7-14 d, in adult patients (pts) with HABP/VABP. Stepwise-selection logistic regression modeling was used to determine independent predictors of D28 ACM and favorable CR at EFU, in the MITT population (randomized pts with ≥1 dose of study drug, except pts with only gram-positive cocci at baseline). Baseline variables (n=19) were pre-selected as candidates for inclusion (Table 1), based on clinical relevance. Variables were added to the model if significant (p &lt; 0.05) and removed if their significance was reduced (p &gt; 0.1) by addition of other variables. Results Baseline variables that met criteria for significant independent predictors of D28 ACM and CR at EFU in the final selected regression model are in Fig 1 and Fig 2, respectively. As expected, APACHE II score, renal impairment, elderly age, and mechanical ventilation were significant predictors for both outcomes. Bacteremia and P. aeruginosa as a causative pathogen were predictors of unfavorable CR, but not of D28 ACM. Geographic region and the hospital service unit a patient was admitted to were found to be significant predictors, likely explained by their collinearity with other variables. Treatment allocation (IMI/REL vs PIP/TAZ) was not a significant predictor for ACM or CR; this was not unexpected, since the trial showed non-inferiority of the two HABP/VABP therapies. No interactions between the significant predictors and treatment arm were observed. Conclusion This analysis validated known predictors for mortality and clinical outcomes in pts with HABP/VABP and supports the main study results by showing no interactions between predictors and treatment arm. Table 1. Candidate baseline variables pre-selected for inclusion Figure 1. Independent predictors of greater Day 28 all-cause mortality (MITT population; N=531) Figure 2. Independent predictors of favorable clinical response at EFU (MITT population; N=531) Disclosures Robert Tipping, MS, Merck & Co., Inc. (Employee, Shareholder) Jiejun Du, PhD, Merck & Co., Inc. (Employee, Shareholder) Maria C. Losada, BA, Merck & Co., Inc. (Employee, Shareholder) Michelle L. Brown, BS, Merck & Co., Inc. (Employee, Shareholder) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Joan R. Butterton, MD, Merck & Co., Inc. (Employee, Shareholder) Amanda Paschke, MD MSCE, Merck & Co., Inc. (Employee, Shareholder) Luke F. Chen, MBBS MPH MBA FRACP FSHEA FIDSA, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder)

Epicardial fat thickness as arterial hypertension predictor in normotensive patients with abdominal obesity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kuznetsova ◽  
M Druzhilov
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Blood Glucose ◽  
Waist Circumference ◽  
Arterial Hypertension ◽  
Multivariate Regression ◽  
Fasting Blood Glucose ◽  
Multivariate Regression Analysis ◽  
Epicardial Fat Thickness ◽  
Fat Thickness

Abstract Objective Arterial hypertension (HTN) is one of the most common diseases associated with obesity. Visceral obesity (VO) with dysfunctional visceral adipose tissue plays the main role in obesity induced HTN. Direct criteria of VO including echocardiographic epicardial fat thickness (EFT) may become an additional predictor of HTN. Purpose The aim was to assess the role of echocardiographic EFT (EEFT) as a predictor of HTN in normotensive patients with abdominal obesity (AO). Methods 526 normotensive men (according to ambulatory blood pressure monitoring (ABPM) without therapy) with AO (waist circumference (WC) &gt;94 cm) and SCORE &lt;5%, without cardiovascular diseases and diabetes mellitus were examined (age 45.1±5.0 years). The lipid and glucose profiles, creatinine, uric acid and C-reactive protein blood levels, albuminuria evaluation, echocardiography, carotid ultrasound, bifunctional ABPM were performed. The values of EEFT ≥75 percentile for persons 35–45 years and 46–55 years were 4.8 mm and 5.8 mm respectively. These values used as epicardial VO criteria. Patients with subclinical carotid atherosclerosis due to the lipid-lowering therapy administration (n=98) were excluded from the follow-up. Re-examination with ABPM was conducted on average through 46.3±5.1 months. Data were summarized as mean ± standard error, statistical analysis conducted with paired two-tailed t-tests, Pearson χ2 criterion and multivariate regression analysis. Results Data of 406 persons were available for analysis. HTN as average daily blood pressure ≥130/80 mm Hg was detected in 157 (38.7%) patients. These patients were characterized by initially higher values of age (45.9±4.6 years vs 44.3±4.9 years, p&lt;0.001), waist circumference (106.9±7.3 cm vs 104.2±7.3 cm, p&lt;0.001), body mass index (BMI) (32.0±3.3 kg/m2 vs 30.9±3.2 kg/m2, p&lt;0.001), average daily systolic and diastolic blood pressure (120.7/74.5±4.6/3.4 mm Hg vs 118.2/73.2±5.5/3.9 mm Hg, p&lt;0.001), EEFT (5.2±0.7 mm vs 4.4±1.0 mm, p&lt;0.001). The epicardial VO was initially detected in 95 (23.3%) patients. In patients with HTN the initial prevalence of epicardial VO was greater (58.0% vs 23.3%, p&lt;0.001). As predictors for the multivariate regression analysis the clinical and laboratory examinations data and EEFT were evaluated. According to the results a mathematical model for estimating the probability HTN was obtained: 0.696*fasting blood glucose + 0.198*systolic BP + 2.844*EFT – 40.166 (constant). Among these predictors EEFT was characterized by the highest standardized regression coefficient (0.302, p&lt;0.001) (0.295, p&lt;0.01 for fasting blood glucose, 0.035, p&lt;0.001 for systolic BP). The Hosmer-Lemeshow test value was 0.863, the total percentage of correct classifications was 86%, the area under the ROC-curve was 0.913. Conclusions EEFT (4.8 mm for persons 35–45 years and 5.8 mm for persons 46–55 years) may be an additional predictor of HTN in normotensive patients with AO. Funding Acknowledgement Type of funding source: None

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