Background Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults. Methods and Results Participants of Hispanic/Latino origin across the US, aged 45–74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography exam to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report; and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1,818 ECHO-SOL participants (mean age 56.4 years; 42.6% male) , 49.7% had LVSD and/or LVDD. LVSD prevalence was 3.6%, while LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all p<0.05). Female sex, hypertension, diabetes, higher body-mass index and renal dysfunction were more common among those with LVDD (all p<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost two-fold more likely to have LVDD compared to those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared to those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1–0.4). Conclusions Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.

Background Diabetic patients have a worse prognosis than nondiabetic patients after myocardial infarction. Although exercise improves risk factors, exercise capacity, and mortality, it is still unclear if these benefits are the same as in nondiabetics. Furthermore, although exercise tolerance is predicted by systolic and diastolic dysfunction in nondiabetics, its role as a predictor of exercise capacity in diabetics remains unclear. Hypothesis Diabetics and nondiabetics see a similar improvement in their cardiac risk factors and exercise parameters from exercise‐based cardiac rehabilitation (CR). Methods A series of 370 diabetics and 942 nondiabetics entered a 36‐session outpatient CR program after interventions for coronary heart disease or after bypass or cardiac valve surgery. The program consisted of physical exercise, lifestyle modification, and pharmacotherapy. Results Quality of life, weight, blood pressure, and lipid profiles improved significantly in both groups during the 12‐week program. Baseline metabolic equivalents (METs) were lower in diabetics vs nondiabetics at the start of CR (2.4 vs 2.7, P < 0.001). Although both groups increased their exercise capacity, diabetics had less improvement (change in METs 1.7 vs 2.6, P < 0.001). Significant predictors for improvement after CR included age, sex, and weight, as well as both systolic and diastolic function. After adjustment for these, diabetes remained a significant predictor of reduced improvement in exercise capacity. Conclusions Diabetics saw a significant benefit in quality of life, weight, exercise tolerance, and cardiac risk factors, but to a lesser extent when compared with nondiabetics. The mechanisms for poorer improvement in diabetics following CR also include noncardiac factors and require further study.

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PURPOSE The correlation between chronic kidney disease (CKD) and increased cardiovascular disease-related mortality is well established. Cardiac rehabilitation (CR) improves exercise capacity, quality of life, and risk factors in patients with coronary artery disease (CAD). Data on the benefits of CR in patients with CKD are sparse. To compare outcomes after CR in patients with CAD but normal renal function, versus those with CAD and CKD. METHODS We studied 804 patients with CAD entering an exercise-based CR program. Demographics, risk factors, exercise capacity in metabolic equivalent levels (METs), and estimated glomerular filtration rate (GFR) were recorded before and after the 3-month CR program. Use of polyunsaturated fatty acid (PUFA) was determined by medical records review. Stage III-V CKD (GFR <60 mL/min/1.73 m2) was present in 167 patients at baseline. RESULTS After CR, METs improved in all patients, although increases in patients with a GFR 30 to 59 mL/min/1.73 m2 (Δ1.6) and a GFR <30 (Δ1.3) were smaller than those in patients with a GFR ≥60 (Δ2.6, P < .05 vs GFR 30–59 and GFR <30). In patients with a GFR ≥60 mL/min/1.73 m2, PUFA use was associated with a 20% greater increase in MET levels compared with nonusers (Δ3.0 vs Δ2.5, P = .02); and in patients with a GFR 30 to 59, PUFA use was associated with 30% increase in MET level compared with nonusers (Δ2.0 vs Δ1.4, P = .03). These observations persisted after multivariable adjustment for baseline MET level, demographics, and risk factors. CONCLUSIONS Potential mitigation by PUFA of the smaller improvement in exercise capacity with decreasing GFR requires confirmation in prospective randomized trials.

Indocyanine green (ICG) is an FDA-approved infrared chromophore used for various biomedical applications such as cardiac and hepatic function evaluation, and ophthalmic angiography. Despite its clinical applications, freely dissolved ICG binds non-specifically to various plasma proteins resulting in changes in its near infrared (NIR) emission properties and rapid elimination from the vasculature. To overcome these shortcomings, we have encapsulated ICG within polymeric nano-constructs composed of poly allylamine hydrochloride (PAH) cross-linked with di-sodium hydrogen phosphate (Na 2 HPO 4 ). To optimize the photophysical properties of nano-encapsulated ICG (NE-ICG) for clinical imaging applications, we report measurements of fluorescent quantum yield (φ) of NE-ICG. Specifically, we constructed capsules of three different diameters (~130, ~240, and ~450 nm). Our preliminary results indicate that NE-ICG shows less quantum yield compared to freely-dissolved ICG. We determined that the 240 nm diameter capsule to have the highest φ and 450 nm diameter capsules to have the least φ at room temperature.

Introduction: Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanic/Latino adults. Hypothesis: Among Hispanic/Latino adults, prevalence of clinical HF and subclinical cardiac dysfunction is high. Methods: Adult participants of Hispanic/Latino origin were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL). Left ventricular systolic dysfunction (LVSD) was defined as an ejection fraction (EF) less than 50%; left ventricular diastolic dysfunction (LVDD) was defined using the Redfield and American Society of Echocardiography criteria. Baseline diagnosis of clinical HF was defined according to self-report; and those with cardiac dysfunction without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Results: Of the 1818 participants (mean age 56.4 years; 42.6% male) enrolled in ECHO-SOL, 52.7% had some form of cardiac dysfunction. The prevalence of LVSD was 3.6%, while LVDD was detected in 53.5%. Participants with LVSD were more likely to be males and current smokers and have lower socioeconomic status (all p<0.05). Female sex, hypertension, diabetes, higher body-mass index and renal dysfunction were more common among those with LVDD (all p<0.05). LVSD prevalence did not vary by Hispanic/Latino background group; however, in age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost two-fold more likely to have LVDD compared to those of Mexican backgrounds. Prevalence of clinical HF with LVSD was 7.3%; prevalence of clinical HF with LVDD was 3.6%. Among those with cardiac dysfunction, 96.2% of the cardiac dysfunction was subclinical or unrecognized. Among those with cardiac dysfunction, prevalent coronary heart disease was the only factor independently inversely associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.14; 95% confidence interval: 0.05-0.38).Conclusion: Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, and there is a high prevalence of diastolic dysfunction. This suggests that Hispanics/Latinos are a high-risk population for the development of clinical HF.