The survival, clinical and echocardiographic variables and the predictors of cardiovascular death... more The survival, clinical and echocardiographic variables and the predictors of cardiovascular death were determined for a group of 168 patients (mean age 63 ± 13 years; 65 females; mean left ventricular ejection fraction 32 ± 10%) with restrictive filling of the left ventricle and depressed systolic function after a mean follow-up period of 2.7 ± 1 years. Shorter deceleration time (DT) of the mitral inflow was the only variable significantly different between survivors and nonsurvivors (p < 0.05) and the only predictor of death found by multivariate logistic regression analysis (odds ratio 2.2, 95% confidence interval 1.7–3.6). In this patient population, a DT of the early wave of the mitral inflow <140 ms identified the patients with the highest risk of cardiac death. DT is a practical echocardiographic parameter for risk stratification of patients with significant left ventricular systolic dysfunction and restrictive filling of the left ventricle.
Purpose: Myocyte growth and fibroblast hyperplasia are major determinants of cardiac hypertrophy ... more Purpose: Myocyte growth and fibroblast hyperplasia are major determinants of cardiac hypertrophy and heart failure (HF). This study examines whether increases over time in high-sensitive Troponin T (hsTnT) are predictive of elevated fibrosis markers in HF patients and controls. Methods: hsTnT was measured at baseline and at 3 years follow-up (Roche Elecsys 2010; lower detection limit 3 pg/mL) in a sub-cohort of the Cardiovascular Health Study (N=353; age=74±6 yrs; 52% women). Fibrosis markers (procollagen type I (PIP), type I collagen telopeptide (CITP), and procollagen type III (PIIINP)) were measured at the 3-year follow-up (101 HF patients, 99 controls with traditional risk factors [hypertension, diabetes, or hypercholesterolemia] and 153 controls without these factors). Non-parametric correlations (Spearman9s rho) and multivariable linear regression on ln-transformed values were used. Covariates included: demographics, baseline hsTnT, and clinical variables (HF status at follow-up, coronary heart disease, traditional risk factors, creatinine, and presence of major ECG abnormalities). A change (Δ) of ≥20% was used to define a significant increase in hsTnT. Results: hsTnT was cross-sectionally associated with CITP (rho=0.34) and PIIINP (rho=0.32) at follow-up (p9s Conclusions: Increases in myocyte injury measured by hsTnT may predict interstitial fibrosis, particularly in HF patients. Early detection of increases in hsTnT may identify patients at risk of myocardial fibrosis and heart failure.
... The patient is a 69-year-old woman who underwent mastectomy and irradiation for ... The prese... more ... The patient is a 69-year-old woman who underwent mastectomy and irradiation for ... The presence of bibasilar rales and rub on the left would indicate continued pleural and perhaps parenchymal involvement and evidence of active pleuritis at the time of the examination. ...
Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification ... more Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification (AVC) burden by echocardiography has diagnostic and prognostic value. Hypothesis: there is a weak association between a qualitative calcium score (QCS) by TEE and AV weight in severe AS. Methods: Between 2010-2014, of 719 pts who underwent surgical AVR for isolated severe AS, QCS was feasible in 483 (67%): mean age 76.7 ± 9.5 yrs, 59% males, EF 56 ±12%, AVAi 0.35 ±0.09 cm2/m2, AVW 2.45 ± 0.09 g, QCS 3.5± 0.57, 11% bicuspid valves . AVC was determined using short- and long-axis views and graded as mild (1) localized, small, nondense calcifications to severe (4) extensive thickening and calcification of all cusps. TEEs were done on the day of surgery and excised valves were weighed. Independent t-test, Fisher’s exact test, analysis of variance, and Pearson correlation were done as appropriate. Results: Intraclass correlations for intra and interobserver variability were 0.76 and 0.53 , res...
Introduction: The process of cardiac calcification bears a resemblance to bone metabolism and its... more Introduction: The process of cardiac calcification bears a resemblance to bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but available epidemiologic data are sparse. Methods: We tested the hypothesis that BMD of total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) are inversely associated with prevalence of 3 echocardiographic (echo) measures of cardiac calcification (mitral annular [MAC], aortic annular [AAC] and aortic valve calcification [AVC]) in 1,497 older adults from the population-based Cardiovascular Health Study. Analyses were stratified by sex. Relative risk (RR) regression was used to evaluate the adjusted risks of MAC, AAC and AVC individually with continuous BMD. Dose-response associations were assessed for MAC and AVC. Fully adjusted models included age, race, BMI, SBP, hypertensive therapy, diabetes, smoking, alcohol, physical activity, e...
Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular... more Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular calcification were investigated in a cross-sectional analysis of a population-based cohort of 1497 older adults. Although there was no association between continuous bone mineral density and outcomes, a significant association between osteoporosis and aortic valvular calcification in men was found. The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1497 older adults from the Cardiovascular Health Study. The adjusted association of BMD w...
Background: Fibrotic changes in the heart and vasculature have been implicated in a diverse range... more Background: Fibrotic changes in the heart and vasculature have been implicated in a diverse range of cardiovascular disease (CVD). However, limited epidemiological data exists to support such associations. Methods: We determined prospective associations of two complementary biomarkers of fibrosis, transforming growth factor- β (TGF-β, n=1,371) and procollagen type III N-terminal propeptide (PIIINP, n=2,568), with congestive heart failure (CHF), myocardial infarction (MI), and stroke among community-living older adults in the Cardiovascular Health Study over 14 years of follow-up. Due to potentially pleiotropic effects of TGF-β on inflammation and fibrosis, we investigated effect modification by C-reactive protein (CRP) in secondary analyses. Results: In age, sex, race, and site-adjusted models, higher PIIINP was associated with risk of total CVD, CHF, and stroke, as was the combined measure of TGF-β and PIIINP (sum of z-scores). Most of these associations remained statistically significant in fully-adjusted models (Table). TGF-β was not associated with CVD in the full cohort, but associations with total CVD, CHF, and stroke were statistically significant among individuals with CRP above the median (2.3 mg/L) ( P -interaction=0.05). Associations involving PIIINP were also statistically significant and stronger among individuals with higher CRP. In the high CRP stratum, HRs for total CVD were 1.15 (CI: 1.02, 1.30) per SD TGF-β, 1.14 (CI: 1.04, 1.25) per SD PIIINP, and 1.21 (CI: 1.06, 1.38) per SD of the combined measure. In the low CRP stratum, HRs were 0.96 (CI: 0.82, 1.12) per SD of TGF-β, 1.02 (CI: 0.92, 1.12) per SD PIIINP, and 1.04 (CI: 0.90, 1.20) per SD of the combined measure. Conclusion: Our findings provide further evidence that circulating biomarkers of fibrosis, measured late in life, are associated with CVD. Research on whether TGF-β has a stronger pro-fibrotic effect in the setting of increased inflammation is warranted.
The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently... more The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently reported as if they were interchangeable. No systematic evaluation of the agreement between these methods has been done. To determine the agreement, correlation and reproducibility of SV values measured by 2-D echo and Doppler methods. 107 healthy subjects (mean age 59 ± 14 yrs, 59 % females), had comprehensive echocardiographic evaluation. 2-D LV volumes (2D) were measured by the biplane Simpson’s method. For Doppler, the product of the area of the LV outflow tract (LVOT) x LVOT time velocity integral (TVI), and the area of aortic annulus (AA), and the product of aortic cusp separation (ACS) x aortic TVI were used. Mixed model analysis of variance was performed and Bland Altman agreement limits, Pearson correlation and within-subject coefficient of variation and intraclass correlation coefficient were determined. The mean SV (ml/beat) measured by 2-D and Doppler methods using LVOT, AA ...
The survival, clinical and echocardiographic variables and the predictors of cardiovascular death... more The survival, clinical and echocardiographic variables and the predictors of cardiovascular death were determined for a group of 168 patients (mean age 63 ± 13 years; 65 females; mean left ventricular ejection fraction 32 ± 10%) with restrictive filling of the left ventricle and depressed systolic function after a mean follow-up period of 2.7 ± 1 years. Shorter deceleration time (DT) of the mitral inflow was the only variable significantly different between survivors and nonsurvivors (p < 0.05) and the only predictor of death found by multivariate logistic regression analysis (odds ratio 2.2, 95% confidence interval 1.7–3.6). In this patient population, a DT of the early wave of the mitral inflow <140 ms identified the patients with the highest risk of cardiac death. DT is a practical echocardiographic parameter for risk stratification of patients with significant left ventricular systolic dysfunction and restrictive filling of the left ventricle.
Purpose: Myocyte growth and fibroblast hyperplasia are major determinants of cardiac hypertrophy ... more Purpose: Myocyte growth and fibroblast hyperplasia are major determinants of cardiac hypertrophy and heart failure (HF). This study examines whether increases over time in high-sensitive Troponin T (hsTnT) are predictive of elevated fibrosis markers in HF patients and controls. Methods: hsTnT was measured at baseline and at 3 years follow-up (Roche Elecsys 2010; lower detection limit 3 pg/mL) in a sub-cohort of the Cardiovascular Health Study (N=353; age=74±6 yrs; 52% women). Fibrosis markers (procollagen type I (PIP), type I collagen telopeptide (CITP), and procollagen type III (PIIINP)) were measured at the 3-year follow-up (101 HF patients, 99 controls with traditional risk factors [hypertension, diabetes, or hypercholesterolemia] and 153 controls without these factors). Non-parametric correlations (Spearman9s rho) and multivariable linear regression on ln-transformed values were used. Covariates included: demographics, baseline hsTnT, and clinical variables (HF status at follow-up, coronary heart disease, traditional risk factors, creatinine, and presence of major ECG abnormalities). A change (Δ) of ≥20% was used to define a significant increase in hsTnT. Results: hsTnT was cross-sectionally associated with CITP (rho=0.34) and PIIINP (rho=0.32) at follow-up (p9s Conclusions: Increases in myocyte injury measured by hsTnT may predict interstitial fibrosis, particularly in HF patients. Early detection of increases in hsTnT may identify patients at risk of myocardial fibrosis and heart failure.
... The patient is a 69-year-old woman who underwent mastectomy and irradiation for ... The prese... more ... The patient is a 69-year-old woman who underwent mastectomy and irradiation for ... The presence of bibasilar rales and rub on the left would indicate continued pleural and perhaps parenchymal involvement and evidence of active pleuritis at the time of the examination. ...
Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification ... more Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification (AVC) burden by echocardiography has diagnostic and prognostic value. Hypothesis: there is a weak association between a qualitative calcium score (QCS) by TEE and AV weight in severe AS. Methods: Between 2010-2014, of 719 pts who underwent surgical AVR for isolated severe AS, QCS was feasible in 483 (67%): mean age 76.7 ± 9.5 yrs, 59% males, EF 56 ±12%, AVAi 0.35 ±0.09 cm2/m2, AVW 2.45 ± 0.09 g, QCS 3.5± 0.57, 11% bicuspid valves . AVC was determined using short- and long-axis views and graded as mild (1) localized, small, nondense calcifications to severe (4) extensive thickening and calcification of all cusps. TEEs were done on the day of surgery and excised valves were weighed. Independent t-test, Fisher’s exact test, analysis of variance, and Pearson correlation were done as appropriate. Results: Intraclass correlations for intra and interobserver variability were 0.76 and 0.53 , res...
Introduction: The process of cardiac calcification bears a resemblance to bone metabolism and its... more Introduction: The process of cardiac calcification bears a resemblance to bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but available epidemiologic data are sparse. Methods: We tested the hypothesis that BMD of total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) are inversely associated with prevalence of 3 echocardiographic (echo) measures of cardiac calcification (mitral annular [MAC], aortic annular [AAC] and aortic valve calcification [AVC]) in 1,497 older adults from the population-based Cardiovascular Health Study. Analyses were stratified by sex. Relative risk (RR) regression was used to evaluate the adjusted risks of MAC, AAC and AVC individually with continuous BMD. Dose-response associations were assessed for MAC and AVC. Fully adjusted models included age, race, BMI, SBP, hypertensive therapy, diabetes, smoking, alcohol, physical activity, e...
Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular... more Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular calcification were investigated in a cross-sectional analysis of a population-based cohort of 1497 older adults. Although there was no association between continuous bone mineral density and outcomes, a significant association between osteoporosis and aortic valvular calcification in men was found. The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1497 older adults from the Cardiovascular Health Study. The adjusted association of BMD w...
Background: Fibrotic changes in the heart and vasculature have been implicated in a diverse range... more Background: Fibrotic changes in the heart and vasculature have been implicated in a diverse range of cardiovascular disease (CVD). However, limited epidemiological data exists to support such associations. Methods: We determined prospective associations of two complementary biomarkers of fibrosis, transforming growth factor- β (TGF-β, n=1,371) and procollagen type III N-terminal propeptide (PIIINP, n=2,568), with congestive heart failure (CHF), myocardial infarction (MI), and stroke among community-living older adults in the Cardiovascular Health Study over 14 years of follow-up. Due to potentially pleiotropic effects of TGF-β on inflammation and fibrosis, we investigated effect modification by C-reactive protein (CRP) in secondary analyses. Results: In age, sex, race, and site-adjusted models, higher PIIINP was associated with risk of total CVD, CHF, and stroke, as was the combined measure of TGF-β and PIIINP (sum of z-scores). Most of these associations remained statistically significant in fully-adjusted models (Table). TGF-β was not associated with CVD in the full cohort, but associations with total CVD, CHF, and stroke were statistically significant among individuals with CRP above the median (2.3 mg/L) ( P -interaction=0.05). Associations involving PIIINP were also statistically significant and stronger among individuals with higher CRP. In the high CRP stratum, HRs for total CVD were 1.15 (CI: 1.02, 1.30) per SD TGF-β, 1.14 (CI: 1.04, 1.25) per SD PIIINP, and 1.21 (CI: 1.06, 1.38) per SD of the combined measure. In the low CRP stratum, HRs were 0.96 (CI: 0.82, 1.12) per SD of TGF-β, 1.02 (CI: 0.92, 1.12) per SD PIIINP, and 1.04 (CI: 0.90, 1.20) per SD of the combined measure. Conclusion: Our findings provide further evidence that circulating biomarkers of fibrosis, measured late in life, are associated with CVD. Research on whether TGF-β has a stronger pro-fibrotic effect in the setting of increased inflammation is warranted.
The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently... more The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently reported as if they were interchangeable. No systematic evaluation of the agreement between these methods has been done. To determine the agreement, correlation and reproducibility of SV values measured by 2-D echo and Doppler methods. 107 healthy subjects (mean age 59 ± 14 yrs, 59 % females), had comprehensive echocardiographic evaluation. 2-D LV volumes (2D) were measured by the biplane Simpson’s method. For Doppler, the product of the area of the LV outflow tract (LVOT) x LVOT time velocity integral (TVI), and the area of aortic annulus (AA), and the product of aortic cusp separation (ACS) x aortic TVI were used. Mixed model analysis of variance was performed and Bland Altman agreement limits, Pearson correlation and within-subject coefficient of variation and intraclass correlation coefficient were determined. The mean SV (ml/beat) measured by 2-D and Doppler methods using LVOT, AA ...
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