RESUMEN
BACKGROUND: The triglyceride glucose (TyG) index has been suggested as a reliable surrogate marker of insulin resistance which is a substantial risk factor for atherosclerotic cardiovascular disease (ASCVD). Several recent studies have shown the relationship between the TyG index and cardiovascular disease; however, the role of the TyG index in coronary artery calcification (CAC) progression has not been extensively assessed especially in low-risk population. METHODS: We enrolled 5775 Korean adults who had at least two CAC evaluations. We determined the TyG index using ln (fasting triglycerides [mg/dL] x fasting glucose [mg/dL]/2). The CAC progression was defined as either incident CAC in a CAC-free population at baseline or an increase of ≥ 2.5 units between the square roots of the baseline and follow-up coronary artery calcium scores (CACSs) of subjects with detectable CAC at baseline. RESULTS: CAC progression was seen in 1,382 subjects (23.9%) during mean 3.5 years follow-up. Based on the TyG index, subjects were stratified into four groups. Follow-up CACS and incidence of CAC progression were markedly elevated with rising TyG index quartiles (group I [lowest]:17.6% vs. group II:22.2% vs. group III:24.6% vs. group IV [highest]: 31.3%, p < 0.001). In multivariate logistic regression analysis, the TyG index was independent predictor of CAC progression (odds ratio: 1.57; 95% confidence interval: 1.33 to 1.81; p < 0.001) especially in baseline CACS ≤ 100 group. CONCLUSION: The TyG index is an independent predictor of CAC progression in low-risk population. It adds incremental risk stratification over established factors including baseline CACS.
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Enfermedades Cardiovasculares , Enfermedad de la Arteria Coronaria , Adulto , Biomarcadores , Glucemia , Calcio , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Glucosa , Humanos , Pronóstico , Medición de Riesgo , Factores de Riesgo , TriglicéridosRESUMEN
BACKGROUND: The prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors. METHODS: Adult cancer patients, who underwent routine health examinations during 2009-2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (loge [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization. RESULTS: A total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01-1.14]); 10% elevated risk for a TyG index of 8.5-8.9 (aHR 1.10 [95% CI 1.03-1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15-1.31]); 34% elevated risk for a TyG index of 9.5-9.9 (aHR 1.34 [95% CI 1.23-1.47]); and 55% elevated risk for a TyG index ≥ 10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure. CONCLUSIONS: The TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors.
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Aterosclerosis , Supervivientes de Cáncer , Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Infarto del Miocardio , Neoplasias , Adulto , Anciano , Biomarcadores , Glucemia , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Femenino , Glucosa , Humanos , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Neoplasias/diagnóstico , Neoplasias/epidemiología , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , TriglicéridosRESUMEN
BACKGROUND AND AIMS: Women with obesity are highly predominant among patients with heart failure with preserved ejection fraction (HFpEF). We aimed to elucidate sex-specific associations of obesity with exercise capacity and diastolic function. METHODS AND RESULTS: Healthy individuals without known cardiovascular diseases undergoing cardiopulmonary exercise test and echocardiography (n = 736) were included and categorized into 4 groups according to their sex and obesity. Exercise capacity was lower in women than men. Obesity was associated with a lower exercise capacity in women (23.5 ± 7.3 vs. 21.3 ± 5.4 ml/kg/min, p < 0.05) but not in men (28.2 ± 7.8 vs. 28.0 ± 6.6 ml/kg/min, p > 0.10). Overall, women had a higher E/e' than men. Women without obesity had a similar E/e' to men with obesity (8.2 ± 1.8 vs. 8.4 ± 2.1, p > 0.10), and women with obesity had the highest E/e'. Among 5 risk factors (aging, obesity, elevated blood pressure, elevated heart rate, and elevated fasting glucose), obesity was a significant determinant of exercise intolerance in women but not men. Furthermore, obesity was associated with a greater risk of diastolic dysfunction in women than men (women, adjusted odds ratio 4.35 [95% confidence interval 2.44-7.74]; men, adjusted odds ratio 2.91 [95% confidence interval 1.42-5.95]). CONCLUSION: Obesity had a more deleterious effect on exercise capacity and diastolic function in women than men, even in a healthy cohort. These subclinical changes might contribute to the development of a female predominance among HFpEF patients, particularly among individuals with obesity.
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Tolerancia al Ejercicio , Insuficiencia Cardíaca/fisiopatología , Obesidad/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Adulto , Anciano , Estudios Transversales , Diástole , Femenino , Disparidades en el Estado de Salud , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/epidemiología , República de Corea/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets. METHODS: This study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived. RESULTS: The combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets. CONCLUSIONS: Smoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.
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Consumo de Bebidas Alcohólicas/sangre , Glucemia/metabolismo , Calcinosis/sangre , Enfermedad de la Arteria Coronaria/sangre , Fumar/sangre , Triglicéridos/sangre , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Área Bajo la Curva , Calcinosis/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Transversales , Conjuntos de Datos como Asunto , Humanos , Resistencia a la Insulina , Modelos Logísticos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Sistema de Registros , República de Corea/epidemiología , Factores de Riesgo , Fumar/epidemiologíaRESUMEN
Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that affects half of all patients with HF. It is rising in prevalence, is associated with high morbidity and mortality, and has very few effective treatments. HFpEF is currently understood as a heterogeneous syndrome originating from the interplay of cardiac and extracardiac abnormalities. The most important pathophysiology in patients with HFpEF is diastolic dysfunction, which presents with impairments in relaxation or increases in chamber stiffness that lead to an increase in left ventricular filling pressures at rest or during exercise that causes dyspnea.
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Manejo de la Enfermedad , Ejercicio Físico/fisiología , Insuficiencia Cardíaca/fisiopatología , Volumen Sistólico/fisiología , Insuficiencia Cardíaca/terapia , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Data on the relationship between the triglyceride glucose (TyG) index and coronary artery calcification (CAC) progression is limited. This longitudinal study evaluated the association of TyG index with CAC progression in asymptomatic adults. METHODS: We enrolled 12,326 asymptomatic Korean adults who had at least two CAC evaluations. The TyG index was determined using ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). CAC progression was defined as a difference ≥ 2.5 between the square roots (â) of the baseline and follow-up coronary artery calcium score (CACS) (Δâtransformed CACS). Annualized Δâtransformed CACS was defined as Δâtransformed CACS divided by the inter-scan period. RESULTS: During a mean 3.3 years, the overall incidence of CAC progression was 30.6%. The incidence of CAC progression (group I [lowest]: 22.7% versus [vs.] group II: 31.7% vs. group III [highest]: 37.5%, P < 0.001) and annualized Δâtransformed CACS (group I: 0.46 ± 1.44 vs. group II: 0.71 ± 2.02 vs. group III: 0.87 ± 1.75, P < 0.001) were markedly elevated with increasing TyG index tertiles. Multivariate linear regression analysis showed that TyG index was associated with annualized Δâtransformed CACS (ß = 0.066, P = 0.036). In multivariate logistic regression analysis, the TyG index was significantly associated with CAC progression in baseline CACS ≤ 100. CONCLUSION: The TyG index is an independent predictor of CAC progression, especially in adults without heavy baseline CAC.
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Glucemia/análisis , Enfermedad de la Arteria Coronaria/sangre , Triglicéridos/sangre , Calcificación Vascular/sangre , Adulto , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Progresión de la Enfermedad , Ayuno/sangre , Femenino , Humanos , Incidencia , Resistencia a la Insulina , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Sistema de Registros , República de Corea/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/epidemiologíaRESUMEN
BACKGROUND: Data on the influence of glycemic status on the progression of coronary calcification, an important marker for future adverse cardiovascular events, are limited. METHODS: Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry on 12,441 asymptomatic Korean adults (52 ± 9 years, 84.2% males) without previous history of coronary artery disease and stroke, who underwent serial coronary artery calcification (CAC) screening examinations, were included in this study. The median inter-scan period was 3.0 (2.0-4.8) years. All participants were categorized into three groups based on their glycemic status: normal (n = 6578), pre-diabetes (n = 4146), and diabetes (n = 1717). CAC progression was defined as a difference ≥ 2.5 between the square roots (â) of the baseline and follow-up CAC scores. RESULTS: The incidence of CAC progression was significantly different between the three groups (normal, 26.3%; pre-diabetes, 30.9%; and diabetes, 46.9%; p < 0.001). In the univariate logistic analysis, the risk of CAC progression was higher in the pre-diabetes (odds ratio [OR] 1.253; 95% confidential interval [CI] 1.150-1.366) and diabetes (OR 2.471; 95% CI 2.215-2.758) groups than in the normal group (p < 0.001, both). In the multivariate logistic analysis, the risk of CAC progression was not significantly different between the normal and pre-diabetes groups but was significantly higher in the diabetes group than in the normal group. CONCLUSIONS: In asymptomatic subjects, diabetes had an incremental impact on CAC progression; however, pre-diabetes did not increase the risk of CAC progression after adjusting for confounding factors.
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Glucemia/metabolismo , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Diabetes Mellitus/sangre , Tomografía Computarizada Multidetector , Calcificación Vascular/diagnóstico por imagen , Adulto , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Progresión de la Enfermedad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estado Prediabético/sangre , Estado Prediabético/diagnóstico , Estado Prediabético/epidemiología , Valor Predictivo de las Pruebas , Sistema de Registros , República de Corea/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Calcificación Vascular/epidemiologíaRESUMEN
PURPOSE: Recently, the diastolic strain rate (DSR) utilizing speckle-tracking echocardiography has been proposed as a novel parameter for left ventricular diastolic function. We aimed to present normal reference data for those in a large-sized, selected group of healthy individuals. METHODS: The current study was a part of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL), a prospective nationwide survey from 23 centers in Korea. We analyzed 447 subjects (age 48 ± 15 years, 234 females) without any history of cardiovascular disease and presented the early and late DSRs (SRe and SRa , respectively) in a total and gender-/age-specified groups. RESULTS: Among the total subjects, the mean SRe and SRa were 1.6 ± 0.4 S-1 and 0.8 ± 0.3 S-1 , respectively. With increasing age, there were significant trends of decreasing SRe and increasing SRa . Although both gender groups showed comparable age, the female group presented significantly higher SRe compared to male subjects with age of 20-59 years, which diminished after the age of 60 years. However, the SRa was comparable between genders in all age groups. On multiple linear regression, age showed independent associations with both SRe (ß = -0.132, P = .010) and SRa (ß = 0.440, P < .001), whereas gender did not show any association with SRe or SRa . CONCLUSION: We present normal reference data of a novel parameter, DSR, in a large-sized selected group with healthy Korean subjects. Additionally, we present significant age-related changes both in SRe and SRa without the impact of their gender.
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Diástole/fisiología , Ecocardiografía/métodos , Corazón/fisiología , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Valores de Referencia , República de Corea , Factores SexualesRESUMEN
BACKGROUND: The purpose of this study was to describe and analyze the relationship between statin benefit groups based on statin-intensity class of drugs and coronary artery calcium score (CACS) using multidetector computed tomography (MDCT) in an asymptomatic Korean population. METHODS: A total of 3914 asymptomatic individuals (mean age: 55 ± 10 years; male: female = 2649: 1265) who underwent MDCT for health examination between January 2009 and December 2012 were retrospectively enrolled. They were categorized into three groups based on statin-intensity class of drugs (high-intensity (n = 1284, 32.8%); moderate-intensity (n = 1602, 40.9%) and low-intensity (n = 931, 23.8%) statin therapy groups) according to the American College of Cardiology (ACC)/American heart Association (AHA) 2013 guideline and the relationship between CACS and statin benefit group was analyzed. The statin benefit group was defined as individuals who should be considered moderate- and high-intensity statin therapy. RESULTS: Ten-year atherosclerotic cardiovascular disease (ASCVD; 12.6 ± 5.3% vs. 2.9 ± 1.9%, p < 0.001) and CACS (98 ± 270 vs. 3 ± 2, p < 0.001) were significantly higher in the high-intensity group compared to the moderate-intensity statin therapy group. In the high-intensity statin therapy group, age [odds ratio: 1.299 (1.137-1.483), p < 0.001], male gender [odds ratio: 44.252 (1.959-999.784), p = 0.001], and fasting blood glucose [odds ratio: 1.046 (1.007-1.087), p = 0.021] were independent risk factors associated with CACS ≥300 on multivariate logistic regression analysis. CONCLUSIONS: CACS on MDCT might be an important complementary tool for cardiovascular disease risk stratification. This study indicates that individualization of statin therapy as well as lifestyle modification will be useful in asymptomatic individuals, especially those in whom high-intensity statin therapy is required.
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Calcio/metabolismo , Enfermedades Cardiovasculares/diagnóstico por imagen , Vasos Coronarios/metabolismo , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Anciano , Aterosclerosis/etiología , Aterosclerosis/prevención & control , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Factores de RiesgoRESUMEN
BACKGROUND: Doppler-driven net atrioventricular compliance (Cn ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). HYPOTHESIS: We hypothesized that decreases in Cn during early-stage exercise underlie exercise intolerance in patients with MS. METHODS: Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. RESULTS: Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative Cn decrease at 50 W (expressed as a percentage of the resting Cn ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P < .001). The overall decrease in relative Cn was significantly greater in the exercise-intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P < .0001 for interaction). Multivariate analysis revealed that the relative Cn decrease at 50 W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. CONCLUSIONS: Decreases in Cn during early-stage exercise are an important mechanism underlying exercise intolerance in MS.
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Ecocardiografía/métodos , Tolerancia al Ejercicio/fisiología , Ejercicio Físico/fisiología , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/fisiopatología , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Here, we report a rare case of isolated leukemic infiltrate of the myocardium (extramedullary involvement) presenting as restrictive cardiomyopathy in a patient in complete remission of acute myeloid leukemia. It was evaluated with multimodality imaging studies (echocardiography and cardiac MRI) and further confirmed by pathology. The present case highlights the importance of maintaining a high degree of clinical suspicion when evaluating patients with progressive ventricular hypertrophy of unknown cause, including recognition of the potential involvement by recurrent hematologic malignancy.
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Cardiomiopatía Restrictiva/diagnóstico , Ecocardiografía/métodos , Leucemia Mieloide Aguda/complicaciones , Infiltración Leucémica/diagnóstico , Miocardio/patología , Cardiomiopatía Restrictiva/etiología , Humanos , Hipertrofia , Imagen por Resonancia Cinemagnética/métodos , Masculino , Persona de Mediana Edad , Inducción de RemisiónRESUMEN
BACKGROUND: Left ventricular apical aneurysm (LVAA) is a serious complication associated with myocardial infarction. However, the effects of a previously formed LVAA on long-term left ventricular (LV) geometry and clinical outcomes have not been fully evaluated. METHODS: From January 2009 to May 2015, we retrospectively identified 70 patients (mean age, 66 ± 12 years; males, 72.9%) with an LVAA due to ischemia. These patients were classified into two groups according to the initial apical conicity ratio (ACR): large LVAA group (ACR ≥ 1.5, n = 40) and small LVAA group (ACR < 1.5, n = 30). An adverse outcome was defined as a composite of fatal arrhythmia, embolic infarction, and readmission due to heart failure. RESULTS: The ACR significantly decreased over the first month and then increased after 1 and 3 years of follow-up. The other examined echocardiographic indexes did not exhibit temporal changes. During the follow-up period (median 1138 days), the large LVAA group experienced a lower event-free survival (P = 0.016). In a multivariate Cox model, the presence of a large LVAA (adjusted hazard ratio [HR] = 2.795, 95% confidence interval [CI] = 1.118-6.986, P = 0.028) and the initial LV ejection fraction (EF) (adjusted HR = 0.964, 95% CI = 0.932-0.997, P = 0.034) were independent predictors of adverse outcomes. CONCLUSIONS: This study demonstrates that LVAAs undergo a dynamic process and that large LVAAs are associated with adverse outcomes. Our results suggest that the ACR could be helpful for predicting adverse outcomes in patients with apical aneurysm.
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Embolia/mortalidad , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/mortalidad , Ventrículos Cardíacos/diagnóstico por imagen , Readmisión del Paciente/estadística & datos numéricos , Anciano , Comorbilidad , Ecocardiografía/estadística & datos numéricos , Embolia/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Aneurisma Cardíaco/terapia , Ventrículos Cardíacos/patología , Humanos , Estudios Longitudinales , Masculino , Tamaño de los Órganos , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , República de Corea/epidemiología , Factores de Riesgo , Sensibilidad y Especificidad , Tasa de Supervivencia , Disfunción Ventricular IzquierdaRESUMEN
Radiofrequency catheter ablation (RFCA) is a useful therapeutic option for atrial fibrillation (AF), although outcomes are less effective for persistent AF. The aim of this study was to elucidate the echocardiographic parameters associated with successful RFCA in patients with persistent AF.A total of 159 patients (mean age, 60.8 ± 9.6 years, 125 males [78.6%]) who underwent RFCA for persistent AF from April 2009 to May 2014 were included, retrospectively. Transthoracic echocardiography was performed at baseline, 3 months, 6 months, and 1 year following RFCA. The subjects were divided into 2 groups, a recurrence group and a non-recurrence group. One hundred eleven of the 159 patients (69.8%) remained free from recurrent atrial tachyarrhythmia during follow-up (mean, 20.6 ± 17.4 months). Peak A wave velocity (38.1 ± 14.1 in the recurrence group; 48.0 ± 20.7 in the non-recurrence group, P = 0.01), peak E wave velocity (76.4 ± 19.1 versus 68.8 ± 19.5, P = 0.03), deceleration time (196.3 ± 54.4 versus 219.9 ± 64.1, P = 0.04), and left atrial (LA) diameter (44.5 ± 7.3 versus 41.0 ± 5.6, P = 0.01) at 3 months after ablation were significantly different between the two groups. Among echocardiographic parameters, peak A wave velocity (OR 0.96, 95% confidence interval [CI] 0.92-0.99) and LA diameter (OR 1.13, 95% CI 1.011.25) were associated with AF recurrence.After RFCA for persistent AF, LA anatomical and functional changes occurred during a 3-month blanking period. Restoration of peak A wave velocity and LA size are associated with successful ablation.
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Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Ablación por Catéter , Sistema de Conducción Cardíaco/fisiopatología , Válvula Mitral/fisiopatología , Anciano , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/mortalidad , Índice de Masa Corporal , Ablación por Catéter/instrumentación , Ablación por Catéter/métodos , Ecocardiografía/métodos , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Recurrencia , Flujo Sanguíneo Regional , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Microvascular obstruction becomes more severe with longer duration of ischemia, such as chronic total occlusion (CTO) which used to have collateral flow. In this study, we explored the correlation between parameters measured using quantitative myocardial perfusion contrast echocardiography (MCE) and the angiographic collateral flow grades in patients with CTO. Furthermore, we investigated the usefulness of the parameters of quantitative MCE for the measurement of microvasculature changes after revascularization of CTO lesions. METHODS: Between January 2011 and January 2013, 44 patients who had undergone coronary angiography (CAG) due to chest pain and had confirmed CTO lesions were enrolled in this prospective observational study. All patients had baseline MCE within 24 hours after diagnostic CAG. Patients were then assigned to one of two groups: a medical therapy group (Group I, n = 20) or a reperfusion group with percutaneous coronary intervention (PCI) (Group II, n = 24). All patients had follow-up MCE 3 months later. RESULTS: Consistent with the CAG results in both groups, on baseline MCE, the myocardial blood flow (AI × ß) values were higher in Grade III collateral flow than in Grade I or II collateral flow (AI of collateral flow Grade I vs. Grade II vs. Grade III: 2.34 ± 2.65 vs. 2.52 ± 2.67 vs. 3.87 ± 4.57, P = 0.038). The plateau acoustic intensity (AI) and wall-motion score index (WMSI) were significantly improved at the 3-month follow-up after successful reperfusion with PCI (5.75 ± 3.52 before vs. 8.11 ± 6.02 after, P = 0.004) and (1.76 ± 0.83 before vs. 1.43 ± 0.64 after, P ≤ 0.001), respectively. However, the AI and WMSI values were not improved in the medical treatment group, (6.04 ± 4.64 before vs. 6.01 ± 5.52 after, P = 0.966) and (1.61 ± 0.82 before vs. 1.66 ± 0.67 after, P = 0.616), respectively. CONCLUSIONS: MCE is a useful tool for estimating microvascularity in patients with CTO lesions and correlates well with angiographic collateral flow.
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Estenosis Coronaria/diagnóstico por imagen , Ecocardiografía/métodos , Microvasos/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , Neovascularización Patológica/diagnóstico por imagen , Anciano , Algoritmos , Enfermedad Crónica , Circulación Colateral , Medios de Contraste , Estenosis Coronaria/complicaciones , Estenosis Coronaria/fisiopatología , Femenino , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Microvasos/fisiopatología , Persona de Mediana Edad , Neovascularización Patológica/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Despite recent advances in understanding of the pathobiology and targeted treatments of pulmonary arterial hypertension (PAH), epidemiologic data from large populations have been limited to western countries. The aim of the Korean Registry of Pulmonary Arterial Hypertension (KORPAH) was to examine the epidemiology and prognosis of Korean patients with PAH. KORPAH was designed as a nationwide, multicenter, prospective data collection using an internet webserver from September 2008 to December 2011. A total of 625 patients were enrolled. The patients' mean age was 47.6 ± 15.7 yr, and 503 (80.5%) were women. The diagnostic methods included right heart catheterization (n = 249, 39.8%) and Doppler echocardiography (n = 376, 60.2%). The etiologies, in order of frequency, were connective tissue disease (CTD), congenital heart disease, and idiopathic PAH (IPAH) (49.8%, 25.4%, and 23.2%, respectively). Patients with WHO functional class III or IV at diagnosis were 43.4%. In total, 380 (60.8%) patients received a single PAH-specific treatment at the time of enrollment, but only 72 (18.9%) patients received combination therapy. Incident cases during the registry represented 297 patients; therefore, the incidence rate of PAH was 1.9 patients/yr/million people. The 1st-, 2nd-, and 3rd-yr estimated survival rates were 90.8%, 87.8%, and 84.4%, respectively. Although Korean PAH patients exhibited similar age, gender, and survival rate compared with western registries, they showed relatively more CTD-PAH in the etiology and also systemic lupus erythematosus among CTD-PAH. The data suggest that earlier diagnosis and more specialized therapies should be needed to improve the survival of PAH patients.
Asunto(s)
Bases de Datos Factuales , Hipertensión Pulmonar Primaria Familiar/epidemiología , Arteria Pulmonar/fisiopatología , Sistema de Registros , Adulto , Anciano , Enfermedades del Tejido Conjuntivo/complicaciones , Recolección de Datos , Hipertensión Pulmonar Primaria Familiar/mortalidad , Hipertensión Pulmonar Primaria Familiar/terapia , Femenino , Cardiopatías Congénitas/complicaciones , Humanos , Internet , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , República de Corea/epidemiología , Tasa de Supervivencia , Adulto JovenRESUMEN
Bacterial endocarditis secondary to jet streams from a congenital heart defect without valvular involvement is very rare, especially in adult patients. We report an unusual case of a 32-year-old woman with a previously known unrepaired ventricular septal defect (VSD) who presented with intermittent fever and chills after dental treatment and was diagnosed with isolated right-sided mural infective endocarditis associated with a muscular-type VSD. Echocardiography revealed a low echogenic, mobile vegetation along the right ventricular outflow tract (RVOT) free wall and a small-sized muscular-type VSD. The patient's blood culture grew Streptococcus viridians. After 3 weeks of antibiotic treatment, VSD patch closure was performed, and the vegetation on the RVOT endomyocardium was removed.
Asunto(s)
Endocarditis Bacteriana/etiología , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/cirugía , Infecciones Estreptocócicas/etiología , Estreptococos Viridans , Adulto , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Femenino , Defectos del Tabique Interventricular/diagnóstico , Humanos , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapiaRESUMEN
INTRODUCTION: The aim of this study was to investigate the role of Doppler-derived left ventricular (LV) -dP/dt in predicting atrial fibrillation (AF) or ischemic stroke in patients with moderate to severe degenerative mitral regurgitation (MR). METHODS: Doppler-derived LV -dP/dt was determined from the continuous-wave Doppler spectrum of the MR jet (-dP/dt = 32/time between 3 and 1 m/sec) in 80 patients (mean age 59 ± 16 years, 41% men) with moderate to severe degenerative MR, normal LV ejection fraction (LVEF ≥ 60%), and sinus rhythm at diagnosis. Events were defined as new AF or ischemic stroke. RESULTS: During a mean follow-up of 18 ± 13 months, there were 9 events (6 new AF, 3 ischemic strokes). Univariate analysis showed that older age, decreased LV -dP/dt, increased LV mass index, and left atrial volume index (LAVI), shortened deceleration time (DT), reduced A' velocity, and elevated E/E' ratio, prolongation of pulmonary venous (PV) atrial reversal (AR) flow duration relative to mitral inflow A-wave duration (AR-Adur) were associated with events. In multivariate Cox regression analysis, Doppler-derived LV -dP/dt (for each 100 mmHg/sec increase, hazard ratio: 0.165, 95% confidence interval: 0.036-0.761, P = 0.021) and E/E' (hazard ratio: 0.820, 95% confidence interval: 0.682-0.987, P = 0.036) were significant independent predictors of AF or ischemic stroke. CONCLUSIONS: Doppler-derived LV -dP/dt is independently associated with the occurrence of AF or ischemic stroke in patients with moderate to severe degenerative MR and provides additional prognostic information.
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Fibrilación Atrial/diagnóstico por imagen , Ecocardiografía Doppler/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Volumen Sistólico/fisiología , Accidente Cerebrovascular/diagnóstico por imagen , Adulto , Anciano , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/etiología , Isquemia Encefálica/patología , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiología , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
Congenital extrahepatic portocaval shunt (CEPS) is a rare anomaly of the mesenteric vasculature in which the intestinal and splenic venous drainage bypasses the liver and drains directly into the inferior vena cava, the left hepatic vein or the left renal vein. This uncommon disease is frequently associated with other malformations and mainly affects females. Here we report a case of pulmonary arterial hypertension associated with CEPS (Abernethy type 1b shunt) in a 20-yr-old man who was incidentally diagnosed during evaluation of multiple nodules of the liver. The patient was treated by inhalation of iloprost (40 µg/day) with improved condition and walking test. Physicians should note that congenital portocaval shunt may cause pulmonary hypertension.
Asunto(s)
Hipertensión Pulmonar/diagnóstico , Vena Cava Inferior/anomalías , Ecocardiografía Doppler , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Iloprost/uso terapéutico , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Arterias Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vasodilatadores/uso terapéutico , Vena Cava Inferior/diagnóstico por imagen , Adulto JovenRESUMEN
The prevention and management of cancer therapy-related cardiac dysfunction (CTRCD) have become increasingly important. Recent studies have revealed the crucial role of genetics in determining the susceptibility to development of CTRCD. We present a case of a 65-year-old woman with breast cancer who developed recurrent CTRCD following low-dose chemotherapy, despite lacking conventional cardiovascular risk factors. Her medical history included anthracycline-associated cardiomyopathy, and her condition deteriorated significantly after treatment with HER2-targeted therapies. Through the use of multimodal imaging, we detected severe left ventricular systolic dysfunction. Further investigation with genetic testing revealed a likely pathogenic variant in the TNNT2 gene, suggesting a genetic predisposition to CTRCD. This case implies the potential role of genetic screening in identifying patients at risk for CTRCD and advocates for personalized chemotherapy and cardioprotective strategies.
Asunto(s)
Neoplasias de la Mama , Cardiomiopatías , Predisposición Genética a la Enfermedad , Humanos , Femenino , Anciano , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Cardiomiopatías/inducido químicamente , Cardiomiopatías/diagnóstico , Cardiomiopatías/genética , Ecocardiografía , Antineoplásicos/efectos adversos , Troponina T/genéticaRESUMEN
AIMS: Cardiovascular health is acknowledged as a crucial concern among cancer survivors. Socioeconomic status (SES) is an essential but often neglected risk factor for cardiovascular disease (CVD). We conducted this study to identify the relationship between SES and CVD mortality in cancer survivors. METHODS AND RESULTS: Using the National Health Insurance Service-National Health Examinee database, we identified cancer survivors diagnosed and surviving beyond 5 years post-diagnosis. SES was assessed based on insurance premiums and classified into 5 groups. The primary outcome was overall CVD mortality. This study analyzed 170 555 individuals (mean age 60.7 ± 11.9 years, 57.8% female). A gradual increase in risk was observed across SES groups: adjusted hazard ratios (95% confidence intervals) for overall CVD mortality were 1.15 (1.04-1.26), 1.28 (1.15-1.44), 1.31 (1.18-1.46), and 2.13 (1.30-3.49) for the second, third, and fourth quartile, and medical aid group (the lowest SES group) compared to the highest SES group, respectively (p for trend < 0.001). The lowest SES group with hypertension exhibited a 3.4-fold higher risk of CVD mortality compared to the highest SES group without hypertension. Interaction analyses revealed that low SES synergistically interacts with hypertension, heightening the risk of CVD mortality (synergy index 1.62). CONCLUSION: This study demonstrates a significant correlation between low SES and increased CVD mortality among cancer survivors. Particularly, the lowest SES group, when combined with hypertension, significantly escalates CVD mortality. Our findings underscore the critical importance of recognizing SES as a significant risk factor for CVD mortality in this population of cancer survivors.
Our population-based cohort study, involving over 170 000 cancer survivors, demonstrates a significant association between socioeconomic status (SES) and cardiovascular disease (CVD) mortality.