ORCID Profile
0000-0002-4908-0641
Current Organisations
University of South Australia
,
University of Technology Sydney
,
Canberra Health Services
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Publisher: Informa UK Limited
Date: 16-08-2017
Publisher: Wiley
Date: 22-02-2021
DOI: 10.1111/PACE.14139
Abstract: Cardiac resynchronization therapy with His-bundle pacing is evolving rapidly as a viable cardiac device strategy for the treatment of severe chronic heart failure. The success of this technique in patients with congenital heart disease is facilitated by advanced integrated imaging modalities. We report a case of cardiac resynchronization therapy with His-bundle pacing with defibrillator for the management of a patient with heart failure with severely reduced ejection fraction, left bundle branch block, and congenital heart disease characterized by Scimitar syndrome with cardiac dextroposition. We highlight the contribution of integrated imaging modalities to guide accurate lead positioning.
Publisher: Oxford University Press (OUP)
Date: 17-06-2016
DOI: 10.1093/AJH/HPW063
Abstract: New techniques that measure central blood pressure (BP) using an upper arm cuff-based approach require performance assessment. The aim of this study was to compare a cuff-based device (CuffCBP) to estimate central BP indices (systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), augmentation pressure (AP), augmentation index (AIx)) with noninvasive radial tonometry (TonCBP). Consecutive CuffCBP (SphygmoCor Xcel) and TonCBP (SphygmoCor 8.1) duplicate recordings were measured in 182 people with treated hypertension (aged 61±7 years, 48% male). Agreement between methods was assessed using standard calibration with brachial SBP and DBP (measured with the Xcel device), as well as with brachial mean arterial pressure (MAP 40% form factor method) and DBP. The mean difference ± SD for central SBP (cSBP), central DBP (cDBP), and central PP (cPP) between methods were -0.89±3.48mm Hg (intra-class correlation (ICC) 0.977 95% confidence interval (CI) 0.973-0.982), -0.50±1.54mm Hg (ICC 0.992, 95% CI 0.987-0.993), and -0.42±3.57mm Hg (ICC 0.966, 95% CI 0.958-0.972), indicating good agreement. Wider limits of agreement were observed for central AP (cAP) and central AIx (cAIx) (-0.91±5.31mm Hg ICC 0.802 95% CI 0.756-0.839, -0.99±10.91% ICC 0.749 95% CI 0.691-0.796). Re-calibration with brachial MAP and DBP resulted in an overestimation of cSBP with CuffCBP compared with TonCBP (8.58±19.06mm Hg, ICC 0.164, 95% CI -0.029 to 0.321). cSBP, cDBP, and cPP derived from CuffCBP are substantially equivalent to TonCBP, although the level of agreement is dependent on calibration method. Further validity testing of CuffCBP by comparison with invasively measured central BP will be required.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2012
Publisher: Elsevier BV
Date: 11-2013
Publisher: Springer Science and Business Media LLC
Date: 12-09-2023
Publisher: American Psychological Association (APA)
Date: 08-2017
DOI: 10.1037/HEA0000496
Abstract: This study examined the longitudinal and cross-sectional effects of both psychosocial stress and depressive symptoms on insulin resistance and percentage body fat in a cohort of healthy Australian children, following them from childhood into adolescence. Participants were 791 healthy, initially Grade 2 children (7-8 years 394 girls), selected from the general community. Psychosocial stress was assessed using the Children's Stress Questionnaire, while depressive symptoms were assessed using the Children's Depression Inventory. Fasting blood s les for serum insulin and plasma glucose were collected to calculate the homeostasis model assessment-insulin resistance (HOMA-IR). Other measurements were height, weight, percentage body fat (dual energy x-ray absorptiometry), physical activity (pedometers), and pubertal maturation (Tanner score). Boys who reported more symptoms of depression had higher insulin resistance, irrespective of adiposity (p = .016) and longitudinally, we found a trend for boys who developed more depressive symptoms to develop higher insulin resistance (p = .073). These findings did not extend to girls. Furthermore, boys and girls with higher depressive symptoms had a higher percentage of body fat (p = .011 and .020, respectively) and longitudinally, boys whose depressive symptoms increased became fatter (p = .046). Our data provide evidence that early symptoms of depression increase insulin resistance, independent of adiposity. Our evidence that early symptoms of depression may lead to overweight, and obesity provides further reason to suggest that early attention to children with depression, even in preclinical stages, may reduce risk of chronic disease in later life. (PsycINFO Database Record
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.AMJCARD.2005.09.143
Abstract: Left atrial (LA) enlargement, left ventricular (LV) diastolic dysfunction, and increased arterial stiffness are all associated with adverse cardiovascular outcomes. The rate, magnitude, and concordance of modifiability of these risk markers have not been well characterized. Twenty-one patients (mean age 69 +/- 8 years 52% women) with isolated diastolic dysfunction and indexed LA volumes > or =32 ml/m(2) were randomly assigned to receive either quinapril at a target dose of 60 mg/day or matching placebo for 12 months. Echocardiographic maximum LA volume and LV diastolic function and arterial stiffness by the augmentation index were measured at baseline and 6 and 12 months. Analysis was based on intention to treat. Baseline characteristics were comparable between the treatment (n = 9) and placebo (n = 12) groups. The mean reduction in LA volume of 4.2 +/- 7.8 ml/m(2) in the quinapril group was significant (p = 0.01) compared with the increase in LA volume in the placebo group (5.5 +/- 8.1 ml/m(2)). This represents a relative improvement of 9.7 ml/m(2). Change in LV filling pressure in terms of E/e' and diastolic function grade did not reach significance. A reduction in the augmentation index was associated with a decrease in indexed LA volume (odds ratio 11, p = 0.046), independent of changes in systolic blood pressure. In conclusion, LA structural remodeling appeared reversible with quinapril, which occurred in parallel with an improvement in arterial stiffness but independent of blood pressure changes.
Publisher: Springer International Publishing
Date: 2022
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.COMPMEDIMAG.2015.08.005
Abstract: White matter lesions (WMLs) are small groups of dead cells that clump together in the white matter of brain. In this paper, we propose a reliable method to automatically segment WMLs. Our method uses a novel filter to enhance the intensity of WMLs. Then a feature set containing enhanced intensity, anatomical and spatial information is used to train a random forest classifier for the initial segmentation of WMLs. Following that a reliable and robust edge potential function based Markov Random Field (MRF) is proposed to obtain the final segmentation by removing false positive WMLs. Quantitative evaluation of the proposed method is performed on 24 subjects of ENVISion study. The segmentation results are validated against the manual segmentation, performed under the supervision of an expert neuroradiologist. The results show a dice similarity index of 0.76 for severe lesion load, 0.73 for moderate lesion load and 0.61 for mild lesion load. In addition to that we have compared our method with three state of the art methods on 20 subjects of Medical Image Computing and Computer Aided Intervention Society's (MICCAI's) MS lesion challenge dataset, where our method shows better segmentation accuracy compare to the state of the art methods. These results indicate that the proposed method can assist the neuroradiologists in assessing the WMLs in clinical practice.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.CLINBIOCHEM.2019.04.014
Abstract: Because the 99th percentile is of such importance in defining myocardial injury and myocardial infarction, it is important to know whether there are real age-related differences in troponin 99th percentiles. We went to our database from the Canberra Heart Study where 1062 apparently healthy subjects were extensively screened for occult cardiac disease, and looking at persons aged 65 years, for men and women separately, we compared a variety of cutpoints from the 99th percentile down to the 50th percentile. With our rigorous criteria for defining cardiac health, we excluded 67.2% of males aged >65 years and 53.8% of women aged 65 years and older. Even with these rigorous exclusions we found that at every cutpoint examined between the 99th percentile and the 50th percentile, persons aged <65 years had lower troponin I concentrations that persons aged 65 years and older. Similarly, at every cutpoint examined, women had lower troponin I concentrations than did men. For the 4 separate groups examined (men and women, age < 65 years and 65 years and older) after the exclusions of persons with subclinical cardiac disease, the distributions were not significantly different to a Gaussian distribution. With the rigorous exclusions of persons with subclinical cardiac disease, and the fact that our populations have a Gaussian distribution, our data suggests that age-related hs-cTnI concentrations are real. This has important implications particularly when assessing older persons in the Emergency Department.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.CCA.2012.12.019
Abstract: To describe the distribution of hs-cTnI in a large cohort of healthy children. As part of the LOOK study, blood was collected from a large cohort of healthy children on 3 separate occasions when the children were aged 8, 10 and 12years. S les were stored at -80°C after collection and assayed after 1 freeze-thaw cycle using a pre-commercial release hs-cTnI assay from Abbott Diagnostics. More than 98% of the 12year-old children had cTnI above the LoD of 1.0ng/L. For the 212 boys the central 95% of results was distributed in a Gaussian fashion. For the 237 girls, the initial analysis was non-Gaussian, but after the elimination of 2 results, the pattern for girls was also Gaussian. In healthy children, cTnI is present in a Gaussian distribution. Even minor illnesses can cause some troponin release, distorting this Gaussian distribution.
Publisher: Public Library of Science (PLoS)
Date: 12-10-2012
Publisher: Springer Science and Business Media LLC
Date: 30-05-2013
DOI: 10.1038/JHH.2013.38
Abstract: Office blood pressure (BP) is recommended to be measured after 5 min of seated rest, but it may decrease for 10 min of seated rest. This study aimed to determine the change (and its clinical relevance) in brachial and central BP from 5 to 10 min of seated rest. Office brachial and central BP (measured after 5 and 10 min), left ventricular (LV) mass index, 7-day home and ambulatory BP were measured in 250 participants with treated hypertension. Office brachial and central BP were significantly lower at 10-min compared with 5-min BP (P<0.001). Seven-day home systolic BP (SBP) was significantly lower than office SBP measured at 5 min (P<0.001), but was similar to office SBP at 10 min (P=0.511). From 5 to 10 min, the percentage of participants with controlled BP increased and the percentage of participants with high central pulse pressure (PP) decreased (P<0.001). Moreover, brachial and central PP were significantly correlated with LV mass index measured at 10 min (r=0.171, P=0.006 and r=0.139, P=0.027, respectively), but not at 5 min (r=0.115, P=0.068 and r=0.084, P=0.185, respectively). BP recorded after 10 min is more representative of true BP control. These findings have relevance to appropriate diagnosis of hypertension and design of clinical trials.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.CCA.2011.12.017
Abstract: Whilst cardiac troponin is considered to be indicative of cardiac necrosis, the advent of new high sensitivity assays for troponin suggests that troponin may be present in the blood of healthy persons. We have examined a cohort of healthy children and measured TnT in their blood. In this community-based prospective study, we collected blood s les from a large cohort of healthy children at ages 8, 10 and 12 years and measured hs-TnT on these s les. 727 children had at least one blood s le collected and of these 28.6% had at least one s le in which troponin was detected. The number of s les with a positive troponin at each period of blood collection varied between 14.0% and 20.3%. Statistical analysis showed that the prevalence of positive TnT varied between schools and the between school pattern was different in different years. Low concentrations of troponin may be seen transiently in healthy children with no evidence of cardiac injury. This between-school by year variation is highly significant and is suggestive of a transient infective agent.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.JCMG.2009.08.011
Abstract: We explored the incremental value of quantification of tissue Doppler (TD) velocity during the brief isovolumic contraction (IVC) phase of the cardiac cycle for the prediction of exercise performance in patients referred for cardiopulmonary exercise testing (CPET). Experimental studies have shown that rapid left ventricular (LV) shape change during IVC is essential for optimal onset of LV ejection. However, the incremental value of measuring IVC velocities in clinical settings remains unclear. A total of 82 subjects (age 53+/-14 years, 56 men) were studied with echocardiography and CPET. Reduced LV ejection fraction (EF) (EF<50%) was present in 38 (46%) subjects. Pulsed-wave annular TD velocities were averaged from the LV lateral and septal annulus during isovolumic contraction (IVCa), ejection, isovolumic relaxation, and early and late diastole (Aa) and compared with peak oxygen consumption (VO2) and percentage of the predicted peak VO2 (% predicted peak VO2) obtained from CPET. Patients with reduced EF had lower IVCa (6.3 vs. 4.5 cm/s, p=0.04), ejection (7.7 vs. 5.5 cm/s, p<0.001), and Aa velocities (7.9 vs. 6.6 cm/s, p=0.04). Similarly, % predicted peak VO2 was lower in patients with reduced EF (52.9% vs. 73.1%, p<0.001) and correlated with the variations in IVCa (r=0.7, p=0.001). Multivariate analysis of 2-dimensional and Doppler variables in the presence of reduced LV EF revealed only IVCa and Aa as independent predictors of % predicted peak VO2 (r2=0.612, p=0.02 for IVCa and p=0.009 for Aa). The overall performance of IVCa in the prediction of exercise capacity was good (area under the curve=0.86, p<0.001). Assessment of TD-derived IVC and atrial stretch velocities provide independent prediction of exercise capacity in patients with reduced LV EF. Assessment of LV pre-ejectional stretch and shortening mechanics at rest may be useful for determining the myocardial functional reserve of patients with reduced EF.
Publisher: Wiley
Date: 25-04-2013
DOI: 10.1111/SMS.12073
Abstract: We investigated longitudinal and cross-sectional relationships between eye-hand coordination (EHC) and cardiorespiratory fitness (multistage run), physical activity (pedometers), percent body fat (%BF, dual energy x-ray absorptiometry), body image, and organized sport participation (questionnaires) in 406 boys and 384 girls at 8 and 10 years of age. EHC was measured by a throw and wall-rebound catch test involving 40 attempts of increasing difficulty. Median EHC improved during two years from 18 to 32 (boys) and 9 to 24 (girls), and gender differences and improvements were both significant (P < 0.001). Cross-sectional analyses showed that boys and girls with better EHC were fitter (P < 0.001), and a longitudinal relationship showed that girls who improved their EHC over the two years became fitter (P 0.3). Finally, even at age 8 years, boys and girls participating in organized sport possessed better EHC than non-participants. These data provide evidence for the premise that early acquisition of this single motor skill promotes the development of a child's fitness, body image, and participation in sport.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.IJCARD.2011.10.065
Abstract: Health outcomes associated with atrial fibrillation (AF) continue to be poor and standard management often does not provide clinical stability. The Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY) compares the efficacy of a post-discharge, nurse-led, multi-disciplinary programme to optimise AF management with usual care. SAFETY is a prospective, multi-centre, randomised controlled trial with blinded-endpoint adjudication. A target of 320 hospitalised patients with a chronic form of AF will be randomised (stratified by "rate" versus "rhythm" control) to usual post-discharge care or the SAFETY Intervention (SI). The SI involves home-based assessment, extensive clinical profiling and the application of optimal gold-standard pharmacology which is in idually tailored according to a "traffic light" framework based on clinical stability, risk profile and therapeutic management. The primary endpoint is event-free survival from all-cause death or unplanned readmission during 18-36 months follow-up. Secondary endpoints include rate of recurrent hospital stay, treatment success (i.e. maintenance of rhythm or rate control and/or application of anti-thrombotic therapy without a bleeding event) and cost-efficacy. With study recruitment to be completed in early 2012, the results of this study will be available in early 2014. If positive, SAFETY will represent a potentially cost-effective and readily applicable strategy to improve health outcomes in high risk in iduals discharged from hospital with chronic AF.
Publisher: Wiley
Date: 31-08-2022
DOI: 10.1002/EHF2.14125
Abstract: Heart failure patients with mid‐range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta‐analysis of studies reporting long‐term outcomes in HFmrEF compared with HFrEF and HFpEF. Data from 18 eligible large‐scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all‐cause death than those with HFrEF [risk ratio (RR) = 0.92 95% CI = 0.85–0.98 P 0.001]. This significant difference was seen in the follow‐up at 1, 2, and 3 years. Patients with HFmrEF had significantly lower risk of cardiovascular (CV) deaths than HFrEF (RR = 0.77 95% CI = 0.65–0.92 P 0.001). Subgroup analysis showed that studies recruiting % of males had higher risk of deaths with HFrEF (RR = 1.15 95% CI = 1.04–1.26 P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all‐cause death (RR = 1.02 95% CI = 0.96–1.09 P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths CV and non‐CV deaths were insignificant between HFmrEF and HFpEF. The results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107.
Publisher: Oxford University Press (OUP)
Date: 14-06-2018
Abstract: Atrial fibrillation (AF) is a progressive disease. Obesity is associated with progression of AF. This study evaluates the impact of weight and risk factor management (RFM) on progression of the AF. As described in the Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up (LEGACY) Study, of 1415 consecutive AF patients, 825 had body mass index ≥ 27 kg/m2 and were offered weight and RFM. After exclusion, 355 were included for analysis. Weight loss was categorized as: Group 1 (<3%), Group 2 (3-9%), and Group 3 (≥10%). Change in AF type was determined by clinical review and 7-day Holter yearly. Atrial fibrillation type was categorized as per the Heart Rhythm Society consensus. There were no differences in baseline characteristic or follow-up duration between groups (P = NS). In Group 1, 41% progressed from paroxysmal to persistent and 26% from persistent to paroxysmal or no AF. In Group 2, 32% progressed from paroxysmal to persistent and 49% reversed from persistent to paroxysmal or no AF. In Group 3, 3% progressed to persistent and 88% reversed from persistent to paroxysmal or no AF (P < 0.001). Increased weight loss was significantly associated with greater AF freedom: 45 (39%) in Group 1, 69 (67%) in Group 2, and 116 (86%) in Group 3 (P ≤ 0.001). Obesity is associated with progression of the AF disease. This study demonstrates the dynamic relationship between weight/risk factors and AF. Weight-loss management and RFM reverses the type and natural progression of AF.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.JACC.2015.03.002
Abstract: Obesity and atrial fibrillation (AF) frequently coexist. Weight loss reduces the burden of AF, but whether this is sustained, has a dose effect, or is influenced by weight fluctuation is unknown. This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese in iduals with AF. Of 1,415 consecutive patients with AF, 825 had a body mass index ≥ 27 kg/m(2) and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. Weight loss was categorized as group 1 (≥ 10%), group 2 (3% to 9%), and group 3 (<3%). Weight trend and/or fluctuation was determined by yearly follow-up. We determined the impact on the AF severity scale and 7-day ambulatory monitoring. There were no differences in baseline characteristics or follow-up among the groups. AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 (p < 0.001 for both). In multivariate analyses, weight loss and weight fluctuation were independent predictors of outcomes (p < 0.001 for both). Weight loss ≥ 10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3 p 5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3 p = 0.02) increased risk of arrhythmia recurrence. Long-term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm. (Long-Term Effect of Goal directed weight management on Atrial Fibrillation Cohort: A 5 Year follow-up study [LEGACY Study] ACTRN12614001123639).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-07-2006
DOI: 10.1161/CIRCULATIONAHA.105.595140
Abstract: Background— Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. Methods and Results— The adult residents of Olmsted County, Minnesota, who had ECG-confirmed first AF in the period 1980 to 2000 (n=4618) were identified. Trends in age-adjusted incidence were determined and used to construct model-based prevalence estimates. The age- and sex-adjusted incidence of AF per 1000 person-years was 3.04 (95% CI, 2.78 to 3.31) in 1980 and 3.68 (95% CI, 3.42 to 3.95) in 2000. According to Poisson regression with adjustment for age and sex, incidence of AF increased significantly ( P =0.014), with a relative increase of 12.6% (95% CI, 2.1 to 23.1) over 21 years. The increase in age-adjusted AF incidence did not differ between men and women ( P =0.84). According to the US population projections by the US Census Bureau, the number of persons with AF is projected to be 12.1 million by 2050, assuming no further increase in age-adjusted incidence of AF, but 15.9 million if the increase in incidence continues. Conclusions— The age-adjusted incidence of AF increased significantly in Olmsted County during 1980 to 2000. Whether or not this rate of increase continues, the projected number of persons with AF for the United States will exceed 10 million by 2050, underscoring the urgent need for primary prevention strategies against AF development.
Publisher: Informa UK Limited
Date: 15-07-2016
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.HRTHM.2012.08.043
Abstract: Obesity is associated with atrial fibrillation (AF) however, the mechanisms by which it induces AF are unknown. To examine the effect of progressive weight gain on the substrate for AF. Thirty sheep were studied at baseline, 4 months, and 8 months, following a high-calorie diet. Ten sheep were s led at each time point for cardiac magnetic resonance imaging and hemodynamic studies. High-density multisite biatrial epicardial mapping was used to quantify effective refractory period, conduction velocity, and conduction heterogeneity index at 4 pacing cycle lengths and AF inducibility. Histology was performed for atrial fibrosis, inflammation, and intramyocardial lipidosis, and molecular analysis was performed for endothelin-A and -B receptors, endothelin-1 peptide, platelet-derived growth factor, transforming growth factor β1, and connective tissue growth factor. Increasing weight was associated with increasing left atrial volume (P = .01), fibrosis (P = .02), inflammatory infiltrates (P = .01), and lipidosis (P = .02). While there was no change in the effective refractory period (P = .2), there was a decrease in conduction velocity (P<.001), increase in conduction heterogeneity index (P<.001), and increase in inducible (P = .001) and spontaneous (P = .001) AF. There was an increase in atrial cardiomyocyte endothelin-A and -B receptors (P = .001) and endothelin-1 (P = .03) with an increase in adiposity. In association, there was a significant increase in atrial interstitial and cytoplasmic transforming growth factor β1 (P = .02) and platelet-derived growth factor (P = .02) levels. Obesity is associated with atrial electrostructural remodeling. With progressive obesity, there were changes in atrial size, conduction, histology, and expression of profibrotic mediators. These changes were associated with spontaneous and more persistent AF.
Publisher: BMJ
Date: 27-10-2021
Publisher: Elsevier BV
Date: 2018
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.JACC.2014.09.028
Abstract: The long-term outcome of atrial fibrillation (AF) ablation demonstrates attrition. This outcome may be due to failure to attenuate the progressive substrate promoted by cardiovascular risk factors. The goal of this study was to evaluate the impact of risk factor and weight management on AF ablation outcomes. Of 281 consecutive patients undergoing AF ablation, 149 with a body mass index ≥27 kg/m(2) and ≥1 cardiac risk factor were offered risk factor management (RFM) according to American Heart Association/American College of Cardiology guidelines. After AF ablation, all 61 patients who opted for RFM and 88 control subjects were assessed every 3 to 6 months by clinic review and 7-day Holter monitoring. Changes in the Atrial Fibrillation Severity Scale scores were determined. There were no differences in baseline characteristics, number of procedures, or follow-up duration between the groups (p = NS). RFM resulted in greater reductions in weight (p = 0.002) and blood pressure (p = 0.006), and better glycemic control (p = 0.001) and lipid profiles (p = 0.01). At follow-up, AF frequency, duration, symptoms, and symptom severity decreased more in the RFM group compared with the control group (all p < 0.001). Single-procedure drug-unassisted arrhythmia-free survival was greater in RFM patients compared with control subjects (p < 0.001). Multiple-procedure arrhythmia-free survival was markedly better in RFM patients compared with control subjects (p < 0.001), with 16% and 42.4%, respectively, using antiarrhythmic drugs (p = 0.004). On multivariate analysis, type of AF (p < 0.001) and RFM (hazard ratio 4.8 [95% confidence interval: 2.04 to 11.4] p < 0.001) were independent predictors of arrhythmia-free survival. Aggressive RFM improved the long-term success of AF ablation. This study underscores the importance of therapy directed at the primary promoters of the AF substrate to facilitate rhythm control strategies.
Publisher: Public Library of Science (PLoS)
Date: 29-01-2013
Publisher: Springer Science and Business Media LLC
Date: 23-07-2016
DOI: 10.1007/S10548-016-0509-Z
Abstract: Cortical thinning is a part of normal ageing. Recent studies suggest that accelerated cortical thinning in vulnerable regions may be a useful biomarker for neuropathologies including Alzheimer's disease (AD). Longitudinal studies, which have largely focused on older adults, have provided estimates of normative rates and patterns of age-related cortical thinning. Very little, however, is known about healthy cortical thinning at midlife. Here we provide longitudinal estimates of age-related cortical thinning observed over 8 years, in a large (n = 404) group of healthy in iduals aged 44-49 years at baseline, who were scanned with MRI (1.5T) on up to three occasions. Age-related cortical thinning was assessed across the whole cortex. We measured a mean annual decrease in cortical thickness of 0.26 % on the left and 0.17 % on the right hemisphere, and largely affecting frontal and cingulate cortices. Medial and lateral temporal regions were generally spared. Studying regions that are specifically vulnerable to-or spared from-healthy age-related cortical thinning at midlife may be important for the early identification of neurodegeneration, including AD.
Publisher: Wiley
Date: 25-03-2019
DOI: 10.5694/MJA2.50117
Abstract: To examine the effectiveness of different strategies for recruiting participants for a large Australian randomised controlled trial (RCT), the Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE). Men and women aged 55-60 years with at least two cardiovascular risk factors (hypertension, hypercholesterolaemia, overweight/obesity) were recruited for a multicentre placebo-controlled RCT assessing the effectiveness of 23-valent pneumococcal polysaccharide vaccine (23vPPV) for preventing cardiovascular events. Invitations were mailed by the Australian Department of Human Services to people in the Medicare database aged 55-60 years reminders were sent 2 weeks later. Invitees could respond in hard copy or electronically. Direct recruitment was supplemented by asking invitees to extend the invitation to friends and family (snowball s ling) and by Facebook advertising. Proportions of invitees completing screening questionnaire and recruited for participation in the RCT. 21 526 of 154 992 invited people (14%) responded by completing the screening questionnaire, of whom 4725 people were eligible and recruited for the study. Despite the minimal study burden (one questionnaire, one clinic visit), the overall participation rate was 3%, or an estimated 10% of eligible persons. Only 16% of eventual participants had responded within 2 weeks of the initial invitation letter (early responders) early and late responders did not differ in their demographic or medical characteristics. Socio-economic disadvantage did not markedly influence response rates. Facebook advertising and snowball s ling did not increase recruitment. Trial participation rates are low, and multiple concurrent methods are needed to maximise recruitment. Social media strategies may not be successful in older age groups. Australian New Zealand Clinical Trials Registry, ACTRN12615000536561.
Publisher: Oxford University Press (OUP)
Date: 12-2012
DOI: 10.1373/CLINCHEM.2012.192054
Abstract: There is little information available on cardiac troponin concentrations in healthy young children. Using a precommercial high-sensitivity assay from Abbott Diagnostics, we measured cardiac troponin I (cTnI) in longitudinal blood s les collected at ages 8, 10, and 12 years from a cohort of healthy, community-dwelling children. The 99th percentile values were calculated and estimates of the long-term biological variation were made. cTnI concentrations were above the limit of detection in 87%, 90%, and 98% of the children at ages 8, 10, and 12 years. The 99th percentiles were lower compared to a healthy adult population in both male and female children at all ages studied. At the 3 periods of study assessment, different children had cTnI concentrations above the 99th percentile. The calculated 99th percentile varied markedly depending upon whether the lowest or highest cTnI measurement for an in idual child was included in the calculation. Biological variation varied markedly between 0% and 136%, the index of in iduality was low at 0.36, and the reference change value was an increase of 147% or a decrease of 59%. In this longitudinal study of cTnI concentrations in healthy children as determined by a high-sensitivity assay, different children had concentrations of cTnI above the 99th percentile at the 3 episodes of assessment. These results suggest that in children the 99th percentile may not be a reliable index of silent cardiac disease, but rather may be indicating low-grade intercurrent illness.
Publisher: Elsevier BV
Date: 02-2021
Publisher: AMPCo
Date: 08-2014
DOI: 10.5694/MJA14.00032
Abstract: The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidence-based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically erse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically erse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high-quality evidence into practice.
Publisher: Elsevier BV
Date: 02-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2009
Publisher: Oxford University Press (OUP)
Date: 24-10-2020
Abstract: Reference intervals are an important aid in medical practice as they provide clinicians a guide as to whether a patient is healthy or diseased. Outlier results in population studies are removed by any of a variety of statistical measures. We have compared several methods of outlier removal and applied them to a large body of analytes from a large population of healthy persons. We used the outlier exclusion criteria of Reed-Dixon and Tukey and calculated reference intervals using nonparametric and Harrell-Davis statistical methods and applied them to a total of 36 different analytes. Nine of 36 analytes had a greater than 20% difference in the upper reference limit, and for some the difference was 100% or more. For some analytes, great importance is attached to the reference interval. We have shown that different statistical methods for outlier removal can cause large changes to reported reference intervals. So that population studies can be readily compared, common statistical methods should be used for outlier removal.
Publisher: IEEE
Date: 09-2014
DOI: 10.1109/ICHI.2014.75
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000479560
Abstract: b i Background: /i /b The aim of this study was to investigate prospective associations between type 2 diabetes mellitus status and the gold standard non-invasive method for ascertaining arterial stiffness, carotid femoral pulse wave velocity. b i Methods: /i /b The prospective analysis employed 508 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study. Pulse wave velocity at wave 7 (2006-2010) was compared between those with type 2 diabetes mellitus at wave 6 (2001-2006) ( i n /i = 52) and non-diabetics at wave 6 ( i n /i = 456), with adjustment for demographic factors, cardiovascular risk factors and lifestyle- and pulse wave velocity-related factors. b i Results: /i /b Type 2 diabetes mellitus status was associated with a significantly higher pulse wave velocity (12.5 ± 0.36 vs. 10.4 ± 0.12 m/s). Multivariate adjustment for other cardiovascular risk factors and lifestyle- and pulse wave velocity-related variables did not attenuate the findings. The risk of an elevated pulse wave velocity (≥12 m/s) was over 9 times higher for those with uncontrolled type 2 diabetes mellitus than for those without diabetes (OR 9.14, 95% CI 3.23-25.9, i /i 0.001). b i Conclusions: /i /b Type 2 diabetes mellitus, particularly if uncontrolled, is significantly associated with risk of arterial stiffness later in life. Effective management of diabetes mellitus is an important element of protection from arterial stiffness.
Publisher: BMJ
Date: 19-07-2006
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.CLINBIOCHEM.2017.02.022
Abstract: The troponin 99th percentile is used as the laboratory decision point in the diagnosis of acute myocardial infarction. A recent publication has shown that the statistical treatment for outlier removal may dramatically change the calculated troponin 99th percentile. We have used our large database from the previously reported Canberra Heart Study to independently assess the effect of various methods for removing outliers on the calculated 99th percentile. We have performed the same exercise using the troponin 97.5th percentile as an exercise to assess how outlier removal may affect calculated upper reference intervals for any analyte which uses this boundary. For healthy males aged 3× depending upon the outlier removal method chosen and for the 97.5th percentile the variation was >50%. For women the variation in the hs-cTnI 99th percentile varied by a factor of nearly 2×. Qualitatively similar results were obtained forhs-cTnT. This is not simply a problem for troponin reference intervals. All analyte reference intervals have the potential to be significantly affected by the method chosen for outlier removal. To ensure that studies can be meaningfully compared, guidance on procedures for removing outliers needs to be standardized as a matter of urgency.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
DOI: 10.1161/HYPERTENSIONAHA.108.123364
Abstract: Childhood obesity is increasingly prevalent in the community and is related to adverse cardiovascular outcomes during adulthood. In this study of healthy children, we evaluated the influence of adiposity and physical activity on carotid-femoral pulse wave velocity (PWV), an index of arterial stiffness and a marker of cardiovascular risk in adults. In 573 community-based children (mean age: 10.1±0.3 years 51% boys), we measured body mass index and waist circumference. Percentage body fat was quantitated by dual-energy x-ray absorptiometry. Cardiorespiratory fitness (CRF) and physical activity levels were assessed using a 20-m shuttle run and 7-day pedometer count, respectively. PWV was estimated by applanation tonometry. In univariate analysis, PWV was positively correlated with body mass index ( r =0.34), waist circumference ( r =0.32), and percentage body fat ( r =0.32 P .001 for all) and negatively correlated with CRF ( r =−0.23 P .001) and pedometer count ( r =−0.08 P =0.046). In separate multivariable linear regression models, body mass index, waist circumference, and percentage of body fat were independently and positively associated with PWV ( P .01 for all) after adjusting for age, sex, systolic blood pressure, mean arterial pressure, heart rate, and CRF ( P .01 for all). The influence of CRF on PWV was attenuated after adjusting for adiposity. In conclusion, increased body mass and adiposity and decreased CRF are associated with arterial stiffening in healthy prepubescent children.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.CLINBIOCHEM.2013.08.004
Abstract: Using objective laboratory and clinical criteria to more accurately determine the 99th percentile values for cardiac troponin I and T. We measured cardiac troponin T and cardiac troponin I with high-sensitivity assays in a large cohort of apparently healthy community subjects and calculated 99th percentiles for different sexes and ages. Subjects with possible subclinical disease were eliminated based on objective laboratory criteria, eGFR and NT-proBNP, and clinical criteria, history and examination and echocardiogram. For men and women of all ages, separately, more than 50% of subjects were excluded using these criteria, with a lesser proportion of younger subjects being excluded. In men aged <75 years, the 99th percentile for cTnI decreased by more than 50% from 22.9 ng/L to 10.3 ng/L. In other age groups and for cTnT the decrease was smaller (%) but still considerable. For establishing cardiac troponin 99th percentiles, simply using self-reporting of health is insufficient. Objective laboratory measures and clinical and echocardiographic assessments are essential to define a healthy population, especially in older persons.
Publisher: Public Library of Science (PLoS)
Date: 03-01-2023
Publisher: Informa UK Limited
Date: 08-2012
Publisher: Peter Lang US
Date: 30-03-2016
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.AMJCARD.2008.01.051
Abstract: The aim of this prospective study was to evaluate the incremental value of left atrial (LA) function for the prediction of risk for first atrial fibrillation (AF) or atrial flutter. Maximum and minimum LA volumes were quantitated by echocardiography in 574 adults (mean age 74 +/- 6 years, 52% men) without a history or evidence of atrial arrhythmia. During a mean follow-up period of 1.9 +/- 1.2 years, 30 subjects (5.2%) developed electrocardiographically confirmed AF or atrial flutter. Subjects with new AF or atrial flutter had lower LA reservoir function, as measured by total LA emptying fraction (38% vs 49%, p <0.0001) and higher maximum LA volumes (47 vs 40 ml/m(2), p = 0.005). An increase in age-adjusted risk for AF or atrial flutter was evident when the cohort was stratified according to medians of LA emptying fraction ( or =38 ml/m(2): hazard ratio 2.0, p = 0.07), with the risk being highest for subjects with concomitant LA emptying fractions or =38 ml/m(2) (hazard ratio 9.3, p = 0.003). LA emptying fraction (p = 0.002) was associated with risk for first AF or atrial flutter after adjusting for baseline clinical risk factors for AF or atrial flutter, left ventricular ejection fraction, diastolic function grade, and LA volume. In conclusion, reduced LA reservoir function markedly increases the propensity for first AF or atrial flutter, independent of LA volume, left ventricular function, and clinical risk factors.
Publisher: Wiley
Date: 28-09-2011
DOI: 10.1111/J.1365-2362.2011.02595.X
Abstract: Central blood pressure (BP) predicts mortality independent of office brachial BP. Whether central BP may be useful to differentiate BP control requires examination and was the first aim of this study. Secondly, we sought to determine the variability in central BP among patients from different categories of BP control [controlled hypertension (CH), masked hypertension (MH), white coat (WCHT) and uncontrolled hypertension (UH)]. We assessed patients with uncomplicated hypertension using measurement of central BP (SphygmoCor 8.1), brachial BP and 24-h ambulatory BP monitoring. BP control was defined according to guidelines using office BP and 24-h BP. Of the 201 patients (63 ± 8 years, 51% men), 67 (33%) were classified as CH 59 (29%) with MH 31 (15%) with WCHT and 44 (22%) with UH. There were no differences in central BP parameters (augmentation pressure, augmentation index, pulse pressure) between patients with CH and MH or between patients with WCHT and UH (P > 0·05 for all). However, there was significant overlap in central systolic BP between BP control categories. For ex le, 27% of patients with normal brachial systolic BP had central systolic BP above age- and gender-specific normal values, including patients from three classifications of BP control (CH: n = 27 MH: n = 22 and WCHT: n = 4). Office central BP alone cannot delineate categories of BP control. However, given the high degree of variability in central BP among patients from different categories of BP control, measurement of central BP may result in significant reclassification of risk related to BP.
Publisher: Massachusetts Medical Society
Date: 26-05-2016
Publisher: Springer Science and Business Media LLC
Date: 20-09-2023
Publisher: Routledge
Date: 16-10-2017
Publisher: Massachusetts Medical Society
Date: 03-12-2020
Publisher: Springer Science and Business Media LLC
Date: 21-06-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-07-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
DOI: 10.1161/HYPERTENSIONAHA.111.190017
Abstract: Modifiable risk factors, such as diet, are becomingly increasingly important in the management of cardiovascular disease, one of the greatest major causes of death and disease burden. Few studies have examined the role of diet as a possible means of reducing arterial stiffness, as measured by pulse wave velocity, an independent predictor of cardiovascular events and all-cause mortality. The aim of this study was to investigate whether dairy food intake is associated with measures of arterial stiffness, including carotid-femoral pulse wave velocity and pulse pressure. A cross-sectional analysis of a subset of the Maine-Syracuse Longitudinal Study s le was performed. A linear decrease in pulse wave velocity was observed across increasing intakes of dairy food consumption (ranging from never/rarely to daily dairy food intake). The negative linear relationship between pulse wave velocity and intake of dairy food was independent of demographic variables, other cardiovascular disease risk factors, and nutrition variables. The pattern of results was very similar for pulse pressure, whereas no association between dairy food intake and lipid levels was found. Further intervention studies are needed to ascertain whether dairy food intake may be an appropriate dietary intervention for the attenuation of age-related arterial stiffening and reduction of cardiovascular disease risk.
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.AMJCARD.2006.06.035
Abstract: There is a paucity of data regarding the relation between the various noninvasive indexes of arterial stiffness and left ventricular diastolic function. In 188 subjects aged > or =65 years (mean 75 +/- 5 71% men), the concordance and strength of the association between measures of arterial stiffness and left ventricular diastolic function were evaluated. Indexes of arterial stiffness (brachial and aortic pulse pressure [PP], carotid-femoral pulse-wave velocity [PWV], and augmentation pressure [AP]) were measured using applanation tonometry. Diastolic function was classified in terms of instantaneous diastolic function grade and quantitated as left atrial volume, a measure of chronic diastolic burden. Risk for new cardiovascular events was estimated using a validated clinical echocardiographic risk algorithm. Aortic and brachial PP, PWV, and AP were correlated positively with left atrial volume and diastolic function grade. After adjusting for age, gender, and clinical and echocardiographic covariates, 1-SD increases in aortic PP, brachial PP, PWV, and AP were associated with 6%, 6%, 4%, and 4% increases in indexed left atrial volume, respectively. Similarly, 1-SD increases in aortic PP, brachial PP, and AP were associated with 84%, 81%, and 83% increased risk for diastolic dysfunction, respectively (all p 50% area under receiver-operating characteristic curve 0.67, 0.67, 0.70, and 0.56, respectively p <0.05). In conclusion, increased arterial stiffness was associated with more severe left ventricular diastolic dysfunction, although the strength of the association varied according to the specific measure used. Aortic PP, brachial PP, and PWV appeared superior to AP in risk discrimination in this elderly cohort.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2023
DOI: 10.1038/S41591-023-02526-X
Abstract: In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function and reduced body weight in patients with obesity phenotype of heart failure and preserved ejection fraction (HFpEF). This prespecified analysis examined the effects of semaglutide on dual primary endpoints (change in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and body weight) and confirmatory secondary endpoints (change in 6-minute walk distance (6MWD), hierarchical composite (death, HF events, change in KCCQ-CSS and 6MWD) and change in C-reactive protein (CRP)) across obesity classes I–III (body mass index (BMI) 30.0–34.9 kg m − 2 , 35.0–39.9 kg m − 2 and ≥40 kg m − 2 ) and according to body weight reduction with semaglutide after 52 weeks. Semaglutide consistently improved all outcomes across obesity categories ( P value for treatment effects × BMI interactions = not significant for all). In semaglutide-treated patients, improvements in KCCQ-CSS, 6MWD and CRP were greater with larger body weight reduction (for ex le, 6.4-point (95% confidence interval (CI): 4.1, 8.8) and 14.4-m (95% CI: 5.5, 23.3) improvements in KCCQ-CSS and 6MWD for each 10% body weight reduction). In participants with obesity phenotype of HFpEF, semaglutide improved symptoms, physical limitations and exercise function and reduced inflammation and body weight across obesity categories. In semaglutide-treated patients, the magnitude of benefit was directly related to the extent of weight loss. Collectively, these data support semaglutide-mediated weight loss as a key treatment strategy in patients with obesity phenotype of HFpEF. ClinicalTrials.gov identifier: NCT04788511 .
Publisher: Oxford University Press (OUP)
Date: 06-12-2019
DOI: 10.1093/AJH/HPZ192
Abstract: Despite readily available treatments, control of blood pressure (BP) with population aging remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both “untreated” and “treated but uncontrolled” high BP. We analyzed baseline data from 19,114 in iduals aged ≥65 years enrolled from Australia and United States (US) in the ASPirin in Reducing Events in the Elderly study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mm Hg and/or the use of any BP lowering medication. “Controlled hypertension” was defined if participants were receiving antihypertensive medication and BP & and 90 mm Hg. Descriptive analyses were used to summarize hypertension control rates logistic regression was used to investigate relationships with treatment and BP control. Overall, 74% (14,213/19,114) of participants were hypertensive and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP ≥140/90 mm Hg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to “treated but uncontrolled” BP included older age, male, Black race (vs. White), using antihypertensive monotherapy (vs. multiple) and residing in Australia (vs. US). High levels of “untreated” and “treated but uncontrolled” BP occur in healthy elderly people without CVD, suggesting there are opportunities for better BP control in the primary prevention of CVD in this population. NCT01038583.
Publisher: Elsevier BV
Date: 09-2000
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: Oxford University Press (OUP)
Date: 22-01-2019
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.IJCARD.2009.04.027
Abstract: Arterial stiffness has been shown to be a potent and independent predictor of cardiovascular risk. In this review, we outline methods for the measurement of arterial stiffness, describe the physiological mechanisms that underpin the utility of arterial stiffness as an integrative marker of cardiovascular disease, and detail the evidence examining the value of arterial stiffness for prediction of adverse cardiovascular events and mortality. The extent to which arterial stiffness may be modified by medical and lifestyle therapy is reviewed.
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-026507
Abstract: The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina. This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event. This was conducted in New South Wales, Australia. The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457). The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics. Among patients with AMI, 71.6% of men (crude rate 3.45 erson-year) and 64.7% of women (2.62 erson-year) received angiography 57.8% of men (1.73 erson-year) and 37.4% of women (0.77 erson-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36 erson-year) and 54.9% of women (1.32 erson-year) received angiography 44.6% of men (0.90 erson-year) and 19.5% of women (0.26 erson-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively. Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.
Publisher: American Diabetes Association
Date: 21-01-2022
DOI: 10.2337/DC21-1944
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.AHJ.2016.04.003
Abstract: Research has shown that vaccination with Streptococcus pneumoniae reduced the extent of atherosclerosis in experimental animal models. It is thought that phosphorylcholine lipid antigens in the S. pneumoniae cell wall induce the production of antibodies that cross-react with oxidized low-density lipoprotein, a component of atherosclerotic plaques. These antibodies may bind to and facilitate the regression of the plaques. Available data provide evidence that similar mechanisms also occur in humans, leading to the possibility that pneumococcal vaccination protects against atherosclerosis. A systematic review and meta-analysis, including 8 observational human studies, of adult pneumococcal polysaccharide vaccination for preventing cardiovascular disease in people older than 65 years, showed a 17% reduction in the odds (odds ratio 0.83, 95% CI 0.71-0.97) of having an acute coronary syndrome event. The AUSPICE is a multicenter, randomized, placebo-controlled, double-blind, clinical trial to formally test whether vaccination with the pneumococcal polysaccharide vaccine protects against cardiovascular events (fatal and nonfatal acute coronary syndromes and ischemic strokes). Cardiovascular outcomes will be obtained during 4 to 5 years of follow-up, through health record linkage with state and national administrative data sets. This is the first registered randomized controlled trial (on US, World Health Organization, Australia and New Zealand trial registries) to be conducted to test whether vaccination with the pneumococcal polysaccharide vaccine will reduce cardiovascular events. If successful, vaccination can be readily extended to at-risk groups to reduce the risk of cardiovascular diseases.
Publisher: SAGE Publications
Date: 08-08-2022
Abstract: There are three traditional categories of empathy – emotional, cognitive and compassionate or radical. For decades, empathy was seen as the antithesis of any kind of good journalism that the journalist must at all times maintain detachment in order to do her job. But this paper interrogates, through the textual analysis of two Australian long form texts, including several epitextual artefacts, how empathy can perform as an evocative tool of narrative literary journalism creating richer and deeper meaning and depth of understanding. Both texts are hybrids of the form, mixing narrative inquiry, reportage and personal reflective practice. Here I argue that the first text conflates emotional and compassionate empathy, while the second privileges cognitive and radical empathy, ultimately and startlingly advocating compassionate empathy. Both provide for their audience an intimate glimpse into the private lives of others affected by trauma or occupying a particular place in cyberspace.
Publisher: Massachusetts Medical Society
Date: 26-05-2016
Publisher: Informa UK Limited
Date: 14-06-2014
Publisher: Informa UK Limited
Date: 02-2010
Publisher: Massachusetts Medical Society
Date: 26-05-2016
Publisher: Elsevier BV
Date: 05-1999
Publisher: Public Library of Science (PLoS)
Date: 25-10-2013
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.AHJ.2012.02.017
Abstract: Noninvasive estimates of central blood pressure (BP) predict cardiovascular morbidity and mortality independent of brachial BP. However, there are limited data on the usefulness of central BP in clinical practice. This study aims to test the value of central BP as a management tool for physicians treating patients with essential hypertension. Participants with uncomplicated essential hypertension (N = 284) will be randomized to 12 months of treatment decisions guided by usual care (based on office, home, and 24-hour ambulatory brachial BP) or, in addition, by central BP estimated using radial tonometry (based on age- and sex-specific normal central systolic BP values). Recommendations regarding titration of antihypertensive medication (increase, decrease, or maintain dose) will be provided to each participant's general practitioner as well as the participant themselves. Relevant clinical information (eg, comorbidities, left ventricular [LV] mass, blood biochemistry, and BP-related symptoms) will be considered when making titration recommendations in all participants. The primary outcome measures will be (1) change in LV mass (by real-time 3-dimensional echocardiography), (2) amount of medication used, and (3) quality of life. Analysis will be by intention to treat. It is expected that there will be no significant difference in LV mass between groups. However, it is hypothesized that there will be significantly reduced use of medication and improved quality of life in the central BP group because more appropriate titration choices will be made to maintain normal central systolic BP. Results are expected in 2012.
Publisher: Wiley
Date: 21-07-2016
DOI: 10.1111/CEN.13143
Abstract: Thyroid disease can be subtle in its presentation, and TSH reference intervals may be artefactually increased by including persons with subclinical thyroid disease. We have therefore used a thyroid disease-free population to determine TSH and fT4 reference intervals. Apparently healthy subjects were assessed by health questionnaire, drug history, clinical assessment and measurement of thyroid antibodies. Healthy subjects in a community setting. TSH, free T4, antithyroglobulin and anti-TPO were measured on the Abbott Architect analyser. Subjects with clinical abnormalities, consumption of thyroid-active medications or with thyroid antibodies above the manufacturer-quoted reference intervals were excluded. TSH and fT4 data were log-transformed, and the central 95% was used to calculate reference intervals. We assessed whether these data were normally distributed. We compared s les spanning the reference intervals for both TSH and fT4 between different assays looking at biases. From a population of 1,606 subjects, 140 males (18%) and 284 females (34%) were excluded. The central population 95% for TSH was 0·43-3·28 mU/l and for fT4 10·8-16·8 pmol/l. There were no age- or sex-related differences. For both analytes, the distribution was not significantly different to a Gaussian distribution (P > 0·05). For 5 commonly used assays for TSH, the maximum difference in the upper limit of the TSH reference interval was 0·48 mU/l and for fT4 the maximum difference for the upper reference limit was 4·1 pmol/l. A substantial proportion of apparently healthy persons have subclinical thyroid disease. These subjects must be excluded for any thyroid hormone reference interval studies.
Publisher: Massachusetts Medical Society
Date: 14-01-2021
Publisher: Informa UK Limited
Date: 23-01-2019
Publisher: Human Kinetics
Date: 02-2012
DOI: 10.1123/PES.24.1.45
Abstract: Relationships of academic achievement (government tests) with physical fitness (multistage run), physical activity (pedometers) and percent body fat (dual emission X-ray absorptiometry) were examined at both the aggregate school level and the in idual child level using data collected from 757 children in 29 elementary schools. Statistical adjustments included gender, grade and socioeconomic status. Between-school relationships of the academic scores with fitness and physical activity were strong and positive, with some evidence of (negative) relationships with percent body fat. The between-child relationships were weaker, and nonexistent with percent body fat. Stronger between-school than between-child relationships favor the argument that variation in school cultures, characterized by concurrent attention to fitness and academic achievement, might play a more dominant role in explaining these relationships than any direct effect of fitness on academic achievement.
Publisher: Wiley
Date: 24-03-2018
DOI: 10.1002/ACR.23329
Publisher: Informa UK Limited
Date: 18-11-2020
Publisher: Elsevier BV
Date: 02-2015
Publisher: Informa UK Limited
Date: 07-2015
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000445876
Abstract: b i Background: /i /b The consumption of chocolate and cocoa has established cardiovascular benefits. Less is known about the effects of chocolate on arterial stiffness, a marker of subclinical cardiovascular disease. The aim of this study was to investigate whether chocolate intakes are independently associated with pulse wave velocity (PWV), after adjustment for cardiovascular, lifestyle and dietary factors. b i Methods: /i /b Prospective analyses were undertaken on 508 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study (MSLS). Habitual chocolate intakes, measured using a food frequency questionnaire, were related to PWV, measured approximately 5 years later. b i Results: /i /b Chocolate intake was significantly associated with PWV in a non-linear fashion with the highest levels of PWV in those who never or rarely ate chocolate and lowest levels in those who consumed chocolate once a week. This pattern of results remained and was not attenuated after multivariate adjustment for diabetes, cardiovascular risk factors and dietary variables (p = 0.002). b i Conclusions: /i /b Weekly chocolate intake may be of benefit to arterial stiffness. Further studies are needed to explore the underlying mechanisms that may mediate the observed effects of habitual chocolate consumption on arterial stiffness.
Publisher: Frontiers Media SA
Date: 05-10-2021
DOI: 10.3389/FNAGI.2021.694982
Abstract: Background : Elevated blood pressure (BP) is a major health risk factor and the leading global cause of premature death. Hypertension is also a risk factor for cognitive decline and dementia. However, when elevated blood pressure starts impacting cerebral health is less clear. We addressed this gap by estimating how a validated measure of brain health relates to changes in BP over a period of 12 years. Methods : Middle-age (44–46 years at baseline, n = 335, 52% female) and older-age (60–64 years, n = 351, 46% female) cognitively intact in iduals underwent up to four brain scans. Brain health was assessed using a machine learning approach to produce an estimate of “observed” age (BrainAGE), which can be contrasted with chronological age. Longitudinal associations between blood pressures and BrainAGE were assessed with linear mixed-effects models. Results : A progressive increase in BP was observed over the follow up (MAP = 0.8 mmHg/year, SD = 0.92 SBP = 1.41 mmHg/year, SD = 1.49 DBP = 0.61 mmHg/year, SD = 0.78). In fully adjusted models, every additional 10 mmHg increase in blood pressure (above 90 for mean, 114 for systolic, and 74 for diastolic blood pressure) was associated with a higher BrainAGE by 65.7 days for mean, and 51.1 days for systolic/diastolic blood pressure. These effects occurred across the blood pressure range and were not exclusively driven by hypertension. Conclusion : Increasing blood pressure is associated with poorer brain health. Compared to a person becoming hypertensive, somebody with an ideal BP is predicted to have a brain that appears more than 6 months younger at midlife.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.JACEP.2016.12.015
Abstract: Atrial fibrillation (AF) imposes a substantial cost burden on the healthcare system. Weight and risk factor management (RFM) reduces AF burden and improves the outcomes of AF ablation. This study sought to evaluate the cost and clinical effectiveness of integrating RFM into the overall management of AF. Of 1,415 consecutive patients with symptomatic AF, 825 patients had body mass index ≥27 kg/m There were no differences in baseline characteristics or follow-up duration (p = NS). Arrhythmia-free survival was better in the RFM compared with control subjects (Kaplan-Meier: 79% vs. 44% p < 0.001). At follow-up, RFM group had less unplanned specialist visits (0.19 ± 0.40 vs. 1.94 ± 2.00 p < 0.001), hospitalizations (0.74 ± 1.3 vs. 1.05 ± 1.60 p = 0.03), cardioversions (0.89 ± 1.50 vs. 1.51 ± 2.30 p = 0.002), emergency presentations (0.18 ± 0.50 vs. 0.76 ± 1.20 p < 0.001), and ablation procedures (0.60 ± 0.69 vs. 0.72 ± 0.86 p = 0.03). Antihypertensive (0.53 ± 0.70 vs. 0.78 ± 0.60 p = 0.04) and antiarrhythmic (0.26 ± 0.50 vs. 0.91 ± 0.60 p = 0.003) use declined in RFM. The RFM group had an increase of 0.1930 quality-adjusted life years and a cost saving of $12,094 (incremental cost-effectiveness ratios of $62,653 saved per quality-adjusted life years gained). A structured physician-directed RFM program is clinically effective and cost saving.
Publisher: Oxford University Press (OUP)
Date: 20-01-2017
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JACC.2015.06.488
Abstract: Obesity begets atrial fibrillation (AF). Although cardiorespiratory fitness is protective against incident AF in obese in iduals, its effect on AF recurrence or the benefit of cardiorespiratory fitness gain is unknown. This study sought to evaluate the role of cardiorespiratory fitness and the incremental benefit of cardiorespiratory fitness improvement on rhythm control in obese in iduals with AF. Of 1,415 consecutive patients with AF, 825 had a body mass index ≥27 kg/m(2) and were offered risk factor management and participation in a tailored exercise program. After exclusions, 308 patients were included in the analysis. Patients underwent exercise stress testing to determine peak metabolic equivalents (METs). To determine a dose response, cardiorespiratory fitness was categorized as: low ( 100%). Impact of cardiorespiratory fitness gain was ascertained by the objective gain in fitness at final follow-up (≥2 METs vs. <2 METs). AF rhythm control was determined using 7-day Holter monitoring and AF severity scale questionnaire. There were no differences in baseline characteristics or follow-up duration between the groups defined by cardiorespiratory fitness. Arrhythmia-free survival with and without rhythm control strategies was greatest in patients with high cardiorespiratory fitness compared to adequate or low cardiorespiratory fitness (p < 0.001 for both). AF burden and symptom severity decreased significantly in the group with cardiorespiratory fitness gain ≥2 METs as compared to <2 METs group (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in those with METs gain ≥2 compared to those with METs gain <2 in cardiorespiratory fitness (p < 0.001 for both). Cardiorespiratory fitness predicts arrhythmia recurrence in obese in iduals with symptomatic AF. Improvement in cardiorespiratory fitness augments the beneficial effects of weight loss. (Evaluating the Impact of a Weight Loss on the Burden of Atrial Fibrillation [AF] in Obese Patients ACTRN12614001123639).
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.CCT.2017.08.010
Abstract: High blood pressure (BP) is the most common modifiable cause of death from cardiovascular disease. Lowering BP with medication improves patient outcomes, but even in populations with normal upper arm (brachial) BP there remains considerable residual risk for cardiovascular disease and this may be due to persistently elevated central BP. There has never been a trial to determine the value of targeted central BP lowering among patients with hypertension, and this was the aim of this study. This is a multi-centre, randomized, open-label, blinded endpoint trial among 308 patients treated for uncomplicated hypertension with controlled brachial BP (<140/90mmHg) but elevated central BP (≥0.5SD above age- and sex-specific normal values). Baseline recruitment has been completed. Participants were randomized to intervention with spironolactone (25mg/d) or usual care and are being followed over 24months, with the primary outcome being left ventricular mass index (using cardiac magnetic resonance imaging). Brachial and central BP will be measured in the clinic, at home over 7-days and by 24-h ambulatory monitoring. Aortic stiffness will be assessed by carotid-to-femoral pulse wave velocity. Primary (intention to treat) analysis will determine the role of central versus brachial BP for predicting changes in left ventricular mass index. Compared with control, intervention is expected to significantly lower left ventricular mass index, and this effect is expected to be independently correlated with central BP lowering. These findings would support the concept of central BP as an important therapeutic target in hypertension management. Results are expected in 2018.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.JACC.2005.08.077
Abstract: We sought to compare left atrial (LA) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes. The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospectively for patients with sinus rhythm or atrial fibrillation (AF). Left atrial size was assessed with biplane LA volume, four-chamber LA area, and M-mode dimension for 423 patients (mean age 71 +/- 8 years, 56% men) who were prospectively followed for development of first AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death. Of the 317 subjects in sinus rhythm at baseline, 62 had 90 new events during a mean follow-up of 3.5 +/- 2.3 years. All three LA size parameters were independently predictive of combined outcomes (all p < 0.0001). The overall performance for the prediction of cardiovascular events was greatest for LA volume (area under the receiver operator characteristic curve: indexed LA volume 0.71 LA area 0.64 LA diameter 0.59). A graded association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume. For subjects with AF, there was no association between LA size and cardiovascular events. Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm. The predictive utility of LA size for cardiovascular events in AF was poor, irrespective of the method of LA size quantitation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Oxford University Press (OUP)
Date: 26-08-2015
DOI: 10.1093/AJH/HPU120
Abstract: Research on associations between blood pressure, brain structure, and cognitive function has produced somewhat inconsistent results. In part, this may be due to differences in age ranges studied and because of sex differences in physiology and/or exposure to risk factors, which may lead to different time course or patterns in cardiovascular disease progression. The aim of this study was to investigate the impact of sex on associations between blood pressure, regional cerebral volumes, and cognitive function in older in iduals. In this cohort study, brachial blood pressure was measured twice at rest in 266 community-based in iduals free of dementia aged 68-73 years who had also undergone a brain scan and a neuropsychological assessment. Associations between mean blood pressure (MAP), regional brain volumes, and cognition were investigated with voxel-wise regression analyses. Positive associations between MAP and regional volumes were detected in men, whereas negative associations were found in women. Similarly, there were sex differences in the brain-volume cognition relationship, with a positive relationship between regional brain volumes associated with MAP in men and a negative relationship in women. In this cohort of older in iduals, higher MAP was associated with larger regional volume and better cognition in men, whereas opposite findings were demonstrated in women. These effects may be due to different lifetime risk exposure or because of physiological differences between men and women. Future studies investigating the relationship between blood pressure and brain structure or cognitive function should evaluate the potential for differential sex effects.
Publisher: Authorea, Inc.
Date: 03-10-2022
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.JCMG.2016.11.003
Abstract: The left atrium is considered a biomarker for adverse cardiovascular outcomes, particularly in patients with left ventricular diastolic dysfunction and atrial fibrillation in whom left atrial (LA) enlargement is of prognostic importance. LA enlargement with a consequent decrease in LA function represents maladaptive structural and functional "remodeling" that in turn promotes electrical remodeling and a milieu conducive for incident atrial fibrillation. Medical and nonmedical interventions may arrest this pathophysiologic process to the extent that subsequent reverse remodeling results in a reduction in LA size and improvement in LA function. This review examines cellular and basic mechanisms involved in LA remodeling, evaluates the noninvasive techniques that can assess these changes, and examines potential mechanisms that may initiate reverse remodeling.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-02-2019
Abstract: Using data from the GARFIELD ‐ AF (Global Anticoagulant Registry in the FIELD –Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). GARFIELD ‐ AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia) 10.9% (n=3613) had moderate‐to‐severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2 ‐ VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe CKD were independent risk factors for all‐cause mortality. Moderate‐to‐severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P =0.001). In GARFIELD ‐ AF , moderate‐to‐severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe CKD on mortality was even greater in patients from Asia than the rest of the world. URL : www.clinicaltrials.gov . Unique identifier: NCT 01090362.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2013
DOI: 10.1161/CIRCEP.113.000163
Abstract: Myocardial infarction (MI) is associated with the development of atrial fibrillation (AF). We aimed to characterize the atrial abnormalities because of MI and determine the role of ischemia to the AF substrate. Forty-four sheep were studied. MI was induced by occlusion of the left circumflex artery (LCX) or left anterior descending artery (LAD). Excluding 11 with fatal arrhythmias, equal groups of animals (LCX LAD and sham-operated) underwent sequential electrophysiology study for 45 minutes to determine atrial effective refractory periods, conduction velocity, conduction heterogeneity index, and AF inducibility. Postmortem evaluation was performed with 2,3,5 triphenyl tetrazolium chloride staining. MI resulted in greater left ventricular dysfunction ( P .05), LA pressure ( P .0003), and reduction in atrial effective refractory periods ( P .0001) compared with control. 2,3,5 triphenyl tetrazolium chloride staining demonstrated that the left circumflex artery, and not the LAD, group had atrial infarction. The left circumflex artery group demonstrated the following compared with the LAD or control groups: greater slowing in atrial conduction velocity ( P .0001 and P .001) increased absolute range of conduction phase delay ( P .001 and P .001) increased conduction heterogeneity index ( P .0001 and P .001) greater AF vulnerability ( P .05 for both) and longer AF duration ( P .05 for both). LAD group had modest but significant slowing in conduction velocity ( P .01) but no change in conduction heterogeneity index or AF duration compared with control. Left ventricular infarction, which is known to result in atrial stretch, hemodynamic change, and neurohumoral activation, contributes partially to the atrial abnormalities in MI. Atrial ischemia/infarction results in greater atrial electrophysiological changes and propensity for AF forming the dominant substrate for AF in MI.
Publisher: Public Library of Science (PLoS)
Date: 23-04-2018
Publisher: Australasian Association of Writing Programs
Date: 30-10-2021
DOI: 10.52086/001C.30986
Abstract: The WoW Project – Words on Wheels Words on Water – is a public transport poetry venture in development, seeking to bring poetry to Sydneysiders (and then others) commuting to work – on buses, light rail, trains, and ferries. The project attributes its genesis to two major public transport schemes in London and New York, where established and legacy poetry is displayed on posters throughout each city’s public transport system. Locally, while upholding established and legacy poets, the project seeks to support new and emerging poets. Additionally, and importantly, the poetry in this project is interested in igniting social justice, equity, and advocacy issues – poetry to start a conversation. ‘The Moving Poet’ is the pilot product of The WoW Project, a collaboration between University of Technology Sydney (UTS) Creative Writing staff (former and current) and UTS undergraduate Visual Communication students. Throughout one semester in 2020, Creative Writing staff became clients of the students’ simulated design company Salt Studio, collaborating at the intersection of text, image, and place. Staff stepped into a space unknown to them as the students designed 20 posters, thematically and conceptually framed, of poetry by eight Australian poets developed social media interfaces and produced teaser videos of the concept for pitching to potential funders and supporters. The collective goal, underpinning both practice and pedagogy, is to use these artefacts to provoke conversation about social injustice in a bid to incite discussion, particularly in an Australian context to surprise commuters by ‘scattering’ poems in public places and to generate further interactions from these poems through social media and digital responses. Drawing on both the field of creative writing and its place within a design education context, this article traces the project from its inception, including its positioning within similar projects internationally, to writing and design collaboration, to its final stage of presentation of deliverables. It outlines the project’s next steps, namely engaging with industry and community partners for full execution.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2015
DOI: 10.1038/JHH.2015.17
Abstract: Plasma homocysteine (tHcy) is associated with kidney disease. However, few, if any, studies have examined homocysteine in relation to arterial stiffness, with stratification by the presence or absence of early-stage chronic kidney disease (CKD). The aim of this study was to examine prospective associations between tHcy and carotid-femoral pulse wave velocity (PWV) in persons with and without early-stage CKD in a s le of community-living in iduals free from end-stage renal disease, dialysis, stroke and dementia. We conducted a prospective study with 498 participants of the Maine-Syracuse Longitudinal Study (mean age 61 years). Levels of tHcy were positively related to PWV measured 4-5 years later for participants with early-stage CKD (estimated glomerular filtration rate <60 ml min(-1) per 1.73 m(2)). Statistical adjustment was made for multiple confounders, including demographic factors, PWV-related variables and cardiovascular risk factors (b=4.27, 95% confidence interval: 0.23-8.31, P=0.04). These associations were not observed in persons free from CKD. Plasma tHcy is an important predictor of arterial stiffness, as indexed by PWV, in community-living in iduals with modest CKD.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.VACCINE.2016.08.038
Abstract: Before pandemic H1N1 vaccines were available, the potential benefit of existing seasonal trivalent inactivated influenza vaccines (IIV3s) against influenza due to the 2009 pandemic H1N1 influenza strain was investigated, with conflicting results. This study assessed the efficacy of seasonal IIV3s against influenza due to 2008 and 2009 seasonal influenza strains and against the 2009 pandemic H1N1 strain. This observer-blind, randomized, placebo-controlled study enrolled adults aged 18-64years during 2008 and 2009 in Australia and New Zealand. Participants were randomized 2:1 to receive IIV3 or placebo. The primary objective was to demonstrate the efficacy of IIV3 against laboratory-confirmed influenza. Participants reporting an influenza-like illness during the period from 14days after vaccination until 30 November of each study year were tested for influenza by real-time reverse transcription polymerase chain reaction. Over a study period of 2years, 15,044 participants were enrolled (mean age±standard deviation: 35.5±14.7years 54.4% female). Vaccine efficacy of the 2008 and 2009 IIV3s against influenza due to any strain was 42% (95% confidence interval [CI]: 30%, 52%), whereas vaccine efficacy against influenza due to the vaccine-matched strains was 60% (95% CI: 44%, 72%). Vaccine efficacy of the 2009 IIV3 against influenza due to the 2009 pandemic H1N1 strain was 38% (95% CI: 19%, 53%). No vaccine-related deaths or serious adverse events were reported. Solicited local and systemic adverse events were more frequent in IIV3 recipients than placebo recipients (local: IIV3 74.6% vs placebo 20.4%, p<0.001 systemic: IIV3 46.6% vs placebo 39.1%, p<0.001). The 2008 and 2009 IIV3s were efficacious against influenza due to seasonal influenza strains and the 2009 IIV3 demonstrated moderate efficacy against influenza due to the 2009 pandemic H1N1 strain. Funded by CSL Limited, ClinicalTrials.gov identifier NCT00562484.
Publisher: The Sax Institute
Date: 2015
DOI: 10.17061/PHRP2531532
Abstract: Objectives and importance of the study: Routine hospital administrative data provide an important source of information about cardiovascular disease (CVD) for health statistics reporting, health services and research. How such conditions are classified and grouped has implications for the use and interpretation of these data. International Classification of Diseases (ICD) diagnosis codes from hospital data collections are often used to classify CVD, but there is little published evidence on the most appropriate ways to use these codes to categorise CVD in a way that maximises the usefulness of hospital data for reporting and research. In particular, ICD codes under 'Diseases of the circulatory system' (I00-I99) are often grouped together into a general CVD category. However, this category is heterogeneous and combines common severe atherosclerotic and thrombotic CVDs (such as myocardial infarction and pulmonary embolism) with common, less severe and pathologically dissimilar conditions (such as varicose veins and haemorrhoids). In addition, hospital data collections contain a range of data fields, including those relating to primary and additional diagnoses and those relating to procedures. All of these have the potential to contribute valuable information on CVD. This paper proposes a pragmatic approach to using ICD diagnosis codes and procedure codes to capture major atherosclerotic and arteriovenous thromboembolic and related CVD. We reviewed the ICD diagnosis codes and procedure codes and developed an algorithm for classifying and categorising major CVD diagnoses. This approach was then applied to linked hospitalisation data from in iduals participating in the 45 and Up Study, a cohort study of 267 153 New South Wales residents aged 45 and over, to investigate the implications of the proposed approach for quantifying CVD. Large differences were observed in the numbers of events in grouped CVD outcomes, depending on the methods used. In cases where the reporting and research interest relates to incident disease, it may be appropriate to prioritise specific disease categories and pathological homogeneity.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.GENHOSPPSYCH.2019.10.001
Abstract: Psychological distress is associated with risk markers for cardiovascular disease, including increased arterial stiffness and high blood pressure, but it's unclear when these first manifest. This study aims to investigate the effect of psychosocial stress and depression on arterial stiffness and blood pressure in a cohort study of Australian children followed through to adolescence. Depression and psychosocial stress in 520 young people (265 boys M age = 11.6 y) were assessed via the Children's Depression Inventory and Children's Stress Questionnaire respectively. Carotid-femoral pulse wave velocity was assessed using applanation tonometry, with further assessments of supine brachial blood pressure and percent body fat (dual x-ray absorptiometry). All measures were repeated four years later at age 16-years. We found no cross-sectional or longitudinal evidence that children self-reporting higher levels of psychosocial stress or depressive symptoms had greater arterial stiffness. Children reporting an increase in depressive symptoms had an increase in diastolic blood pressure and mean arterial pressure over time. An effect was also evident for pulse pressure, where higher pulse pressure was found in children with lower psychosocial stress at baseline and in children self-reporting a decrease in stress between baseline and follow-up. Findings from the current study contribute to the scant paediatric literature but only provide limited support for any influence of psychological factors on blood pressure. Depressive symptoms in apparently healthy adolescents may exert some influence on later risk for cardiovascular disease via increases in diastolic blood pressure and mean arterial pressure, but these effects were small.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2019
DOI: 10.1186/S42155-019-0079-8
Abstract: Antiplatelet and anticoagulant therapy are commonly used before, during and after peripheral arterial endovascular intervention. This survey aimed to establish antiplatelet and anticoagulant choice for peripheral arterial endovascular intervention in contemporary clinical practice. Pilot-tested questionnaire distributed via collaborative research networks. One hundred and sixty-two complete responses were collected from responders in 22 countries, predominantly the UK (48%) and the rest of the European Union (44%). Antiplatelet monotherapy was the most common choice pre-procedurally (62%). In the UK, there was no difference between dual and single antiplatelet therapy use post procedure (50% vs. 37% p = 0.107). However, a significant majority of EU respondents used dual therapy (68% vs. 20% p 0.001). There was variation in choice of antiplatelet therapy by the device used and the anatomical location of the intervention artery. The majority (82%) of respondents believed there was insufficient evidence to guide antithrombotic therapy after peripheral endovascular intervention and most (92%) would support a randomised trial. There is widespread variation in the use of antiplatelet therapy, especially post peripheral arterial endovascular intervention. Clinicians would support the development of a randomised trial comparing dual antiplatelet therapy with monotherapy.
Publisher: Massachusetts Medical Society
Date: 18-10-2018
Publisher: American Diabetes Association
Date: 15-08-2022
DOI: 10.2337/DC22-0294
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
Publisher: Massachusetts Medical Society
Date: 21-09-2023
Publisher: MDPI AG
Date: 31-05-2022
DOI: 10.3390/JCM11113127
Abstract: Background: To quantify the association between blood pressure (BP) across its full range, brain volumes and white matter lesions (WMLs) while investigating the effects of age, sex, body mass index (BMI), and antihypertensive medication. Methods: UK Biobank participants (n = 36,260) aged (40–70) years were included and stratified by sex and four age groups (age ≤ 45, 46–55, 56–65 and 65 years). Multi-level regression analyses were used to assess the association between mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and brain volumes segmented using the FreeSufer software (gray matter volume [GMV], white matter volume [WMV], left [LHCV] and right hippoc al volume [RHCV]) and WMLs. Interaction effects between body mass index (BMI), antihypertensive medication and BP in predicting brain volumes and WMLs were also investigated. Results: Every 10 mmHg higher DBP was associated with lower brain volumes (GMV: −0.19%–−0.40%) [SE = 47.7–62.4] WMV: −0.20–−0.23% [SE = 34.66–53.03] LHCV: −0.40–−0.59% [SE = 0.44–0.57] RHCV: −0.17–−0.57% [SE = 0.32–0.95]) across all age groups. A similar pattern was detected in both sexes, although it was weaker in men. Every 10 mmHg higher MAP was associated with larger WMLs across all age groups but peaked years (1.19–1.23% [SE = 0.002]). Both lower BMI and anti-hypertensive medication appeared to afford a protective effect. Conclusion: Higher BP is associated with worse cerebral health across the full BP range from middle adulthood and into old age.
Publisher: Public Library of Science (PLoS)
Date: 21-11-2012
Publisher: Springer Science and Business Media LLC
Date: 10-10-2018
DOI: 10.1038/IJO.2017.254
Abstract: High BMI at midlife is associated with increased risk of dementia as well as faster decline in cognitive function. In late-life, however, high BMI has been found to be associated with both increased and decreased dementia risk. The objective of this study was to investigate the neural substrates of this age-related change in body mass index (BMI) risk. We measured longitudinal cortical thinning over the whole brain, based on magnetic resonance imaging scans for 910 in iduals aged 44-66 years at baseline. Subjects were s led from a large population study (PATH, Personality and Total Health through Life). After attrition and exclusions, the final analysis was based on 792 in iduals, including 387 in iduals aged 60-66 years and 405 in iduals aged 44-49 years. A mixed-effects model was used to test the association between cortical thinning and baseline BMI, as well as percentage change in BMI. Increasing BMI was associated with increased cortical thinning in posterior cingulate at midlife (0.014 mm kg The pattern of cortical thinning-in association with increasing BMI at both midlife and late-life-is consistent with known obesity-related dementia risk. Increased cortical thinning in association with decreasing BMI at late-life may help explain the 'obesity paradox', where high BMI in midlife appears to be a risk factor for dementia, but high BMI in late-life appears, at times, to be protective.
Publisher: American Medical Association (AMA)
Date: 20-11-2013
Abstract: Obesity is a risk factor for atrial fibrillation. Whether weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation is not known. To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure. Single-center, partially blinded, randomized controlled study conducted between June 2010 and December 2011 in Adelaide, Australia, among overweight and obese ambulatory patients (N = 150) with symptomatic atrial fibrillation. Patients underwent a median of 15 months of follow-up. Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors. The primary outcomes were Atrial Fibrillation Severity Scale scores: symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness. Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. The intervention group showed a significantly greater reduction, compared with the control group, in weight (14.3 and 3.6 kg, respectively P < .001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P < .001), symptom severity scores (8.4 and 1.7 points, P < .001), number of episodes (2.5 and no change, P = .01), and cumulative duration (692-minute decline and 419-minute increase, P = .002). Additionally, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, P = .02) and left atrial area (3.5 and 1.9 cm2, P = .02). In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation. anzctr.org.au Identifier: ACTRN12610000497000.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
DOI: 10.1161/HYPERTENSIONAHA.108.126342
Abstract: We hypothesized that carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, interacts with age such that the magnitude of associations between PWV and cognitive performance are greater with increasing age and that this interaction is observed despite adjustments for demographic variables, mean arterial pressure, and cardiovascular risk factors. PWV was estimated using applanation tonometry in 409 dementia- and stroke-free participants of the Maine-Syracuse Longitudinal Study (24 to 92 years of age 62.3% women). Using linear regression analyses in a cross-sectional design, associations between PWV and age and the interaction of PWV and age were examined in relation to a global composite score, the Wechsler Adult Intelligence Scale Similarities test (abstract reasoning), and 4 cognitive domains indexed by multiple cognitive measures. Adjusting for age, gender, education, height, weight, heart rate, mean arterial pressure, and antihypertensive treatment, PWV-by-age interactions were obtained for the global, visual-spatial organization and memory, scanning and tracking, and verbal episodic memory composites, as well as similarities. The combination of higher PWV and age resulted in progressively lower cognitive performance. This finding was the same with an extended model, which also included adjustment for cardiovascular risk factors and other confounds. PWV interacts with age in a multiplicative way to exert a negative influence on cognitive performance level. Early interventions to prevent an increase in arterial stiffness could possibly play an important role in the preservation of cognitive ability.
Publisher: Elsevier BV
Date: 11-2006
DOI: 10.1016/J.AHJ.2006.05.007
Abstract: There is limited information regarding the clinical utility of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) for the detection of left ventricular (LV) dysfunction in the community. We evaluated predictors of circulating NT-proBNP levels and determined the utility of NT-proBNP to detect systolic and diastolic LV dysfunction in older adults. A population-based s le of 1229 older adults (mean age 69.4 years, 50.1% women) underwent echocardiographic assessment of cardiac structure and function and measurement of circulating NT-proBNP levels. Predictors of NT-proBNP included age, female sex, body mass index, and cardiorenal parameters (diastolic dysfunction [DD] severity LV mass and left atrial volume right ventricular overload decreasing ejection fraction [EF] and creatinine clearance). The performance of NT-proBNP to detect any degree of LV dysfunction, including mild DD, was poor (area under the curve 0.56-0.66). In contrast, the performance of NT-proBNP for the detection of EF 0.90 regardless of age and sex history of hypertension, diabetes, coronary artery disease or body mass category. The ability of NT-proBNP to detect EF < or = 40% and/or moderate-severe DD was optimized by using age/sex-specific limits. Of "false-positive" tests, 88% (124/141) were explained after considering cardiorenal determinants of NT-proBNP levels. Amino-terminal pro-B-type natriuretic peptide is a suboptimal marker of mild LV dysfunction, but performs strongly as a marker of EF < or = 40% and/or moderate-severe DD in the community. Most subjects with a positive NT-proBNP test, using age/sex-specific cutoffs, had prognostically significant abnormalities of cardiac structure or function.
Publisher: Massachusetts Medical Society
Date: 24-01-2019
Publisher: Cold Spring Harbor Laboratory
Date: 22-10-2019
DOI: 10.1101/19006932
Abstract: Here we describe genomic screening of the healthy elderly to identify those resilient to adult-onset genetic disease, despite being at exceptionally high genetic risk. We sequenced 13,131 in iduals aged 70 or older (mean age 75 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Participants had no prior history of cardiovascular disease, life-threatening cancer, persistent physical disability or dementia. We compared the prevalence of pathogenic variants in medically actionable autosomal dominant disease genes with that from the UK Biobank population, and assessed their clinical impact using personal medical history and adjudicated study outcomes during 4.5 years of follow-up. The frequency of pathogenic variants was less than reported among the younger UK Biobank population, suggesting these variants confer a survival disadvantage during the middle years of life. Yet we identified 141 in iduals with pathogenic variants free of any associated disease up to average age 79.5 years. Further study of these elderly resilient in iduals might help uncover genetic mechanisms that protect against the development of disease.
Publisher: Oxford University Press (OUP)
Date: 29-01-2013
DOI: 10.1093/AJH/HPS077
Abstract: The J-curve relationship between brachial diastolic blood pressure (DBP) and mortality is believed to be mediated through reduced myocardial perfusion. This study aimed to determine the relationship between DBP and subendocardial perfusion in patients with and without coronary artery disease (CAD) and to examine central hemodynamic variables that may explain the risk associated with low DBP (aortic stiffness, central pulse pressure, and augmentation index). Brachial DBP and radial tonometry were measured in 134 patients with CAD (aged 76±7years 69% male), 134 in iduals without a prior cardiovascular event (control subjects) (aged 77±2years 69% male) and 47 patients (aged 63±10years) during dobutamine stress echocardiography. Central hemodynamics and subendocardial viability ratio (SEVR), a marker of subendocardial perfusion, were recorded by tonometry. There was no difference in DBP or SEVR between control subjects and CAD patients (P > 0.05), nor was there a difference in SEVR across quartiles of DBP in CAD patients (P = 0.07) or control subjects (P = 0.14). After adjustment for age and height, associations between DBP and SEVR in control subjects (r = 0.185 P = 0.03) and CAD patients (r = 0.204 P = 0.02) were attenuated (P = 0.07 and P = 0.11, respectively). There were no significant relationships between DBP and central hemodynamics (P > 0.05 for all). At peak dobutamine stress, SEVR was significantly reduced in patients with inducible ischemia vs. those with nonischemic response (84±17 vs. 101±22% P = 0.01). However, DBP was not significantly different (65±14 vs. 67±15mm Hg P = 0.32). Brachial DBP is a poor marker of subendocardial perfusion. The J-curve relationship between DBP and mortality is unlikely attributable to reduced myocardial perfusion or adverse central hemodynamics.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Oxford University Press (OUP)
Date: 04-08-2008
DOI: 10.1093/EJECHOCARD/JEN235
Abstract: We sought to compare the predictive power and reproducibility between minimum and maximum left atrial (LA) volume for the development of first atrial fibrillation (AF)/flutter. This prospective study included 574 adults, mean age 74+/-6 years, in sinus rhythm, and had no history or evidence of prior atrial arrhythmias. During a mean follow-up of 1.9+/-1.2 years, 30 (5.2%) developed first AF/flutter. The 3-year risk estimates of freedom from AF/flutter by tertiles of minimum and maximum LA volumes were, respectively, 97, 87, and 74% (P<0.0006) and 94, 85, and 78% (P=0.03). Minimum LA volume was incremental to clinical and other echocardiographic parameters of AF/flutter prediction [per tertile, hazard ratio (HR) 2.4], as was maximum LA volume (per tertile, HR 1.8) in a separate model. When both volumes were entered into the same model and adjusting for covariates, minimum but not maximum LA volume retained significance. However, in terms of interobserver reproducibility, maximum LA volume compared more favourably (mean difference 3.1+/-7.1 vs. 7.4+/-7.3 mL/m(2)). Minimal LA volume was an independent predictor of first AF/flutter. Although it was marginally superior to maximal LA volume in terms of predictive ability, the interobserver variability was greater.
Publisher: Oxford University Press (OUP)
Date: 13-04-2016
DOI: 10.1093/AJH/HPW037
Abstract: The average of multiple blood pressure (BP) readings (mean BP) independently predicts target organ damage (TOD). Observational studies have also shown an independent relationship between BP variability (BPV) and TOD, but there is limited longitudinal data. This study aimed to determine the effects of changes in mean BP levels compared with BPV on left ventricular mass index (LVMI) and aortic pulse wave velocity (aPWV). Mean BP levels (research-protocol clinic BP (clinic BP), 24-hour ambulatory BP, and 7-day home BP) and BPV were assessed in 286 patients with uncomplicated hypertension (mean age 64±8 SD years, 53% women) over 12 months. Reading-to-reading BPV (from 24-hour ambulatory BP) and day-to-day BPV (from 7-day home BP) were assessed at baseline and 12 months, and visit-to-visit BPV (clinic BP) was assessed from 5 visits over 12 months. LVMI was measured by 3D echocardiography and aPWV with applanation tonometry. The strongest predictors of the changes in LVMI (ΔLVMI) were the changes in mean 24-hour systolic BPs (SBPs) (P < 0.02). Similarly, the strongest predictors of the changes in aPWV (ΔaPWV) were the changes in mean 24-hour ambulatory SBPs (P < 0.01) and the changes in mean clinic SBP (P 0.05 for all). Changes in mean BP levels, but not BPV, were most relevant to changes in TOD in patients with uncomplicated hypertension. Thus, from this point of view, BPV appears to have limited clinical utility in this patient population.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2022
DOI: 10.1007/S11357-022-00547-X
Abstract: Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6–77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people. Trial registration Clinicaltrials.gov (NCT01038583)
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.JACC.2010.11.045
Abstract: The aim of this study was to characterize the relationship between pericardial fat and atrial fibrillation (AF). Obesity is an important risk factor for AF. Pericardial fat has been hypothesized to exert local pathogenic effects on nearby cardiac structures above and beyond that of systemic adiposity. One hundred ten patients undergoing first-time AF ablation and 20 reference patients without AF underwent cardiac magnetic resonance imaging for the quantification of periatrial, periventricular, and total pericardial fat volumes using a previously validated technique. Together with body mass index and body surface area, these were examined in relation to the presence of AF, the severity of AF, left atrial volume, and long-term AF recurrence after ablation. Pericardial fat volumes were significantly associated with the presence of AF, AF chronicity, and AF symptom burden (all p values <0.05). Pericardial fat depots were also predictive of long-term AF recurrence after ablation (p = 0.035). Finally, pericardial fat depots were also associated with left atrial volume (total pericardial fat: r = 0.46, p < 0.001). Importantly, these associations persisted after multivariate adjustment and additional adjustment for body weight. In contrast, however, systemic measures of adiposity, such as body mass index and body surface area, were not associated with these outcomes in multivariate-adjusted models. Pericardial fat is associated with the presence of AF, the severity of AF, left atrial volumes, and poorer outcomes after AF ablation. These associations are both independent of and stronger than more systemic measures of adiposity. These findings are consistent with the hypothesis of a local pathogenic effect of pericardial fat on the arrhythmogenic substrate supporting AF.
Publisher: Cold Spring Harbor Laboratory
Date: 29-09-2021
DOI: 10.1101/2021.09.27.21264168
Abstract: White matter lesion (WML) is one of the common cerebral abnormalities, it indicates changes in the white matter of human brain and have shown significant association with stroke, dementia and deaths. Magnetic resonance imaging (MRI) of the brain is frequently used to diagnose white matter lesion (WML) volume. Regular screening can detect WML in early stage and save from severe consequences. Current option of MRI based diagnosis is impractical for regular screening because of its high expense and unavailability. Thus, earlier screening and prediction of the WML volume/load specially in the rural and remote areas becomes extremely difficult. Research has shown that changes in the retinal micro vascular system reflect changes in the cerebral micro vascular system. Using this information, we have proposed a retinal image based WML volume and severity prediction model which is very convenient and easy to operate. Our proposed model can help the physicians to detect the patients who need immediate and further MRI based detail diagnosis of WML. Our model uses quantified measurement of retinal micro-vascular signs (such as arteriovenular nicking (AVN), Opacity (OP) and focal arteriolar narrowing (FAN)) as input and estimate the WML volume/load and classify its severity. We evaluate our proposed model on a dataset of 111 patients taken from the ENVISion study which have retinal and MRI images for each patient. Our model shows high accuracy in estimating the WML volume, mean square error (MSE) between our predicted WML load and manually annotated WML load is 0.15. The proposed model achieves an F1 score of 0.92 in classifying the patients having mild and severe WML load. The preliminary results of our study indicate that quantified measurement of retinal micro-vascular features (AVN, OP and FAN) can more accurately identify the patients who have high risk of cardio-vascular diseases and dementia.
Publisher: Informa UK Limited
Date: 02-2011
Publisher: Springer Science and Business Media LLC
Date: 19-02-2016
DOI: 10.1007/S10865-016-9723-0
Abstract: Stress and depression can affect an in idual's level of physical activity and fitness, which may place them at risk of developing cardiovascular disease. This study investigates the longitudinal effects of stress and depression on physical activity and cardiorespiratory fitness among youth. Six hundred and seventy-six children, initially aged 8 years, from the LOOK study completed a modified version of the Children's Depression Inventory, the Children's Stress Questionnaire, and objective physical activity and cardiorespiratory fitness assessments on three occasions, every 4 years. Depressive symptoms had a direct effect (longitudinal) on the cardiorespiratory fitness of girls, with a similar trend for boys. In cross-sectional analyses, a child who identified with more symptoms of depression and stress was likely to be less fit and less physically active, which in girls extended to less moderate-to-vigorous physical activity. Our findings, that both physical activity and fitness are impacted by depression and stress may contribute to strategies directed towards achieving enhanced physical activity and reductions in obesity.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.JACC.2006.02.048
Abstract: Left atrial (LA) enlargement has been proposed as a barometer of diastolic burden and a predictor of common cardiovascular outcomes such as atrial fibrillation, stroke, congestive heart failure, and cardiovascular death. It has been shown that advancing age alone does not independently contribute to LA enlargement, and the impact of gender on LA volume can largely be accounted for by the differences in body surface area between men and women. Therefore, enlargement of the left atrium reflects remodeling associated with pathophysiologic processes. In this review, we discuss the normal size and phasic function of the left atrium. Further, we outline the clinically important aspects and pitfalls of evaluating LA size, and the methods for assessing LA function using echocardiography. Finally, we review the determinants of LA size and remodeling, and we describe the evidence regarding the prognostic value of LA size. The use of LA volume for risk stratification is an evolving science. More data are required with respect to the natural history of LA remodeling in disease, the degree of LA modifiability with therapy, and whether regression of LA size translates into improved cardiovascular outcomes.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2008
Publisher: American Diabetes Association
Date: 13-06-2023
DOI: 10.2337/DC23-ER09
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.ECHO.2015.11.019
Abstract: Chronic kidney disease (CKD) is associated with increased cardiovascular mortality and morbidity, particularly ischemic heart disease and cardiomyopathy. Newer echocardiographic techniques such as myocardial strain analysis provides the opportunity to detect early myocardial dysfunction. The aim of this study was to examine echocardiographic parameters, in particular left atrial (LA) function and volume, in patients with CKD. A further aim was to determine echocardiographic parameters that are sensitive to detect cardiovascular involvement in early CKD. Seventy-six patients with stage 3 CKD (estimated glomerular filtration rate, 30-59 mL/min/1.73 m(2)) with hypertension and/or diabetes mellitus, without any previous cardiac illness, were prospectively recruited. These patients were compared with subjects matched for age, sex, and risk factors (hypertension and/or diabetes mellitus) with normal renal function and 76 healthy age-matched control subjects. Two-dimensional strain analyses of the left atrium and left ventricle were performed. Comprehensive echocardiographic examinations were performed in all participants, and traditional echocardiographic parameters including indexed LA volume (LAVI) and two-dimensional strain analysis of the left ventricle and left atrium were performed in all participants. Differences among the three groups on demographic, clinical, and echocardiographic parameters were examined. LA systolic strain (20.9 ± 6.3% vs 27.4 ± 7.9%, P < .0001) and systolic and late diastolic strain rates were altered in the CKD group, while early diastolic strain rate was similar to that in the risk factor-matched group. LAVI was significantly larger in the CKD group compared with the risk factor-matched group and healthy control subjects (38.5 ± 10 vs 31.2 ± 9 vs 22.3 ± 5 mL/m(2), P < .0001). LV strain as well as LV systolic and early diastolic strain rates were similar in the CKD and risk factor-matched groups. LV late diastolic strain rate, a surrogate measure of LA contractile function, was, however, reduced in the CKD group. Forward logistic regression analysis showed LA global strain to be the most sensitive predictor for the presence of CKD, followed by LAVI though LV late diastolic strain rate was reduced in the CKD group, it was not an independent predictor. Furthermore, the addition of LA strain to traditional echocardiographic parameters significantly increased the predictive power to detect cardiovascular involvement (C statistic = 0.65 vs C statistic = 0.84, P < .0001). Increased LAVI, reduced left ventricular global strain, and the presence of CKD were independent predictors of LA strain, while left ventricular mass index, E/e' ratio, and the presence of CKD were predictors of LAVI. LA strain and LAVI are more sensitive parameters than traditional echocardiographic parameters as well as left ventricular strain in patients with early CKD. LA strain and LAVI may be useful to detect myocardial involvement in stage 3 CKD, and LA alterations may be consequent to increased activation of the renin-angiotensin-aldosterone pathway, causing myocardial fibrosis in CKD.
Publisher: Oxford University Press (OUP)
Date: 30-09-2013
DOI: 10.1093/AJH/HPT179
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.HRTHM.2011.02.016
Abstract: During acute myocardial infarction (MI), the incidence of atrial fibrillation (AF) is 6% to 22%, and its occurrence in this setting is associated with increased short- and long-term morbidity and mortality. The purpose of this case control study was evaluate the characteristics associated with the development of new-onset AF. Of 2,460 consecutive patients with acute MI, 149 (6%) were identified as having AF within 7 days of MI. After excluding patients with prior AF, previously documented heart failure, reduced left ventricular (LV) ejection fraction, valvular heart disease, LV hypertrophy, AF after coronary artery bypass grafting, or pericarditis we identified 42 AF patients in whom coronary anatomy was assessed by invasive angiography and cardiac structure and function was evaluated using transthoracic echocardiography. Another 42 patients from the same cohort with MI but no AF matched for age, gender, and LV ejection fraction were studied as controls. AF patients were more likely to present with an inferior MI (P = .002) but less likely to present with ST-segment elevation MI (P = .02). Univariate associations with AF included indexed left atrial volume (P <.001), LV filling pressure (E/e' P = .001), right atrial branch disease (P <.001), left atrial branch disease (P = .009), sinoatrial branch disease (P <.001), left main stem disease (P = .02), and time from onset of symptoms to coronary intervention (P = .002). In multivariable analysis, right and left coronary artery atrial branch disease (P = .02) were predictors of AF post-MI. Coronary artery disease affecting the atrial branches is an independent predictor for the development of AF after MI.
Publisher: Oxford University Press (OUP)
Date: 07-07-2015
DOI: 10.1093/AJH/HPV108
Abstract: Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance. A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation. Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (∆UC vs. ∆CBP P = 0.27) and E/e' ratio (∆UC vs. ∆CBP P = 0.60), and systolic parameters: LV longitudinal strain (∆UC vs. ∆CBP P = 0.55), circumferential strain (∆UC vs. ∆CBP P = 0.79), and ejection fraction (∆UC vs. ∆CBP P = 0.15). Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. Clinical trials registration: Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2023
DOI: 10.1007/S10840-023-01553-5
Abstract: Late gadolinium enhancement (LGE) detected by cardiac MRI (CMR) has low correlation with low voltage zones (LVZs) detected by electroanatomical mapping (EAM). We aim to study correlation of myocardial strain by CMR- Feature Tracking (FT) alongside LGE with LVZs detected by EAM. Nineteen consecutive CMRs of patients with EAM were analyzed offline by CMR-FT. Peak value of circumferential strain (CS), longitudinal strain (LS), and LGE was measured in each segment of the left ventricle (17-segment model). The percentage of myocardial segments with CS and LS −17% was determined. Percentage area of LGE-scar was calculated. Global and segment–wise bipolar and unipolar voltage was collected. Percentage area of bipolar LVZ ( .5 mV) and unipolar LVZ ( .3 mV) was calculated. Mean age was 62±11 years. Mean LVEF was 37±13%. Mean global CS was −11.8±5%. Mean global LS was −11.2±4%. LGE-scar was noted in 74% of the patients. Mean percentage area of LGE-scar was 5%. There was significant correlation between percentage abnormality detected by LS with percentage bipolar LVZ ( r = +0.5, p = 0.03) and combined percentage CS+LS abnormality with percentage unipolar LVZ ( r = +0.5, p = 0.02). Per-unit increase in CS increased the percentage area of unipolar LVZ by 2.09 ( p = 0.07) and per-unit increase in LS increased the percentage area of unipolar LVZ by 2.49 ( p = 0.06). The concordance rates between CS and LS to localize segments with bipolar/unipolar LVZ were 79% and 95% compared to 63% with LGE. Myocardial strain detected by CMR-FT has a better correlation with electrical low voltage zones than the conventional LGE.
Publisher: Oxford University Press (OUP)
Date: 25-04-2007
Abstract: To estimate the incidence of dementia after the first atrial fibrillation (AF), and its impact on survival in a community-based cohort. Olmsted County, Minnesota adult residents diagnosed with first AF during 1986-2000 were identified, and followed until 2004. The primary outcome was new detection of dementia. Interim stroke was censored in the analyses. Of 2837 subjects (71 +/- 15 years old) diagnosed with first AF and without any evidence of cognitive dysfunction or stroke at the time of AF onset, 299 were diagnosed with dementia during a median follow-up of 4.6 years [interquartile (IQR) range 1.5-7.9 years], and 1638 died. The Kaplan-Meier cumulative rate of dementia was 2.7% at 1 year and 10.5% at 5 years. After adjustment for age and sex, dementia was strongly related to advancing age [hazard ratio (HR)/10 years, 2.8 95% confidence interval (CI), 2.5-3.2], but did not vary with sex (P = 0.52). The occurrence of post-AF dementia was associated with significantly increased mortality risk (HR 2.9 95% CI 2.5-3.3), even after adjustment for multiple comorbidities, and did not vary with age (P = 0.75) or sex (P = 0.33). Dementia appeared common following the diagnosis of first AF, and was associated with premature death.
Publisher: Springer Science and Business Media LLC
Date: 27-11-2020
DOI: 10.1186/S42155-020-00173-8
Abstract: An amendment to this paper has been published and can be accessed via the original article.
Publisher: Elsevier BV
Date: 10-2023
Publisher: SAGE Publications
Date: 24-02-2017
Abstract: Objective: We investigated whether volumetric differences in ADHD-associated brain regions are related to current symptoms of inattention and hyperactivity in healthy middle-aged adults and whether co-occurring anxiety/depression symptoms moderate these relationships. Method: ADHD Self-Report Scale and Brief Patient Health Questionnaire were used to assess current symptoms of inattention, hyperactivity, anxiety, and depression in a population-based s le ( n = 269). Brain volumes, measured using a semi-automated method, were analyzed using multiple regression and structural equation modeling to evaluate brain volume–inattention/hyperactivity symptom relationships for selected regions. Results: Volumes of the left nucleus accumbens and a region overlapping the dorsolateral prefrontal cortex were positively associated with inattention symptoms. Left hippoc al volume was negatively associated with hyperactivity symptoms. The brain volume–inattention/hyperactivity symptom associations were stronger when anxiety/depression symptoms were controlled for. Conclusion: Inattention and hyperactivity symptoms in middle-aged adults are associated with different brain regions and co-occurring anxiety/depression symptoms moderate these brain–behavior relationships.
Publisher: Oxford University Press (OUP)
Date: 06-01-2006
Abstract: We sought to determine whether the incidence of and survival following congestive heart failure (CHF) in patients with atrial fibrillation (AF) have changed over time. Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed in medical records to 2004. The trends of incidence and survival of CHF over time were assessed. Of the 3288 subjects (mean age 71+/-15 years) diagnosed with first AF and without CHF prior to or at AF diagnosis, 790 (24%) developed a first CHF during a mean follow-up of 6.1+/-5.2 years (unadjusted incidence, 44 per 1000 person years). Age- and sex-adjusted CHF incidence was unrelated to calendar year of AF diagnosis (P = 0.86). The age- and sex-adjusted mortality risk following CHF was higher than that in patients without CHF (hazard ratio 3.4, 95% confidence interval 3.1-3.8, P < 0.0001). There were no detectable changes over time with respect to the absolute (P = 0.94) or the relative (P = 0.68) mortality risk after CHF diagnosis. In this study spanning two decades, there appeared to have been no significant reduction in terms of the incidence and mortality risk of CHF following first AF diagnosis.
Publisher: Wiley
Date: 17-05-2022
DOI: 10.1111/RESP.14279
Abstract: The clinical significance of sleep-disordered breathing (SDB) in older age is uncertain. This study determined the prevalence and associations of SDB with mood, daytime sleepiness, quality of life (QOL) and cognition in a relatively healthy older Australian cohort. A cross-sectional analysis was conducted from the Study of Neurocognitive Outcomes, Radiological and retinal Effects of Aspirin in Sleep Apnoea. Participants completed an unattended limited channel sleep study to measure the oxygen desaturation index (ODI) to define mild (ODI 5-15) and moderate/severe (ODI ≥ 15) SDB, the Centre for Epidemiological Studies Scale, the Epworth Sleepiness Scale, the 12-item Short-Form for QOL and neuropsychological tests. Of the 1399 participants (mean age 74.0 years), 36% (273 of 753) of men and 25% (164 of 646) of women had moderate/severe SDB. SDB was associated with lower physical health-related QOL (mild SDB: beta coefficient [β] -2.5, 95% CI -3.6 to -1.3, p < 0.001 moderate/severe SDB: β -1.8, 95% CI -3.0 to -0.6, p = 0.005) and with lower global composite cognition (mild SDB: β -0.1, 95% CI -0.2 to 0.0, p = 0.022 moderate/severe SDB: β -0.1, 95% CI -0.2 to 0.0, p = 0.032) compared to no SDB. SDB was not associated with daytime sleepiness nor depression. SDB was associated with lower physical health-related quality of life and cognitive function. Given the high prevalence of SDB in older age, assessing QOL and cognition may better delineate subgroups requiring further management, and provide useful treatment target measures for this age group.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 05-06-2023
DOI: 10.1007/S10840-023-01577-X
Abstract: The prognosis of m ixed cardiomyopathy (CMP) in patients with implanted cardioverter-defibrillators (ICDs) has not been investigated. We aim to study the demographic, clinical, device therapies and survival characteristics of mixed CMP in a cohort of patients implanted with a defibrillator. The term mixed CMP was used to categorise patients with impaired left ventricular ejection fraction attributed to documented non-ischemic triggers with concomitant moderate coronary artery disease. This is a single center observational cohort of 526 patients with a mean follow-up of 8.7 ± 3.5 years. There were 42.5% patients with ischemic cardiomyopathy (ICM), 26.9% with non-ischemic cardiomyopathy (NICM) and 30.6% with mixed CMP. Mixed CMP, compared to NICM, was associated with higher mean age (69.1 ± 9.6 years), atrial fibrillation (55.3%) and greater incidence of comorbidities. The proportion of patients with mixed CMP receiving device shocks was 23.6%, compared to 18.4% in NICM and 27% in ICM. The VT cycle length recorded in mixed CMP (281.6 ± 43.1 ms) was comparable with ICM (282.5 ± 44 ms p = 0.9) and lesser than NICM (297.7 ± 48.7 ms p = 0.1). All-cause mortality in mixed CMP (21.1%) was similar to ICM (20.1% p = 0.8) and higher than NICM (15.6% p = 0.2). The Kaplan–Meier curves revealed hazards of 1.57 (95% CI: 0.91, 2.68) for mixed CMP compared to NICM. In a cohort of patients with ICD, the group with mixed CMP represents a phenotype predominantly comprised of the elderly with a higher incidence of comorbidities. Mixed CMP resembles ICM in terms of number of device shocks and VT cycle length. Trends of long-term prognosis of patients with mixed CMP are worse than NICM and similar to ICM.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Routledge
Date: 14-08-2027
Publisher: Wiley
Date: 14-08-2013
DOI: 10.1111/J.2047-6310.2013.00194.X
Abstract: The index of body mass related to stature, (body mass index, BMI, kgm(-2) ), is widely used as a proxy for percent body fat (%BF) in cross-sectional and longitudinal investigations. BMI does not distinguish between lean and fat mass and in children, the cross-sectional relationship between %BF and BMI changes with age and sex. While BMI increases linearly with age from age 8 to 12 years in both boys and girls, %BF plateaus off between 10 and 12 years. Repeated measures in children show a systematic decrease in %BF for any given BMI from age 8 to 10 to 12 years. Because changes in BMI misrepresent changes in %BF, its use as a proxy of %BF should be avoided in longitudinal studies in this age group. Body mass index (BMI, kgm(-2) ) is commonly used as an indicator of pediatric adiposity, but with its inability to distinguish changes in lean and fat mass, its use in longitudinal studies of children requires careful consideration. To investigate the suitability of BMI as a surrogate of percent body fat (%BF) in pediatric longitudinal investigations. In this longitudinal study, healthy Australian children (256 girls and 278 boys) were measured at ages 8.0 (standard deviation 0.3), 10.0 and 12.0 years for height, weight and percent body fat (%BF) by dual-energy X-ray absorptiometry. The patterns of change in the means of %BF and BMI were different (P < 0.001). While mean BMI increased linearly from 8 to 12 years of age, %BF did not change between 10 and 12 years. Relationships between %BF and BMI in boys and girls were curvilinear and varied with age (P < 0.001) and gender (P < 0.001) any given BMI corresponding with a lower %BF as a child became older. Considering the ergence of temporal patterns of %BF and BMI between 10 and 12 years of age, employment of BMI as a proxy for %BF in absolute or age and sex standardized forms in pediatric longitudinal investigations is problematical.
Publisher: Springer Singapore
Date: 2016
Publisher: Oxford University Press (OUP)
Date: 04-12-2013
DOI: 10.1093/AJH/HPT222
Abstract: Mechanisms underlying the inverse relationship between height and cardiovascular mortality are unknown but could relate to central hemodynamics. We sought to determine the relation of height to central and peripheral hemodynamics, as well as clinical characteristics. The study population was comprised of 1,152 randomly selected community-dwelling adults (aged 67.7 ± 12.3 years 48% men). Brachial blood pressure (BP) was recorded by sphygmomanometry central BP and aortic pulse wave velocity were estimated by applanation tonometry. Stepwise multiple regression analysis was used to determine associations between height and central and peripheral hemodynamics. Height was not significantly associated with aortic pulse wave velocity in men or women. The relationship with height and brachial systolic BP was borderline in women (β = -0.115 P = 0.051) but not significant in men (β = -0.096 P = 0.09). Conversely, central systolic BP, estimated by transfer function (β = -0.139 for men [βM] β = -0.172 for women [βW]) or radial second systolic peak (β M = -0.239 β W = -0.281), augmentation index at 75 bpm (β M = -0.189 β W = -0.224), and aortic pulse wave timing (β M = 0.224 β W = 0.262) were independently associated with height in both sexes (P < 0.003 for all). Both men and women of greater than median height were less likely to have coronary artery disease (P < 0.05), to have systemic hypertension (P < 0.01), or to be taking vasoactive medication (P < 0.001) compared with participants of less than median height. Even after correcting for conventional cardiovascular risk factors, taller in iduals have more favorable central hemodynamics and reduced evidence of coronary artery disease compared with shorter in iduals. These findings may help explain the decreased cardiovascular risk associated with being taller and also have important clinical consequences regarding therapy.
Publisher: Elsevier BV
Date: 10-2018
Publisher: Wiley
Date: 17-09-2020
DOI: 10.1111/ECI.13395
Publisher: AMPCo
Date: 21-12-2018
DOI: 10.5694/MJA2.12060
Publisher: Springer Science and Business Media LLC
Date: 27-01-2022
DOI: 10.1007/S10840-022-01133-Z
Abstract: Localisation of the conduction system under fluoroscopy is not easy and the ideal location of the pacing leads in physiological pacing is still being debated. The primary aim was to assess the lead locations using cardiac CT scan. Secondary aims were clinical outcomes including success and safety of the procedure and lead performance. Of the 100 consecutive patients who received physiological pacing, 34 patients underwent follow-up cardiac CT scan. The four different types of pacing were identified as His bundle (HBP), para-Hisian, left bundle branch (LBBP), and deep septal pacing. Most patients had successful HBP via the right atrium (RA) (87.5%) as compared to the right ventricle (RV) (12.5%). Lower thresholds were observed when leads were placed within 2 mm of the junction of the membranous and muscular ventricular septum. Unlike HBP, LBBP was possible at a wide region of the septum and selective capture of in idual fascicles was feasible. LBBP showed deeper penetration of leads into the septum, as compared to deep septal pacing (70% vs. 45%). Approximately, 80% of patients did not have an intra-ventricular portion of the membranous septum. The anterior part of the atrio-ventricular (AV) septum at the junction between the membranous and muscular septum via RA appeared to be the best target to successfully pace His bundle. LBBP was possible at a wide region of the septum and selective capture of in idual fascicle was feasible. Adequate depth of penetration of lead was very important to capture the left bundle.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.ATHEROSCLEROSIS.2022.02.011
Abstract: Observational studies have demonstrated that the pneumococcal polysaccharide vaccine (PPV) is associated with reduced risk of cardiovascular events. This may be mediated through IgM antibodies to OxLDL, which have previously been associated with cardioprotective effects. The Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE) is a double-blind, randomised controlled trial (RCT) of PPV in preventing ischaemic events. Participants received PPV or placebo once at baseline and are being followed-up for incident fatal and non-fatal myocardial infarction or stroke over 6 years. A subgroup of participants at one centre (Canberra n = 1,001) were evaluated at 1 month and 2 years post immunisation for changes in surrogate markers of atherosclerosis, as pre-specified secondary outcomes: high-sensitive C-reactive protein (CRP), pulse wave velocity (PWV), and carotid intima-media thickness (CIMT). In addition, 100 participants were randomly selected in each of the intervention and control groups for measurement of anti-pneumococcal antibodies (IgG, IgG2, IgM) as well as anti-OxLDL antibodies (IgG and IgM to CuOxLDL, MDA-LDL, and PC-KLH). Concentrations of anti-pneumococcal IgG and IgG2 increased and remained high at 2 years in the PPV group compared to the placebo group, while IgM increased and then declined, but remained detectable, at 2 years. There were statistically significant increases in all anti-OxLDL IgM antibodies at 1 month, which were no longer detectable at 2 years there was no increase in anti-OxLDL IgG antibodies. There were no significant changes in CRP, PWV or CIMT between the treatment groups at the 2-year follow-up. PPV engenders a long-lasting increase in anti-pneumococcal IgG, and to a lesser extent, IgM titres, as well as a transient increase in anti-OxLDL IgM antibodies. However, there were no detectable changes in surrogate markers of atherosclerosis at the 2-year follow-up. Long-term, prospective follow-up of clinical outcomes is continuing to assess if PPV reduces CVD events.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.CLINBIOCHEM.2012.05.008
Abstract: There have been limited studies generating BNP and NT-proBNP reference intervals for paediatric populations. We prospectively assessed NT-proBNP levels in a cohort of 854 healthy school children from the Lifestyle of Our Kids (LOOK) prospective longitudinal study. NT-proBNP analysis was performed on 172 girls and 212 boys with average age 8.1 years, 183 girls and 181 boys, average age 10.1 years and 183 girls and 180 boys with average age 11.9 years. Data were stratified according to age and gender with the median, range of results and 2.5th and 97.5th percentiles calculated There were no significant differences between males and females at any of the 3 study ages. Significant differences were seen between the 8 and 12 year-olds, 10 and 12 year-olds and the 8 and 12 year-old boys. Our study demonstrated that NT-proBNP concentrations in healthy children progressively decline between ages 8 and 12 years. Our selection of unambiguously healthy children produced similar median but lower 97.5th percentile NT-proBNP concentrations to previously published studies.
No related grants have been discovered for Walter Abhayaratna.