Additional file 1: of Assessment of reverse remodeling predicted by myocardial deformation on tissue tracking in patients with severe aortic stenosis: a cardiovascular magnetic resonance imaging study

Figure S1. Bland-Altman plot with LVMI values of the baseline Echo and CMR. There was a positive correlation between LVMI values of the baseline Echo and CMR images (r = 0.73, p < 0.001), and ICC was 0.723 (95% confidence interval: 0.580–0.823, p < 0.001). Figure S2. The median time duration from AVR to follow-up Echo (median days [interquartile range]: 833[372–1183] days) (PPTX 82 kb

Gender Difference in Ventricular Response to Aortic Stenosis: Insight from Cardiovascular Magnetic Resonance

<div><p>Background</p><p>Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients.</p><p>Methods and Results</p><p>A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1g/m² vs. 86.1±29.2g/m², p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively).</p><p>Conclusion</p><p>Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.</p></div

Baseline clinical characteristics of the study participants.

<p>The data are presented as mean (SD) or number (percentage).</p><p>Abbreviations: ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; BMI, body mass index; HTN, hypertension; NYHA, New York Heart Association.</p><p>Baseline clinical characteristics of the study participants.</p

The association between left ventricular remodeling index and the severity of aortic stenosis or valvuloarterial impedance.

<p>Males consistently showed relatively higher left ventricular remodeling index in (A) larger aortic valve area index, (B) lower mean transaortic pressure gradient, or (C) lower valvuloarterial impedance, compared with females. However, there were significant differences between the two genders in the degree of correlation between the left ventricular remodeling index and the above three parameters. The univariate linear regression coefficient and the interaction p value across the gender are shown. Abbreviations: AV, aortic valve; AVA, aortic valve area; CMR, cardiovascular magnetic resonance; PG, pressure gradient.</p

Echocardiographic and cardiovascular magnetic resonance (CMR) parameters of the study participants.

<p>The data are presented as mean (SD), except adjusted mean (SE) in the body mass index adjusted LV mass.</p><p>^†When quantifying the LV mass, the trabeculations and the papillary muscles were excluded.</p><p>Abbreviations: AR, aortic regurgitation; AS, aortic stenosis; AVA, aortic valve area; BMI, body mass index; BSA, body surface area; E, early diastolic velocity at the mitral valve tip; e’, early mitral annular velocity at the septal annulus; IVST, interventricular septal thickness; LV, left ventricle; PG, pressure gradient; PWT, posterior wall thickness; Vmax, maximal transaortic velocity; Z_VA, valvuloarterial impedance.</p><p>Echocardiographic and cardiovascular magnetic resonance (CMR) parameters of the study participants.</p

Additional file 1: of S-amlodipine plus chlorthalidone vs. S-amlodipine plus telmisartan in hypertensive patients unresponsive to amlodipine monotherapy: study protocol for a randomized controlled trial

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 124 kb

The Association of Family History of Premature Cardiovascular Disease or Diabetes Mellitus on the Occurrence of Gestational Hypertensive Disease and Diabetes

<div><p>Background</p><p>Gestational hypertensive diseases (GHD) and gestational diabetes mellitus (GDM) increase the risk of cardiovascular disease (CVD) later in life. However, the association between gestational medical diseases and familial history of CVD has not been investigated to date. In the present study, we examined the association between familial history of CVD and GHD or GDM via reliable questionnaires in a large cohort of registered nurses.</p><p>Methods</p><p>The Korean Nurses’ Survey was conducted through a web-based computer-assisted self-interview, which was developed through consultation with cardiologists, gynecologists, and statisticians. We enrolled a total of 9,989 female registered nurses who reliably answered the questionnaires including family history of premature CVD (FHpCVD), hypertension (FHH), and diabetes mellitus (FHDM) based on their medical knowledge. Either multivariable logistic regression analysis or generalized estimation equation was used to clarify the effect of positive family histories on GHD and GDM in subjects or at each repeated pregnancy in an individual.</p><p>Results</p><p>In this survey, 3,695 subjects had at least 1 pregnancy and 8,783 cumulative pregnancies. Among them, 247 interviewees (6.3%) experienced GHD and 120 (3.1%) experienced GDM. In a multivariable analysis adjusted for age, obstetric, and gynecologic variables, age at the first pregnancy over 35 years (adjusted OR 1.61, 95% CI 1.02–2.43) and FHpCVD (adjusted OR 1.60, 95% CI 1.16–2.22) were risk factors for GHD in individuals, whereas FHH was not. FHDM and history of infertility therapy were risk factors for GDM in individuals (adjusted OR 2.68, 95% CI 1.86–3.86; 1.84, 95% CI 1.05–3.23, respectively). In any repeated pregnancies in an individual, age at the current pregnancy and at the first pregnancy, and FHpCVD were risk factors for GHD, while age at the current pregnancy, history of infertility therapy, and FHDM were risk factors for GDM.</p><p>Conclusions</p><p>The FHpCVD and FHDM are significantly associated with GHD and GDM, respectively. Meticulous family histories should be obtained, and women with family histories of these conditions should be carefully monitored during pregnancy.</p></div

Baseline characteristics of the study population.

<p>Baseline characteristics of the study population.</p

Pregnancy outcome after GHD or GDM at each parity (total 6,685 parity).

<p>Pregnancy outcome after GHD or GDM at each parity (total 6,685 parity).</p

Distribution of the occurrence of GHD or GDM according to the order of pregnancy.

<p>(A) The x-axis denotes the order of pregnancy. The y-axis indicates the arbitrary numbers of subjects. Every number matches each patient with GHD. To better demonstrate the distribution of the occurrence of GHD, subjects with more occurrences and subjects with earlier occurrence were placed at lower arbitrary numbers. (B) A magnified graph from the dashed-line rectangle in (A). (C), (D) Similarly, distribution of the occurrence of GDM according to the order of pregnancy.</p