Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study.

Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid-60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end-systolic volume was 0.09 mL (95% CI, 0.04-0.14 mL) larger per 1-mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.

Prevalence of atrial fibrillation and cardiovascular risk factors in a 63-65 years old general population cohort: the Akershus Cardiac Examination (ACE) 1950 Study.

OBJECTIVES: To investigate the sex-specific prevalence of atrial fibrillation (AF), including subclinical AF found by screening in a general population aged 63-65 years. The prevalence of cardiovascular risk factors and their association with AF will also be investigated. DESIGN: Cross-sectional analysis of an observational, prospective, longitudinal, population-based cohort study. SETTING: General population in Akershus county, Norway. PARTICIPANTS: Women and men born in 1950. We included 3706 of 5827 eligible individuals (63.6%); 48.8% were women. METHODS: All participants underwent extensive cardiovascular examinations, including 12-lead ECG. History of AF and other cardiovascular diseases were self-reported. Subsequent validation of all reported or detected AF diagnoses was performed. RESULTS: Mean age was 63.9±0.7 years. Prevalence of ECG-verified AF was 4.5% (women 2.4%, men 6.4%; p<0.001), including screen-detected AF in 0.3% (women 0.1%, men 0.6%; p<0.01). Hypertension was found in 62.0% (women 57.8%, men 66.0%; p<0.001). Overweight or obesity was found in 67.6% (women 59.8%, men 74.9%; p<0.001). By multivariate logistic regression, risk factors associated with AF were height (OR 1.67 per 10 cm; 95% CI 1.26 to 2.22; p<0.001), weight (OR 1.15 per 10 kg; 95% CI 1.01 to 1.30; p=0.03), hypertension (OR 2.49; 95% CI 1.61 to 3.86; p<0.001), heart failure (OR 3.51; 95% CI 1.71 to 7.24; p=0.001), reduced estimated glomerular filtration rate (OR 2.56; 95% CI 1.42 to 4.60; p<0.01) and at least one first-degree relative with AF (OR 2.32; 95% CI 1.63 to 3.31; p<0.001), whereas male sex was not significantly associated (OR 1.00; 95% CI 0.59 to 1.68; p=0.99). CONCLUSION: In this cohort from the general population aged 63-65 years, we found a higher prevalence of known AF than previously reported below the age of 65 years. The additional yield of single time point screening for AF was low. Body size and comorbidity may explain most of the sex difference in AF prevalence at this age. TRIAL REGISTRATION NUMBER: NCT01555411; Results.

Troponinas de alta sensibilidad T vs I en Sindrome Coronario Agudo: Predicción de lesiones coronarias significativas y pronóstico a largo plazo / High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

Antecedentes: Los ensayos de troponinas cardíacas de alta sensibilidad (hs-cTn) tanto T e I son una herramienta crucial y bien establecida para el diagnóstico de infarto agudo de miocardio (IAM), ya que se ha demostrado ampliamente su superioridad respecto a las antiguas determinaciones de troponina. Sin embargo, eventuales diferencias entre ambos ensayos en la predicción de lesiones coronarias significativas y el pronóstico a largo plazo en pacientes con síndrome coronario agudo (SCA) no han sido aclarados completamente. Métodos: Se evaluaron las concentraciones séricas de hs-cTnT (Roche), hs-cTnI (Abbott) y porción amino-terminal del pro-péptido natriurético tipo B (NT-proBNP) (Roche) en 390 pacientes con SCA sin elevación del segmento ST, y se relacionaron con lesiones coronarias significativas detectadas por angiografía coronaria (definidas como estenosis >50% del diámetro luminal, con necesidad de revascularización) y con la precisión pronóstica de mortalidad cardiovascular, mortalidad por cualquier causa, así como también con el punto final compuesto por mortalidad cardiovascular y hospitalizaciones por IAM o insuficiencia cardiaca. Resultados: La media (+DE) del seguimiento fue de 2921+168 días. Las concentraciones absolutas de hs-cTnI fueron significativamente mayores que las concentraciones de hs-cTnT. La relación entre los biomarcadores analizados y lesiones coronarias significativas en angiografía coronaria, cuantificada por el área bajo la curva ROC (AUC), no reveló diferencias entre hs-cTnT [AUC, 0,81; IC del 95%, 0,77- 0,86] y hs-cTnI (AUC, 0,81; IC del 95%, 0,76-0,86; P=NS). Sin embargo, NT-proBNP fue superior a ambos ensayos de hs-cTn en relación con la precisión pronóstica tanto para mortalidad cardiovascular y por cualquier causa, como para el punto final compuesto durante el seguimiento, aún también en análisis multivariados. Conclusiones: Los determinaciones de hs-cTnT y hs-cTnI mostraron una capacidad similar para predecir lesiones coronarias significativas en pacientes con SCA sin elevación del segmento ST. NT-proBNP fue superior a ambos ensayos de uscTn, como marcador de pronóstico a largo plazo en este grupo de pacientes.

Background: High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. Methods: Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis >50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure. Results: The mean+SD follow-up was 2921+168 days. Absolute hs-cTnI concentrations were significantly higher than the hs-cTnT concentrations. The relationship between analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by the area under the ROC curve (AUC), revealed no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77-0.86] and hs-cTnI (AUC, 0.81; 95% CI, 0.76-0.86; P=NS). NT-proBNP was superior to both hs-cTn assays regarding prognostic accuracy for both cardiovascular and all-cause mortality and for the composite end point during follow-up, also in multivariate analyses. Conclusions: The hs-cTnT and hs-cTnI assays displayed a similar ability to predict significant coronary lesions in NSTE-ACS patients. NT-proBNP was superior to both hs-cTn assays as a marker of long-term prognosis in this patient group.