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1.
J Hypertens ; 38(6): 1140-1148, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32371804

RESUMEN

OBJECTIVES: Increased arterial stiffness is currently recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort. METHODS: We included 1156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by cardio-ankle vascular index (CAVI). Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit, and pump strain as well as left ventricular global longitudinal strain (LVGLS). RESULTS: CAVI was negatively correlated with reservoir and conduit strain (r = -0.37 and -0.45, both P < 0.001), whereas weakly, but positively correlated with LA volume index and pump strain (r = 0.12 and 0.09, both P < 0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors and LV morphology and function including LVGLS (standardized ß = -0.22 and -0.27, respectively, both P < 0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir and conduit strain (adjusted odds ratio = 2.61 and 3.73 vs. normal CAVI, both P < 0.01) in a fully adjusted model including laboratory and echocardiographic parameters. CONCLUSION: Arterial stiffness was independently associated with LA phasic function, even in the absence of overt cardiovascular disease, which may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.

2.
ESC Heart Fail ; 2020 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-32253826

RESUMEN

AIMS: Although serum uric acid (SUA) level is correlated with oxidative stress and serves as a marker of poor prognosis in heart failure patients, its possible association with subclinical left ventricular (LV) dysfunction has not been evaluated. This study aimed to investigate the association between SUA and subclinical LV dysfunction in a sample of a general population without overt cardiac disease. METHODS AND RESULTS: We examined 1175 participants who underwent extensive cardiovascular health check-up including laboratory tests and speckle-tracking echocardiography to assess LV global longitudinal strain (GLS). The association of SUA concentration, as a continuous variable and a categorical variable using quartiles, with the presence of abnormal LVGLS was assessed. Mean age was 62 ± 12 years, and 656 (56%) were male participants. Mean SUA was 5.6 ± 1.3 mg/dL (25th-75th percentile, 4.6-6.5 mg/dL). The prevalence of abnormal LVGLS (greater than -18.6%) was greatest in the upper quartile of SUA. In multivariable analysis, SUA as a continuous variable was significantly associated with abnormal LVGLS [adjusted odds ratio (OR), 1.26 per 1 mg/dL; P = 0.008] independent of traditional cardiovascular risk factors, pertinent laboratory parameters and echocardiographic measures, and medications. In the categorical analysis, the upper quartile of SUA was independently associated with abnormal LVGLS in a fully adjusted model (adjusted OR, 2.28 vs. lowest quartile; P = 0.020). CONCLUSIONS: In a sample of the general population, an elevated SUA was independently associated with subclinical LV dysfunction. Assessment of LVGLS may add important prognostic information in individuals with elevated SUA, even in the absence of overt cardiac disease.

4.
J Hypertens ; 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32004209

RESUMEN

OBJECTIVES: Increased arterial stiffness is currently recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort. METHODS: We included 1156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by cardio-ankle vascular index (CAVI). Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit, and pump strain as well as left ventricular global longitudinal strain (LVGLS). RESULTS: CAVI was negatively correlated with reservoir and conduit strain (r = -0.37 and -0.45, both P < 0.001), whereas weakly, but positively correlated with LA volume index and pump strain (r = 0.12 and 0.09, both P < 0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors and LV morphology and function including LVGLS (standardized ß = -0.22 and -0.27, respectively, both P < 0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir and conduit strain (adjusted odds ratio = 2.61 and 3.73 vs. normal CAVI, both P < 0.01) in a fully adjusted model including laboratory and echocardiographic parameters. CONCLUSION: Arterial stiffness was independently associated with LA phasic function, even in the absence of overt cardiovascular disease, which may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.

5.
Int Heart J ; 61(1): 15-20, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32009122

RESUMEN

Body weight gain in middle age is thought to be mainly attributable to body fat gain. However, the association between the change in body weight and change in fat weight is not fully understood. In this study, we aimed to clarify the association between the changes in body weight and fat weight in a middle-aged general population using a community-based cohort. We studied 3,193 subjects who underwent health check-ups. Fat weight was measured using a TANITA DC-270A body composition analyzer (Tanita Corporation, Tokyo). Good correlation was observed between the changes in body weight and fat weight (Pearson r = 0.88, P < 0.001). Among the study subjects, 408 (13%) were categorized in the weight loss group (weight loss ≥ 5%), 2,442 (76%) in the weight stable group, and 343 (11%) in the weight gain group (weight gain ≥ 5%). The percentage of change in fat weight in relation to the change in body weight was 65% on average in subjects with body weight loss, and 70% on average in those with body weight gain. Good correlation between changes in body weight and fat weight was observed regardless of age, gender, and baseline body mass index. A change in body weight was closely correlated with a change in fat weight among the middle-aged general population. Body weight change in the middle-age population appears to be mainly attributable to the change in fat weight.


Asunto(s)
Tejido Adiposo/crecimiento & desarrollo , Peso Corporal/fisiología , Aumento de Peso/fisiología , Tejido Adiposo/fisiología , Anciano , Composición Corporal , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología
6.
Pediatr Int ; 62(3): 390-398, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31957140

RESUMEN

BACKGROUND: Working is an important concern in transitional care for adults with congenital heart disease (ACHD) because work connects people with society. Employment status is correlated with gender, but studies on patient employment by gender have rarely been conducted. This study therefore aimed to examine the employment status of ACHD by gender and to explore the factors influencing this status. METHODS: In this study, 193 Japanese ACHD (mean age: men-33.62 years, women-32.69 years; 89 men, no students included) completed a questionnaire including questions about employment status, an evaluation of hindrances to employment, the Linear Analog Scale to assess quality of life (QOL), and the Satisfaction with Life Scale (SWLS). RESULTS: In the study sample, 13 of 89 (14.6%) men and 13 of 104 (12.5%) women did not have a job. These rates were higher than the national standard rates in Japan (men: 5.0%, women: 2.9%). Of these patients, only one man and one woman listed their illness as a reason for their unemployment. The factors thought to explain unemployment were age for men and disease severity for women (P < 0.05 for both). Unemployed patients had significantly lower QOL and SWLS scores. CONCLUSIONS: Most ACHD can join the workforce but a higher percentage of ACHD do not work and find it challenging to have a career compared with the general population. Moreover, because unemployed patients have low QOL and SWLS scores, obtaining work is crucial to enable these people to have mentally and emotionally stable and fulfilling lives.

7.
Int Heart J ; 61(1): 103-108, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956154

RESUMEN

Waist circumference (WC) is measured for the assessment of abdominal obesity, whereas carotid intima-media thickness (IMT) is a marker of preclinical atherosclerosis. The relationship between WC and carotid IMT in the general population is not fully understood. In this study, we examined 1,182 subjects (658 men and 524 women, 62.3 ± 11.7 years on average) who underwent voluntary health check-ups and sought to determine the optimal cut-off value of WC for predicting carotid IMT thickness. Receiver operating characteristic curve analysis of WC was utilized to predict high carotid IMT (defined as carotid IMT ≥ 1.1 mm). We determined that the appropriate WC cut-off value was a WC ≥ 79 cm for men and women. There was a statistically significant difference in the prevalence of high carotid IMT between WC ≥ 79 cm and WC < 79 cm in both men and women. However, multivariable logistic regression analysis demonstrated that the WC category was independently associated with high carotid IMT in men, but not in women. Our study indicates that the optimal cut-off value of WC to identify preclinical atherosclerosis may be lower than the current Japanese diagnostic criteria for metabolic syndrome (MetS) in both men and women. Compared to women, the association between WC and preclinical atherosclerosis may be more pronounced in men.


Asunto(s)
Aterosclerosis/diagnóstico , Obesidad Abdominal/diagnóstico , Anciano , Aterosclerosis/epidemiología , Grosor Intima-Media Carotídeo , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad Abdominal/epidemiología , Prevalencia , Curva ROC , Factores Sexuales , Circunferencia de la Cintura
8.
Heart Vessels ; 35(1): 22-29, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31222551

RESUMEN

Cigarette smoking is closely associated with the development of cardiovascular diseases. However, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. We sought to clarify the association between cigarette smoking and carotid intima-media thickness (cIMT) in a general Japanese population. Among 1,209 participants who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We evaluated cIMT as a marker of subclinical atherosclerosis. The value of cIMT and rate of carotid plaque defined as IMT ≥ 1.1 mm did not differ between smokers and never smokers. However, the rate of carotid high-risk atheroma, defined as carotid artery atheroma including hypoechoic dominant and ulceration, was significantly higher among smokers than never smokers (30.4%, vs 23.6%, p = 0.009). Even after adjustment for covariates, cigarette smoking was independently associated with high-risk atheroma formation (odds ratio 1.384, 95% CI 1.019-1.880; p = 0.038). The value of cIMT and the rate of high-risk atheroma were significantly higher in smokers than never smokers in the subgroup of participants aged ≥ 60 years, whereas the rate of high-risk atheroma only was higher in smokers than never smokers in the subgroup of participants aged < 60 years. In conclusion, the development of high-risk carotid artery atheroma may precede the thickening of cIMT in cigarette smokers, which suggests the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.

9.
J Atheroscler Thromb ; 27(2): 155-163, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31231080

RESUMEN

AIM: Obesity and metabolic syndrome (MetS) frequently coexist and are both important risk factors for cardiovascular disease. However, the pathophysiological role of obesity without MetS, also referred to as metabolically healthy obesity (MHO), remains unclear. In this study, we aim to clarify the effect of MHO on the development of carotid plaque using a community-based cohort. METHODS: We examined 1,241 subjects who underwent health checkups at our institute. Obesity was defined as body mass index of ≥ 25.0 kg/m2. Subjects were divided into three groups: non-obese, MHO, and metabolically unhealthy obesity (MUO). RESULTS: The prevalence of carotid plaque, defined as intima-media thickness (IMT) ≥ 1.1 mm, was higher in subjects with MUO and MHO than in non-obese subjects. Multivariable analysis demonstrated that MHO (odds ratio 1.6, p=0.012) and MUO (odds ratio 1.9, p=0.003) as well as age of ≥ 65 years, male sex, hypertension, and diabetes mellitus were independently associated with carotid plaque formation. A similar trend was observed in each subgroup according to age and sex. CONCLUSIONS: MHO increased the prevalence of carotid plaque when compared with non-obese subjects, suggesting the potential significance of MHO in the development of subsequent cardiovascular diseases.

10.
J Cardiol ; 75(5): 578-582, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31874723

RESUMEN

BACKGROUND: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for hypertension have lowered the threshold of normal blood pressure (BP). However, how this updated guideline should be applied to the general population is still under debate, and may depend on gender because of a substantial gender difference in the risk of cardiovascular disease. We aimed to clarify the gender difference in the association between BP category and cardio-ankle vascular index (CAVI), as a marker of subclinical atherosclerosis, using a community-based cohort. METHODS: We examined 1,241 subjects (699 males and 542 females) who underwent health check-ups at our institute. We defined normal pressure as systolic (s)BP <130 mmHg and diastolic (d)BP <80 mmHg, stage 1 hypertension as 130 mmHg ≤ sBP < 140 mmHg or 80 mmHg ≤ dBP <90 mmHg and stage 2 hypertension as sBP ≥140 mmHg or dBP ≥90 mmHg, including subjects on antihypertensive medications. High CAVI was defined as CAVI ≥9.0. RESULTS: Age and the prevalence of most of atherosclerotic risk factors increased with increasing BP category in both male and female subjects. A linear relationship between the prevalence of high CAVI and high BP category was observed in males, but not in females. Multivariable logistic regression analysis revealed that BP category was independently associated with high CAVI in males but not in females. CONCLUSION: There was a difference seen between males and females in the association between BP category, according to the updated ACC/AHA guideline, and CAVI, suggesting that the optimal management strategy for hypertension may depend on not only age, obesity, and diabetes mellitus, but also gender.

11.
Int Heart J ; 60(6): 1381-1386, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735787

RESUMEN

The association between changes in body weight and blood pressure (BP) in overweight people in the general population still remains unclear. We sought to clarify the effect of body weight change on BP using a community-based cohort. We studied 1,170 overweight subjects with a body mass index (BMI) ≥ 22 kg/m2 who underwent health check-ups. Among the study subjects, 175 (15%) were categorized in the weight loss group (weight loss ≥ 5%), 869 (74%) in the weight stable group, and 126 (11%) in the weight gain group (weight gain ≥ 5%). There were no significant differences in baseline BP between the 3 groups. In the weight loss group, systolic and diastolic BP, and the rates of stage 2 (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) and stage 1 hypertension (130 mmHg≤ systolic BP < 140 mmHg or 80 mmHg≤ diastolic BP < 90 mmHg) decreased. In contrast, in the weight gain group, systolic and diastolic BP and the rate of stage 2 hypertension increased. Subgroup analysis showed that the correlation between change in body weight and BP was seen in each subgroup according to age, sex, and BMI. The results of the present study suggest the significance of body weight control for BP control in subjects with BMI ≥ 22 kg/m2.


Asunto(s)
Presión Sanguínea , Índice de Masa Corporal , Hipertensión/epidemiología , Sobrepeso/fisiopatología , Aumento de Peso , Pérdida de Peso , Adulto , Anciano , Estudios de Cohortes , Femenino , Frecuencia Cardíaca , Humanos , Japón , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones
12.
J Am Coll Cardiol ; 74(14): 1789-1800, 2019 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-31582139

RESUMEN

BACKGROUND: The impact of aging on cardiac function is not fully elucidated. Speckle-tracking echocardiography can unmask subclinical cardiac dysfunction. OBJECTIVES: This study investigated the impact of healthy aging on left ventricular (LV), right ventricular (RV), and left atrial (LA) performance and their relationship with serum B-type natriuretic peptide (BNP) levels in a sample of the general population without prevalent cardiovascular risk factors and structural heart disease. METHODS: Speckle-tracking echocardiography was performed to assess LV global longitudinal strain (LVGLS), RV free wall strain, and LA phasic strain in 481 normal weight healthy participants who underwent extensive cardiovascular examination. Elevated BNP was defined as BNP >37.82 pg/ml for men and >50.86 pg/ml for women, which was the 90th percentile of BNP value distribution in the study population. RESULTS: Mean age was 60 ± 12 years (range: 24 to 86 years), and 46% of the participants were men. The earliest alteration of age-related cardiac performance was observed in LA reservoir and conduit strain starting from decade 5, followed by elevated E/e' from decade 6. LVGLS decreased starting from decade 7, whereas there were no significant differences in RV strain, LV ejection fraction, or LV mass index across the decades. In the multivariable linear regression analyses, age was an independent predictor of decreased LVGLS (standardized ß = 0.21; p < 0.001) and decreased LA phasic strain (standardized ß = -0.40 and -0.61 for reservoir and conduit strain; both p < 0.001). Age and LA strain were significantly associated with elevated BNP values (adjusted odds ratios: 1.10 and 0.93; both p < 0.05, respectively), independent of ventricular morphology and function. CONCLUSIONS: Decreases in LA reservoir and conduit strain are the earliest markers of age-related cardiac remodeling, and LA reservoir strain is an independent predictor of elevated serum BNP level, with both possibly being markers of increased risk of heart failure in older adults.

13.
Eur J Drug Metab Pharmacokinet ; 44(6): 853, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31643024

RESUMEN

The publisher has retracted this article [1] because it is an incorrect version that was published in error: Figures 5 and 6 are missing.

14.
J Nephrol ; 32(5): 843-846, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31429048

RESUMEN

After the online first publication of their research, the authors realized they made several mistakes in the data conversion process from the original data of health check-up at the Center for Preventive Medicine at The University of Tokyo Hospital to the datasheet which was used for the statistical analysis by SPSS. Particularly, the prevalence of hypertension, diabetes mellitus, and hypercholesterolemia was not appropriately analyzed. Therefore, the authors re-analyzed the data according to the corrected database.

15.
Am J Cardiol ; 124(3): 396-401, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31171318

RESUMEN

American College of Cardiology/American Heart Association recently updated their guidelines for hypertension, and lowered the threshold of normal blood pressure (BP). However, the validity of the updated guidelines remains controversial. We investigated the relation between the revised BP classification and carotid intima-media thickness, using a community-based cohort. We examined 1,241 subjects who underwent health check-ups at our institute. They were divided into 3 groups based on their BP levels: normal blood pressure (sBP <130 mm Hg and dBP <80 mm Hg, n = 556); stage 1 hypertension (130 mm Hg ≤sBP <140 mm Hg or 80 mm Hg ≤ dBP <90 mm Hg, n = 236); and stage 2 hypertension (sBP ≥140 mm Hg or dBP ≥90 mm Hg, including subjects prescribed with antihypertensive medications, n = 449). With an increase in BP, increase in the mean age, proportion of males, and prevalence of CVD risk factors was seen. The prevalence of carotid plaque, defined as intima-media thickness ≥1.1 mm, also increased with increase in BP. After adjustment with covariates, higher BP was seen to be associated with carotid plaque presence. Atherosclerotic changes are present in stage 1 hypertension even in the healthy population, suggesting the importance of aggressive antihypertensive treatment based on the updated American College of Cardiology/American Heart Association guidelines.


Asunto(s)
Grosor Intima-Media Carotídeo , Hipertensión/clasificación , Hipertensión/diagnóstico , Guías de Práctica Clínica como Asunto , Factores de Edad , American Heart Association , Estenosis Carotídea/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipercolesterolemia/epidemiología , Hipertensión/epidemiología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Estados Unidos
16.
J Nephrol ; 32(5): 775-781, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30955155

RESUMEN

BACKGROUND: Risk factors for renal function deterioration in the general population are not fully understood. We aimed to clarify the determinants of estimated glomerular filtration rate (eGFR) decline using a community-based cohort. METHODS AND RESULTS: Among 3217 subjects who underwent repeated health check-ups, we excluded 478 subjects with eGFR ≤ 60 mL/min/1.73 m2 and examined 2739 subjects. EGFR decline rate was calculated from the difference in eGFR between the first and last visits. EGFR decline, which was defined as a drop in GFR accompanied by a 25% or greater drop in eGFR from baseline and/or a sustained decline of more than 5 mL/min/1.73 m2/year, was observed in 209 subjects (7.6%). Anemia according to the WHO definition (16.7% vs. 11.7%, p = 0.03), and proteinuria (3.3% vs. 0.8%, p < 0.001) at baseline were more commonly observed in subjects with eGFR decline. Multivariable logistic regression analysis showed that anemia and proteinuria were independently associated with eGFR decline. CONCLUSION: Anemia and proteinuria were closely related to eGFR decline, which suggests that we should consider these parameters as risk factors of the development of renal function deterioration even in the general population.

17.
J Atheroscler Thromb ; 26(5): 476-487, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-30344204

RESUMEN

AIM: We investigated the clinical usefulness of carotid arterial strain and the strain rate for evaluating the progression of arteriosclerosis measured using a two-dimensional speckle-tracking method in carotid ultrasonography. METHODS: We enrolled 259 participants (age: 64±12 years; men: 149; women: 110) in this retrospective analysis. The circumferential strain and the strain rate were measured in bilateral common carotid arteries, and the lowest values were used for the analyses. To assess the characteristics of strain and the strain rate, we investigated the associations between the strain values and gender, age, body mass index (BMI), blood pressure (BP), and the presence of hypertension, diabetes mellitus, and hyperlipidemia. We also examined the explanatory factors for the strain values using clinical parameters along with the intima-media thickness (IMT), the ankle brachial index (ABI), and the cardio-ankle vascular index (CAVI) as possible candidates. Finally, we investigated whether the strain values might be an independent predictor for vascular diseases using multivariate logistic regression analyses. RESULTS: The carotid circumferential strain and the strain rate were significantly correlated with age, IMT, and the CAVI, but not with the BMI, BP, or ABI. Strain and the strain rates were lower in participants with hypertension or cerebrovascular disease and were selected as significant predictive factors for the presence of cerebrovascular diseases, together with diabetes and the CAVI. CONCLUSIONS: Strain and the strain rate of carotid arteries, which could represent local arterial stiffness, might be associated with atherosclerosis and could possibly be used to predict cerebrovascular disease.


Asunto(s)
Arteriosclerosis/diagnóstico , Arterias Carótidas/patología , Ultrasonografía/métodos , Anciano , Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/epidemiología , Arterias Carótidas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
18.
Eur Heart J Cardiovasc Imaging ; 19(2): 136-142, 2018 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-29237001

RESUMEN

Aims: Left ventricular (LV) diastolic dysfunction may lead to heart failure. A high body mass index (BMI) is associated with worse LV diastolic function. However, knowledge of the longitudinal relation between changes in BMI and LV diastolic function is limited. Methods and results: We retrospectively identified 165 asymptomatic individuals (aged 60 ± 10 years, 55% male) with preserved LV ejection fraction, who underwent repeated health check-ups (median interval: 365 days) at our hospital between 2009 and 2012. The longitudinal data were analysed using a linear mixed-effects model adjusted for important clinical variables at baseline to evaluate the associations between changes in BMI and LV diastolic function from one visit to the next. Baseline characteristics were BMI, 23 ± 3 kg/m2; E/E' ratio, 9 ± 2; E' velocity, 8 ± 2 cm/s; and left atrial (LA) volume index, 26 ± 8 mL/m2. Eighty-two of our participants had baseline LV diastolic dysfunction. In multivariable analyses, a BMI change was associated with a change in LV diastolic function. A one-unit decrease in BMI between consecutive visits corresponded to an average decrease in LA volume index of 0.80 mL/m2 (95% confidence interval: 0.38, 1.23; P < 0.001), a decrease in E/E'ratio of 0.11 (-0.015, 0.23; P = 0.086), and an increase in E' velocity of 0.11 cm/s (0.18, 0.031; P = 0.006). Conclusion: Our study showed that there was an association between changes in BMI and LV diastolic function. A decrease in BMI corresponded to a significant decrease in LA volume index and a significant increase in E' velocity.


Asunto(s)
Índice de Masa Corporal , Ecocardiografía Doppler/métodos , Obesidad/prevención & control , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular/fisiología , Factores de Edad , Anciano , Atención Ambulatoria/métodos , Peso Corporal , Estudios de Cohortes , Diástole , Femenino , Hospitales Universitarios , Humanos , Japón , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Disfunción Ventricular Izquierda/fisiopatología
19.
Geriatr Gerontol Int ; 18(1): 65-71, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28776906

RESUMEN

AIM: To clarify whether carotid atherosclerosis and its risk factors are associated with cognitive decline. METHODS: We evaluated 206 individuals who visited our center for health screening. We carried out physical examinations, blood tests, intima-media thickness (IMT) measurement by carotid ultrasonography, brain magnetic resonance imaging scanning and cognitive function assessments. A total of 30 individuals, who had significant cerebrovascular lesions detected in magnetic resonance imaging scans, were excluded. To detect early cognitive decline, we defined "cognitive impairment (CI)" when a patient satisfied at least one of three criteria. These were Mini-Mental State Examination score <24, clock-drawing test score <4 coexisting with forgetfulness and Wechsler Memory Scale-revised delayed recall score below the normal range for the duration of education (>16 years of education: ≥9, 10-15 years: ≥5, 0-9 years: ≥3). RESULTS: Among 176 individuals, 27 were placed in the CI group. IMT was significantly higher in the CI group as compared with the non-CI group (mean ± SD: 2.0 ± 1.0 vs 1.7 ± 0.7, P = 0018 by Student's t-test). Other atherosclerotic risk factors, such as blood pressure, low-density lipoprotein cholesterol, and hemoglobin A1c, were not significantly different between the two groups. In multivariate analysis, maximum IMT was associated with impaired immediate recall score on Wechsler Memory Scale-revised, independent of the presence of deep white matter hyperintensities on the magnetic resonance imaging scan. CONCLUSIONS: Subclinical carotid atherosclerosis, defined as thickened IMT, could be a marker for early stages of CI, especially for immediate memory recall. The impairment is presumably caused by inducing cerebral microvascular dysfunction in the frontal lobe. Geriatr Gerontol Int 2018; 18: 65-71.


Asunto(s)
Enfermedades de las Arterias Carótidas/psicología , Grosor Intima-Media Carotídeo , Enfermedades de las Arterias Carótidas/diagnóstico , Trastornos del Conocimiento/epidemiología , Humanos , Trastornos de la Memoria/epidemiología , Memoria a Corto Plazo , Factores de Riesgo
20.
Int J Cardiol ; 229: 125-131, 2017 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-28340978

RESUMEN

BACKGROUND: Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. METHODS: Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. RESULTS/CONCLUSION: The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy.


Asunto(s)
Prestación de Atención de Salud/normas , Cardiopatías Congénitas/terapia , Grupo de Atención al Paciente , Adulto , Comités Consultivos , Competencia Clínica , Cardiopatías Congénitas/enfermería , Humanos , Rol de la Enfermera , Defensa del Paciente , Guías de Práctica Clínica como Asunto , Autocuidado
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