Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy

Simone, Giovanni de; Izzo, Raffaele; Losi, Maria Angela; Stabile, Eugenio; Rozza, Francesco; Canciello, Grazia; Mancusi, Costantino; Trimarco, Valentina; Luca, Nicola De; Trimarcö, Bruno

doi:10.1097/hjh.0000000000001007

Cited by 58 publications

(126 citation statements)

References 51 publications

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“…Despite advances in recognize subclinical findings of impaired left ventricular function, in acute heart failure the diagnosis is challenging [17–19]. Diastolic dysfunction of the left ventricle, present in all the types of heart failure, regardless of the values of EF, is characterized by increased left ventricular filling pressure with congestion or pulmonary edema and consequent respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea

Sforza

Mancusi

Carlino

et al. 2017

Cardiovasc Ultrasound

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BackgroundThe availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD).MethodsWe included 68 patients presenting to the ED of “Maurizio Bufalini” Hospital in Cesena (Italy) for AD. All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The series was divided into patients with dyspnea of cardiac or non-cardiac origin. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive value and negative predictive value of the three ultrasonic methods and their various combinations for the diagnosis of cardiogenic dyspnea (CD), comparing with the final diagnosis made by an independent emergency physician.ResultsLUS alone exhibited a good sensitivity (92.6%) and specificity (80.5%). The highest accuracy (90%) for the diagnosis of CD was obtained with the combination of LUS and one of the other two methods (heart or IVC).ConclusionsThe IUE with PUD is a useful extension of the clinical examination, can be readily available at the bedside or in ambulance, requires few minutes and has a reliable diagnostic discriminant ability in the setting of AD.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea

Sforza

Mancusi

Carlino

et al. 2017

Cardiovasc Ultrasound

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“…Thus, MEE could be measured as the ideal amount of blood pumped by one single heart beat in 1 s. However, as we have previously shown, this amount is strictly related to the amount of myocardium available for pump performance [4]. Thus, ratiometric normalization of MEE for LV mass (MEEi) provides the estimate of the ideal amount of blood pumped by each gram of LV mass in 1 s [4, 5].…”

Section: Methodsmentioning

confidence: 99%

“…We developed a simple method for non-invasive, ultrasound-guided estimation of myocardial mechano-energetic efficiency per gram of LV mass (MEEi), which has been prognostically validated [4, 5]. Low levels of MEEi predict increased incidence of composite cardiovascular events in a large hypertensive population from an open registry in the Campania district in Southern Italy [5] and are associated with high prevalence of obesity and diabetes. At this time, however, there is no information on whether increasing insulin-resistance is a factor compromising MEEi, which can at least in part explain the association with CV morbidity [6].…”

Section: Introductionmentioning

confidence: 99%

Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort

Mancusi

Simone

Best

et al. 2019

Cardiovasc Diabetol

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Background Myocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS). Methods We selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18–93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/“double product” of SBP × heart rate (HR), as an estimate of O 2 consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi). Results Linear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001). Conclusions Severity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians. Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134 , Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988 Electronic supplementary material The online version of this article (10.1186/s12933-019-0862-9) contains supplementary material, which is available to authorized users.

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“…To verify whether the markers of TOD retained their effect on incident diabetes, sequential multivariable logistic regression models were implemented for each TOD marker, to identify confounders (if any) that could help explain its association with incident type 2 diabetes. Because among the variables of interest, we found about 2% of missing values, with no variables exceeding more than 10% of missing values, multiple imputation was adopted, using the SPSS automatic imputing algorithm [25, 26]. …”

Section: Methodsmentioning

confidence: 99%

Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

Simone

Wang

Best

et al. 2017

Cardiovasc Diabetol

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BackgroundRecent analyses in a registry of hypertensive patients suggested that preceding left ventricular (LV) hypertrophy (LVH) and/or carotid atherosclerosis are associated with incident type 2 diabetes, independent of confounders. We assess the relation between prevalent cardio-renal target organ damage (TOD) and subsequent incident type 2 diabetes in a population-based study with high prevalence of obesity.MethodsWe selected 2887 non-diabetic participants from two cohorts of the Strong Heart Study (SHS). Clinical exam, laboratory tests and echocardiograms were performed. Adjudicated TODs were LVH, left atrium (LA) dilatation, and high urine albumin/creatinine ratio (UACR). Multivariable logistic regression models were used to identify variables responsible for the association between initial TODs and incident diabetes at 4-year follow-up (FU).ResultsAfter 4 years, 297 new cases of diabetes (10%) were identified, 216 of whom exhibited baseline impaired fasting glucose (IFG, 73%, p < 0.0001). Participants developing type 2 diabetes exhibited higher inflammatory markers, fat-free mass and adipose mass and higher prevalence of initial LVH and LA dilatation than those without (both p < 0.04). In multivariable logistic regression, controlling for age, sex, family relatedness, presence of arterial hypertension and IFG, all three indicators of TOD predicted incident diabetes (all p < 0.01). However, the effects of TOD was offset when body fat and inflammatory markers were introduced into the model.ConclusionsIn this population-based study with high prevalence of obesity, TOD precedes clinical appearance of type 2 diabetes and is related to the preceding metabolic status, body composition and inflammatory status. Trial registration Trial registration number: NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134, Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988

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Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy

Cited by 58 publications

References 51 publications

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea

Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort

Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

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