Background: The prognostic importance of left atrial (LA) dysfunction is increasingly recognized. Magnetic resonance imaging can provide excellent visualization the LA wall. We aimed to study association measured using feature-tracking magnetic with incident adverse cardiovascular events among subjects or without heart failure (HF) at baseline. Methods and Results: prospectively studied 640 adults HF (n=419), preserved ejection fraction (n=101), reduced (n=120). phasic function by volumetric...

Large artery stiffening is increased in advanced chronic kidney disease (CKD) but likely develops progressively earlier stages of CKD. Active matrix Gla-protein (MGP) a potent vitamin K-dependent inhibitor vascular calcification. A recent animal model demonstrated intrinsic abnormalities K metabolism even early CKD, whether human CKD associated with deficiency unknown.We enrolled 137 adults without HF varying degrees renal function: normal estimated glomerular filtration rate (eGFR; >90...

Background Heterogeneity in the underlying processes that contribute to heart failure with preserved ejection fraction ( HF p EF ) is increasingly recognized. Diabetes mellitus a frequent comorbidity , but its impact on left ventricular and arterial structure function unknown. Methods Results We assessed of diabetes cellular interstitial hypertrophy (assessed cardiac magnetic resonance imaging, including T1 mapping pregadolinium postgadolinium administration), stiffness tonometry), pulsatile...

Effective arterial elastance (E(A)) was proposed as a lumped parameter that incorporates pulsatile and resistive afterload is increasingly being used in clinical studies. Theoretical modeling studies suggest E(A) minimally affected by load, but little human data are available. We assessed the relationship between load determined noninvasively from central pressure-flow analyses among middle-aged adults general population (n=2367) diverse of older (n=193). In separate study, we investigated...

To evaluate the rate of agreement pulmonary embolism diagnosis in computed tomography (CT) angiogram studies and to inaccurate interpretations community hospital setting.Using keywords "pulmonary embolism/embolus/emboli," radiology information system was searched for CT angiograms performed over a 3-year period at three U.S. hospitals. Studies containing probable or definite emboli were independently reviewed by four subspecialty thoracic radiologists.Agreement about presence progressively...

Despite pronounced increases in central pulse wave velocity (PWV) with aging, reflected transit time (RWTT), traditionally defined as the timing of inflection point (TINF) pressure waveform, does not appreciably decrease, leading to controversial proposition a "distal-shift" reflection sites. TINF, however, is exceptionally prone measurement error and also affected by ejection pattern only reflection. We assessed whether RWTT, advanced pressure-flow analysis, demonstrates expected decline...

Large artery stiffness is increased in diabetes mellitus and causes an excessive pulsatile load to the heart microvasculature. The identification of pathways related arterial may provide novel therapeutic targets ameliorate diabetes. Matrix Gla-Protein (MGP) inhibitor vascular calcification. Activation MGP vitamin K dependent. We hypothesized that levels inactive (dephospho-uncarboxylated MGP; dp-ucMGP) are type 2 diabetes.We enrolled a multiethnic cohort 66 participants with Carotid-femoral...

Background Data regarding the phenotypic correlates and prognostic value of albumin in heart failure with preserved ejection fraction (HFpEF) are scarce. The goal current study is to determine (myocardial hypertrophy, myocardial fibrosis, detailed pulsatile hemodynamics, skeletal muscle mass) implications serum HFpEF. Methods Results We studied 118 adults All-cause death or heart-failure-related hospitalization was ascertained over a median follow-up 57.6 months. measured left ventricular...

Background Wave reflections, which are increased in patients with heart failure preserved ejection fraction, impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine coadministration unknown. Methods Results We randomized 44 fraction a double‐blinded fashion to isosorbide dinitrate ( ISDN ; n=13), +hydralazine +hydral; n=15), placebo (n=16) for 6 months. The...

Background Stable plasma nitric oxide ( NO ) metabolites M ), composed predominantly of nitrate and nitrite, are attractive biomarkers bioavailability. levels integrate the influence ‐synthase‐derived production/metabolism, dietary intake inorganic nitrate/nitrite, clearance . Furthermore, most abundant , can be reduced to via nitrate‐nitrite‐ pathway. Methods Results We compared serum among subjects without heart failure (n=126), with preserved ejection fraction HF p EF ; n=43), r n=32). LV...

Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct decision making effectively. A useful organizing theme should include consideration of patient's response tolerance uncertainty associated with screening.The objectives this study are to: (1) describe patients respond specific categories in the context screening, (2) inform strategies for addressing concerns about as part making.We...

Objective The aim of this study was to determine the ideal circulation time fluorine-18 fluorodeoxyglucose (18F-FDG) in order detect and quantify atherosclerotic plaque inflammation with PET computed tomography (CT) imaging. Methods Fifteen patients underwent multiple time-point imaging at ∼60, 120, 180 min after 18F-FDG administration. For each point, global assessment aortic carotid uptake determined qualitatively by visual semiquantitatively calculation mean maximum standardized values...

Late systolic load has been shown to cause diastolic dysfunction in animal models. Although the loading sequence of ventricular myocardium likely affects its coupling with left atrium (LA), this issue not investigated humans. We aimed assess relationship between myocardial and LA function human hypertension.We studied 260 subjects hypertension 19 normotensive age- sex-matched controls. Time-resolved central pressure geometry were measured carotid tonometry cardiac magnetic resonance imaging,...

Background The impact of skeletal muscle size, quantified using simple noninvasive images routinely obtained during cardiac magnetic resonance imaging studies on mortality in the heart failure ( HF ) population is currently unknown. Methods and Results We prospectively enrolled 567 subjects without (n=364), with reduced ejection fraction (n=111), or preserved (n=92), who underwent a imaging. Skeletal cross-sectional area was assessed manual tracing major thoracic groups axial chest images....

Impaired left atrial (LA) mechanical function is present in hypertension and likely contributes to various complications, including arrhythmias, stroke, heart failure. Various antihypertensive drug classes exert differential effects on central hemodynamics ventricular function. However, little known about their LA function.We studied 212 subjects with without failure or fibrillation. strain was measured from cine steady-state free-precession cardiac MRI images using feature-tracking...

Background The role of arterial load in severe aortic stenosis is increasingly recognized. However, patterns pulsatile and their implications this population are unknown. We aimed to assess the relationship between properties both (1) left ventricular remodeling fibrosis (2) clinical course patients with undergoing valve replacement ( AVR ). Methods Results enrolled 38 participants symptomatic scheduled undergo surgical . Aortic root characteristic impedance, wave reflections parameters...

The aim of this study is to evaluate whether compromised renal function has an effect on the uptake and clearance 2-deoxy-2-[F]fluoro-D-glucose (F-FDG) in normal tissues F-FDG PET/CT imaging.Patients were divided into three groups basis their status: 25 patients with [estimated glomerular filtration rate (eGFR)>90 ml/min], 21 mildly (90≥eGFR≥60 ml/min), 12 moderate or severe (eGFR<60 ml/min). All underwent imaging at 1, 2, 3 h after tracer injection. Maximum standardized values (SUVmax)...

OBJECTIVE We assessed whether poor glycemic control is associated with an increase in myocardial fibrosis among adults diabetes. RESEARCH DESIGN AND METHODS studied 47 type 2 diabetes and stratified them into three groups according to their hemoglobin A1c (HbA1c) level: &amp;lt;6.5% (group 1; n = 12), 6.5–7.5% 2; 20), &amp;gt;7.5% 3; 15). Left ventricular (LV) mass was using cardiac MRI. The extracellular volume fraction (ECVF), index of fibrosis, measured by T1 mapping before after the...