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- Ali, Amna, et al.
(author)
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Autonomic dysfunction is associated with cardiac remodelling in heart failure patients
- 2018
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In: Heart Failure Clinics. - : Wiley. - 1551-7136 .- 2055-5822. ; 5:1, s. 46-52
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Journal article (peer-reviewed)abstract
- AIMS: Orthostatic hypotension (OH) is a cardinal sign of autonomic dysfunction and a common co-morbidity in heart failure (HF). The role of autonomic dysfunction in the development of structural cardiac anomalies in HF patients has not been sufficiently explored. We aimed to assess relations between orthostatic blood pressure (BP) responses during active standing and echocardiographic changes in a series of patients admitted for HF.METHODS AND RESULTS: One hundred and forty-nine patients hospitalized for HF [mean age: 74 years; 30% women; ejection fraction (LVEF) 40 ± 16%] were examined with conventional echocardiograms and active-standing test. Associations of cardiac remodelling parameters with the difference between supine and standing (after 3 min) systolic/diastolic BP were examined. Systolic BP decreased (-1.1 ± 15 mmHg), whereas diastolic BP increased (+1.0 ± 9.5 mmHg) after 3 min of active standing. A total of 34 patients (23%) met conventional OH criteria; i.e. systolic/diastolic BP decreases by ≥20/10 mmHg. In the multivariable linear regression analysis, adjusted for traditional cardiovascular risk factors and LVEF, a decrease in systolic BP upon standing was associated with greater left atrial volume [β per -10 mmHg: 2.37, standard error (SE) = 1.16, P = 0.043], and greater left ventricular mass (β per -10 mmHg: 5.67, SE = 2.24, P = 0.012), but not with other echocardiographic parameters. No significant associations were observed between signs of cardiac remodelling and decrease in diastolic BP.CONCLUSIONS: Orthostatic decrease in systolic BP among older HF patients is associated with structural cardiac changes such as increased left atrial volume and left ventricular mass, independently of traditional risk factors and left ventricular dysfunction.
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| 2. |
- Chau, Kénora, et al.
(author)
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Obesity and metabolic features associated with long-term developing diastolic dysfunction in an initially healthy population-based cohort
- 2018
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In: Clinical Research in Cardiology. - : Springer Science and Business Media LLC. - 1861-0684 .- 1861-0692. ; 107:10, s. 887-896
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Journal article (peer-reviewed)abstract
- Background: Diastolic dysfunction (DD) is increasingly common. However, its metabolic determinants are poorly known. This study aims to determine which metabolic and inflammatory features predict DD in initially healthy adults. Methods: We prospectively analyzed the association between metabolic features and DD in 728 initially healthy adults aged 30–60 from Eastern France enrolled in the STANISLAS population-based cohort. Clinical and biological cardiovascular features were collected at baseline (1994–1995). DD was assessed twenty years later (2011–2016) by echocardiography using current international guidelines. For replication purposes, 1463 subjects from the Malmö Preventive Project cohort were analyzed. Results: In the STANISLAS cohort, 191 subjects (26.2%) developed DD. In age-sex-adjusted logistic models, significant predictors of DD were body mass index (BMI, odds ratio for 1-standard-deviation increase (OR) 1.28, 95% CI 1.08–1.52), waist circumference (WC, OR 1.48, 95% CI 1.18–1.84), waist-hip ratio (OR 1.53, 95% CI 1.16–2.02), systolic blood pressure (OR 1.19, 95% CI 1.00–1.43) and triglycerides (TG, OR 1.18, 95% CI 1.00–1.40). Subjects with elevated WC (> 80th percentile) and TG (> 50th percentile) had a twofold higher DD risk (age-sex-adjusted odds ratio 2.00, 95% CI 1.20–3.31, P = 0.008), whereas no such interplay was observed for BMI. In the Malmö cohort, BMI was similarly associated with DD; participants with both elevated BMI and TG were at higher DD risk (age-sex-adjusted odds ratio 1.61, 95% CI 1.18–2.20, P = 0.002). Conclusions: Subjects with elevated WC and TG may have a higher long-term DD risk. Prevention targeting visceral obesity may help reduce the incidence of DD.
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| 3. |
- Tremmel, Maximilian, et al.
(author)
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Characteristics and prognosis of healthy severe obesity (HSO) subjects - The Malmo Preventive Project
- 2018
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In: Obesity Medicine. - : Elsevier BV. - 2451-8476. ; 11, s. 6-12
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Journal article (peer-reviewed)abstract
- Background: The characteristics and prognosis of healthy obesity (HO) still remain unclear. We aimed to examine the characteristics of healthy severe obesity (HSO), defined by a novel approach, with a focus on self-reported physical activity (PA) and a genetic risk score for type 2 diabetes (GRS DM2). Methods: A cross-sectional analysis was carried out in a subsample of severly obese subjects (BMI≥35 kg/m2; n = 809) selected from the population-based Malmo Preventive Project (MPP). Subjects with HSO (n = 57) were defined by having no records of hospitalisation in the Swedish Hospital Discharge Register during a time period of 33.4 ± 3.9 years between baseline (1974–1992) and the end of follow-up (31st of December 2014). They were compared to subjects with unhealthy severe obesity (USO; n = 752), as well as age- and sex-matched non-obese controls (n = 1618). Results: Subjects with HSO had a significantly lower GRS DM2 (HSO 40.4 ± 3.7 vs. USO 41.8 ± 3.8, p = 0.007). Compared to subjects with USO, the HSO subjects reported significantly more leisure-time physical activity, PA (p = 0.016). There were no significant differences between HSO and USO subjects in the distribution of fat mass or obesity-associated gene phenotypes (FTO gene; variant rs9939609; p = 0.8). Conclusion: Higher PA and lower GRS DM2 might be protective factors against all-cause hospitalisation in subjects with severe obesity. These findings support the concept of HO being fat but fit. Still, it remains unclear whether higher PA is causally related to HSO, and which role environmental factors such as PA play in the interaction with genetic factors such as GRS DM2.
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