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Sung, Kuo-Tzu ; Chandramouli, Chanchal ; Lo, Chi-In ; [et al.]

Frontiers Media SA ; 2022

In: Frontiers in Cardiovascular Medicine Vol. 9 ( 2022-4-21)

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In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 9 ( 2022-4-21)

Abstract: Despite known sex differences in cardiac structure and function, little is known about how menopause and estrogen associate with atrioventricular mechanics and outcomes. Objective To study how, sex differences, loss of estrogen in menopause and duration of menopause, relate to atrioventricular mechanics and outcomes. Methods Among 4051 asymptomatic adults (49.8 ± 10.8 years, 35%women), left ventricular (LV) and left atrial (LA) mechanics were assessed using speckle-tracking. Results Post-menopausal (vs. pre-menopausal) women had similar LV ejection fraction but reduced GLS, reduced PALS, increased LA stiffness, higher LV sphericity and LV torsion (all p & lt; 0.001). Multivariable analysis showed menopause to be associated with greater LV sphericity (0.02, 95%CI 0.01, 0.03), higher indexed LV mass (LVMi), lower mitral e’, lower LV GLS (0.37, 95%CI 0.04–0.70), higher LV torsion, larger LA volume, worse PALS (∼2.4-fold) and greater LA stiffness (0.028, 95%CI 0.01–0.05). Increasing years of menopause was associated with further reduction in GLS, markedly worse LA mechanics despite greater LV sphericity and higher torsion. Lower estradiol levels correlated with more impaired LV diastolic function, impaired LV GLS, greater LA stiffness, and increased LV sphericity and LV torsion (all p & lt; 0.05). Approximately 5.5% (37/669) of post-menopausal women incident HF over 2.9 years of follow-up. Greater LV sphericity [adjusted hazard ratio (aHR) 1.04, 95%CI 1.00–1.07], impaired GLS (aHR 0.87, 95%CI 0.78–0.97), reduced peak left atrial longitudinal strain (PALS, aHR 0.94, 95%CI 0.90–0.99) and higher LA stiffness (aHR 10.5, 95%CI 1.69– 64.6) were independently associated with the primary outcome of HF hospitalizations in post-menopause. Both PALS & lt; 23% (aHR:1.32, 95%CI 1.01–3.49) and GLS & lt; 16% (aHR:5.80, 95%CI 1.79–18.8) remained prognostic for the incidence of HF in post-menopausal women in dichotomous analyses, even after adjusting for confounders. Results were consistent with composite outcomes of HF hospitalizations and 1-year all-cause mortality as well. Conclusion Menopause was associated with greater LV/LA remodeling and reduced LV longitudinal and LA function in women. The cardiac functional deficit with menopause and lower estradiol levels, along with their independent prognostic value post-menopause, may elucidate sex differences in heart failure further.

Type of Medium: Online Resource

ISSN: 2297-055X

URL: Article

DOI: 10.3389/fcvm.2022.804336

DOI: 10.3389/fcvm.2022.804336.s001

Language: Unknown

Publisher: Frontiers Media SA

Publication Date: 2022

detail.hit.zdb_id: 2781496-8

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Associations of serum uric acid level and gout with cardiac structure, function and sex differences from large scale asymptomatic Asians

Sung, Kuo-Tzu ; Lo, Chi-In ; Lai, Yau-Huei ; [et al.]

Public Library of Science (PLoS) ; 2020

In: PLOS ONE Vol. 15, No. 7 ( 2020-7-20), p. e0236173-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 15, No. 7 ( 2020-7-20), p. e0236173-

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0236173

DOI: 10.1371/journal.pone.0236173.g001

DOI: 10.1371/journal.pone.0236173.g002

DOI: 10.1371/journal.pone.0236173.g003

DOI: 10.1371/journal.pone.0236173.t001

DOI: 10.1371/journal.pone.0236173.t002

DOI: 10.1371/journal.pone.0236173.t003

DOI: 10.1371/journal.pone.0236173.s001

DOI: 10.1371/journal.pone.0236173.s002

DOI: 10.1371/journal.pone.0236173.s003

DOI: 10.1371/journal.pone.0236173.s004

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2020

detail.hit.zdb_id: 2267670-3

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Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography

Liu, Lawrence ; Yun, Chun-Ho ; Kuo, Jen-Yuan ; [et al.]

MDPI AG ; 2020

In: Diagnostics Vol. 10, No. 9 ( 2020-09-18), p. 712-

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In: Diagnostics, MDPI AG, Vol. 10, No. 9 ( 2020-09-18), p. 712-

Abstract: Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, p 〈 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all p 〈 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (p for ∆AUROC: 〈 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.

Type of Medium: Online Resource

ISSN: 2075-4418

URL: Article

DOI: 10.3390/diagnostics10090712

Language: English

Publisher: MDPI AG

Publication Date: 2020

detail.hit.zdb_id: 2662336-5

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Association of Non-Alcoholic Fatty Liver Disease and Hepatic Fibrosis with Epicardial Adipose Tissue Volume and Atrial Deformation Mechanics in a Large Asian Population Free from Clinical Heart Failure

Lai, Yau-Huei ; Su, Cheng-Huang ; Hung, Ta-Chuan ; [et al.]

MDPI AG ; 2022

In: Diagnostics Vol. 12, No. 4 ( 2022-04-06), p. 916-

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In: Diagnostics, MDPI AG, Vol. 12, No. 4 ( 2022-04-06), p. 916-

Abstract: Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease share several cardiometabolic risk factors. Excessive visceral fat can manifest as ectopic fat depots over vital organs, such as the heart and liver. This study assessed the associations of NAFLD and liver fibrosis with cardiac structural and functional disturbances. We assessed 2161 participants using ultrasound, and categorized them as per the NAFLD Fibrosis Score into three groups: (1) non-fatty liver; (2) fatty liver with low fibrosis score; and (3) fatty liver with high fibrosis score. Epicardial fat volume (EFV) was measured through multidetector computed tomography. All participants underwent echocardiographic study, including tissue Doppler-based E/e’ ratio and speckle tracking-based left ventricular global longitudinal strain, peak atrial longitudinal strain (PALS), and atrial longitudinal strain rates during systolic, early and late-diastolic phases (ALSRsyst, ALSRearly. ALSRlate). Larger EFV, decreased e’ velocity, PALS, ALSRsyst, and ALSRearly, along with elevated E/e’ ratio, were seen in all groups, especially in those with high fibrosis scores. After multivariate adjustment for traditional risk factors and EFV, fibrosis scores remained significantly associated with elevated E/e’ ratio, LA stiffness, and decreased PALS (β: 0.06, 1.4, −0.01, all p 〈 0.05). Thus, NAFLD is associated with LV diastolic dysfunction and subclinical changes in LA contractile mechanics.

Type of Medium: Online Resource

ISSN: 2075-4418

URL: Article

DOI: 10.3390/diagnostics12040916

Language: English

Publisher: MDPI AG

Publication Date: 2022

detail.hit.zdb_id: 2662336-5

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Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study

Chien, Shih-Chieh ; Chandramouli, Chanchal ; Lo, Chi-In ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS Medicine Vol. 18, No. 6 ( 2021-6-1), p. e1003661-

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In: PLOS Medicine, Public Library of Science (PLoS), Vol. 18, No. 6 ( 2021-6-1), p. e1003661-

Abstract: Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. Methods and findings We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, ≤25 kg/m 2 [lean]; high, 〉 25 kg/m 2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, 〈 45 g/L [malnourished]; high, ≥45 g/L [well-nourished] ), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean–well-nourished (low BMI, high SA), 1,369 (25.8%) obese–well-nourished (high BMI, high SA), 1,154 (21.8%) lean–malnourished (low BMI, low SA), and 681 (12.8%) obese–malnourished (high BMI, low SA) individuals. Obese–malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p 〈 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) ( p 〈 0.001 in both) participants. The obese–malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m 2 ; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e′ 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e′ 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m 2 ) compared to the lean–well-nourished (low BMI, high SA) group, as well as all other subgroups ( p 〈 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese–malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean–malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese–well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean–well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. Conclusions In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.

Type of Medium: Online Resource

ISSN: 1549-1676

URL: Article

DOI: 10.1371/journal.pmed.1003661

DOI: 10.1371/journal.pmed.1003661.g001

DOI: 10.1371/journal.pmed.1003661.g002

DOI: 10.1371/journal.pmed.1003661.t001

DOI: 10.1371/journal.pmed.1003661.t002

DOI: 10.1371/journal.pmed.1003661.t003

DOI: 10.1371/journal.pmed.1003661.t004

DOI: 10.1371/journal.pmed.1003661.s001

DOI: 10.1371/journal.pmed.1003661.s002

DOI: 10.1371/journal.pmed.1003661.s003

DOI: 10.1371/journal.pmed.1003661.s004

DOI: 10.1371/journal.pmed.1003661.s005

DOI: 10.1371/journal.pmed.1003661.s006

DOI: 10.1371/journal.pmed.1003661.s007

DOI: 10.1371/journal.pmed.1003661.s008

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2164823-2

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The association among MDCT-derived three-dimensional visceral adiposities on cardiac diastology and dyssynchrony in asymptomatic population

Lai, Yau-Huei ; Hou, Charles Jia-Yin ; Yun, Chun-Ho ; [et al.]

Springer Science and Business Media LLC ; 2015

In: BMC Cardiovascular Disorders Vol. 15, No. 1 ( 2015-12)

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In: BMC Cardiovascular Disorders, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2015-12)

Type of Medium: Online Resource

ISSN: 1471-2261

URL: Article

DOI: 10.1186/s12872-015-0136-8

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2015

detail.hit.zdb_id: 2059859-2

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