Aim
Left ventricular (LV) global longitudinal strain (GLS) may detect subtle abnormalities in myocardial contractility among individuals with normal LV ejection fraction (LVEF). However, the ...prognostic implications of GLS among healthy, community‐dwelling adults is not well‐established.
Methods and results
Overall, 2234 community‐dwelling adults (56% women, 47% Black) with LVEF ≥50% without a history of cardiovascular disease (CVD) from the Dallas Heart Study who underwent cardiac magnetic resonance (CMR) with GLS assessed by feature tracking CMR (FT‐CMR) were included. The association of GLS with the risk of incident major adverse cardiovascular events (MACE; composite of incident myocardial infarction, incident heart failure HF, hospitalization for atrial fibrillation, coronary revascularization, and all‐cause death), and incident HF or death were assessed with adjusted Cox proportional hazards models. A total of 309 participants (13.8%) had MACE during a median follow‐up duration of 17 years. Participants with the worst GLS (Q4) were more likely male and of the Black race with a history of tobacco use and diabetes with lower LVEF, higher LV end‐diastolic volume, and higher LV mass index. Cumulative incidence of MACE was higher among participants with worse (Q4 vs. Q1) GLS (20.4% vs. 9.0%). In multivariable‐adjusted Cox models that included clinical characteristics, cardiac biomarkers and baseline LVEF, worse GLS (Q4 vs. Q1) was associated with a significantly higher risk of MACE (hazard ratio HR 1.55, 95% confidence interval CI 1.07–2.24, p = 0.02) and incident HF or death (HR 1.57, 95% CI 1.03–2.38, p = 0.04).
Conclusions
Impaired LV GLS assessed by FT‐CMR among adults free of cardiovascular disease is associated with a higher risk of incident MACE and incident HF or death independent of cardiovascular risk factors, cardiac biomarkers and LVEF.
Left ventricular (LV) global longitudinal strain (GLS) assessed via feature tracking cardiac magnetic resonance imaging is associated with increased risk of major adverse cardiovascular events (MACE). LV GLS is associated with MACE in adults without prevalent cardiovascular disease (CVD). Among participants without pre‐existing CVD, a higher burden of cardiovascular (CV) risk factors was associated with impairment of LV GLS. CI, confidence interval; EDMi, end‐diastolic mass index; HF, heart failure; HR, hazard ratio; LVEF, left ventricular ejection fraction.
Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (E
), an intermediate ...phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with E
independent of each other and other potential confounders is not known.
Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and E
quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with E
after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis.
The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in E
. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in E
(β: 0.19, P = 0.002). SAT and LBF were not significantly associated with E
, however, CRF remained associated with E
in the fully adjusted model including all fat depots (β: - 0.15, P < 0.001).
VAT and CRF are each independently associated with impairment in E
, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.
•We examine the burden of lifetime healthcare expenses among disadvantaged individuals.•Black men have higher lifetime healthcare expenses compared to other demographic groups.•Lifetime healthcare ...expenditure tends to increase with higher cardiovascular risk factor prevalence.
To understand the burden of healthcare expenses over the lifetime of individuals and evaluate differences among those with cardiovascular risk factors and among disadvantaged groups based on race/ethnicity and sex.
We linked data from the longitudinal multiethnic Dallas Heart Study, which recruited participants between 2000 and 2002, with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through December 2018, capturing encounter expenses. Race/ethnicity and sex, as well as five risk factors, hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity, were defined at cohort enrollment. For each individual, expenses were indexed to age and cumulated between 40 and 80 years of age. Lifetime expenses across exposures were evaluated as interactions in generalized additive models.
A total of 2184 individuals (mean age, 45±10 years; 61% women, 53% Black) were followed between 2000 and 2018. The mean modeled lifetime cumulative healthcare expenses were $442,629 (IQR, $423,850 to $461,408). In models that included 5 risk factors, Black individuals had $21,306 higher lifetime healthcare spending compared with non-Black individuals (P < .001), and men had modestly higher expenses than women ($5987, P < .001). Across demographic groups, the presence of risk factors was associated with progressively higher lifetime expenses, with significant independent association of diabetes ($28,075, P < .001), overweight/obesity ($8816, P < .001), smoking ($3980, P = .009), and hypertension ($528, P = .02) with excess spending.
Our study suggests Black individuals have higher lifetime healthcare expenses, exaggerated by the substantially higher prevalence of risk factors, with differences emerging in older age.
Telltale T Waves Kondamudi, Nitin; Ali, Shah R.; Khera, Amit
The American journal of medicine,
February 2019, 2019-02-00, 20190201, Letnik:
132, Številka:
2
Journal Article
Purpose of review
Sudden cardiac death is a feared outcome in young athletes. In rare cases, premature ventricular contractions (PVCs) can be associated with underlying structural or genetic heart ...disease and reflect a higher risk of sudden cardiac death. Given that PVCs are common among athletes and the potential risk associated with them, comprehensive evaluation should be performed without exposing athletes to excessive testing. Furthermore, athletes may necessitate treatment with medications or ablation to reduce symptoms and prevent PVC-associated cardiomyopathy.
Recent findings
New diagnostic strategies have emerged to more effectively evaluate PVCs in athletes. Recent innovations in PVC ablation techniques may make ablation a more safe and durable strategy for reducing PVC burden.
Summary
We recommend athletes with PVCs be risk-stratified according to prognostic factors. Risk assessment can inform the testing strategy. Athletes who are symptomatic or who have high PVC burden should undergo treatment with PVC ablation.
Introduction: Diabetic cardiomyopathy (DbCM) is characterized by abnormalities in cardiac structure or function in the absence of cardiovascular (CV) disease. The prevalence of DbCM and its ...independent contribution to the risk of heart failure (HF) among community-dwelling individuals with prediabetes or diabetes (Pre-DM/DM) is not well known.
Methods: Adults without prevalent CAD or HF were pooled from 3 community-based cohort studies (ARIC, CHS, and CRIC cohorts). Presence of DbCM in patients with Pre-DM/DM was defined by elevated NT-proBNP levels (>125 in normal/overweight or >100 pg/mL in obese) plus either ≥1 or ≥2 echocardiographic abnormalities (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction). The DbCM definition with ≥2 echo abnormalities was used for the primary analysis and the cohort was stratified into three groups: euglycemia, pre-DM/DM without DbCM, and pre-DM/DM with DbCM. Kaplan-Meier and Cox models adjusted for demographics, CV risk factors, and kidney function were used to evaluate the risk of overt HF across the study groups.
Results: The study included 10,208 individuals, of which 6,852 had pre-DM/DM. The prevalence DbCM in the overall cohort was 6.6% and 19.5% based on the presence of ≥2 or ≥1 echocardiographic abnormalities with elevated NT-proBNP levels. Over 10-year follow up, individuals with pre-DM/DM had a higher risk for overt HF than euglycemic individuals (10.1% vs. 6.4%). Among individuals with pre-DM/DM, presence of DbCM identified a higher risk subset of individuals with significantly greater risk for developing overt HF as compared with pre-DM/DM without DbCM in unadjusted (19.6% vs. 9.1%) as well as adjusted analysis (HR 95% CI pre-DM/DM without DbCM = 1.32 1.12-1.55, pre-DM/DM with DbCM = 2.28 1.81-2.86, ref: euglycemia).
Conclusions: Presence of DbCM in individuals with pre-DM/DM identifies a high-risk subgroup for development of overt HF.
Disclosure
M. W. Segar: None. K. Patel: None. N. Kondamudi: None. A. Pandey: None.
Funding
Applied Therapeutics
Purpose of Review
Current risk prediction tools do not include physical activity (PA) or cardiorespiratory fitness (CRF), despite their robust association with adverse cardiovascular disease (CVD) ...events and their potential as targets for preventive interventions.
Recent Findings
PA and CRF are each associated with cardiovascular (CV) morbidity and mortality, independent of traditional risk factors. Improvement in CRF is associated with reduced risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Risk prediction tools have been developed for ASCVD, and more recently for HF, to refine CVD risk assessment and inform CVD prevention strategies. Attempts have been made to incorporate PA and CRF into available CVD risk prediction models.
Summary
Inclusion of PA and CRF into established CVD risk assessment models improves CVD risk prediction incremental to established CVD risk prediction tools, suggesting PA and CRF are markers of CVD risk and targets for CVD prevention.
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF ...with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
•Regular moderate intensity aerobic exercise reduces the risk of atherosclerotic coronary artery disease.•Higher levels of exercise, above the current guideline recommended levels of 500–1000 MET-min/week, may be needed to significantly lower the risk of heart failure.•Low fitness and physical inactivity associated risk of heart failure is driven by greater risk of heart failure with preserved ejection fraction.•Prolonged high intensity aerobic exercise over a lifetime may accelerate subclinical coronary atherosclerosis and increase the risk of atrial fibrillation.
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