71 research outputs found

    Left atrial enlargement is associated with pulmonary vascular disease in heart failure with preserved ejection fraction

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    Aims: Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF. Methods and results: Data from 85 patients (aged 69 ¬Ī‚ÄČ8‚ÄČyears) who underwent exercise right heart catheterisation and echocardiography were retrospectively analysed. All had symptoms of heart failure, LVEF ‚Č•50% and haemodynamic features of HFpEF. Patients were divided into LAVI-based tertiles (‚ȧ34mL/m2, >34 to ‚ȧ45mL/m2, >45mL/m2). A subgroup analysis was performed in patients with recorded LA global reservoir strain (n=60), with reduced strain defined as ‚ȧ24%. Age, sex, BSA and LVEF were similar between volume groups. LA volume was associated with blunted increases in cardiac output with exercise (őĒCO) (Padjusted < .001), higher resting mean pulmonary artery pressure (mPAP) (Padjusted = .003), with similar wedge pressure (PCWP) (Padjusted =‚ÄČ1). Pulmonary vascular resistance (PVR) increased with increasing LA volume (Padjusted < .001). Larger LA volumes featured reduced LA strain (Padjusted < .001), with reduced strain associated with reduced pulmonary vascular resistance-compliance (RC) time (0.34 [0.28‚Äď0.40] vs 0.38 [0.33‚Äď0.43], P = .03). Conclusion: Increasing LA volume may be associated with more advanced pulmonary vascular disease in HFpEF, featuring higher pulmonary vascular resistance and pulmonary pressures. Reduced LA function, worse at increasing LA volumes, is associated with a disrupted pulmonary resistance-compliance relationship, further augmenting impaired pulmonary haemodynamics

    Obesity in Heart Failure with Preserved Ejection Fraction:Insights from the REDUCE LAP-HF II Trial

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    BACKGROUND AND AIMS: Obesity is causally related to the development of HFpEF but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and hemodynamic parameters in a large cohort of patients with documented HFpEF. METHODS: The REDUCE LAP-HF II trial randomized 626 patients with EF =40% and exercise pulmonary capillary wedge pressure (PCWP) =25?mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. RESULTS: 60.9% of patients had BMI =30?kg/m . As the severity of obesity increased, symptoms (KCCQ score) and 6-min walk distance worsened. More severe obesity was associated with lower natriuretic peptide levels despite more cardiac remodeling, higher cardiac filling pressures, and higher cardiac output. Lower cut points for E/e' were needed to identify elevated PCWP in more obese patients. Strain measurements in all 4 chambers were maintained as BMI increased. Pulmonary vascular resistance at rest and exercise decreased with higher BMI. Obesity was associated with more first and recurrent HF events. However, there was no significant interaction between obesity and treatment effects of the atrial shunt. CONCLUSIONS: Increasing severity of obesity was associated with greater cardiac remodeling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent HF events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy. This article is protected by copyright. All rights reserved

    Diminishing benefits of urban living for children and adolescents’ growth and development

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    Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1‚Äď6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5‚Äď19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m‚Äď2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

    Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

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    From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

    Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight